Asthma

Asthma is a chronic lung disease affecting people of all ages. It is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe. Symptoms can include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be mild or severe and can come and go over time.

Asthma triggers

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

• Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste

• Respiratory infections, such as the common cold

• Weather changes

• People who have chronic conditions such as allergies, emphysema, and bronchitis

• Exercise

• Stress

• Certain medications, such as antiplatelet drugs, aspirin, NSAIDs, and beta-blocker antihypertensives

• Genetics and family history of asthma and allergies.

  
  

Symptoms

• A persistent cough, especially during exercise, weather change and at night.

• Wheezing when exhaling and sometimes when inhaling.

• Shortness of breath or difficulty breathing, sometimes even when resting.

• Chest tightness, making it difficult to breathe deeply.

• Symptoms worsen at night, causing difficulty sleeping or waking up due to shortness of breath.

• Symptoms are triggered by allergens.

• Improvement occurs after using medication or bronchodilators.

• There is often a history of conditions such as allergies, emphysema, or bronchitis.

Diagnosis

The doctor will diagnose asthma by taking a medical history, conducting a physical examination, and performing pulmonary function tests, which are accurate in diagnosing bronchoconstriction due to asthma and in differentiating from other diseases. Chest X-ray results for individuals with asthma often do not show any abnormalities.

There are two methods for pulmonary function testing:

1. Spirometry: This is the standard method for measuring the volume of air inhaled and exhaled from the lungs, as well as the lungs' efficiency in delivering oxygen to the bloodstream. The doctor will administer a bronchodilator, instructing the patient to take a deep breath and then exhale forcefully and quickly into a spirometer. This measures the volume of air the patient can exhale in one second compared to the total volume of air exhaled. By considering these results alongside the patient's symptoms, the severity of the condition can be determined.

   
   

2. Peak Expiratory Flow (PEF): This test uses a Peak Flow Meter to measure lung function. The patient is instructed to take a deep breath and then exhale as forcefully as possible to determine the maximum speed of airflow during exhalation. If the measured value is lower than normal, it may indicate bronchoconstriction.

   
   

Treatment

Treatment includes oral medications, injections, and inhalers, depending on the doctor's assessment of the severity and frequency of the condition.

1. Oral medications have a slower onset of action compared to injections and inhalers but tend to have fewer side effects. These include: Antihistamines, Corticosteroids, and Bronchodilators

2. Injections act quickly but must be administered at the appropriate intervals and doses.

3. Inhalers come in two types: those for symptom relief and those for controlling exacerbations.

There are two main types of inhaler:

• Bronchodilators (such as salbutamol), that open the air passages and relieve symptoms; and

• Steroids (such as beclometasone) that reduce inflammation in the air passages, which improves asthma symptoms and reduces the risk of severe asthma attacks and death.

Complications from asthma include:

• Asthma can cause chronic cough, chronic gastroesophageal reflux disease (GERD), and chronic sinusitis.

• Pneumonia

• Dehydration

• Lung atelectasis

• Acute respiratory failure

  
  

Self-Care

• Avoid allergens that trigger symptoms.

• Maintain general health by getting enough rest and engaging in appropriate exercise without overexertion.

• Consume a nutritious diet.

• Treat or manage other underlying conditions that may contribute to asthma, such as allergies, sinusitis, and bronchitis.

• Refrain from smoking.

• If symptoms occur, stop the activity and sit down to rest.

• Use the bronchodilator as directed by your doctor or pharmacist.

• If use the inhaler 3-5 times without symptom relief, seek immediate medical attention.

Thiptiwa Nontama, M.D.