CHEARS

Have you ever come across the term “Asthma” or someone suffering from it? If you have, then do you know what it is? And if not, let us take a sneak peek into its whereabouts in this article. Bronchial Asthma is commonly referred to as Asthma which is a chronic inflammatory disorder of the respiratory tract that cause periodic attacks of coughs, wheezing, chest tightness and shortness of breath. It is due to narrowing of the airways as a result of inflammation and extra secretion of mucous. Allergies are strongly related to asthma and people having both tend to suffer from night time awakening and high dose medications are required to control the symptoms. Asthma is associated to mast cells, eosinophils and T lymphocytes. Mast cells secrete histamine which is an inflammatory substance that is normally produced as part of an immune response in cold, asthma or allergies. Eosinophils is linked to allergic responses; lymphocytes are responsible for allergies and inflammation. All these cells along with other inflammatory cells lead to hyperactivity of the airway, airflow limitation and chronic disease.

Airway obstruction in bronchial asthma is mainly caused by:

• Contraction of smooth muscle of bronchioles

• Swelling of the airway walls

• Mucous accumulation

• Irreversible changes in the lungs ("remodelling")

Triggers can be varied like:

• Allergens – molds, pollen, dust, pet dander

• Physical activity

• Cold air

• Air pollution and irritants like smoke, fumes

• Emotional changes, stress, anxiety

• Medications like beta blockers, aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen sodium.

• Sulfites, preservatives

Some people experience chest tightness of breathlessness during the night or early morning and some due to exercise.

Based on the triggers there are different types of asthma:

• Nocturnal Asthma – Symptoms mostly occur at night as it is influenced by the sleep wake cycle. These types are particularly dangerous.

• Exercise induced Asthma – It is triggered by exercise or physical exertion.

• Occupational Asthma – It is a work-related lung disease. Dust, Chemicals, pollen, viral infections, allergens, etc. act as triggers.

There several risk factors that predisposes individual towards acquiring Asthma:

• Hereditary – genetic predisposition

• Allergic condition like atopic dermatitis or hay fever

• Obesity

• Chain smoking

• Constant exposure to secondhand smoke

• Constant exposure to pollutants, allergens, etc.

Asthma is further classified by the doctor based on patient’s severity which is:

1. Mild intermittent – mild symptoms for two days a week or two nights a month.

2. Mild persistent – mild symptoms more than two times a week but not more than once in a day.

3. Moderate persistent – Symptoms once a day and more than one night a week.

4. Severe persistent – Symptoms throughout the day and night.

Worsening of asthma can happen at any time without any intimidation and can be mild to severe. Therefore, prevention strategy should be implemented although asthma cannot be prevented but attacks can be prevented and controlled. Follow this plan to bring your asthma under control -

Diagnosis

Physical examination – Observing for tachypnea, orthopnea, chest constrictions, prolonged expiratory phase, etc.

Spirometry – It checks how much air you can forcefully expire after a deep breath and its speed. It tells narrowing of bronchial tubes.

Peak Flow – A peak flow meter monitors your forceful expiration.

Methacholine challenge – Methacholine is a trigger, if you react to it you are diagnosed with asthma.

Imaging tests – Chest X-ray looks for structural abnormalities or infections.

Allergy testing – It is a skin or blood test that identifies allergen.

Nitric oxide test – Asthma patients release high amount of nitric oxide in breath.

Sputum eosinophils – Screens for eosinophils in the mixture of saliva and sputum.

Provocative testing for exercise and cold induced asthma – Degree of airway obstruction before and after exercise or cold air breaths is measured.

Reference:

• https://www.webmd.com/asthma/guide/bronchial-asthma#:~:text=When%20people%20talk%20about%20bronchial,of%20breath%2C%20and%20chest%20tightness.

• https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696883/pdf/Dtsch_Arztebl_Int-105-0385.pdf