Asthma is one of the most common respiratory diseases in the world today.
It affects one in ten children (10%) and one in twenty adults (5%).
It occurs for the first time at any age, even in adulthood, although it usually begins before the age of five years.
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A few children affected will "outgrow" asthma during their teenage years although it usually persists if contracted in adulthood.
It tends to run in families, as do related allergic conditions, such as hay fever and eczema
It cannot as yet be cured, but if kept under control, those affected will be able to live normal lives enjoying full involvement in sport and all other activities.
The greatest tragedy of asthma is that sometimes it is not recognised and treated, in which case the patient undergoes unnecessary suffering.
What is asthma?
Asthma affects the breathing pipes or tubes called airways or bronchi. When one takes a breath, air passes through the voice-box and down the wind-pipe (called the trachea). The wind-pipe branches into the two main bronchi which take air into the lungs. These bronchi then divide further and further becoming smaller and smaller as they take air deeper into the lungs to the point where oxygen passes into the bloodstream.
Asthma is characterised by narrowing of the bronchi caused by:
swelling of the lining
increased sticky mucus or secretions lying in the airways produced by the
mucus glands. The swelling and increased secretions are called inflammation.
muscles going into spasm. Spasm occurs only when there is inflammation.
When the bronchi become too narrow, or are partially obstructed due to inflammation and spasm, the typical symptoms of asthma will develop. These symptoms are:
coughing which often occurs more frequently with activity and at night. This can be dry or wet and is persistent or recurrent.
wheezing which is a whistling noise in the chest.
tightness of the chest causing difficulty in breathing.
shortness of breath, especially after exercise.
The exact cause of the asthmatic process is not well understood but it is
thought to be triggered off by an allergy or when the lungs are irritated by
something in the air. It is also a condition that runs in families.
What starts an asthma attack? A viral cold
A viral cold or flu can aggravate asthma symptoms temporarily. This effect may last for up to six weeks after the illness.
Allergies
Asthma attacks are sometimes triggered by an allergy to airborne particles including house-dust mites, grass or tree pollens, fungal spores and skin flakes from furry animals such as cats and dogs. On rare occasions certain foods and additives may also trigger off asthma when taken by mouth.
Pollution
Pollution in the environment, especially cigarette smoke, car exhaust fumes and certain chemical gases can aggravate an asthma attack. Children will even be affected by passively inhaling their parents’ cigarette smoke.
Sport and exercise
Sport and exercise, particularly in cold weather, can set off an asthma attack. However with the correct treatment asthma can be well controlled so that asthmatics need not avoid sport or exercise. In fact about 10% of Olympic athletes have asthma.
Emotion
Emotion such as excitement, anger, fear or laughter can aggravate asthma.
So-called "nerves" are not responsible for causing asthma.
Drugs
Certain commonly used medicines such as aspirin and other anti-pain and anti-inflammatory tablets may trigger an asthma attack. . Be cautious when using "beta blocker" blood pressure tablets or eye-drops for glaucoma as they may also trigger off asthma in adult life.
Types of asthma
Asthma is divided into four main types depending on the frequency and severity of the symptoms (chest tightness, wheezing, shortness of breath, coughing) before any medication or treatment is started. Asthma attacks are typically episodic. The intervals between the attacks may be days, months or even years. For severe asthmatics, however, attacks can take place on a daily basis.
There are usually telltale signs before a full-blown attack but these vary from person to person. Some experience an itchy chin or throat and a dry mouth. Still others may feel tired and irritable. Common warning signs include light wheezing, pain when coughing, chest tightness, shortness of breath or restlessness. As an asthmatic you need to take note of these warning signals so that you can takes steps to help ward off a severe attack.
The different types of asthma include:
Severe Persistent: Breathing is almost always a problem and you experience continual symptoms and frequent attacks interfere with normal activities. Peak flow decreases to less than 60%. Physical activity is limited. Attacks during the night are also frequent and medication doesn’t completely relieve the symptoms. Multiple long-term control medications are required, including high-dose inhaled corticosteroids and, where necessary, oral corticosteroids.
Moderate Persistent: Symptoms occur every day or 5 or more nights a month. Attacks last up to seven days and limit activity. During attacks, peak flow decreases to between 60 – 80%. Inhaled corticosteroids with or without additional long-term control medications are used.
Mild Persistent: Symptoms occur 3 to 6 times a week, or 3 to 4 nights a month. Peak flow doesn’t fall below 80% during attacks. Daily long-term medication is necessary.
Mild intermittent: Symptoms occur at most twice a week. Attacks are brief and don’t limit activity. During attacks, peak flow doesn’t fall below 80% of the person’s best. No daily medication is needed. However, the use of a short-acting beta2-agonist more than twice per week may indicate the need to start long-term control therapy.
Symptoms of asthma
Asthma symptoms vary from person to person and within each individual over time. Asthma attacks can range from mild to severe and can change severity at any given time. Symptoms vary depending on the severity of the airway obstruction.
This prevents sufficient oxygen from reaching the alveoli, and consequently less can be transferred to the blood. This makes sufferers feel as though they aren’t getting enough air and so they’re forced to breathe harder and faster. Asthmatics often experience a whistling sound as they breathe in – this is air being forced past the obstruction.
They may also try coughing to dislodge the blockage, but this won’t help as the bronchi themselves are constricted or their lining is thickened. There may also be thick mucus plugs that can’t be dislodged no matter how hard you cough. Asthma symptoms are often worst at night and in the early morning.
If you’re concerned about developing this condition, keep an eye out for the following symptoms:
Adults
coughing;
wheezing;
shortness of breath or rapid, panting breath;
chest tightness;
tiring quickly during exercise.
Children
fatigue and lack of stamina causing the child to slow down or stop play;
complaints of chest pain;
avoidance and a refusal to participate in active sports and games.
Infants
rapid breathing;
grunting during feeding;
difficulty feeding.
Symptoms of asthma may develop or worsen when you:
are exercising;
are sleeping (or during the night) ;
come in contact with animals with fur or feathers, house dust mites or cockroaches;
are exposed to mold, pollen, perfumes or chemicals at work;
are exposed to high levels of air pollution, smoke and dust from wood-burning fires, cigarette smoke or sudden changes in the weather;
are suffering from a viral respiratory infection such as respiratory syncytial virus (RSV) or influenza;
experience a change in hormones, such as at the start of your menstrual cycle or during pregnancy;
eat foods that you’re allergic to;
laugh or cry very hard.
How is asthma diagnosed?
Asthma is divided into four main types depending on the frequency and severity of the symptoms (chest tightness, wheezing, shortness of breath, coughing) before any medication or treatment is started. Asthma attacks are typically episodic. The intervals between the attacks may be days, months or even years. For severe asthmatics, however, attacks can take place on a daily basis.
There are usually telltale signs before a full-blown attack but these vary from person to person. Some experience an itchy chin or throat and a dry mouth. Still others may feel tired and irritable. Common warning signs include light wheezing, pain when coughing, chest tightness, shortness of breath or restlessness. As an asthmatic you need to take note of these warning signals so that you can takes steps to help ward off a severe attack.
Treatment of asthma
While asthma can’t be cured, it can be controlled in the vast majority of cases. It is a chronic disease and may need long-term treatment and even lifelong management. In most cases good control can be achieved and there is little reason why an asthma sufferer cannot lead a perfectly normal life.
Today asthma medication is usually extremely effective. Your asthma medication, complemented by your lifestyle and the accurate early identification of asthma symptoms, will assist in optimising your asthma control.
Asthma is the result of two factors, bronchoconstriction and inflammation in the airways.
The most effective treatment now consists of a two-pronged approach treating both these factors at the same time, and thus addressing asthma more holisticly.
How to prevent an asthma attack
Bronchodilators are used to provide instantaneous relief when your chest begins to tighten at the onset of an attack. They act by relaxing the constricted smooth muscles surrounding the bronchioles, so allowing the airways to widen. The airway passage, already very narrow due to inflamed and swollen mucous membranes, can almost close completely if the airway muscles start constricting.
The bronchodilator can relieve this muscle constriction, and thus open the airway passage again. This reduces the symptoms of breathlessness and enables sufferers to breathe more freely but will do little to douse the underlying inflammation. They may be taken prior to exercise in patients who experience exercise-induced asthma.
Both types of drugs are usually administered by inhalation but some can be given orally or intravenously in the case of an emergency.
Doctors recommend sufferers to identify the possible asthma trigger and eliminate it as part of the holistic approach to treatment and living with asthma. Allergy tests can be conducted on babies from as young as six months. No need to wait till they are three years old, as doctors previously believed.
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