Asthma is an inflammatory disease affecting the airway (bronchi) of the lungs that manifests in symptoms like shortness of breath & bronchospasm.
SIGNS & SYMPTOMS
- Shortness of breath
- Chest tightness
- Thick sputum
- Worsening symptoms at night & in the morning on exposure to cold air.
COMPLICATIONS ARISING FROM ASTHMA
- Sleep apnea (disruption in sleep)
- Permanent narrowing of the bronchial tubes
- Severe anxiety & panic attacks
- Risk of developing obesity due to reduced exercise
- Frequent cough
- Asthma attack
- Acute severe asthma that can be triggered due to certain respiratory infections like SARS, Covid-19, MERS, pneumonia, etc.
- Some symptoms that it produces are;
- A very rapid heart rate & breathing rate
- Bluish discoloration of skin
- Inability to form sentences
- Agitation & confusion
- Medical emergency which needs immediate hospital visit.
- Smoking during & after pregnancy
- Low air quality, exposure to air pollution & ozone.
- Exposure to VOCs like formaldehyde, phthlates, pesticides, etc.
- Exposure to dust, cockroach, animal fur, insect or bird droppings, etc.
- Certain viral infections from virus like rhinovirus.
- Exposure to bacterial endotoxin in later life can lead to bronchoconstriction.
- Delivery by caeserian section increases the risk of development of asthma in the baby.
RISK FACTORS OF ASTHMA
- Atopic eczema
- Allergic rhinitis
- History of atopic diseases
- Autoimmune disease called EGPA is strongly associated with asthma
- An overactive immune system.
- If one identical twin is affected the chances of the other being affected rise by 25%.
- Over 100 genes are associated with development of asthma.
- Exposure to bacterial endotoxin can trigger immune response.
Risk factors associated with drugs
- Beta blockers like propanolol
- ACE inhibitors
- PPI use during pregnancy
- H2 receptor antagonists drug use during pregnancy.
- Physical symptoms like wheezing, shortness of breath & coughing (with or without presence of sputum are first noted).
- Spirometry is an efficient test for asthma. Diffusivity of the lung is the parameter for differentiating between COPD & asthma.
- Metacholine or bronchial challenge test is performed. If the test is positive, asthma can be speculated.
- Measurement of peak expiratory flow rate by a peak flow meter.
- X-ray, MRI or other imaging scans may be done for assessment/detection of damage (if any) present in the lungs, scarring, swelling due to fluid buildup, tumor, etc.
- Biopsy of bronchial tissue for differentiation between COPD & asthma.
VARIOUS TYPES OF ASTHMA
- Exercise Induced
- Alcohol induced
- Aspirin exacerbated respiratory disease
TREATMENT OF ASTHMA
Short term medicines for mild asthma
- Short acting bronchodilators like salbutamol.
- Anticholinergic medications like ipratropium
- Inhalational epinephrine
Long term medicines
- Corticosteroids, like inhalational beclomethasone.
- Long acting bronchodilators like salmeterol
- Leukotriene receptor blockers like montelukast
- 5-LOX inhibitors like zileuton
- Inhalational aminophylline
- Mast cell stabilizers (such as cromolyn sodium) are another non-preferred alternative to corticosteroids.
- Delivery based, metered dose inhalers (MDIs) in combination with a spacer or a nebulizer, that deliver a full dose of a short acting bronchodilator.
Other medications & management remedies
- Inhalational oxygen in case oxygen levels in blood fall.
- Oral dose of corticosteroids like prednisone.
- Magnesium sulfate IV therapy in acute asthma attack.
- Heliox, a mixture of helium and oxygen, may also be considered in severe unresponsive cases.
- Ketamine a dissociative anesthetic is used in people with respiratory arrest.
- Bronchial thermoplasty in severe asthma, delivers controlled thermal energy to the bronchial walls.
- Monoclonal antibody injections may be useful in those with poorly controlled atopic, such as mepolizumab.
- Allergen immunotherapy for desensitization of environmental allergens.
MANAGEMENT & PREVENTION
- Recognition of allergens than lead to inflammatory reactions & exacerbation of symptoms.
- Avoiding such allergens like pollen, dust, bird droppings, animal fur, etc.
- Usage of air filters.
- Not indulging in smoking
- Avoiding second-hand smoking
- Wearing a protective face mask
- Avoiding much exposure to traffic exhaust & air pollution.
- Avoiding medicines that can lead to asthma & similar symptoms.
- Not coming in contact with chemical exposure like pesticides, asbestos, silcon.
- Breathing exercise are useful for management of breathless & anxiety.
- Cognitive behavioral therapy.
- Meditation & yoga.
- Mild exercise.