Asthma: Symptoms, Risk factors & management!

Asthma is an inflammatory disease affecting the airway (bronchi) of the lungs that manifests in symptoms like shortness of breath & bronchospasm.


  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Coughing
  • Thick sputum
  • Worsening symptoms at night & in the morning on exposure to cold air.


  • GERD
  • 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
  • Breathlessness
  • Agitation & confusion
  • Medical emergency which needs immediate hospital visit.


  • Allergens
  • Smoking
  • 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.


Medical conditions

  • Atopic eczema
  • Allergic rhinitis
  • Sinusitis
  • History of atopic diseases
  • Autoimmune disease called EGPA is strongly associated with asthma
  • Vasculitis
  • Hives
  • Obesity
  • An overactive immune system.

Genetic factors

  • 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
  • Aspirin
  • NSAIDs
  • PPI use during pregnancy
  • H2 receptor antagonists drug use during pregnancy.


  1. Physical symptoms like wheezing, shortness of breath & coughing (with or without presence of sputum are first noted).
  2. Spirometry is an efficient test for asthma. Diffusivity of the lung is the parameter for differentiating between COPD & asthma.
  3. Metacholine or bronchial challenge test is performed. If the test is positive, asthma can be speculated.
  4. Measurement of peak expiratory flow rate by a peak flow meter.
  5. 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.
  6. Biopsy of bronchial tissue for differentiation between COPD & asthma.


  • Exercise Induced
  • Occupational
  • Alcohol induced
  • Aspirin exacerbated respiratory disease
  • Non-atopic


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.

Intra-nasal delivery

  • 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.


  • 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 smokingĀ 
  • 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.