Introduction:
Asthma is a chronic disease that affects the bronchial tubes, causing the airways to narrow and reducing the flow of air into and out of the lungs. This triggers recurrent asthma attacks of breathlessness and wheezing in the chest, accompanied by cough, phlegm, after being exposed to allergic triggers or pulmonary irritants. Such asthma attacks vary from one person to another, in terms of their recurrence and severity. It is one of the most common diseases among children.
Causes of Asthma:
According to some studies, the principal causes of asthma reside in genetic or environmental factors, such as pollution with factory smokes and car exhausts.
Triggers of Asthma:
- Tobacco use.
- Allergy from some triggers, such as chemicals, bird feathers, animal fur, pollen, dust, certain foods or liquids or preservatives.
- Viral inflammation of the respiratory system.
- Certain medications can trigger asthma: aspirin and other non-steroid anti-inflammatory drugs.
- Extreme Emotional arousal such as anger or fear.
- Harsh physical exercise.
- Hormonal changes, like the menstrual cycle of some women.
- Gastro Esophageal Reflux Disease.
Symptoms indicating asthma:
Symptoms range from mild to acute, varying from one person to another:
- Shortness of breath.
- Chest clenching and pain.
- Sleep disorders owing to the shortness of breath.
- Whistling sound when breathing or exhaling.
- Frequent cough, accompanied by sniffles and sneezing, especially in case of a viral infection of the respiratory tract.
Acute symptoms of asthma:
Increase of the acceleration and severity of symptoms.
Acute shortness of breath.
The patient becomes in bad need for bronchodilators.
Persons at Risk:
Following are some of the factors believed to increase the risk of asthma incidence:
Medical history of asthma in the family.
Overweight and obesity.
Smoking (or passive smoking).
Exposure to irritants (such as the chemicals used in hair transplantation and hairdressing).
Pollution (especially air pollution: factory smoke, vehicle exhaust, etc.)
Asthma Diagnosis:
To diagnose asthma, your doctor will review your medical history, family history, symptoms and triggers. Your doctor will also perform a physical examination and listen to your heart and lungs.
Lung Function Measure:
- Spirometry: This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
- Peak flow: A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Your doctor will give you instructions on how to track and deal with low peak flow readings.
- Lung function tests often are done before and after taking a bronchodilator (brong-koh-DIE-lay-tur), such as albuterol, to open your airways. If your lung function improves with use of a bronchodilator, it's likely you have asthma.
- Methacholine challenge: Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
- Nitric oxide test: This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath. When your airways are inflamed — a sign of asthma — you may have higher than normal nitric oxide levels.
- Imaging tests: A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
- Allergy testing: This can be performed by skin test or blood test. Allergy tests can identify allergy to pets, dust, mold and pollen. If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.
How asthma is classified
Asthma is classified into four general categories:
| Mild intermittent |
Mild symptoms up to two days a week and up to two nights a month |
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Symptoms more than twice a week, but no more than once in a single day |
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| Moderate persistent |
Symptoms once a day and more than one night a week |
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| Severe persistent |
Symptoms throughout the day on most days and frequently at night |
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Following are some of the objectives of asthma treatment:
- Driving the patient onward to stability.
- Reducing the recurrence of severe asthma attacks, and using bronchodilators as least as possible.
- Enabling asthma patients to lead a normal life.
Medications
Long-term asthma control medications:
| Inhaled corticosteroids |
anti-inflammatory drugs |
Fluticasone, budesonide, flunisolide and ciclesonide
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| Leukotriene modifiers |
help relieve asthma symptoms for up to 24 hours |
montelukast, zafirlukast and zileuton |
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| Long-acting beta agonists |
open the airways |
salmeterol and formoterol |
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| Theophylline |
helps keep the airways open |
Theophylline |
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Quick-relief (rescue) medications:
It is a set of medicines used to widen the airways by causing the trachea to relax, thus alleviating the symptoms of the shortness of breath, cough, chest tightness, and the other asthmatic symptoms associated with severe attacks. Your doctor might prescribe using such medicines prior to hard physical activity (exercise, etc.).
| Short-acting beta agonists |
inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. |
Albuterol, levalbuterol and pirbuterol |
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| Ipratropium |
acts quickly to immediately relax your airways |
Ipratropium |
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| Oral and intravenous corticosteroids |
relieve airway inflammation caused by severe asthma |
prednisone and methylprednisolone |
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Allergy medications:
They may help if your asthma is triggered or worsened by allergies. These include:
- Allergy shots (immunotherapy): Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years.
- Omalizumab (Xolair): This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system.
- Allergy medications: These include oral and nasal spray antihistamines and decongestants as well as corticosteroid and cromolyn nasal sprays.
Bronchial thermoplasty:
This treatment — which isn't widely available nor right for everyone — is used for severe asthma that doesn't improve with inhaled corticosteroids or other long-term asthma medications. Generally, over the span of three outpatient visits, bronchial thermoplasty heats the insides of the airways in the lungs with an electrode, reducing the smooth muscle inside the airways. This limits the ability of the airways to tighten, making breathing easier and possibly reducing asthma attacks.
Tips for prevention and control of asthma:
Asthma patients have a crucial role to play in controlling the disease, by following these tips:
- Avoid triggers of internal and external allergy.
- Cooperate with the doctor, and follow a comprehensive therapeutic plan, including medications, basic tests and examinations, as well as scheduled appointments for follow-up.
- Follow up with the doctor of the family, and comply with his instructions.
- Keep a medical file for you at the hospital or health center.
- Cooperate with the doctor of the family at the health center, as well as at the hospital (through the Referral System).
- Keep with you a card indicating the medications you take.
- Don’t by medications from the pharmacy by yourself, without consulting your doctor.
- Don’t use the medications prescribed for others.
- Pay attention to public health, fitness, health food and exercise.
- Quit smoking, and avoid being close to smokers, as well as the triggers of asthma.
- Take the seasonal influenza vaccine, to curb the possibility of being infected by influenza.
It is recommended to head to the emergency sections in the following cases:
- Acute or ongoing symptoms, such as whistling breathe, shortness of breath and chest pain.
- When there is no response to bronchodilators.
- Exacerbation of symptoms, and failure to breathe or speak.
- Chest clenching, shortness of breath, and increase the rate of breathing and heartbeat.
- When the limbs turn blue, and the general health condition deteriorates, accompanied fainting in advanced cases.