Just what is asthma?
As many as nine million children in America below the age of eighteen have asthma. Another seven to eight million adults suffer from asthma too. Around the world, many times those numbers are afflicted with the disease, although estimates vary widely. So just what is asthma?
Asthma is an inflammatory disease affecting the airways of the lungs. It is a chronic illness, meaning that it tends to persist over long periods of time. The inflammation has the effect of narrowing the airways, which causes breathing difficulties. The patient may start wheezing and may gasp for breath in some cases.
One of the characteristics of asthma is that the airway obstruction generally goes away on its own or else responds well to various types of medication. However, acute asthma attacks have also been fatal on occasion.
The airways in the lungs consist of the bronchi (or ‘breathing tubes’) and the bronchioles. In an asthma patient, they are hypersensitive to one or more kinds of stimuli. For example, they may be hypersensitive to pollutants, pollen, animal dander, cold air, dust mites or even internal triggers like anxiety and stress.
In non-asthmatic people, these stimuli do not usually produce an adverse effect on the lungs. However in an asthmatic, the muscle tissues that line the walls of the bronchi start to spasm when exposed to these triggers. Also, the cells along the airways swell to more than their normal size and discharge mucus. These responses have the effect of narrowing the bronchi, a phenomenon called bronchoconstriction.
The net effect of bronchoconstriction is that the patient must make a much greater effort to breathe normally. This gives rise to the symptoms of asthma.
The cells that line the walls of the bronchi are called mast cells. These cells release groups of substances called histamines and leukotrienes. Both these chemical groups cause mucus to form and also cause the bronchi to contract.
Histamines and leukotrienes are released in response to allergens – quite often, with a delay after the initial exposure to the allergens. These allergic responses can result in an asthma attack. At the same time, many asthma patients do not exhibit allergic reactions and yet have asthma attacks.
Asthma usually (but not always) begins during childhood or adolescence. Childhood asthma is thought to occur when a child becomes hypersensitive to substances in the environment as a result of genetic reasons. Such children are known as atopic persons.
Researchers in Finland have identified two genes that may predispose people to become atopic. This is significant because it may help identify children who have a greater chance of developing asthma.
It is estimated that one third to one half of the population may be atopic. When such people are exposed to potential allergens in their environments, their systems respond by producing an antibody to capture and destroy these foreign substances. The effect of this response is that the airways become sensitive to these allergens. Repeated or continued exposure to these substances can produce an asthmatic response.
Since allergens are a common cause of the bronchoconstriction that leads to an asthma attack, minimizing exposure to such substances is a crucial step in managing asthma.
In asthma patients, inflammation of the nose lining – a condition called rhinitis – can worsen asthma symptoms. So can sinusitis and even acid reflux, which is a condition when acidic stomach contents back up into the esophagus. Other illnesses like viral infections that affect the respiratory tract can set off or worsen asthma attacks.
Severe asthma episodes are easy to spot because of wheezing and other symptoms. But some attacks may be quite mild and the patient may only experience moderate difficulty in breathing. In such cases, listening to chest sounds using a stethoscope can help identify the presence of an asthmatic condition.
The good thing about asthma is that even in the case of severe attacks, the patient will almost always recover completely.
Check out the other pages of this site for information on symptoms, treatment, disease types and in general, additional information in answer to the question “What is asthma?”
Do you know what to do when someone has an asthma attack?
An asthma attack can be scary to watch. Your best friend may have come over to your house and you are enjoying a conversation with her. All of a sudden, she bends over and starts gasping for breath. Then she falls to the ground and looks completely panic-stricken while struggling for breath.
That is one of the many possible faces of asthma attacks. How should you tackle this situation?
An asthma attack can possibly be life-threatening. Knowing how to handle it is critical.
Dealing with an asthma attack
Here is a broad outline of what you can do if you suspect someone is having an asthma attack or if that person tells you she is having one.
First things first – stay calm. Watching someone having an asthma attack is frightening for you. But it is even more frightening for the person who is having the attack. If you act agitated, you will induce more fear and panic in the victim. This will act to worsen their condition.
When you remain calm, you reassure them that you have a certain amount of control over the situation and that you will be in a position to help them. That gives them confidence and they will find it easier to let you know what must be done. Which brings up the next point.
Ask them what must be done. Most people who have an asthma attack are not in that situation for the first time. They know that they have an asthma problem and their doctor has very likely prescribed a plan to tackle asthma attacks. So they know precisely what must be done.
Ask them if they have an inhaler and where they have kept it. If they don’t have an inhaler, ask if anyone else around has an inhaler. Also ask the victim if they want you to call for help.
If that person is having a severe asthma attack, she may not be in a position to talk. That is why many asthma patients carry a written instruction card with them at all times. In fact, they may have kept an instruction card with their inhaler. If you find such a card, just follow the instructions.
Get the patient into a sitting position. She will find better relief from asthma symptoms while in a sitting position than while lying down. Also, she needs to take medication, which is easier to do in a sitting position.
Assist the person in using the inhaler. Delivering medication by way of an inhaler is the single most important thing to do to tackle an asthma attack.
An inhaler is a small, portable device that is used to deliver a preset quantity of medication. This medication helps to relax the patient’s airways and makes breathing easier. In case the patient does not have an inhaler with her, it is usually acceptable to use someone else’s inhaler, because medication is critical.
Here is how to use an inhaler. Basically, you need to deliver two to four puffs of medication using the inhaler and then wait for five minutes before delivering another round.
The mouthpiece of the inhaler should be positioned between the person’s lips. The medication is delivered when you depress the plunger on the inhaler. Before you do so, let the person know that you are about to do so; that way, she can get ready to inhale the medication.
After you deliver a puff, wait for several seconds before giving another. The patient should be ready to inhale another puff when you deliver it.
During an acute asthma attack, the patient may find it difficult to inhale the entire medication at once. In such cases, use a spacer, which is a tube that sits between the inhaler and the mouth. The medication is puffed into the spacer and the patient can then inhale it over the course of several breaths instead of in one single breath. If a spacer is not available, just roll up a piece of paper to create a hollow tube to act as a spacer.
Next, observe the patient. Once you give the prescribed dose of medication, it should take effect in about five to ten minutes. See if the patient is finding it easier to breathe within that timeframe. Continue to remain calm and talk to them normally.
If the asthma attack does not subside within ten minutes at most, call for help. While waiting for help to arrive, continue to give about four puffs of medication every five minutes. Medication will help keep symptoms from deteriorating. This is true even in cases it does not seem to be helping the patient.
Those are basic steps in helping someone cope with an asthma attack. Keep them in mind and you may be able to help someone having an acute attack.
Are you aware of these common asthma symptoms?
Did you know that many cases of asthma worldwide go undiagnosed? Large numbers of people do not realize that they have the disease. Such people are said to have ‘hidden asthma’. In that context, it is important to be aware of asthma symptoms because you can then seek medical attention promptly if you suspect you have this health condition.
Undiagnosed cases of asthma can be a health risk because in addition to developing asthma symptoms, such people are considerably more likely to have illnesses like chronic bronchitis, pneumonia and other respiratory diseases.
Apart from that, people with hidden asthma may have lowered immunities, experience fatigue more often and have impaired sleep. They are more likely to have severe colds as well. All of these can result in poor health and a greater tendency to fall victim to a variety of illnesses.
You can see why it is important to recognize common asthma symptoms. If you have any of the following symptoms, your doctor will use several diagnostic methods to either confirm or deny the presence of asthma. Most importantly, he can prescribe the right treatment plan so that asthma episodes are minimized and any attacks that do occur can be dealt with appropriately.
Let’s take a look at common asthma symptoms
Coughing tops the list. You need to pay attention to coughs that appear even without any other disease or infection. This is particularly true of chronic coughs that occur during the night.
Asthma related coughs are usually not productive. This is because unlike normal coughs which are generated by the necessity to get rid of mucus, asthma coughs are the result of inflamed or irritated airways.
Although asthma may exhibit many different symptoms, coughing is the most common sign that occurs by itself, without the presence of other symptoms. Cough-variant asthma is diagnosed using special tests that try to stimulate reactions by making use of histamines.
Fortunately, cough-variant asthma usually responds very well to a combination of corticosteroids (inhaled) and bronchodilators.
Asthma attacks are often accompanied by wheezing – another common symptom. However, if a person has mild asthma that is chronic in nature, wheezing may not be present as a telltale asthma symptom.
The point of the breathing cycle at which wheezing occurs indicates the severity of the person’s asthma. If the wheezing occurs only towards the end of an outgoing breath, it may indicate a mild asthma episode. Wheezing that occurs throughout exhalation is a symptom of a moderate asthma attack.
And if wheezing is present both while inhaling and while exhaling, it means the person is having a severe attack of asthma. In such cases, medication often relieves symptoms. However, if it does not within say ten minutes at most, then urgent medical help should be sought.
Shortness of breath is one of the major asthma symptoms. If you feel short of breath after even very mild exertion, it may be a sign of asthma. Exercise induced asthma is a common type of asthma. However, a doctor will need to carefully evaluate this to make sure it really is a sign of asthma because in many cases, it is not.
For instance, one study found that 60% of all children tested apparently had exercise induced asthma. However, a more detailed investigation showed that this was not true – the children simply had exaggerated expectations of how much they should be able to exert themselves before they get out of breath.
Being aware of asthma symptoms can help you diagnose and control the disease early. In some situations, it may even help save a life.
Effective asthma treatment depends on what you do
Asthma treatment isn’t just about medication. While your doctor has a critical role to play, he can’t take care of the problem on his own. Asthma management is about managing your life and environment well.
The doctor will prescribe preventive as well as emergency relief medication. Both are important. However, asthma treatment also depends on reducing the chances of having an attack in the first place. You and your family have a key role here. You can keep asthma from degrading the quality of your life if you adopt sensible self help techniques.
It turns out that there are several different things you can do to reduce the number of attacks and the severity of those attacks. Your doctor can create a personalized action plan for you. A lot of asthma treatment and management revolves around avoiding asthma triggers.
Here are several ways you can manage asthma better
The most important asthma treatment step is to follow the doctor’s orders precisely. In particular, this means taking the preventive medication as per the schedule drawn up by him. Unfortunately, many asthma patients quit taking preventive medication when they feel better. This ultimately results in more asthma attacks. Likewise, if your doctor has asked you to measure peak flow every day, make sure you do that so that he can monitor your condition.
- Pet dander is a common asthma trigger. If possible, avoid keeping any pets in the house. If that is impractical, at least keep pets out of the bedroom.
- Dust is another cause of asthma attacks. Keep your home as dust free as possible. Use cylinder vacuums, especially ones where the cleaner bag is enclosed inside a canister. This will prevent dust from being blown back into the air.
- Dust control doesn’t mean just vacuuming or dusting your home regularly. You need to create an environment where dust – and dust mites – can’t accumulate. If possible, avoid carpeting and heavy draperies throughout the house. At the minimum, avoid using them in the bedroom. And regularly vacuum the ones you do have in the house.
- Get rid of stuffed animals and other similar decorations. The same goes for down feather pillows, comforters, etc. Use mite-proof plastic covers on mattresses, because mattresses are breeding grounds for dust mites.
- Quit smoking, if you are a smoker. Cigarette smoke can easily trigger asthma attacks. If anyone else in the family smokes, they should avoid smoking in the house, since secondary smoke can lead to asthma too.
- Some foods and drinks can set off allergies and asthma attacks, as can some medications. Remain aware of what foods and drugs do not suit you and be sure to stay away from them.
- Prevent mould growth because of its linkage to asthma. Don’t keep plants in the house, since mould can grow in the soil. Wet laundry should not be kept for long and should be dried immediately. Bathrooms should be disinfected and thoroughly washed frequently.
- If your asthma symptoms are set off by airborne allergens, monitor air quality on a daily basis. Pollen season can be particularly tricky and you should avoid woods and open fields during the season. If cold air acts as a trigger, it may help to cover your nose and mouth with a scarf during cold weather.
As you can see, a large part of effective asthma treatment depends on you. Follow the prevention plan prescribed by your doctor and you should see significant reduction in asthma attacks.
Essentials of asthma medication
Broadly speaking, asthma medication is of two types: relief medication and preventive medication. The former is used to provide relief from distressing asthma symptoms such as shortness of breath, wheezing, etc. The latter is meant to prevent asthma attacks or at least, reduce their frequency and severity.
In most cases, bronchodilators are used to achieve quick results in providing symptomatic relief. It is usually delivered through inhalers. Inhalers are pocket-sized devices called metered-dose inhalers or MDIs.
An inhaler delivers a specific dose of medication when a pump attached to it is depressed. Of course, the medication has to be inhaled as soon as it is dispensed from the device, or else it will disperse in the air. That means the patient must breathe in the asthma medication as soon as the pump on the inhaler is pressed. Further, they must hold their breath in for a few seconds so that the medication can take effect in the airways.
In cases where the patient has difficulty inhaling the entire medication as soon as it is released, using a spacer can help. A spacer mixes the medication with air and allows the patient to inhale the drug in smaller quantities.
Bronchodilators relax the smooth muscles around the airways and thus help the air flow easily. In general, asthmatics have more difficulty breathing out than breathing in; bronchodilators make it easier to breathe out.
Asthma medication used to provide symptomatic relief include terbutaline, levalbuterol, bitolterol and salbutamol, among others.
Tremors used to be a widely observed side effect produced by preventive asthma medication. This was so when the medication was either injected or taken orally. Tremors have greatly reduced now that medication is delivered by inhalation most of the time. Inhaled medication acts directly on the lungs – injected or oral medication spreads throughout the body and is not limited to the lungs.
Preventive asthma medication
If the asthma symptoms are severe or if they occur frequently – say, more than twice a week – doctors usually recommend taking preventive medication.
Preventive drugs are important both because they help avoid asthma attacks and also because they help avoid overuse of relief medication. Minimizing use of relief drugs is important because overuse produces several side effects.
If asthma symptoms continue despite use of preventive drugs, the doctor may prescribe additional preventive medication to get rid of symptoms completely.
One of the problems concerning preventive drug use is that patients often stop taking medication when they are symptom-free for a short while. This often results in additional attacks and no real long term benefit.
Like relief medication, preventive drugs are also inhaled. A class of drugs called glucocorticoids is the most commonly used asthma medication for attack prevention. Some of the common drugs used include beclomethasone, ciclesonide, fluticasone and budesonide.
Mast cell stabilizers are also used as preventives. They include nedocromil and cromoglicate. Leukotriene modifiers like zafirlukast, montelukast and pranlukast are used as well.
Asthma may be triggered by allergic reactions. Therefore antihistamines are prescribed by doctors to prevent attacks in some cases. In case of severe allergies, so-called allergy shots, or hyposensitisation may be recommended.
There is a wide range of effective asthma medication available today. Your doctor will be able to prescribe a combination that’s right for your condition.