What is Asthma, asthma attack, symptoms, etiology, types, diagnosis, risk factors, its treatment

What is Asthma?

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

Asthma is an inflammatory disease of the airways to the lungs. It makes breathing difficult and can make some physical activities challenging or even impossible.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

What is an asthma attack?

When your asthma symptoms get progressively worse, it’s known as an exacerbation, or an asthma attack.

It becomes increasingly difficult to breathe because the airways are swollen and the bronchial tubes have narrowed.

The symptoms of an exacerbation may include:

• Hyperventilation
• Cough
• Wheezing
• Shortness of breath
• Increased heart rate
• Agitation
• Confusion
• Blue lips

Although an exacerbation can end quickly without medication, you should contact your doctor because it can be life threatening.

The longer an exacerbation continues, the more it can affect your ability to breathe. That’s why exacerbations often require an emergency contact.

Exacerbations can be prevented by taking medications that help manage your asthma symptoms.

Sign & Symptoms of Asthma:

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times such as when exercising or have symptoms all the time.

The most common symptom of asthma is wheezing. This is a squealing or whistling sound that occurs when you breathe.

Other asthma symptoms may include:

• Shortness of breath
• Rapid Breathing
• Difficulty in talking
• Chest tightness or pain
• Wheezing when exhaling, which is a common sign of asthma in children
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
• Fatigue

For some people, asthma signs and symptoms flare up in certain situations:

• Exercise-induced asthma, which may be worse when the air is cold and dry.
• Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust.
• Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste, or particles of skin and dried saliva shed by pets.

Etiology of Asthma:

Although asthma is especially common in children, many people don’t develop asthma until they are adults.

No single cause has been identified trusted source for asthma. Instead, researchers believe it’s caused by a variety of factors.

These factors include:

• Genetics. If a parent or sibling has asthma, you’re more likely to develop it.
• History of viral infections. People with a history of severe viral infections during childhood, such as respiratory syncytial virus infection (RSV), may be more likely to develop the condition.
• Hygiene hypothesis. This theory explains that when babies aren’t exposed to enough bacteria in their early months and years, their immune systems don’t become strong enough to fight off asthma and other allergic conditions.

Many factors can also trigger asthma and cause symptoms to worsen and these triggers for asthma can vary and some people may be more sensitive to certain triggers than others.

The most common triggers include:

• Health conditions, such as respiratory infections
• Exercise
• Environmental irritants
• Allergens
• Intense emotions & stress
• Extreme weather conditions
• Pests
• Certain medications, including aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine.
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat.

Risk Factor for Asthma:

A number of factors are thought to increase your chances of developing asthma. They include:

• Having a blood relative with asthma, such as a parent or sibling.
• Having another allergic condition, such as atopic dermatitis which causes red, itchy skin or hay fever which causes a runny nose, congestion and itchy eyes.
• Being overweight.
• Being a smoker.
• Exposure to secondhand smoke.
• Exposure to exhaust fumes or other types of pollution.
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing.

Types of Asthma:

The most common type is allergic asthma, representing 60% of all cases of asthma, additional types of asthma are related to a person’s stage in life.

Other specific types of asthma are described below:

1. Allergic Asthma:  Seasonal allergens triggers this common type of asthma. These might include:
2. pet dander from animals like cats and dogs
3. food
4. mold
5. pollen
6. dust

Allergic asthma is often seasonal because it goes hand-in-hand with seasonal allergies.

1. Non-allergic asthma: Irritants in the air not related to allergies trigger this type of asthma. These irritants might include:
2. burning wood
3. cigarette smoke
4. cold air
5. air pollution
6. viral illnesses
7. air fresheners
8. household cleaning products
9. perfumes
10. Occupational asthma: Occupational asthma is a type of asthma induced by triggers in the workplace. These irritants can exist in a wide range of industries, including farming, textiles, woodworking & manufacturing etc.

These triggers include:

• dust
• dyes
• gases and fumes
• industrial chemicals
• animal proteins
• rubber latex
• Aspirin-induced asthma:
• Aspirin-induced asthma (AIA), also called aspirin exacerbated respiratory disease (AERD), is usually severe.
• It’s triggered by taking aspirin or another NSAID, such as naproxen or ibuprofen.
• The symptoms may begin within minutes or hours. People with AIA also typically have nasal polyps.
• About 09% of people with asthma have AIA. It usually develops suddenly in adults between the ages of 20 to 50 year.
• Nocturnal asthma: In this type of asthma, symptoms worsen at night, the body’s natural sleep cycle may also trigger nocturnal asthma.

Triggers that are thought to bring on symptoms at night include:

• heartburn
• pet dander
• dust mites
• Cough-variant asthma (CVA):
• Cough-variant asthma (CVA) doesn’t have classic asthma symptoms of wheezing and shortness of breath. It’s characterized by a persistent, dry cough.
• If it’s not treated, CVA can lead to full-blown asthma flares that include the other more common symptoms.
• Exercise-induced bronchoconstriction (EIB):
• Exercise-induced bronchoconstriction (EIB) usually affects people within a few minutes of starting exercise and up to 10 to 15 minutes after physical activity.
• This condition was previously known as exercise-induced asthma (EIA).

Diagnosis for Asthma:

Physical examination:

• Your doctor will perform a physical examination to rule out other possible conditions, such as a respiratory infection or chronic obstructive pulmonary disease (COPD).
• Your doctor will also ask you questions about your signs and symptoms and about any other health problems.

Diagnostic Tests:

You may be given lung function tests to determine how much air moves in and out as you breathe.

These tests may include:

• 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 that 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 medication to open your airways called a bronchodilator, such as albuterol. If your lung function improves with use of a bronchodilator, it’s likely you have asthma.

Additional Diagnostic Test for Asthma:

• Methacholine challenge test: It is also called Bronchoprovocation Test. Methacholine is a known asthma trigger. When inhaled, it will cause your airways to narrow slightly. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal.
• Imaging tests: A chest X-ray can help identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.
• Allergy testing: Allergy tests can be performed by a skin test or blood test. They tell you if you’re allergic to pets, dust, mold or pollen. If allergy triggers are identified, your doctor may recommend allergy shots.
• Nitric oxide test: This test measures the amount of the gas nitric oxide in your breath. When your airways are inflamed, a sign of asthma, you may have higher than normal nitric oxide levels. This test isn’t widely available.
• Sputum eosinophils: This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing. Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye.
• Provocative testing for exercise and cold-induced asthma: In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

Therapeutics and Treatment for Asthma:

Treatment usually involves learning to recognize your triggers, taking steps to avoid triggers and tracking your breathing to make sure your medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quickrelief inhaler.

To treat asthma, the National “Asthma Education and Prevention Program (NAEPP)” classifies the condition based on its severity before treatment.

Asthma classifications according to treatment include:

• Intermittent. Most people have this type of asthma, which doesn’t interfere with daily activities. Symptoms are mild, lasting fewer than 2 days per week or 2 nights per month.
• Mild persistent. The symptoms occur more than twice a week — but not daily — and up to 4 nights per month.
• Moderate persistent. The symptoms occur daily and at least 1 night every week, but not nightly. They may limit some daily activities.
• Severe persistent. The symptoms occur several times every day and most nights. Daily activities are extremely limited.

Treatments for asthma fall into four primary categories:

• Quick relief medications
• Long-term control medications
• A combination of quick relief and long-term control medications.
• Biologics, which are given by injection or infusion usually only for severe forms of asthma

Your doctor may recommend one treatment or a combination of treatments based upon following what works best to keep your asthma under control.

• The type of asthma you have
• Your age
• Your triggers

Your treatment plan may also involve learning your triggers, monitoring your symptoms carefully, and taking steps to avoid flare-ups.

Long-term asthma control medications:

• Preventive, long-term control medications reduce the swelling (inflammation) in your airways that leads to symptoms.
• These medications are taken daily to help reduce the number and severity of your asthma symptoms, but they don’t manage the immediate symptoms of an attack.

Long-term asthma control medications include:

• Anti-inflammatories. Taken with an inhaler, corticosteroids and other anti-inflammatory medications help reduce swelling and mucus production in your airways, making it easier to breathe.
• Anticholinergics. These help stop your muscles from tightening around your airways. They’re usually taken daily in combination with anti-inflammatories.
• Long-acting bronchodilators. These should only be used in combination with anti-inflammatory asthma medications.

Types of long-term control medications include:

• Inhaled corticosteroids: These medications include fluticasone propionate, budesonide, ciclesonide, beclomethasone, mometasone and fluticasone furoate you may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, inhaled corticosteroids have a relatively low risk of serious side effects.

• Leukotriene modifiers: These oral medications including montelukast, zafirlukast and zileuton to help relieve asthma symptoms. Montelukast has been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away if you experience any of these reactions.

• Combination inhalers: These medications such as fluticasone-salmeterol, budesonide-formoterol, formoterol-mometasone & fluticasone furoate vilanterol contain a long-acting beta agonist along with a corticosteroid.

• Theophylline: Theophylline is a daily pill that helps keep the airways open by relaxing the muscles around the airways. It’s not used as often as other asthma medications and requires regular blood tests.

Quick-relief asthma medications:

These medications should only be used in the event of asthma symptoms or an attack. They provide quick relief to help you breathe again. They may also be used before exercise if your doctor recommends it.

 Types of quick-relief medications include:

Bronchodilators:

• Bronchodilators work within minutes to relax the tightened muscles around your airwaves and decrease symptoms quickly.
• Although they can be administered orally or injected, bronchodilators are most commonly taken with an inhaler (rescue) or nebulizer.
• They can be used to treat sudden symptoms of asthma or taken before exercise to prevent a flare-up.

Types of Bronchodilators:

• Short-acting beta agonists: These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol and levalbuterol. Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer, a machine that converts asthma medications to a fine mist. They’re inhaled through a face mask or mouthpiece.
• Anticholinergic agents: Like other bronchodilators, ipratropium and tiotropium act quickly to immediately relax your airways, making it easier to breathe. They’re mostly used for emphysema and chronic bronchitis, but can be used to treat asthma.

Oral and intravenous corticosteroids: These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so these drugs are used only on a short-term basis to treat severe asthma symptoms.

Biologics:

 Biologics are used to treat severe asthma that doesn’t respond to other medications or to treatment by trigger control.

They work by targeting specific antibodies in your body. This disrupts the pathway that leads to asthma-causing inflammation. There are five types of biologic medications including:

1. Mepolizumab
2. Reslizumab
3. Benralizumab
4. Omalizumab
5. Dupilizumab

 These medications need to be administered either by injection or by infusion.

Bronchial thermoplasty:

• This treatment uses an electrode to heat the airways inside the lungs, helping to reduce the size of the surrounding muscle and prevent it from tightening.
• This minimally invasive procedure is performed by a doctor in a clinic or hospital and usually takes around an hour.
• Bronchial thermoplasty is intended for people with severe asthma and can provide relief from symptoms for up to 5 year.
• However, because it’s a relatively new procedure, it’s not yet widely available.

First aid asthma treatment:

• If you think that someone you know is having an asthma attack, tell them to sit them upright and assist them in using their rescue inhaler or nebulizer.
• The dosage will vary depending on the medication. Check the instructions insert to make sure you know how many puffs of medications you need in the event of an attack.
• If symptoms persist for more than 20 minutes and a second round of medication doesn’t help, seek emergency medical attention.
• If you frequently need to use quick-relief medications, ask your doctor about another type of medication for long-term asthma control.

Prevention and management:

The researchers have yet to identify the exact cause of asthma, it’s challenging to know how to prevent the inflammatory condition.

However, more information is known about preventing asthma attacks, these strategies include:

• Avoiding triggers: Steer clear of chemicals, smells, or products that have caused breathing problems in the past.
• Reducing exposure to allergens: If you’ve identified allergens, such as dust or mold, that trigger an asthma attack, avoid them if possible.
• Getting allergy shots: Allergen immunotherapy is a type of treatment that may help alter your immune system. With routine shots, your body may become less sensitive to any triggers you encounter.
• Taking preventive medication: Your doctor may prescribe medication for you to take on a daily basis. This medication may be used in addition to the one you use in case of an emergency.

Your doctor can help you put an asthma action plan in place so that you know which treatments to use and when.

In addition to using maintenance medications, you can take steps each day to help make yourself healthier and reduce your risk for asthma attacks. These includes:

• Eating a healthier diet: Eating a healthy, balanced diet can help improve your overall health.
• Maintaining a moderate weight: Asthma tends to be worse in people with overweight and obesity. Losing weight is healthy for your heart, your joints, and your lungs.
• Quitting smoking, if you smoke: Irritants such as cigarette smoke can trigger asthma and increase your risk for COPD.
• Exercising regularly: Activity can trigger an asthma attack, but regular exercise may actually help reduce the risk of breathing problems.
• Managing stress: Stress can be a trigger for asthma symptoms. Stress can also make stopping an asthma attack more difficult.

Nutrient rich foods are vital to helping reduce symptoms, but food allergies can trigger asthma symptoms.