Asthma

By: Me

What is asthma?

• Asthma is a lifelong, or chronic breathing problem caused by swelling (inflammation) of the airways in the lungs. It cannot be cured, but it can be prevented and controlled. When you have asthma, your airways are super sensitive. They may react to many things. These things are called triggers. People who have asthma may wheeze or complain of feeling "tight" in the chest. They may also cough a lot when their asthma is not under control.

Asthma triggers Animals Cold and viral infection Stress Exercise Certain foods Dust mites Environment pollen

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. This makes them swollen and very sensitive. They tend to react strongly to certain inhaled substances.

Our lungs are made up of millions of tiny airways or bronchial tubes.  It’s in these tiny airways that oxygen from the air we breathe is able to get into our blood.  The bloodstream then brings the oxygen to all the cells in our body.  Anything that makes it harder for air to get into the lungs makes it hard to breathe.With asthma, these airways get blocked.  This happens in three main ways:1) Swelling of the airways, called “inflammation”.2) Airways get squeezed shut, called

“bronchoconstriction”3) Airways get plugged up with mucus.

Swelling of the airways…

There is swelling or “inflammation” inside the airways.  The swelling takes up some space where the air used to flow.  So the airways are smaller.  Usually the swelling happens slowly, over weeks or months.For people who have persistent asthma, swelling of the airways is the most important thing causing the airways to be smaller.  In these people, this swelling in the lungs is always there.  The swelling is there even when these people feel that they don’t have asthma and are breathing well.  But even if you can’t feel it, the swelling is the key to asthma.  Even a little bit of swelling makes the bronchial tubes sensitive (called “hyper-sensitivity”).  Sensitive lungs can get more swollen very easily.  And every time the lungs swell up a little, it becomes easier to swell up even more.  Sensitive lungs also get squeezed shut (bronchoconstriction) more easily.  It takes less of a trigger to cause an attack in sensitive lungs. If the swelling is not controlled well, then the asthma can not be controlled well.  There are certain medicines that help keep the swelling down.

Broncoconstriction

All lung airways have little muscles wrapped around them.  During an asthma attack, these tiny muscles get tighter, and squeeze the airways closed.  So the airways are smaller.  This is known as “bronchoconstriction”.  Bronchoconstriction usually happens fast.  Usually when the airways get tight, people with asthma have some trouble breathing. There are medicines that relax the tightened muscles so that the airways can open back up.  When the airways open up, breathing gets easier.

Mucus plugging

A little bit of mucus is always made inside everyone’s airways.  With asthma, more mucus is made.  Also, the mucus that is made is thicker than regular mucus.  If the airways are already small from inflammation and bronchoconstriction, the extra mucus can plug up the airways even more.  If airways get plugged with mucus, air can’t go in or out and breathing gets harder.  Many people with asthma will sometimes cough up some mucus.  Sometimes it feels like mucus is “rattling” around in the chest, but you can’t cough it out.

…out of the 7,000,000,000 people in this world…

…approximately 300,000,000 are

affected by asthma...

…and asthma kill 255,000 people each year world wide.

How serious is asthma?

Asthma is not generally considered by doctors to be a serious illness in most people who have it, mainly due to the mildness of symptoms and the range of very effective medicines that control these symptoms and stop asthma worsening. Asthma does, however, have an effect on quality of life because attacks can be unpleasant and distressing and can restrict activity. Whilst most sufferers learn to live with and manage their condition, for some it can be disabling. In exceptional cases, asthma can be life-threatening, particularly if it is not treated adequately or promptly. For some of these, an attack is so severe that it results in death.

Child-Onset Asthma

Asthma that begins during childhood is called child-onset asthma. This type of asthma happens because a child becomes sensitized to common allergens in the environment - most likely due to genetic reasons. The child is atopic - a genetically determined state of hypersensitivity to environmental allergens.Allergens are any substances that the body will treat as a foreign body, triggering an immune response. These vary widely between individuals and often include animal proteins, fungi, pollen, house-dust mites and some kind of dust. The airway cells are sensitive to particular materials making an asthmatic response more likely if the child is exposed to a certain amount of an allergen.

Adult-Onset Asthma

This term is used when a person develops asthma after reaching 20 years of age. Adult-onset asthma affects women more than men, and it is also much less common than child-onset asthma.It can also be triggered by some allergic material or an allergy. It is estimated that up to perhaps 50% of adult-onset asthmas are linked to allergies. However, a substantial proportion of adult-onset asthma does not seem to be triggered by exposure to allergen(s); this is called non-allergic adult-onset asthma. This non-allergic type of adult onset asthma is also known as intrinsic asthma. Exposure to a particle or chemical in certain plastics, metals, medications, or wood dust can also be a cause of adult-onset asthma.

Exercise-Induced Asthma

If you cough, wheeze or feel out of breath during or after exercise, you could be suffering from exercise-induced asthma. Obviously, your level of fitness is also a factor - a person who is unfit and runs fast for ten minutes is going to be out of breath. However, if your coughing, wheezing or panting does not make sense, this could be an indication of exercise-induced asthma.As with other types of asthma, a person with exercise-induced asthma will experience difficulty in getting air in and out of the lungs because of inflammation of the bronchial tubes (airways) and extra mucus. Some people only experience asthma symptoms during physical exertion. The good news is that with proper treatment, a person who suffers from exercise-induced asthma does not have to limit his/her athletic goals. With proper asthma management, one can exercise as much as desired. Mark Spitz won nine swimming gold medals during the 1972 Olympics and he suffered from exercise-induced asthma. Eighty percent of people with other types of asthma may have symptoms during exercise, but many people with exercise-induced asthma never have symptoms while they are not physically exerting themselves.

Cough-Induced Asthma

Cough-induced asthma is one of the most difficult asthmas to diagnose. The doctor has to eliminate other possibilities, such as chronic bronchitis, post nasal drip due to hay fever, or sinus disease. In this case the coughing can occur alone, without other asthma-type symptoms being present. The coughing can happen at any time of day or night. If it happens at night it can disrupt sleep.

Nocturnal Asthma

Nocturnal asthma occurs between midnight and 8 AM. It is triggered by allergens in the home such as dust and pet dander or is caused by sinus conditions. Nocturnal or nighttime asthma may occur without any daytime symptoms recognized by the patient. The patient may have wheezing or short breath when lying down and may not notice these symptoms until awoken by them in the middle of the night - usually between 2 and 4 AM. Nocturnal asthma may occur only once in a while or frequently during the week. Nighttime symptoms may also be a common problem in those with daytime asthma as well. However, when there are no daytime symptoms to suggest asthma is an underlying cause of the nighttime cough, this type of asthma will be more difficult to recognize - usually delaying proper therapy. The causes of this phenomenon are unknown, although many possibilities are under investigation.

Occupational Asthma

This type of asthma is triggered by something in the patient's place of work. Factors such as chemicals, vapors, gases, smoke, dust, fumes, or other particles can trigger asthma. It can also be caused by a virus (flu), molds, animal products, pollen, humidity and temperature. Another trigger may be stress. Occupational asthma tends to occur soon after the patients starts a new job and disappears not long after leaving that job.

Steroid-Resistant Asthma (Severe Asthma)

While the majority of patients respond to regular inhaled glucocorticoid (steroid) therapy, some are steroid resistant. Airway inflammation and immune activation play an important role in chronic asthma. Current guidelines of asthma therapy have therefore focused on the use of anti-inflammatory therapy, particularly inhaled glucocorticoids (GCs). By reducing airway inflammation and immune activation, glucocorticoids are used to treat asthma. However, patients with steroid resistant asthma have higher levels of immune activation in their airways than do patients with other types of asthma.

How long does Asthma last?

Asthma attacks come and go, with wide variation in the symptoms at different times. Many people with asthma have problems only occasionally but others struggle with it every day. Modern medicines control and relieve symptoms and so attacks may only last a few hours or minutes, but without treatment this may go on for several days. Some children grow out of asthma and some people are only affected at different times of the year.

Treatment for asthma

Asthma is not so much "treated" as it is "controlled". As a chronic, long-term disease, there is no cure. However, there are tools and medicines to help you control asthma as well as benchmarks to gauge your progress.

The peak flow meter

A peak flow meter is a simple, small, hand-held tool that can help you maintain control of asthma by providing a measurement of how well air moves out of the lungs.After blowing into the device, the meter reveals your peak flow number. A physician will indicate how often to test as well as how to interpret the result to determine the amount of medication to take. Some people record scores every morning while others use the peak flow meter intermittently. Often, each test with the peak flow meter will be judged against your "personal best" peak flow number (found during 2 to 3 weeks of good asthma control). If peak flow tests begin to decline - even before other symptoms are present - it may indicate a looming asthma attack. After taking asthma medication, the peak flow meter can be used to test the effectiveness of drug therapy.

Preventive Checkups

Part of good asthma control is seeing a doctor every 2 to 6 weeks for regular checkups until it is under control. Then checkups may be reduced to once a month or twice a year. It is a good habit to keep track of asthma symptoms and attacks and diagnostic numbers such as the peak flow measurement. Doctors and nurses will ask about these and about daily activities in order to gauge the status of your asthma control.

Well-controlled Asthma

Chronic and troublesome symptoms (coughing and shortness of breath) are prevented and occur no more than 2 days per week. There is little need for quick-relief medicines or they are needed less than 2 days per week. You maintain good lung function. Your activity level remains normal. Your sleep level remains normal and symptoms do not wake you from sleep more than 1 to 2 nights per month. You do not need emergency medical treatment. You have no more than one asthma attack each year that requires inhalation of corticosteroids. Your peak flow stays above 80% of your personal best number.

Medicine • Medication for asthma is broadly categorized as either quick-relief medicine or long-term control medicine. Reducing airway inflammation and preventing asthma symptoms is the goal of long-term control medicines, where as immediate relief of asthma symptoms is the goal of quick-relief or "rescue" medicines.

• Medications can be ingested in pill form, but most are powders or mists taken orally using a device known as an inhaler. Inhalers permit medicines to travel efficiently through the airways to the lungs.

• Medication may also be administered using a nebulizer, providing a larger, continuous dose. Nebulizers vaporize a dose of medication in a saline solution into a steady stream of foggy vapor that is inhaled by the patient.

Long-term control medicines

Long-term control medicines are taken every day and are designed to prevent asthma symptom such as airway inflammation. Inhaled corticosteroids are the most effective long-term control medicine - the best at relieving airway inflammation and swelling. They are usually taken daily to greatly reduce the inflammation that initiates the chain reaction of the asthma attack.Even if taken every day, inhaled corticosteroids are not habit-forming. However, the medicines do have side effects such as the mouth infection known as "thrush". Thrush occurs when the corticosteroids land in your throat or mouth. Spacers or holding chambers have been developed to help avoid this. Thrush can also be avoided by rinsing the mouth out after inhalation. Inhaled corticosteroids also increase the risk of cataracts (clouding of the eye's lens) and osteoporosis (weakening of the bones) if taken for long periods of time. There are other long-term control medicines available that doctors may prescribe. Most of them are taken by mouth and are designed to open the airways and prevent airway inflammation. Examples include inhaled long-acting B2-agonists (used with low-dose inhaled corticosteroids), leukotriene modifiers, cromolyn and nedocromil, and theophylline.

Quick Relief Medicines

Quick-relief medicines relieve asthma symptoms when they occur. The most common of these are inhaled short-acting B2-agonists - bronchodilators that quickly relax tight muscles around the airways, allowing air to flow through them. The quick-relief inhaler should be used when asthma symptoms are first noticed, but should not be used more than 2 days a week. Most people carry the quick-relief inhaler with them at all times. Quick-relief medicines usually do not reduce inflammation and therefore should not be used as a replacement for long-term control medicines.

Vitamin D

Researchers from King’s College London have discovered how vitamin D can reduce asthma symptoms. Catherine Hawrylowicz and team explained in the Journal of Allergy and Clinical Immunology (May 2013 issue) that their findings may offer a new way of treating the debilitating and usually chronic condition. Asthma patients are currently prescribed steroid tablets, which may have harmful side effects. There is a type of asthma, however, that is resistant to steroid therapy. Patients with this type are susceptible to severe and often life-threatening asthma attacks. The scientists found that people with asthma have higher levels of IL-17A (interleukin-17A). IL-17A is part of the immune system that protects the body against infection. However, this natural compound also worsens asthma symptoms. Large amounts of IL-17A can reduce the clinical effects of steroids. The team found that asthma patients who were on steroids had the highest levels of IL-17A. They also found that vitamin D significantly lowers IL-17A production in cells. Hawrylowicz believes vitamin D could be a safe and useful add-on treatment.

Ancient Egypt

• We know that asthma existed in ancient Egyptian times, because there is some evidence that asthma has been around even before that. The Georg Ebers Papyrus - found in Egypt in the 1870s - contains prescriptions written in hieroglyphics for over 700 remedies. One of the ancient Egyptian remedies was to heat a mixture of herbs on bricks and inhale their fumes.

• Asthma, as an inflammatory disease, was not really recognized until the 1960s when anti-inflammatory medications started being used.

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