Asthma

What is Asthma? 

Asthma is a chronic respiratory condition that affects the airways in the lungs, making them inflamed and narrowed. This inflammation and narrowing can lead to difficulty breathing, wheezing, coughing, and chest tightness. Asthma symptoms can range from mild to severe, and in some cases, it can be life-threatening.

Causes and Risk Factors for Asthma

The exact cause of asthma is not completely understood, but it is believed to result from a combination of genetic and environmental factors. Some key factors contributing to asthma development and exacerbation include:

• Inflammation: Asthma is characterised by chronic airway inflammation, leading to swelling and increased mucus production.
• Airway Hyperresponsiveness: People with asthma have more sensitive airways and are prone to narrowing in response to various triggers.
• Allergic Reactions: Allergens like pollen, dust mites, and pet dander can trigger asthma symptoms in individuals with allergic asthma.
• Respiratory Infections: Viral respiratory infections, especially in early childhood, can play a role in the development of asthma.
• Environmental Factors: Exposure to environmental irritants and pollutants can worsen asthma symptoms and contribute to the development of the condition.
• Genetics: Asthma tends to run in families, suggesting a genetic component. Specific genes associated with asthma susceptibility have been identified.

Symptoms of Asthma

Asthma symptoms can vary in severity and frequency from person to person. Common symptoms of asthma include:

• Shortness of Breath: Individuals with asthma often experience a sensation of difficulty in breathing, particularly during or after physical activity or exposure to asthma triggers.
• Wheezing: Wheezing is a high-pitched whistling or rattling sound that occurs during breathing, especially when exhaling. The narrowing of the airways causes it.
• Coughing: Persistent coughing, especially at night or early in the morning, is a common asthma symptom. The cough may be dry or produce mucus.
• Chest Tightness: Some people with asthma describe a feeling of tightness or pressure in the chest, which can be uncomfortable or painful.
• Increased Mucus Production: Asthma can lead to increased mucus production in the airways, contributing to coughing and congestion.
• Difficulty Sleeping: Asthma symptoms often worsen at night, leading to sleep disturbances and fatigue.
• Difficulty Speaking: Severe asthma attacks can make speaking in full sentences difficult and cause a person to use accessory muscles for breathing.

Asthma symptoms can range from mild to severe, and they may come and go. In some cases, asthma symptoms can worsen suddenly, leading to an asthma attack and a medical emergency.

Types of Asthma

There are several types of asthma, and these are often categorised based on the triggers or underlying causes. Common types of asthma include:

• Allergic Asthma: This type of asthma is triggered by exposure to allergens such as pollen, dust mites, pet dander, or mould. Allergic asthma often runs in families and is associated with other allergic conditions like hay fever or eczema.
• Non-Allergic (Intrinsic) Asthma: Non-allergic asthma is not triggered by allergens. Instead, it may be triggered by factors like respiratory infections, exercise, cold air, smoke, or stress.
• Occupational Asthma: This type of asthma is caused by exposure to irritants or allergens in the workplace. People who work in industries like agriculture, manufacturing, or healthcare may be at risk.
• Exercise-Induced Bronchoconstriction (EIB): Some individuals experience asthma symptoms, particularly coughing and shortness of breath, during or after physical activity. This is known as exercise-induced asthma or EIB.
• Childhood-Onset Asthma: Asthma can develop in childhood and persist into adulthood. Childhood-onset asthma may have different triggers and characteristics than adult-onset asthma.

Stages of Asthma

Asthma severity is often categorised into four stages or levels based on the frequency and severity of symptoms, lung function, and medication requirements. These stages are:

• Intermittent Asthma: In this stage, symptoms occur less than two days a week, nighttime awakenings due to asthma are rare, and lung function is normal between episodes.
• Mild Persistent Asthma: Symptoms occur more than two days a week but not daily. Nighttime awakenings due to asthma may occur 3-4 times a month. Lung function is generally normal.
• Moderate Persistent Asthma: Symptoms occur daily, nighttime awakenings are more frequent (more than once a week but not nightly), and lung function is reduced.
• Severe Persistent Asthma: Symptoms are continuous, frequent nighttime awakenings occur, and lung function is significantly reduced. Severe persistent asthma often requires high-dose medications and may be difficult to control.

Diagnosis of Asthma

• Medical History: Your doctor will ask about your symptoms, frequency, and potential triggers or patterns. It's important to provide detailed information about your symptoms, including when they occur and what seems to worsen or improve them.
• Physical Examination: A physical exam may be performed to assess your lung function and listen for wheezing or other respiratory sounds. Your doctor will also check for signs of allergies or other conditions that can contribute to asthma symptoms.
• Lung Function Tests: These tests are crucial for asthma diagnosis and monitoring. The most common lung function test for asthma is spirometry. During this test, you will be asked to take a deep breath and exhale forcefully into a spirometer. This measures how much air you can exhale and how quickly you can do it. Another test, called peak flow measurement, measures the force of your breath.
• Bronchoprovocation Tests: In some cases, your doctor may recommend bronchoprovocation tests, which involve inhaling substances that can temporarily worsen asthma symptoms. This helps confirm the diagnosis of asthma.
• Allergy Testing: If allergic triggers are suspected, allergy tests such as skin prick tests or blood tests may be conducted to identify specific allergens contributing to your asthma.
• Chest X-rays or Other Imaging: Imaging tests may be performed to rule out other lung conditions that can mimic asthma symptoms.

Treatment of Asthma

Asthma is a chronic condition that can be managed effectively with the right treatment. Treatment options include:

• Controller Medications: These medications are taken regularly to prevent asthma symptoms and inflammation in the airways. Common controller medications include inhaled corticosteroids, leukotriene modifiers, and long-acting beta-agonists.
• Rescue Medications: Short-acting beta-agonists are used as rescue medications to relieve acute asthma symptoms quickly. They work by relaxing the airway muscles.
• Biologics: In some cases, biologic medications may be prescribed for severe asthma that doesn't respond well to other treatments. These drugs target specific molecules involved in the inflammatory process.
• Lifestyle Management: Identifying and avoiding asthma triggers is essential. This may include reducing exposure to allergens, quitting smoking if you smoke, and managing stress.
• Asthma Action Plan: Your doctor will work with you to develop an asthma action plan, which outlines when and how to use your medications and what to do in case of worsening symptoms or asthma attacks.

What if Asthma is Untreated?

If asthma is left untreated or poorly managed, it can lead to various complications and negative consequences, including:

• Worsening Symptoms: Untreated asthma can result in worsening and more frequent symptoms, making it challenging to perform daily activities and affecting overall quality of life.
• Asthma Attacks: Without proper treatment, the risk of asthma attacks increases. Asthma attacks can be severe and even life-threatening.
• Reduced Lung Function: Over time, uncontrolled asthma can lead to a decline in lung function, which may be irreversible.
• Increased Healthcare Costs: Untreated asthma often requires more frequent medical visits, hospitalisations, and emergency care, leading to higher healthcare costs.
• Impaired Quality of Life: Untreated asthma can limit physical activity, disrupt sleep, and cause anxiety and depression, negatively impacting a person's quality of life.
• Complications: Severe or uncontrolled asthma can lead to complications such as pneumonia, pneumothorax (collapsed lung), and respiratory failure.

It's crucial to work closely with a doctor to manage asthma effectively. With proper treatment and self-care measures, most people with asthma can lead normal, active lives and minimise the risk of complications. Regular follow-up appointments and adherence to the prescribed asthma management plan are key to controlling the condition.