Asthma

Description of Asthma

Definition
 
Asthma is a chronic disease that causes inflammation and narrowing of the air passage of the lungs (bronchi) obstructing the airflow and making breathing difficult.
Asthma affects both adults and children. According to WHO, there are about 15 to 20 million people with asthma in India. It is a common long-term disease in children and approximately 10% to 15% children between 5 and 11 years are estimated to have asthma.
 
Causes and Risk Factors
 
Asthma usually results from an allergic reaction or due to other forms of hypersensitivity. Agents that may trigger an asthma attack include allergic reactions to:
1. Pollens
2. Tobacco smoke
3. Smoke from burning wood, leaves, or grass
4. Dust mites
5. Cockroach residue
6. Dander or pet’s fur
7. Molds
8. Viral and bacterial infections
9. Chemical fumes
10. Cold air
11. Exercise

Some medicines may also trigger an asthma attack. Examples include:
1. Beta-blockers
2. Angiotensin-converting enzyme inhibitors
3. Aspirin
4. Nonsteroidal anti-inflammatory drugs (NSAIDS)
 
Signs and Symptoms
 
Symptoms of asthma include:
1. Wheezing -- a whistling sound that occurs during breathing.
2. Breathlessness even with regular or moderate activity.
3. Chest tightness -- a squeezing or crushing sensation in the chest.
4. Coughing that often worsens at night and early morning hours leading to difficulty in sleeping.
A cough may be the only symptom in elderly. A cough may be accompanied with phlegm (sputum).

Asthma may be more severe and difficult to control in people aged 55 years or more. Conditions that may worsen asthma include:
1. Being overweight
2. Smoking
Having someone in the family with asthma increases the risk of getting the disease.
 
Investigations
 
Diagnosis of asthma is based on the pattern of symptoms, medical history, family history, clinical examination, and tests. The doctor will ask about the history related to symptoms of asthma and when and how often they occur.
The tests and investigations for asthma include:
1. Spirometry: This test estimates how much air you can breathe in and breathe out.
2. Allergy test: To find out which allergen is possibly causing asthma.
3. Peak flow: A peak flow meter is a device that measures how hard you can breathe out. Lower than usual peak flow reading indicates that asthma may be getting worse.
4. Chest x-ray: Scan of your lungs can identify whether a foreign object or any other disease is causing your symptoms related to asthma.
5. A blood test for IgE (immunoglobulin E) level to assess the severity of asthma. However, it does not help make a diagnosis of asthma.
 
Treatment
 
There is no specific cure for asthma. The goal of treatment is to reduce the symptoms and control the disease. The treatment is provided on the basis of severity of asthma whether intermittent, mild, moderate, or severe.
Avoiding exposure to triggers that may cause an asthma attack is one of the best strategies to control asthma.
Treatment for asthma includes the use of bronchodilators. These are medicines that relax the muscles in the bronchi and allow the airways to open up so that air can flow through them. Bronchodilators are two kinds, quick-relief, and long acting. Bronchodilators are usually taken using an inhaler for relief.

Quick-relief bronchodilators are prescribed to quickly relieve asthma symptoms that may flare-up. Examples include:
1. Short-acting beta-adrenoceptor agonists (SABAs) such as salbutamol
2. Anticholinergic medicines, such as ipratropium and aclidinium

Long-term medications are prescribed to prevent further exacerbation over long-term. These include:
1. Corticosteroids
2. Long-acting beta-adrenoceptor agonists (LABAs), such as salmeterol and formoterol
3. Leukotriene receptor antagonists
4. Theophylline
Medicines need to be altered depending on the frequency of patient’s symptoms. Maintain a diary of your asthma episodes and potential triggers to help manage it over the years. Discuss this with the doctor to help manage asthma.
 
Complications and When Should You See a Doctor
 
If not treated completely, asthma attacks may increase in severity. Complications include:
1. Difficulty sleeping due to a persistent cough
2. Decreased lung function
3. Severe shortness of breath that may require use of ventilator for breathing
In severe cases, asthma may be life-threatening.

Consult a doctor if you have:
1. Recurrent cough
2. Severe shortness of breath
3. Severe pain in the chest
4. Bluish face or lips
5. Rapid pulse
6. Sweating
7. Decreased consciousness, confusion, or drowsiness
8. Regular allergic reactions to environmental triggers
 
Prognosis and Prevention
 
Asthma attacks reduce in frequency and severity with proper medication and minimum exposure to allergens that trigger asthma attacks.
Pollen levels are higher in early mornings and late evening, especially during the spring season. Follow these tips to prevent asthma attacks due to pollens.
1. Stay indoors during high pollen time (early morning and late evening)
2. Take a bath if you have been outdoors. Also, wash the clothes you wore while you were outside.
3. Dry clothes indoors to avoid pollens on them.
4. Use air conditioners during pollen season.

If your allergy is caused due to pet dander, cockroach, mice, smoke, mold, or other environmental allergens, following these tips may help reduce asthma attacks:
1. Do not smoke. Do not let others smoke around you.
2. Keep pets out of the house, especially the bedroom.
3. Use air conditioners with a filter.
4. Fix any tap or pipe leakages in the house.
5. Maintain humidity inside the house at less than 50%.
6. Wash the pets once a week.
7. Wash the bedding once a week.
8. Remove carpets and clean the area regularly.
9. Do not let food left overs be present openly in the kitchen, sinks, or any other part of the house. Keep them in closed containers.
10. Keep the house clean and remove trash such as old newspapers and cardboard boxes, regularly.
 
References
 
Centers for Disease Control and Prevention. Learn how to control asthma. Updated January 27, 2017. https://www.cdc.gov/asthma/faqs.htm. Accessed June 21, 2017.
Koul PA, Patel D. Indian guidelines for asthma: Adherence is the key. Lung India?: Official Organ of Indian Chest Society. 2015;32(Suppl 1):S1-S2. PMCID: PMC4405918
Lugogo N, Que LG, Gilstrap DL, Kraft M. Asthma: Clinical diagnosis and management. In: Broaddus VC, Mason RJ, Ernst JD, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders. 2016:chap 42.
Nowak RM, GF Tokarski. Asthma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 63.
World Health Organization. Bronchial asthma. The scale of the problem. http://www.who.int/mediacentre/factsheets/fs206/en/. Accessed June 21, 2017.
 
Content Details
Last updated on:
04 Sep 2017 | 01:08 PM (IST)
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Frequently Asked Questions about Asthma

No, asthma is not a contagious or communicable disease as it does not spread from one person to other by direct or indirect contact. It is a chronic (long-term) disease in which there is inflammation and narrowing of airways leading to wheeze, cough, and difficulty in breathing.
Exact cause of asthma is not properly known, but many risk factors are identified in causation of asthma. Genetic or hereditary factors are among most important risk factors involved in asthma. It means chances of getting asthma is increased when someone’s parent or siblings are suffering from it.
No, asthma is not considered as a form of chronic obstructive pulmonary disease (COPD). Asthma usually start in early childhood, not because of smoking, symptoms are intermittent and stable but acute attacks may be present. Whereas COPD usually start above age of 40 years, may be associated with smoking, and symptoms may become progressively worse.
Yes, asthma is considered as a chronic or long-term disease of airways in which there inflammation of airways leading to progressive narrowing. This causes difficulty in breathing, wheezing, and other respiratory symptoms.
Vitamin C may be helpful in asthma. As per research studies, diets low in antioxidants like Vitamin C, Vitamin A, etc. may be a risk factor for development of asthma, but clear evidence of this association is lacking.
Some research studies show that Vitamin D deficiency is a predisposing factor for development of asthma, but there is no scientific evidence that supplementary Vitamin D is useful for asthma patients.
Yes, exercise is an important factor that may worsen your asthma symptoms and it is called exercise-induced asthma. It may start during exercise and become worse after 10 to 15 min. Exercise causes hyperventilation, i.e., fast breathing, due to which there is loss of water and heat from the airway linings leading to release of inflammatory mediators. These mediators can worsen asthma.
Not all asthma patients need emergency treatment, but when severe exacerbations occur, asthma can be life-threatening and become an emergency condition. Patients with such severe asthmatic attacks should receive treatment with oxygen and injectable medications at earliest.
Duration of asthma attacks depends on severity of the disease. Mild asthma symptoms usually resolve within few minutes to few hours after treatment with asthma medications. Severe asthma attacks last longer and can be an emergency condition requiring immediate treatment.
Infectious disease means a disease that is caused by microorganisms like viruses, bacteria, etc. Exact cause of asthma is still not very well known, but various risk factors are involved in its causation. Some research studies have shown that few viruses like rhinovirus, respiratory syncytial virus (RSV), and some bacteria like chlamydia are involved in development of asthma.
Asthma can appear at any age and it is fairly common in kids. Exact cause of asthma in children is not known. These are some of the risk factors involved in asthma. • Genetic and hereditary factors (family history of asthma in parents) • Allergies • Viral infections like respiratory syncytial virus (RSV) • Low birth weight babies • Smoking during pregnancy
Asthma attacks can appear in early childhood or adult age. These are important early signs of asthma one should look for: • Chronic cough • Wheezing or whistling sound • Difficulty in breathing • Chest tightness • Runny nose (especially in toddlers)
Narrowed airways leading to whistling sound while breathing out or expiration is called wheezing. Whereas asthma is a chronic disease in which airways become supersensitive to various triggers leading to chronic cough, wheezing, and difficulty in breathing. So, wheezing is one of the important sign of asthma attack.
Bronchitis is a form of chronic obstructive pulmonary disease (COPD). In this disease inflammation of bronchi occur leading to formation of excess mucus that causes difficulty in breathing and cough with expectoration. Asthma on the other hand is a chronic airways disease where allergy or some other mediators of inflammation causes narrowing of airways. This leads to chronic cough, wheezing, and breathlessness.
N-acetylcysteine (NAC) is a mucolytic medication that breaks and dissolves mucus plugs in the airways. NAC also acts as an antioxidant. Hence, NAC may be useful in conditions with increased mucus in the airways like chronic bronchitis. On the contrary, it has been shown that NAC can worsen asthma symptoms like cough and wheezing, hence to be avoided in chronic asthma.
Pneumonia is an infection in one or both the sides of the lungs that is caused by bacteria, viruses, or fungi. This infection leads to accumulation of pus or infected fluid in the air sac of lungs giving rise to various respiratory symptoms. Common symptoms of pneumonia include fever with chills, cough with expectoration, and difficulty in breathing. Asthma is a chronic airways disease where allergy or some other mediators of inflammation causes narrowing of airways. This leads to chronic cough, wheezing, and breathlessness.
The term hiatal hernia refers to protrusion of upper part of stomach into the chest cavity by tearing the diaphragm. Symptoms of hiatal hernia include acid reflux leading to heartburn, difficulty in breathing, etc. Acid reflux may cause irritation of lungs and airways and subsequent breathing difficulty worsening asthma symptoms. Asthma is a chronic allergic disease of airways where narrowing of airways leads to wheezing, cough, and breathlessness. Asthma and hiatal hernia may worsen each other, but strong scientific evidence for this association is lacking.
Panic attack is a form of severe anxiety and consists of symptoms like sweating, shortness of breath, feeling dizzy, chest tightness, feeling of impending death, etc. Panic attack usually resolve within an hour. Asthma attack on the other hand is characterized by wheezing, coughing, chest discomfort, difficulty in breathing, etc. This is due to narrowing of airways leading to these symptoms. When untreated it can be fatal unlike panic attack which is usually not fatal.
Severe exacerbation or acute attack is a life-threatening complication of asthma. In this, high concentration of oxygen is given along with other short acting asthma medications like salbutamol and corticosteroids to relieve the symptoms.
Asthma symptoms are usually reversible. Proper diagnosis and early treatment show good prognosis of this disease. On the other hand, symptoms in chronic obstructive pulmonary disease (COPD) are generally worse and progressive, and are only partly reversible.
Inhaler from a class of short-acting beta-2 agonist medications, e.g., salbutamol or albuterol is usually the first medicine of choice by your physician for mild intermittent asthma.
It is very important to maintain good health of pregnant asthmatic patient, so that it should not affect growing baby inside the womb. Asthma inhalers like salbutamol, salmeterol, or inhaled corticosteroids like budesonide, fluticasone may be unsafe in pregnancy. Although there are safety issues with these inhalers during pregnancy, it is very important to control asthma attacks in pregnancy. Hence, benefits of using these inhalers may outweigh the risks many a times.
Inhaled steroids appears to be promising in treatment of asthma. Some of the commonly used inhaled steroids include Budecort (budesonide), Flohale (fluticasone), and Beclate (beclomethasone dipropionate).
"Role of dietary factor in asthma is controversial. Asthma may become worse by any food if the person is allergic to that food and there is no special diet for asthma people, but certain foods may improve or worsen the symptoms of asthma. Foods to eat in asthma include: • Fruits and vegetables • Omega-3 fatty acids (fish, flaxseed) Food to avoid in asthma include: • Shell fish • Nuts • Salicylate rich foods, e.g., tomato, guava, almonds • Wheat and rice (some people are allergic) • Food preservatives • Food coloring agents • Foods you are allergic to
Hypokalemia is condition when serum potassium concentration is significantly reduced leading to symptoms like weakness, muscle cramps, etc. Certain medications used to treat asthma like salbutamol, salmeterol, aminophylline, etc. may cause hypokalemia. These medications cause increased entry of potassium inside the cells leading reduced potassium in blood which manifest as hypokalemia.
Some factors may aggravate your asthma symptoms. For prevention of asthma you should know what things lead to worsening of your asthma symptoms. Some of the important preventive measures include: • Avoid asthma triggers like smoke, cold, fragrance, air pollution, etc. • Do allergy skin testing to find out what all are you allergic to and try to avoid them. • Avoid doing vigorous exercise when you have history of exercise-induced asthma. • Flu vaccination is sometimes useful in prevention of asthma. • Always keep your asthma inhalers with you wherever you go.
Asthma has no complete cure till date due to its multifactorial triggering factors. It can be an allergic response to factors like air pollution, cold, exercise, etc. leading to wheezing, coughing, and breathlessness. So, there is always a chance that one can get exposed to such triggering factors anytime. The best way is to avoid these factors as much as possible and to keep the symptoms in control with lifestyle, diet, and appropriate medications.
Asthma which may become worse at night is called nocturnal asthma. Exact cause of nocturnal asthma is not known, but various mechanisms are proposed. There is night time increase in inflammatory cells and some chemicals that may be responsible for asthma attacks. At night time, functions of some receptors present in the airways and lungs may be disturbed leading to worsening of asthma.
Rigorous exercises may lead to worsening of asthma attacks especially in patients with exercise-induced asthma. Running may be a cause of asthma attacks in susceptible people. So, before doing such intense exercise, asthma patients should take certain precautions like proper warming-up, taking medications before running, or taking medications when you experience asthma attacks. You can also try some alternate less intense exercises like swimming, walking, gymnastics, etc. that may appear helpful for asthma patients.
Asthma greatly affects life of children in the form of physical, emotional, and social disturbances. Frequent asthma attacks may lead to various bad consequences in growing children. Many children with asthma: • May miss school days leading to bad performance in studies • Are reluctant to participate in sports activities • Have to keep asthma medications or inhalers always with them So, always try to control asthma attacks by medications prescribed by your physician, having healthy habits and diet, and family counselling of children as well as parents. Controlling asthma attacks will definitely have positive impact on life of your asthmatic children.
No, asthma inhalers are not addictive. Asthma is a chronic or long-term disease that require prolonged treatment with inhaled medications like salbutamol, budesonide, fluticasone, etc. During such long-term treatment you may feel that you are becoming addicted to them. However, do not stop your medication without your physician's advice.
Eczema is an allergic condition characterized by inflamed and itchy skin. Individuals who are prone to get allergies show a number of related allergic diseases at a time like asthma, eczema, allergic rhinitis (runny nose), etc. Genetic and environmental factors play an important role in it.
Asthma inhalers can be used again and again as per requirement and physician’s prescription till sufficient amount of medication is present in it, but it should be within expiry date mentioned on it usually around 1 year. Nowadays, inhalers come with the counters on it which guide us about amount of medication remaining in it. If counter is not there, patients should get education from physicians regarding how to track dosages and when to replace your inhaler.
Usually asthma inhalers are well tolerated by patients with minimal side effects. Some patients on inhaled beta-2 agonists like salbutamol may experience palpitations. Side effects on heart like rapid heart rate, arrhythmias, and raised blood pressure appear when these medications are taken in injectable or tablet form.
Remember, not all patients of asthma get shortness of breath or wheezing. Asthma symptoms may be negligible when disease is mild and at an early stage. Asthma symptoms may vary from person to person and each attack may have different symptoms depending on the triggering factor.
Obesity is considered as one of the independent risk factor for development of asthma especially in females. Exact mechanism of obesity causing asthma is unknown, but increase in some chemicals from adipose tissue called as proinflammatory, adipokines may be involved in this.
Although drinking alcohol is not a well-established cause of asthma, it can act as a trigger in some asthmatic patients leading to worsening of asthma attacks. Possible reasons may be related to acid reflux in alcoholics that can worsen asthma. Also, some alcoholic beverages may contain preservatives that may trigger asthma attacks.
Common triggers include: Dust, flowers, pets, smoke, cigarette smoking, vigorous exercise, anti-inflammatory drugs, extreme weather conditions, and extreme emotions such as anxiety, anger, and fear.
There is no single test for asthma. Diagnosis is made on the basis of medical history, family history, history of allergies, possible triggers, and lung function tests (like spirometry and peak flow monitoring).
Heat some mustard oil with little camphor oil and gently massage it into the chest and upper back. Repeat this three to four times a day till symptoms subside.
Asthma can be life-threatening if not controlled properly. Deaths occur more frequently in adults than children. The single factor leading to severe or fatal asthma attacks seems to be a delay in administering appropriate drug therapy. Having an action plan in place, working with your doctor, recognizing the triggers and early warning signals of an attack can all contribute to a decrease in the frequency and severity of attacks.
Take one whole amla, de-seed and crush into a fine paste. Add honey to this paste. Have this paste every morning. You can also use one teaspoonful of amla powder instead.
Medications used to treat asthma are not addictive; however, because asthma is a chronic disease, long-term use of medicine is often needed to manage the condition and prevent asthma attacks. It’s important to follow your doctor’s recommendations for treatment, even when symptoms are well controlled.
Asthma is a chronic, treatable condition that develops in childhood. It’s no longer considered a disease that children outgrow. However, symptoms may improve during adolescence and adulthood.
The presence of rosmarinic acid (antioxidant) in mint prevents conditions like hay fever. It shows promise in fighting allergies as it is also antiinflammatory in nature. To relieve the symptoms of asthma, it can taken along with warm water.
Onions are rich in sulfur that play an important role in different biochemical functions. The sulfur rich formulations prevent the occurrence of biochemical reactions that may lead to problems such as asthma.
To help your lungs breathe better, boil one tablespoon of methi seeds in a cup of water and mix one teaspoon each of ginger juice and honey in it. Drink this solution every morning and evening.
Boil two or three cloves in one-quarter cup of milk. Allow it to cool to room temperature and then drink it.
The common symptoms are shortness of breath, difficulty in breathing, wheezing, and a dry, irritating, and continual cough (especially at night/early in the morning, or with exercise or activity).
Childhood asthma is more common in boys than in girls. Around age 20, the ratio of asthma between men and women is the same. At age 40, more females than males have adult asthma. Other risk factors include family history, history of allergies, smoking, and obesity.
Treatment involves a combined approach of, 1) Preventive long-term asthma control medications: To keep asthma under control on a day-to-day basis and minimize the chances of an asthma attack. These include steroids, beta agonists, theophylline, and leukotriene modifiers. 2) Quick relief medications: For rapid, short-term symptom relief during an asthma attack like short-acting beta agonists.
Your body’s immune system helps keep you healthy by producing disease-fighting antibodies. These antibodies can destroy harmful foreign substances such as viruses and bacteria that cause disease. But if you have an allergy, certain types of antibodies get over stimulated and your body reacts when it comes into contact with a normally harmless substance. The air we breathe. The food we eat. The things we touch. They can all trigger an allergic reaction.
Important tips, 1) Calm down the person and do not leave him/her alone. 2) Make the patient rest in a comfortable upright position. 3) Loosen any tight clothing around chest, neck area. 4) Get into well ventilated, open area. 5) If inhaler is handy, give four puffs of inhaler, at intervals of 1 min. 6) If the person does not feel better, give another set of four puffs. 7) If the person is not relieved and feels dizzy, call ambulance immediately.
Asthma is not an infectious disease. It does not spread from person to person. It occurs due to inflammation of the air passages that result in a temporary narrowing of the airways that carry oxygen to the lungs leading to asthma symptoms.
That depends. There are four categories of asthma: intermittent, mild persistent, moderate persistent and severe persistent. People who have mild, moderate or severe persistent asthma need a daily long-term controller medicine, usually an inhaled corticosteroid, to control inflammation and minimize asthma attacks.
This is an unscientific and bizarre practice in many parts of the country where patients are made to gulp down the fish stuffed with a yellow herbal paste, in the hope it will help them breathe more easily. Not only is it unscientific but also unhygienic and baseless with no medical evidence of cure.
Beetroot is a powerful vegetable to treat asthma which is a respiratory disorder caused by temporary constriction in the airway passage of the lungs. The magnesium and Vitamin C content in beetroot help to relax the muscles near the bronchial tubes thus treating any discomfort caused by an asthma attack.
Cut 1 inch of ginger into small pieces, add it to a pot of boiling water, let it steep for 5 min and drink this once it cools down. You can also mix equal quantities of ginger juice, pomegranate juice and honey. Consume one tablespoon of this mixture two or three times a day.
Mix one teaspoon of turmeric powder in a cup of warm milk and drink this up to three times a day.
Soak three dried figs in a cup of water overnight. In the morning, eat the soaked figs, and drink the fig water on an empty stomach.