ASTHMA

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Asthma

Asthma is a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. During an asthma attack, the lining of the bronchial tubes swells, causing the airways to narrow and reducing the flow of air into and out of the lungs.

 Key facts

·         Asthma is one of the major non communicable diseases. It is a chronic disease of the air passages of the lungs which inflames and narrows them.

·         Some 235 million people currently suffer from asthma. It is a common disease among children.

·         Most asthma-related deaths occur in low- and lower-middle income countries.

·         The strongest risk factors for developing asthma are inhaled substances and particles that may provoke allergic reactions or irritate the airways.

·         Medication can control asthma. Avoiding asthma triggers can also reduce the severity of asthma.

·         Appropriate management of asthma can enable people to enjoy a good quality of life.

Signs & symptom

1.    Coughing

2.      Wheezing

3.      Chest tightness

4.      Shortness of breath

Causes

1.      Environmental 

2.      Hygiene hypothesis

3.      Genetic

4.      Medical conditions ( atopic disease)

5.      Exacerbation ( dust, animal dander (especially cat and dog hair), cockroach allergens and mold)

Pathopysiology

Asthma is the result of chronic inflammation of the airways which subsequently results in increased contractability of the urrounding smooth muscle. This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or without treatment. Occasionally the airways themselves change. Typical changes in the airways include an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways' smooth muscle may increase in size along with an increase in the numbers of mucous glands.

Diagnosis

Your primary care doctor will diagnose asthma based on your medical and family histories, a physical exam, and test results.

Your doctor also will figure out the severity of your asthma—that is, whether it's intermittent, mild, moderate, or severe. The treatment your doctor prescribes will depend on the level of severity.

Your doctor may recommend that you see an asthma specialist if:

• You need special tests to help diagnose asthma
• You've had a life-threatening asthma attack
• You need more than one kind of medicine or higher doses of medicine to control your asthma, or if you have overall problems getting your asthma well controlled
• You're thinking about getting allergy treatments

Treatment

Asthma is a long-term disease that has no cure. The goal of asthma treatment is to control the disease. Good asthma control will:

• Prevent chronic and troublesome symptoms, such as coughing and shortness of breath
• Reduce your need for quick-relief medicines
• Help you maintain good lung function
• Let you maintain your normal activity level and sleep through the night
• Prevent asthma attacks that could result in an emergency room visit or hospital stay

To control asthma, partner with your doctor to manage your asthma or your child's asthma. Children aged 10 or older—and younger children who are able—should take an active role in their asthma care.

• Taking an active role to control your asthma involves:
• Working with your doctor to treat other conditions that can interfere with asthma management.
• Avoiding things that worsen your asthma (asthma triggers). However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.
• Working with your doctor and other health care providers to create and follow an asthma action plan.

An asthma action plan gives guidance on taking your medicines properly, avoiding asthma triggers (except physical activity), tracking your level of asthma control, responding to worsening symptoms, and seeking emergency care when needed.

Asthma is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms. Quick-relief, or "rescue," medicines relieve asthma symptoms that may flare up.

Your initial treatment will depend on the severity of your asthma. Follow up asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Your level of asthma control can vary over time and with changes in your home, school, or work environments. These changes can alter how often you're exposed to the factors that can worsen your asthma.

Your doctor may need to increase your medicine if your asthma doesn't stay under control. On the other hand, if your asthma is well controlled for several months, your doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

Asthma treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will be adjusted to meet their special needs.

Follow an Asthma Action Plan

You can work with your doctor to create a personal asthma action plan. The plan will describe your daily treatments, such as which medicines to take and when to take them. The plan also will explain when to call your doctor or go to the emergency room.

If your child has asthma, all of the people who care for him or her should know about the child's asthma action plan. This includes babysitters and workers at daycare centers, schools, and camps. These caretakers can help your child follow his or her action plan.

Avoid Things That Can Worsen Your Asthma

Many common things (called asthma triggers) can set off or worsen your asthma symptoms. Once you know what these things are, you can take steps to control many of them.

For example, exposure to pollens or air pollution might make your asthma worse. If so, try to limit time outdoors when the levels of these substances in the outdoor air are high. If animal fur triggers your asthma symptoms, keep pets with fur out of your home or bedroom.

One possible asthma trigger you shouldn’t avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active.

If your asthma symptoms are clearly related to allergens, and you can't avoid exposure to those allergens, your doctor may advise you to get allergy shots.

You may need to see a specialist if you're thinking about getting allergy shots. These shots can lessen or prevent your asthma symptoms, but they can't cure your asthma.

Several health conditions can make asthma harder to manage. These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea. Your doctor will treat these conditions as well.

Medications

Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation.

Fast–acting

 Salbutamol metered dose inhaler commonly used to treat asthma attacks.

·         Short-acting beta2-adrenoceptor agonists (SABA), such as Salbutamol (albuterol USAN) are the first line treatment for asthma symptoms. They are recommended before exercise in those with exercise induced symptoms.

·        Anticholinergic medications, such as ipratropium bromide, provide additional benefit when used in combination with SABA in those with moderate or severe symptoms. Anticholinergic bronchodilators can also be used if a person cannot tolerate a SABA.

·         Older, less selective adrenergic agonists, such as inhaled epinephrine, have similar efficacy to SABAs. They are however not recommended due to concerns regarding excessive cardiac stimulation.

Long–term control

·         Corticosteroids are generally considered the most effective treatment available for long-term control. Inhaled forms such as beclomethasone are usually used except in the case of severe persistent disease, in which oral corticosteroids may be needed. It is usually recommended that inhaled formulations be used once or twice daily, depending on the severity of symptoms.

·        Long-acting beta-adrenoceptor agonists LABA) such as  salmeterol and formoterol can improve asthma control, at least in adults, when given in combination with inhaled corticosteroids. In children this benefit is uncertain. When used without steroids they increase the risk of severe side-effects and even with corticosteroids they may slightly increase the risk.

·         Leukotriene antagonists (such as montelukast and  zafirlukast ) may be used in addition to inhaled corticosteroids, typically also in conjunction with LABA. Evidence is insufficient to support use in acute exacerbations. In children they appear to be of little benefit when added to inhaled steroids In those under five years of age.

·        Mast cell stabilizers (such as cromolyn sodium) are another non-preferred alternative to corticosteroids