Asthma

What is asthma?

Asthma is an allergy affecting the airways of the respiratory system.

What is an allergy?

The function of the immune system is to protect us from infections (bacterial/ fungal/ viral). Sometimes, due to genetic composition and environmental factors, the immune system starts regarding some substances/ particles entering our body to be harmful. In defence to these harmful substances/ particles, the immune system attacks them causing a reaction which is termed as an allergy. These substances/ particles could be pollen, smoke, strong smells, cold, fungal moulds, dust mite, dust, pet animal’s dander/ fur. This reaction in respiratory airways leads to swelling, redness, narrowing of airways and increased mucous secretions thus blocking the airways. These changes cause symptoms like a cough, sputum, chest tightness, breathing difficulty and wheezing in the chest. If these changes/ reactions occur in our nose, we call it as ‘allergic rhinitis.’ The symptoms are cold, running nose, nose block, sneezes, itching and throat pain. In a person, both can co-exist and such person requires treatment for the both.

What are the types of asthma?

Asthma is classified into types like extrinsic, intrinsic, cough variant, lymphocytic, eosinophilic, predominant asthmas, etc. Now-a-days with the rising awareness, since the spectrum of disease is wide, it is also termed as a syndrome. As allergic rhinitis and asthma co-exist, therefore, it is called as ‘United Airway Disease’ or ‘Combined Allergic Rhinitis and Asthma Syndrome (CARAS)’. Allergic asthma or extrinsic asthma is more common. It commonly develops in childhood. Though allergic asthma often alleviates in early adulthood, however, in many cases, it reappears again later. Intrinsic asthma is not associated with allergies and usually develops after the age of 30. Women are more prone to it and usually, a respiratory tract infection develops before intrinsic asthma.

How to prevent asthma in children?

Whether it is children or adults, the preventive measures are same. We need to avoid the trigger factors which initiates the attack. Trigger factors are pollution, strong fragrance, exposure to cold like air conditioner, cold beverages, ice-creams, emotional imbalance (crying, laughing, anger), etc. People having food allergies like peanuts, egg, seafood, citrus fruit, etc. should be careful. Avoid smoke and dust exposure. Presence of cockroaches, rats, pet animals at home increases exposure to their droppings which can trigger asthma. Avoid exposure to the pollen of flowers entering the homes, which is a seasonal hazard. Usually, pollen is not visible and are airborne.

How to diagnose asthma?

Asthma is basically diagnosed by checking the patient’s family history and genetics. Pulmonary function tests are also conducted to check the extent of the allergy and response to the treatment. It is possible to check the presence or absence of the airway reaction. Sputum eosinophilia can be detected through blood allergy tests like blood eosinophilia and specific Immunoglobulin E (IgE).

What are the treatments available for asthma?

Basically, the primary treatment is to prevent the trigger factors as explained above. The only best treatment available is inhalers. Inhalers have a combination of preventers and controllers. Controllers act immediately to relieve the situation, so the patient experiences instant relief. Whereas the preventers act to avoid future attacks while controlling the ongoing inflammation. Controller and preventers act together to avoid the complications. The usage of inhalers must be continued at least for 3 months and sometimes prolonged if background symptoms are present consistently. Even for the children, the treatment is the same. Along with the inhalers, add-on treatments in the form of oral medications like theophyllines, leukotriene receptor antagonists etc, can be added depending on disease severity and response to the treatment. In severe cases, nebulisation and IV medications are prescribed.

What are the complications if we don’t treat asthma?

About 42% of Indian patients experience asthma symptoms every night. India reports the highest school or work absenteeism (around 78%) due to asthma. As per GINA (Global Initiative for Asthma), 60% of Indian asthmatics had partly controlled asthma and 40% had uncontrolled asthma. In children, lack of proper treatment leads to continuous irritation and chest comfort which in turn leads to a loss of concentration finally affecting their career and physical growth. In elders, this may lead to the loss of working days which can affect the economic growth of a person. Continuous inflammation in the airway can predispose the person to a danger of infection like flu, pneumonia, tuberculosis and organ damage if the disease is not controlled for many years.

Common myths and facts of asthma :

Myth: Asthma is present only when you face trouble in breathing.

Fact: Asthma is a disease which is difficult to identify. Even without visible symptoms, there is a chance of underlying inflammation in the airways of people with asthma. Asthma exists even when symptoms are not visible. Asthma needs to be controlled by regularly consuming controller medicines and avoiding asthma triggers.

Myth: Every asthma patient should avoid “cold” food like milk, curd etc.

Fact: If in case there is an identifiable food item that has been known to trigger an asthma attack in a particular patient, then that food item must be avoided.

Myth: Asthma symptoms are the same for everyone.

Fact: Asthma affects each person differently. Each person may experience symptoms varying from wheezing, chest tightness, and fatigue, to just coughing. You should know what your or your child’s symptoms are in order to get help quickly.

Myth: Children often outgrow their asthma.

Fact: Asthma is a lifelong disease. Asthma in children can diminish or vanish completely as it is less serious. When children’s lungs grow, the airways expand. However, the symptoms of asthma can get triggered again without prior warning.

Myth: Steroids used in asthma are dangerous and these steroids will stunt growth.

Fact: The National Institutes of Health (NIH) suggests inhaled corticosteroids (ICS) are the preferred treatment for persistent asthma. When used at recommended doses for most patients, the benefits of ICS outweigh the risks. These steroids are not similar to the anabolic steroids used by athletes build muscle. Inhaled corticosteroids do not hinder a child’s growth. Studies have shown that children using inhaled corticosteroids reach normal adult height, although it may cause some delays in their growth early on. A child suffering from asthma symptoms regularly may experience stunted growth. This is due to the fact that a sick child will not grow at the same rate as a good child. Consult a doctor to chalk out an effective action plan to treat your child’s asthma.

Myth: Inhalers are addictive, unsafe and cause many side-effects.

Fact: Inhaled corticosteroid therapy is highly effective in reducing inflammation of airways, improving pulmonary functions, easing asthma symptoms and reducing asthma exacerbations. Its regular use has been associated with substantial reduction in the rates of hospital admissions and rate of deaths from asthma. Unfortunately, in India, almost 80% of asthma patients consume oral medications due to the stigma associated with inhalers. Oral medications lead to more side effects and are required in large dosage in comparison to inhalers, which are more effective.

Myth: Asthmatic children should not play sports or be active.

Fact: Sports and other forms of activity are just as important for someone with asthma as they are for someone without asthma. It is important to control a child’s asthma and make sure they follow the guidelines set by their doctor to take controller medications, as well as ensure that they take medications before the sports activity. They should be aware of an action plan to help prevent asthma attacks.

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