Seeing your child fight for his/ her breath, looking all sweaty and doubling up with terrible cough and noisy breathing is not a pleasant experience. To see this happen repeatedly is even worse. Asthma precisely does this and that’s why it is one of the most feared illnesses. On top of that, it is a prolonged illness with no quick cure. Although with proper precautions and treatment, asthma can be controlled pretty well. As the world-wide incidence of asthma goes on increasing at an alarming rate, it is wise to get some information about this common but potentially deadly medical condition. What is asthma?
When we breathe, the air is inhaled through nose and then it passes through wind-pipe to a set of branching airways– bronchi and bronchioles that finally carry it to small sacs in lungs called alveoli. In alveoli, the oxygen in that air is used to purify our blood. In asthma, the small airways in lung are chronically inflamed. They are hyper-reactive i.e. that they excessively react to some internal or external stimuli and then get narrowed and filled with mucus, making it difficult for inhaled air to reach alveoli. This leads to difficulty in breathing, cough and wheezing. These symptoms usually show an episodic waxing-waning, so usually there are ‘asthma attacks’ when symptoms suddenly flare up, followed by symptom-free periods. Night- cough, decreased exercise tolerance and exercise- induced cough are often there in between the ‘attacks’. Is wheezing and asthma the same?
Wheezing is the breezy, whistling sound heard from chest as the air faces resistance to its passage from narrowed airways. It is an important diagnostic feature of asthma but it is not synonymous with asthma. It can also be heard in lung infections like bronchitis or bronchiolitis and also with some congenital anatomic abnormalities of airways. Often there is a tendency among doctors to convey the diagnosis of asthma as ‘wheezing tendency’ as somehow that seems to be more acceptable to parents and patients, who find the diagnosis of asthma too hard to take. This ‘wheezing’ is mostly same as ‘asthma’ if it is recurrent in nature. Is asthma inherited?
Often, it is an inherited condition. Likelihood of asthma is more in a child whose parents or siblings have asthma or other allergic disorders (atopic dermatitis or allergic rhinitis). But not all cases have a positive family history. Can an infant have asthma?
Yes, unfortunately no age is exempt from asthma and it can even start early in infancy. What are the triggering factors for asthma?
Viral infections like influenza, exercise, allergies (to dust-mites, pollens, grasses, molds, cockroaches, animal dander, medicines and foods), smoke, air pollutants, fog, changes in weather, cold air exposure and strong smells (perfumes and deodorants) are important triggers for asthma attacks. What is the role of allergy in asthma?
Even though triggers for asthma attacks might differ, allergy plays a causative role in majority cases of asthma. Often asthma patients have associated allergic disorders like allergic rhinitis or atopic dermatitis. Allergy is a hypersensitive, exaggerated response from body’s immune system to external or internal stimuli. The simplest analogy is that of a highly sensitive and irritable man. A casual remark from somebody will be tolerated in good humor by most people but the same remark can cause such irritable man to throw a fit of anger. In allergy the same thing happens. The stimulus which doesn’t offend normal individuals can lead to exaggerated immune response in an allergic person, leading to damaging consequences to his body. Does severity vary in asthma cases?
The frequency and severity of asthma attacks vary in different cases. Based on that, there are four different groups of asthma patients. No.
| Type of Asthma
| Frequency of attacks
| Night Symptoms
| Physical activity
| 1
| Mild, Intermittent
| Up to 2 / week
| Up to 2 times / month
| Normal
| 2
| Mild, Persistent
| More than 2 but not every day/ week
| 2 or more times / month
| Affected
| 3
| Moderate, Persistent
| Daily symptoms, Frequent and prolonged attacks (>2/week)
| More than 1 time/ week
| Affected
| 4
| Severe, Persistent
| Continuous symptoms, Frequent and severe attacks
| Frequent, severe
| Severely affected
|
What are the early warning signs in asthma?
Early warning signs (EWS) are subtle negative changes in mood, behaviour or physical appearance experienced by patients, before asthma attacks. Parents should try and watch for such signs. As these signs appear a few hours or even a day before actual attack, they can provide warning about impending attack and the treatment plan can be modified to avoid such episode. What investigations are necessary in diagnosing asthma?
More than lab investigations, detailed history and physical examination (especially during an attack) can tell more about possibility of asthma. A complete blood count and a chest X-ray are preferred in initial evaluation. Pulmonary function tests (to judge lung performance and detect airway obstruction) and allergy testing (in suspected cases) are sometimes necessary. Skin-prick allergy tests are simple and practically painless. Drops of allergenic substances are placed on patient’s forearm and pricks are made with a plastic pointed device through each drop. The offending allergens are detected by appearance of weals (red, raised blisters) at the site of the particular drop. Peak-flow meter is a simple, diagnostic device, which can be even used at home to monitor the severity of asthma and treatment- progress. It is a tubular instrument into which the patient is told to blow out after full inhalation and the reading shows the level of air-flow to give an idea about none-too- obvious airway obstruction. How do we treat asthma?
Treatment of asthma consists of short-term, immediate acting medicines as well as long- term, maintenance and preventive medicines. Identifying and eliminating asthma triggers, prompt treatment of acute attacks and planning long-term treatment strategy to control symptoms and prevent flare-ups are the steps in this treatment. Why are nebulisers and inhalers used in treatment of asthma? Don’t they cause dependence? Nebulisers and MDIs (Metered Dose Inhalers) used in treatment of asthma deliver anti-asthmatic medicines directly to lungs bringing instant relief from symptoms. They also have much less side-effects compared to oral medicines. MDIs can even be carried on person and that allows for treatment to be flexible and according to the need of patient. That’s why modern treatment of asthma relies mainly on these instruments. Since asthma is a chronic and recurrent condition, these treatments might be needed repeatedly but that doesn’t mean that they make the patients dependent on them. Oral medicines are better accepted because it is a norm since centuries but it has been found that their use in treatment of asthma has many side-effects and even their efficacy is unreliable. Don’t you ever be afraid to use these ‘new’ treatments like nebulisers or MDIs if advised to do so. They are really effective and safe. Are steroids safe to use in treatment of asthma?
The core abnormality in asthma is chronic inflammation of small airways in lungs. Steroids are potent anti-inflammatory medicines and hence, very useful in its treatment. Steroid inhalers, injections and oral preparations are often used by doctors and if used in proper dose and duration as per medical advice, they are safe and practically priceless in controlling asthma – especially the moderate and severe varieties. What are the general preventive measures in asthma?
- Following treatment plan correctly, using medicines in proper doses and for proper duration.
- Yearly Flu (Influenza) vaccination.
- Measures against Dust-mite exposure – regular vacuuming; avoidance of carpets, curtains, thick clothed sofas, thick blankets and soft toys (all of which accumulate dust and dust-mites); dust-mite proof covers for mattresses and pillows; weekly washing blankets, bed-sheets and pillow covers in hot (120*F) water.
- Avoidance of irritants – smoke (including cigarette smoke), strong smells (paints, perfumes, deodorants, hair-sprays), pollution.
- Avoid pet- exposure.
- Reducing pollen exposure- closing doors and windows in pollen season; bathing and changing clothes after any outside stroll or play;
- Air-conditioning with regular cleaning of filters.
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Bronchial Asthma - The Wheezing Illness
