Asthma

Types Of Asthma

There are many different types of asthma, and the causes can vary depending on the individual. Some common triggers include allergies, exercise, cold air, and respiratory infections. Asthma is classified based on severity,

1. Mild Intermittent

Intermittent asthma occurs at regular intervals. It is considered intermittent if any of the following symptoms appear without treatment:

•  Symptoms include coughing, wheezing, difficulty breathing, and chest congestion.
•  Occurs on less than two days in a week.
•   Do not affect normal daily activities.
•  Night-time symptoms occur on less than two days in a month.
•  LFTs are normal when there is no asthma attack.

2. Mild Persistent

Asthma is considered mild persistent if any of the following symptoms appear without treatment:

•  Symptoms include coughing, wheezing, difficulty breathing, and chest congestion.
•  Symptoms occur on more than two days in a week.
•  Asthma attack affects daily activities.
•  Night-time symptoms occur 3-4 times in a month.
•  LFTs are normal when there is no asthma attack.

3. Moderate Persistent

Asthma is considered moderately persistent if any of the following symptoms appear without treatment:

•  Symptoms occur daily.
•  Asthma attack affects daily activities.
•  Night-time symptoms occur more than once time in a week but not every day.
•  LFTs are abnormal when there is no asthma attack.

4.  Severe Persistent

Asthma is considered severe and persistent if any of the following symptoms appear without treatment:

•  Symptoms occur daily.
•  Asthma attack severely affects daily activities.
•  Night-time symptoms occur every night.
•  LFTs are abnormal when there is no asthma attack.

Other types include nocturnal, intrinsic, extrinsic, occupational, and cough-variant asthma. It is also induced by exercise.

Symptoms of asthma

The signs and symptoms of asthma include,

•  Wheezing
•  Shortness of breath
•  Chest tightness
•  Persistent cough
•  Dyspnoea (difficult breathing)
•  Mucus secretion

What Causes Asthma?

There is a wide range of causative agents or asthmatic triggers that can cause asthma. For example,

•  Allergens: Pollens, Moulds, House dust, Animal saliva, dander and urine.
•  Industrial chemicals: Epoxy resins, Aluminium, Penicillin, Hair spray, cimetidine, and isocyanate-containing paints.
•  Food: Fish, Nuts, Food colors, Benzoic acid, Sodium metabisulfite, Seafood and Dairy Products.
•  Drugs: Aspirin, Ibuprofen and β-adrenoceptor blockers
•  Environmental Pollutants: Traffic fumes, Sulphur dioxide, and Cigarette smoke.
•  Industrial Triggers: Grain weevils, Mites, Wood or Grain dust, Cotton, Dust

What is the best treatment for asthma?

Pharmacological Treatment

The purpose of pharmacological treatment is to control symptoms of persistent asthma. The prescribed medicines include,

• • Anti-inflammatory drugs: Anti-inflammatory drugs are one of the most effective options for asthma. These drugs help us to control the asthma attack. Anti-inflammatory drugs treat airway inflammation and mucous production by making the airways more sensitive. Anti-inflammatory drugs include corticosteroids. These are,
    • Beclomethasone
    • Budesonide
    • Ciclesonide
    • Fluticasone
    • Fluticasone furoate
    • Mometasone
    • Salmeterol

• • Bronchodilators: It is an important drug that causes the relaxation of bronchi in the lungs. It causes dilation of the airways which results in easy breathing. There are two types of bronchodilators, short and long-acting.
    • Short-acting bronchodilators are:
      • Albuterol
      • Levalbuterol
      • Pirbuterol                              
    • Long-acting bronchodilators are:
      • Salmeterol
      • Formoterol
      • Aclidinium
      • Tiotropium
      • Umeclidinium

• • Methylxanthines: Theophylline is an effective treatment option for the long-term prevention of asthma symptoms. It increases the contraction of the diaphragm and helps in mucous clearance.

• • Leukotriene receptor antagonists: Leukotriene receptor antagonists include montelukast tablets and granules. This is effective for long-term control and prevention of asthma symptoms. This medicine is used in children under seven years of age.

• Non-Pharmacological Strategies:

Non-pharmacological treatment options include,

• Smoking cessation advice
• Avoid NSAIDs including aspirin
• Avoid Occupational changes
• Alter Physical activities

What is the step 5 treatment for asthma?

There is a stepwise approach to treating asthma based on severity. These steps are,

• Step 1: SABA with no controller (as needed): If there is no night waking and no exacerbation in the last year, then this is an effective option. Another consideration is that your forced expiratory volume is normal. Alternative options include low-dose inhaled corticosteroids.

• Step 2: Regular low doses of ICS plus SABA (as needed): This step is effective for seasonal allergic asthma. Alternative options include leukotriene receptor antagonists and low-dose theophylline.

• Step 3: Low-dose ICS /LABA: This is an effective option if the exacerbation is greater than last year. Alternative options include medium or high-dose inhaled corticosteroids and low-dose inhaled corticosteroids with leukotriene receptor antagonists.

• Step 4: Medium/high ICS/LABA: This step is effective if there is a history of exacerbation and severe side effects. Alternative options include tiotropium and high-dose inhaled corticosteroids with leukotriene receptor antagonists.

• Step 5: Refer to expert investigation and add on treatment