Asthma Symptoms, Causes And Treatment

Asthma is an inflammatory disease of the lungs airways. It is one of the most common chronic conditions. According to the National Institute of health (NIH) : “A chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, neutrophils and epithelial cells.” The word asthma is derived from Greek word that means short breath. It results in difficult breathing and airway hyper-responsiveness.

Types Of Asthma

Asthma is classified on the basis of severity,

1.               Mild Intermittent

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

•  Symptoms include coughing, wheezing, difficult 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, difficult 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 moderate persistent if any of the following symptoms appear without treatment:

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

4.               Severe Persistent

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

•  Symptoms occur on a daily basis.
•  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

The sign and symptoms of asthma includes,

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

Causes

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

•  Allergens : Pollens, Moulds, House dust, Animals 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

Treatment And Management

Pharmacological Treatment

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

A.              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 the 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

B.              Bronchodilators

It is an important drug that causes relaxation of bronchi in the lungs. It causes dilation of the airways that result 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

C.              Methylxanthines

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

D.              Leukotriene receptors 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 includes,

·         Smoking cessation advice

·         Avoid NSAIDs including aspirin

·         Avoid Occupational changes

·         Alter Physical activities

Management of Asthma

MEDICATION/TREATMENT

There is a stepwise approach to treat asthma on the basis of 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 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

Frequently Asked Questions

What are the risk factors for asthma?

Family history of asthma is the major risk factor for asthma. Asthma is more common in children than adults.

Who is more susceptible to develop asthma?

Boys are more susceptible to asthma than girls.