Asthma

You may suspect asthma if you or your child are experiencing symptoms such as coughing and wheezing (whistling sounds) while breathing. These are common asthma symptoms. The symptoms of asthma can be characterized by:

• Breathlessness (shortness of breath) when exposed to triggering factors
• Cyanosis (blue discoloration of the face and extremities)
• Wheezing or whistling sound during breathing
• Chest tightness, which feels like a tightened band around the chest
• Intense coughing or the urge to cough that may be triggered by an allergen or other environmental factors
• Fatigue during and after an asthma attack

These symptoms usually occur during attacks, mostly at night. This is why some individuals may feel tired during the day. During an asthma attack, breathing difficulties can worsen and develop into more serious shortness of breath if not treated. Most doctors classify asthma as intermittent (comes and goes) or persistent (lasting). Persistent asthma can be mild, moderate, or severe. The severity of the condition is based on the frequency of attacks.

Know more about the causes, symptoms, treatment, and prevention of asthma in Hindi.

The exact cause of asthma is still not known. It is believed to be a multifactorial pathology influenced by both genetics and environmental factors. Ideally, when the immune system encounters an allergen, it triggers an immune response to combat it. However, in individuals with asthma, this immune response is excessively strong, leading to inflammation. This results in the airways swelling and narrowing, making it difficult to breathe. During an asthma attack, three things can happen:

• Bronchospasm: The muscles around the airways constrict (tighten), narrowing the airways and restricting airflow.
• Inflammation: The airway linings become swollen, limiting air intake and outflow from the lungs.
• Mucus production: The body produces excess mucus, which clogs the airways.

Asthma in children

According to the Global Initiative for Asthma (GINA) guidelines, around 300 million individuals worldwide, including both adults and children, are affected by asthma. The World Health Organization (WHO) estimates that India has approximately 15-20 million asthmatics. The prevalence of asthma in children aged 5-11 years is estimated to be between 10-15%. Most children with asthma may not exhibit any signs or symptoms for an extended period or until they experience an asthma attack. Additionally, the symptoms of asthma in children can often be confused with other respiratory illnesses, making diagnosis challenging and primarily symptom-based. There is no known way to identify the cause of asthma in children; however, some studies have identified factors that may increase the risk of asthma in this population.

Asthma in pregnancy

Uncontrolled asthma can lead to insufficient oxygen for the mother, which has adverse consequences for both the mother and the fetus. Well-controlled asthma, however, can result in a normal pregnancy, delivery, and healthy child. Common concerns pregnant women may have regarding asthma include:

• Will asthma adversely affect my pregnancy or my baby?
• Will pregnancy adversely affect my asthma?
• Can asthma medications be taken safely during pregnancy?
• Will my child also have asthma?

Well-managed and controlled asthma does not pose problems during pregnancy and delivery for either the mother or the baby. Here are all your concerns about asthma and pregnancy addressed by an expert.

Note: Intrinsic asthma is a type of asthma seen in a minority of asthmatic patients (around 10%), characterized by negative skin tests to common allergens and normal serum concentrations of immunoglobulin E (IgE). It is typically observed in adults, often accompanied by nasal polyps, and may involve sensitivity to aspirin.

Some of the common triggers and risk factors for asthma include:

• Genetics: Evidence suggests that the presence and severity of asthma can be influenced by a person's genetic makeup.
• Air Pollution: Exposure to outdoor pollutants such as nitrogen dioxide and diesel particulates is associated with increased asthma symptoms.
• Diet: Diets low in antioxidants, including Vitamin A, Vitamin C, Vitamin D, magnesium, and selenium, may predispose individuals to the development of asthma.
• Viral Infections: Respiratory tract infections caused by viruses during childhood can lead to asthma in adulthood.
• Allergens: Environmental allergens such as pollen, dust, or mites can trigger an asthma attack.
• Medications: Certain medications, including aspirin and beta-blockers, may induce asthma attacks in some individuals.
• Exercise: Physical activity may exacerbate asthma and make breathing more difficult.
• Chronic Sinusitis: Post-nasal drip caused by sinusitis can trigger coughing and an itchy throat, aggravating asthma symptoms.
• Insects or Plants: Some individuals may be allergic to specific plants or insects that can act as triggers for asthma.
• Obesity: Being overweight increases the risk of asthma and symptoms such as shortness of breath and wheezing.
• Stress: Emotional factors like stress can trigger anxiety and asthma symptoms, including breathlessness.
• Smoke: Smoke or chemical irritants, such as fumes, can lead to asthma symptoms like wheezing and shortness of breath.

Here’s more on the ill effects of smoking and why quitting smoking is beneficial for asthma patients.

Asthma is usually suspected if the patient has a history of recurrent dry coughing, particularly at night and early morning, along with other symptoms such as chest tightness, shortness of breath, and wheezing. The following are the diagnostic tests for asthma:

1. Physical examination: During a physical examination, your doctor might assess your eyes, ears, nose, or throat for swelling or drainage that may indicate an allergic reaction. They will also check your chest and lungs for wheezing or whistling sounds, which may indicate inflammation and contraction of the airways.
2. Blood tests: Your doctor may recommend certain blood tests to check the levels of inflammation, antibodies, and eosinophils (a type of immune cell). These tests include complete blood count (CBC), immunoglobulin E (IgE), and absolute eosinophil count (AEC).
3. Pulmonary function test: Pulmonary or lung function tests are performed to determine if there are any airway obstructions. If there is clinical suspicion but the lung function test results are normal, additional tests such as a post-exercise test or allergen challenge test can help assess bronchial hyperresponsiveness in adults.
4. Chest X-ray: In severe cases, hyperinflation of the lungs may be observed, which can be detected through a chest X-ray.
5. Allergy panel/asthma/rhinitis screening test: If you exhibit symptoms of asthma and an allergic trigger is suspected, allergy diagnosis is generally recommended. This diagnosis consists of a medical history review, skin prick test, and specific IgE (immunoglobulin E) test.

The best possible way to prevent asthma is to eliminate or reduce exposure to triggers that could lead to asthma attacks. Some of the common triggers of asthma and their prevention include:

• Staying away from allergens such as animal dander, dust mites, and mold.
• If possible, wear a mask whenever you come in contact with smoke and other irritating fumes.
• Patients suffering from asthma should avoid exposure to viruses and other respiratory infections.
• It is important to wash your hands carefully. Don’t forget to get your flu and/or pneumonia vaccine every year to reduce the risks of an asthma attack.
• Maintain an asthma diary and note specific triggers so you can inform your doctor about these and reduce flare-ups in the future.

Click here to know about some common triggers of asthma. Read To Know!

Specific tips based on the triggers

1. Exercise-induced asthma

• Avoid exercising in cold, dry air.
• Workout indoors or avoid exercising during early morning hours.
• If a person is very much into workouts, warm up before working out to help the airways adjust and ease breathing.
• Before working out, it is beneficial to use an asthma inhaler or bronchodilator. These asthma medications can help prevent the airways from contracting and control exercise-induced asthma.

2. Drug-induced asthma

• Stay away from foods or medications that trigger asthma attacks, such as aspirin or beta-blockers.
• Oral contraceptives may produce asthma exacerbation with long-term use, and high doses of postmenopausal hormone replacement therapy also increase the risk of asthma.

3. Pregnancy-induced asthma

• Avoid smoking and places where people smoke, as cigarette smoke can increase the risk of having an asthma attack.
• Avoid triggers that can induce asthma attacks whenever possible. Depending on the type of allergy, triggers might include animal fur, pollen, cold air, or dust mites.

4. Stress-induced asthma

• Emotional stress can also trigger asthma attacks. Practice meditation and other relaxation techniques to manage stress.
• Getting enough rest, eating a healthful diet, and exercising regularly are effective ways to reduce stress levels. Making a few lifestyle changes can help manage stress levels and provide relief from asthma symptoms.

The common treatment approach for people with asthma involves the use of preventive medicines (also known as controllers) and quick-relief medicines (also known as relievers).

Controllers

These medicines help reduce the swelling of the airways and prevent mucus formation. They are mostly used to prevent asthma attacks and protect the lungs. The classes of these medicines are:

• Corticosteroids: These are the best and most commonly prescribed drugs for asthma. They act by inhibiting the activity of inflammatory compounds such as prostaglandins, leukotrienes, and histamines, which are responsible for inflammation. They are broadly classified into:
  • Inhaled corticosteroids (ICSs): ICSs are amongst the most effective anti-inflammatory medications available to treat asthma. Low-dose monotherapy of inhaled corticosteroids is usually given as first-line maintenance therapy for most children and adults dealing with asthma. Regular use of ICS has been shown to reduce symptoms and flare-ups of asthma along with improvement in lung function. Examples include:
    • Beclomethasone
    • Budesonide
    • Fluticasone
  • Oral corticosteroids: These are generally given for the acute treatment of moderate to severe asthma. Prolonged use of oral steroids is generally avoided as it has been associated with potentially serious side effects. Examples include:
    • Prednisone
    • Prednisolone
• Leukotriene receptor antagonists: These medicines are effective for the treatment of asthma, are well tolerated, and are safe to use. They work by blocking the action of the inflammation-causing chemical messenger called leukotriene, thereby reducing inflammation in the airways and relieving symptoms of allergies. Common examples include:
  • Montelukast
  • Zafirlukast
• Biological therapies: Biological therapies such as the anti-IgE monoclonal antibody, omalizumab, can reduce the frequency of asthma attacks. This drug is administered subcutaneously once every 2–4 weeks. It is specific to patients with difficult-to-control asthma with an elevated serum IgE level and is also given to those whose asthma symptoms do not improve even with ICS therapy in combination with a second controller medication.

Relievers (bronchodilators)

These are the preferred medications for the treatment and maintenance of acute symptoms of asthma and are generally prescribed to all patients with asthma. They work by dilating the bronchioles, providing temporary relief. These medicines are used to relieve the symptoms of asthma when they occur but do not reverse the inflammation that has already occurred. The classes of bronchodilators include:

• Short-acting beta agonists (SABA): These medicines are used for the treatment of asthma symptoms and its exacerbations. They provide quick relief. For example, salbutamol has an onset of action of under 5 minutes and lasts for 3 to 6 hours. Common examples include:
  • Salbutamol
  • Terbutaline
  • Levalbuterol
• Long-acting beta agonists (LABA): This class contains low doses of controllers and relievers with a long-lasting effect. They help relieve symptoms and protect against asthma attacks. These medicines are often used in conjunction with other drugs such as corticosteroids. They have an onset of action of more than 5 minutes but the effect lasts for at least 12 hours. Common examples include:
  • Salmeterol
  • Formoterol
  • Indacaterol
  • Olodaterol
  • Vilanterol
• Methylxanthines: This is a new class of medicines known to aid in the treatment of asthma by reducing airway inflammation and obstruction. Theophylline is one of the most commonly prescribed methylxanthines.
• Anticholinergic drugs: This class works by blocking the action of acetylcholine, a neurotransmitter that plays a key role in controlling the constriction of smooth muscles and inflammation. They are further classified into:
  • Short-acting muscarinic antagonists (SAMA): Ipratropium is commonly used to treat and prevent the symptoms of asthma and COPD while improving breathing.
  • Long-acting muscarinic antagonists (LAMA): Tiotropium is primarily used for the treatment of chronic obstructive pulmonary disease (COPD) and asthma.

Other therapies

Bronchial thermoplasty is a bronchoscopic treatment using thermal energy to ablate airway smooth muscle in accessible bronchi. It may reduce exacerbations in patients not responding to maximal inhaler therapy.

To care for your condition, you can follow these simple steps at home to manage your asthma better:

1. Stay away from allergens: Identify and avoid triggers such as plants, dust, or certain food items.
2. Stay hydrated: Drinking plenty of water throughout the day helps keep mucus thinner, aids in better breath control, and supports digestion.
3. Keep the air filters clean: Regularly clean or change air filters to maintain clean air and avoid asthma triggers.
4. Avoid strong fragrances: Strong scents from cleaning sprays, perfumes, and air fresheners can trigger asthma, so it's best to avoid them.
5. Keep yourself active: Moderate exercise can be beneficial if you take your medication regularly, helping you stay active and fit.
6. Avoid exposure to dust: Maintain a clean environment to prevent dust accumulation and wear a mask while cleaning or vacuuming.
7. Keep inhaler handy at all times: Always have an inhaler accessible in case of emergencies.

Here are 10 mistakes to avoid if you are using inhalers.

If asthma is left undiagnosed or untreated, it can lead to an increased risk of lung scarring. Scarring refers to the permanent damage to your lungs and airways, making it difficult to breathe without external aid. This represents an irreversible stage of asthma, which cannot be corrected with medications. Some of the permanent changes that may occur include:

• Increased production of mucus
• Thickening of airways
• Irreversible narrowing of airways over time
• Pulmonary hypertension

There is also a risk of complete respiratory failure during severe asthma attacks. During such an attack, the airways can become obstructed, and even emergency medications may fail to provide relief.

• Home remedies for asthma
  • Garlic: Garlic is known for its several health benefits, including anti-inflammatory properties. Its anti-inflammatory nature may help relieve asthma symptoms.
  • Ginger: Ginger possesses anti-inflammatory properties, which may aid in treating severe asthma. Oral ginger supplements can help improve asthma symptoms.
  • Honey: Honey is often used as a remedy for colds. It soothes sore throats and reduces coughing. You can take honey with herbal tea or warm water for symptom relief.
  • Omega-3 fatty acids: Foods rich in omega-3 fatty acids, such as fish and flax seeds, may decrease airway inflammation and improve lung function in individuals with severe asthma.
  • Caffeine: Caffeine acts as a bronchodilator, reducing respiratory muscle fatigue. It is effective for asthma sufferers and can enhance airway function for several hours after consumption.
• Breathing techniques: Breathing exercises can help reduce asthma symptoms by promoting slow and gentle breathing. These techniques emphasize exhaling through the nose rather than the mouth, as mouth breathing can dry out the airways and increase sensitivity to allergens, potentially triggering an asthma attack.
• Yoga: Yoga includes both stretching and breathing exercises that contribute to overall fitness. It is also an excellent stress reliever, which can help decrease daily stress that may trigger asthma.
• Mindfulness: Mindfulness is a form of meditation that focuses on being present and can be practiced almost anywhere. To practice, sit in a quiet place, close your eyes, and concentrate on your breath, thoughts, feelings, or bodily sensations. This stress-relieving exercise can be beneficial for alleviating stress-related asthma symptoms.

Who said asthmatics have to live their life under restrictions? If your asthma is under control, you can lead a normal, active life just like others. Do not let asthma control your life with these simple tips and tricks.

1. Stay informed and aware of your condition
   It is common to feel anxious about your condition if you are not well-informed. Therefore, it is advised to be aware of your condition. This may include reading books about asthma. When researching online, ensure you follow legitimate sources and not everything that appears on search engines. Speaking to your doctor to get your queries answered by a medical professional who knows about your condition in depth is also a good idea.
2. Always take your medication on time
   Taking your medications on time is crucial for managing asthma symptoms. Remember, preventive medicines for asthma help to reduce swelling over time. You do not become addicted to them, nor do they become less effective with time. Your doctor may recommend these medicines regularly if you:
   
   • Have frequent asthma attacks
   • Wake up in the middle of the night due to asthma
   • Use quick relief medicine more often (like twice a week) to stop asthma attacks
   Note: If you are pregnant, talk to your doctor, as most medicines are safe during pregnancy. Keeping your asthma under control can also protect your child.
3. Never miss your doctor’s appointment
   It is important to schedule appointments at regular intervals, even if you feel good or have no breathing issues. These check-ups help your doctor track asthma symptoms and make necessary adjustments to your treatment plan. They also assist in preventing complications as your doctor monitors your condition regularly. You can ask for an asthma action plan from your doctor, which will help you recognize when your asthma is worsening and how to respond. Inform your doctor if your asthma is not yet controlled with medication. Also, let them know if you need to take controllers before, during, or after exercise.
4. Make some special changes for the patient
   You can implement minor changes in your bedroom to prevent asthma attacks. For example:
   
   • Avoid rugs or carpets in your room, as these could accumulate dust or mold.
   • Refrain from using soaps, shampoos, incense, or lotions with strong fragrances that may trigger your asthma. No smoking or strong smells in the bedroom.
   • Keep animals out of your bedroom. If possible, keep them out of your house and ask someone else to clean their area or litter.
   • Use dust-proof covers with zippers for pillows, mattresses, and quilts. Avoid pillows or mattresses made from straw, as these can trigger allergic reactions.
   • Wash bed sheets, pillow covers, and blankets in hot water and sun-dry them.
   • Always keep your windows open, especially when cooking, cleaning, or if there are strong smells.
   • Perform chores like painting, vacuuming, cleaning, or dusting when the person is not around. The same applies when using sprays or disinfectants.
   • Keep your inhaler near your bedside to avoid panic during late-night symptoms. Always carry your inhaler while traveling.
5. Maintain an asthma journal
   Keep an asthma diary to note the time, severity, and triggers of your asthma attacks. Different people have different triggers, so documenting them can help you identify and avoid triggers. This can also assist in deciding treatment and managing the condition more effectively.
6. Get vaccinated
   As individuals with asthma are at higher risk of developing complications from respiratory infections such as influenza and pneumonia, it is important to get vaccinated. Ask your doctor about the recommended vaccines.

Everyone loves to travel and see new places! Asthmatics are no different. However, traveling and visiting new places can pose certain risks and challenges. With proper care and attention to detail, asthmatics can travel safely and enjoy their experiences without asthma being a hindrance! Here are some quick and effective tips for asthmatics to travel safely.