Bronchial asthma is a chronic inflammatory disease of the lungs in which the airways undergo reversible obstruction. There are recurrent episodes of wheezing, breathlessness, chest tightness and coughing. These episodes are associated with viral infections, allergens, and occupational exposures. About 235 million people suffer from asthma according to WHO and it is the most common chronic disease in children. One-third of those affected are under the age of 18 yrs. The prevalence of asthma and associated mortality has been increasing since the 1980s but in the last decade, it has been stabilized.
Risk Factors:
These are factors which increase airway responsiveness and contribute to acute and long-term exacerbation of asthma:
1. Allergens – pollens, mites, fungal molds, pet body hair
2. Upper respiratory tract infection – viral and bacterial
3. Irritants – perfumes, cleaners
4 Smoke – tobacco, burnt wood and rubber
5. Weather – change in weather or cold weather
6. Medications – Use of NSAIDs (Painkillers), Aspirin, β-blockers( used by patients for hypertension) can exacerbate an attack of asthma.
7. Obesity – though not a direct causative factor for asthma, it is being increasingly recognized as a comorbid condition with asthma. Asthma control is also relatively poor in obese individuals.
Symptoms:
Recurrent episodes of cough, breathing difficulty, chest tightness are indicative of asthma. Patients usually complain of an increase in symptoms in the night and early morning.
Common symptoms of asthma are:
1. Cough –
• usually dry,
• more in the night
• increased on exercise and in cold weather
2. Wheezing-
• musical or whistling sound while breathing
• due to narrowing of the airway
• heard during exhalation (breathing out)
3. Breathlessness
• More in cold weather
• More on exercise
4. Chest tightness
• Patients usually feel like a tight band compressing the chest
• More difficulty while exhaling out breath
All these symptoms happen on and off, revert back keep recurring. Usually, the symptoms are worse at night and early morning and exacerbated by an allergen trigger like dust, pollen, etc.
Signs of a severe asthma attack include:
• Severe wheezing, coughing and chest tightness
• Unable to eat, speak or sleep
• Drowsiness, confusion
• Cyanosis (blue lips or fingers)
Diagnosis:
Usually, the doctor will diagnose as a case of bronchial asthma on a typical history as mentioned above which will increase on specific exposure either to an allergen or on change of weather
Doctor will use a stethoscope and listen to breath sounds and confirm the wheezing sound on breathing out
Further confirmation can be done undergoing a ‘Pulmonary Function test’ which is a graphical representation of the breathing pattern of both inspiration (breathing in) and (breathing out). It will show an obstructive pattern in the exhalation part of breathing
Further investigations will include a chest X-ray. Patients may undergo CT scan of the chest in severe cases of asthma who do not respond to treatment to evaluate for the presence for an alternative diagnosis.
Treatment:
1. Activity –
it is advised to maintain a healthy lifestyle with regular physical activity and exercise. If the symptoms are well controlled on medications, patients are advised to maintain regular physical activity
2. Avoiding triggers –
if the specific allergen is known it is best to avoid contact with it. Patients are advised to avoid exposure to cold weather. It is better to wear full winter clothing in cold season especially covering extremities and head. In cases of uncontrolled asthma, it is advised not to move outdoors in extreme cold climate/night.
3. Medication –
the medical management of asthma is titrated according to the severity of the patient’s complaints. Usually, the patient is first started on inhalers which open up the airway and advised to use them as and when required.
In case of nonrelief, long-acting similar inhalers and tablets are also started. In severe cases, steroid tablets are also started. In case of Status Asthmaticus (Severe most form of asthma which does not respond to usual medicines) patient will be admitted and started on intravenous medicines and oxygen inhalation
Conclusion:
Most patients with asthma can achieve effective control of their symptoms on the correct institution of treatment protocol and lead a physically active life. Patients should avoid ongoing exposure to chronic irritants or allergens.
