Asthma

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Asthma is a chronic disease that affects the airways of the lungs. During an asthma episode or attack, the airways narrow and swell causing breathing difficulties, chest tightness and wheezing.

Asthma symptoms vary in severity. For some people, asthma is only a minor irritation. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Symptoms of asthma, such as coughing, often become worse during physical activity or at night.

There are an estimated 235 million people suffering from asthma around the world. It affects people of all ages, but most often starts during childhood. Asthma is also the most common chronic disease among children. Often under-diagnosed and under-treated, its symptoms can be controlled with the right treatment plan.

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Asthma symptoms are not the same for everyone. Symptoms can range from minor to severe, and can even change from episode to episode in the same person. Some common signs and symptoms of asthma include:

  • Coughing, which is often worse at night or early in the morning
  • A whistling or wheezing sound when exhaling
  • Chest tightness or pain
  • Shortness of breath

Symptoms of a severe asthma attack can also include a rapid pulse, sweating, flared nostrils, pursed lips and a bluish discolouration of the lips and fingernails.

If you are experiencing any of these symptoms, contact your doctor. For those who have already been diagnosed with asthma, monitor your symptoms and regularly review your treatment.

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The exact causes of asthma are not completely understood. The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental factors. The airways in a person with asthma are very sensitive and are set off by many triggers. Contact with these triggers cause asthma symptoms. Although triggers differ from person to person, common environmental triggers include:

  • Airborne allergens such as pollen, mold, dust mites, cockroaches, or animal dander and saliva
  • Respiratory infections, such as the common cold
  • Allergic reactions to some foods, such as peanuts or shellfish
  • Physical activity, including exercise
  • Cold, dry air
  • Air pollutants and irritants, such as smoke and perfume
  • Certain medications including beta blockers, aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
  • Strong emotions and stress, such as crying or laughing hard
  • Sulfites in some types of foods and beverages.
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To diagnose asthma, your doctor will first review your symptoms, medical history and family history. Your doctor will ask about the severity of your symptoms, as well as when and how often they occur. He or she will also want more information about your personal and family histories of asthma, allergies and respiratory illnesses. Afterwards, your doctor will perform a physical examination and conduct some diagnostic tests. An overview of these is provided below.

  • Physical exam: Your doctor will listen to your breathing and look for signs of asthma or allergies. These signs include wheezing, a runny nose or swollen nasal passages, blue lips and skin conditions caused by allergies.
  • Tests to measure lung function: The two main tests used to determine how much air moves in and out as you breathe are:
    • Spirometry: During spirometry, you exhale into a device that analyses the amount and volume of airflow. This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
    • Peak-flow meter: This is a small portable tube that measures the speed of air expelled when you blow forcibly through it. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse.

Your doctor may also order allergy tests, blood tests, and chest and sinus X-rays. The tests will determine whether you have asthma and if there are any other conditions that are contributing factors.

Asthma severity

Once you have been given a diagnosis of asthma, your doctor will classify the severity of your condition into one of the four general categories below. Determining your asthma severity is an important part of choosing the most appropriate treatment.

  • Mild intermittent: Mild symptoms up to 2 days a week and up to 2 nights a month.
  • Mild persistent: Symptoms more than twice a week, but no more than once in a single day.
  • Moderate persistent: Symptoms once a day and more than 1 night a week.
  • Severe persistent: Symptoms throughout the day on most days and frequently at night.

 

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Treatment for asthma generally focuses on preventing inflammation or relaxing the muscles that line airways. It is important to work with your doctor to write an asthma action plan that’s right for you. Below is a list of treatments commonly prescribed.

  • Medications: Several types of medication are available to treat asthma. Some treat acute attacks (known as "relievers"), while others prevent attacks from occurring (the "controllers").
    • Anti-inflammatory medications: These are controllers that work by reducing swelling and mucus production in the airways. As a result, airways are less sensitive and less likely to react to triggers. Anti-inflammatory medications are usually taken regularly, regardless of whether a person is having asthma symptoms. Anyone with asthma symptoms that occur more than a few times per week should consider taking an anti-inflammatory medication. The first choice is usually an inhaled corticosteroid.
    • Bronchodilators: These drugs are commonly inhaled and work by relaxing the muscles around the airways to improve airflow. In short-acting forms, bronchodilators act as relievers and stop asthma symptoms by quickly opening the airways during an asthma episode. In long-acting forms, they are used as controllers to reduce or prevent the number of asthma attacks.
  • Immunotherapy: Immunotherapy can sometimes be a treatment option for asthma sufferers. In immunotherapy, the person is injected with small doses of substances to which they are allergic. The aim is to densensitise the person’s immune system so, over time, the body may become less responsive to allergens. Immunotherapy appears to be most effective for mild to moderate asthma symptoms caused by sensitivity to indoor allergens.
  • Alternative medicine: Certain alternative treatments may help with asthma symptoms. However, talk to your doctor before taking any herbs or supplements, as some may interact with medications you take. Breathing techniques, such as the Buteyko breathing technique, may help keep asthma symptoms under control. A few herbal remedies to improve asthma symptoms include butterbur, Indian frankincense and pycnogenol. Increasing the amount of omega-3 fatty acids consumed, found in fish, flaxseed and other foods, may also reduce the inflammation that leads to asthma symptoms.

 

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It is not possible to prevent asthma. However, you can take steps to prevent the symptoms and keep the disease under control. These steps include:

  • Educating yourself about asthma: Learn about your asthma and ways to control it.
  • Avoiding environmental triggers: Stay away from triggers such as cigarette smoke and strong chemicals.
  • Taking your medication as prescribed: Even if your asthma seems to be improving, don't change anything without first talking to your doctor.
  • Eliminating triggers at home: If dust mites are a trigger, clean your home regularly, wash bedding frequently and remove carpets and heavy drapery from sleeping areas.
  • Anticipating future attacks: Monitor your symptoms and peak-flow readings to help identify a coming attack before symptoms develop. Learn to recognise warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. This allows you to adjust your medications to prevent an attack.
  • Getting immunisations for influenza and pneumonia: Staying up-to-date with immunisations can prevent the flu and pneumonia from triggering asthma flare-ups.

 

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