ASTHMA

Introduction

Asthma is a long-term respiratory condition that affects the airways of the lungs, causing them to become inflamed, swollen, and narrow. This makes breathing difficult and often results in coughing, wheezing, and shortness of breath. It can affect people of all ages but often starts during childhood. According to the World Health Organization (WHO), asthma affects more than 260 million people worldwide and causes thousands of deaths each year — most of which can be prevented with proper management.

Asthma is not just a medical condition; it’s a lifestyle challenge. However, with early diagnosis, correct treatment, and awareness, most people with asthma can live normal, active, and healthy lives.

What Is Asthma?

Asthma is a chronic (long-term) lung disease that causes inflammation and narrowing of the airways. When you breathe, air passes through your airways into your lungs. In asthma patients, these airways are hypersensitive and can easily react to allergens, smoke, pollution, or even weather changes.

During an asthma attack, the muscles around the airways tighten, the airway lining swells, and mucus production increases — all of which restrict airflow and make breathing hard.

🫁 Types

🌿 1. Allergic (Extrinsic Asthma)

Is the most common type of asthma that affects both children and adults.
Allergic asthma is a chronic inflammatory disease of the lungs where exposure to allergens triggers asthma attacks.
When you breathe in an allergen, your body releases a chemical called immunoglobulin E (IgE).
This causes the airways to swell, tighten, and fill with mucus — leading to breathing difficulties.

🌾 Pollen (from trees, grass, or weeds)
🐕 Pet dander (skin flakes, saliva, or fur)
🧹 Dust mites (tiny insects found in bedding, carpets, and furniture)
🍞 Mold spores (in damp areas like bathrooms or basements)
🥜 Certain foods (like peanuts, shellfish, milk, or eggs)
🚗 Air pollutants and smoke

Common Symptoms Include:

Wheezing (whistling sound when breathing)
Coughing, especially at night or early morning
Chest tightness or pressure
Shortness of breath
Nasal congestion or runny nose
Itchy, watery eyes

🧘 Lifestyle Management Tips

🚭 Avoid smoking and secondhand smoke
🧹 Keep your home clean and dust-free
🧺 Wash clothes and bedding regularly
🧘 Practice breathing exercises (like yoga or pranayama)
💧 Stay hydrated and maintain a balanced diet
🕰️ Follow regular sleep patterns to strengthen immunity

💨 2. Non-Allergic Asthma (Intrinsic Asthma)

Non-allergic asthma, also known as intrinsic asthma, is a type of asthma that is not triggered by allergens like pollen, dust mites, or pet dander. Instead, it occurs due to non-allergic factors such as respiratory infections, pollution, weather changes, or stress.

Respiratory infections
Stress
Cold air
Air pollution
Certain medications (like aspirin or beta-blockers)

Symptoms:

Persistent cough
Tightness in chest
Shortness of breath triggered by weather or infections
Wheezing (whistling sound while breathing)
Difficulty breathing during or after exercise
Fatigue after minor physical activity

Lifestyle Management

Avoid smoking, pollution, and chemical fumes.
Practice deep breathing and yoga to manage stress.
Exercise regularly but avoid overexertion in cold air.
Eat a balanced diet rich in antioxidants (fruits, vegetables, omega-3 fatty acids).
Stay hydrated to help clear mucus from the airways.

Causes and Risk Factors

Genetic Factors

Asthma often runs in families. If one or both parents have asthma, the likelihood of a child developing asthma is higher. Certain genetic variations can make the immune system more sensitive to allergens and environmental triggers.

Allergies

Pollen
Dust mites
Pet dander
Mold
People with allergic conditions like eczema or hay fever are at higher risk of developing asthma.

Environmental Factors

Air pollution and smoke
Chemical fumes or strong odors
Indoor pollutants like secondhand smoke
Living in urban areas with high pollution levels is linked to a higher prevalence of asthma.

Respiratory Infections

Severe respiratory infections, especially in early childhood, can affect lung development and increase the risk of asthma. Viral infections such as respiratory syncytial virus (RSV) have been associated with asthma development later in life.

Occupational Exposures

Chemicals in factories
Dust in construction or farming
Fumes from cleaning products
This type of asthma is often referred to as occupational asthma.

Lifestyle and Health Factors

Obesity
Smoking (active or passive)
Poor diet lacking in essential nutrients

Triggers that Can Worsen Asthma

Exercise, especially in cold or dry air
Strong emotions or stress
Weather changes

Symptoms

Common Symptoms of Asthma:

Shortness of Breath: Feeling like you can’t catch your breath, especially during physical activity, at night, or early in the morning.
Wheezing: A whistling or squeaky sound when breathing, often noticeable during exhalation.
Coughing: Frequent coughing, particularly at night or early morning, which may worsen with exercise or respiratory infections.
Chest Tightness: A feeling of pressure or heaviness in the chest that can make breathing uncomfortable.
Difficulty Sleeping: Asthma symptoms can worsen at night, leading to restless sleep or frequent waking.
Fatigue: Feeling unusually tired due to difficulty in breathing, especially after mild physical exertion.

Triggers that Can Worsen Symptoms:

Allergens like pollen, dust mites, and pet dander
Cold air or sudden weather changes
Respiratory infections, such as cold or flu
Smoke, pollution, or strong odors
Physical activity or exercise
Stress or strong emotions

When to Seek Medical Attention:

Severe shortness of breath that does not improve with medication
Wheezing or coughing that worsens rapidly
Blue lips or face
Difficulty speaking due to breathlessness

Diagnosis

Medical History

Symptoms: Wheezing, coughing (especially at night or early morning), shortness of breath, chest tightness.
Triggers: Allergens, exercise, cold air, smoke, respiratory infections.
Family history: Asthma, allergies, eczema.
Symptom patterns: Frequency, seasonal variation, or relation to activities.

Physical Examination

Listening to lungs for wheezing or other abnormal sounds.
Checking for signs of allergies (eczema, nasal polyps, allergic rhinitis).
Note: Asthma may appear normal when not experiencing symptoms.

Lung Function Tests

a. Spirometry

FEV₁ (Forced Expiratory Volume in 1 second): How much air you exhale in the first second.
FVC (Forced Vital Capacity): Total air exhaled.
FEV₁/FVC ratio: Reduced in asthma (<0.75–0.80 in adults indicates obstruction).
Reversibility test: Using a bronchodilator to see if lung function improves (FEV₁ increase ≥12% confirms asthma).

b. Peak Expiratory Flow (PEF)

Measures maximum speed of exhalation.
Can track daily variations.
Helps in diagnosing and monitoring asthma.

c. Bronchoprovocation Test

Used if spirometry is normal but asthma is suspected.
Inhalation of methacholine or histamine triggers airway narrowing; a drop in FEV₁ indicates asthma.

Allergy Testing

Skin prick tests or blood tests (IgE levels) to identify allergic triggers.
Helpful for allergic asthma diagnosis.

Other Tests

Exhaled nitric oxide (FeNO): Measures airway inflammation.
Chest X-ray: Usually normal in asthma; done to rule out other lung diseases.
Sputum eosinophils: Detect airway inflammation (special cases).

Differential Diagnosis

Doctors also rule out:
COPD
Respiratory infections
Heart problems
Gastroesophageal reflux (GERD)
Vocal cord dysfunction

Treatment and Management

Goals of Asthma Treatment

The primary objectives of asthma treatment are:

Preventing asthma attacks
Reducing inflammation in the airways
Controlling symptoms like wheezing, coughing, and shortness of breath
Maintaining normal activity levels and quality of life

Types of Asthma Treatments

Asthma treatment generally involves medications, lifestyle modifications, and monitoring.

A. Medications

Asthma medications are categorized into two main types:

Quick-Relief (Rescue) Medications
These provide rapid relief during an asthma attack:

Short-acting beta-agonists (SABA): e.g., Albuterol
Anticholinergics: e.g., Ipratropium
Usage: Only when symptoms appear or before exercise in exercise-induced asthma.

Long-Term Control (Preventive) Medications
These are taken daily to reduce airway inflammation and prevent attacks:

Inhaled corticosteroids: e.g., Budesonide, Fluticasone
Long-acting beta-agonists (LABA): e.g., Salmeterol (always combined with corticosteroids)
Leukotriene modifiers: e.g., Montelukast
Theophylline: Helps relax the airways
Biologic therapies: e.g., Omalizumab (for severe allergic asthma)

B. Lifestyle and Environmental Management

Managing triggers is essential to prevent asthma attacks:

Avoid allergens like dust mites, pollen, mold, and pet dander
Avoid exposure to smoke, pollution, and chemical fumes
Maintain a healthy weight and exercise regularly (with precaution)
Use air purifiers and maintain proper ventilation indoors

C. Asthma Action Plan

An individualized asthma action plan helps patients recognize symptoms early and take appropriate steps:

Green Zone: Breathing is normal; continue daily medications
Yellow Zone: Early signs of worsening; use rescue inhaler as directed
Red Zone: Severe symptoms; seek immediate medical attention

Monitoring and Follow-Up

Regular check-ups with a doctor or pulmonologist
Peak flow monitoring: Measures the airflow from the lungs to detect early signs of worsening asthma
Symptom diary: Tracking coughing, wheezing, and nighttime symptoms

Emergency Management

In case of a severe asthma attack:

Sit upright and remain calm
Use a rescue inhaler immediately
If no improvement within minutes, call emergency services
Severe attacks may require oxygen therapy or systemic corticosteroids

Tips for Effective Asthma Management

Always carry your rescue inhaler
Take preventive medications regularly, even when symptom-free
Avoid known triggers and allergens
Educate family and caregivers about your asthma plan
Vaccinations: Stay updated with flu and pneumonia vaccines

Prevention Tips

While asthma cannot always be prevented, you can reduce the risk of attacks by following these tips:

Avoid Triggers: Stay away from dust, smoke, and allergens.
Use Air Purifiers: Maintain clean indoor air.
Vaccinate: Get flu and pneumonia vaccines to prevent infections.
Maintain Hygiene: Wash hands and bedding regularly.
Follow Treatment Plans: Take prescribed medications consistently.
Regular Checkups: Monitor lung function and consult your doctor often.
Educate Yourself: Understand your condition and how to respond during attacks.

Asthma First Aid: What to Do During an Attack

If someone is having an asthma attack:

Stay calm — panic worsens symptoms.
Sit upright — don’t lie down.
Use reliever inhaler (2 puffs every 30–60 seconds, up to 10 puffs).
Call emergency services if breathing doesn’t improve after 10 minutes.
Avoid triggers and ensure fresh air.

Immediate action can save lives.

Living with Asthma: Tips for Daily Life

Track Symptoms: Use a mobile app or asthma diary.
Keep Medicines Handy: Always carry your inhaler.
Create an Asthma Action Plan: Work with your doctor to develop a personalized plan.
Maintain Indoor Air Quality: Use air filters and avoid incense or candles.
Stay Active: Gentle exercise improves breathing efficiency.
Eat a Balanced Diet: Include foods rich in antioxidants and omega-3 fatty acids.
With awareness and discipline, asthma patients can live freely without constant fear of attacks.