Asthma

Respiratory

Asthma is a chronic inflammatory condition of the airways that leads to reversible and episodic troubled breathing. Affecting approximately7 million children in the United States, asthma is the most common childhood chronic disease. However, adults can also have asthma (17 million in the United States alone). When an asthma “attack” or episode occurs, the lining of the lungs becomes inflamed and swollen while the muscles that surround airways spasm and fill with mucus. An asthma episode is characterized by restricted airways and difficulty breathing with symptoms of wheezing, chest tightness, and breathlessness. The cause of inflammation is unknown, but it is thought to be due to a variety of genetic and environmental factors. While asthma can be frightening as a parent or a person dealing with symptoms, there are ways to manage the condition by avoiding triggers and using medications correctly. Many with asthma can live normal, active lives by following their asthma action plan designed with their healthcare team.

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Symptoms

  • Wheezing (whistling sound when you exhale)
  • Rapid breathing
  • Coughing (worse at night and in the morning)
  • Chest tightness
  • Shortness of breath

Types

Allergic asthma. The most common form of asthma, allergic asthma is caused by environmental triggers, such as pollen or food allergies. 8 in 10 people who suffer from allergic asthma will have an allergic condition (eczema, food allergies, etc.).

Nonallergic asthma. This type of asthma is less common than allergic asthma and is known to affect more females than males. People with nonallergic asthma develop symptoms if they are exposed to humidity, cold, or stress. Respiratory infections may also trigger an asthmatic episode.

Seasonal asthma. Environmental conditions and certain times of the year can cause people to develop seasonal asthma. Symptoms may become present or worsen when pollen levels are at their highest or during the winter months when there are more viruses prevalent. Seasonal and nonallergic asthma have similar triggers.

Exercise-induced asthma. People with this type of asthma will develop symptoms soon after exercising or any form of strenuous activity. Some environmental conditions can worsen symptoms, including humidity, polluted air, or cold, dry air.

Occupational asthma. This type of asthma occurs due to occupational conditions that exacerbate symptoms. A person may seek medical attention finding that working makes symptoms worsen and time away from work improves them. Exposure to aerosols, insecticides, paint chemicals, and other toxic substances can cause people to develop occupational asthma.

Some people do not show symptoms of asthma for days, months, and, sometimes, years after exposure.

Risk Factors

  • Prenatal exposure to cigarette smoke
  • Exposure to chemical irritants or industrial dust
  • Family history of asthma
  • History of respiratory infections
  • Obesity
  • History of allergic reactions, especially in early childhood

Diagnosis

Your doctor will take a full medical history and give you a physical exam. When taking your medical history, your doctor will ask many questions about your symptoms, when they occur, your environment (especially exposure to tobacco smoke and other airborne irritants), and your occupation. Your physical exam will include a close examination of your ear, nose, and throat and listening to your breathing with a stethoscope. Your doctor will most likely ask about any allergies you have and look to see if your skin has shown any signs of an allergic skin condition (i.e., hives or eczema). Your doctor may look for signs of a viral or bacterial infection. If your child is being tested for asthma, the diagnosis will usually involve a medical history, a physical examination, and ask you about your child’s signs and symptoms. Children under the age of 5 are not asked to conduct any lung tests. Tests your physician may order:

Spirometry. This test is used to diagnose asthma in people over the age of five years old. In this test, you will be asked to take a deep breath and exhale into a tube that is connected to a spirometer. A spirometer measures the volume of air you breathe out and how much time it takes for you to breathe out a full breath. People with a history of chronic asthma will have narrowed airways and will have a below-normal measurement of the volume of air exhaled.

Challenge test. In some cases, the spirometer results can come back normal. Your doctor will then ask for you to inhale a substance that can trigger asthma symptoms or induce asthma by asking you to perform a physical activity. You will then be asked to retake the spirometry test to see if the results return below the normal measurement.

Exhaled nitric oxide test. This test measures the amount of nitric oxide gas in your exhaled breath to determine if your airways are inflamed.

Other tests your doctor may order to rule out other conditions or diseases that mimic asthma:

  • X-ray or computerized tomography (CT) of your chest
  • CT scans of your sinuses
  • Blood tests
  • Sputum induction and examination (from phlegm in your lungs)
  • Allergy tests.

Treatments

Your physician will aim to help you or your child to gain control of symptoms and help to normalize daily life activities while minimizing the risk of future episodes. Treatment goals for asthma are to help the patient function without limitations because of asthma. You will begin treatment by learning to understand what triggers episodes and becoming educated about how the medication works and how to use it. Your doctor will help you develop a self-management plan which includes self-monitoring your symptoms, taking medication correctly, and controlling environmental triggers.

Medications for asthma include two general classes, quick-relief, and long-term control medications. Patients who suffer from mild asthma symptoms that do not occur regularly are often prescribed short-acting or quick-relief medications such as albuterol. The inhalant is prescribed and indicated to be used when a patient is suffering from bronchospasm. Long-term or daily medications are prescribed to patients who have frequent attacks and persistent asthma. These medications help to prevent the symptoms of asthma or improve the symptoms.

Alternative Treatments and Home Remedies

Always inform your doctor before you take any herb or dietary supplement. Some herbs worsen asthma symptoms and may interfere with prescribed medications. Many alternative treatments are not regulated and the safety and efficacy of the herbal or dietary supplements cannot be guaranteed. Because asthma is triggered by environmental factors and can be life-threatening, it is advised that one seeks medical treatment to treat symptoms as opposed to trying alternative treatments, including home remedies. There has been substantial research into complementary health approaches to relieve asthma symptoms. Some of these include:

Acupuncture. This treatment involves the stimulation of specific points on the body with thin metal needles to evoke a therapeutic response. Some studies have shown that acupuncture helps to improve the symptoms and quality of life in people with asthma while reducing the dependence on medication use.

Breathing exercises. Retraining techniques in breathing may help to regulate breathing patterns and improve the balance of carbon dioxide and oxygen in the blood by reducing the tendency to hyperventilate in asthma patients. Breathing techniques can also help to reduce anxiety and distress that can occur in someone who is having trouble breathing due to an episode.

Yoga. This holistic therapycan help to relieve physical and psychological distress caused by asthma symptoms. Yoga involves the combined use of breathing, posture, and meditation to build strength and promotes relaxation. There are no serious adverse events that have occurred in studies that research the effects of yoga on asthma and participants showed improvement in mental and social well-being with improvements in physical functioning.

References

American Academy of Allergy, Asthma, and Immunology. (2013). Introduction to asthma. Retrieved from:https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/ASTHMA.pdf

Centers for Disease Control and Prevention. (2020, August 21). Asthma: Triggers. Retrieved from:https://www.cdc.gov/asthma/triggers.html

Holland, K. (2020, May 28). What do you want to know about asthma? Retrieved from:https://www.healthline.com/health/asthma

Lewsley, J. (2020, April 28). What are the different types of asthma? Retrieved from:https://www.medicalnewstoday.com/articles/types-of-asthma

Mayo Clinic Staff. (2020, April 14). Asthma: Steps in testing and diagnosis. Retrieved from:https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20045198

National Center for Complementary and Integrative Health. (2013, April). Asthma: In depth. Retrieved from:https://www.nccih.nih.gov/health/asthma-in-depth

National Heart, Lung, and Blood Institute. (2014, September 18). Asthma. Retrieved from:https://www.nhlbi.nih.gov/health-topics/asthma

Tew, G., et al.(2017, June 23). Adapted yoga to improve physical function and health-related quality of life in physically-inactive older adults: a randomized controlled pilot trial. BMC Geriatrics, 17, 131. Retrieved from PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481961/

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