ASTHMA – TAKING CONTROL OF ASTHMA…. YOU CAN WIN…!

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Asthma is a common condition that affects the airways. The typical symptoms are wheeze, cough, chest tightness, and shortness of breath. Symptoms can range from mild to severe. Treatment usually works well to ease and prevent symptoms. Treatment is usually with inhalers. A typical person with asthma may take a preventer inhaler every day (to prevent symptoms developing), and use a reliever inhaler as and when required (if symptoms flare up).

Introduction

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Asthma is a disease of airways. Airways are the pipe/tube-like structures through which you breathe. In asthma, airways get swollen and secrete a sticky substance called as mucus. Thus, the airway becomes narrow and you find it difficult to breathe. Asthma is generally hereditary, which means it is passes through families. It does not spread from one person to other. it has nothing to do with how you were raised or your relationships or your social status. Asthma is treatable and you can keep symptoms well under control. This booklet helps you to understand asthma and its management in detail.

Asthma – What actually Happens?

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In Asthma the normally pink and thin mucosa is swollen and red (inflamed), thus reducing the inner diameter of the bronchiole.  To make matters worse, the ribbons of muscle around the bronchioles contract and constrict the tubes, referred to as (bronchospasm).  To appreciate the difficulty of breathing through these narrowed air passages, one may try to breathe for 30 seconds through a straw!

Asthma is frequently misunderstood and hence feared.  As you learn more about asthma and the management options, it is obvious that a normal life is possible like everyone else.  Asthma is common and treatable.  Furthermore, asthma does not spread from person to person. Asthma is referred by different names in different regions of India.  Symptoms of asthma such as cough and breathlessness are sometimes confused with other diseases such as Chronic Bronchitis and/or Emphysema, a condition which is due to Tobacco Smoking.  It is important to differentiate these two common respiratory disorders because Asthma is reversible while Chronic Bronchitis is not.

Who suffers from asthma?

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Asthma is common in all age groups including the children and the elderly.  In India, on an average, about 3 to 5 percent of the population suffer from asthma.   (4 crore Indians may have Asthma).

Asthma is More Common in children than in adults.  Diagnosis of asthma in a child therefore must Not surprise the parents.

Although asthma Commonly Starts in Childhood, it may occur for the first time at any age.  Occasionally, the first asthma attack may be reported even in the elderly.  Asthma is frequently missed, under recognized and many times under treated in the elderly.

Asthma prevalence is generally equal in males and females.  It is said to be more common in boys than girls.  Among adults however, Asthma is more common in women than in men.

Asthma can affect anyone regardless of the social status.  Many politicians, cinema celebrities, singers, scientists, doctors and even top sportsmen have had Asthma.  Their lives are examples to show that asthma can never be a hindrance for success and normal life.

WHAT ARE THE SYMPTOMS OF ASTHMA?

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There are many different ways in which asthma can present.  Some of the common symptoms are: breathlessness, cough, wheezing or whistling sounds, chest tightness, breathlessness/cough.  In some patients, these symptoms may occur only after exercise or a common cold.

Cough is usually dry, but some patients may complain of sputum.  The sputum is generally white and frothy.

The symptoms are generally episodic.  In more severe forms, the patient may remain symptomatic continuously for several weeks or months at times without any relief.

Asthma attack tends to occur more frequently at night or in the early hours of morning.  Sleep is frequently disturbed.  Patient may develop new symptoms or get worsening of existing complaints with exercise or any other form of physical exertion.

• Triggers i.e. Factor/s precipitating an attack or causing worsening of symptoms
• Seasonal Change:  Most patients experience worsening during the change of seasons, for example between mid-February to April and between September and November.  This is generally attributed to the heavy load of pollens and dust in the air, besides sudden changes in environmental temperature and humidity.  In the crop rich areas, smoke from the burning of dried residues of wheat crop during April and rice straw during September/October can be an important trigger.
• Infections:  Almost three out of four patients start with the symptoms of asthma following an episode of common cold, or upper respiratory catarrh due to a viral infection of the upper respiratory tract.  Typically, the patient would start with fever, running nose, sneezing and sore throat followed by asthma symptoms.
• Home-dust:  Dust mites are small insects not seen by the naked eye.  These mites are present and grow in the hot and humid conditions, hidden in the crevices of couches and sofas, carpets, curtains, cushions and bed mattresses.  The faecal droppings of the dust mites are allergenic.  One gram of dust contains 1000 dust mites and 250,000 faecal droppings.  When these faecal droppings are breathed, larger particles are trapped in the nose and finer ones find their way into the lungs.  The nose gets the allergy symptoms first, referred to as hay fever, which manifests as runny nose, nasal polyps and watering of eyes.  The lower respiratory condition presents as asthma.  Cleaning and dusting of rooms and furnishings make these allergens to suspend in air (air borne) which when inhaled by the susceptible individual sensitize and cause asthma attacks.   A lot of patients develop symptoms during September/October when people routinely get their houses cleaned and white-washed before the general festival season of Diwali.  This is also the time when people in North India take out their warm clothes stored in the closets (which may be dust covered) during the summer months.
• Others:  There are several other exposures which can trigger asthma:
• Smoking or exposure to smoking by others i.e. passive smoking or environmental smoking
• Breathing the fumes while cooking/frying foods or the smoker from the combustion of the bio mass cooking fuels
• Strong perfumes and smells
• Breathing cold air during cold and foggy weather
• Air pollution (from vehicular traffic and industrial exhausts)
• Fur or feathers from pets, specially cats and dogs
• Fumes, paints, dusts of different grains Besides the exposures, there could be other factors causing aggravation:
• Physical exertion and exercise
• Emotional disturbances and psychological stress
• Onset of menstrual periods
• Gastro-oesophageal reflux (Acid reflux)
• Drugs, such as aspirin, some high blood pressure and heart medicines Sometimes, a trigger may not be clearly identifiable.

How to diagnose asthma?

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Diagnosis is essentially based on the characteristic history of symptoms of cough, breathlessness and wheezing which occurs in relation to a variety of trigger factors like seasonal changes, exposure to dust etc.  However, the diagnosis needs to be confirmed by laboratory tests.  Your doctor will take a detailed history.  He/she will examine for signs of allergies, such as eczema, nasal polyps, sinusitis and will listen for the wheezing sounds from the chest.  It is important to remember that All That Wheezes is Not Asthma; and All Asthma Does Not Wheeze

How is asthma diagnosed?

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Sometimes symptoms are typical, and the diagnosis is easily made by a doctor. If there is doubt then some simple tests may be arranged. The two commonly used tests are called spirometry and assessment with a peak flow meter.

Spirometry

Spirometry is a test which measures how much air you can blow out into a machine called a spirometer. Two results are important:

The amount of air you can blow out in one second - called forced expiratory volume in one second (FEV1).

The total amount you can blow out in one breath - called forced vital capacity (FVC).

Your age, height and sex affect your lung volume. So, your results are compared with the average predicted for your age, height and sex.

A value is calculated from the amount of air that you can blow out in one second divided by the total amount of air that you blow out in one breath (called FEV1:FVC ratio). A low value indicates that you have narrowed airways which are typical in asthma (but a low value can occur in other conditions too). Therefore, spirometry may be repeated after treatment. An improvement in the value after treatment to open up the airways, is typical of asthma.

Note: spirometry may be normal in people with asthma who do not have any symptoms when the test is done.

Remember, the symptoms of asthma typically come and go. Therefore, a normal result does not rule out asthma. But, if your symptoms suggest that you have asthma, ideally the test should be repeated when your symptoms are present. See separate leaflet called Spirometry for more details.

Management:

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Remedies for asthma have varied from the folklore practices to the modern therapy.  There are innumerable faith healing and miracle treatments offered in different societies.   It is important to realize that currently there is permanent cure of asthma.  But the natural behaviour of asthma may vary from person to person.  At times, spontaneously occurring long periods of relief (remission) may incidentally coincide with some interventions/treatments.

There are two major principles in the management:

• Drugs to control asthma (i.e. Pharmacotherapy)
• Avoidance of trigger factors which aggravate asthma

Pharmacotherapy

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There are two kinds of drugs for asthma:

• Relievers:  drugs which relieve the symptoms of Asthma.
• Controllers or preventers:  drugs which actually prevent the process of Asthma

Relievers are used on an “as and when needed” basis when asthma symptoms are present.

The Controllers are used on a regular basis for an extended period of time.

Appropriate and regular use of controllers can control asthma well and decrease the need for the reliever medications.  An increasing use of relievers indicates a poor control of asthma.

The message is: Use Controllers (Preventers) regularly and avoid asthma from worsening.

Although doctors prescribe drugs for asthma, asthmatics and their relatives play an important role and can help if they are aware and knowledgeable about Asthma.   Appropriate and timely use of emergency drugs, especially the relievers, at home can prevent deterioration of disease as well as expensive hospitalization. Similarly, well-informed asthmatics can regulate the controller drugs at home, either by themselves or with the help of the caregivers.

Prevention

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You should ask your doctor if you are a candidate for the pneumonia or flu vaccines that can help prevent certain strains of pneumonia. Wash your hands regularly with soap and water. Avoid touching your eyes and nose. Also, Cigarette smoke damages the lining of the airways and makes the lungs more prone to infection. So, stopping smoking will lessen your risk of developing lung infections.

INHALER THERAPY

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Treatment for asthma is best administered in the form of inhalers.  Contrary to the general belief that inhalers are better reserved for non-responsive or severe asthma, they are used ideally as the first line of therapy.

Use of inhalers for asthma can be compared to using ointments for skin diseases and eye drops for eye condition.

Inhaler medications deliver the drug to the site of the disease.  Therefore:

• The effect is almost instantaneous
• Dose required is about one tenth of the tablet or a capsule
• Side effects are negligible.

Fortunately, many of the drugs of both the reliever and controller groups are now available as inhalers.

• Costlier
• Difficult to understand the proper use i. Costs:  Although the initial cost of the drug in an inhaler (compared to a tablet) is higher, in the long run an inhaler drug works out to be more economical.   Better control of asthma reduces the periods of absence from work or school.  Furthermore, all the expensive hospital bills of poorly controlled Asthma are saved. ii. Difficulties to use:  Proper use of inhalers requires good understanding of the technique.   It is especially challenging to the elderly and small children.   With time and patience (for both the doctor and the User) proper use of inhalers can be explained well to ensure their effective use.

⦁ Costlier ⦁ Difficult to understand the proper use i. Costs:  Although the initial cost of the drug in an inhaler (compared to a tablet) is higher, in the long run an inhaler drug works out to be more economical.   Better control of asthma reduces the periods of absence from work or school.  Furthermore, all the expensive hospital bills of poorly controlled Asthma are saved. ii. Difficulties to use:  Proper use of inhalers requires good understanding of the technique.   It is especially challenging to the elderly and small children.   With time and patience (for both the doctor and the User) proper use of inhalers can be explained well to ensure their effective use.

Avoidance of triggers

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Avoiding triggers is as important as the use of drugs. Alterations in living conditions are required to minimize dust, smoke and other allergens in the house.  Particular attention must be paid to the bedroom of the patient where about 8-10 hours of the day are spent and contact with dust mites occurs. Some of the exposures are easy to avoid while others may require major changes.

• Patient should preferably stay away when sweeping, cleaning, white washing or when similar activities are being carried out.
• Replace sweeping of floors and dusting of walls with vacuum cleaning, or at least with wet cleaning (or mopping).
• Give sufficient exposure of sun and air to the clothes taken out from the closets after storage.
• Keep the bedroom and possibly other places in the house as simple as possible.  Furnishing items that are likely to collect dust such as the stuffed toys, curtains, carpets, mattresses (etc.) should be either removed or replaced and covered with easily washable/plastic materials.
• The most important trigger to avoid is the smoke – cigarettes, stove etc.  Strong odours of seasoning should be avoided around the asthmatic.  Of all the allergens and triggers such as the pollens, dust mite droppings, it is the cigarette and the stove smoke which stay airborne the longest.

Use of maintenance inhaler medications is very important in the overall prevention strategy.

Immunotherapy or use of “allergy injections” have limited role and should be undertaken ONLY on doctor’s advice.

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SECTION II. SOME IMPORTANT AND USEFUL TIPS

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A: The Do’s and the Don’ts

The Do’s: What should be done. The Don’ts – What must be avoided

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If you develop prolonged cough, breathlessness, wheezing, chest tightness or other respiratory symptoms lasting for more than few days –

Consult your doctor Do not continue to ignore

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If the diagnosis of asthma is established by your doctor –

Accept it as an illness that can be controlled… Do not panic

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Asthma is a common illness. You share the illness with some top achievers and celebrities.

Try to look for factors or triggers Do not ignore even minor (listed earlier) in your surroundings or brief exposures Check your technique of use of inhalers

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Triggers are frequently identifiable and potentially avoidable.  You might have to make efforts to avoid and plan alternatives.

• If you identify aggravation of your problems in the presence of the following:
• Smoking by you or from those around you

Quit smoking and seek help to quit Do not sit in smokers’ company.  Ask them to stop

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Your health is more important than the smoking.  Your fear of annoying others should not deter you from following a healthy practice.  You may humbly remind others that

• Smoking is injurious to your health
• A smoker does not enjoy the freedom of exposing others to smoke.
• House dust on floors, in the carpets, bedding and curtains etc.
• Adopt wet sweeping/mopping Do not do dusting and/or vacuum cleaning of floors sweeping in the presence of an asthmatic
• Use dust proof covers for pillows, do not allow dust to mattresses, blankets; synthetic collect over furnishings curtains and carpets; – adopt    – avoid dampness frequent washing and cleaning
• Pet animals: Either give away your pet or keep Do not handle your it outside your room pet yourself. Keeping well is more important than keeping your pet.  You shall have to bear the separation.
• Exercise and sports: Use preventive treatment Do not unduly restrict before any exercise.  Exercise exercise just for the fear is the only trigger that you of precipitating asthma do not avoid Allow normal activities and Avoid hard exercise and exercise esp. in children competitive sports, if symptoms worsen. Do not allow asthma to get worsened.  Moderation of exercise may be required.
• Foods: If you suspect a food item, Do not generalize as a trigger for asthma, try to restrictions on food items establish a definite relationship. Foods are relatively uncommon causes of asthma exacerbations.  Only the patient giving definite history of allergy to a particular food needs to avoid that item.  Some examples of food allergies include, peanuts, shrimp and other sea foods and red wine.
• Gastro oesophageal reflux i.e. “Hyperacidity” problems: Take early and light dinner at Do not lie or sleep night; reduce weight immediately after a heavy meal. Sleep with head elevated. Seek treatment for reflux Avoid strong spicy foods
• Fumes, paints, strong smells, (perfumes, incense, toiletries) Keep the item/s out of home/ Do not allow the rooms bed room; minimize their use; to get stuffy with the ventilate the rooms adequately vapours and smell of the items. Fresh and clean air in the patient’s environment is always better than smelly, smoky or stale surroundings. While the triggers may not be altogether avoidable, their use and exposure should be minimized.
• Your treatment works better if you know of your drugs and their role:
• Reliever drugs are used for: i. Do not over use relievers as immediate relief from the only method of treatment symptoms. If you need to use them more than twice a week, consult your doctor to introduce or increase your preventive drug.
• Preventive drugs are required: ii. Do not stop preventers on regular basis to keep away yourself. They are quite from getting the attacks safe.
• Inhalation is a safe and Do not be afraid of inhalers effective route for both groups Learn to use them properly of drugs. They are neither addictive, nor the drugs for reserve use.

Remember that:

• Inhalers are the preferred Drugs over tablets
• Inhalers are Safe
• Inhalers are Non-addictive
• Inhalers are Effective
• Most inhalers contain similar drugs as in tablets, capsules, syrups and injections of same name, with the added advantage of

-The dose of the drug is very small

-The drug is delivered to the site of the problem – i.e. the lung.

DO NOT HESITATE to ask questions.

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Always rinse your mouth and spit the water after an MDI or DPI is used.  Some steroid inhalers can result in hoarseness of voice and fungus growth in the mouth in a small percentage of patients.  Rinsing mouth prevents these problems.

MONITORING ASTHMA:

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Peak expiratory flow (PEF) is the measure of how forcefully you can blow from your lungs. PEF helps to evaluates the extent of the airway obstruction. Peak flow meter is measured using simple instrument useful in measuring the functioning of your lung. The device has a mouth piece, a cursor and a measuring scale. PEF is useful in asthma diagnosis, to evaluate improvement, to evaluate how asthma medicines are working and to adjust the medication by your doctor. PEF is useful for the following purposes.

For day-to-day recording of asthma severity

To evaluate progress of asthma

During an asthma attack

After taking asthma drug

Measuring PEFR:

To measure Peak Expiratory Flow Rate (PEFR), you have to do the following steps:

Step 1: Set the cursor to 0

Step 2: Stand up and take a deep inhalation. Close your lips tightly around the mouth piece to ensure there is no leak.

Step 3: Breathe out as hard and forcefully as you can.

Step 3: Notice and record the reading (indicated by cursor) on the measuring scale.

Step 4: Repeat step 1 to 3 for 2 more times to take best of the 3 readings.

You have to maintain the values in a book or paper. Your doctor will interpret and tell you the findings of PEF.

Asthma diary:

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Maintaining an asthma diary helps you to keep track of your asthma control and medicines that you are taking. You can download an asthma diary from internet, take printout and maintain it.

Myths and Facts about Asthma

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Unfortunately, many consider asthma as a taboo and the patients get stigmatised and guilty about the condition. There are several myths about asthma, which you should not believe. Here are some myths and facts.

Do not get scared. Do not feel ashamed of asthma.

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There are many other harmful things which can be gainfully avoided, such as Tobacco Smoking and addictive drugs – but not Inhalers required for controlling a medical problem. We hope this information is helpful to you in understanding your condition better.  We wish you a normal and healthy life!

Conclusion:

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Asthma is a condition which can be well controlled with medication and you can lead a normal life like any other person. However, you have to take medicines as suggested by doctor, visit the doctor regularly, do yoga, do exercise, follow healthy lifestyle, follow healthy diet and keep a watch on your asthma and its symptoms. If you do all these, there is very high possibility that you would lead a normal, active and productive life as anyone else.

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Dr.Amol kumar Diwan15 | 10 | 2019

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