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).
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.
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.
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.
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.
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
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 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.
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:
There are two kinds of drugs for 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.
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.
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:
Fortunately, many of the drugs of both the reliever and controller groups are now available as inhalers.
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.
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.
A: The Do’s and the Don’ts
If you develop prolonged cough, breathlessness, wheezing, chest tightness or other respiratory symptoms lasting for more than few days –
If the diagnosis of asthma is established by your doctor –
Asthma is a common illness. You share the illness with some top achievers and celebrities.
Triggers are frequently identifiable and potentially avoidable. You might have to make efforts to avoid and plan alternatives.
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
-The dose of the drug is very small
-The drug is delivered to the site of the problem – i.e. the lung.
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.
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
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.
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.
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.
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!
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.
Dr.Amol kumar Diwan15 | 10 | 2019