ASTHMA
It is a respiratory disease which is defined as chronic inflammatory disorder of the airway that can cause breathing difficulties.
The problem of asthma is global and with an increase in air pollution, the number of asthma attacks is increasing too.
Females are more prone to asthma compared to males.
RISK FACTORS AND TRIGGERS FOR ASTHMA :
1) ATOPY: It is a genetic factor that controls our body’s allergic response. It works with our body immune system and in people suffering from asthma immune system response is more to any allergen compared to a normal person.
But atopy alone is not responsible for the development of asthma and it will produce allergic disease when combined with some other factors like environmental or genetic.
2) OBESITY: It has been seen that people who are overweight are at increased risk of asthma. Overweight people’s lung expansion is also reduced due to increases in fat accumulation around the respiratory muscles.
Some adipokines which are released from the fat are also responsible for producing inflammatory action which can lead to an asthma attack.
3) DIET: Some studies show that diet which is deficient in vitamin A, C, and E increase the risk of an asthma attack. Seafood, nuts also have been linked in inducing asthma attacks.
4) RESPIRATORY INFECTION: Viral, bacterial or fungal infection of the respiratory system can cause or aggravate the attack of asthma as they infect the respiratory system and our body in response activates our immune system and with atopy this immune system response increases and produce an increased inflammatory response and causes obstruction of the airway.
5) AIR POLLUTION: Air pollutants when reaches the airway then body inflammatory response is activated and it causes breathing difficulty.
6) ALLERGEN: Allergen such as house dust mite, pet hairs are associated strongly with asthma. Allergen when reaches inside our respiratory system causes activation of mast cell which leads to the secretion of bronchoconstrictor and also the airway becomes edematous which further aggravates the asthma attack.
7) OCCUPATIONAL EXPOSURE: Mostly seen in people working around irritant chemicals, birds, or other animals.
8) MEDICINES :
A) ß blocker– they can cause bronchoconstriction by an increase in cholinergic secretion.
B) ACE INHIBITORS – Kinin are bronchoconstrictor and ACE Inhibitors stop their breakdown and hence can result in an asthma attack.
C) NSAIDs – These medicines prevent the production of prostaglandin and because of this there is increased production of mast cells and this can stimulate
the asthma attack.
9) STRESS: Cholinergic secretion increases due to increase stress level which causes bronchoconstriction and can trigger asthma attacks.
10) HORMONAL CHANGES: Thyroid hormone imbalance can aggravate asthma attacks. Progesterone hormone deficiency can aggravate asthma attacks in women.
11) EXERCISE: if any person suffering from asthma does exercise or runs without taking proper preventive measures then hyperventilation can occur because of exercise and leads to an asthma attack.
12) PREMATURE BIRTH: children who are born before 9 months are at increased risk of developing asthma because of poor lung development.
13) HIGH ALTITUDE: The oxygen level is low at high altitude and makes it difficult to breathe and can cause asthma attacks.
14) SMOKING: Smoking damages the lungs and decreases its ciliary movement and hence mucus clearance becomes more difficult. Smoking also damages lung cells and further damages occur.
15) ALCOHOL: Alcohol-induced gastritis can induce an asthma attack.
PATHOLOGY:
Activated eosinophils and T lymphocyte are found in the asthmatic airways and they can cause inflammation of the airway. Inflammation is more marked at the bronchi in the lungs.
Mucus plug which is formed by goblet cells can block the airway lumen and causes difficulty in breathing.
Airway hyperresponsiveness ( AHR ) which can occur due to eosinophils deposition in the airway causes inflammation which can lead to difficulty in breathing as airway response to allergen Is increased compared to the normal person.
Mast cells are known to produce bronchoconstriction when an allergen enters the hyperresponsive airway.
T Lymphocytes plays the most important role in recruiting eosinophils and mast cells in the airways.
Eosinophils can cause fibrosis of the basement membrane in asthmatics.
SIGNS AND SYMPTOMS:
The most common complaint with which asthmatic patient comes is difficulty in breathing.
Other complaints include :
Coughing which is mostly dry in nature because the mucus produced by goblet cells in asthmatics are sticky type and are not cough out easily.
Sometimes the patient feels breathless in the night time when sleeping and also breathing difficulty can occur after eating a heavy meal.
Some of the symptoms which a patient can feel just before the attack of asthma are :
1) Fear of death
2) Pain between the scapular region (on the back just below the neck)
3) Itching sensation near the chin.
Wheezing sound which is like whistling in nature can be heard while breathing in an asthmatic patient.
DIAGNOSIS
1) Blood test: it will show an increase in the eosinophil level.
2) Sputum test: sputum test will also show an increase in the eosinophil level.
3) X-Ray: can show hyperinflated lungs.
4) ECG: signs of right ventricular hypertrophy can be seen which includes :
Dominant R wave in V1 ( > 7 mm)
Dominant S wave in V5 ( > 7 mm)
Right axis deviation.
5) Spirometry: It is a test that is done to check the lung function. In asthmatic patients, the FORCED EXPIRATORY VOLUME IN ONE SECOND (FEV1) is reduced and FORCED VITAL CAPACITY ( FVC) is also reduced. PEAK EXPIRATORY FLOWis also reduced in asthmatics.
PREVENTION OF ASTHMA ATTACKS :
1) It is important to keep weight under control.
2) Avoid eating a heavy meal at once.
3) Avoid spicy or very cold foods or drinks.
4) Avoid dust or smoke which can start an asthma attack.
5) Don’t exercise or run at an extreme level as they can lead to an increase in oxygen demand by the body and this can lead to an asthma attack.
6) Always take medicines with doctor’s advice as many medicines are known to increase the chances of asthma attacks.
7) Avoid smoking and drinking as they can increase the chances of an asthma attack.
8) Avoid occupation in which the work is done around irritant gases or around too many dust particles.
9) Hormonal imbalance disease can lead to asthma attacks so its important to take proper treatment for these diseases.
10) Avoid going to hilly areas and polluted areas.
11) Pet hairs can start an asthma attack so if possible then try to avoid pets if suffering from asthma.
TREATMENT
Different types of medicines used for the treatment of asthma are available which are given according to patient compliance and disease stage :
SHORT ACTING ß2 agonist ( SABA ) such as albuterol or terbutaline.
LONG ACTING ß2 agonist ( LABA ) such as salmeterol or formoterol.
ANTICHOLINERGICS like ipratropium bromide or tiotropium bromide.
THEOPHYLLINE
INHALED CORTICOSTEROIDS
These are some of the medicines used for the treatment of asthma prescribed by doctor.
TAKE HOME MESSAGE: Asthma attacks can be controlled with proper medication and its important to visit the doctor if you have difficulty in breathing and take medicine as prescribed.
STAY HEALTHY AND FIT.
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