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  Asthma

july 2010
Defend Yourself From Asthma
Dr Rajeeva Moger
 
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. The predominant feature of asthma is episodic shortness of breath, particularly at night or in the early morning, often accompanied by cough and wheezing.

How does asthma affect breathing?
Asthma causes a narrowing of the breathing airways, which interferes with the normal movement of air in and out of the lungs. Asthma involves only the bronchial tubes and does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors:
  1. Inflammation: The most important factor causing narrowing of the bronchial tubes is inflammation. The bronchial tubes become red, irritated, and swollen. This inflammation occurs due to release of chemical mediators in response to an allergen or irritant and results in thickening of the walls of the bronchial tubes and narrow airways.
  2. Bronchospasm: The smooth muscles of the bronchii could contract painfully and involuntarily, as a response to multiple chemical mediators. This condition is largely reversible by bronchodilators though.
  3. Hyperreactivity: In patients with asthma, the airways become highly sensitive (hyper-responsiveness) to triggers such as allergens, irritants, and infections.
Developing Asthma
There are situations within ourselves, called endogenous factors, which help develop asthma. Some things you can change, some things you can’t – but it is good to be aware of them.
  1. Genetic predisposition to have asthma has been well documented. There is a 30 percent chance of the child having asthma if one parent is asthmatic - and 70 percent chance if both parents are.
  2. Atopy, or allergic hypersensitivity affecting parts of the body not in direct contact with the allergen, is also a culprit.
  3. Hyper-responsive airways in some people put them at a higher risk.
  4. Obese people are more likely to have asthma.
  5. Sex: In childhood, asthma is twice more common in boys than in girls. In adults the prevalence of asthma is more in women though.
7 Environmental factors
Even when you could be thus disposed to have asthma, triggers from the environment usually kick it in.
  1. Allergens –both the indoor and outdoor variety
  2. Infections
  3. Exercise and cold air
  4. Smoking
  5. Stress
  6. Irritants like household sprays, paint fumes, etc.
  7. Occupational sensitisers
How is asthma diagnosed?
The demonstration of airflow limitation and its reversibility aids in the confirmation of the diagnosis. The characteristic symptoms are:
  1. Episodic breathing difficulty
  2. Chest tightness
  3. Cough and wheezing
Appearance of symptoms on exposure to potential environmental triggers and a confirmatory family history are helpful in making the diagnosis. In some patients, particularly in children, longstanding cough may be the predominant feature, known as cough variant asthma.

Treatment
The goal of asthma treatment is to achieve and maintain good control over the illness. There are two types medicines for asthma – those which prevent asthma attacks are called as controllers and those that give relief during an attack of asthma are called as relievers.
  • Controllers are to be taken daily on a long term basis to keep asthma under control. Inhaled corticosteroids are the most effective controllers currently available.
  • Relievers are used on an ‘as-needed’ basis to get quick relief from symptoms. Rapid acting Beta 2 Agonists are the medications of choice for relief. Other medicines used in the treatment of asthma include Leucotriene modifiers, Theophilline, anticholinergics and cromones.
  • Asthma treatment can be administered in different ways – inhalation, orally or by injections. The advantage of inhalations is that the drugs are delivered directly into the airways, producing higher local concentrations with significantly less side effects. Inhaled medications for asthma are available as pressurised Metered Dose Inhalers (MDIs), breath actuated inhalers, dry powder inhalers (DPI), soft mist inhalers and nebulisers.
  • There is another treatment option which is so smart that even its acrostic is called SMART (Single Maintenance and Reliever Therapy). This is a combination of glucocorticoid with a rapid and long acting Beta 2 Agonist, which can be used both as a controller and reliever medication.
Dr. Rajeeva Moger is Consultant Physician at Apollo Hospitals, Bengaluru
 


    
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