Healthplus With Dr Hanna (MBBS, MRCS): All You Need To Know About Asthma

 

Are you always struggling to breathe whenever you come into contact with dust and mite? Do you have any family history of asthma or do you know someone with asthma?

 

Today’s article is for your learning and also for you to educate others.

 

Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness. 

 

People present differently with varying severity but the good thing aboutAsthma is that it can be controlled well in most people most of the time, although some people may have more persistent problems.

 

Occasionally, asthma symptoms can be mild or suddenly get worse. This is known as an "asthma attack", although doctors sometimes use the term "exacerbation". 

 

Severe attacks may require hospital treatment and can be life threatening, although this is unusual.

 

To be honest I don’t know if there is a well-structured pathway for asthma people in Nigeria but I recommend a good hospital if you have asthma or know someone with asthma.

 

Prevention is better than cure and the first step in preventing  any disease is the knowledge about the disease.

 

What causes asthma?

Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs. If you have asthma, the bronchi will be inflamed and more sensitive than normal. 

 

When you come into contact with something that irritates your lungs – known as a trigger – your airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).

Asthma symptoms can have a range of triggers, such as:

•respiratory tract infections – particularly infections affecting the upper airways, such as colds and the flu 

•allergens – including pollen, dust mites, animal fur or feathers 

•airborne irritants – including cigarette smoke, chemical fumes and atmospheric pollution 

•medicines – particularly the class of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), which includes aspirin and ibuprofen, and beta-blockers sometimes given for high blood pressure or some types of heart disease 

•emotions – including stress or laughing 

•foods containing sulphites – naturally occurring substances found in some food and drinks, such as concentrated fruit juice, jam, prawns and many processed or pre-cooked meals 

•weather conditions – including a sudden change in temperature, cold air, windy days, thunderstorms, poor air quality and hot, humid days 

•indoor conditions – including mould or damp, house dust mites and chemicals in carpets and flooring materials 

•exercise 

•food allergies – including allergies to nuts or other food items Asthma may also be triggered by substances (allergens or chemicals) inhaled while at work. In summary find out what triggers your asthma and avoid contact with it.

 

In some cases, asthma is associated with occupation. This is known as "occupational asthma", where people who work at a certain places are exposed to some irritant that triggers off asthma. Such occupational asthma can be seen in people dealing with:

•isocyanates (chemicals often found in spray paint) 

•flour and grain dust 

•colophony (a substance often found in solder fumes) 

•latex 

•animals 

•wood dust

The reason why some people develop asthma is not fully understood, although it is known that you are more likely to develop it if you have a family history of the condition. 

 

Symptoms of asthma 

The symptom of asthma sometimes depends on its severity and it could range from mild to severe.

The main symptoms of asthma are: 

•wheezing (a whistling sound when you breathe) 

•shortness of breath 

•a tight chest – which may feel like a band is tightening around it  

 

•coughing 

These symptoms are often worse at night and early in the morning, particularly if the condition is not well controlled. They may also develop or become worse in response to a certain trigger, such as exercise or exposure to an allergen. 

 

Asthma attacks

When the above mentioned symptoms become worse its called asthma attack or "acute asthma exacerbation" by the physicians. Remember this is not the time to look for the nearest chemist or the nurse next door. It is an emergency and needs to be treated in a good hospital.

If you are already taking inhalers, during an asthma attack, it may not work despite maximum usage hence the need to be rushed to hospital.

Asthma attacks often develop slowly, sometimes taking a couple of days or more to become serious, although some people with asthma are prone to sudden, unexpected severe attacks. It is important to recognise attacks early and take appropriate action.

 

Signs of a particularly severe asthma attack can include:

•your reliever inhaler (which is usually blue) is not helping symptoms as much as usual, or at all 

•wheezing, coughing and chest tightness becoming severe and constant 

•being too breathless to eat, speak or sleep 

•breathing faster 

•a rapid heartbeat 

•feeling drowsy, exhausted or dizzy 

•your lips or fingers turning blue (cyanosis) 

These signs are very serious and ignoring it could Respiratory Failure and DEATH.

 

Diagnosis

Diagnosis is made by the physicians or general practitioners. I know many people in Nigeria rely on their local chemist or their nurse or lab scientist friend which is quite unfortunate as they cannot afford a better medical care. This should not be the case because asthma if properly diagnosed early can be well treated and well managed.

 

Spirometry

A breathing test called spirometry will often be carried out to assess how well your lungs work. This involves taking a deep breath and exhaling as fast as you can through a mouthpiece attached to a machine called a spirometer. 

 

I will not go into the technicality of this test as it is reserved for your doctor to explain how it works when you are doing the test. Its interpretation is also reserved for the physician hence the need to make sure you go and seek the right medical attention. Not all doctors are trained to this test even though with their basic medical knowledge understands this example I don’t expect a gynaecologist or a psychiatrist to dabble in this.

 

Sometimes an initial set of measurements is taken, and you are then given a medicine to open up your airways (a reliever inhaler) to see if this improves your breathing when another reading is taken. 

 

This is known as reversibility testing, and it can be useful in distinguishing asthma from other lung conditions, such as chronic obstructive pulmonary disease (COPD)- this will be discussed later.

 

Peak expiratory flow test

This is a small hand-held device that can be used to measure how fast you can blow air out of your lungs in one breath. This is your peak expiratory flow (PEF) and the test is usually called a peak flow test. 

 

This test requires a bit of practise to get it right, so your doctor or respiratory nurse (a nurse trained in respiratory diseases) will show you how to do it and may suggest you take the best of two or three readings.

 

You may be given a peak flow meter to take home and a diary to record measurements of your peak flow over a period of weeks. This is because asthma is variable and your lung function may change throughout the day. 

 

Your diary may also have a space to record your symptoms. This helps to diagnose asthma and, once diagnosed, will help you recognise when your asthma is getting worse and aid decisions about what action to take.

 

Other tests

Some people may also need a number of more specialised tests. The tests may confirm the diagnosis of asthma or help diagnose a different condition. This will help you and your doctor to plan your treatment.

 

• Airways responsiveness.

This test is sometimes used to diagnose asthma when the diagnosis is not clear from the more simple tests discussed above. It measures how your airways react when they come into contact with a trigger. 

 

• Testing airway inflammation

It may also be useful in some cases to carry out tests to check for inflammation in your airways. This can be done in two main ways:

-A mucus sample – the doctor may take a sample of mucus (phlegm) so it can be tested for signs of inflammation in the airways 

-Nitric oxide concentration – as you breathe out, the level of nitric oxide in your breath is measured using a special machine; a high level of nitric oxide can be a sign of airway inflammation 

 

• Allergy tests

Skin testing or a blood test can be used to confirm whether your asthma is associated with specific allergies, such as dust mites, pollen or foods.

 

Treatment

Asthma is not a sentence to death or something to be scared about. Anyone with asthma should be able to lead a full and unrestricted life. The treatments are effective in most people and should enable you to keep the condition under control.

 

Treatment is based on two important goals, which are:

•relieving symptoms  

 

•preventing future symptoms and attacks

 

Inhalers

There are two types of Inhalers. Those used to relieve asthma and those used to prevent asthma. Inhalers are used because they introduce the medication straight to the lungs where they directly act and relieve symptoms.

 

This is an effective way of taking an asthma medicine as most goes straight to the lungs, with very little ending up elsewhere in the body.

You should have training from your doctor on how to use your device or how to help your child use theirs. This should be checked at least once a year.

 

Some inhalers are pressurised canisters – similar to a spray deodorant or an air freshener. You press the inhaler while breathing in, so the vapour containing the medication can pass into your lungs.

 

Some inhalers are not pressurised canisters but contain the medication in dry powder form, usually in a capsule that is punctured when the inhaler is "primed". 

Reliever inhalers – usually blue – are taken to relieve asthma symptoms quickly. 

 

The inhaler usually contains a medicine called a short-acting beta2-agonist, which works by relaxing the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. 

 

Reliever inhalers do not reduce the inflammation in the airways, so they do not make asthma better in the long term – they are intended only for the relief of symptoms.

Example of a reliever Inhaler is Salbutamol and Terbutaline inhalers.

 

Preventer inhalers – usually brown, red or orange – work over time to reduce the amount of inflammation and sensitivity of the airways, and reduce the chances of asthma attacks occurring. 

 

They must be used regularly (typically twice or occasionally once daily) and indefinitely to keep asthma under control.

 

You will need to use the preventer inhaler daily for some time before you gain the full benefit. You may still occasionally need the blue reliever inhaler to relieve your symptoms, but your treatment should be reviewed if you continue to need them often.

 

The preventer inhaler usually contains a medicine called an inhaled corticosteroid. Examples of preventer medicines include Beclometasone, Budesonide, Fluticasone, Ciclesonide and Mometasone

 

 

Spacers

Pressurised canister inhalers can work better if given through a spacer – a hollow plastic or metal container with a mouthpiece at one end and a hole for the inhaler at the other. 

 

Children under the age of three may have a spacer attached to a face mask rather than a mouthpiece, as this can make it easier for them to breathe in the medicine.

 

When using a spacer, the vapour from the inhaler is released into the container, where it is held while you breathe in slowly and progressively until your lungs are full. You should then hold in your breath before relaxing so the vapour has time to settle in your lungs. 

 

This can make the medication more effective because much more of it reaches your lungs and much less stays in your mouth or is swallowed, where it has no effect on your lungs but is more likely to cause possible unwanted effects. 

 

Spacers are also good for reducing t he risk of thrush in the mouth or throat, which can be a side effect of some inhaled asthma preventer medicines.

Spacers can also be very helpful for people who find using inhalers difficult, such as young children. 

 

In general, you should have a personal asthma action plan agreed with your doctor or respiratory nurse that includes information about the medicines you need to take, how to recognise when your symptoms are getting worse, and what steps to take when they do so.

 

Remember IGNORANCE KILLS MORE THAN ANY DISEASE KNOWN TO MANKIND.

Get yourself checked and treated and live a fulfilled life.

See you next week.