Asthma

During normal breathing, the muscles surrounding the airways are relaxed, allowing the air to move in and out of the lungs easily. During an asthma attack, the following three things can occur:

• Bronchospasm
  The muscles surrounding the airways tighten, following which the airways become narrow. Air can’t freely flow through the constricted airways.
• Inflammation
  The lining that covers the airways swells up. These inflamed airways don’t let air go in and out of the lungs.
• Mucus production
  During an asthmatic attack, the body produces more mucus. Clogging of airways occurs due to this thick mucus. When the airways become tighter, a sound called wheezing is produced. This noise is produced by the airways when you breathe out. An asthma attack is also known as an exacerbation or a flare-up.

Depending on the type of asthma and severity of its symptoms, it is classified into the following types:

• Intermittent
  This type of asthma comes and goes, therefore, you feel normal between the flares.
• Persistent
  Having persistent asthma means that your symptoms are present most of the time. The symptoms can be severe, moderate, or mild. The degree of severity of asthma depends on how often you experience the symptoms. How well you can function during an attack is also considered.

Causes of asthma

Following are the causes of asthma:

• Allergic asthma
  An asthma attack is caused by allergies in some people. Allergens include pollens, moulds, and pet dander.
• Non-allergic asthma
  External factors can also result in asthma flare up. Stress, exercise, adverse weather, and illness may also cause a flare.

Asthma can also be:

• Adult-onset asthma
  This type of asthma starts after the age of 18.
• Paediatric asthma
  This type of asthma is also called paediatric asthma. It often starts before the age of 5 and can affect toddlers and infants. Children may sometimes outgrow asthma. You must talk to your healthcare provider to know if your child needs an inhaler when they experience an asthma attack.

Apart from the ones mentioned above, following are three more types of asthma:

• Exercise-induced asthma
  This type of asthma is triggered by exercise. It is also known as exercise-induced bronchospasm.
• Occupational asthma
  This type of asthma develops mostly in people who work around irritating substances.
• Asthma-COPD overlap syndrome (ACOS)
  This type of asthma develops when you have both chronic obstructive pulmonary disease and asthma. Both these conditions make breathing challenging for the patient.

Asthma can affect any individual at any age. Individuals who have allergies or who are exposed to tobacco smoke are more likely to develop asthma. This includes secondhand and thirdhand smoke. Females are more susceptible to developing asthma than males.

The exact cause of asthma is unknown. However, your chances of the developing the disease is increased for you have certain risk factors:

• Allergies
  If you have allergies, your risk of having asthma is increased.
• Environmental factors
  Exposure to certain environmental factors that results in airway irritation can lead to the development of asthma. These factors include allergens, toxins, fumes, and secondhand or thirdhand smoke. These factors are more harmful to young children and infants whose immune system has not completely formed.
• Genetics
  If you have a family history of asthma or allergic diseases, you are at a higher risk of developing asthma yourself.
• Respiratory infections
  Your children’s developing lungs can be damaged by certain respiratory infections like respiratory syncytial virus infection.

Your asthma attack can be triggered if you come in contact with certain irritative agents. These substances are known as “triggers”. Avoiding asthma attacks will be easier if you know your triggers.

A trigger can bring on an attack right away from some people. At other times, it may take hours or days for an attack to start.

While triggers are different for each person, some of those include the following:

• Air pollution
  An asthma attack can be caused by many external factors. Air pollution includes car exhaust, factory emissions, wildfire smoke, and more.
• Dust mites
  These bugs are not easily seen but they are all around us. An asthma attack may be triggered if you have a dust mite allergy.
• Exercise
  Exercising can give risk to an asthma attack in some people.
• Mould
  Mould can be spawned by damp places, which can lead to problems if you have asthma. You don’t even need to be allergic to mould if you have an attack.
• Pests
  Mice, cockroaches, and other household pests can trigger asthma attacks.
• Pets
  Asthma attacks can be triggered in some people by exposure to pets. If you are allergic to pet dander, breathing those flakes in can cause airway irritation.
• Tobacco smoke
  You are at a higher risk of developing asthma if you or someone at your home smokes. The best you can do is to quit smoking.
• Strong chemicals or smells
  Strong smells and chemicals can also trigger asthma attacks in some people.
• Certain occupational exposures
  You can be exposed to a lot of things at your workplace including dust from flour or wood, cleaning products, or other chemicals. These are all potential
triggers of asthma.

Asthma patients usually have very obvious symptoms. Some of these signs and symptoms resemble other respiratory infections including coughing, chest tightness, pressure, or pain, wheezing, and shortness of breath. If you have chronic asthma, you can have different signs and symptoms at different times. The symptoms can sometimes change between asthma attacks.

Your medical history will be reviewed by your healthcare provider, including information regarding your siblings and parents. Your healthcare provider will also inquire about your symptoms including any history of allergy, lung diseases, or skin problems.

A spirometry test may be ordered by your healthcare provider. This test is used to measure airflow through the lungs and is used to detect and monitor your response to treatment. Your doctor may order a blood test, chest X-ray, or skin test.

Many treatment options are available to help manage asthma. Your doctor may prescribe certain medications to keep the symptoms under control. Those include medications to keep the muscles of your airways relaxed and dilated, medications that reduce inflammation, and biologic therapies for asthma. The medications for asthma can be taken in several different ways. You may breathe those with the help of a metered-dose inhaler or any other type of asthma inhaler. Certain oral medications may also be prescribed.

Asthma medications can be taken in several different ways. You may be given the medications through a metered-dose inhaler, nebulizer, or any other type of asthma inhaler. Your doctor may also prescribe oral medications so that you can take those easily by swallowing.

Achieving a control on your symptoms is the main goal of asthma treatment. Control over your asthma means that you:

• Have no (or minimal) asthma symptoms.
• Perform activities that you want to do at home and work.
• Sleep without asthma interrupting your rest.
• Rarely need to use your reliever medicine (rescue inhaler).

It is best to keep track of your asthma symptoms as it helps to manage the disease effectively. Your doctor may recommend you to use a peak flow (PF) metre. It is a device used to measure how fast you can blow air out of the lungs. It can help your doctor make some adjustments to your medications. It also helps determine if your symptoms are worsening.

If you have been diagnosed with asthma, you must know what triggers your attacks. You can avoid asthma attacks if you avoid your triggers. However, you can’t prevent yourself from getting asthma.

You can still live a very productive life and participate in activities like sports if you have asthma. Your doctor can help you manage your symptoms, manage or prevent attacks, and learn your triggers.

Your doctor will work with you so that a suitable asthma action plan can be developed. This plan will help you understand how and when you should use your medicines. It also help you determine what you should do based on your asthma symptoms and when to seek emergency medical care and attention.

If you have a severe attack of asthma, you should seek immediate medical care. However, the first thing to do is to use your rescue inhaler. It will help open up your airways by releasing certain fast-acting medicines. Your rescue inhaler is different from the maintenance inhaler that you use everyday. The rescue inhaler is reserved for use for when your symptoms are bothering you. You will need to use it more frequently if your asthma flare ups are severe.

If you don’t have a rescue inhaler with you or you have one but it fails to help you, you must go to the emergency department if you experience:

• Panic or anxiety.
• Chest pain or pressure.
• Bluish lips, fingernails, or whitish or grey lips or gums.
• Coughing that won’t stop or severe wheezing while breathing.
• Pale, sweaty face.
• Difficulty talking.
• Rapid or very quick breathing.

Asthma that tends to worsen at night is sometimes known as nocturnal or nighttime asthma. There are no known reasons for this condition, however some things that can trigger this include:

• The way you sleep
  If you sleep on your back, you can have mucus dripping into your throat or reflux of acid into the stomach. Sleeping on your back also exerts pressure on your lungs and chest, making breathing more challenging. Lying down or on your side can also exert pressure on your lungs.
• Triggers in your bedroom and triggers that happen in the evening
  If you have stayed outside in the early evening, you may have brought pollen in with you. You may also find your sheets, blankets, and pillows having mould, mites, pet hair, or dust on them.
• Side effects of medication
  Some medications used to treat asthma such as steroids can adversely affect your sleeping pattern.
• Air that’s too cold or too hot
  Hot air can cause narrowing of the airways if you breathe in. For some people, cold air is also an asthma trigger.
• Lung function changes
  It is a natural process for lung function to lessen at night.
• Asthma is poorly controlled during daytime
  Asthma symptoms that are not controlled well during the day won’t become better during the night. You must work with your healthcare provider to ensure that your symptoms are under control both during the day and night. It is very important to seek treatment for nighttime symptoms. At night, serious asthma attacks and even death can occur.

If you are suffering from moderate to severe asthma or your asthma symptoms are not well controlled, you are at an increased risk of having to get hospitalised if you develop COVID-19. You should, therefore, wear a mask and take extra precautions.

Many people with asthma live with a normal and fulfilled liver. Some professional athletes who have asthma have even set records in their professional lives. Consult the best pulmonologists in Indore to help manage your asthma symptoms.

The Department of Pulmonary Medicine at Kokilaben Dhirubhai Ambani Hospital, Indore, offers comprehensive diagnostic and therapeutic care for a diverse range of pulmonological diseases. Our services include endoscopic ultrasound, endo bronchial ultrasound, endobronchial brachytherapy, innovative therapeutic techniques, bronchial thermoplasty and surgical interventions like video-assisted thoracoscopic surgery and lung volume reduction. Consult our team of highly qualified pulmonologists for the best asthma care in Indore.

Apart from having a fully-equipped Bronchoscopy suite with C-arm facilities, we house a state-of-the-art PFT machine. Our focus is on ensuring the speedy recovery of the patient and helping him return to normal activities of daily life as soon as possible.