Asthma (Allergic and Non-Allergic)

Definition

Asthma is a disorder characterized by reversible narrowing (bronchospasm) and inflammation of the airways with subsequent shortness of breathing, tightness of the chest and wheezing. Depending upon the triggering factor asthma can be allergic or non-allergic. A wide variety of factors starting from exposure to pollens to depression can precipitate an attack of asthma.

Asthma is often associated with childhood and early life, but can persist throughout life. The condition affects the quality of life of the patient, interfering with sleep and daily functioning. In children it can even compromise growth and normal development. Fortunately there are various drugs now available for the treatment and long term management of asthma.

Symptoms

Some patients only suffer from mild bouts of shortness of breathing with long symptom-free intervals, whereas in others there is chronic breathing difficulty with frequent acute aggravation of symptoms.

  • Shortness of breath: increased with exercise or cold exposure.
  • Wheezing: It is the whistling sound produced during difficulty in breathing. Wheezing increases during early morning and night, exposure to cold air, exercise, emotional stress and rising stomach acid.
  • Cough: sputum may be present-as excess mucous secretion occurs in asthma.
  • Tightness of chest.

There are some very serios symptoms which requires immediate medical attention and urgent hospitalization. These warning signs include :

  • Bluish color of lips, nail bed
  • Drowsiness, confusion
  • Sudden temporary stoppage of breathing
  • Profuse sweating

Depending on the severity, availability of treatment and emergencyl management, asthma can lead to :

  • Death
  • Respiratory failure
  • Depression due to the poor quality of life
  • Growth retardation

Causes

Causes of asthma can be classified under two headings environmental (allergic asthma) and genetic. In most cases interplay of the two factors is responsible.

Environmental

  • Allergen: pollen, dust mite, mold, pet animals (hair, dander), food (peanut, sea fish, eggs and so on)
  • Exposure to cold air
  • Air pollutants (traffic)
  • Exercise
  • Tobacco smoke
  • Emotional stress
  • Drug induced: aspirin and other NSAIDs
  • Acidity (gastroesophageal reflux disease)
  • Preservatives added in food

Genetic

Asthma may run in the family along with allergic rhinitis and eczema. Usually a favorable genetic make-up for asthma along with favorable environmental factor produces asthma.

Risk factors

There are various risk factors making a person vulnerable to asthma :

  • Family history
  • Obesity (BMI>30)
  • Smoking (active and passive)
  • Excessive exposure to traffic pollutants
  • Occupational exposure to chemicals
  • Low birth weight, cesarean section delivery
  • Current hygiene practices prevent exposure of children to bacteria, viruses leading to decreased infection. This may increase the chance of development of asthma in children of developed countries.

Treatment

There is no cure for asthma but effective medication can improve the symptoms. The aim of treatment is prevent an attack and manage the symptoms during an acute episode.

Prevention of attack :

  • by avoiding precipitating factors
  • lifestyle modification (cessation of smoking)

Medication :

  • Steroids: Beclomethasone, budesonide, fluticasone (inhalational), prednisolone (oral).
  • Combination of inhalational steroids and long acting β agonists ( salmeterol and fluticasone).
  • Mast cell stabilizer namely cromolyn sodium.

Management of acute attack:

  • Short acting (bronchodialators): for immediate relief.
  • β agonists: Salbutamol, yurbutaline (via inhalers or nebulizer)
  • Anticholinergics: Ipratropium (inhaler)
  • Aminophylline: Theophylline (oral or injection)

Other measures :

  • Moist oxygen inhalation
  • Heliox inhalation (mixture of helium and oxygen)

Outcome of treatment is generally favorable in children as they usually outgrow the symptoms.

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