ASTHMA: Reversible Narrowing of Airway

title with a baby girl taking inhaler

Asthma is a common chronic reversible airway disease which is episodic in nature and usually develops at an early age. When the airway i.e. windpipe becomes inflamed, edematous due to either triggering substances or neurogenic mechanism, the patient experienced shortness of breathing, coughing, wheezing, because of the narrowing of the airway. This is known as asthma. 
The prevalence of asthma is increasing day by day, especially in developed and developing country. The socio-economic impact of Asthma is enormous, as poor control or acute attack leads to unwanted leaves from school or work as well as unavoidable health care visit or even hospital admission.

Causes of Asthma:

Although the etiology of asthma is not well known, genetic and some environmental factors have influences over the asthma attack.
In many individuals, there is a clear relationship between asthma and allergen exposure.
The common example of allergens includes house dust, mites, pets such as cats & dogs, pests such as cockroaches, fungi, pollen.
Presence of other allergic diseases like eczema, rhinosinusitis, nasal polyp may exacerbate the disease.
Sometimes occupational exposure to fumes, dust, chemical precipitates asthma attack, which is known as occupational asthma.
In some cases, Asthma is triggered by medications, like Beta-blockers, aspirin, NSAIDs (Non-steroidal anti-inflammatory drugs), oral contraceptive pill, cholinergic agents and prostaglandin F2∝.

Clinical Presentation:

Typically the patient present with episodes of a recurrent cough, breathlessness, chest tightness wheezing particularly at late night and early morning.
Classical precipitants include exercise, particularly in cold weather. Even loud laughing may exacerbate the condition.
Some conditions like obesity, Gastro-esophageal reflux disease (GERD), sinusitis, obstructive sleep apnoea make asthma control more troublesome.
visible illustration of airway of asthma patient

Diagnosis:

Diagnosis of asthma is predominantly clinical, associated with characteristic history. But some investigations are available for diagnosis of the disease.
Spirometry is done to identify the obstructive defects & severity of the disease.
Peak flowmetry is also an option for the diagnosis of the disease.
In some patients, lung function tests are found normal, then challenge test is performed.
Other options for the diagnosis of the disease-
  • Chest X-ray.
  • Measurement of allergic status.
  • Assessment of eosinophilic airway inflammation.

Treatment:

Asthma is a non-curable disease. The goal of the treatment is to control the symptoms and prevent the exaggerations. The drugs are also classified into 2 categories-
  1. Controlled drugs: to prevent the acute attack.
  2. Reliever drugs: to relieve the symptoms.

Prevention:

As it is not a curable disease, prevention is the best possible option.
Although there is no control over genetic susceptibility, avoiding the precipitating factors is the way of prevention of acute attack.
Taking the drugs regularly, according to the physician and carrying the inhaler with you so that whenever breathlessness occurs, you can use it and prevent the acute exacerbation.
Communicates with your doctor, if your disease is not controlled by following your doctors advice.
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