Asthma

What is Asthma?

Asthma is a disease that makes the lungs over-sensitive, causing many bothersome symptoms that occur in attacks with intervals during which a patient might appear completely normal.  The lungs are responsible for ventilating the blood, for that purpose large quantities of air enter and leave the lungs every minute. Sometimes irritating material enters with the air .This material is unwanted because it is useless to the body and can be dangerous, so the lungs have a natural defense mechanism: coughing starts in an attempt to expel this material. Mucus is also produced in large quantities to lubricate the airways so any material can be “washed out”. Those ways the lungs are able to expose our blood to the air while at the same time protect us from the harmful substances in that air.
From that we gather that the coughing and mucus production is NORMAL in response to irritants. In asthma, this normal protective response is EXAGGERATED, leading to frequent over-reaction by the lungs in response to certain stimuli.

Causes of Asthma:

There are 2 types of Asthma depending on the causes;

1. Extrinsic asthma: Occurs in younger patients , it is usually caused by exposure to    “allergens”, and it is associated with a genetic predisposition (family history ,either of asthma or other “atopies” like eczema  and hay fever)
   
2. Intrinsic asthma: Occurs in older patients, it is usually not related to allergy or family history. 
   Although the exact cause of asthma is not understood, the first type is closely related to allergy; sometimes treating the allergy will cure the disease.

Both types of asthma happen in the form of ATTACKS that are precipitated by TRIGGERS. The concept of triggers is important, because avoiding the triggers can decrease frequency of attacks. Such triggers include: cigarette smoke, cold weather, dust, pollen, aerosol, exercise, anxiety and allergies.

Symptoms of Asthma:

1. Coughing is a common early symptom, usually productive cough producing copious mucus.
   
2. Wheezing: A well recognized feature, it is the whistling, musical sound that occurs when the patient breathes against narrow airways in the lung.
   
3. Breathlessness: A patient grows gradually more out of breath; breathing gradually becomes more difficult, heavy and painful.
4. These are the typical complaints in an asthma attack. If they are not treated in a timely manner they could progress to;
   Cyanosis: the face turns bluish because the blood is not oxygenated properly (dangerous sign)
   Agitation: the patient becomes frantic as the need of air (air hunger) increases.
   Apnea:  The respiratory drive eventually fails, and the breaths become less frequent     and might stop altogether.
   Loss of consciousness: the patient passes out from too little oxygen delivered to the brain. Finally:
   Heart arrest and death.

Prevention of Asthma:

Prevention is important in asthma because it improves quality of life and reduces the cost of drug treatment and medical intervention.

1. In established allergies, avoiding the allergens like pet fur, house dust, aerosol like insecticides and perfumes, food like peanuts and shellfish etc.
   
2. U.V. treatment of bed covers and carpets can kill MITES which are small insects that cause the house dust to be allergenic. UV treatment can be done with special equipment like UV lamps, or simply by exposure to the sun.
   
3. Avoiding heavy exertion when medicine is not at hand.
   
4. Protection from excessive cold temperature.
   
5. Good hydration at all times helps by making the excess secretions in the lungs of asthmatics more liquid and less viscid.
   
6. Use of protective medicine like steroid inhalers, which prevent the attacks from happening but are ineffective once the attack begins.
   
7. Self education about asthma triggers and treatment and emergencies.

Treatment of Asthma:

There are 2 aspects of drug treatment in asthma: preventing the attacks and reversing the established attack.

1. Drug prevention :
   a. Immunotherapy and hyposensitization:  Allergens are foreign substances that precipitate allergy in the body. Asthma might be a response to exposure to allergens. In that case , immunotherapy is directed at decreasing the body’s reaction to allergens  by a technique known as “hyposensitization” where the essence of various allergens are injected into the body by the treating physician in small amounts  ,that only result in minor reactions in the body . The amounts are gradually increased over weeks and months until the patient is able to withstand a large exposure to the allergens without developing an asthma attack. Obviously this will only work with type 1 asthma.
   b. Steroids:  Steroids are compounds that occur naturally in the body that are involved with inflammatory regulation in the body. It has been proven that taking small amounts of steroids every day (glucocorticoids, not the type abused by performance enhancers, those are androgen steroids) will prevent asthma attacks or at least decrease the severity of the attack. However steroids have drastic effects on the body if taken for prolonged periods, like gastric ulcers and thinning of bones. That is why steroid INHALERS are used. Inhalers contain small doses of steroid that are delivered as an AEROSOL that can be inhaled and will only produce it’s effect  LOCALLY on the lungs ,with minimal effects on the rest of the body.Regular intake of these steroids can be very helpful in controlling asthma symptoms.
   
2. Drug Treatments: The drugs used to control an attack of asthma, like:

                        a. Bronchodilators: They are medicines that widen the airways. They can be given as inhalers, syrup, tablets or for the optimal effect, in a NEBULIZER (a nebulizer is a machine that produces a fine mist of the medicine that can be breathed in by the patient producing a rapid effect). Examples of inhalers include Ventolin, Serevent etc.
                        b. Steroids: In large doses, steroids can be given as either injections or tablets to control severe asthma symptoms. E.g. Prednisolone.
                        c. Phosphodiesterase inhibitors: Like Theophylline can be given as adjunct in severe asthma in either injection form or tablets. They act by dilating the airways and also by boosting the breathing effort.
                        d. Mucolytic drugs: Function by decreasing the viscidity of the mucus blocking the airways, they can be given either as aerosol or syrup or tablets, like L-cysteine and Bromohexine.

Spacers: 

Spacers are accessories to inhalers that are useful when it is difficult to learn to use the inhaler in asthma patients, as in little children and older people. Inhalers require timing the inhalation phase of breathing with the release of the aerosol, which can be difficult to learn leading to the patient not benefiting from treatment. The spacer is a big mouthpiece that can be fitted to the mouthpiece of the inhaler and used to cover the whole face. There is no need to time the breathing with the press of the inhaler, the aerosol is released into the spacer and the patient can breathe it in at their own leisure.

Home remedies for Asthma:

1. Water: Drinking a lot of water will keep the secretions in the lung moist and this will decrease the cough severity and frequency and will decrease breathlessness.
   
2. Tea: Contains the substance theophylline which is used as a drug in treatment of asthma. Also the caffeine helps the respiratory effort.
   
3. Honey: Eating honey regularly might gradually heal asthma related to pollen allergy!
   However the honey must be produced by bee keepers in the same area the patient lives in, so that the allergens in the honey are similar to the pollen the patient is exposed to in the environment at home and work. This is similar to the hyposensitization technique described above.

When to see the Doctor? 

1. The doctor should be visited regularly so he can measure the lung functions through SPIROMETRY tests, like Peak Flow Rate. The latter is a test where the patient breathes forcefully through a tube connected to a device that calculates the speed of the air leaving the patients lung, which indicates how much obstruction there is in the lungs. Successive measurements are useful to measure response to treatment.
2. Whenever the symptoms do not respond to the maintenance therapy (for example steroid inhaler and bronchodilator inhaler) medical advice should be sought expeditiously, before the symptoms develop to a full blown attack.
3. Any NEW symptoms should be promptly reported to the doctor because they might indicate medicine side effects or underlying disease.