A Guide To Asthma

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What is Asthma?

Asthma is one the most common chronic lung conditions. It affects the bronchioles, which are the smallest airways in the lungs, causing them to narrow even more. This narrowing is reversible and temporary, and it causes the typical symptoms of asthma, such as coughing, wheezing, and shortness of breath.

Asthma is more common during childhood, but it can start at any age and in some cases, it continues through to adulthood. It can also run in some families. Currently there is no cure for asthma, but there are many ongoing clinical trials focusing on asthma treatments.

What Causes Asthma?

The exact cause of asthma hasn’t been discovered, but it is known to be the result of different environmental and genetic factors. Some of these factors include:

  • Environmental
    There are many environmental factors that play a role in the development of asthma, such as air pollution, presence of allergens, mold, and dust mites. Overall air quality greatly affects the incidence of asthma.
  • Infectious diseases
    Infections, such as the one caused by the respiratory syncytial virus, can increase the risk of developing asthma.
  • Genetics
    Although asthma is not a hereditary condition, certain genes have been found to be implicated in the disease. It is likely that asthma is caused by the combination of the expression of these genes and the presence of certain environmental factors.
  • Medications
    Certain drugs, such as aspirin and beta blockers, can trigger asthma attacks in some people.
  • Animals
    Pets, or animal fur or feathers, can trigger an attack in certain patients.

During an asthma attack, certain triggers cause excessive inflammation in the bronchioles, which in turn causes the airways to narrow and to produce more secretions or mucus. The combination of narrowed bronchioles and secretions block the airway, which makes it harder to breathe properly. Much clinical research is ongoing to not only further understand the cause of asthma, but also how to treat an asthma attack.

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How is Asthma Diagnosed?

First, the doctor must examine the patient and their medical history. Certain symptoms, such as shortness of breath (dyspnea), coughing, wheezing, and chest tightness, will point to an asthma diagnosis. After this, a procedure called spirometry will be carried out to confirm the diagnosis.

During a spirometry, the patient will be asked to blow air into a device called spirometer, and said device will deliver certain results which will allow the doctor to classify the patient’s symptoms according to severity. A spirometry measures:

  • Forced Expiratory Volume in One Second or FEV1
    This represents the total amount of air that you can blow out in one minute.
  • Forced Vital Capacity or FVC:
    The total amount of air that you can exhale in one breath.

A peak flow meter can also be used to measure your breathing capacity. It is a small device and it is recommended that every asthma patient own one, so that they can measure their peak expiratory flow rate or PEFR, which will allow them to know the degree of obstruction in their airways at any given point in time.

Using data such as the frequency of symptoms, how often they occur during the night, FEV1 and its variability, and how often medications need to be used, asthma is classified as intermittent, mild persistent, moderate persistent, and severe persistent. It can also be classified as extrinsic or intrinsic depending on whether the symptoms are triggered by allergens or not, respectively.

Treating Asthma

There isn’t a permanent cure for asthma, however, different medications can be used to improve the symptoms it causes. Patients usually receive certain types of drugs to treat acute episodes, and different ones to decrease or prevent attacks in the long term. Some of these medications include:

Fast Acting Drugs:

  • Short-acting beta2-adrenoceptor agonists (SABA): these drugs represent the first choice of treatment for acute asthma symptoms, and they include salbutamol, bitolterol, fenoterol,levosalbutamol, and orciprenaline.
  • Anticholinergics: can be used in conjunction with SABA to strengthen their effects, or alone in people allergic to them. The most used anticholinergic is ipratropium bromide.
  • During severe attacks, inhaled epinephrine is sometimes used.

Long-Term Management:

  • Corticosteroids are commonly used to control asthma. Inhaled corticosteroids are preferred, such as beclomethasone, budesonide, and fluticasone.
  • Long-acting beta-adrenoceptor agonists (LABA) can be used together with corticosteroids, and they are not used alone frequently. They include formoterol and salmeterol.
  • Leukotriene receptor antagonists can be added to the long-term treatment of mild or moderate asthma. They include montelukast and zafirlukast.

Monoclonal Antibody Therapy:

Medications such as omalizumab, mepolizumab, and reslizumab have been approved for use in teenagers and adults with severe asthma, and they have been found to reduce the use of corticosteroids by up to 50%.

Bronchial Thermoplasty:

This procedure involves the delivery of thermal energy to the airway wall during a series of bronchoscopy procedures. Symptoms might be exacerbated during the first months after therapy, but they seem to decrease afterwards.

Asthma Clinical Trials

Considering the fact that asthma affects a large number of people, it is only natural for doctors and scientists to want to discover new ways to treat this condition and improve the quality of life of those who suffer from it.

Asthma clinical trials aim to understand the causes of asthma, and to test out new medications and even lifestyle and dietary changes to treat the disease.

Joining a clinical trial provides patients a greater control over their health, and gives them access to healthcare provided by teams of experts in their fields. Trials are carried out in universities, hospitals, and research centers. If you are interested in joining a clinical trial to find new ways to manage your asthma, ask your doctor about clinical trials in your area or contact one of the following organizations to find out more:

Lifestyle Changes

  • Recognize what triggers your symptoms, so that you can avoid the situations or substances which can lead to an attack, or take the necessary precautions, such as premedicating, to manage or prevent your symptoms.
  • Avoid smoke inhalation and exposure to substances or chemicals with strong smells.
  • Maintain a healthy lifestyle and lose excess weight. Certain food preservatives can trigger symptoms, so it is helpful to consume fresh, healthy foods.
  • Practice exercise within your limits. Physical activity helps keep asthma symptoms at bay, since it improves your aerobic capacity.
  • Keep your asthma medication with you and be prepared for acute attacks.

Tips for Friends and Family

  • Don’t discourage your loved one from enjoying physical activities and sports.
  • Don’t smoke or use strong-smelling substances around your loved one.
  • Help maintain a clean environment which is allergen-free.
  • Get flu shots to ensure herd immunity and avoid infectious diseases which could trigger acute episodes.
  • Know when to seek emergency care for your loved one.

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