Asthma

What is Asthma?

Asthma is a disease of the breathing passages (bronchi), which are prone to tighten up making it difficult to breathe.

What causes Asthma?

Sometimes asthma is triggered following exposure to certain things that can cause allergies such as furry animals (cats and dogs), dust, pollens (tree and grass) and mould. However, some people without allergies can experience asthma symptoms with pollution, cold weather, certain medications (e.g. aspirin, ibuprofen and beta-blockers) and exposure to cigarette smoke. Some people have both allergic and non-allergic triggers. One of the questions I am often asked is, ‘why have I developed asthma now?’ Sometimes people may be more susceptible to asthma if they have hay fever or eczema and asthma can often go hand-in-hand. Sometimes it may be simply be that they have been exposed to a trigger or allergen for the first time e.g. a new pet or new home.

What are the symptoms of Asthma?

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, which can cause a variety of symptoms. These symptoms can vary in severity and frequency from person to person. Common symptoms of asthma include:

1. Shortness of Breath

• Feeling unable to get enough air or difficulty breathing, especially during physical activity or at night.

2. Wheezing

• A whistling or squeaky sound when you breathe, particularly when exhaling.

3. Coughing

• Persistent coughing that may worsen at night or early in the morning. It can also be triggered by exercise, cold air, or laughing.

4. Chest Tightness

• A feeling of pressure or tightness in the chest, often described as if something is squeezing or sitting on your chest.

5. Difficulty Sleeping

• Trouble sleeping due to coughing, wheezing, or shortness of breath, especially at night.

6. Fatigue

• Feeling unusually tired or fatigued, which can result from poor sleep due to nighttime symptoms or the extra effort required to breathe.

7. Rapid Breathing

• Breathing faster than usual, which can occur during an asthma attack or flare-up.

8. Exacerbation Triggers

• Symptoms often worsen in response to specific triggers such as allergens (pollen, dust mites, pet dander), irritants (smoke, pollution, strong odors), respiratory infections, physical activity (exercise-induced asthma), cold air, stress, or certain medications.

How do you Diagnose Asthma?

Diagnosing asthma involves a combination of medical history, physical examination, and specific diagnostic tests. Here’s an overview of the process:

1. Medical History

• Symptoms: Professor Branley will ask about your symptoms, such as wheezing, coughing, shortness of breath, and chest tightness. He will inquire about the frequency, duration, and triggers of these symptoms.
• Family History: A family history of asthma, allergies, or other respiratory conditions can be significant.
• Personal History: Past medical history, including any history of allergies, eczema, or respiratory infections.

2. Physical Examination

• Professor Branley will perform a physical exam, focusing on your respiratory system. He will listen to your lungs with a stethoscope to detect wheezing or other abnormal sounds.

3. Pulmonary Function Tests (PFTs)

These tests measure how well your lungs are working:

• Spirometry: This is the most common test for diagnosing asthma. It measures the amount of air you can exhale after a deep breath and how quickly you can do so. Key metrics include:
  • Forced Vital Capacity (FVC): The total amount of air exhaled.
  • Forced Expiratory Volume in 1 Second (FEV1): The amount of air exhaled in the first second of the FVC test. A lower than normal FEV1 suggests asthma or other obstructive lung conditions.
  • FEV1/FVC Ratio: This ratio helps differentiate between obstructive and restrictive lung diseases.
• Bronchodilator Reversibility Test: Spirometry is repeated after administering a bronchodilator (a medication that opens the airways). An improvement in FEV1 suggests asthma.
• Peak Flow Meter: This device measures the highest speed of exhalation. Regular monitoring can help track asthma control.

4. Bronchial provocation Tests

• Methacholine/Mannitol Challenge Test: Methacholine & mannitol are substances that can cause airway narrowing in people with asthma. You inhale increasing doses of methacholine or mannitol, and spirometry is performed after each dose to see if there is a significant drop in lung function.
• Exercise-Induced Asthma Test: Exercise is used to induce symptoms, and lung function is measured before and after physical activity.

5. Allergy Testing

• Skin or blood tests to identify allergies that might be triggering asthma symptoms.

6. Imaging Studies

• Chest X-ray: To rule out other conditions that might be causing symptoms.
• CT Scan: In certain cases, a more detailed imaging study might be needed to look for other lung diseases.

7. Fractional Exhaled Nitric Oxide Test (FENO)

• This test measures the level of nitric oxide in your breath, which can indicate inflammation in the airways.

8. Differential Diagnosis

• Professor Branley will consider and rule out other conditions that can mimic asthma, such as chronic obstructive pulmonary disease (COPD), vocal cord dysfunction, heart disease, and other respiratory infections.

 

How do you Treat Asthma?

Treating asthma involves a combination of medications, lifestyle changes, and monitoring to manage symptoms and prevent asthma attacks. The treatment plan is tailored to your specific symptoms and triggers. Here are the main components of asthma treatment:

1. Medications

A. Long-Term Control Medications

These are taken daily to manage chronic symptoms and prevent asthma attacks:

• Inhaled Corticosteroids: The most effective long-term control medications. They reduce inflammation in the airways. Examples include beclomethasone (Clenil, Qvar), fluticasone (Flixotide) and budesonide (Pulmicort).
• Long-Acting Beta Agonists (LABAs): Often used in combination with inhaled corticosteroids to relax the muscles around the airways. Examples include salmeterol (Serevent) and formoterol (Foradil).
• Leukotriene Modifiers: Oral medications that help control asthma by reducing inflammation and preventing airway constriction. An example is montelukast (Singulair).
• Combination Inhalers: These contain both inhaled corticosteroids and LABAs. Examples include fluticasone/salmeterol (Seretide), beclometasone/formoterol (Fostair) and budesonide/formoterol (Symbicort).

B. Quick-Relief Medications

These are used to relieve symptoms during an asthma attack:

• Short-Acting Beta Agonists (SABAs): These bronchodilators quickly relax the muscles around the airways. Examples include salbutamol (Ventolin, Salamol).
• Anticholinergics: These bronchodilators can be used in combination with SABAs. Examples include ipratropium (Atrovent).
• Oral and Intravenous Corticosteroids: Used to treat severe asthma attacks. Examples include prednisolone and methylprednisolone.

C. Biologics

For severe asthma, biologic medications may be prescribed. They target specific molecules involved in the inflammatory process. Examples include omalizumab (Xolair), mepolizumab (Nucala), and dupilumab (Dupixent).

2. Lifestyle Changes and Home Management

• Avoid Triggers: Identify and avoid asthma triggers such as allergens (pollen, dust mites, pet dander), smoke, pollution, and cold air.
• Exercise: Regular physical activity can improve overall lung function, but be mindful of exercise-induced asthma. Warm up before exercising and use a SABA if recommended by your doctor.
• Healthy Diet: A balanced diet can support overall health and potentially reduce inflammation.

3. Asthma Action Plan

Develop an asthma action plan with Professor Branley. This plan should include:

• Daily Management: Instructions on what medications to take daily.
• Recognizing Symptoms: How to recognize early signs of worsening asthma.
• Emergency Instructions: Steps to take during an asthma attack, including when to use quick-relief medications and when to seek emergency care.

4. Regular Monitoring

• Peak Flow Meter: Use a peak flow meter to monitor your lung function regularly. This helps in detecting early signs of worsening asthma.
• Regular Check-Ups: Visit Professor Branley regularly to review and adjust your asthma management plan.

5. Education and Support

• Asthma Education: Learn about asthma and how to manage it effectively.
• Support Groups: Consider joining a support group to share experiences and strategies with others who have asthma.

6. Emergency Plan

• Know when and how to seek emergency medical help.
• Keep quick-relief inhalers accessible at all times.

7. Vaccinations

• Stay up to date with vaccinations, especially for flu and pneumonia, as respiratory infections can worsen asthma symptoms.

Effective asthma management requires a comprehensive approach that combines medication, lifestyle adjustments, and regular monitoring. Collaborate with your healthcare provider to create a personalized asthma management plan that suits your needs.

Will my Asthma get better?

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