About Asthma

Asthma: the basic facts

Asthma is a common disease worldwide and its incidence is on the increase globally. It has been ranked as the sixth greatest cause of morbidity. It is estimated that around 300 million people worldwide currently have asthma and it is expected that a total of 400 million people will be affected by 2025. In United Kingdom, over 50 million people are suffering from Asthma and allergies, but in Nigeria, it is assumed that about 10-15 million people may be suffering from Asthma. Asthma affects all ages but it is commoner in children and young adults. . In a recent study, 14.1% of University students (Obafemi Awolowo University) were found to have probable asthma and only 32.5% of these were previously diagnosed. Many people living with asthma have not been diagnosed and quite a lot are under-treated. However, with proper long term treatment and necessary preventive measures, the symptoms of asthma can be controlled. Nearly every person with asthma can expect to become symptom free. For that to happen, the person requires careful and diligent diagnosis and care from a physician.

WHAT IS ASTHMA?

Asthma is a condition that causes temporary narrowing of the airways in the lungs. During an asthma attack, the patient feels short of breath, wheeze (noisy respiration), cough and tightness of the chest. Fortunately the narrowing of the airways usually lessens with prompt treatment although the degree of relief varies with severity of the attack. In between asthma attacks, the disease is still there even though there are no symptoms. Some children seem to outgrow their asthma but teenagers and adults have asthma for the rest of their lives. Asthma tends to run in families. Children with strong family history of allergic disorders are likely to have it. . However, it is likely that family history combined with environmental factors, influence whether or not someone develops asthma. Many aspects of modern life styles such as changes in housing and diet and a more hygienic environment may have contributed to the rise of asthma over the past decades. Today, asthma can be well controlled and you can expect your child who is asthmatic to live a normal life as long as the correct medications are taken in adequate doses under supervision of knowledgeable doctors.

THE ASTHMATIC PROCESS:

Asthma results when the airways in the lungs become hyperactive and hyper-responsive to irritants. Hyperactive means the lungs are more sensitive to irritants than most peoples’ and hyperresponsive means the airways overreact to things that would be minor irritants in people without asthma. Some have described the asthmatics as having twitchy airways.
When asthmatics are exposed to one or more triggers, it initiates the asthmatic process. The airway that contains cells (inflammatory cells) flare up a process called inflammation. These cells release chemicals. Some of these chemicals tell the body to send more inflammatory cells to the area. The lining of the broncxhial tubes of asthmatics contain more of these special cells . These special cells also release more chemicals into the airway causing all the changes in the lungs and lead to three main processes:

1. Bronchial Muscle Spasm
The bronchial muscle contracts causing the airway to narrow in a process called bronchospasm. These tightened muscles block the airways thus restricting the movement of air.

2. Excess Mucus
Inflammation causes the mucus glands to produce mucus in excess. This mucus clumps together in the airway. Mucus buildup causes swelling of the inner lining of the lungs (mucosal oedema). This results in further narrowing of the bronchial tubes and partial blockage of the airway, hindering breathing. Excess mucus can form plugs that clog very small airways.

3. Coughing and Phlegm Production:
The mucus gland produces sticky sputum (phlegm). When secretions become thick, the individual coughs to remove the unwanted substance. Dry cough is the product of extra thick mucus plugs or bronchioles so blocked that the mucus cannot be removed.

TRIGGERS OF ASTHMA

Asthma symptoms can get worse for no apparent reason. However, most asthma symptoms are caused by irritants called triggers. There are various kinds of triggers, some acting in isolation, others working together. The severity of Asthma depends on how many substances in the environment act as triggers and how sensitive the lung is to these substances.

Allergens
An Australian paediatrician, Clemns von Perquet (1974-1929) first coined the term allergy in 1906. He used the term to refer to an foreign substance that provokes the immune system or hypersensitivity. Research has shown that the body’s tendency to produce abnormal immunoglobin E (1gE) in response to foreign substances (allergens) is the strongest identifiable factor for asthma.. A person is said to have atopy (or to be atopic) when he or she is prone to allergy. Allergy tends to occur in families. People are not born with allergies. However, they inherit the tendency to develop some form of allergy. In other words, both the child and the parent might be allergic to something, but not necessarily the same thing. They pass this tendency from one generation to another. Children are more susceptible to allergy induced asthma. These children also show reactions to other allergic conditions such as eczema (dry scaly skin patches), rhinitis (inflammation of the mucus membrane that lines the nose, pharyngitis (sore throat) and conjunctivitis (red eye).

For those with an inherited tendency towards allergies, the more you encounter a particular allergen, the more likelihood that you will develop an allergy from it. The length of these contacts contributes to your becoming allergic. In other words, what you breathe, eat or touch can trigger asthma. Most allergens are so tiny and light that they can circulate in the air for a long time. As children grow up, the percentage of people with atopic or allergic asthma declines.
Although atopic asthma usually manifests before age 35, half adults with asthma are allergic. For some people, allergy builds up over the years until they become strong enough to exhibit symptoms of asthma. Sometimes a change in routine, job or movement to a new environment can expose you to different allergens that can result in asthma.

Common allergens include saliva, fur and dander (tiny flakes of skin) from pets like dogs and cats, moulds and pollens, cockroaches, food and food additives and house dust mites to mention a few. This write-up will not complete without mentioning house dust allergy which is common cause of asthma. Dust mites are extremely little animals that live in dust, feeding on bits of shed human skin and other appetizing little morsels. Dust mites grow especially well in mattresses, pillows and beddings. Evidence points to dust mites as being the most common indoor allergen and major cause of asthma.

Irritants
Some lungs react to certain substances in the air, which are strong enough to trigger asthma. Yet allergic tests reveal no specific allergens. These symptoms develop slowly over several years, may first be noticed at work or when one moves to a new house. Irritants include tobacco smoke, perfumes, pungent odours, combustible substances, formaldehyde or household chemicals and work related triggers (occupational asthma).
Other triggers of asthma include medications (e.g.Aspirin), emotions (anger, anxiety and sadness) and common cold. About 90% of asthma in children are triggered by colds and the ‘flu’. Exercise is another trigger for asthma. Over 70% to 80% of asthmatics have asthma triggered by running especially in cold weather. However, asthmatics should not avoid sports. Exercise induced asthma can be well controlled with drugs.

SYMPTOMS OF ASTHMA

The symptoms may occur intermittently, or continuously in response to recognised trigger or out of the blues. It can improve either spontaneously (that’s without intervention) or after the use of drugs. This variability is so characteristic of asthma. The symptoms are usually common and worse at night. The common symptoms are:

Cough

Especially at night and after exercise or an exposure to triggers.

Wheeze

A high-pitched whistling sound that can be heard during asthma attack. However, all wheezes are not asthma. In fact if the asthma is very severe there may not be enough movement of air through a person’s airways to produce the sound.

Shortness of breath

Especially during exercise or severe attack.

Chest tightness

This is an uncomfortable feeling in the chest which asthmatics experience during an attack of asthma.

Cough variant asthma

A few asthmatics do not present classically as above. They do not have trouble breathing and do ot wheeze. However, they present with excessive coughing as the only symptom. Doctors call this ‘cough variant asthma’. This group of individuals has persistent cough at night, during exercise and when it is cold. This kind of cough is common amongst children.

BREATHING TESTS

There are two main types of breathing tests, Peak Flow tests and Spirometry. Both measure how narrow the airways are. The slower the flow of air through the tubes, the lower the reading. The peak flow is particularly useful in Asthma. It is measured using a peak flow meter. The peak flow meter is small, cheap and robust. It is not only useful in diagnosing asthma but essential in monitoring the progress of the disease. The physician can also use the peak flow meter reading to plan the management of your asthma.

For more information visit – www.asthma.org.uk

MANAGEMENT OF ASTHMA:

To control asthma symptoms, you need to be in partnership with your phycisian. You must attend asthma clinics regularly, monitor your symptoms and take your medications regularly. You also need to study your asthma and avoid triggers that initiate your asthma symptoms. Drugs are usually prescribed according to the severity of your asthma and a step approach is used. This means that the more drugs are added if the asthma worsens and the number is reduced as it gets less severe. Generally, drugs used in treating asthma are iun three groups: Preventers, Relievers and Lifesavers.

Preventers:

These groups of drugs act by reducing the inflammation of the airways. These drugs also make your airways less reactive to the triggers., allergens and irritants that cause asthma attack. They should be used on regular basis rather than when symptoms occur. Preventers are very effective means to control asthma. They are usually administered twice daily. There are two forms of preventers, the steroid type and non steroid type of preventers. Preventer medications are also known as “controller” medications because of their actions in preventing symptoms and attack.

Relievers:

These drugs act temporarily relaxing the muscles of the wall of the airway during an attack. This is essential to making air move in and out of the lungs freely during asthma attack. They are also called bronchodilators. Reliever drugs should be used only when symptoms occur rather than on a regular basis. However, in those with severe asthma, regular use may be needed on the advice of a physician. Relievers come in various forms, as tablets and inhalers. However, inhalers are preferred.

Combination drugs (Preventer and Reliever)

These are drugs that combine preventer and reliever activities. They reduce the burden of taking lots of inhalers and help in compliance with treatment. They have been very effective in the control of chronic asthma.

Lifesavers:

These are drugs used in an emergency setting to treat severe asthma. You must know how to recognise severe attacks and see doctor (preferable at the Accident and Emergency Unit) as soon as possible so that he can initiate treatment early enough. In acute asthma, the condition becomes so serious that you cannot perform your normal duties and this kind of asthma does not respond to your usual drugs. The medications are:

S: Salbutalmol in form of nebulizers. This is a bronchodilator.

O: Oxygen

S: Steroids. These are given in tablets or sometimes in form of injections. If response to the above is poor the physician will add other drugs to relieve your asthma.

Your doctors will also advise you and tell you when to leave hospital after treatment. You will be given WRITTEN instructions on discharge.

Your doctor should give you a treatment plan for your own asthma. Do not stop medications or modified them even when you feel better. Seek your doctor’s advice before you take action.

Please visit Asthma UK website for more information about Asthma and Allergy

Thanks to Prof G.E. Erhabor-Director Asthma and Chest Care Foundation for allowing me to use his leaflet and Asthma UK for their website and Asthma Information which is translated into Yoruba Language.

Mrs Dorcas O. Akeju, OBE

Chair & Co-Founder of Breathe Easy Foundation.