Asthma - When you can't breathe

What is asthma?

Asthma is a chronic disease of the lungs, involving the respiratory system in which the airway constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. These episodes may be triggered by such things as exposure to an stimulus from the environment (or allergen) such as cold air, warm air, perfume, moist air, exercise , or emotional stress. In children, the most common triggers are viral illnesses such as those that cause the common cold.

This airway narrowing causes wheezing, shortness of breath, chest tightness, and coughing. The airway constriction responds to medications called bronchodilators. Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual.

The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes are implemented.

In the developed world, asthma patients are on the rise, affecting up to one in four urban children.





What are the signs and symptoms of Asthma?

The following symptoms may be present in those with asthma:

Dyspnea ( shortness of breath )
Wheezing ( Not present on severe asthma cases )
Stridor
Coughing
Inability for physical exertion.

Signs of an asthmatic episode include:

Wheezing
Prolonged expiration
Rapid heart rate (tachycardia),
Rhonchous on lungs
Over-inflation of the chest.
Use of accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) In-drawing of tissues between the ribs and above the sternum and clavicles.
Cyanosis ( turning blue )
Loss of conciousness


Causes of Asthma

Not really well known or understood. Probably a complex interaction between genetics and environmental factors contribute to it.

Genetic: Over 100 Genes have been traced and associated with Asthma, most of these are related to the immune system or the inflammatory cascade.

Environmental: Conditions such as traffic pollution or high ozone levels, Tobacco smoke, viral respiratory infections at an early age, early in life antibiotic use ( disturbance of the intestinal flora? ) and psychological stress on the baby's caregiver has been associated with increased asthma morbidity.

Diagnosis of Asthma


Asthma is defined simply as reversible airway obstruction. Reversibility occurs either spontaneously or with treatment. Currently the test standard is a pulmonary function test ( PFT ). In many cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination. An asthma patient may also have atopic dermatitis or other allergic conditions, suggesting a general atopic constitution .

While measurement of airway function is possible for adults, most new cases are diagnosed in children who are unable to perform such tests. Diagnosis in children is based on the patient's medical history and subsequent improvement with an inhaled bronchodilator medication.

Differential diagnosis

Chronic obstructive pulmonary disease ( COPD ), which resembles asthma, is correlated with exposure to cigarette smoke, an older patient and decreased likelihood of family history of atopy.

Pulmonary aspiration, whether direct due to dysphagia (swallowing disorder) or indirect (due to acid reflux), can show similar symptoms to asthma.

After a pulmonary function test has been carried out, radiological tests, such as a chest X-ray or CT scan of the chest, may be required to exclude the possibility of other lung diseases.

In some people, asthma may be triggered by gastroesophageal reflux disease, which can be treated with suitable antacids.


How can I avoid allergens and irritants?

Buy one or two good HEPA air filters ( Use consumer reports for the best ones and their prices ), open your doors and windows as there are more triggers on closed environments than in open ones. Change the filter on your heating and cooling system frequently.To keep mold down, clean and air out bathrooms, kitchens and basements often. Keep the level of humidity under 50%. You can do this with an air conditioner or a dehumidifier.

People who are allergic to dust are actually allergic to the droppings of dust mites. To reduce dust mites in your home, wash bedsheets weekly in hot water (above 130°F). Cover mattresses and pillows in airtight covers and remove carpets and drapes. If you must have carpet, you can treat it with chemicals to help reduce dust mites. Avoid stuffed animals, dried flowers and other things that catch dust. Give away old stuff from your house, keep only what you use often . Pets can cause problems if you're allergic to them. If you have a pet, keep it out of your bedroom.Don't allow smoking in your house or car, keep away from tobacco!


Triggers of an asthma attack

Air pollution
Dust
Mold
Pollen
Tobacco smoke
Pet dander
Exercise
Changes in temperature
Some foods
Sulfite (food preservative in red wine, beer, salad bars, dehydrated soups and other foods)
Aspirin, or ibuprofen (brand names: Advil, Motrin, Nuprin)
Heartburn
Sinus infections
Strong emotions
Perfume
Spray-on deodorants
Viruses

Treatment of Asthma

Medications

Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators ( known as SABA ) . These are typically provided in pocket-sized, metered-dose inhalers (MDIs). For encouraging a better distribution of the inhaled medication and their use with children and elderly adults an asthma spacer is sometimes used to help with the difficulty with the coordination necessary to use inhalers. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug and allows for the active agent to be dispersed into smaller, more fully inhaled bits.

A nebulizer which provides a larger, continuous dose can also be used. Nebulizers work by vaporizing a dose of medication in a saline solution . The patient inhales continuously the vapor until the full dosage is administered. There is no clear evidence, however, that they are more effective than inhalers used with a spacer. Nebulizers may be helpful to some patients experiencing a severe attack. Such patients may not be able to inhale deeply, so regular inhalers may not deliver medication deeply into the lungs, even on repeated attempts. Since a nebulizer delivers the medication continuously, it is thought that the first few inhalations may relax the airways enough to allow the following inhalations to draw in more medication.

On this category we have:

Short-acting beta2-adrenoceptor agonists, such as albuterol , levalbuterol or Xopenex, terbutaline and formoterol .Tremors are the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically. At higher doses, there may also be cardiac side effects at higher doses (due to Beta-1 agonist activity). Do not use these medicines too frequently, as with such use their efficacy may decline which may lead to refractory asthma and death.

Other Medications include:

A. Anticholinergic medications, such as ipratropium bromide may be used instead or in addition to short acting agents. They have no cardiac side effects and thus can be used in patients with heart disease; however, they are slower and take up to an hour to achieve their full effect and are less powerful as the β2-adrenoreceptor agonists.

B. Inhaled glucocorticoids are usually considered preventive medications, as they work on inflammation of the respiratory airway. Other medications that work are cromolyn and nedocromil

C. Newer medicines, called anti-leukotrienes, are also used to prevent asthma attacks. These include montelukast, zafirlukast and zileuton.

D. Long-acting β2-agonists such as salmeterol, (LABA) are similar in structure to short-acting selective beta2-adrenoceptor agonists, but have much longer side chains resulting in a 12-hour effect, and are used to give a smoothed symptomatic relief (patients need to use them constantly morning and night). These are drugs that should be used in addition and not in replacement of short acting medications. There are concerns about these last inhalers when used alone, because they have been linked to worsening symptoms or death from asthma. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair ) Another combination is budesonide/formoterol ( Symbicort ).


Alternative Medicine

Eat a healthy diet with plenty of raw veggies, fruits, seeds, whole grains in moderation, and lean sources of protein such as lean poultry or fish. Add garlic and onions to your food. Keep your system clean by drinking plenty of water.

Dairy and processed foods should be decreased if not eliminated.

Consider a 1 or 3 day juice or fruit fast every 3 or 6 months.

With respect to supplements and herbs, consider homeopathy. The medication you should take should match your specific symptoms ( there are many remedies , please consult a specialist or visit http://www.hpathy.com/diseases/asthma1-symptoms-treatment-cure.asp ).

Consider starting Omega 3 fatty acids, probably even up to 4 or 8 grams of Fish Oil a day ( there are several brands out in the market, please refrigerate the fish oil after opening the bottle, please visit http://www.nordicnaturals.com/ for the best fish oil in industry ). IF allergic, use either flaxseed oil or borage oil. These work by reducing inflammation.

Magnesium is usually good at 250mg two or three times a day, vitamin C at 1000 to 4000mg a day, vitamin B12 can also be taken.

Acupuncture, Acupressure and chinese herbs are very effective for asthma, so do consider them as an alternative.