INTRODUCTION–
Bronchial asthma which is termed also as ‘Asthma’ (common name) is a chronic inflammatory respiratory system disease which is marked by bronchial hyperreactivity which needs lifelong management and physician care. It is a life debilitating condition in long run and can impose life threatening situation when neglected and not taken care of properly by individual (not taking proper medications).
We must understand what is meant by the term ‘ASTHMA ATTACK’’ which is used very commonly in our daily life. It is also called as an Exacerbation or a flare-up when it is a condition which is not properly managed or controlled in a case. So, during the phase of attack normal inspiration is altered which is marked by a wheezing (high pitched whistling sound ) sound which means as in normal physiology when an individual inhales then their muscles around airway relaxes and air is moved easily and quietly without any hinderance but this smooth process is altered during attack, it includes 3 main phenomenon, they are-
1)INFLAMMATION- Tracheal lining is swollen which interferes in passage of air in lungs.
2)BRONCHOSPASM-Constriction of airways (narrowing).
3)INCREASED SECRETION OF MUCUS- It also interfere in passage of air through clogging the airways during attack.
CLASSIFICATION–
A)BASED ON TIMING OF ATTACK-
1)INTERMITTENT TYPE- It is marked by period of relief in a case where attack comes and go in the patient.
2)PERSISTENT TYPE- It is the type where symptoms (mild, moderate, severe) prevail for a considerable time. Patient presents with symptoms on daily basis and there is absence of relief window for the individual.
B)BASED ON CAUSATIVE FACTOR-
1)Allergic asthma- Sometimes allergens triggers the attack of asthma in may individuals, like- molds, pollens, pet dander, etc.
2)Non-allergic asthma- In cases where allergens are not the cause of asthma attack comes under non-allergic asthma. Other causes includes- exercises, stress, weather. etc.
C)BASED ON ONSET-
1)ADULT TYPE- When asthma starts after age of 18, it means the asthma symptoms shows for the first time after the age of 18.
2)PAEDIATRIC/CHILDHOOD ASTHMA- When asthma sets in at the age of 5 years old or even in infant and toddlers is defined as paediatric asthma
D)MISCELLENEOUS TYPE ARE-
1)EXERCISE- INDUCED ASTHMA- In this type of asthma bronchospasm is triggered by exercise in the individual.
2)OCCUPATIONAL ASTHMA-It is related to job or occupation which involves respiratory irritants and their chronic exposure, like persons working in a cement factory may develop occupational asthma in long run, etc
3)ASTHMA-COPD OVERLAP SYNDROME (ACOS)- It is a combination of COPD (Chronic obstructive pulmonary disease) and asthma at the same time which makes individual life very difficult as both of the disease in combination makes breathing a difficult task which needs prompt treatment and management.
CAUSATION–
Till today exact cause of asthma onset in any individual is not certain. It is also not yet confirmed that why some suffers from it while some remain unaffected throughout their life, although several factors contributes in onset of asthma , they are as follows-
1)ALLERGIC INDISPOSITION- Those individuals who already suffers from allergies in their life are at higher risk of developing asthma.
2)ENVIRONMENTAL FACTORS- It includes exposure to allergens, toxins, passive smoking, etc. Risk is greater for babies and children as their immunity is not yet developed completely.
3) GENETIC FACTOR- It refers to chances of having asthma is more in those who have family history of asthma or other allergic diseases than those who don’t have such history.
4)INFECTIONS AFFECTING RESPIRATORY SYSTEM- It especially affects during growing phase when developing lungs are affected by various viruses affecting them, such as-RSV (Respiratory syncytial virus ), etc.
SIGN AND SYMPTOMS–
It is very important to know and observe symptoms of asthma, especially in long standing case, they are as follows-
1)Nocturnal coughing.
2) Pain, pressure as well as tightness in chest.
3) Difficulty in breathing as well as shortness of breath.
4)Altered breathing marked by continuous adventitious lung sounds normally called as wheezing (high pitched whistling sound ).
These symptoms are present differently and not all at the same time in case of chronic asthma cases when patient experiences flare as they are also present in many other respiratory disorders too.
AGGRAVATION FACTOR-
In cases of asthma triggers (aggravating factors ) are of many types, it is very important to know the trigger in each particular case and avoid it to in order to prevent flares of asthma more frequently, they are as follows-
1)Air pollutants – It acts as triggers in many cases when air is highly polluted (emissions, smoke, traffic pollution, etc.) and worse AQI index persists for a considerable period of time then patients must avoid going outside frequently.
2)Smoking or being in a surrounding with smokers (passive smoking)- Tobacco in any form (cigarettes, cigars, etc.)
3)High intensity physical exercise- It also act as triggers in many asthmatics.
4)Mites and pest allergy- It includes dust mites in our homes which are microscopic but can trigger the attack as well as cockroaches, mice and other pests can also act as triggers to some people.
5)Dampness and moulds can trigger asthma attack in many cases.
6)Pungent strong chemicals and their fumes also act as trigger in many cases.
7)Occupational hazard- Many people due to occupational exposure (ex- chemicals, dust, etc.) to allergens can trigger the attack.
RISK FACTORS–
Asthma onset is not dependent on age that’s why we can see small babies suffering from asthma as well as adults too ,but according to studies female baby at birth is more at risk than male baby to suffer from asthma. People with family history are at high-risk side of getting asthma than those without any family history. Also, smokers and those who lives in such surroundings (passive smoking) are at risk of various respiratory disorders including asthma.
DIAGNOSIS–
In process of diagnosis individual personal (history of allergies, etc.), past as well as family history is taken in detail.
Other tests for complete diagnosis and management of asthma are-
1)Spirometry (for airflow measurement)
2) Chest X-ray, haematological (CBC) test as well as skin test (if there is personal history of eczema or allergies present).
All these are not useful for diagnosis but also for further management of the cases.
MANAGEMENT–
Treatment includes-
1)Medicines- It includes anti-inflammatory which aims at reduction of swelling and mucus production. It is prescribed as per individual in chronic cases.
2)Bronchodilators- They are used in acute as well as chronic cases for immediate relief from attack phase.
Medicines are prescribed in various ways, mainly as follows-
1)Nebulizers
2)Asthma inhalers
3)Metered-dose inhalers.
It is dependent on requirement by the individuals where symptoms are monitored by using peak flow meter which also helps in dose management in chronic cases.
PREVENTION–
It is aimed at detection of the trigger and aggravating factor in each case of asthma, so as to minimize the flare ups and emergency situations by avoiding them as much as one should.
PROGNOSIS–
Even when a person suffers from asthma they can lead a productive life with the help of medical care and management. It includes- medicine routine, regular check ups, counselling about do’s and don’t , etc.
In case of severe attack, one should immediately contact emergency medical care. Meanwhile administer rescue inhaler till the medical help arrives.
Symptoms which require emergency care are as follows-
1)Severe cough which do not responds to any thing as well as severe wheezing while breathing.
2)Lips, fingernails turning blue or gray in different individuals.
3)Moderate to severe pain and pressure in chest.
4)Difficulty in talking.
5)Face become pale and profuse sweating.
6)Breathing become quick in many cases.
7)Anxiety or panic is seen.
RELATION BETWEEN COVID-19 AND ASTHMA-
If you have asthma that is moderate-to-severe, or if your asthma symptoms aren’t well controlled, you’re at greater risk of having to be hospitalized if you get COVID-19. Therefore, you should wear a mask if you go to indoor spaces with other people, get vaccinated and avoid exposure to people who have the virus.
HAPPY LEARNING
Contributor- Dr. Apurva Varangi
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