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ASTHMA

What is Asthma ?

Bronchial asthma is perhaps the commonest of all chronic medical disorders. About one person in ten of the population will suffer from asthma of some degree, at some time in their life. However, in only a small minority will asthma become a severe lifelong problem. It is a disorder of the breathing tubes (bronchi). The bronchi are a series of branching tubes, which carry air from the main windpipe (trachea) to the lung tissues, where oxygen gets absorbed into the bloodstream. In asthma, there is an inflammation of the lining of the bronchi. This makes the bronchi swollen and narrowed. As a result, less air passes through them, so that breathing becomes more difficult and cough and breathlessness develop. The typical wheezing noise that occurs with asthma is the sound of air travelling through narrowed tubes.

How does Asthma occur ?

Many people with asthma have inherited the tendency to develop this disease and have at least one other affected family member. Other diseases, hay fever, rhinitis and eczema are often inherited along with the asthma. People with this inherited tendency are described as atopic. We don't understand why asthma appears at different times in different people. Most commonly, it starts in childhood and tends to quieten down during the teens. In other people, it doesn't appear until middle age or later. Another pattern is for the asthma to settle down for months or even years, but then recur again for no obvious reason. We have some explanations for these differing patterns, but no definitive proof.

Why does Asthma occur ?

We know much more about factors that start off, or trigger, individual episodes of attacks of asthma. These factors are called allergens. Allergic reactions to house dust mites, grass pollens, animal dander and moulds are common, however there are many other possible allergens. Infections caused by viruses are the most frequent triggers. They nearly always start as a cold, which then leads on to an asthma episode. Exercise is a common trigger in children, but probably only more of a problem for children because they tend to run around much more. Atmospheric factors, such as extremes of air temperature and humidity, will often bring on asthma attacks; also smoky or polluted atmospheres. Occupational asthma, where substances in the work environment provoke attacks, is less common but very important. Emotions such as laughter, tension, anxiety, may provoke or worsen asthma. It used to be thought that asthma was the result of an over-anxious or highly-strung personality. We now know that this is not the case, and emotions are just one of the triggers for asthma. Drugs used for other conditions, may provoke or worsen asthma. The most important ones are aspirin and beta-blockers, but there are others.

Treatment Involved for Asthma

When you have asthma, you should not smoke or and avoid exposure to smoky or polluted air. These conditions are likely to make the asthma worse. Usually treatment is taken regularly and in an inhaled form. Using inhalers means that the drug can be taken in much smaller dose than by tablet or injection, because it goes straight to the place where it is needed. However, sometimes tablets are prescribed. There are two types of inhaler where the drug is either is delivered as an aerosol or as a dry powder. The aerosol spray inhalers are most commonly prescribed. However not everyone can use these effectively. Very occasionally, asthma drugs are prescribed to be used with a nebuliser. This is a machine that converts the drug into a fine spray, making it easier to breathe in the drug. Nebulisers are mostly in the elderly and very young patients who really cannot manage to use an inhaler. Treatments are of two basic types: relievers and preventers. Relievers are drugs, which relax muscle spasm in the bronchi (bronchodilators). Examples of reliever drugs include Ventolin or Airomir (salbutamol) and Bricanyl (terbutaline). By relaxing the muscle spasm, they bring rapid relief when the breathing has become tight. Because of this action, they are often taken only when needed. However, the doctor may prescribe them to be taken regularly, especially the so-called long-acting relievers. On the other hand, preventers are drugs that act to prevent or suppress the inflammation that is the underlying problem. Examples of preventer drugs include the inhaled steroids (such as Becotide or Pulmicort) and Tilade (nedocromil) or Intal (cromoglycate). It is vital that these treatments are taken regularly. They will not be of use if taken now and again when symptoms are bad. They are extremely safe drugs, and side-effects are rare. To be effective, inhalers must be used correctly. Some patients appear not to respond to treatment because of poor inhaler technique. In these cases, inhalers are often prescribed together with a delivery device (a spacer) to make them easier to use. They will also reduce the amount of drug that gets swallowed instead of being inhaled. Recently, a tablet form of preventer treatment has been licensed in the United Kingdom. This drug, falls into a group called Lecotriene receptor antagonists (or LTRSs). They are used especially if asthma occurs with exercise, is not well controlled on other drugs or if the person is allergic to aspirin. Severe attacks of asthma are sometimes treated with oral steroids (cortisone-like) drugs, usually prednisolone. These drugs are safe when used in high doses for short periods of time.

During Treatment of Asthma

The most important sign of impending acute asthma is a failure of usual treatment to be effective. This can be detected by symptoms of cough, wheeze and breathlessness, but also by a small device called a peak flow meter. This measures, by a simple blowing technique, the degree of narrowing in the bronchi. It can be provided on prescription. You should always have a plan of action for dealing with worsening symptoms, and this should be agreed with their doctor. It is best to recognise the danger signs of an attack as early as possible. Sometimes, if the asthma is bad or not improving, admission to hospital may be required.

After Treatment of Asthma

The early weeks and months after an attack are important, because a relapse is more likely to happen then. It is important to remember that treatment should be taken regularly, as prescribed, and any worsening of symptoms reported. After a prolonged period without symptoms, it is reasonable to try reducing treatment. It can sometimes be stopped. This should always be done with caution, under medical supervision, remembering that asthma may recur at any time.

If Asthma is Left Untreated

Death from acute asthma is rare, but can occur. Severe attacks should always be treated as a matter of urgency. Milder symptoms may be tolerated without treatment, and from time to time the asthma will improve by itself. However, prolonged untreated asthma is quite likely to lead to some lung damage, with chronic obstructive pulmonary disease (COPD) and/or emphysema.

Effects on Family of Asthma

Your family and friends need to be aware of the symptoms and problems caused by asthma, so that they can provide positive support when required. Parents also need to know about inhaler techniques, so that they can supervise their child's treatment effectively.

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