Asthma definition
Asthma is a chronic inflammatory respiratory condition that is characterized by symptoms of intermittent dyspnea (shortness of breath), cough, and wheezing. Distinguishing asthma from other respiratory illnesses can be challenging because of the non-specific nature of these symptoms. Asthma that develops in childhood involves a complex interaction between genetic and environmental factors. A confirmed diagnosis of asthma depends on constant respiratory symptoms and detection of expiratory obstruction of the airway recorded on spirometry. Physicians prioritize symptomatic control and preventing future progression through tailored treatment by considering the severity and potential risk in a systematic and step wise approach.
Pulmonologists can successfully treat and manage asthma.
Asthma meaning
The actual term asthma is derived from the Greek word “aazein” which means to exhale with an open mouth, to pant. The word asthma appeared for the first time in the Iliad with the meaning of short drawn breath, but the Corpus Hippocraticum was the earliest term from where the medical term was found.
With increasing prevalence rates in many countries, asthma is a substantial global health problem. As per World Health Organization (WHO) reports, 30 crore people have asthma, and two lakh fifty-five thousand (255000) people died due to asthma in the year 2005.
Asthma prevalence in India is estimated to be 3% (3 crores) with a prevalence of 2.4 percent in adults aged more than 15 years and between 4 and 20 percent in children. About 57,000 deaths attributed to asthma were reported in the year 2004. It has become one of the leading causes of morbidity and mortality in rural India and is predicted to increase in the coming year.
Asthma is no longer thought of as a single disease, and it is categorized into different types based on the factors causing it. Following are some of the types of bronchial asthma:
Asthma is a heterogeneous disease and since early childhood, depending on the phenotypes and endotypes many classifications have been proposed. A deep understanding of the endotype and phenotype of the patient gives an idea regarding a tailored therapeutic approach.
Asthma phenotypes classification
Five major phenotypes in adult patients include
Asthma endotypes classification
Four major endotypes of asthma include:
Symptoms of asthma occur intermittently and last for about a few hours to days. These symptoms resolve when the triggers are removed or with the administration of medications.
Common asthma signs and symptoms include
Symptoms of severe asthma are often persistent, and these symptoms are observed at least once a day. Below are some of the asthma attack symptoms observed in patients:
The exact cause of asthma is not known, and the causes may vary from person to person, however, asthma can develop when the body’s defense system reacts strongly to a new substance in the lungs. Asthma usually develops during childhood (called childhood asthma); however, some people don’t show signs of asthma until adulthood (adulthood asthma). Many factors like allergens in the environment, viral infections, and family history work together to develop asthma.
Several factors have been linked to the development of asthma although it is difficult to identify the actual cause. Below are some of the causes of bronchial asthma:
Asthma is believed to result from the interaction between genetic and environmental factors. Several risk factors contribute to asthma, and these factors of bronchial asthma are described below:
The complications of bronchial asthma include complications that are disease related and adverse effects of glucocorticoids and endotracheal intubation. Some of the common complications associated with asthma are as follows:
Early diagnosis and treatment of asthma is necessary to prevent the progression of asthma. General physicians and pulmonologists develop a definitive diagnosis. Following are some of the tests to diagnose asthma:
Treatment of asthma depends on the age, severity of the disease, and how the body responds to the specific drug.
Drug therapy is important in the treatment of asthma and in keeping the disease under control. But some non-pharmacological interventions are also suggested in the treatment of asthma. Nonpharmacological management of asthma includes:
Treatment mainly focuses on providing education, regular assessment of symptoms, providing access to fast acting bronchodilators and controller medications. The following are the treatment options available:
Below are some of the measures that can be followed for asthma treatment during pregnancy:
Inhalers are devices that deliver or incorporate medications in a fine mist right into the lungs. These are considered as the first line treatments for asthma and can be used to treat other respiratory conditions.
Following are some of the common types of inhalers:
The exact cause of asthma is unknown; therefore, it may not be possible to prevent asthma, but the severity and further progression of the disease can be prevented.
Further progression of the disease severity can be prevented by adopting a stepwise approach to disease management and strategies to prevent risk factors. Essential parts of asthma management include patient education, monitoring the symptoms to prevent the progression of the disease, controlling factors that trigger asthma, managing co-morbid conditions, and following a stepwise treatment approach.
The severity of asthma varies and differs among individuals and different age groups therefore it is essential to monitor the effectiveness of asthma control to suggest the required adjustments or modifications in a treatment plan.
Below are some of the measures to prevent asthma from further progression and severity:
Asthma vs COPD
Both asthma and
chronic obstructive pulmonary disease (COPD) are respiratory diseases that affect breathing, but they have some key differences. The following are the parameters that differentiate asthma and chronic obstructive pulmonary disease (COPD):
Parameters | Asthma | Chronic obstructive pulmonary disease (COPD) |
---|---|---|
Definition | It is a chronic inflammatory respiratory condition characterized by dyspnea, cough, and wheezing | It is a common respiratory condition that is characterized by progressive airflow limitation and tissue destruction. |
Symptom | Shortness of breath, coughing, wheezing, and chest tightness. | Dyspnea, chronic cough with sputum production, wheezing, chest tightness. |
Causes | Causes are unknown but there are some factors that trigger asthma such as allergens, dust, pollen, air pollution, and mold. | Causes include prolonged exposure to harmful gases and smoking. Environmental and occupational exposure, and deficiency of alpha 1 anti-trypsin are the other causes that cause chronic obstructive pulmonary disease. |
Treatment | Treatment mainly focuses on providing education, regular assessment of symptoms, providing access to fast acting bronchodilators and controller medications. | Treatment includes drug classes such as bronchodilators, inhaled corticosteroids, and systemic glucocorticoids. |
Asthma vs bronchitis
Asthma and bronchitis both are respiratory conditions that present cough as their symptom, but they have some key differences. Below are some of the factors that differentiate between asthma and bronchitis.
Parameters | Asthma | Bronchitis |
---|---|---|
Definition | It is a chronic inflammatory respiratory condition characterized by dyspnea, cough, and wheezing | It is a condition which is characterized by inflammation of bronchial tubes that cause coughing. Cough is often associated with the production of sputum. |
Symptom | Shortness of breath, coughing, wheezing, and chest tightness. | Cough with mucus, chest pain, tiredness, shortness of breath, wheezing. |
Causes | Causes are unknown but there are some factors that trigger asthma such as allergens, dust, pollen, air pollution, and mold. | Acute bronchitis is caused by viral infections such as cold, flu, it is also caused by viral infections. Chronic bronchitis is caused by several factors like smoking, exposure to fumes, family history of asthma or other respiratory conditions. |
Treatment | Treatment mainly focuses on providing education, regular assessment of symptoms, providing access to fast acting bronchodilators and controller medications. | Treatment includes oxygen therapy, pulmonary rehabilitation, and a few lifestyle modifications like smoking cessation. |
There is no cure for asthma, but treatment helps in decreasing symptoms, preventing complications and helps in slowdown of disease. Treatment involves the use of inhalers that provide relief from symptoms. Tablets are prescribed in severe cases and when inhalers alone cannot control symptoms.
Surgical treatment of asthma includes the following classifications:
The role of immunotherapy in the treatment of asthma:
To treat asthma, immunotherapy uses house dust mite, this allergen improves symptoms of asthma and airway hyperresponsiveness and decreases drug needs. With subcutaneous immunotherapy long term use of medications that treat asthma is reduced. It improves quality of life and immunotherapy reduces the use of quick relief providing drug class (bronchodilators). The effect of immunotherapy lasts for about a year and the progression of disease can be prevented.
The treatment goal of asthma is to achieve and maintain control of the disease to prevent the worsening of symptoms and decrease the rate of morbidity and mortality. Drug treatment can be divided as
Controller and reliever are the two types of medications used in the treatment of asthma.
The Food and Drug Administration (FDA) in the year 2010 approved bronchial thermoplasty, which is a device based nonpharmacological treatment for severe asthma. In this procedure, radiofrequency energy is released during bronchoscopy to selectively separate or remove airway smooth muscle. The right middle lobe part of the lung is not treated using bronchial thermoplasty.
Spirometry is a pulmonary function test that measures the amount of air inhaled or exhaled. It measures forced expiratory volume in 1 sec (FEV) and forced vital capacity (FVC) by measuring maximum inhalation which is followed by rapid and forced exhalation into a spirometer. On the spirometer, asthma presents an obstructive pattern indicated by a reduced forced expiratory volume (FEV) to forced vital capacity (FVC) ratio.
Yes, allergy testing is important for the diagnosis of asthma. About 2 to 3 crores of people are affected by asthma which commonly has an allergic component. Allergy testing has many indications of which persistent asthma is one of them. This test does not directly diagnose asthma, but it identifies allergens that trigger asthma.
Chest X-rays are usually normal in asthma patients, however during exacerbations abnormal findings like hyperinflation and bronchial thickening may be observed. Chest X-ray is suggested for patients aged 40 years or older with new onset or moderate or severe asthma. It also rules out conditions that imitate asthma mediastinal mass with tracheal compression.
Treatment of cough variant asthma is similar to the treatment of asthma. Inhaled corticosteroid is the first line of treatment in cough variant asthma. When monotherapy with inhaled corticosteroid is insufficient other agents such as long-acting beta 2 agonist and leukotriene receptor antagonist are prescribed.
The goals of asthma management include preventing symptoms, maintaining pulmonary function and activity levels normal, preventing exacerbations of asthma and monitoring adverse effects of medications.
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