Breath of Life

Don't allow asthma to bog you down. Get hold of it to lead a healthy and active life

AsthamaThirty-five-year-old Rakesh is hassled - suddenly. He gasps for breath.

It's a routine that he's accustomed to - for long. He knows what he needs to do, quickly. He takes his "puff" of medicine from the inhaler. He soon feels better - and, he's back to work as if nothing has happened.

It ain't as easy as it sounds. Asthma can be severe - even debilitating. More so, when regular measures don't provide quick or long-lasting relief.

The word "asthma" is derived from the Greek aazein, which translates to "sharp breath."

The expression was originally used in Homer's Iliad. Hippocrates, the father of medicine, was, of course, the first to use it for a condition in 450 BC.

Asthma is a chronic disease that affects your airways. The airways are tubes [bronchi] that carry air in and out of your lungs.

In an asthmatic individual, the inside walls of the airways get swollen [inflamed]. This inflammatory state causes the airways to become sensitive. Reason enough why they respond strongly to things that you are allergic to, or find irritating.

As the airways react, they get narrower. This leads to reduced air flow through to your lung tissues. Result: you experience typical asthmatic symptoms such as wheezing, or a whistling sound when you breathe, coughing, tightness of the chest, and troubled breathing, especially at night and towards the wee hours of the morning.

The important point is: asthma should not be considered a single disease. It simply does not have a uniform mechanism of presentation. In other words, its symptom picture is often variable. What's more, while factors that cause airway obstruction in asthmatic patients are typically spasm of the bronchial muscles, mucosal swelling, and mucous plugs, or heightened bronchial reactivity to a variety of stimuli, including pollutants, they may not necessarily be diagnostic.

Beyond allergy

Asthma is highlighted by a prolonged expiratory [exhalation] breathing phase, and reduced inspiratory [inhalation] breathing phase. This is a result of bronchial spasm. The condition is caused by a combination of several exciting factors. Some examples: allergy, due to inhalation of dust, grass, pollen, pollutants, or physical exertion, viral infections, cold air, tobacco smoke, feathers, and animal danders, or food such as egg, prawn, shell fish, and certain medicines - e.g., aspirin.

On the other hand, the condition may also be precipitated by any irritation/infection of the respiratory tract, or gastro-intestinal disturbance. Examples: late meals, hyperacidity, improper eating habits, and dietetic excesses, or junk-food.

Emotional factors in the form of anxiety and worry may also cause the problem - including sudden bouts of wheezing.

Psychologists suggest that asthma is essentially a psychosomatic and/or psycho-physiological disorder. They contend that it is a form of allergy, which occurs most among children and males.

It is also suggested that a constitutional predisposition may be an important factor in the development of the disorder - one that is often connected with unsatisfied feelings of dependency. For instance, a child's asthmatic attacks are sometimes considered as an unconscious appeal to its mother for help.

This is not all. A wide spectrum of respiratory viruses can provoke broncho-spasm [airway obstruction] in asthmatics. But, what characterises asthma is a common clinical observation - the occurrence of increased wheezing in individuals following a short period of exercise.

Age is a significant influencing factor in the development of the problem just as well. The first asthma attack often occurs before the age of 20.

Some experts concur that the condition is not only hereditary and familial, but it may also be strongly influenced by weather changes.

Classical symptoms

Some of the typical symptoms of asthma are breathlessness, wheezing, coughing, or chest tightness. Tenacious sputum, by way of cough, is another common accompaniment and major symptom.

The extent of breathlessness, or wheezing, is variable and may range from slight to extreme difficulty in breathing, even at rest. In severe asthma, the inspiratory effort during respiration, or breathing, is all the more exhausting than expiration.

Asthmatic signs will inevitably depend on the severity. There are paradoxes, too. At one end of the problem, a patient may have no obvious abnormality; while on the other, the patient may be frantic during an acute, or severe, asthmatic attack.

Other indicators of severe asthma include increased heart rate, respiratory rate etc., - in addition to a rising level of carbon dioxide. The factor last mentioned is associated with increased exhaustion and drowsiness. This isn't all.

While all these signs may be useful, they are best evaluated by simple measurements of airflow, such as the peak expiratory flow rate, and blood analysis.

Types

Extrinsic asthma is a term applied when outside [extrinsic] allergic factors can be identified for asthmatic attacks. While a vast number of extrinsic asthma patients have a positive family history, the onset of the disorder usually occurs in infancy, or childhood.

While wheezy episodes are spurred on by cough in association with respiratory tract infections in the initial stages of the disorder, a more typical pattern of sporadic wheezing develops as the child grows older. The latter may be seasonal in nature and/or related to exposure to specific allergens — the most common being the house dust mite. Extrinsic asthma has good forecast in terms of response to treatment. However, a type of extrinsic asthma, in a small percentage of patients, may be dangerous, thanks to its sea-changes - from apparent harmony to sudden life-threatening attacks.

Intrinsic asthma is a term applied to those patients in whom there is no obvious allergic factor. This is also called as cryptogenic asthma - a form that tends to develop in one's middle age, following a respiratory tract infection. While suffocation [dyspnoea] is quite often severe, there may also be sudden and marked improvement on occasions. Aspirin and other drug-related asthma, including occupational types of the disorder, are other forms of intrinsic asthma. There are other types too - classified in accordance with their clinical patterns, or features.

Managing asthma

The management of asthmatic patients depends upon a host of factors. This may not necessarily be related to the type and/or the severity of the disorder.

The significance of reassurance for many parents of asthmatic children and asthmatic patients themselves need not be stressed. It is simple, effective, and practical. Also, since asthma is a condition that is subject to natural fluctuations, it would be a good idea to identify the offending mechanism - e.g., allergy. This will help reduce one's exposure to the allergen wherever and whenever possible - to minimise its traumatic influence.

Measures such as meditation, self-hypnosis, and yoga, along with medications, may all be incorporated for the overall benefit of the patient - especially in the more severe forms of the disorder.

Investigations

Investigations that may be useful in the management of asthma are blood [haematological] examination, skin tests, lung function tests, and chest X-ray. These tests not only hold value in confirmatory diagnosis of asthma, but they also go a long way in documenting its reversibility and exclusion of complications. Most important: diagnosis of asthma should be seriously considered in middle-aged patients, who are non-smokers, but have "evidence" of airway obstruction.

Your physician/therapist will also listen to your breathing and look for signs of asthma, or allergies. S/he will use a device called the spirometer to check how well your lungs are functioning The test measures how much air you can blow out of your lungs after taking a deep breath, and how quickly you can do it. What the test signifies? It will help your physician/therapist to know whether your airways are inflamed and narrowed, or the muscles around your airways are constricted. Depending upon the result, your physician/therapist may prescribe a medicine that helps open narrowed airways. S/he will also conduct the test, as and when required, to figure out if the medicine changes, or improves, your results.

Asthma cannot always be cured. However, most people with asthma can control it, reduce its symptoms, and lead active lives. Remember, asthma never bogged down the likes of tennis stars like Vijay Amritraj, Olympic champions, athletes, footballers, and other sportspersons, including one of cricket's greatest all-rounders Ian Botham who, as a kid, suffered from the disorder. So, take a lungful of fresh air and confidence from their success stories - and, do a star-turn for yourself, right now!

Wheeze of the matter

When your asthma symptoms become worse than usual, it is called an asthma episode, or attack. During an asthma attack, the muscles around the airways tense up. This makes the airways narrower - it leads to reduced air flow. Cells in the airways now produce more mucous than normal. The excess mucous narrows the airways - leading to difficulty in breathing.

Asthma attacks are not all the same. They differ in their intensity. In a severe asthma attack, the airways can close to such an extent that not enough oxygen reaches the vital organs. This condition is a medical emergency. People can die from severe asthma attacks, if they are not attended to quickly. So -

  • Stay calm, sit upright with hands on knees for support
  • Loosen tight clothing; try to breathe slowly and deeply
  • Sip a cup of warm water; take your prescribed medication
  • Call your physician/therapist, if your symptoms don't recede.

Other things to do

  • Take good care of your asthma and control it
  • Work closely with your physician/therapist to learn what to do, and what you should not do
  • Avoid things that trouble your airways
  • Take medicines as directed by your physician/therapist
  • Keep track of your asthma episodes. This will help you respond quickly to signs of an impending attack
  • Control your asthma every day, because this is the only way you can prevent serious symptoms and also take part in all activities
  • Help your kids control their asthma. This will help them attend school, with relatively less "absentee-days," and allow them to take part in their regular school activities
  • Keep your medicines handy.

Asthma Facts

  • The World Health Organisation [WHO] estimates that there are 15-20 million asthmatics in India
  • Globally, asthma kills 1,80,000 every year
  • In 2003, there were 12.7 million physician office visits and 1.2 million outpatient department visits due to asthma
  • There are 3 million asthma-related visits to emergency departments on an annual basis
  • The value of reduced productivity due to death represented the largest single indirect cost-related factor to asthma is $1.7 billion
  • 13 million school days are missed annually due to asthma
  • Asthma accounts for approximately 24.5 million missed work days for adults annually
  • The prevalence of asthma in adult females is 35 per cent greater than the rate in males
  • Approximately 40 per cent of children who have asthmatic parents will develop asthma.

- Sourced from the Web

Seek Help.

  • When your fast-relief medicine does not work within 20-25 minutes
  • When you have difficulty in walking, talking, or eating
  • When you breathe rapidly and with difficulty than usual
  • When your kid has a feeble cry.

Living with Asthma

  • Undergo regular check-ups
  • Identify allergies and avoid things that trigger asthma
  • Have an asthma action plan and follow it
  • Use medications as prescribed by your physician/therapist. Make sure you understand how to use medicines and medical devices [inhaler/nebuliser]
  • Use a peak flow meter and track your peak flow regularly. A peak flow meter measures the air flow out of the lungs. It also indicates a breathing problem before an emergency crops up
  • Eat healthy foods, drink plenty of water, get enough sleep, exercise regularly, and take a flu shot - on the advice of your physician/therapist
  • When your asthma does not get controlled, in spite of your best efforts, speak to your physician/therapist about your lifestyle, environment, and medications including possible changes that can help you
  • Vacuum clean your home regularly
  • Some alternative treatments, such as ayurveda, yoga, and homoeopathy, are said to be useful for asthma. Speak to a therapist; don't self-treat
  • If your kid has asthma, inform the school staff. Also, teach your kid how to use/take medication while at school, or baby-sitting/childcare.

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Rajgopal Nidamboor
Rajgopal Nidamboor, a trained physician, is a writer, commentator, and author. In a career spanning 25 years, Nidamboor has published over 2,000 articles, on a variety of subjects, two coffee table books, an E-book, and a primer on therapeutics, aside from an encyclopaedic treatise on Indian philosophy.

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