What is Asthma?
Asthma is a chronic, obstructive disease of the lungs of varying severity affecting 6-7% of the UK population. It is most common in Western populations, and appears to be on the increase. Asthma can affect all ages but around 50 per cent of sufferers are children, mostly boys under 10.
What are the Symptoms of Asthma?
The breathing difficulties linked with asthma are caused by constriction of the bronchial tubes or airways, and are compounded by the inflammation and accumulation of secretions in these passages. During an asthma attack, the muscles around the airways and lung branches tighten and go into spasm. The tissues swell, causing air to be trapped making it difficult to breathe.
The main symptoms of asthma are:
• Dyspnoea (shortness of breath)
• Wheezing
• Chest tightness
• Coughing
• Fatigue or drowsiness
There are also ‘danger’ signs of severe asthmatic attacks that require immediate medical attention:
• Blue skin colour
• Severe exhaustion
• Gasping breath
• Confusion and restlessness
What are the Causes of Asthma?
In many cases, asthma seems to run in families, and is often the other side of the coin to the skin disease eczema. However, whilst a large component can be said to be hereditary, asthma can be triggered by individual allergic sensitivity to external agents such as irritants in the atmosphere. Asthma inducing factors are often separated into:
• Non-specific factors such as physical exertion, cold, smoke and pollution which affect all asthma patients
• Specific factors such as pollen, dust, animal fur, pollen and certain medications such as aspirin
Smoking mothers and a lack of exposure to infection during childhood have also been associated with the development of asthma
Types of Asthma
Nocturnal asthma can be a common problem, and in many may be a sign of overall poor control. Drugs that are long-acting are sometimes helpful in these cases.
Exercise-induced asthma often becomes apparent in children when they perform games at school or run around at home. The child is often found to be wheezy after exertion. Preventative measures may involve the sufferer having to take an inhaled 'puff' of steroid before a games lesson.
Occupational asthma is said to affect around 5% of the working population. This is often difficult to diagnose, but may involve continued exposure to certain substances or conditions such as cellulose paints or dusty atmospheres.
How is Asthma Treated?
Treatment of asthma involves a number of self-help actions combined with a number of possible medications.
Self-help
• Avoid specific factors that affect you
• Avoid general irritants such as tobacco smoke or very cold atmospheres
• Seek medical attention immediately if you experience a serious asthmatic attack
• Use your inhaler device correctly, contact our nurse, doctor or GP if unsure
• Discuss your treatment regime with your doctor
Medicines
Asthma drug treatment can be split into three groups: relievers, preventers and reserve/emergency.
Reliever drugs:
• Short acting Beta-2-agonists e.g. Salbutamol (Ventolin), Terbutaline (Bricanyl),
• Long acting Beta-2-agonists e.g. Salmeterol (Serevent) and Formoterol (Foradil, Oxis)l
• Anti-cholinergics e.g. Ipratropium Bromide (Atrovent)
• Theophyllines
Reliever drugs work by relaxing airway muscles thus allowing more air entry to ease breathing. These are known as bronchodilators and are taken in inhaled form. They are also referred to by the colour of their container i.e. blue, green or grey.
Preventer Drugs:
• Corticosteroids e.g. Beclomethasone (Beclazone), Budesonide (Pulmicort), Fluticasone (Flixotide)
• Cromones e.g. Sodium cromoglicate (Intal) and Nedocromil sodium (Tilade).
• Leukotriene receptor antagonists e.g. Montelukast (Singulair) , zafirlukast (Accolate)
Preventer drugs work by reducing inflammation in the airways and soothing irritability. Unlike reliever drugs, these need to be taken at a regular frequency such as twice a day. Again, colour coding plays its part with these being mostly brown, orange, red and yellow.
Leukotriene receptor antagonists block leukotriene receptors in the lungs and therefore block the actions of leukotrienes. Leukotrienes cause inflammation and increase mucus production which can narrow airways.
Emergency Drugs:
• Salbutamol
• Ipratropium bromide
Emergency treatment for asthma can be taken either orally via nebuliser (air compressor) or injection. Often in acute attacks, patients need to contact their GP or attend a hospital casualty department without delay. Sometimes nebulisers need to be obtained for home use, though these are not always available on the NHS.
Using asthma devices can take some time to master, though inhaler techniques are taught at doctors' surgeries and clinics, where regular clinical monitoring is initiated using a 'stepwise' approach to management. This will include measuring the 'peak flow' (lung capacity) of the sufferer to help determine the degree or severity.
Step 1 is a category in which most cases will fit. This means that they will usually need to use their relief inhaler at less than 1 puff per day with no other treatment being necessary.
Step 2 is for those who require more than 1 puff daily for relief but may also require a preventative inhaler to help limit the frequency of relief 'puffs.'
Step 3 is reserved for those on higher doses of preventative medication perhaps with an additional drug. Other steps may include a combination of higher doses involving inhaled preventative medication with oral steroids and nebulisers.
Complementary Medicine in Asthma
These days there is considerable interest in alternative treatments for asthma. Particularly as conventional treatment involves long-term use of steroid drugs. However, many of these complementary approaches have not been assessed, and so have not been accepted as a viable alternative by the medical establishment.
• Acupuncture
Acupuncture has had some benefits in treatment of minor conditions of asthma, but not so much in severe cases.
• Homeopathy
The methods of Homeopathy differ radically with conventional medicine, and in the case of asthma involve withdrawing conventional medication altogether. This is seen as too controversial for many practitioners of accepted medicine. If thinking of trying this method, you should not stop taking your usual medication without first consulting your GP.
• Hypnosis
Hypnosis has claimed some success, particularly in helping sufferers cope with acute asthmatic attacks.
• Herbalism
Herbal treatments are often aimed at treating symptoms rather than conditions such as reducing sputum production or complementing diet.
Useful addresses:
National Asthma Campaign (NAC)
Providence House
Providence Place
Islington N1 0NT
Asthma Helpline: 08457 010203
www.asthma.org.uk
The British Allergy Foundation (BAF)
Deepdene House
30 Bellegrove Road
Welling, Kent DA16 3PY
Allergy helpline: 0181 303 8583
www.allergyfoundation.com
Dr. A. Bose
Mr Jai Cheema
© Allcures.com September 2011