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Information about Asthma

What is asthma?

Asthma is a chronic lung disorder that results in episodic inflammation and narrowing of the bronchial tubes when certain substances (that may be harmless to anyone else) are inhaled. Excess mucus can also build up in the airways making it hard to breathe.

Asthma is most likely to develop in childhood and continues into adulthood although some people may see a reduction in symptoms as they get older. In the UK, 5.4 million adults and 1.1 million children are currently receiving asthma treatment, according to Asthma UK. Asthma appears to be more common in boys in childhood and more common in women in adulthood.

Asthma symptoms

The severity and frequency of asthma symptoms varies from person to person; some people may have mild symptoms with occasional wheezing and others can have severe, life-threatening asthma attacks or have symptoms all the time. Typical symptoms include:

• Cough
• Wheezing
• Shortness of breath
• Chest tightness
• Increased heart rate

Types of asthma

• Allergic (extrinsic) asthma: This type of asthma is associated with an immune response (allergy) and triggered by allergens, such as pollen, moulds, animal dander, dust mites and cockroach faeces. Read more about allergic asthma here.
• Non-allergic (intrinsic) asthma: This type of asthma tends to develop in adults and is not associated with allergies. Non-allergic asthma can be caused by upper respiratory tract viral infections, air pollution, dust and strong scents, such as perfumes, household chemicals and fumes.
• Exercise-induced asthma: Is caused by breathing in pollen or air pollutants while exercising. Exercising with upper respiratory tract viral infections or exercising in cold, dry air can also trigger exercise-induced asthma.
• Occupational asthma: Breathing in irritants in the workplace, such as chemical fumes, wood dust, gases, insecticides, vapours and metals over a long period of time can cause occupational asthma.
• Nocturnal asthma: Asthma symptoms occur during sleep and can be triggered by temperature changes in the body, allergens in the bedroom, gastroesophageal reflux disease (GERD) and low circulation of adrenal gland hormones.

What causes asthma?

Scientists believe that asthma is caused by a combination of environmental, lifestyle and genetic factors. These include:

• A family history of asthma and/or allergies (hay fever, eczema) - asthma tends to be an inherited condition.
• Smoking during pregnancy or having parents who smoke increases the risk of a child developing asthma.
• Environmental pollution, such as chemical fumes and tobacco smoke.
• Premature birth.
• Low birth weight.
• Airborne allergens e.g. dust, pollen, animal dander, mould, dust mites and cockroaches.
• Upper respiratory viral infections in infancy or childhood, such as common cold, flu.
• Sulphites in food and drinks.
• Emotions, such as stress or laughing.
• Cold air.
• Exercise.
• Medicines, such as nonsteroidal anti-inflammatory drugs (NSAIDs), beta-blockers (high blood pressure medications).

How is asthma diagnosed?

• Medical history and physical examination.
• Spirometry: Also called a lung function test, a spirometry measures how much air you can breathe in and out and how fast you can blow air out.
• Peak flow: This is a hand-held meter that measures how much air you can breathe in and out of the lungs. A reading is also taken after a short-term medication is given. If the result is better than the initial reading, it usually indicates asthma.
• Allergy test: In the case of allergic asthma, an allergy test can help to determine which allergens are triggering symptoms.

Asthma treatments

Conventional asthma treatments

The majority of people with asthma take daily medications to prevent symptoms. Some of the common ones include:

• Inhaled corticosteroids:These inhalers reduce inflammation of the airways. Long-term use of corticosteroids, especially oral medications, can have adverse side effects, such as obesity, osteoporosis, cataracts, elevated blood sugar levels and in rare cases, psychosis.
• Inhaled long-acting beta-2 agonists (LABAs): These are bronchodilators - they open the airways to the lungs and reduce inflammation. People using only LABAs have a slightly higher risk of death, so they are often given in combination with inhaled corticosteroids.
• Leukotriene modifiers: These are inhaled medications that open the airways, reduce inflammation and decrease mucus.
• Mast cell stabilisers: These are inhaled and contain the substances cromolyn and nedocromil that reduce asthma caused by allergic reactions.
• Methylxanthines: Theophylline is a type of methylxanthine thatopens the airways. It is usually taken in pill form every day.

In addition to the long-term medications listed above, many asthmatics resort to quick-relief medications for asthma attacks and temporary relief of symptoms. These include:

• Short-acting beta-2 agonists: These inhalers open the airways and relax the surrounding muscles temporarily within minutes. They are used to prevent exercise-induced asthma. Short-acting beta-2 agonist inhalers are associated with side effects, such as rapid heartbeat, restlessness, headache and muscle tremors.
• Medications with anticholinergic effects: Acetylcholine is responsible for smooth muscle contraction of the airways and excess mucus production. Anticholinergic medications, such as ipratropium, blocks acetylcholine from these effects. Ipratropium is typically inhaled.
• Immunomodulators (anti-IgE monoclonal antibodies): These consist of antibodies that reduce the body's response to allergens by controlling Immunoglobulin E (IgE). Omalizumab is an example of such an antibody and is injected every two weeks.

Natural alternatives for asthma

• Nutritional supplements: Clinical evidence and several double-blind scientific studies have shown that supplements containing grape seed extract (resveratrol), carotenoids, quercetin, n-acetylcysteine, ginkgo biloba, coenzyme Q10 and omega-3 fish oils (EPA/DHA) in addition to vitamins and minerals are effective at preventing asthma attacks, reducing bronchial spasms and inflammation, and reducing allergic symptoms. The exact mechanism of action is unknown.

References