Bronchial asthma is a condition in which the airways narrow and swell, causing suffocation, coughing, and wheezing..
For some people, asthma is just a minor nuisance. For others, it can be a serious problem that interferes with everyday life, and sometimes causes dangerous attacks that, without assistance, can end fatally.
Asthma cannot be completely cured, but its symptoms can be effectively controlled. The course of the disease changes significantly over time, so it is very important to constantly be monitored by a doctor. If necessary, the doctor will be able to adjust the dose of your medication on time or prescribe new ones..
It is not entirely clear why some people have asthma, while others do not. Scientists believe that heredity and environmental factors play a role in the development of asthma.
The main triggers that cause bronchial asthma are:
• Airborne allergens such as pollen, animal dander, mold, particles of insects (especially cockroaches).
• Airborne irritants such as cigarette smoke, industrial dust.
• Food, among which peanuts and shellfish are especially distinguished.
• Respiratory infections, including common cold.
• Physical activity (asthma physical effort).
• The effect of cold air.
• Strong emotional distress and stress..
• Sulphites and preservatives added to food and drinks.
• Gastroesophageal Reflux Disease (GERD).
• Menstrual cycle in women.
There are many known factors that increase the risk of bronchial asthma..
• The presence of asthma in close relatives (brothers, sisters or parents).
• Another allergic disease, such as atopic dermatitis or allergic rhinitis (hay fever).
• Tobacco smoking, including secondhand smoke.
• Intrauterine exposure to tobacco (mother smoked during pregnancy).
• Exposure to exhaust gases and industrial smog.
• Inhalation of harmful substances at work: chemical laboratories, pharmacies, beauty salons, industrial production, etc..
• Exposure to certain bacterial and viral infections, as well as parasites.
• Low birth weight.
The severity of bronchial asthma can vary significantly. You may have rare asthma attacks during exertion or stress, or there may be daily, ongoing problems.
Symptoms of asthma include:
• Choking Attacks.
• Severity or chest pain.
• Sleep disturbance due to shortness of breath, cough and wheezing.
• Whistling sound when exhaling.
• Coughing and wheezing that gets worse with respiratory infections.
There are several signs that your asthma is getting worse:
• Attacks become more and more difficult.
• Breathing is harder than before.
• It is required to use an inhaler more often.
In some people, asthma worsens in the following situations:
• Physical activity, especially in cold air.
• Contact with food or air allergens..
• Stay in a room saturated with dust, perfumes, reagents, etc..
1. Call an ambulance.
In the event of an asthma attack, a person may die if help is not provided on time. If you or someone near you is having an asthma attack, call an ambulance. Threatening symptoms for asthma:
• Choking and wheezing suddenly worsen, the patient cannot breathe.
• With minimal physical activity, shortness of breath occurs.
• Using an inhaler does not bring relief.
2. Contact your doctor.
In the following cases, you need to plan a visit to the doctor in the near future:
• You think you have asthma. If you are concerned about frequent coughing, shortness of breath, or wheezing that lasts several days, consult your doctor. Early asthma treatment helps prevent serious consequences.
• Monitoring the status after diagnosis. If you have asthma, check with your doctor regularly for control. Good long-term control of asthma will reduce the frequency of attacks, prevent complications and help you live a full life..
• Your condition has become worse. If you notice a worsening of asthma symptoms, see your doctor as soon as possible. The same applies if your previously prescribed medications are worse off. Perhaps the doctor will review the appointment. Do not increase the dose of medication yourself.!
1. Physical examination.
To rule out other possible conditions, such as a respiratory infection or COPD (chronic obstructive pulmonary disease), the doctor should conduct a physical examination and make a series of tests.
2. Tests for measuring lung function.
These tests are done to see how well your lungs work. Spirometry is a common procedure. During spirometry, you will have to inhale and exhale air in order for the device to measure lung capacity and other parameters.
A peak flow meter is another useful asthma control device. Peak flow meters are compact devices that determine how hard it is for you to exhale. This appliance can be used at home - at any time it will help you find out how much your condition has changed..
Tests to determine lung function can be performed before and after taking a bronchodilator, such as albuterol. These drugs expand your airways and help you breathe more freely. If your lung function has improved with these drugs, then you are most likely to have asthma..
3. Additional tests.
Other procedures used to diagnose asthma include:
• Test with methacholine. This test is very common in the USA. Metacholine is considered a powerful trigger for asthma, when it is inhaled, narrowing of the bronchi occurs. If you are keenly responding to methacholine, then you probably have asthma. This test can be prescribed even if your spirometry was normal..
• Test with nitric oxide. This test is rarely used. It measures the amount of gas (nitric oxide) that you inhaled. When the airways are inflamed - this is a sign of asthma - you will have elevated levels of nitric oxide.
• Visualization. A chest x-ray and high-resolution computed tomography (CT) scan of the lungs and nasal sinuses can detect structural abnormalities and other diseases that cause respiratory failure.
• Sputum analysis for eosinophils. In this test, a lab technician examines your sputum for eosinophils, a type of white blood cell. Eosinophils are present in sputum with asthma, and become clearly visible in the sample when pink eosin is added..
• Provocative tests to detect asthma of physical effort and reaction to cold. With these tests, the doctor determines the condition of the bronchi before and after exercise, as well as after inhaling cold air.
Prevention of attacks and long-term control is the main goal of asthma treatment. Treatment begins with triggers that cause asthma attacks in your area. Your doctor will recommend that you carefully avoid these triggers. In addition, you will be prescribed medications for continuous use and funds for urgent relief of an attack that you will always need to carry with you.
The choice of medication for you depends on many things, including your age, symptoms, asthma triggers, concomitant diseases, etc. Long-acting prophylactic drugs will reduce airway inflammation and prevent attacks. Fast-acting inhalers (bronchodilators) can quickly open the airways and stop the attack. In some cases, antiallergic drugs are also prescribed..
1. Prophylactic agents of long action.
These drugs, which are usually the cornerstone of asthma, are taken daily. They constantly keep asthma under control and significantly reduce the likelihood of an asthmatic attack. These drugs include:
• Inhaled corticosteroids. These include fluticasone (Flonase), budesonide (Rhinocort, Pulmicort), mometasone (Nasonex), flunisolid (Aerobid), cyclesonide (Alvesco), beclomethasone (Qvar, Beconase) and others. You may need to take these medicines for several days or weeks before you feel the result. Unlike oral corticosteroids, these drugs have a relatively low risk of side effects and are more suitable for regular use..
• Leukotriene modifiers. These oral medications - including montelukast (Singulair) and zafirlukast (Accolate) - help relieve asthma symptoms for up to 24 hours. In rare cases, these drugs cause side effects from the psyche, such as depression, hallucinations, aggressiveness, agitation, suicidal thoughts, etc. In case of unusual reactions, you should immediately consult a doctor.
• Long-acting beta-agonists. These inhalation preparations, which include salmeterol (Serevent) and formoterol (Foradil), expand the airways and improve breathing for a long time. Some studies show that they can increase the risk of a severe asthma attack, so they are recommended to be used in parallel with inhaled corticosteroids..
• Combined inhalers. These preparations may contain a combination of fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), mometasone and formoterol (Dulera). That is, they contain a beta-agonist that dilates the bronchi, and a corticosteroid that suppresses inflammation.
• Theophylline (Theotard, Theo-24, Elixophyllin). This is an oral daily drug that helps to expand the bronchi, relaxing the smooth muscles of the airways. Now it is not used as widely as in previous years..
2. Medicines for quick relief of attacks.
These drugs are used for quick, short-term relief of asthma symptoms during an attack, as well as before exercise (on the recommendation of a doctor). These include:
• Inhaled anticholinergics, such as ipratropium bromide (Atrovent) and combination preparations based on it (Berodual N). Like other bronchodilators, ipratropium rapidly expands the bronchi and facilitates breathing. It is often used for emphysema and chronic bronchitis, but is sometimes prescribed for the relief of asthma attacks..
• Short-acting beta-agonists. These inhaled drugs act very quickly and stop an asthma attack. These include albuterol (Ventolin), levalbuterol (Xopenex HFA) and pirbuterol (Maxair). Short-acting beta-agonists can be used with a portable hand-held nebulizer or nebulizer.
• Oral and intravenous corticosteroids. These drugs, including prednisone and methylprednisolone, reduce airway inflammation caused by severe bronchial asthma. They can cause serious side effects with long-term use, so they are used only for short-term treatment..
If you have an asthma attack, then a fast-acting inhaler will help you best. But with proper long-acting medication, you should not often need such measures. Remember to keep track of how many doses of inhaler you use each week. If you started to use it too often, consult your doctor for advice. You may need an additional seizure prevention tool..
3. Antiallergic drugs for asthma.
Antiallergic medicines prescribed for asthma include:
• Means for immunotherapy. This is a kind of vaccine that teaches the body to respond normally to the introduction of a particular allergen. Such drugs are administered parenterally. Initially, one dose is prescribed per week for a couple of months, after which injections are made only once a month for the next 3-5 years.
• Omalizumab (Xolair). This injectable drug modifies the immune system and is prescribed for patients with severe bronchial asthma..
• Antihistamines. Among them are the well-known loratadine, diphenyramine (diphenhydramine), chloropyramine (Suprastin), ketotifen and others. They are usually combined with other asthma medications..
This treatment, which is not suitable for everyone, is used only for severe asthma, which does not respond to drug treatment. During this procedure, the inside of the airways is heated using electrodes, which reduces the smooth muscle layer inside the bronchi. This limits the ability of the bronchi to taper, making breathing free and preventing asthma attacks. Treatment takes several sessions.
1. Avoid triggers that are dangerous for you:
• Use an air conditioner with special filters to clean the air.
• Clean all objects in the house from particles that can cause asthma..
• Maintain optimum humidity with a humidifier.
• Avoid mold in the living room..
• Avoid animals if you are sensitive to them..
• Clean your home and workplace regularly.
• Cover your mouth and nose when it's cold outside..
2. Take care of your health:
• Exercise regularly following your doctor’s recommendations.
• Eat more vitamins and fiber (fruits, vegetables).
• Get vaccinated against flu and other infections..
• Maintain a healthy body weight.
Some unconventional treatments can relieve asthma symptoms. However, remember that these methods will never replace the traditional, medicine-approved treatment. Talk with your doctor before trying this or that method - it may not work for you..
Alternative asthma treatments include:
• Breathing techniques, such as Buteyko technique or yoga.
• Acupuncture (acupuncture): an ancient oriental treatment technique that only a specialist should practice.
• Relaxation. These techniques include meditation, biofeedback, hypnosis, progressive muscle relaxation, etc..
• Omega-3 fatty acids: biologically active substances found in fish oil, flax seeds and other natural sources. They can reduce bronchial inflammation in asthma..
• Medicinal herbs. Some plants can improve asthma. Especially a lot of herbal recipes in Chinese and Indian medicine. Be sure to consult your doctor before taking any unconventional remedies.!
Possible asthma complications include:
• Sleep disturbance, lack of sleep and low ability to work.
• Irreversible narrowing of the bronchi (remodeling of the airways).
• Side effects associated with long-term treatment of asthma.
• Life threatening asthma attacks.
By working closely with your doctor, you can create a plan to treat your illness, prevent seizures, and improve your quality of life..
• Follow your treatment plan and visit your doctor regularly.
• Take all medicines exactly as your doctor has prescribed..
• Get vaccinated against flu and other respiratory infections.
• Identify and avoid all triggering asthma factors that are dangerous to you..
• Closely monitor your condition, especially breathing.
• In time to recognize and stop asthmatic attacks.
Konstantin Mokanov: Master of Pharmacy and professional medical translator