Asthma

Asthma is a chronic respiratory disease that is characterized by lung inflammation and narrowing of the airways, ultimately leading to difficulty in breathing. Think of your body like a house, in your house you likely have an air conditioning system plus windows that helps bring in fresh air and lets out old, used air. The respiratory system in our body does this function for us in our body. The respiratory system’s job is to bring in “good” air in the form of oxygen and gets rid of the “bad” air, carbon dioxide. The respiratory system is made of different parts that help to achieve this goal:

• Nose and mouth: The start of respiration begins here when we take a big breathe in, the air enters through our nose and mouth, this air then goes through our windpipe which is a long tube called the trachea. This trachea then splits into two tubes called bronchi and each of our lungs have a bronchi.
• Lungs: The lungs are made up of three distinct parts: bronchi, bronchial tubes and alveoli
• Bronchi: This is the large big tube on each side of the lungs. Each bronchi then gets divided further into bronchial tubes. Air flows through the bronchi to the bronchial tubes.
• Bronchial tubes: The bronchial tubes look like the branches of a tree that get spread throughout our lungs. Air flows throughout the bronchial tubes.
• Alveoli: At the very end of each bronchial tube there are any tiny sacs of air called alveoli. Think of the alveoli as little balloons filled with air. These tiny balloons or alveoli get filled with air every time we take a deep breath in. The alveoli walls are paper thin and have tiny blood vessels that surround them called capillaries. The paper thin walls allow for air to flow through them. The “good” air or oxygen that we breath in flows from the alveoli to the capillaries and gets transported throughout our bloodstream and to our organs that need it. As we take a breath out the “bad” air, carbon dioxide flows from the capillaries to the alveoli and takes the reverse path back out to our nose and mouth

The respiratory cycle is incredible at breathing oxygen in, delivering oxygen to the body and getting rid of the waste product carbon dioxide.

In a patient with asthma, their respiratory system, in particular their airway/bronchial tubes are more sensitive. This sensitivity leads to an airway that is more irritated and inflamed. The irritation and inflammation then cause the bronchial tubes to narrow or constrict making it harder for air to flow throughout the lungs. The airway constriction can then lead to difficulty breathing. The inflammation in the airways leads to swelling and excess mucus being produced. The excess mucus can make it even harder for air to flow throughout the lungs. In a patient with asthma, difficulty breathing often looks like persistent cough, a feeling of tightness in the chest, shortness of breath or wheezing ( a high-pitched whistling sound when they take a breath in or out). If a patient with asthma has significant difficulty breathing and their normal treatment methods aren’t helping we call this an asthma exacerbation or asthma attack, and the patient needs to be seen promptly at their local urgent care or emergency department.

At its core asthma is the result of narrowed airways leading to difficulty in airflow exchange. The signs and symptoms of asthma can vary in terms of severity and frequency for each individual. The common signs and symptoms include:

• Coughing, especially at night or in the early morning
• Chest tightness
• Wheezing (high-pitched whistling sound)
• Increased Mucus Production
• Difficulty breathing during exertion
• Trouble sleeping due to breathing difficulties
• Frequent respiratory infections
• Shortness of breath

Asthma can be classified into various sub-types based on the clinical features and the type of triggers that can prompt an asthma exacerbation. The most common sub-types include but are not limited to:

• Allergic asthma: Triggered by allergens such as pollen, mold, pet dander, cockroaches, dust mites etc.
• Non-allergic asthma: Triggered by cold air, smoke, strong odors, exercise, etc.
• Occupational asthma: Derived from constant exposure to irritants or allergens exposed to in the workplace like wood or coal-burning smoke, paint fumes, formaldehyde

The exact cause of asthma remains unclear but it is believed to result from both genetic and environmental factors. The most common risk factors for developing asthma include:

• Family history of asthma or allergies
• History of respiratory infections in early childhood – Recurrent wheezing episodes in early childhood associated with common respiratory viruses like rhinovirus or respiratory syncytial virus or influenza virus have been linked as a contributor to the development of asthma
• Exposure tobacco smoke or air pollution
• Occupational exposure to certain irritant substances
• Having a personal history of allergies
• Microbiome exposure
• Smoking – Smoking leads to increased airway inflammation and corticosteroid insensitivity. A number of studies have demonstrated a clear association between smoking and an increased risk of developing asthma. Link citation.
• Sex hormones

There is no specific screening test for asthma, having regular follow-up appointments with your healthcare provider can ensure that any asthma-like symptoms are identified early. Asthma is typically diagnosed using a combination of medical history, physical examination and breathing tests.

• Medical History: A healthcare provider will ask a series of questions to assess what symptoms you are currently having, the frequency of your symptoms and if you have noticed any obvious triggers that initiate episodes of breathing difficulties.
• Physical examination: A healthcare provider will perform a physical examination listening to your heart and lungs. The focused exam on the lungs will be done with a stethoscope to check for any abnormal breathing sounds like wheezing.
• Confirmatory Testing: The diagnosis of asthma is confirmed by having the patient perform a lung function test also known as pulmonary function tests (PFTs). These test use a spirometer, a tube that the patient blows in to and is able to measure how well you can breath air in and out. The test allows healthcare professionals to asses your lung capacity and your ability to move air throughout your lungs.
  • In a patient with a likely diagnosis of asthma, these tests will demonstrate a decreased ability for air to flow out of the lungs indicative of an obstructive pattern.
  • Patients who are suspected to have asthma and demonstrate an obstructive pattern on their lung function tests may also undergo a bronchodilator test. A bronchodilator is a category of medications that help open up your airways. Some examples of bronchodilators are albuterol, salmeterol and levalbuterol. The patient will be given a bronchodilator to inhale and then have their lung function test performed again. If the patients lung function improves significantly it suggest that the airway constriction is reversible— a KEY feature of asthma and the diagnosis is confirmed.

Treatment of asthma focuses on 3 main goals: 1) controlling symptoms, 2) preventing future exacerbations and 3) improving quality of life. In general, patients should avoid known triggers and maintain a healthy lifestyle. Symptoms can be alleviated through the use of certain medications:

• For an acute symptoms, patients can use quick relief medications known as a short- acting beta agonists. These medications help open up the airway and have an effect that last *** minutes.
• To help decrease inflammation and keep asthma symptoms at bay, patients can use certain medications such as inhaled corticosteroids, leukotriene modifiers and long-acting beta-agonists.
• For patients with allergic asthma, they can receive immunotherapy in the form of allergy shots as well as
• For patients with severe asthma certain biollogic therapies can be given as well

Asthma is a chronic condition that can have an impact on personal relationships and intimacy. Patient with asthma should adhere to having open communication with partners and their loved ones so they understand the condition, know their triggers and what treatment can be helpful when symptoms present themselves. Patient with asthma

There are several common misconceptions about asthma and it is important to dispel some of these common myths. Some common myths include:

• Myth: Asthma is just a childhood condition that goes away with age 
  Fact: Asthma can persist into adulthood and require ongoing management 
• Myth: Asthma medications can become addictive 
  Fact: Asthma medications are essential for managing symptoms and preventing asthma exacerbations. They are NOT addictive 
• Myth: Patient’s with asthma should avoid heavy physical activity 
  Fact: Regular exercise is beneficial for people with asthma and can help improve lung function