Understanding the Types, Symptoms, and Management of Asthma

Introduction 

Bronchial asthma is a global public health concern. It usually starts in childhood, with an approximate worldwide prevalence of about 262 million cases, and results in the deaths of 455,000 people. In general, 50% and 80% of asthma cases show up by the age of 5. Although it is most problematic during childhood, up to 50% of those with relatively mild severity find that the symptoms disappear later in adolescence. In comparison, 80% of those with more severe symptoms of asthma will persist with the disease into adulthood. Fortunately, as immunologic capacity declines, the symptoms also usually decline in the older population.

There are multiple organizations conducting Asthma Research in search of potential treatment options for those suffering from this condition. Read on to learn more about the treatment options, its symptoms, and the types of asthma.

What exactly is Asthma?

According to the World Health Organization (WHO), asthma is a chronic inflammatory disorder of the airways resulting in airflow obstruction.

The asthma triad—breathlessness, coughing, and wheezing—is its defining feature. These symptoms are associated with variable airflow making it challenging to breathe in and breath out due to airflow obstruction, airway wall thickening, and increased mucus.

Classification of Asthma

Asthma is classified as:

• Intermittent
• Mild persistent
• Moderate persistent
• Severe persistent

1. Intermittent Asthma

The following symptoms are true in intermittent asthma:

• Exacerbations occur only 2 days per week.
• No hindrance in daily activities.
• Symptoms occur fewer than 2 days every month.
• Lung function tests (spirometry and peak expiratory flow [PEF]) remain normal when the person is not having an asthma attack.

2. Mild Persistent Asthma

Mild persistent asthma occurs if:

• Symptoms occur more than 2 days a week but do not occur daily.
• Attacks can interfere with daily activities.
• Nighttime symptoms appear 3 to 4 times a month.
• Lung function tests remain normal, like with intermittent asthma.

3. Moderate Persistent Asthma

Asthma is moderately persistent if any of the following are true:

• Symptoms occur daily.
• Symptoms interfere with daily activities.
• Nocturnal symptoms occur more than once every week, but not every day.
• Lung function tests indicate abnormality (more than 60% to less than 80% of the expected value), and PEF varies by more than 30% from morning to afternoon.

4. Severe Persistent Asthma

In severe asthma:

• Symptoms occur throughout each day, severely limiting daily physical activities.
• Nighttime symptoms are common (daily in some cases).
• Lung function tests are abnormal (60% or less of the expected value), and PEF varies more than 30% from morning to afternoon.

The goal of ongoing asthma treatment is to reduce symptoms’ frequency equal to intermittent asthma.

Symptoms of Asthma 

An Asthma exacerbation includes the following signs:

• Difficulty breathing
• Elevated heartbeat
• Coughing, wheezing, or gasping for air
• Rapid breathing
• Panic and anxiety attacks
• Loss of consciousness and orientation
• Hands and feet turning blue or white

Although uncommon, a person may even die if unable to breathe for extended periods due to an asthma attack.

Some patients show warning signals one or two days before an asthma attack. By recording these symptoms of asthma, one may be able to predict their next attack. Common warning signs are:

• An undiagnosed cough
• Difficulty breathing and a sore throat
• Poor sleep
• Increased chest congestion
• Exhaustion
• A headache, stomachache, fever, or chills
• A flare-up of eczema aggravated allergy symptoms
• Itchy or watery eyes
• A stuffy or runny nose

Triggers of Asthma

 Possible factors that may be triggering asthma episodes include:

• Viral respiratory infection (URI)
• House dust (mites)
• Plant pollens
• Exercise
• Exposure to smoke (cigarettes, cigars, indoor heaters)
• Environmental irritants such as air pollution, perfumes
• Latex-based products (latex gloves or tubing)
• Animals and animal dander
• Specific medications
• Emotional stress
• Occupational factors such as chemical fumes
• Food allergies

Management of Asthma

Overview

An asthma management plan works on two basic principles:

1. Investigate and minimize possible triggering factors whenever possible.
2. Use the appropriate medication as per established guidelines.

Medications:

The usual treatment plan involves a “reliever” and a “controller” medication. The reliever medication is generally a short-acting beta 2 agonist inhaler, such as salbutamol, for acute symptoms of asthma including chest tightness, sudden wheezing, cough, or shortness of breath. The “controller” medicine specifically aims to decrease the chronic inflammatory response asthma triggers. These are taken daily in most cases.

Reliever Medications:

• Salbutamol inhaler
• Salmeterol inhaler
• Itratropium inhaler

Controller Medications:

• Beclomethasone inhaler
• Cromolyn inhaler
• Nedocromil inhaler
• Zafirlucast tablets
• Montelukast tablets or granules
• Theophylline tablets, liquid, or sustained release
• Prednisone, prednisolone

Along with medications, doing the following may also help:

• Keep the person calm:  A panic can make it harder to breathe.
• Avoid triggers or allergens: A calm, well-ventilated environment is beneficial.
• Use a rescue inhaler: Keeping a rescue inhaler nearby is a good idea for patients. This help reduces the attack’s intensity. Inhalers contain bronchodilators, so it is important to follow the prescription.
• Avoid breathing too quickly: Try to sit up straight and take deep and slow breaths. A more severe exacerbation requires oxygen masks. Occasionally, the use of a ventilator may be necessary.

People having Asthma should remain in contact with their doctors to develop a strategy that may aid in identifying treatment options and assist a person in maintaining calm during an Asthma attack.

Asthmatics should inform others of their condition. Parents must inform the educational institute about their child’s Asthma state and advise them to follow the Asthma treatment plan.

Make an Asthma Action Plan

Formulating an Asthma treatment plan with your doctor is important. Your plan should include:

• A list of the potential triggers that lead to an attack
• Ways to spot an attack
• Your medication, dosage, and instructions for use
• When to seek medical attention
• How to adjust your medications
• Emergency contacts

Asthma First Aid

Asthma can be a frightening situation. An attack may last from a few minutes to a few days. Anyone having an asthma attack (flare-up) needs immediate first aid care.

The steps of first aid are as follows:

1. Sit the person upright and provide reassurance.
2. Without delay, give the person 4 separate puffs of their blue/grey reliever medications. Ask the person to take 4 breaths from the spacer after each puff of medication.
3. Observe for 4 minutes. If no improvement, repeat steps 2 and 3.
4. If there is still no improvement, call 911 and request an ambulance immediately. One should repeat steps 2 and 3 while waiting for the ambulance to arrive.

The Takeaway

Asthma is a chronic respiratory inflammation making breathing a challenge. It can affect both adults and kids, varying in severity. A range of drugs is available to treat asthma in the long term to control symptoms of asthma over time, or short-term to treat asthma exacerbations.

It is important to alter one’s way of life to prevent flare-ups. This could entail dietary, physical activity, or stress-reduction adjustments. Many clinical research studies on asthma are being conducted to help those who have the disease and are unhappy with the currently available options.