Asthma

What is Asthma?

Asthma is a common long-standing disease of the airways in the lungs and it’s not the disease of the airsacs of the lungs. It occurs due to swelling and narrowing of the airways (figure 1 and figure 2) which causes obstruction of airflow. In asthma the obstruction in airways is typically reversible so asthma is characterized by variable and recurring symptoms of wheezing, coughing, chest tightness, and shortness of breath.

Asthma is the most common chronic disease in children, affecting approximately 8 to 12% of children. It is thought to be caused by a combination of genetic and environmental factors. It’s prevalence is increasing significantly. Despite this, with proper control of asthma, long term outcome are generally good

What is the cause or what are the risk factors for Asthma?

  • Family history of asthma, allergies, or eczema
  • Childhood viral infections
  • Long term exposure to indoor and outdoor pollution
  • Exposure to tobacco smoke during pregnancy and throughout childhood
  • Stress

Children with these risk factors are born with hypersensitive airways. On exposure to asthma triggers (like allergens/irritants, infections, exercise, cold air, pollution-see below) these hypersensitive airways get inflamed/swollen and narrowed (bronchospasm) and this causes obstruction and interferes with the normal movement of air in and out of the lungs which causes breathing difficulty and wheeze. The inflamed tissues produce an excess amount of “sticky” mucus into the tubes which clump together and form “plugs” that can clog the smaller airways and this results in coughing. The muscles around the bronchial tubes tighten during an attack of asthma. This muscle constriction of the airways is called bronchospasm.

What are symptoms of asthma?

  • Cough- that can be dry or wet
  • Wheezing a whistling sound heard when one breathes out.
  • Breathlessness, chest tightness, and chest pain

The above symptoms

  • Usually starts in childhood
  • Begin suddenly, comes in episodes with symptom-free periods in between and last for minutes to days to weeks.
  • May be worse at night when one sleeps or in early morning.
  • May go away on its own or gets better when using drugs that open the airways (bronchodilators)

What are triggers of asthma?

Asthma is Triggered by
  1. Exposure to Allergens and irritants that include:
    • House dust (eg. dust mites, cockroaches, insects)
    • Animal exposures; cats and dogs dander, and other furry animals
    • Pollens (pollen season and types of pollen vary depending upon the area and climate)
    • Molds (eg, during rainy seasons or in damp areas)
    • Indoor pollutants (eg, paint, perfume, smells)
    • Smoke (from cigarettes, biomass burning)
  2. Exercise eg running
  3. Stress
  4. Exposure to Cold air and wind
  5. Upper respiratory infections — Viral colds
  6. Air Pollution in cities like Delhi
  7. Heartburn (acid reflux)

How is asthma diagnosed?

If you or your child have typical pattern above mentioned symptoms which occur on exposure to triggers, then its best for you to search for an asthma specialist near me, especially if your problem is not settling with routine medications.  An Asthma Doctor will best diagnose asthma based on medical based on the pattern of symptoms and their behaviour over time, family history of asthma and wheeze found on physical examination. A good asthma specialist may also ask of pulmonary function test (spirometry) with bronchodilator reversibility which confirms the presence of airway obstruction and also tells level/grade of airway obstruction and whether the obstruction is reversible with treatment like inhalers.

The best hospital or centre for Asthma in Delhi will have an asthma specialist who will ask for spirometry with bronchodilator reversibility which confirms asthma as well as do some blood test like Allergy Screen Phadia Top ® or comprehensive allergy test or skin prick test as well as FENO to help the asthma doctor take care of all kinds of asthma patients including those with severe uncontrolled asthma. Its best to get the PFT test done when you have ongoing symptoms of asthma.  Though not the best way to diagnose asthma but sometimes a device called peak expiratory flow rate (PEFR) meter is given by few asthma specialist hospitals in Delhi to diagnose asthma in children by showing variability in values by checking record of PEF values over a period of time. The best doctor for asthma will also figure out the severity of asthma and whether it’s intermittent, mild, moderate, or severe. The level of severity on PFT will help your asthma doctor to determine what treatment you’ll start on. Only few best doctors of asthma in India run a “difficult asthma clinic” at their centres/hospitals. If your asthma is not getting controlled in spite of best treatments search for best doctor for asthma in Delhi or best doctor for asthma near me.

What pulmonologists do to cure Asthma?

Asthma is a long-term disease that can’t be cured. The goal of its treatment is to control the disease. A specific, customized plan for proactively monitoring and managing symptoms should be created by a good asthma doctor. Someone who has asthma should understand the importance of reducing exposure to allergens, testing to assess the severity of symptoms, and the usage of medications. The treatment plan should be written down and adjusted according to changes in symptoms. It is treated with two types of medicines: long-term control and quick-relief medicines. Long-term control medicines help reduce airway inflammation and prevent asthma symptoms eg inhaled long acting bronchodilators and inhaled corticosteroids and leukotriene antagonists like monteleukast. Quick-relief, or “rescue,” medicines eg an inhaled short-acting beta-2 agonist (such as salbutamol) along with inhaled steroids relieve asthma symptoms that may flare up. Your initial treatment will depend on the severity of your asthma. Follow up asthma treatment will depend on how well your asthma action plan is controlling your symptoms and preventing asthma attacks.

Your asthma doctor may need to increase your medicine if your asthma doesn’t stay under control. On the other hand, if your asthma is well controlled for several months, your asthma doctor may decrease your medicine. These adjustments to your medicine will help you maintain the best control possible with the least amount of medicine necessary.

It’s treatment for certain groups of people—such as children, pregnant women, or those for whom exercise brings on asthma symptoms—will need to be adjusted to meet their special needs.

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