Asthma (from the Greek άσθμα, ásthma, “panting”) is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath. It is clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate. It may also be classified as atopic (extrinsic) or non-atopic (intrinsic).

It is thought to be caused by a combination of genetic and environmental factors. Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol). Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids. Leukotriene antagonists are less effective than corticosteroids and thus less preferred.

It’s diagnosis is usually made based on the pattern of symptoms and/or response to therapy over time. It’s prevalence has increased significantly since the 1970s. As of 2010, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally. Despite this, with proper control of asthma with step down therapy, prognosis is generally good.

What are symptoms ?

Most people with asthma have attacks separated by symptom-free periods. Some people have long-term shortness of breath with episodes of increased shortness of breath. Either wheezing or a cough may be the main symptom. The attacks can last for minutes to days, and can become dangerous if the airflow is severely restricted.

Symptoms include :

  1. Cough with or without sputum (phlegm) production.
  2. Pulling in of the skin between the ribs when breathing (intercostal retractions).
  3. Shortness of breath that gets worse with exercise or activity.
  4. Wheezing, which :
    • Comes in episodes with symptom-free periods in between.
    • May be worse at night or in early morning.
    • May go away on its own.
    • Gets better when using drugs that open the airways (bronchodilators).
    • Gets worse when breathing in cold air.
    • Gets worse with exercise.
    • Gets worse with heartburn (reflux).
    • Usually begins suddenly.
  1. Emergency symptoms:
    • Bluish color to the lips and face.
    • Decreased level of alertness, such as severe drowsiness or confusion, during an asthma .
  1. Extreme difficulty breathing.
  2. Rapid pulse.
  3. Severe anxiety due to shortness of breath.
  4. Sweating.
  5. Other symptoms that may occur with this disease :
    • Abnormal breathing pattern –breathing out takes more than twice as long as breathing in.
    • Breathing temporarily stops.
    • Chest pain.
    • Tightness in the chest.

How does it affect breathing?

Asthma causes a narrowing of the breathing airways, which interferes with the normal movement of air in and out of the lungs. It involves only the bronchial tubes and does not affect the air sacs or the lung tissue. The narrowing is caused by three major factors: inflammation, bronchospasm, and hyperreactivity. Inflammation increases the thickness of the wall of the bronchial tubes and thus results in a smaller passageway for air to flow through.

The inflammation occurs in response to an allergen or irritant. 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. The muscles around the bronchial tubes tighten during an attack of asthma. This muscle constriction of the airways is called bronchospasm. The chronically inflamed and constricted airways become highly sensitive, or reactive, to triggers such as allergens, irritants, and infections.

Exposure to these triggers may result in progressively more inflammation and narrowing.

How is it diagnosed?

A doctor will diagnose asthma based on medical and family histories, a physical exam, and test results. Doctor also will figure out the severity of it—that is, whether it’s intermittent, mild, moderate, or severe. The level of severity will determine what treatment you’ll start on. The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between the episodes.

What pulmonologists do to cure Asthma?

Asthma is a long-term disease that can’t be cured. The goal of it’s treatment is to control the disease. A specific, customized plan for proactively monitoring and managing symptoms should be created. Someone who has it 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. Quick-relief, or “rescue,” medicines 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 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 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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