Asthma: Causes, Diagnosis and Treatment
By Dr Prasanna Kumar Thomas
Bronchial Asthma is a common respiratory disorder which is chronic and recurrent and has a wide prevalence amongst children and adults . The word Asthma originates from the Greek Word ‘Azein’ which means laboured breathing . Hence the primary symptoms of asthma is breathlessness accompanied by cough – sputum production – repeated respiratory infections with a very frequent accompaniment of Allergic rhinitis which is an acute inflammation of the nose and the sinuses . The inflammation in asthma is predominantly oesonophilic and is related to the IGE Immunoglobulin . The cause of Asthma is multifactorial but two entities are invariably involved in the causation and progression of asthma
1. Genetic factors – Asthma is known to run in families though the severity and the extend may be different in generations. Needless to say that no specific gene that causes Asthma has been identified, except for a gene called ADAM 33 which is sometimes associated but not definitely proven
2. Environmental factors – Environmental pollution, both indoors and outdoors, are very commonly associated with the disease and this can vary from industrial pollutants – organic sources such as fine particles flour, house dust, sprays, perfumes, mosquito coils, etc. There is a possibility that the above, if not causative, can be definitely affect the prognosis and treatment of the disease
The clinical symptoms of asthma are:
1. Breathlessness - which is often manifested as what is commonly known as wheezing or tightness in the chest which is the result of constriction in the airways as a result of smooth muscle contraction. This is a reversible component and is treatable with a group of drugs called Bronchodilators
2. Cough - is a common accompaniment that is produced by irritation in the airways and the combination of breathlessness and cough form the foundation of asthma symptomatology .
3. Sputum - is another common symptom and is often the result of recurrent infections with bacteria and virus that is so typical of asthma. Longstanding asthmatics can also have architectural distortion of the bronchial tree producing Bronchiectasis, which is a structural damage to the peripheral airways and Emphysema, which is a conglomeration of air sacks that ultimately results in disorted oxygen, carbon dioxide exchange.
4. Chest Pain - This is an non-specific symptom probably secondary to chronic cough or wheezing except in a certain condition called Pleurisy
5. Nasal Discharge - This is the result of accompanying nasal hypersensitivity – rhinitis - and is common in younger asthmatics.
6. Fever – commonly the result of viral or bacterial infections.
DIAGNOSIS: The characteristics clinical features of Asthma can easily be picked up but it is often missed as a recurrent cold and cough thus delaying the diagnosis of Asthma. The singular test to diagnose Asthma is a test which is called Spirometry or a Lung Function Test which will measure the flow and volume over a period of time. This flow volume loop has a characteristic pattern and an increase in volume Post Bronchodilator between 12-15% will establish the diagnosis of asthma. Other supportive investigations would include the chest x-ray, Paranasal sinus x-ray and a routine blood work.
TREATMENT: The site of the problem in Asthma is predominantly in the airways and hence the inhaled medication /inhalers/ nebulizers are most effective in treatment. The inhalers act at the site of the problem and have no side-effects and can be used safely in children in adults and even in pregnant women. It is needless to say that pregnant women need to be monitored closely. The corner stone of Asthma treatment today is inhalation therapy with various types of inhalers: Dry powder inhalers, Metered dose inhalers, Breath actuated inhalers
All these need to be used under strict medical supervision. Hence inhalation therapy using what we called Combination Inhalation Therapy – with an inhaled corticosteroid and a long acting betaageonist. This will take care of the inflammation and broncho spasm. All additional problems like rhinitis, gastric reflux recurrent infection need to be addressed adequately .
Asthma is a continuous disease with episodic symptoms. The continuous use of inhalation therapy is the backbone of Asthma control and hence the dictum would be ‘absence of symptoms is not absence of disease’. Treat your Asthma continuously irrespective of your symptoms and we can achieve good Asthma control.
Dr Prasanna Kumar Thomas is Consultant Pulmonologist at Apollo and Fortis Hospitals at Chennai. His expertise lies in Airways Diseases and Smoking Cessation. Dr Thomas is actively engaged in promoting continuing medical education for professionals and Smoking Cessation for Public. He is also actively involved in socially sensitive activities like free medical camps and awareness programmes and has done multiple such events all over the country