What is Asthma & Airway Inflammation?

What puts people at risk for developing Asthma?

While the exact cause of asthma is unknown, several factors can increase the risk of developing the condition. These include:

• Family history of Asthma or allergies
• Exposure to second-hand smoke during early childhood
• Viral respiratory infections
• Allergies
• Occupational exposure to dust and fumes
• Air Pollution
• Obesity

What triggers Asthma?

Asthma triggers can vary among individuals, but common triggers include:

• Exposure to allergens (such as pollen, mold, dust, and animal dander)
• Cold temperatures
• Exercise
• Other lung problems ( COPD: This might be the reason for your breathing difficulties )
• Some medications
• Strong odors or irritants
• Tobacco smoke
• Stress

Diagnosis of Asthma

To diagnose asthma, doctors typically perform a combination of medical history assessment, physical examination, lung function tests such as spirometry, and sometimes additional tests like peak flow measurements or bronchial provocation tests. These tests help evaluate lung function and airway responsiveness.

Medical History: The doctor will ask about your medical history, including any other health conditions you have, your family history, and your symptoms. They will also ask about any triggers that worsen your symptoms.

Physical examination: The doctor will listen to your lungs with a stethoscope to hear for wheezing or other abnormal sounds. They may also examine your chest and back for signs of inflammation.

Lung function test: Lung function tests measure how well your lungs work. These tests can help the doctor see if you have asthma and determine your condition’s severity.

⇒ Some of the most common lung function tests include:

• Methacholine challenge test: This test is used to see how your airways react to a medication called methacholine that can trigger asthma symptoms. This also helps to make the diagnosis of asthma.
• Peak flow testing: Peak flow testing involves using a device known as a peak flow meter to gauge the volume of air that can be forcefully exhaled. Individuals with asthma typically exhibit a reduction in this airflow. The purpose of peak flow testing is to monitor the effectiveness of asthma treatment and track the progress of the individual. This testing is particularly valuable because certain individuals, especially children, may encounter difficulties in accurately conveying the severity of their symptoms. Moreover, peak flow meters are cost-effective tools that can benefit individuals managing moderate or severe asthma.

Steps for measuring your peak flow at home

Step 1: Before each use, make sure the sliding marker or arrow on the Peak Flow Meter is at the bottom of the numbered scale (zero or the lowest number on the scale).

Step 2: Stand up straight. In one breath, blow out as hard and as quickly as possible. Blow a “fast hard blast” rather than “slowly blowing” until you have emptied nearly all the air from your lungs.

Step 3: The force of the air from your lungs causes the marker to move along the numbered scale. Note the number on a piece of paper.

Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)

Step 5: Record the highest of the three ratings.

Step 6: Measure your peak flow rate at the same time each day.  Some people measure peak flow both before and after taking medication. Try to do it the same way each time.

Step 7: Keep a chart of your peak flow rates. Discuss the readings with your healthcare provider.

Treatments for Asthma

Medications play a crucial role in minimizing the risk of exacerbating symptoms that could potentially result in the requirement of additional medications or a visit to the hospital or emergency room. In the daily management of asthma, two essential types of medications are employed: rescue and controller therapies. These medications are employed to effectively control and prevent asthma symptoms, ensuring better overall respiratory health.

Rescue therapy

• Used on an as-needed basis
• Provide symptom relief within minutes
• Some people with asthma may only need a rescue inhaler, such as people with symptoms only when physically active or with intermittent asthma symptoms.
• Using rescue therapy more than 2 days a week may be a sign of uncontrolled asthma and should be brought to a doctor’s attention.
• Standard rescue therapy is Short-acting bronchodilators (used among all age groups)

Controller therapies

• Used daily to reduce the underlying inflammation and narrowing of airways, to obtain overall asthma control
• Not used to treat acute asthma attacks
• Not all patients with asthma need a controller medicine
• If your asthma symptoms happen more than 2 times per week, you wake up more than 2 nights per month, you need a rescue inhaler more than 2 days a week, or your asthma interferes with your daily activities, your asthma is likely severe enough to need controller therapy.

Inhaled Corticosteroids

• Standard controller therapy for asthma for all ages.
• Decreases inflammation
• Taken daily
• Precaution: rinse your mouth out after each use to prevent fungal infections in your mouth.

Anti-inflammatory medications – Montelukast, Zafirlukast, Cromolyn, and Nedocromil

• Reduces inflammation
• Long-term asthma control medicines
• Added to inhaled corticosteroids to help obtain better asthma control.
• It needs to be taken regularly
• Not for the treatment of an acute asthma attack

Bronchodilators – Theophylline

Bronchodilators relax the muscles around the airways (breathing tubes). When the airways are more open, it is easier to breathe. There are two general types of bronchodilators, and you may be prescribed one or both types:

• Short-Acting bronchodilators work quickly after you take them so that you feel relief from symptoms quickly.
• Long-Acting bronchodilators have effects that last a long time. They should not be used for quick relief. These medications are only recommended when combined with an anti-inflammatory asthma medicine.

Biologic therapies

• Biologic therapies have emerged as a promising approach to treating asthma. These therapies target specific immune system pathways involved in asthma and are designed for individuals with severe, uncontrolled asthma that are not adequately managed by traditional medications.
• Examples include Omalizumab, Mepolizumab, and Reslizumab.

Antibiotics

• People with asthma can have flare-ups that may be caused by bacterial or viral infections. Your doctor may want you to have an antibiotic or antiviral medication prescription.
• It is important to take an antibiotic exactly as prescribed and to take it all, even if you start to feel better before it is all used up. The infection may become even stronger and harder to treat if you do not take it all.

Devices for Inhaled Medications

1. Inhaler: Inhalers are commonly used to deliver asthma medications directly to the airways. They can be metered-dose inhalers (MDIs) or dry powder inhalers (DPIs). Spacers or holding chambers are often used with MDIs to enhance medication delivery and reduce the risk of side effects.
2. Nebulizer: A nebulizer turns the medication into a mist that can get into the lungs with less effort than required when using an inhaler and may be preferred for some patients who are very short of breath.

What is an Asthma attack?

Most people with asthma will experience a temporary worsening of symptoms at some point in their lives, even if they use their medications correctly. This is called an asthma attack.

Asthma attacks can range from mild to life-threatening, and it is important to know when to go to a doctor’s office or emergency department to seek treatment.

What to do if you have an Asthma attack?

If your symptoms are severe and you are completely out of breath, unable to speak in full sentences, using a lot of muscles in your chest and abdomen to breathe, or feeling sleepy, then:

1. Call Emergency services or 911
2. While awaiting paramedics, use a bronchodilator, specifically a short-acting beta-agonist (SABA) such as albuterol, to help control the attack, even if your symptoms are not severe. Treatment with SABAs can be repeated every 20 minutes for an hour if symptoms do not resolve after the first treatment.
3. After the first hour, the next step for treating mild or moderate asthma attacks depends on how good the response has been to the medications. This is based on symptoms (how you feel) and, in some cases, on your peak flow. If your symptoms resolve after the first hour, you can continue using the SABA as needed every 3 to 4 hours for the next 1 to 2 days.

Tips for anyone living with Asthma

1. Avoid any known triggers
2. Take your regular asthma medications.
3. If your symptoms improve but do not resolve, see your doctor or visit an urgent care center for further management.
4. If your symptoms do not improve, seek immediate treatment by contacting the emergency department or paramedics.
5. Rinse your mouth after each inhaled corticosteroid use to prevent fungal infections in your mouth.

When to see your doctor?

Call a healthcare provider immediately when:

• You feel faint, dizzy, or weak
• You have trouble doing routine activities, such as cooking dinner, cleaning, or taking out the trash.
• You have a cough that won’t go away.
• You’re wheezing when you breathe in or out, especially if this is different from your usual breathing pattern
• Your wheezing gets worse even after you have given your medicine time to start working (most quick-relief medicines work within 15 minutes)

Go to urgent care, go to the Emergency room, or call Emergency services right away when:

• Your lips or nails are turning blue.
• Your nostrils are flaring each time you breathe in.
• The skin between your ribs or at the base of your throat appears stretched every time you breathe in.
• You are taking 30 or more breaths per minute.
• Talking or walking at a normal pace is difficult.

Questions for your doctor

Here are a few questions you may consider asking your doctor:

1. Am I using my medication correctly?
2. How do I best manage my asthma?
3. How do I reduce my asthma triggers?
4. Could my home or workplace be making me sick?
5. What other changes can I make to improve my asthma?

References

• https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma
• https://jamanetwork.com/journals/jama/fullarticle/199122
• https://jamanetwork.com/journals/jama/fullarticle/2492878
• https://jamanetwork.com/journals/jama/fullarticle/2678019