Breathing should be the most natural and primal act of our bodies. It is the essential activity of shifting air carrying life-giving oxygen to our blood, which flows around to deliver it to our cells and organs. So, any trouble breathing puts life in both discomfort and in threat.
This is the problem for those with asthma- a chronic inflammatory condition of the airways with occasional acute episodes. It affects 300 million people worldwide. Lets inhale a deep breath and take in some facts about the disease.
Asthma means having hyper-responsive airways which react and close up in the presence of allergens like pollen, dust mites and animals or irritant stimuli such as exercise, cold air, upper respiratory tract viruses or cigarette smoke. The reaction involves inflammation chemicals causing muscle constriction that narrows the airway tube diameter, mucus plugs that block them and inner lining swelling that further narrows it. The result is obstructed flow of air which gives rise to the familiar and serious symptoms of: breathlessness, wheezing, chest tightness and repeated coughing. However, fortunately this process is reversible with correct treatment.
But what causes asthma in the first place? On-going research is discovering that asthma is the result of epigenetics. So, while there are underlying genes that pass on the condition, it requires environment triggers to come alive. Two important triggers found so far are maternal smoking and traffic pollution chemicals.
Asthma can present anytime; but often starts in children under 5, so any symptoms as mentioned above must be reviewed by a doctor. In older children and adults, the diagnosis of asthma is better made, being based not only on symptoms and examination signs, but also with breathing tests like peak-flow and spirometry, which both involve small machines that record the velocity and volume of air the lungs move in a breath.
However, asthmatics are of different types. Some are fortunate to have intermittent symptoms- for example only after exercise, or once in a while upon exposure to a trigger- while others are less fortunate and suffer on a weekly basis. A small proportion continues as persistent cases and suffer daily. For all types, the treatments are the same but the intensity and combination is matched to the symptoms.
Intermittent asthmatics are given the basic reliever inhaler (commonly ventolin/salbutamol) to take when they need which lasts for 2-3 hours. However, those with recurring and frequent symptoms are additionally treated with regular preventer inhalers lasting 12 hours, containing steroids. Those with a clear allergic base are often given allergy specific treatment inhalers or tablets. Persistent cases are treated with increased doses, combinations and often steroid tablets.
Many completely outgrow their asthma over time. But even those that don’t get better and better at understanding their personal triggers and most effective medicines. The best way to manage asthma over the long-term is to prevent symptoms from occurring in the first place with these simple measures:
- Learn and avoid the individual triggers – particularly allergens and minimise exposure to them (for example, regular vacuuming against the dust mite.)
- Stick to the treatment plan as recommended by your doctor and have a yearly review.
- Stop smoking! It not only triggers asthma (in oneself and others around) but also reduces the effectiveness of steroids used in treatment. For advice on stopping, see our earlier article.