LivingAsthma: more dangerous than you think

Asthma: more dangerous than you think

Surely it is not the first time that you come across the term asthma , since it is a fairly common disease in our country. In Spain it affects up to 5% of the population, and can affect up to 12% of the inhabitants of other countries.

At first these figures are not too alarming, but if I tell you that in children it is even more prevalent than in adults, it is already a little more frightening, and it is the most frequent chronic disease in children.

Asthma is often downplayed because it is so common in our population and, apparently, has so few negative implications. But something you may not know is that each year more than 250,000 people worldwide die from asthma.

What is asthma?

Asthma is a chronic disease of the respiratory system characterized by narrowing of the airways , which is generally reversible, in response to different stimuli.

An outbreak or aggravation of the underlying disease of asthma is called an asthma attack or asthma crisis , and it usually appears without any prior warning, simply in response to a certain stimulus.

During the normal respiratory process, relaxation of the muscles present around the airways occurs, allowing air to flow freely and easily. However, an asthma attack is marked by inflammation, bronchospasm, and mucus production.

Bronchospasm is a constriction of the muscles surrounding the airways, causing them to narrow. This prevents the free and easy flow of air through the airways, and in people with asthma, because they have bronchial hyperreactivity and overreact to stimuli that are normal in other people, this constriction it stretches out over time. A characteristic sign of bronchoconstriction is wheezing , a slight whistling sound coming from obstructed airways.

What are some of the common symptoms of asthma?

The most common signs and symptoms of asthma are clearly visible and often resemble those that occur during respiratory illnesses.

Some symptoms are shortness of breath, cough, wheezing, and sometimes chest tightness . The lungs can produce sputum when you cough, but it is often difficult to get the sputum to the mouth. Cough and other symptoms may worsen at night and with exposure to cold air.

Keep in mind that patients may not experience all symptoms with every asthma attack, and they may vary between flare-ups. It is also possible that in patients with persistent asthma, different symptoms occur at different times.

Research and published studies have shown that patients with asthma are more prone to other conditions , such as obstructive sleep apnea, gastroesophageal reflux disease, and rhinosinusitis. In addition, patients are also more likely to develop mood or anxiety disorders, and psychological problems.

What are the different types of asthma?

There are different types of asthma depending on the age of onset, the severity of symptoms, the cause and other associated factors.

Adult-onset asthma is one in which the individual begins to experience symptoms after the age of 18. When the disease begins before the age of 5 years, it is classified as childhood or pediatric asthma . This type of asthma can also affect young children and babies, and these, in general, cannot perform spirometry and the definitive diagnosis of asthma cannot be established. It is treated according to clinical judgment and determined by an allergy test. It is after five years that the tests that lead to the diagnosis can be done.

Intermittent asthma is a type characterized by intervals of good health between periods of exacerbation of symptoms. Symptoms come and go and patients can feel fine between exacerbations. Instead, when a patient experiences symptoms almost all the time, it is classified as having chronic or persistent asthma . In this type, patients may experience moderate, severe, or mild symptoms, and the severity of symptoms may vary from time to time. It should be noted that the most severe form of asthma is called status asthmaticus .

On the other hand, there is an asthma-like syndrome consisting of reactive airway dysfunction (SDRVA) . This is of rapid onset, appears in a matter of minutes or a few hours, and develops in people with no history of asthma, after exposure (single and specific) to a gas or an irritating agent (paint, spray, solvents, adhesives,… ). If instead of a single exposure to irritants, we speak of a multiple or chronic exposure (for example through the work environment), it is more likely that irritant-induced asthma or occupational asthma will develop.

It is common for people with any type of asthma to have asthma attacks that are triggered by exercise or strenuous activity and are classified as bronchospasm or exercise-induced asthma .

What are the causes of asthma?

To date, the reasons why a person develops asthma are still unknown, but it is suspected that it is multifactorial and depends on interactions between susceptibility genes (more than 100 susceptibility genes for asthma have been identified) and environmental factors, such as perinatal factors, respiratory infections, exposure to allergens and irritants, or physical exercise

Family history of asthma or a variety of other allergic conditions, underlying allergic diseases, and lung damage during childhood development can increase susceptibility to asthma.

Usually, the main cause of the narrowing of the airways is an abnormal and excessive response to certain stimuli , hypersensitivity, which triggers the contraction of the muscles surrounding the airways (bronchospasm), blocking the passage of air.

Among the stimuli that cause bronchospasm we find exposure to substances that cause irritation of the respiratory tract, such as allergens, toxins, pests, mold, tobacco smoke, dust mites, and pet dander, among others.

How is asthma treated?

Currently, there is no cure for asthma, but there is a treatment that helps control symptoms, such as anti-inflammatories, bronchodilators, or antihistamines and allergy shots.

Anti- inflammatory drugs help decrease mucus production as well as inflammation in the airways. They may be prescribed to be used daily to prevent or control symptoms in severe cases.

Bronchodilators help relax the muscles in your airways, allowing air to move freely through your respiratory system. It can also make it easier to move mucus out of the airways, depending on the inhaler or nebulizer used.

If your symptoms are triggered or exacerbated by allergies, your doctor may decide to prescribe antihistamines , or, depending on the case, recommend an allergy shot to decrease your immune reaction to certain allergens.

The intention of treatment is to achieve control of asthmatic symptoms regardless of the severity of the disease . So asthma can be classified according to whether the symptoms have been controlled or not. We can differentiate between well controlled asthma, with less than 3 days of weekly symptoms, poorly controlled asthma, with symptoms more than 2 days a week, and very poorly controlled asthma, with daily symptoms.

It is worth mentioning that, although everyone is familiar with the “famous Ventolín” (active ingredient: Salbutamol), it is a rescue bronchodilator, so the goal is to use it as little as possible, that is, reduce the number of asthmatic crises that make us need it..

Prevention and prognosis

There is no proven effective way to prevent the development of asthma , but there is an asthmatic crisis. In addition, the World Health Organization maintains that reducing respiratory infections and exposure to various triggers can help. It should be noted that, although asthma has no treatment, sometimes childhood asthma disappears over the years , and only 1 in 4 asthmatic children suffer from asthma in adulthood.

Although there is a significant number of asthma deaths each year, most of them can be prevented with proper treatment. Therefore, it can be said that the prognosis of a person with asthma with good therapeutic adherence is good . People with well-controlled asthma can lead a normal and full life, and even play sports without major complications.

References:

Asthma. (2021). World Health Organization: WHO. https://www.who.int/en/news-room/fact-sheets/detail/asthma

BlueGlobule (2021). Asthma: symptoms, diagnosis and treatment options [Video]. Youtube. https://www.youtube.com/watch?v=vIT2IX5FjWo

Jones-Dillon, S.A. (2020).  78. Asthma. In Wolfson, Allan B. (Ed.). Harwood-Nuss’ Clinical Practice of Emergency Medicine (7th ed.). Wolters Kluwer Health. ISBN-13: 9781975111601

Ortega, V.E., & Genese, F. (2019). Asthma. MSD Manuals. https://www.msdmanuals.com/es/home/pulm%C3%B3n-and-v%C3%ADas-respiratory-disorders/asma/asma?query=asma

 

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