Overview of asthma
Asthma is a chronic, inflammatory condition characterized by reversible airflow obstruction and airway hyperresponsiveness. This disease which can occur at any age, accounts for thousands of hospitalizations each year and requires long-term follow-up. Epidemiological and observational evidence had shown an increasing morbidity and mortality due to asthma despite the increased understanding of its pathogenesis, availability of effective anti-asthma medications and newer delivery devices.
Although chronic in nature and cannot be cured, asthma is a preventable condition and can be kept under control. Appropriate management can enable people to lead a good quality of life. Treatment approach aims to reduce the severity and frequency of the attacks and assist patients in controlling future exacerbations. The strategies include the use of relief medications such as beta (β2) agonists and medications such as inhaled and oral corticosteroids to control the long-term effects of the airway inflammation. Recent evidence indicates that asthma self-management education is effective in improving outcomes of chronic asthma.3
Symptoms of asthma (Clinical Features)
The symptoms of asthma vary from person to person and can range from mild to severe. In between episodes, asthma patients may feel normal and have no difficulty in breathing. Some asthmatics may have chronic coughing and wheezing. As the symptoms mentioned below can be present in other respiratory and sometimes in heart conditions, diagnostic testing is vital in recognizing this disorder. A positive family history for asthma or allergic diseases supports a suspected diagnosis of asthma.
The four major recognized symptoms are:
- Shortness of breath (dyspnea)—especially with exertion or at night
- Wheezing—a whistling or hissing sound when breathing out
- Coughing—may be chronic, usually worse at night and early morning and may occur after exercise or when exposed to cold, dry air
- Chest tightness—may occur with or without the above symptoms
Characteristically asthmatics suffer in the early morning. The patient may wake up at 3 or 4 a.m. with tightness, cough and wheezing. These attacks may be confused with paroxysmal nocturnal dyspnea due to left ventricular failure. However, the symptom of nocturnal chest tightness is a diagnostic of asthma.
Emergency asthma symptoms include the following:
- Extreme difficulty in breathing
- Bluish discoloration (cyanosis) of the lips and face
- Rapid pulse
- Decreased level of alertness
Diagnosis and Tests for asthma
The first step in providing optimal care to patients with asthma is accurate diagnosis of the condition. Clinical evaluation should include a precise description of the symptoms, as in many patients, particularly children, asthma may present as chronic cough with few associated features. Similarly, it may present as isolated dyspnea in the elderly patients. In the clinical setting, asthma is diagnosed based on the history, physical examination and physiological testing. A thorough occupational history is crucial to identify patients with work-related asthma.
Diagnosis of asthma in children is based on a compilation and review of the patient’s medical history and subsequent improvement with an inhaled bronchodilator medication. In adults, lung function test with a peak flow meter which tests airway restriction by looking at both the diurnal variation and any reversibility following inhaled bronchodilators can help in the diagnosis.
The basic measurement is peak flow rates. The British Thoracic Society uses the following diagnostic criteria: 4
- Difference of ≥20% in peak flow on at least three days in a week for at least two weeks
- Improvement of ≥20% in peak flow following treatment
- Decrease of ≥20% in peak flow following exposure to a trigger
Use of a peak flow meter on an ongoing basis helps in self-monitoring of asthma. Subsequent to pulmonary (lung) function test, radiological studies such as chest X-ray or CT scan will help to exclude the possibility of other lung diseases. Allergy testing is helpful in identifying allergens in patients with persistent asthma.
Living with Asthma
The impact of asthma on an individual’s life can be controlled by adhering to proper asthma management plans. The following strategies can reduce inflammation, decrease the severity, frequency and duration of asthma attacks.
- Asthma education
- Understand the difficulties and solutions
- Develop management goals relating to quality of life
- Consult health professional regularly
- Follow daily asthma treatment plan
- Aggarwal AN, Chaudhry K, Chhabra SK, D’Souza GA, Gupta D, Jindal SK, et al. Prevalence and risk factors for bronchial asthma in indian adults: A multicentre study. Indian J Chest Dis Allied Sci. 2006; 48: 13-22.
- Masoli M, Fabian D, Holt S, Beasley R. Global burden of asthma. Global Initiative for Asthma (GINA). Wellington, New Zealand, Medical Research Institute of New Zealand; Southampton, United Kingdom, University of Southampton. 2004.
- National Institutes of Health, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Expert panel report 3. Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Institute, 2007.
- Pinnock H, Shah. Asthma. Br Med J. 2007; 334 (7598): 847–850.