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Myths, facts, and statistics about asthma
Before we present the typical symptoms of asthma, we should dispel some common myths about this condition. This is best achieved by conducting a short true or false quiz.
Here are the answers:
- T or F - Asthma is "all in the mind."
- T or F - You will "grow out of it."
- T or F - Asthma can be cured, so it is not serious and nobody dies from it.
- T or F - You are likely to develop asthma if someone in your family has it.
- T or F - You can "catch" asthma from someone else who has it.
- T or F - Moving to a different location, such as the desert, can cure asthma.
- T or F - People with asthma should not exercise
- T or F - Asthma is best controlled when one has an asthma management plan designed by your doctor. This should include the medications used for quick relief as well as maintenance therapy.
- T or F - Medications used to treat asthma are habit forming.
- T or F - Someone with asthma can provoke episodes anytime they want in order to get attention.
- F - Asthma is not a psychological condition. However, emotional triggers can cause flare-ups.
- F - You cannot outgrow asthma. In about 50% of children with asthma, the condition may become inactive in the teenage years. The symptoms, however, may reoccur anytime in adulthood.
- F - There is no cure for asthma, but the disease can be controlled in most patients with good medical care. The condition should be taken seriously, since uncontrolled asthma may result in emergency hospitalization and possible death.
- T - You have a 6% chance of having asthma if neither parent has the condition, a 30% chance if one parent has it, and a 70% chance if both parents have it.
- F - Asthma is not contagious.
- F - A new environment may temporarily improve asthma symptoms, but it will not cure asthma. After a few years in the new location, many people become sensitized to the new environment and the asthma symptoms return with the same or even greater intensity than before.
- F -Swimming is an optimal exercise for those with asthma. On the other hand, exercising in dry, cold air may be a trigger for asthma in some people.
- F - Asthma is best controlled by having an asthma management plan designed by your doctor that includes the medications used for quick relief and those used as controllers.
- F - Asthma medications are not addictive.
- F - Asthma attacks cannot be faked. In rare cases, there is a psychological condition known by a variety of names (factious asthma, spastic dysphonia, globus hystericus) where emotional issues may cause symptoms that mimic the symptoms of asthma.
What is asthma?
Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.
Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.
Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.
From the past to the present
Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.
Allergy jargonThe balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."
Asthma is derived from the Greek word panos, meaning panting.
Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and exercise.
The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma.
Allergy fact
Maimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the royal princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy...chicken soup.
By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.
Allergy factBronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.
As early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.
Normal bronchial tubes
Before we can appreciate how asthma affects the bronchial airways, we should first take a quick look at the structure and function of normal bronchial tubes.
The air we breathe in through our nose is processed to prepare it for presentation to our lower respiratory tract. This air is moistened, heated, and cleansed prior to passage through the vocal cords (larynx) and into the windpipe (trachea). Dry or cold air presented to our trachea can cause coughing and wheezing as a normal response to this type of irritation. The air then enters the lungs by way of two large air passages (bronchi), one for each lung. The bronchi divide within each lung into smaller and smaller air tubes (bronchioles), just like branches of an inverted tree. Inhaled air is brought through these airways to the millions of tiny air sacs (alveoli) that are contained in the lungs. Oxygen (O2) passes from the air sacs into the bloodstream through numerous tiny blood vessels called capillaries. Similarly, the body's waste product, carbon dioxide (CO2), is returned to the air sacs and then eliminated upon each exhalation.
Normal bronchial tubes allow rapid passage of air in and out of the lungs to ensure that the levels of O2 and CO2 remain constant in the bloodstream. The outer walls of the bronchial tubes are surrounded by smooth muscles that contract and relax automatically with each breath. This allows the required amount of air to enter and exit the lungs to achieve this normal exchange of O2 and CO2. The contraction and relaxation of the bronchial smooth muscles are controlled by two different nervous systems that work in harmony to keep the airways open.
The inner lining of the bronchial tubes, called the bronchial mucosa, contains: (1) mucus glands that produce just enough mucus to properly lubricate the airways; and (2) a variety of so-called inflammatory cells, such aseosinophils, lymphocytes, and mast cells. These cells are designed to protect the bronchial mucosa from the microorganisms, allergens, and irritants we inhale, and which can cause the bronchial tissue to swell. Remember, however, that these inflammatory cells are also important players in the allergic reaction. Therefore, the presence of these cells in the bronchial tubes causes them to be a prime target for allergic inflammation
How does asthma affect breathing?
Asthma causes a narrowing of the breathing airways, which interferes with the normal movement of air in and out of the lungs. Asthma involves only the bronchial tubes and does not affect the air sacs or the lung tissue. The narrowing that occurs in asthma is caused by three major factors: inflammation, bronchospasm, and hyperreactivity.
Inflammation
The first and most important factor causing narrowing of the bronchial tubes is inflammation. The bronchial tubes become red, irritated, and swollen. This inflammation increases the thickness of the wall of the bronchial tubes and thus results in a smaller passageway for air to flow through. The inflammation occurs in response to an allergen or irritant and results from the action of chemical mediators (histamine, leukotreines, and others). The inflamed tissues produce an excess amount of "sticky" mucus into the tubes. The mucus can clump together and form "plugs" that can clog the smaller airways. Specialized allergy and inflammation cells (eosinophils and white blood cells), which accumulate at the site, cause tissue damage. These damaged cells are shed into the airways, thereby contributing to the narrowing.
Bronchospasm
The muscles around the bronchial tubes tighten during an attack of asthma. This muscle constriction of the airways is called bronchospasm. Bronchospasm causes the airway to narrow further. Chemical mediators and nerves in the bronchial tubes cause the muscles to constrict. Bronchospasm can occur in all humans and can be brought on by inhaling cold or dry air.
Hyperreactivity (hypersensitivity)
In patients with asthma, the chronically inflamed and constricted airways become highly sensitive, or reactive, to triggers such as allergens, irritants, and infections. Exposure to these triggers may result in progressively more inflammation and narrowing.
The combination of these three factors results in difficulty with breathing out, or exhaling. As a result, the air needs to be forcefully exhaled to overcome the narrowing, thereby causing the typical "wheezing" sound. People with asthma also frequently "cough" in an attempt to expel the thick mucus plugs. Reducing the flow of air may result in less oxygen passing into the bloodstream, and if very severe, carbon dioxide may dangerously accumulate in the blood.
adto og gymwa na gyud ko atakeha og hubak after gym, sauna or steam daun
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The importance of inflammation
Inflammation, or swelling, is a normal response of the body to injury or infection. The blood flow increases to the affected site and cells rush in and ward off the offending problem. The healing process has begun. Usually, when the healing is complete, the inflammation subsides. Sometimes, the healing process causes scarring. The central issue in asthma, however, is that the inflammation does not resolve completely on its own. In the short term, this results in recurrent "attacks" of asthma. In the long term, it may lead to permanent thickening of the bronchial walls, called airway "remodeling." If this occurs, the narrowing of the bronchial tubes may become irreversible and poorly responsive to medications. When this fixed obstruction to airflow develops, asthma is then classified in the group of lung conditions known as chronic obstructive pulmonary disease (COPD). Therefore, the goals of asthma treatment are: (1) in the short term, to control airway inflammation in order to reduce the reactivity of the airways; and (2) in the long term, to prevent airway remodeling.
Allergy assist
The hallmark of managing asthma is the prevention and treatment of airway inflammation. It is also likely that control of the inflammation will prevent airway remodeling and thereby prevent permanent loss of lung function.Various triggers in susceptible individuals result in airway inflammation. Prolonged inflammation induces a state of airway hyperreactivity, which might progress to airway remodeling unless treated effectively.
Which triggers cause an asthma attack?
Asthma symptoms may be activated or aggravated by many agents. Not all asthmatics react to the same triggers. Additionally, the effect that each trigger has on the lungs varies from one individual to another. In general, the severity of your asthma depends on how many agents activate your symptoms and how sensitive your lungs are to them. Most of these triggers can also worsen nasal or eye symptoms.
Triggers fall into two categories:
Once your bronchial tubes (nose and eyes) become inflamed from an allergic exposure, a re-exposure to the offending allergens will often activate symptoms. These "reactive" bronchial tubes might also respond to other triggers, such as exercise, infections, and other irritants. The following is a simple checklist.
- allergens ("specific");
- nonallergens -- mostly irritants (nonspecific).
Common asthma triggers:
Allergens
- "seasonal" pollens
- year-round dust mites, molds, pets, and insect parts
- foods, such as fish, eggs,peanuts,nuts, cows milk and soy.
- additives, such as sulfites
- work-related agents, such as latex, epoxides, and formaldehyde
Allergy factIrritants
About 80% of children and 50% of adults with asthma also have allergies.
- respiratory infections, such as those caused by viral "colds," bronchitis, and
- sinusitisdrugs, such as aspirin, other NSAIDs (nonsteroidal antiinflammatory drugs), and beta blockers(used to treat blood pressure and other heart conditions)
- tobacco smoke
- outdoor factors, such as smog, weather changes, and diesel fumes
- indoor factors, such as paint, detergents, deodorants, chemicals, and perfumes
- nighttime
- GERD (gastroesophageal reflux disorder)
- exercise, especially under cold dry conditions
- work-related factors, such as chemicals, dusts, gases, and metals
- emotional factors, such as laughing, crying, yelling, and distress
- hormonal factors, such as in premenstrual syndrome.
The many faces of asthma
The many potential triggers of asthma largely explain the different ways in which asthma can present. In most cases, the disease starts in early childhood from 2-6 years of age. In this age group, the cause of asthma is often linked to exposure to allergens, such as dust mites, tobacco smoke, and viral respiratory infections. In very young children, less than 2 years of age, asthma can be difficult to diagnose with certainty. Wheezing at this age often follows a viral infection and might disappear later, without ever leading to asthma. Asthma, however, can develop again in adulthood. Adult-onset asthma occurs more often in women, mostly middle-aged, and frequently follows a respiratory tract infection. The triggers in this group are usually nonallergic in nature.
Types: allergic (extrinsic) and nonallergic (intrinsic) asthma
Your doctor may refer to asthma as being "extrinsic" or "intrinsic." A better understanding of the nature of asthma can help explain the differences between them. Extrinsic, or allergic asthma, is more common (90% of all cases) and typically develops in childhood. Approximately 80% of children with asthma also have documented allergies. Typically, there is a family history of allergies. Additionally, other allergic conditions, such as nasal allergies or eczema, are often also present. Allergic asthma often goes into remission in early adulthood. However, in 75% of cases, the asthma reappears later.
Intrinsic asthma represents about 10% of all cases. It usually develops after the age of 30 and is not typically associated with allergies. Women are more frequently involved and many cases seem to follow a respiratory tract infection. The condition can be difficult to treat and symptoms are often chronic and year-round
Typical asthma symptoms and signs
The symptoms of asthma vary from person to person and in any individual from time to time. It is important to remember that many of these symptoms can be subtle and similar to those seen in other conditions. All of the symptoms mentioned below can be present in other respiratory, and sometimes, in heart conditions. This potential confusion makes identifying the settings in which the symptoms occur and diagnostic testing very important in recognizing this disorder.
The following are the four major recognized asthma symptoms:
- Shortness of breath, especially with exertion or at night
- Wheezing is a whistling or hissing sound when breathing out
- Coughing may be chronic, is 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
Asthma fact
Asthma is classified according to the frequency and severity of symptoms, or "attacks," and the results of pulmonary (lung) function tests.
- 30% of affected patients have mild, intermittent (less than two episodes a week) symptoms of asthma with normal breathing tests
- 30% have mild, persistent (two or mores episodes a week) symptoms of asthma with normal or abnormal breathing tests
- 40% have moderate or severe, persistent (daily or continuous) symptoms of asthma with abnormal breathing tests
Acute asthma attack
An acute, or sudden, asthma attack is usually caused by an exposure to allergens or an upper-respiratory-tract infection. The severity of the attack depends on how well your underlying asthma is being controlled (reflecting how well the airway inflammation is being controlled). An acute attack is potentially life-threatening because it may continue despite the use of your usual quick-relief medications (inhaled bronchodilators). Asthma that is unresponsive to treatment with an inhaler should prompt you to seek medical attention at the closest hospital emergency room or your asthma specialist office, depending on the circumstances and time of day. Asthma attacks do not stop on their own without treatment. If you ignore the early warning signs, you put yourself at risk of developing status asthmaticus.
Allergy factThe symptoms of severe asthma are persistent coughing and the inability to speak full sentences or walk without shortness of breath. Your chest may feel closed, and your lips may have a bluish tint. In addition, you may feel agitation, confusion, or an inability to concentrate. You may hunch your shoulders, sit or stand up to breathe more easily, and strain your abdominal and neck muscles. These are signs of an impending respiratory system failure. At this point, it is unlikely that inhaled medications will reverse this process. A mechanical ventilator may be needed to assist the lungs and respiratory muscles. A face mask or a breathing tube is inserted in the nose or mouth for this treatment. These breathing aids are temporary and are removed once the attack has subsided and the lungs have recovered sufficiently to resume the work of breathing on their own. A short hospital stay in an intensive-care unit may be a result of a severe attack that has not been promptly treated. To avoid such hospitalization, it is best, at the onset of symptoms, to begin immediate early treatment at home or in your doctor's office.
Prolonged attacks of asthma that do not respond to treatment with bronchodilators are a medical emergency. Physicians call these severe attacks "status asthmaticus," and they require immediate emergency care.
Allergy fact
The presence of wheezing or coughing in and of itself is not a reliable standard for judging the severity of an asthma attack. Very severe attacks may clog the tubes to such a degree that the lack of air in and out of your lungs fails to produce wheezing or coughing.
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