What is Bronchial Asthma?
Asthma is a syndrome of airway obstruction that makes the sensitive individual overtly responsive to trivial stimuli causing marked airway narrowing, which begins suddenly, without any warning signs and precipitates an attack of breathlessness and wheezing.
Understanding Bronchial Asthma
Asthma is strongly associated with allergies (atopy). Most commonly airborne allergens precipitate an acute attack of asthma. The narrowing of airways is generally reversible in younger individuals.
In response to a trigger, there is profound inflammation in the airways. Inflammatory cells produce a range of provoking molecules that irritate the airway, cause narrowing of the airway and increase the secretions. With progressive narrowing of the airway breathing becomes difficult (dyspnoea) and noisy (wheezing).
With advancing age, the attacks tend to be more severe with some residual obstruction persisting even after the acute attack is over.
Adult-onset asthma rarely ever becomes completely asymptomatic.
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- Intrinsic: With known family history of atopy (allergy or sensitivity). Generally, the triggering factor is identifiable.
- Extrinsic: Without any known history of atopy of identifiable allergy.
- Status Asthamaticus (acute severe asthma): Attack not subsiding even after 30 mins of treatment with airway dilators or loss of consciousness at anytime during the attack. It is the most severe and dreadful event.
How common is Asthma?
It is one of the most common chronic airway diseases worldwide but is relatively less common in elderly without childhood history.
It has been noted to be common among elderly taking beta blockers, a class of antihypertensive drugs, that can precipitate airway obstruction as a side effect.
What are the causes and risk factors for Asthma?
- Genetic predisposition
- Occupational exposure to irritants
- Viral infections
- Air pollution
- Gastrointestinal reflux
- Cigarette smoking
What are the symptoms of Bronchial Asthma?
Range from mild breathlessness to severe wheezing, coughing and choking sensations. The symptoms tend to be worse at night and early in the morning.
Patients generally complain of very thick mucous early in the morning which is difficult to expectorate, as a result of which they get woken up before their waking hours. Elderly tend to prominently give this kind of history.
How is Asthma diagnosed?
- Chest X-ray is generally normal.
- Chest expansion is exaggerated. Wheeze is characteristic. During an acute severe attack on auscultation (to hear) the chest cavity can be exceptionally silent due to complete airway obstruction. This is a bad sign.
- Airway responsiveness to dilators can confirm the diagnosis of asthma. Sensitivity testing to various allergens and the change in airflow rates also can help in diagnosis.
What is the treatment for Asthma?
An acute attack is generally treated with inhaled Beta-agonists (like salbutamol) and anticholinergics (like theophylline) these are called broncho-dilators.
Long term prevention is done with long-acting beta-agonists or with inhaled corticosteroids. Very severe cases may need oral corticosteroids.
For regular preventive therapy there are newer classes of drugs which target the inflammatory process in the airway and reduce the airway responsiveness to airborne stimuli.
The mainstay of treatment in atopic asthma is to identify the allergen and prevent exposure to the allergen. In an acute attack, only bronchodilators are of use.
What are the complications with Asthma?
Elderly tend to have other comorbid conditions like reduced chest wall expansion or chronic cough that delays the recognition of symptoms and therefore delays the beginning of treatment.
Life-threatening complications are rare these days with the availability of inhaled drugs for both treatment and prevention. The mortality due to asthma is now reduced to negligible numbers.
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What lifestyle changes are recommended to prevent Asthma?
- Reducing exposure to triggering factors
- Reduction of weight
- Quit smoking
- Regular Pranayam and breathing exercises can help reduce the frequency of attacks.
How can one take care of someone with Asthma?
- Reassure the patient that the attack shall pass and is not fatal though it may feel rather scary. Regular preventive medication is of paramount importance for smooth maintenance.
- Reduce the level of suspended dust in the house by mopping all surfaces with wet cloth. Suspended dust particles are an important trigger.
- Elderly tend to be on various kinds of medication for a multiple ailments. Anti hypertensive drugs and painkillers are known triggers to asthma. Always mention your patient’s history of asthma to the treating physician whenever a new medication is started or existing medication is changed.
- Regular chest physiotherapy is useful
- Healthy home cooked hot food should be consumed
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