Dr Vikram Rathi is a successful chest physician who works with Rathi Chest Clinic, CARE Hospital and Seven Star Hospital in Nagpur.
World Asthma Day is an annual event organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. Every year, World Asthma Day takes place on the first Tuesday of May. Today, on World Asthma Day, we tell you all things you need to know about Asthma: Its causes, cures, symptoms and the precautions one needs to take for fighting the disease.
What is asthma?
Asthma affects all age groups but often starts in childhood. It is a disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. In an individual, these attacks may occur from hour to hour and day to day.
This condition is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they become easily irritated. In an attack, the lining of the passages swell causing the airways to narrow and reducing the flow of air in and out of the lungs. These attacks can cause sleeplessness, fatigue, reduced activity and absenteeism from work or school.
The scale of the problem
Asthma is not just a public health problem for developed countries. In developing countries, however, the incidence of the disease varies greatly. India has an estimated 15-20 million asthmatics. The burden of asthma on India is immense. With more than 300 million individuals currently suffering from asthma worldwide, about a tenth of those live in India. The prevalence of asthma has been estimated to range 3-38% in children and 2-12% in adults, being the common chronic disorder among children.Worldwide, deaths from this condition have reached over 180,000 annually.
The basic causes of asthma are not completely understood, but risk factors for developing the disease include a genetic predisposition along with exposure to particles and substances that irritate the air passages and cause allergic reactions. Some irritants include dust in furnishings, pets, tobacco smoke, chemicals and air pollution. Other causes include physical exercise, medications (aspirin and beta blockers), cold air and even emotional reactions such as stress, anger and fear, low birth weight and respiratory infections.
Asthma cannot be cured, but can be controlled. The strongest risk factors for developing asthma are exposure, especially in infancy, to indoor allergens (such as domestic mites in bedding, carpets and stuffed furniture, cats and cockroaches) and a family history of asthma or allergy. A study in the South Atlantic Island of Tristan da Cunha, where one in three of the 300 inhabitants has asthma, found children with asthmatic parents were much more likely to develop the condition.Urbanization appears to be correlated with an increase in asthma. One of the causes of increasing cases of asthma among children is urbanization.
The nature of the risk is unclear because studies have not taken into account indoor allergens although these have been identified as significant risk factors. Experts are struggling to understand why rates world-wide are, on average, rising by 50% every decade.
Diagnosis of Asthma
Asthma diagnosis is mainly clinical i.e., it is more subjectively-driven rather than being objective.There are tests which are available and can help diagnose asthma like there is spirometer test and FENO test. However, though there are tests available, there is no such test which can diagnose with 100% accuracy that a person has asthma.
Asthma triggers can aggravate your asthma symptoms – coughing, wheezing and difficulty catching your breath. While there’s no asthma cure, there are steps you can take to keep your asthma in control and prevent an asthma attack.
Identify Triggers for Asthma Prevention
Certain asthma triggers can set off the cascade of asthma symptoms. Some asthma triggers may include:
→ Air pollution
→ Allergies to cold air
→ Cold or flu virus
It’s vital to learn to identify your asthma triggers and take steps to avoid them. Keep track of your asthma symptoms in an asthma diary for several weeks, detailing all the environmental and emotional factors that are associated with your asthma. When you have an asthma attack, go back to your asthma-diary to see which factor, or combination of factors, might have contributed to it. Some common asthma triggers are not always obvious, such as molds and cockroaches.
If you have exercise-induced asthma or are planning vigorous exercise or exercise in cold, humid, or dry environments, prevent exercise-induced asthma by following your doctor’s advice regarding asthma treatment.
Allergies and asthma prevention
If you have allergies and asthma, it’s important to minimize your exposure to allergens (substances to which you are allergic to).
Avoid smoke to prevent asthma
Smoke and asthma are a bad mix. Minimize exposure to all sources of smoke, including tobacco, incense, candles, fires, and fireworks. Do not allow smoking in your home or car, and avoid public places that permit smoking. If you smoke cigarettes, get help to quit successfully.
Avoid colds to prevent asthma
Do what you can to stay well. Avoid close contact with people who have a cold or the flu, because your asthma symptoms may worsen if you catch the infection from them. Wash your hands thoroughly after touching items that may have been handled by others with a respiratory infection.
Get a flu vaccine for asthma prevention
Get a flu shot every year to protect against the flu virus, which almost always makes asthma much worse for days to weeks. People with asthma are more likely to have complications from the flu, such as pneumonia, and are more likely to be hospitalized because of the flu. Also, those over age 19 should get a pneumonia shot once every five years. People with asthma are about twice as likely as others to get pneumococcal pneumonia, a common type of bacterial pneumonia.
Treatment: Adherence is the key
Because asthma is a chronic condition, it usually requires continuous medical care. Asthma is generally treated with two types of medications. Long-term control medicines help to reduce airway inflammation and prevent symptoms. The second are quick-relief medications which relieve asthma symptoms when they flare up. Patients with moderate to severe asthma have to take long-term medication daily (for example, anti-inflammatory drugs) to control the underlying inflammation and prevent symptoms and attacks. If symptoms occur, short-term medications (inhaled short-acting beta2-agonists) are used to relieve them.
Medication is not the only way to control asthma. It is also important to avoid asthma triggers — stimuli that irritate and inflame the airways. Each person must learn what triggers he or she should avoid.
There is no known cure for asthma but the best treatment is to control the disease by working closely with a physician, taking medications and avoiding triggers.
Education is a key part of controlling asthma and the World Asthma Foundation is helping to inform asthma sufferers, their families and the general public about the disease.
Although asthma does not kill on the scale of chronic obstructive pulmonary diseases (COPD), failure to use appropriate drugs or comply with treatment, coupled with an under-recognition of the severity of the problem, can lead to unnecessary deaths, most of which occur outside hospital.
Asthma can be managed by taking medicines. But it is seen that patients stop taking medicines when they feel better. Patients should continue taking medicines even when the symptoms seem to have subsided.
However, it would be wrong to say that a patient with asthma will have to take medicine lifelong and also it would be wrong to say that he will be completely cured.