Asthma is an anti-inflammatory condition that affects our airways leading to the lungs. It is known for its variable and reoccurring symptoms, indirect airflow blockage, and bronchospasms. Shortness of breath, wheezing, feeling of tightness in the chest, and coughing are the episodes of its symptoms. Few times in a week or few times per day, this may occur. It may worsen at night depending on the person.

Two factors might contribute to causing asthma i.e. environment and genes. Exposure to pollutants in our air and allergens are the main environmental factors.

Sometimes common medications (aspirin and b-blockers) are other potential triggers(1). Diagnosis can be made on following factors: Spirometry, lung function testing, symptoms, and your response to therapy.

If asthma conditions remain uncontrolled then, LABA or long-acting beta agonists can also be used with inhaled corticosteroids.

Causes of Asthma: – It is a combination of environmental and genetic interactions. These factors might also influence the severity and its responsiveness to treatment. The recent increased rate of asthma depending on the changing of epigenetics and changing of the living environment is alarming. If asthma starts from the age of 12 then it might be due to genetic influence, while after 12 years it might be due to environmental influence.

  • Environment: – Asthma’s development can be attributed to many environmental factors including air pollution, allergens, and environmental chemicals. During pregnancy and after delivery smoking is associated with great risks of  Asthma symptoms. Low air quality is associated with both asthma development and increased asthma severity. In the United States over half of the cases in children occur where air quality is below the EPA standards,  with exposure to indoor allergens increasing the risks even more. Cockroaches, animal dander, dust mites are common indoor allergens.
  • Hygiene hypothesis: – To prevent the development of asthma, exposure to bacterial endotoxin in early childhood can be utilized, but it may provoke bronchoconstriction exposure at an older age.  The hygiene hypothesis is that the less affected individuals often have more exposure to bacteria and viruses, there is a link between asthma and the degree of influence.
  • Genetics: – CD14 SNP-C-159T based on CD14- endotoxin interactions.
Endotoxin level CC genotype TT genotype
Low Exposure High risk Low risk
High exposure Low risk High risk

 

Tobacco, smoke, dogs, and farms are common sources of endotoxin exposure. A person’s genetics and the level of endotoxin determine the risk of asthma.

Signs and symptoms(2): – one episode of asthma might contain a mix of breath shortness, feeling of tightness in the chest, coughing, and wheezing. Sputum is produced from the lungs and due to white blood cells known as eosinophil’s it might look like pus. In response to exercise or cold air, symptoms might worsen at night or in the early morning hours.

Associated condition: – In people with asthma, some other diseases are also common such as rhinosinusitis, obstructive sleep apnea, and GERD or gastro-esophageal reflux, anxiety, and mood disorders. However, it is yet to be established whether asthma leads to these diseases or not. The effects of beta 2 agonists in decreasing saliva may be related to it. This may increase the risk of dental erosions.

Specialty Pulmonology.
Complication Obstructive sleep apnea, sinusitis, Gastro – esophageal reflex disease (GERD).
Symptoms Coughing, shortness of breath, wheezing.
Duration Long term.
Cause Environmental factors and genetics.
Usually onset Childhood.
Risk factor Allergens, Air pollution.
Treatment Corticosteroids, avoiding triggers, triggers, salbutamol.
Diagnostic method Response to therapy, Based on symptoms, spirometry.
Deaths 397,100.
Frequency 358 million.

 

Treatment of asthma: – It is defined as airway hyper–responsiveness that leads to recurrent episodes of wheezing associated with chronic inflammation by the Global Initiative for Asthma. The diagnosis is usually made because of the pattern of symptoms and also how you respond to therapy over time, it is based on no precise test for diagnosis. There might be chances that you have asthma when you have episodes of recurrent wheezing, difficulty in breathing, or coughing, however, these symptoms might also occur due to viral infections, air pollution. For confirmation, Spirometry is used for diagnosis. It is more difficult for spirometry tests to be performed in children under 6.

Spirometry: The FEV1 measured in this technique helps in diagnosing asthma. In guiding treatment in those with acute exacerbations, it may be helpful. The treatment aims of asthma are as follows.

  • Sufficient control symptoms.
  • The failure risk of exacerbation minimized.
  • Lung function should be maintained normal.
  • The risk of side effects is also minimized.

The most commonly used medications for asthma are(3):

  • bronchodilators which are short-acting in nature (Ventolin, Pro Air RespiClick, Maxair, Pro Air, and Xopenex). They work by providing quick relief.  These may be used for the patients experiencing symptoms. Inhalable steroids (Pulmicort Turbuhaler, budesonide, Pulmicort respules).
  • LABA or Long-acting bronchodilators (serevent, Foradil) can also be used in therapy. However, using them alone is not recommended.
  • Long-acting bronchodilators and corticosteroids combine ICS/LABA combination agents.
  • As anti-inflammatory agent leukotriene modifies can serve.
  • To decrease the production of sputum Anticholinergic agents might be used.
  • In allergic asthma the use of Anti – IgE is recommended.
  • In eoinophilic asthma Anti – IL5 treatment is recommended.
  • For moderate to severe eosinophilic asthma Anti – IL4 receptor antagonist is approved. For atopic dermatitis and nasal polyposis, it is also approved.
  • Nedocromit and chromones are used in clinical practice.
  • Due to an unfavorable side–effect profile theophylline that helps in bronchodilation is rarely used in clinical practice.
  • Systemic steroids are potent anti – inflammatory agents used to treat asthma.

 

    References.

  1. https://www.medicalnewstoday.com/articles/beta-blockers-and-aspirin-may-protect-the-heart-after-bereavement
  2. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
  3. https://www.healthline.com/health/asthma