Asthma

Breathing……..

We all need air to live……

Breathing is the process that moves air in and out of the lung.

What is asthma?

Asthma is a long-term lung condition which can be controlled, but cannot currently be cured. People with asthma have sensitive airways. These airways are more likely to react to triggers. The lining of the airways is thicker and inflamed. When a person with asthma is having an asthma flare-up, the muscles around the airway squeeze tight, the airways swell and become narrow with more mucus. This make hard to breath. Any person with asthma can have an asthma flare-up.
Asthma flare-up can occur slowly (over hours, days or even weeks) or very quickly (over minutes) – a sudden or severe asthma flare-up is sometimes called an asthma attack.
The good news is, for most people, asthma can be well-controlled by following a daily management plan.
Asthma affects an estimated 300 million individuals worldwide. It is a serious global health problem affecting all age groups, with increasing prevalence in many developing countries, rising treatment costs, and rising burden on patients and the community.

What are asthma symptoms?

Symptoms of asthma often occur at night, early in the morning or during activity or after exercise.

• Breathlessness
• Wheezing
• Chest tightness
• Cough

 

Who gets asthma and why?

Asthma affects people of all ages but some people get asthma during young age and others when they are older. Children are more likely to have asthma than adult, but they can sometimes “outgrow” it. The causes for asthma are not fully understood. But family history of asthma, eczema and hay fever play a role in asthma. Exposure to environmental factors such as workplace chemicals, tobacco smoke can lead to asthma.

 What are the trigger factors?

People with asthma have sensitive airways for triggers and each person has different triggers. When airways come in contact with an asthma trigger; the airways become inflamed, narrow and fill with mucus. This makes airway resistance increase and the work of breathing more difficult, causing shortness of breath, cough and wheezing.

•  Colds and flu
• Smoke, for example from cigarettes or fire
• Inhaled allergens, for example pollens, moulds, pet allergen, dust mite and cockroach
• Workplace chemicals
• Dust and pollution
• Changes in temperature and weather
• Emotions, for example laughter or stress
• Some medications
• Work place environment
• Some food chemicals and additives (e.g. sulfites can trigger asthma in some people)
• Exercise can be an asthma trigger – this is less likely when asthma is well-controlled.

What are the criteria for asthma diagnosis?

• Multiple wheezing episodes or attacks
• Family history of asthma, eczema or hay fever
• The cough, chest tightness, difficulty in breathing and wheeze improve with reliever medications such as Ventoline

How to diagnose asthma?

The chest specialist will ask about the symptoms of asthma, episodes or attacks, trigger factors and family history of asthma, etc…

Clinical examination with blood test may required, chest x ray and others such as….

• Peak flow meter – this is measure how much air flow from lungs. This test can be done in the office or at home to monitor asthma
• Spirometry – this measure lung volume.

How do people with asthma keep well?

• To learn more about asthma symptoms.
• To know trigger factors of asthma
• To know about plan of management with your doctor, and step-by-step instructions on how to prevent and treat symptoms and when to get medical help.

 

Asthma attack severity guide

Mild attack

• Cough
• Quiet wheeze
• Little breathing difficulty
• Able to speak in sentences.

Moderate

• Persistent cough
• Loud wheeze
• Obvious difficulty breathing (drawing in at tummy or throat)
• Only able to speak a few words at a time.

Severe

• Very distressed and frightened
• Gasping for breath
• Unable to speak more than single words
• Working very hard to breathe
• Sucking in at the throat and tummy a lot.

Life threatening

• Unable to move around
• Unable to speak
• Pale, blue around the lips
• No wheeze heard.

All severe or life threatening attacks require IMMEDIATE medical attention.

 Asthma Management

Everyone’s asthma is different and can change over time; that’s why it’s important for people with asthma to see their doctor at least twice a year for as asthma check up and more frequently if they have concerns.

Fortunately, most patients can achieve good control of their asthma. When asthma is under good control, patient can:

• Avoid troublesome symptoms during day and night
• Need little or no reliever medication
• Have productive, physically active lives
• Have normal or near normal lung function
• Avoid serious asthma flare-ups (Exacerbations, or attacks)

When can patients see their doctor?

• Wake up coughing, wheezing or breathless
• Limitation of normal activity
• Use reliever more than 2 times per day
• If several asthma triggers make symptoms of asthma worse such as exercise, laughter, exposure to smoke or others, that means there is extra inflammation in the airway.

How can asthma be treated and controlled?

There is a wide range of medications help in asthma control.

The most common are:

Combination Inhalers (Purple or Red & White)

These inhalers combine a preventer and symptom controller in one inhaler.

Singulair is a preventer medication in tablet form. It is taken once a day. It is not a steroid. It is used in mild to moderate asthma and seems to benefit children whose asthma is allergy or exercise based. .

Other medicines 

• Ipratropium (e.g., Atrovent inhaler) – can relax airways and may help some people with severe asthma and other airways diseases.

 

• Prednisolone and prednisone tablets or liquid

Prednisolone is anti-inflammatory corticosteroids that may be used to treat moderate and severe asthma. Prednisolone reduces the swelling and mucus in the airway. It takes about four hours to start working. It is usually given once a day, for three days, with food. In severe attacks, you may be given a longer course.

Side effects: increased appetite, weight gain, moodiness, etc

 

• Theophylline (e.g., Nuelin tablets, Aminophylline injection) – can relax airways and is occasionally used for severe asthma.

 

• Xolair injection (Anti-immunoglobulin therapy)– may prevent or relieve the symptoms of moderate-severe allergic asthma in adults and children over 12 years old. It is usually only given after other asthma medications have been tried without successful treatment of symptoms. Xolair works by blocking a substance called immunoglobulin E. Your doctor will measure the amount of this substance in your blood to help decide what dose you should have. Xolair is given by injection, every 2 to 4 weeks, usually only in a hospital clinic following a respiratory specialist’s advice.
  

Inhalation devices 

 

Inhalers 

Inhalers deliver medicine directly into the lungs.

There are two main types of inhalers:

1. Aerosol inhalers (e.g., Metered Dose Inhalers)
2. Dry powder inhalers (e.g., Turbuhalers and Accuhalers).

Good asthma control depends on using inhalers properly. If you are prescribed an inhaler, ask a pharmacist, doctor or asthma educator to demonstrate its correct use and to check your inhaler technique regularly.

Spacers 

A spacer is a chamber that fits onto a MDI (Metered Dose Inhaler) to help get more medicine into the lungs. Spacers can also reduce side effects from inhaled medicines. The medicine is sprayed into the spacer at one end and breathed in from the other end. There is a variety of different spacers available including children’s spacers, large volume spacers, compact spacers and disposable spacers. It is recommended that an MDI always be used with a spacer.

Nebulizers 

If patients have difficulty in using small inhalers, the doctor may prescribe an asthma nebulizer. This machine has a mouthpiece or mask and is typically used for infants, small children, older adults, or anyone who has difficulty using inhalers with spacers. The nebulizer changes asthma medications from a liquid to a mist, so that they can be more easily inhaled into the lungs. This takes a few more minutes than using inhalers. For most people, a puffer and spacer are easier to use than a nebulizer and just as effective

Nebulizer therapy such as Ventolin, Combivent, Pulmicort and Flixotide

Asthma First Aid

1. Sit the person upright

Be calm and reassuring

Don’t leave them alone

2. Give 4 puffs of blue reliever (Ventolin)

Use spacer if there is one

[Shake Puffer and put 2 puffs in spacer and take 4 breaths from spacer then repeat again]

3. Wait for 4 minutes and if there is no improvement, give 4 more puffs as above.
4. If there is still no improvement call emergency and your doctor

Self care 

• Avoid or manage triggers that make your asthma worse.
• Use inhalers correctly. Check your technique.
• Always carry a blue reliever inhaler with you (unless your doctor has told you to use Symbicort as both a preventer and a reliever).
• Develop a written Asthma Action Plan with a doctor. Use this plan to manage worsening asthma symptoms.
• Check there is medicine left in your asthma inhalers.
• Check that your medicine has not expired.
• After using inhalers containing corticosteroids (Flixotide, Pulmicort, Seretide or Symbicort) rinse mouth with water, gargle and spit out. This reduces the risk of side effects of thrush and hoarse voice.
• Clean inhaler devices regularly. Refer to the product information for cleaning instructions for each device.
• If using a spacer, wash it before use, and then about once a month, in warm water and leave it to air dry without rinsing or wiping.
• Don’t smoke.

 

Important information for you to know:

• Asthma treatment aims to prevent asthma symptoms by regular daily use of a preventer or combined preventer and symptom controller.
• Consult a doctor or follow your Asthma Action Plan if you:
• Need to use a reliever more than 3 times a week
• Have asthma symptoms more than 3 times a week
• Notice peak flow readings deteriorating
• Have an asthma attack.
• Ask your doctor or pharmacist for information and advice about how and when to use asthma medicines and always read and follow instructions carefully.

 Contacts and Resources

Please do not hesitate to ask questions if you do not understand or want more specific information.

Elia Clinic contact details:

Tel: 00973 17692323

Dr. Suad Al Monfaradi, MBBS, DCTM, MSc. (UK)

Pulmonologist & General Physician