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Introduction:
Asthma Day 2008
was observed on Tuesday, May 6, 2008. The theme of this year's event is
“You Can Control Your Asthma”. Over 300 million people around the world suffer from this non-communicable
respiratory disease. Asthma affects 3.5 per cent to over 20 per cent of the
population in any country. Asthma cause more deaths in India than in any other
country. About 60% of patients develop this allergy in childhood itself. This disease is more commonly found in advanced,
industrialized, polluted countries as compared to tribal communities. It’s more
common in men than women.
Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing. The airways are the tubes that carry air in and out
of your lungs. In case of asthma, the inside walls of airways are inflamed (swollen). The inflammation makes the airways very sensitive, and they tend to react strongly to things that you are allergic to or find irritating. When the airways react, they get narrower, and less air flows through to your lung tissue.
During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. Inflammation increases, and the airways become more swollen and even narrower. Cells in the airways may also make more mucus than usual. This extra mucus also narrows the airways. These changes make it harder to breathe.
Asthma education is essential for asthma management. The patient should
understand their disease process, understand their medication and how to use it,
and be able to react to changes in their disease by symptoms and/or actual
measured peak flow.
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Muscles around the
bronchiole have normal tone.
During an asthma attack, muscles around the airways tighten up, making the airways narrower so less air flows through. |
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Sign and Symptoms
Asthma is Greek word meaning “panting or short drawn breath’’. Patients
suffering from this disease appear gasping for breath. Actually they have more
difficulty in breathing out than breathing in and this is because of spasm of
air passage in the lungs. The effect is to blow the lung up because the patient
can not drive the air properly out of the lungs before he has to take another
breath.
Asthma onset is either abrupt or gradual. Sudden spells of coughing can be the
first sign. When the onset is gradual, the attack is usually brought on by
respiratory infections. A severe attack causes an increase in heartbeat and
respiratory rates and the patient feels restless and fatigued. There may be
coughing, tightness in the chest, profuse sweating and vomiting. There may also
be abdominal pain, especially if the coughing is severe. The wheezing sound
identified with asthma is produced by the air being pushed through the narrowed
bronchi. All asthmatics have more difficulty at night, especially late nights/
very early mornings.
In the elderly, the recurring periods of distressing and often nocturnal cough,
may occur after an upper respiratory infection, suggesting the late onset of
asthma. Wheezing if not the original complaint, would have been noticed often by
the patient or people around him. The lungs may appear normal when examined
during the day, but serial measurements of peak expiratory flow rate several
times a day and night if woken by cough will normally show the wide fluctuations
characteristic of asthma.
During very severe attacks, an asthma sufferer can turn blue from lack of
oxygen, and can experience chest pain or even loss of consciousness. Just before
loss of consciousness, there is a chance that the patient will feel numbness in
the limbs and palms may start to sweat. The person's feet may become icy cold.
Severe asthma attacks, are life-threatening and may lead to respiratory arrest
and death. Despite the severity of symptoms during an asthmatic episode, between
attacks an asthmatic may show few or even no signs of the disease.
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Risk factors and causes of Asthma
There are different theories about the low prevalence of asthma. The genetic background of the patients,
increasing pollution, including that from allergens, smoke and
toxins, weak immune system and changes in lifestyle are the
main reason for the increase in the prevalence of asthma. Asthma is caused by a complex interaction of genetic and environmental factors.
Environmental factors: Many environmental risk factors have been associated with asthma,
some that support their direct association:
Poor air quality, from traffic pollution or high ozone levels, has been
associated asthma development.
Environmental tobacco smoke, especially maternal cigarette smoking, is associated with high risk of asthma prevalence and asthma morbidity, wheeze, and respiratory
infections.
Viral respiratory infections at an early age.
Antibiotic use early in life has been linked to development of asthma
as they modify gut flora, immune system.
Psychological stress on the part of a child's caregiver has been associated with asthma,
because stress may influence the immune system.
Genetic factors: Over 100 genes have been associated with asthma in at least one genetic
association study. Through the end of 2005 study, 25 genes had been associated with asthma in six or more separate
populations. Many of these genes are related to the immune system or to modulating
inflammation.
Gene-environment Interactions: Research suggests that some genetic variants may only cause asthma when they are
combined with specific environmental exposures.
Allergens:
Asthma cause due to allergens from nature, typically inhaled, which include waste from common household pests, such as the house dust mite and cockroach, grass pollen, mould spores, and pet epithelial
cells. Indoor air pollution from volatile organic compounds, including perfumes and perfumed products. Food allergies such as milk, peanuts, and eggs. However, asthma is rarely the only symptom, and not all people with food or other allergies have
asthma.
Use of fossil fuel related allergenic air pollution, such as ozone, smog, summer smog, nitrogen dioxide, and sulfur dioxide, which is thought to be one of the major reasons for the high prevalence of asthma in urban
areas. Various industrial compounds and other chemicals, notably sulfites; chlorinated swimming pools generate
chloramines —monochloramine (NH2Cl), dichloramine (NHCl2) and trichloramine
(NCl3) - in the air around them, which are known to induce
asthma.
Early childhood infections: However, persons of any age can have asthma triggered by colds and other respiratory infections. Eighty percent of asthma attacks in adults and 60% in children are caused by respiratory
viruses.
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Types of Asthma
Inflamed airways
asthma: Airways narrowed as a result of the inflammatory response cause
wheezing.
Bronchoconstriction: During an asthma episode, inflamed airways react to environmental triggers such
as smoke, dust, or pollen. The airways narrow and produce excess mucus, making
it difficult to breathe. In essence, asthma is the result of an immune response
in the bronchial airways.
Stimuli: The airways of asthmatics are "hypersensitive" to certain triggers,
known as stimuli In response to exposure to these triggers, the bronchi
(large airways) contract into spasm (an "asthma attack"). Inflammation soon
follows, leading to a further narrowing of the airways and excessive mucus
production, which leads to coughing and other breathing difficulties.
Occupational asthma: That's asthma caused by exposure to allergens present in the average office - and a new study says it's on the rise.
Exposure to wood dust, paint fumes, solvents, latex and baking flour - all workplace allergens - cause thousands of cases of asthma every year, according to a report released on
Moay 12, 2008 by
the Australian Institute of Health and Welfare (AIHW). The study shows that anywhere from 9 to 15 per cent of
adult-onset asthma cases can be attributed to exposure to agents at the workplace,
Science Alert reported. Occupations with the greatest risk for occupational asthma include farming, painting, cleaning, baking, animal handling and chemical work. Other at-risk occupations include nursing, welding, food processing, dentistry, timber and forestry industries, and industries that produce metals, plastics, electronics, rubber and textiles.
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Diagnosis
Asthma is defined simply as reversible airway obstruction. Reversibility occurs
either spontaneously or with treatment. The basic measurement is peak flow rates.
In many cases, a physician can diagnose asthma on the basis of typical findings
in a patient's clinical history and examination. Diagnosis in children is based on a
careful compilation and analysis of the patient's medical history. Monitoring asthma with a peak flow meter on an ongoing basis assists with self
monitoring of asthma. Peak flow readings can be charted on graph paper charts
together with a record of symptoms or use peak flow charting software. A peak flow meter, a simple device to measure lung volume, can be used at home
to help you "see an attack coming" and take the appropriate action, sometimes
even before any symptoms appear.
Asthma Diagnosed by a device called a spirometer to check how your lungs are working. This test is called spirometry. The test measures how much air you can blow out of your lungs after taking a deep breath, and how fast you can do it . The results will be lower than normal if your airways are inflamed and narrowed, or if the
muscles around your airways have tightened up.
In capnography which measures the amount of exhaled carbon
dioxide, along with pulse oximetry which shows the amount of oxygen dissolved in the blood, to determine the severity of an asthma
attack as well as the response to treatment. Direct aspiration (dysphagia) can be diagnosed by performing a Modified Barium Swallow
test and treated with feeding therapy.
A majority of children who are asthma sufferers have an identifiable allergy
trigger. Allergy tests can help identify avoidable symptom triggers. After a pulmonary function test has been carried out, radiological tests, such
as a chest X-ray or CT scan, may be required to exclude the possibility of other
lung diseases.
Some of other tests includes:
Allergy testing to find out if and what allergens affect you.
A test to see how your airways react to exercise.
Tests to see if you have gastro esophageal reflux disease.
A test to see if you have sinus disease.
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Treatment Options
For people suffering from mild asthma (infrequent attacks), the use of inhalers
can be need-based, while those having significant asthma (symptoms occurring
every week) must be treated with anti-inflammatory medication, preferably inhaled corticosteroids and bronchodilators. Acute or severe asthma attacks may
require hospitalisation, administration of oxygen and intravenous medication.
Drugs and inhalers have only a limited value in alleviating symptoms. Most of
these drugs are habit forming and the dose has to be increased from time to
time, thus making patient more dependent on them. The root cause, i.e., allergy
has to be taken care of. The natural way to treat asthma consists of stimulating
the functioning of slack excretory organs, adopting appropriate diet patterns to
eliminate morbid matter and reconstruct the body, and practicing yoga-pranayam
to permit proper assimilation of food and strengthen lungs, digestive system and
circulatory system.
The patient should be given enema to clean the colon and prevent auto-intoxication. Mud packs applied to abdomen will relive fermentation caused
by undigested food and will promote intestinal peristalsis. Wet packs should be
applied to the chest to relive congestion of lungs and to strengthen them. The
patient should be made to perspire through steam bath, hot foot bath, hot hipbath and sun bath. This will remove accumulated toxins and will also help in
removing congestion of lungs.
The patient should fast for 3-4 days on lemon juice with honey. After fasting,
he/she should start a fruit diet, but care has to be taken that acid forming
foods are kept limited. More liberal use of alkaline food should be made, like
green vegetables and germinated gram. Foods like rice, sugar, lentils, fried
foods and curds should be avoided as it forms phlegm.
Asthmatics should avoid taking water with meals and should always eat less then
their capacity to make stomach fire stronger and thereby hardly leaving any
chance to form phlegm. In acute cases, do no force the patient to eat. Warm water sips at frequent
intervals will be helpful. 2 spoons of dry ginger powder are added in one liter
of water, which is boiled for 10 minutes, and this water on cooling is supposed
to be sipped every hour. This produces sufficient heat in the body to break down
the mucus, dilate air passages and decrease congestion by reducing inflammation
also.
Regular intake of onion juice helps in reliving acute symptoms as it is a strong
anti-inflammatory. This quality is because of the compound named
diphenylthiosulphinate, thiosulphinates which has stronger anti-inflammatory
property than prednisolone.
The patient’s diet should contain regular use of black pepper powder and garlic.
Both of them have mucus moving capacity thereby making breathing easier. Honey
contains higher alcohols and ethereal oils and the vapors given off by them are
soothing and beneficial to asthma patients. Honey usually brings relief when the
air flowing over it is inhaled or is consumed with warm water/ milk. It tones up
the pulmonary parenchyma and thereby prevents the production of mucus in future.
It also aids in thinning mucus which has already been accumulated. Use of turmeric powder - half a spoon thrice a day with one full glass of water acts as
anti-infective and anti inflammatory.
During an attack, mustard oil mixed with little camphor should be massaged over
the back of the chest. This loosens phlegm immediately and eases breathing.
Inhaling vapors of caraway seeds (ajwain seeds) after adding it to boiling water
dilates the bronchial passage.
The patient should do breathing exercises twice a day at an empty stomach. After
taking a deep breath (in a way that even the clavicular part of shoulder is
raised up while inhalation), the patient should practice keeping the air inside
the lungs, forcefully as long as possible, followed by very slow exhalation.
This breathing exercise will increase lung capacity and dead space of the lung
(upper lobe) will start functioning gases’ exchange. With this the lungs are
strengthen, oxygen levels in body is increased, fast flow of blood eliminates
mucus and dilated bronchus. Keeping air inside the lungs for longer periods
improves digestion thereby providing good digestion and good absorption of
nutrients.
Prevention methods
Inhaled glucocorticoids are the most widely used of the prevention medications and normally come as inhaler devices.
Long-term use of corticosteroids can have many side effects including a redistribution of fat, increased appetite, blood glucose problems and weight gain.
To control bronchitis and asthma
some suggestions: |
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Quit smoking: If you smoke, quit. Bronchitis will ease dramatically and may even be cured within a few years when you quit smoking.
Walk away from people who smoke.
Gargle: Gargle with warm water twice a day. It cleanses the grease off your throat. When the throat gets an oily film, it gets irritated and makes you hack. Avoid salt in the gargling water
as it’s not asthma-friendly.
Drink hot fluids: Have hot clear soups, hot milk laced with honey and
haldi, hot water through the day. Keep a thermos handy for soothing sips whenever possible.
Use expectorants sparingly: Some expectorants are addictive
- avoid them. Have a safe expectorant only if you have dry cough. If you’re coughing up phlegm, avoid expectorants, stick to hot water.
Walk, don’t run: If jogging makes you cough, walk daily for 30-45 minutes at a speed you can manage. Carry your thermos of hot water with you. You could also swim as swimming is ideal for asthma. Keep active — play
tennis, cricket, golf.
Fresh and nourished meal: Avoid oily or fatty food and be
selective for fresh and nutritious vegetable food. For example, have only plain steamed rice, salad,
yoghurt, bread, cheese, fruits, cornflakes, digestive biscuits, roast channa, jam, baked beans,
pickles etc. You can also have them with warm milk, or try a banana sandwich.
Eat light: Overeating presses on your insides and causes wheezing. Stop when you’re on top
- that is when you are comfortable, not ‘full’ or ‘heavy’.
Asthmatics should avoid taking water with meals and should always eat less then
their capacity to make stomach fire stronger and thereby hardly leaving any
chance to form phlegm.
Sleep elevated: Sleep with two pillows. Keeping your head slightly elevated prevents stomach reflux.
Sometimes, if the stomach acid drips into your throat, it causes coughing and asthma.
Learn deep breathing: Correct deep breathing regularly.
Learn the correct technique from an experienced Yoga teacher. Practicing
yoga-pranayam to permit proper assimilation of food and strengthen lungs, digestive system and
circulatory system.
Asthma medication: If you are on asthma medication, you can have it 15 minutes before you exercise.
Lose weight: Lose your excess weight and it will dramatically improve your health and level of confidence. You will lose weight when you follow the lifestyle of an athlete.
No depression: Never allow yourself to be depressed. Be
always cheerful and do all the positive things gladly, joyfully.
Herbal medicines: Regular intake of onion juice helps in reliving acute symptoms as it is a strong
anti- inflammatory. The patient’s diet should contain regular use of black pepper powder and garlic.
Both of them have mucus moving capacity thereby making breathing easier. Honey
is soothing and beneficial to asthma patients. Use of turmeric powder - half a spoon thrice a day with one full glass of water acts as
anti-infective and anti - inflammatory.
During an attack, mustard oil mixed with little camphor should be massaged over
the back of the chest. This loosens phlegm immediately and eases breathing.
Inhaling vapors of caraway seeds (ajwain seeds) after adding it to boiling water
dilates the bronchial passage.
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Possible complications
Respiratory fatigue,
side effects of asthma medications, Pneumothorax and Death.
Prognosis
Current research suggests that the prevalence of childhood asthma has been
increasing. Asthma prevalence, morbidity, mortality, and drug response vary greatly across
populations. There is an almost 30-fold difference in asthma prevalence between
some of the countries included in the International Study of Asthma and Allergy
in Childhood , with a trend toward more developed and westernized countries
having higher asthma prevalence.
History
Asthma was long considered a psychosomatic disease, and
during the 1930s–50s, was even known as one of the 'holy seven'
psychosomatic illnesses. At that time, psychoanalytic theories described the aetiology of asthma as psychological, with treatment often primarily involving psychoanalysis and other 'talking
cures'.
New study on Asthma
Tree-lined streets lower asthma risk
: Columbia University scientists on May 10, 2008 have suggested that tree-lined streets can reduce the risk of developing asthma in young children.
While it is commonly believed that the pollen released by trees can contribute to asthma attacks, the present study shows trees cut asthma risk by
cleaning the air and encouraging kids to play outdoors. According to the study
published in the Journal of Epidemiology and Community Health, an increase of 343 trees per square kilometer lowers the prevalence of asthma by 29%.
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