What is asthma?
Asthma is a common disease which affects millions of people in the world. Asthma often starts in childhood, but it can happen for the first time at any age. Asthma actually means allergic disorder affecting lungs.
Asthma affects the airways – the tubes carrying air in and out of the lungs. People with asthma have sensitive airways (over reactive) which become irritated in some situations. The airways become narrow and sometimes produce more mucus than usual. This makes it difficult to breathe.
Asthma may get better or disappear completely during teenage years. But about 30% of children with asthma will go on to have problems as an adult. Asthma can run in families, but many people with asthma do not have relatives with the condition.
Asthma can not be cured, but it can be controlled so that attacks can be prevented. Most people with asthma who receive proper treatment (and take it correctly) can lead normal lives. You do not have to lose time from school or work and enjoy full involvement in sport and other activities.
What happens in asthma?
When you have asthma, your airways are irritable because they are inflamed. This makes them more likely to become narrow, which makes it harder to get air in and out of the lungs. This can happen all the time or only when you are having an asthma attack. It is often noted that asthma symptoms are more pronounced during winter and rainy seasons.
The symptoms of asthma are breathlessness, cough, wheezing (musical sound like ‘cats crying’) and a tight feeling in the chest. Symptoms are often worse at night or early morning when you wake up.
What causes asthma?
Exact cause is not known but we do know that many factors contribute. For instance, there is more and more evidence that allergies are a factor, especially if you are <16 yrs of age.
What makes asthma worse?
On many occasions asthma gets worse for no obvious reason. There are some triggers which can make asthma worse (or trigger an asthma attack):
- Common cold– one of the most common causes in many people.
- Exposure to allergens– Common things which people with asthma are allergic to are cold air, grass pollen, house dust and animal fur (including your own pets).
- Exercise– running, particularly in cold weather.
- Irritants like tobacco smoke, fumes and a dusty atmosphere.
- Emotion – anger, anxiety or happiness.
- Pollution, especially from traffic, is increasingly recognised as making asthma worse.
Most tablets and medicines are very safe if you have asthma. However, if you have high blood pressure or angina, some medication (such as beta-blockers) can make asthma worse. People with asthma should also avoid aspirin and ibuprofen. Even certain eye drops can provoke attacks. However, alternatives do exist. Check with your doctor or pharmacist if you are not sure, but never stop taking any medication suddenly without taking medical advice first or consulting your doctor.
What treatments are there for asthma?
Many treatments are available, often given as an inhaler or nebulizer and in tablet form also.
Some treatments are for rapid relief of symptoms (relievers). Others – such as inhaled steroids must be taken regularly (preventers). Discuss your treatment with your doctor and make sure you understand how it should be taken for the greatest benefit. The dose of steroid in the inhaler is too small to cause any obvious side effects and these medicines do not cause addiction when used on a regular basis. Check with your doctor the duration of using the medicines; please do not stop medications by yourself. Do a mouth gargle with plain drinking water each time you finish using the inhaler. Please remember to use a spacer device (big plastic flask like object) with your inhaler when advised by your doctor. And check that you know how to use your inhaler properly (inhaler technique) – a lot of people don’t!
How to recognise when your asthma is causing problems?
It’s important to recognise when your asthma is getting worse so that you can get the right treatment at the right time. Asthma is often worse at night. One of the signs that you need more treatment is if you wake up during the night or in the early morning with wheezing, breathlessness or coughing. If you are wheezy during the day and need to use your inhalers more frequently than usual, you should arrange to see your doctor as soon as possible. If you have a bad attack that is not relieved by your inhalers, and particularly if you have trouble talking, you should seek urgent treatment at the emergency Department of your nearest hospital.
Why is my asthma not improving despite treatment?
There may be several reasons for poorly controlled asthma despite treatment.
1) Your doctor needs to reassess and confirm that you have asthma, it’s important to make a correct diagnosis so that appropriate treatment can be given and more importantly not miss other conditions which may mimic asthma.
2) Your doctor should review the treatment you are taking, especially, the right inhaler and right dose of medicine in it.
3) Your inhaler technique should be cross checked. It’s possible you are using the inhaler in a wrong way, if so, the medicine may not be reaching your lungs properly hence, it is ineffective
4) You may not be using the inhaler for a sufficient duration. It’s important to take the inhaler for a period of few weeks as per the response you achieved with it. In asthma, patients feel better after starting treatment but the response is not maintained if treatment is discontinued prematurely. Check with your doctor the exact duration of treatment. Do not worry about side effects or any possibility of addiction.
5) You may be having other problems which may not allow asthma to stay corrected despite treatment like allergy of the nose and acidity + acid reflux from stomach. You may need treatment to correct these problems also.
6) Smoking can blunt the response to treatment. So, it’s important to discontinue smoking.
7) It’s possible that the triggers (allergens) which aggravate asthma might still be around in your environment and unless the repeated exposure is avoided asthma may not come under control. Avoid triggers.
8) Consult your doctor and get assessed for any infection in lungs or elsewhere. Presence of infection which is not corrected can make asthma control difficult.
What other precautions are important?
It is important to recognize the triggers of your asthma and avoid them to enjoy a healthy and normal life. Not every patient with asthma will have the same triggers. It’s not right to assume that all asthma patients are allergic to citrus fruits or cold water or cold air. Different patients have different triggers or allergies.
It is recommended that you carry a reliever inhaler with you at all times. Sometimes, in some patients certain environments may trigger an attack which is unexpected and timely treatment can be administered if a reliever inhaler is readily available.
Do not delay treatment if you realize your symptoms are not improving with usual medications. Early and prompt treatment can avoid an attack. Frequent asthma attacks can weaken your lungs.
Take vaccinations like the flu vaccine or pneumonia vaccine as advised by your doctor. It’s important to keep your house environment as clean as possible. House dust is one of the most common triggers for asthma.
