WHAT IS ASTHMA?

Updated 06 November 2023

Asthma is an inflammatory disorder affecting the lungs and the airways. It makes breathing challenging and can make certain physical activities difficult. When you breathe, air passes through your mouth or nose into the airways in the throat, eventually reaching the lungs. Several small air passages in your lungs help transfer oxygen from the air into your bloodstream.Asthma causes the inner walls of the airways, known as the bronchial tubes, to swell and narrow. Excess mucus may also be produced, which then fills the airways, further decreasing the amount of air that can travel through it.

According to 2019 statistics provided by the Global Burden of Disease Collaboration, asthma was estimated to affect as many as 262 million people worldwide. Compared to other chronic diseases, the fatality rate of asthma is relatively low; however, there is no cure available yet, and it is also under-diagnosed and under-treated, according to the World Health Organization. This puts a heavy burden on those who suffer from it, potentially restricting their quality of life. Fortunately, some management methods can provide a certain amount of help.

What Happens During An Asthma Attack?

Three things can happen during an asthma attack:

• Bronchospasm: This occurs when the muscles surrounding the airways constrict. When they contract, your airways narrow. Air cannot move freely through restricted airways.
• Inflammation: This causes the lining of your airways to swell, restricting the amount of air that enters and exits your lungs.
• Production of mucus: Your body produces more mucus during an attack. This thick mucus obstructs the airways.

When your airways become tighter, wheezing may be heard. This is a sound created by your airways when you breathe and exhale. An asthma episode may also be called a flare-up or an exacerbation. It refers to when your asthma is uncontrolled.

Types Of Asthma

Asthma is classified based on the etiology and severity of symptoms.

Based on Severity

• Intermittent asthma: This type of asthma is episodic, which comes and goes, allowing you to feel normal between asthma attacks.
• Persistent asthma: Here, you have symptoms almost all of the time. Symptoms might range from minor to severe. The severity of your asthma depends on the frequency with which you experience symptoms. They also consider how well you can perform tasks during an attack.

Based on Causes

• Allergies: In certain people, allergies can trigger asthma attacks. Pollens, molds, and pet dander are some examples of allergens.
• Non-allergic: External events can also trigger asthma flare-ups. Stress, exercise, illness, and the weather can all trigger a flare.

Based on Age

• Pediatric asthma: Also known as childhood asthma, pediatric asthma frequently begins before the age of five and can affect infants and toddlers. However, children can outgrow asthma. You should consult your healthcare provider before deciding if your child needs to keep an inhaler with them in case of an asthma attack. Your child's doctor can also help you understand the risks.
• Adult-onset asthma: This kind of asthma develops after the age of 18. Some factors that influence the likelihood of acquiring asthma in adulthood are allergies and exposure to allergens, respiratory illness, stress, smoking, etc.

Based on Triggers

• Occupational asthma: This type of asthma develops due to exposure to an allergen or irritant in the workplace. One in every six adult-onset asthma cases begins at work. Furthermore, approximately 21% of working adults with asthma have reported worsening symptoms at work. Asthma triggers can be found in both indoor and outdoor work environments.
• Exercise-induced asthma: Also known as exercise-induced bronchospasm, this type is brought on by physical activity.
• Eosinophilic asthma: This kind of asthma may not respond to standard medicines in severe situations. Although normal asthma drugs can help some patients with eosinophilic asthma, others may benefit from specific biologic therapies. A particular type of biologic drug reduces the number of eosinophils, which are white blood cells that participate in allergic reactions that can cause asthma.
• ACOS (Asthma-COPD overlap syndrome): This occurs when you have chronic obstructive pulmonary disease (COPD) and asthma. Both conditions make breathing difficult.
• Seasonal asthma: This type of asthma is caused by allergens only present in the environment at specific seasons of the year. For example, cold winter air or spring or summer pollen may aggravate seasonal asthma symptoms. Seasonal asthma patients still have the condition for the remainder of the year but typically do not have symptoms.
• Difficult-to-control and severe asthma: According to a 2014 study, 5-10% of patients with asthma have severe asthma. Some people get severe symptoms for reasons unrelated to asthma. For example, they may not have learned how to utilize an inhaler correctly.

Others have severe refractory asthma. In these circumstances, asthma does not respond to treatment, even with large doses of medication or the correct use of an inhaler. This kind of asthma may affect 3.6% of those who have it.

Causes Of Asthma

Researchers remain perplexed as to why some people develop asthma, and others do not. However, several circumstances increase the risk:

• Allergies: Allergies make you more vulnerable to developing asthma.
• Genetics: If someone in your family has a history of asthma or allergic diseases, you are more prone to the disease.
• Environmental factors: Asthma can develop due to exposure to things that irritate the airways. These are especially dangerous for newborns and young children whose immune systems are still growing.
• Respiratory infections: Respiratory syncytial virus (RSV), a common respiratory tract infection, can harm young children's developing lungs.

Triggers of an Asthma Attack

You may experience an asthma attack if you come into contact with irritants. Doctors refer to these substances as "triggers”. Knowing what causes your asthma episodes makes it easier to avoid them.

For certain people, a trigger can immediately cause an attack. For others, an attack may begin hours or days later or at varying times.

Triggers can vary from person to person. However, some typical triggers include:

• Air pollution: Various sources, including manufacturing pollutants, car exhaust, and wildfire smoke, cause air pollution, which can trigger an asthma attack.
• Exercising: Physical activity can trigger an attack in some people.
• Dust mites: These are invisible organisms that live in our homes. Allergies to dust mites can trigger an asthma attack.
• Pests: Cockroaches, mice, and other domestic pests can all trigger asthma episodes.
• Mold: Mold grows in damp areas. This can be problematic if you have asthma. You don’t even have to be allergic to mold to have an asthma attack.
• Tobacco smoke: If you or someone in your house smokes, you are more likely to get asthma. You should never smoke in enclosed spaces. If you are a smoker, it is advisable to quit; your healthcare provider can help you with this.
• Pets: Asthma episodes might be triggered by your pets. Inhaling pet dander can irritate your airways if you are allergic to it.
• Certain occupational exposures: You may be exposed to various substances at work, such as cleaning products, flour or wood dust, or other chemicals. If you have asthma, they can all be triggers.
• Strong chemicals or odors: These can cause allergic reactions in some people.

Diagnosing Asthma

The causes of asthma symptoms can be diagnosed by a pulmonologist or even an allergist/immunologist. Your medical history, including information about your parents and siblings, will be reviewed by your healthcare professional. Your doctor will also inquire about your symptoms. Any allergies, eczema, or other lung problems must be disclosed to your provider.

Your doctor may order spirometry. This test monitors airflow through your lungs and diagnoses and tracks your treatment progress. A person must take a deep breath and then violently exhale into a tube. The tube connects to a spirometer, which measures the rate at which individuals evacuate air from their lungs.

A chest X-ray, blood test to look for elevated eosinophils and immunoglobulin E (an antibody produced by the immune system in people with allergic asthma), or skin test for allergy testing may be ordered by your healthcare practitioner.

Treatment

The treatment options for asthma are improving and increasing. The purpose of treatment is to assist a person in breathing better, minimize the number of attacks, and improve the number of activities in which they can participate.

A person should collaborate with a healthcare practitioner to devise the best treatment plan for them. Current therapy options include pain relievers and long-term control drugs.

If used daily, quick-relief drugs relieve symptoms, and long-term control medication minimizes the number of attacks.

Medications currently used to treat asthma include the following:

• Long and short-term bronchodilators that relax the muscles around the airways.
• Antibiotics are prescribed for bacterial pneumonia or bronchitis.
• Anti-inflammatory drugs, such as inhaled corticosteroids, are used for long-term maintenance, whereas oral steroids are used for acute attacks.
• Bronchodilators and corticosteroids are combined.

As with any disease, early treatment is essential. Untreated asthma can lead to various issues, from lifestyle restrictions to death. If undiagnosed and untreated with medication, asthma can increase the risk of lung scarring, which means permanent lung and airway damage leading to breathing difficulties without external help.

If the disease progresses to this stage, the damage becomes irreversible and is labeled COPD (chronic obstructive pulmonary disease). Severe asthma attacks can also cause complete respiratory failure, which means that the airways are closing and medication fails to open them up. This can be fatal if not treated immediately.

Outlook

If you have asthma, you can still be productive and participate in sports and other activities. Your doctor can help you manage symptoms, identify triggers, and prevent or tackle attacks.

Conclusion

Asthma is a chronic inflammatory disorder that causes airway edema. It can affect people of all ages, with symptoms ranging from mild to severe. In most circumstances, effective therapy can help a person with asthma to lead a full and active life.

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References:

• Ilmarinen, Pinja et al. “Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma.” Mediators of inflammation vol. 2015 (2015): 514868. doi:10.1155/2015/514868
• Hekking, Pieter-Paul W., et al. “The Prevalence of Severe Refractory Asthma.” Journal of Allergy and Clinical Immunology, vol. 135, no. 4, Elsevier BV, Apr. 2015, pp. 896–902. Crossref, https://doi.org/10.1016/j.jaci.2014.08.042.
• Asthma Trends Brief. www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learn-about-asthma/asthma-children-facts-sheet.html.
• https://community.aafa.org/blog/what-happens-in-your-airways-when-you-have-asthma
• https://acaai.org/asthma/types-of-asthma/
• http://globalasthmareport.org/resources/Global_Asthma_Report_2022.pdf

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