What to know about asthma

Asthma is a respiratory condition where breathing becomes difficult due to constriction of the airways. In this article, consultant in respiratory medicine Dr Ana de Ramon explains what causes asthma and how it is managed.

 

 

What is asthma?

Asthma is a chronic condition that can manifest at any age, and its impact on patients’ lives can range from a mild nuisance to a serious concern that, at times, can prove to be fatal. The severity of asthma can and is expected to change throughout a patient’s life. An asthma attack is a disruption of regular, relaxed breathing, where the airway can spasm and tighten, become inflamed, and overproduce mucus. All of these symptoms obstruct the airway and make it very difficult to breathe. People undergoing an asthma attack may begin wheezing, and coughing, and experience chest tightness and shortness of breath.

Asthma can be intermittent, where attacks are occasional and breathing is normal in between them, or persistent, meaning a constant difficulty with breathing properly. An attack can be triggered by overexertion, exposure to irritants like chemicals, dander, or pollens, stress, and even changes in weather.

Asthma is thought to be caused by a combination of environmental and genetic factors, such as:

• Allergies
• Exposure to allergens, toxins, fumes, or smoke
• Prior respiratory infections and diseases

 

How is asthma diagnosed?

To diagnose asthma, the doctor will obtain a detailed clinical history, perform a physical exam, and request objective tests to confirm the diagnosis including:

• A blood test
• A lung function test including spirometry with reversibility test to assess the degree of narrowing of your airways, and FENO levels to asses if there is inflammation in your airways. Alternatively, you may be asked to have a peak-flow measure for 2 weeks. 

The doctor may also require tests to rule out other conditions that could interfere with your breathing. 

 

How can asthma be managed?

Asthma cannot be definitively cured, but is treatable. That is, it can be managed to the point that allows you to keep a normal life, and flare-ups free or reduced. The treatment may include using medications such as:

• Bronchodilators, which are relaxants for the muscles around the airway
• Anti-inflammatories, which the inflammation in your airways, and subsequently, prevent flare-ups by
• Biologic therapies, which work by acting upon the inflammatory products intervening in causing asthma changes in the airways, and reserved for very specific cases, 

Asthma medication is typically administered via an inhaler, that can be taken daily and /or during an active attack. There are multiple different inhaler devices, each one requiring a different inhalation technique, with different compounds and doses

Monitoring your asthma control is based in clinical facts, which may be collected in standards symptoms questionnaires. There are many different reasons for which your asthma may not be well controlled, including:

• Alternative diagnosis
• Suboptimal adherence to treatment
• Suboptimal inhaler techniques
• Smoking 
• Environmental triggers (pollution, colds, seasonal)

You may be instructed in what to do if you have a flare-up of your respiratory symptoms (a self-management plan), which is normally provided by your asthma nurse in the community

Patients with asthma are recommended to receive annual vaccinations for flu and COVID, and to cease smoking.