Breathe Easy: Stay Informed About Effective Asthma Management

What is asthma?

It is usually defined by a history of breathing problems, including wheezing, breathlessness, chest tightness and cough².

These symptoms may vary over time and fluctuate in intensity². Another hallmark of asthma is airway hyper-responsiveness (AHR) to numerous stimuli – although this symptom on its own is not enough to diagnose asthma³. Asthma is common but has different triggers^1,3.

What is an asthma attack?

An asthma attack is a temporary worsening of symptoms⁴. It can range from a mild attack that can be treated with inhalers to a life-threatening attack that needs emergency treatment in hospital⁴. Triggers may include⁴:

• Respiratory tract infections like the common cold
• Allergens, such as dust or animal dander
• Irritants, such as cigarette smoke
• Intense exercise.

Types

Early-onset asthma: Begins in childhood³. In children, there are 3 distinct types, and all three of these demonstrate an association between severe illness early in life and progressive and persistent wheeze in later life:⁵

• Transient early wheezing: Clears up before the age of 3 years and with no family history of asthma. Risk factors include premature birth, exposure to other children at childcare, mother smoking during pregnancy and exposure to tobacco smoke as a baby.
• Nonatopic wheezing: Is related to viral infection during the first 2 to 3 years of a child’s life.
• Atopy-associated wheezing: Is associated with a family history of allergy, sensitisation to allergens at an early age and genetic predisposition to allergen sensitisation.

Adult-onset asthma: Is diagnosed after the age of 18 years⁶.

People with certain types of adult-onset asthma, such as adult-onset eosinophilic asthma, tend to have symptoms constantly and allergies are not a major factor³.

Risk factors for adult-onset asthma include⁶:

• Being born prematurely
• Lung infections early in life
• Rhinitis
• Smoking
• Obesity
• Long history of sinusitis.³

Additional types of asthma

• Cough-variant asthma⁶: Is when cough is the main symptom. People with this type of asthma typically do not wheeze.
• Exercise-induced asthma⁶: Is when a person experiences asthma symptoms after vigorous exercise as a result of excessive sensitivity to cold or dry air. Symptoms typically start shortly after exercise and may last for up to an hour.
• Aspirin-exacerbated respiratory disease (AERD)⁶: Is asthma that is worsened by nonsteroidal anti-inflammatory drugs.
• Occupational asthma³: Is when asthma develops in the workplace, usually as a result of exposure to a trigger.
• Asthma with obesity³: Has prominent respiratory symptoms. One theory is that obesity affects a person’s breathing mechanics⁸. Another is that inflammation resulting from adipose tissue may play a role⁸.
• Near-fatal asthma⁷: Is acute asthma, known as an asthma attack, where the person stops breathing or has a significant build-up of carbon dioxide because they are not breathing out effectively. In addition, the person may experience disturbances in consciousness and will require mechanical ventilation. It can get gradually worse over a period of days or weeks in people who have severe or uncontrolled asthma or come on suddenly. When it is sudden, it also tends to respond to treatment quickly.

Symptoms

Asthma is usually recognised through its episodic nature⁹. Symptoms are⁴:

• Wheezing
• Trouble breathing
• Chest tightness
• Cough.

Risk factors for asthma include⁸

• Genetic predisposition.
• Indoor allergens, including house dust mites, mice, cockroach, animal dander and fungi.
• Lack of exposure to microbes. Exposure to domestic animals early in life seems to create microbial diversity that helps protect against allergic asthma.
• Respiratory viruses can trigger asthma either on their own or in conjunction with an allergic predisposition.
• Environmental tobacco smoke increases the risk for asthma in early life.
• Air pollution can cause asthma or make existing asthma worse.
• Smoking – asthmatics who smoke have worse symptoms and an increased chance of death compared to non-smokers.
• Occupational exposures to certain chemicals in the workplace can trigger asthma.
• Gender – boys have increased risk of asthma in childhood, whereas girls and women have increased risk from puberty onwards.
• Stress – Psychological stress can trigger asthma.
• Medications – Beta blockers can potentially result in narrowing of the airways in asthmatics and should therefore be administered on a case-by-case basis, at the lowest dose possible.

Diagnosis

Asthma is diagnosed based on symptoms as well as the variation in a person’s ability to breathe out effectively³.

Wheezing while exhaling is a prominent symptom³.

The healthcare provider will use a peak flow meter to determine how well you can breathe out³. Your doctor may also want³:

• To know if symptoms started in childhood
• To know if you have a history of allergy
• To know if you have a family history of allergies
• To send you for an allergy test, if need be.

Cough-variant asthma is associated with airway hyper-responsiveness, although lung function may be normal. It is more common in children and more prevalent at night. Once diagnosed, patients will be classified as having mild, moderate, or severe asthma.³

Treatment

The goals of asthma treatment are good control of symptoms and minimising the risk of future attacks, fixed airflow limitation, and side effects³.  

Asthma control refers to the level of symptoms (daytime, night-time, limitation of activity and use of reliever medication)³. Asthma severity refers to the level of treatment required to control symptoms and flare-ups.³ It can change over time³.

Asthma patients should be reviewed regularly, every 1 – 3 months at first and then every 3 – 12 months, to see how well their asthma is controlled and if their treatment needs to be adjusted³.

Asthma is considered to be under control after two weeks of⁶:

• 2 or fewer days of symptoms
• 2 or fewer days of reliever (rescue) inhaler use
• No days waking at up night due to asthma
• No limitation of activity due to asthma.

Medical

• Controller medications are used over the long-term³. They reduce airway inflammation, control symptoms, and reduce the risk of future attacks and a decline in lung function³. Their effectiveness can be assessed after a period of a few months and dosage can be adjusted up or down as needed³. Asthma is a chronic condition, so absence of symptoms means the medication is working, and not that asthma is no longer present⁶.

• Reliever medications are used to relieve symptoms as needed³. Reliever medication is administered in the form of an inhaler that contains a short-acting medication that provides immediate bronchodilation⁶. It can be used up to 4 times a day⁶.

Mild asthma can be treated with as-needed reliever medication only or in conjunction with low-intensity controller medication, such as low-dose inhaled corticosteroids³.

Moderate asthma can be treated with one or two low-dose inhaled, long-acting controller medications, plus reliever medication³.

Severe asthma requires two or more high-dose controller medications, plus reliever medication³. Add-on treatments may also be prescribed³.

Uncontrolled asthma may result from incorrect technique in using the inhaler, not using medication as prescribed, comorbidities and complications, or being exposed to irritants persistently³.

Other treatments

• Allergen-specific immunotherapy may be considered if allergy plays a prominent role and may be administered via injection or taken under the tongue³.
• Bronchial thermoplasty has been shown to be effective in very select cases of severe asthma that remains uncontrolled despite optimal treatment³.
• Stopping smoking³
• Physical activity³
•  Weight loss of 10 – 15 kg in obese asthmatics.⁶

Prevention

Avoiding triggers is the best way to avoid an asthma attack⁶. This includes:

• Staying indoors during the pollen season or in areas with severe air pollution, based on individual sensitivities⁶.
• Avoiding second-hand smoke⁶
• Avoiding workplace triggers³
• Getting a seasonal influenza vaccination.³

Asthma Education

Living with asthma can be a daily challenge, but you don’t have to face it alone. The Bronki Boosters are here to support you every step of the way. The mission is simple: to empower you with the knowledge and tools you need to effectively manage your asthma and master the correct use of your inhaler.

Visit bronkiboosters.com