World asthma day is celebrated on the first Tuesdays of May every year (4th May 2021) and is organized by GINA – Global Initiative for Asthma.

It is a global initiative to practice asthma awareness, promote its recognition, educate people on asthma and care worldwide. Various activities such as educational talks and debates in schools and colleges, media advertisements, free screenings etc. are organized on this day for awareness and promotion.

What is asthma? 

Asthma is the chronic inflammatory condition of the lungs that causes difficulty in breathing. During asthma, the inner lining of the airways or the bronchial tubes gets swollen due to inflammation. The surrounding muscles of the airway path become stiffer, causing wheezing, breathing issues and other physical challenges.

In India, women show a higher rate of prevalence than men. Within the age range of 15-49 years, asthma occurrence is 2% among women and 1% in men. Young women in the age range of 15-19 years also present a 1% asthma occurrence rate.

The prevalence of disease in the country depends on the geographical factor, environmental, behavior, and lifestyle of people.

Symptoms:

1. Shortness of breath

• 2. Wheezing sound during breathing

• 3. Chest tightness

• 4. Difficulty in talking

• 5. Anxiety and panic attack

• 6. Fatigue and weakness

• 7. Cough during the night, exertion during exercise

• 8. Abdominal pain

• 9. Increased respiratory pulse rate

How does asthma occur? What is an asthma attack?

During breathing, the inhaled air passes through the nose and mouth and crosses the throat to eventually enter the lungs. Multiple small air passages are present in the lungs that help deliver good oxygen supply from the inhaled air into the lungs. Dysfunctionality in this pathway of air travel due to inflammation of the inner lining of the airways causes swelling in the airways and tightening of the surrounding muscles. This leads to the passage obstruction and difficulty in breathing, thus producing a wheezing sound while exhaling. It is also associated with coughing and chest tightness which is termed as an asthma attack. This condition can be life-threatening.

What are the triggers?

Multiple factors trigger asthma. Exposure to these factors can trigger an attack. Most commonly the asthma attacks are seen during the spring and fall season for patients who are allergic to pollen.

Some examples are:

· Smoke of tobacco or wood

· Dust and mites

· Air pollution

· Danger of cats or dogs

· Some pests such as mice etc

· Seasonal allergies such as Pollens, grass

· Chemicals in perfumes or any other fumes

· Weather changes

· Smell of some cosmetics

· Cold air breeze

Types of asthma

There are various types of asthma.

Bronchial Asthma: Most common type of asthma. It occurs in 5% - 10% of persons of all age groups. It occurs due to bronchial hyperreactivity and airway obstruction and is diagnosed by clinical history, pulmonary function tests, and physical examination.

Childhood asthma: Also called pediatric asthma. Among infants and children, this is the most common severe chronic disease. It may develop as early as 5 years of age. 

Exposure to respiratory infections, cold or pollen can trigger this asthma. Symptoms associated are wheezing or whistling sound during breathing, coughing, shortness of breath, and chest congestion.

 

Adult-onset asthma: This type of asthma occurs after 20 yrs of age and presents with difficulty or discomfort in breathing and sleeping. 

Allergic Asthma: This type is also called extrinsic asthma and is triggered by exposure to allergens such as food, pollen, dust, or pet dander. Also termed seasonal asthma.

Nonallergic asthma: Also called intrinsic asthma. This is caused by irritants that are not related to the allergies, such as cigarette smoke, wood smoke, cold breeze, air pollution, perfumes, household cleaning, viral illness, air fresheners, etc.

Occupational asthma: As the name suggests, asthma is triggered by the person’s occupation in his/her workplace, which leads to exposure to the irritating toxic substance that one is sensitive to, such as gas, dyes, industrial chemicals, rubber latex, animal proteins, farming, manufacturing etc.

Nocturnal asthma: Nocturnal asthma triggers or worsens during the night and maybe due to pets, heartburn, or dust mites.

Exercise-induced asthma: Sometimes, exercise can induce asthma by causing bronchoconstriction. This triggers during exercise and subsides in a few minutes after the exercise.

Cough-variant asthma: This type of asthma does not present the classic symptom of wheezing and shortness of breath. Instead, it is characterized by persistent dry cough.

Sleep problems associated with asthma

Many people suffering from asthma have trouble sleeping due to congestion, allergies, secretion, wheezing and breathing issues. People feel discomfort while sleeping at night, causing inadequate sleep. The persistence of such a condition, if left untreated, may lead to severe sleep disorders like:

• • Nocturnal hypoxemia

• • Paroxysmal nocturnal dyspnea

• • Systemic hypertension

• • Chronic respiratory failure

• • Left ventricular dysfunction

• • Cognitive impairment, etc.

How can people with asthma manage their condition?

There are few essential home measures that one can adapt to calm during an asthma attack. Sitting upright and taking quick-acting inhalers such as albuterol, ProAir HFA, Ventolin HFA, etc., can be effective as the first line of treatment. Four breaths from one puff are recommended. Observe the breathing for 2 min and repeat the puff if still having difficulty in breathing. For children and patients having trouble taking inhalers, nebulizers are recommended. If the symptoms are not under control, it is advised to immediately rush to the doctor for an emergency.

Doctors use short-acting beta-agonists such as albuterol inhalers followed by an oral corticosteroid. These drugs reduce the airway inflammation in the lungs and provide asthma relief. For those who are nauseous with respiratory issues, intravenous corticosteroids are given. Often a bronchodilator Ipratropium is given during severe attacks. If the symptoms persist, intubation is preferred for mechanical ventilation.

Asthma and COVID-19

People suffering from asthma need to be more careful in protecting themselves from COVID-19 infection as they may manifest more severe symptoms. They are recommended to take asthma medications regularly to prevent the attacks or triggers. They are also advised to take all precautions, avoid stepping in crowds, and contact sick people. Asthma patients need to be watchful of nebulizer use as the risk of infection by the spread of droplets is high during nebulizer treatment.  

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