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Bronchial Asthma

Asthma is a chronic respiratory disease which is characterised by airway inflammation, increased sensitivity of the airways to certain triggers, and narrowing of the airways, It can flare up from time to time, causing increased wheezing, cough and chest tightness. However, though it is bothersome and inconvenient, it can be managed very well by following some precautions and medications.

The prevalence of asthma in India is roughly 2.5-3.5 %. With a population of about 1.2 billion; this means there are roughly 30-40 million people who suffer from asthma in India. The majority of patients can be in control of the disease and lead perfectly normal lives with a few simple measures.

Many famous cricketers, sportsmen, actors, leaders etc. have asthma and lead very successful and healthy lives

What are the symptoms of asthma?

These symptoms may be present at rest precipitated by activity. Not all patients will have all the symptoms. In severe attacks, the patient may have difficulty speaking in full sentences, breathe shallow and fast and have hunched shoulders and you may be able to see nostrils flaring and neck muscles tightening and moving with each breath. This patient needs immediate emergency medical attention.

What causes asthma?

Family History-While no single culprit gene has yet been identified, asthma has been seen to run in families.

Early exposure in childhood to certain infections or toxins can make the lungs and airways more susceptible to asthma later in life.

Immune system – The immune systems response to certain triggering factors like dust, smoke, pollen, hair (fur/ dander) from animals, preservatives, emotional stress. stomach acid from acid reflux disease, and certain medications can cause the changes in the airways which lead to the development of asthma.

Asthma does not affect everyone in the same way.

Asthma has been classified into different types based on certain characteristics. It may be occupational asthma, night-time asthma or seasonal asthma etc. There are other technical classifications which help health care providers customize the treatment better and thus help their patients manage their asthma better.

How Is asthma diagnosed?

Your health care provider will go over your personal history and conduct a physical examination. Certain breathing tests or lung function tests like spirometry and peak flow measurements help in establishing the diagnosis of asthma and are also done to get a measurement of the patient’s baseline lung function. Additionally, some blood tests and chest X-rays may be requested to evaluate any other conditions.

How is asthma treated?

In asthma management, both prevention and treatment of symptoms are of paramount importance.

A number of oral and inhaled medications are available to help control the symptoms of asthma and allow patients to lead healthy fulfilling lives. These can be classified into:

(However, these have a limited role when symptoms appear and are more important as a baseline to prevent frequent recurrences of symptoms)

What are common triggers For asthma?

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Frequently Asked Questions

Certain types of asthma are sometimes referred to as reactive airway disease or allergic bronchitis. Allergic bronchitis refers to an airway inflammation caused by certain allergens. The type of asthma where certain allergens are identified as triggers is called allergic bronchitis.
Will I become addicted to inhalers if I use them regularly?

Addiction is a term used for substances that are not good for you. One can become addicted to cigarettes, alcohol, drugs. We do not say that people with other chronic conditions like diabetes or high blood pressure are addicted to their medicines. We understand that these medicines help them to have normal blood sugar or normal blood pressure. Similarly, asthma medications or inhalers help people with asthma to have good lung function and lead normal lives,

It is not an addiction but a necessary support for a health fulfilling life. As your symptoms improve, medications can be reduced or stopped. Medications are essential to solve the problem and are categorically not addictive.

NO, asthma is not contagious. You cannot get it by being in the same room as someone with asthma.

No. Inhaled medications are the most effective way of treating asthma with minimal side effects. Just as for an eye problem, we use eye drops and ointments or lotions for skin problems so that the medication directly acts on the affected part of the body; inhalers allow the medication to directly reach the airway where the main problem lies. In fact, this allows for fast and better relief.

Is it true that inhalers for asthma are strong medicine and have steroids and are only meant for severe asthma?

Inhalers are now the mainstay of asthma treatment. The medication formulations in inhalers are based on many clinical trials which have proven the safety of these medicines. In fact, the doses of medicines contained in inhalers are much smaller than the dose contained in pills or syrups or injection. As the inhaled medication directly acts on the airways, you can achieve greater relief of symptoms with smaller doses of medicines.

The main problem in the airways in patients with asthma is inflammation- redness and swelling. This inflammation is best treated with anti-inflammatory steroid medications. The steroids in the inhalers are of much lower doses than the type given in tablets or syrups or injection. (40-50 times lower than the dose in tablets) Also, as they are given in inhaled form, there is minimal absorption in the bloodstream to cause side effects in the rest of the body. Patients should always rinse their mouths with normal water Immediately after using inhalers containing steroids. This ensures that there is no chance of any fungal infection in the mouth which is the only easily preventable concern with regular steroid inhaler use.

Most people are wary of steroids due to concerns with side effects such as bone weakness, weight gain, sugar control etc. These problems are seen mainly in cases where higher doses of oral steroids have to be given for prolonged periods.

In some severe asthma attacks, your doctor may prescribe higher doses of oral steroids for SHORT duration (usually less than 2 weeks). This kind of treatment regimen has been extensively studied in scientific research trials and is recommended by the guidelines of various professional health organisations like the WHO, ACCP: NICE etc for the management of sever asthma attacks.

My asthma comes and goes, it’s not always there. Why do I need to take regular medication?

Even though the symptoms of asthma may abate, the airways remain inflamed. Thus they are prone to repeat attacks. Taking regular medication keeps the inflammation, increased sensitivity and narrowing of the airways under control at all times.

There is evidence to suggest that the chronic uncontrolled inflammation of the airways can lead to permanent structural changes in the airways in the long term. This is called airway remodeling and can cause a long term permanent decline in lung function.

It is therefore important to continue your medication as long as your health care provider advises. They may decrease the doses depending on results of lung function tests as well as symptom control.

In case of an acute attack, your regular doses may not be enough to control your asthma. Please visit your doctor at the hospital. You may require a short course of steroids- oral or Injection- and you may require inhaled nebulisation treatment

Asthma can be controlled and managed very well with medications. Some patients may not need daily asthma medications whereas some patients will be well managed with daily medication. The main goal of asthma treatment is to enable all patients to lead a symptom free life with none-to-minimal loss of lung function. This requires a comprehensive approach to asthma management.

Do children outgrow asthma symptoms? Some people may outgrow childhood atopic conditions such as food allergies/eczema. Similarly, some people with childhood asthma may have resolution of symptoms with medications, sometimes to the point where they do not need everyday medication.

However, they may experience symptoms when faced with triggers later in life as well. It is very important to treat childhood asthma appropriately as inadequate control of childhood asthma can predispose to a greater decline in lung function later in life.

Can I lead a normal life with asthma? It is perfectly possible to lead a normal healthy life with asthma. The only caveat to this statement is that patients with asthma need to take care of their lifestyle, environment and take their medications as prescribed.

It is possible to exercise and play sports even if you have asthma. Regular use of controller/maintenance or on acting medications will allow you to enjoy all activities: some patients’ exercise may be a trigger for asthma. In these cases, it will be helpful to take a dose of fast reliever medication/inhaler 15-20 minutes before exercise.

What about yoga & pranayama for asthma. Yoga is a form of exercise which includes physical poses or asanas and breathing exercises called pranayama. It is beneficial for overall health. In addition, pranayama has been shown to have a beneficial effect on anxiety and stress. As a result of its overall health benefit, the practice of yoga and pranayama is beneficial to patients with asthma as well as the general population.

However, it is important to note that yoga and pranayama has clearly not shown to be a substitute for medications. It is an adjunct to management of chronic symptoms. It is important to note that certain asanas and certain breathing exercises are not to be performed when you have an infection, asthma attack or nasal congestion. It is important that patients with asthma learn and practice yoga only under well trained yoga instructors or yoga therapists who are well versed in what poses are beneficial and what is potentially harmful for patients with asthma.

(Ayurveda /Homeopathy /Unani /Fish therapy /Acupuncture) While alternative medicine may have benefits in some chronic diseases, we cannot make a recommendation for it as there has been no systematic scientific research study comparing modern allopathic medicine against alternative medicines. So far no research study has shown improvement in lung function with alternative medicine.

We advise our patients to continue their medication as prescribed by us. In addition, we do not know about possible drug interactions if the medications are combined. Alternative medicine is NOT effective in acute/severe asthma attacks. Most definitely in case of an asthma attack, it is advisable to immediately see your doctor and follow their instruction

Pregnancy is safe in patients with well-controlled asthma. Pregnant patients are advised to continue their asthma inhalers as prescribed to them by their doctors during their pregnancy. It is advisable for you to see your doctor if you are planning a pregnancy so that the medications can be adjusted as needed.

Steroid inhalers have been used safely in pregnant patients.

The most important thing to keep in mind is that a healthy mother can have a healthy baby. If a pregnant patient’s asthma is well controlled, she can have a healthy baby. Therefore, it is important to continue asthma maintenance medications to ensure the healthiest state for the pregnant mother.

I thought the best treatment for asthma attack is Deriphylline injection. Why is it not given these days? An injection of theophyllines used to be the treatment of choice before the availability of treatment modalities available today. The theophylline medications are sometimes used in severe cases of asthma where there is chronic irreversible narrowing of airways. They may be given as oral tablets. However, as per current research and international guidelines, they are not the first line of treatment and have Significant side effects by themselves.

There is no special dietary restriction for patients with asthma.

What are the Do’s & Don’ts to control Asthma?

Do’s

Don’ts