Asma

asthma summary

Asthma is a chronic disease of the bronchi. This condition is characterized by asthma attacks (tightness in the chest), in which there is a strong contraction of the muscles that control the opening and closing of the bronchi.
Asthma is a disease that kills dozens of people around the world every day. Therefore, it is up to the patient and the medical team to consider this disease as serious.

It is a non-communicable disease, a chronic disease that is more common in children.

The causes, or rather the events that trigger asthma (in particular the asthmatic crisis) can be an allergy, pollution or certain weather conditions such as the cold (read all the causes of asthma). Heredity plays a key role in the development of asthma, we know that children of asthmatics are more likely to suffer from this condition.

The main symptoms of asthma are shortness of breath (dyspnea), chest tightness, coughing or wheezing when exhaling.

The main complications of asthma are asphyxia and, therefore, possible death in the absence of adequate treatment.

Asthma treatment is mainly based on two types of medication: bronchodilators and anti-inflammatories (cortisone).

It should be noted that treatment varies depending on the type of asthma and especially the intensity of the disease. For severe cases, the therapy is, of course, heavier and the patient must take daily medication to prevent asthma attacks. Recently new treatments have been marketed to treat severe or allergic-type asthma.

In addition to taking medication to prevent or treat asthma properly and regularly, the main advice for therapy and prevention of asthma is still not smoking and avoiding events that trigger it. For example, if you’re allergic to cat dander, don’t visit a house with cats.

Doctors are increasingly recommending regular exercise to prevent asthma attacks. Attention in case of patients with severe asthma, always consult your doctor before starting to practice sports.

Definition

Asthma is a chronic inflammatory disease of the bronchi, characterized by hyperresponsiveness of the lower airways and limitations of the respiratory flow, which lead to dyspnea crises or wheezing asthma attacks (breathing difficulties), caused by a brutal contraction of the muscles that command the opening and closing of the bronchi, which are associated with edema and hypersecretion of the mucous membranes of the airways.

It is also frequently associated with a cough (mainly at night and in the morning upon awakening) and a viscous sputum.

We can highlight different types of asthma: allergic asthma (the most frequent), caused by allergy to pollen, dust, or food; non-allergic asthma (pollution), exertional or sports-related asthma; asthma linked to cold; or asthma linked to medication (aspirin).

It is important to consult a doctor in case of suspected respiratory disorders, as we emphasize that asthma is a disease that kills even in industrialized countries, so we cannot make light of it. Unfortunately, many people are still unaware that they suffer from asthma.

Epidemiology

– Around the world, approximately 330 million people (roughly equivalent to the population of the United States) suffer from asthma, according to a press release from the University of Manchester published in April 2020.

asthma mortality

– In Brazil, 6 people die every day from an asthma attack

– In the United States, it is estimated that asthma kills 5,000 people a year (a little over 13 a day).

– In France, asthma kills several people a day. The newspaper Le Figaro estimated in an April 2018 article that asthma kills around 2,000 people a year in France.

The majority of asthma-related deaths in industrialized countries, at least, are associated with poor maintenance of chronic asthma treatment (see Asthma Treatment for a better understanding of the treatment concept). People stop the daily preventative therapy and then one day the crisis strikes and the catastrophe strikes.

Note that there is a significant portion of asthma-related deaths in the elderly, especially those over 75.

Causes

It is not clear why some people develop asthma and others do not, it is possible that this is a combination of genetic influence (hereditary factor) with external triggers such as those mentioned below:

– Allergens (pollen, dust mites)

– Chemical irritants (toxic drugs, cigarette smoke) or pollutants, in particular substances and particles inhaled, according to the WHO, would be the main risk factor for the development of asthma.

– Effort (running, sport)

– Genetic (hereditary) factors

– Emotional factors (including fear of a crisis) and stress

– Colds and flu

– Medicines, e.g. NSAIDs: acetylsalicylic acid

– The cold air, we know that asthma attacks are more intense in winter.

– Some foods like peanuts

A study published on August 20, 2016 in the scientific journal BMC Pediatrics , children with food allergies are at a higher risk of developing asthma. About 35% of children diagnosed with food allergy currently suffer from asthma or will develop it, the risk increases even more when the number of foods that cause allergy is greater. The proportion of 35% is double that observed in the general population (without food allergy).

– Very humid conditions (high air humidity)

– Some perfumes and deodorants

– Stomach acidity, including gastroesophageal reflux disease (GERD), can worsen asthma symptoms.

– Preservatives such as sulphites

– Allergies to pets (cats, etc…)

– Dust

– Menstrual cycle

– Occurrence of many infectious respiratory diseases in childhood

Knowing the triggering factor allows the patient to better face the problem, acting in prevention and correctly taking their medications.

Asthma and bacteria

According to Swiss researchers at the Center Hospitalier Universitaire de Lausanne, the microbes in the lungs protect against asthma, according to an experiment carried out on rats. It is possible that the first few weeks after birth already decide whether or not asthma will appear, according to a study published in May 2014 in the journal Nature Medicine.

For a long time it was thought that the lung was a sterile and aseptic organ. Only recently has it been established that, like the gut or the skin, our respiratory organ is colonized by bacteria. Lead researcher Benjamin Marsland, from the Center Hospitalier Universitaire de Lausanne, has demonstrated through tests on mice that these microbes protect the lungs from allergic asthma.

Asthma and medication, risks of asthma with medications

Medications and asthma can be a dangerous combination, especially for people at risk.
In fact, drugs from the NSAID class (for example: ibuprofen, diclofenac, acetylsalicylic acid,…) can trigger an asthma attack.
NSAIDs inhibit an enzyme called COX-1, inhibiting some protective systems in our body, which can lead to a narrowing of the diameter of the bronchi, leading to an asthma attack. Therefore, if you are asthmatic, in case of a headache, it is preferable to take a medicine based on paracetamol instead of an NSAID. In cases of inflammation, the use of COX-2 selective anti-inflammatories is preferable.

If you are a user of beta-blockers, prescribed by a doctor, you will need to take selective beta-blockers (scientific term), as non-selective beta-blockers can narrow the bronchi and trigger a crisis, which is very common in the medical world .

It is also advised to take good care of colds and coughs in asthmatic patients (eg with washes), as it is important to free the airways to avoid serious consequences in case of asthma attacks.

risk people

Children are twice as likely to suffer from asthma than adults. On the other hand are allergic people, who are more likely than anyone else to develop the problem.

A study published on August 20, 2016 in the scientific journal BMC Pediatrics , children with food allergies are at a higher risk of developing asthma. About 35% of children diagnosed with food allergy currently suffer from asthma or will develop it, the risk increases even more when the number of foods that cause allergy is greater. The proportion of 35% is double that observed in the general population (without food allergy).

Symptoms

Typical asthma symptoms are:

– Difficulty breathing = dyspnea (which appears in the form of an attack: asthma attack)

– Sensation of oppression in the chest

– Cough (eg accompanied by phlegm). A cough is often made worse by a cold or flu episode.

– Wheezing in the chest during exhalation

– Insomnia

– daytime tiredness

– Decreased activity and performance at school or work.

You should know that asthma symptoms can occur several times a day or a week. The intensity varies from one individual to another.

Doctors highlight different types of asthma, this allows, depending on the degree of severity, to prescribe the most appropriate treatment.

types of asthma

We highlight for simplicity, 3 types (sometimes there is talk of 4 types)

– Mild asthma: this stage generally requires taking medication against asthma, about 3 times a week.

– Medium severity asthma: taking medications up to three or four times a day. Essentially sprays or pills are used.

– Severe asthma: the frequency of taking medication can be 3 to 4 times a day, with the use of sprays (« inhaler »), pills, among others. It is a heavier treatment.

asthma attack

What happens in an asthma attack?

In the case of an asthma attack, the bronchial smooth muscle contracts markedly in the form of a spasm, causing inflammation with subsequent edema and mucus hypersecretion in the tissues lining the airways.

This process reduces the diameter of the bronchi and causes breathing difficulties. The person in question must make much more effort to ensure air circulation in the lungs, whether it is to inhale or exhale air.

When does an asthma attack usually occur?

In adults, asthma tends to occur at night.

In addition to the symptoms mentioned above (discomfort, coughing, wheezing) what are the warning signs of an asthma attack?

Before the asthmatic crisis, the patient may also experience headaches, digestive disorders, sneezing or an itchy body.

Diagnosis

The diagnosis of asthma is made by a doctor who will ask the patient several questions about his breathing, (if he suffers from coughing at night, etc.). In addition to anamnesis (medical history of the patient), he can also use a debitometer (peak flow meter) that allows you to measure the expired volume and good indications about the breathing capacity. In general, asthmatics usually perform measurements with a debitometer at home for several days and record the results. The doctor will analyze and thus be able to prescribe the best treatment, depending on the result.

Other diagnostic methods can be the detection of allergens (by different tests) or X-rays of the lungs and bronchi.

Spirometry
The most appropriate method for diagnosing asthma is spirometry, as revealed by a study published in January 2017 in the Journal of the American Medical Association   by the University of Ottawa, Canada. Spirometry primarily measures the width of the bronchi.
This Canadian study showed that 33% of adults diagnosed with asthma by a physician did not actually suffer from the disease, since tests such as spirometry had been performed.

Doctors sometimes do a scanner (for example, CT scan) to identify possible serious illnesses, particularly bleeding from internal organs.

Complications

Complications of asthma are serious breathing problems that can lead, in certain cases, to suffocation and therefore death.

In Brazil, asthma kills about 2,000 people a year, so it is a disease that must be taken seriously.

In case of severe asthma, consult a doctor immediately.

A survey by the Mayo Clinic (United States) published at the end of 2015 showed that asthmatics had a 70% higher risk of suffering from herpes zoster, compared to people without asthma . This study was published in the journal  Journal of Allergy and Clinical Immunology (JACI) .

When to see a doctor?

It is essential to see a doctor if you are having difficulty breathing. In particular if the peak flow meter is below 50% of its usual rate (in case of urgency!). We emphasize that asthma is a chronic disease and needs regular medical follow-up.

Attention: non-exhaustive list, for every suspicious symptom, please consult a doctor.

Treatments

The medications available for the treatment of asthma depend on the severity of the disease and they are always prescribed by the doctor.
As always in medicine, one tries to discover the cause that triggers asthma in order to treat it depending on the cause.
There are two main classes of medications to treat asthma, however, new classes of medications have emerged on the market in recent years (see below):

– Bronchodilators (beta-2 agonists: salbutamol…)

– Anti-inflammatories (inhaled steroids or pills)

Depending on the severity of the asthma (see the different levels), one or two drugs from a class or two (often better) will be introduced into asthma therapy.

Therapy can be as follows:

– For moderate asthma, beta-2 agonists (sulbutamol) or low-dose cortisone spray should be used.

– For moderately severe asthma, glucocorticoid-type anti-inflammatories will be used (eg budesonide ), inhaled cortisone spray. Caution: cortisone spray does not cause the side effects of cortisone in pills because cortisone spray does not cross into the bloodstream, however, a possible side effect of inhaled cortisone could be the development of canker sores, so it is recommended to use cortisone spray before after meals or before drinking and rinse your mouth after soaking up the spray.

In general, beta-2 agonist brochodilators are associated.

It is also possible to use theophylline in tablets.

– For severe or severe asthma, anti-inflammatory drugs of the glucocorticoid=cortisone type are used systematically (tablets) supplemented with a beta-2 agonist bronchodilator and inhaled glucocorticoids and theophylline.

Daily use of inhaled corticosteroids would be useless
A study carried out in the USA published on September 12, 2012 in the Journal of the American Medical Association (JAMA) came to the conclusion that daily inhalations of corticosteroids to control asthma would be useless. The researchers did not find any significant difference in asthma and its attacks with taking two puffs a day of steroids or not.

Attention, always follow the treatment suggested by your doctor. Talk with your doctor to find the best therapy to treat and prevent asthma.

Other asthma treatments

To treat asthma, the doctor may also prescribe anti-leukotrienes such as cromolyn sodium. Ketotifen is another possible compound for the treatment of asthma. These drugs act on the allergic reaction. These two molecules appear to be relatively effective in children.
In case of severe asthma, tiotropium (tiotropium bromide), a long-acting anticholinergic drug, can be used.

New treatments for severe asthma

There are so-called “biological” medications that treat severe asthma. Omalizumab (distributed by the Novartis laboratory) is a drug belonging to this new generation of treatment, it is used according to our information in injectable form, every 2 weeks for specific cases of asthma. The downside is the high cost of these “biological” drugs. Talk to your doctor for more information about these new treatments.

Alternative treatments for asthma

In cases of allergic asthma, with a particular allergen, it may be possible to perform desensitization. The advantage of this treatment is that it treats the cause of the asthma. Talk to your doctor.

Asthma treatment notes

– In cases of medium-severity asthma and especially severe asthma, the treatment must be carried out in most cases every day, even in the absence of an attack. This is called chronic treatment (treatment to prevent asthma attacks). Attention, establishing chronic treatment and crisis treatment should only be done with the help of a doctor.

– Asthma therapy can vary between a child (in particular, under 5 years old) and an adult. It is known, for example, that before the age of 5 years, bronchodilators should only be administered by nebulization.

– As seen earlier in this file, asthma kills (in Brazil, many people per day). It is therefore important to know the dosage of the medication (when and how to administer it) and in case of doubt, speak to a doctor or pharmacist.

– Theophylline is less and less used to treat asthma, mainly because of a high risk of toxicity if the therapeutic dose is exceeded. Some experts recommend not using this medication.

Tips

– If you are using a cortisone-based treatment in a spray, to avoid the development of “thrush” (a side effect of cortisone-based sprays), rinse your mouth with some liquid and eat something after inhaling the cortisone, this will eliminate the remains of cortisone in the mouth and use the spacer.

– In case of an asthma attack on a desert island or in an unknown place (and only if you don’t have your usual treatments with you), you can drink strong coffee. In fact, the effect of caffeine is very close to that of theophylline (a molecule to treat asthma) and can therefore help dilate the bronchi.

– It is very important to use a peak-flow (debitometer) to measure and diagnose your asthma level. It is a device that measures the volume of expired air, so that you can adapt your therapy depending on the volume. A precious aid for asthmatics!

Fruits and vegetables
– According to Swiss researchers from the Center Hospitalier Universitaire de Lausanne, eating fiber-rich fruits and vegetables can have a preventive effect against allergic asthma by altering the microbial flora. In pregnant women, this protection can spread to their newborns.
– A French study published in July 2018 confirmed the results of Swiss scientists. In fact, people who have a healthy diet rich in fruits, vegetables and whole grains have fewer asthma symptoms and better control of the disease. The scientists observed that for men who eat healthily, the risk of having asthma symptoms that are difficult to control was 60% lower than the other men surveyed, in women this figure was 27%. Fruits and vegetables are rich in nutrients with antioxidant and anti-inflammatory properties, which seems to explain their positive action on asthma symptoms. This French study was published online on July 11, 2018 in the European Respiratory Journal (DOI: 10.1183/13993003.02572-2017).

– Avoid smoking .

Prevention

– Even if we are repeating ourselves, it is important to remember that the best prevention of asthma is to completely respect the therapy instituted by the doctor. In fact, if your doctor tells you to take your medication every day (chronic treatment) it is necessary to follow these recommendations. Most cases of asthma-related deaths are linked to non-compliance with medication administration.

– If you have small children, do not smoke near the child (or rather, do not smoke inside the house). It has been proven that cigarette smoke favors the development of asthma in children by 5 times!

– Avoid contact with allergens, they can trigger an asthma attack. Note, there is a special risk in contact with cats, especially if you are allergic, because dander (or rather cat saliva found in hair) is highly allergenic and can cause a severe asthma attack. Avoid buying clothing or furniture made from animal products (eg fur coats).

– It is advised to practice sports, preferably endurance sports. The sport par excellence is swimming, especially if it is practiced in a hot and humid atmosphere. Avoid, for example, running in winter, which can trigger asthma due to exertion and cold, as well as sporadic exertion sports. In patients with severe asthma, consult your physician before starting any strenuous exercise.

– Stomach acidity, including gastroesophageal reflux disease (GERD), can worsen asthma symptoms and damage the lungs. Treating GERD can improve asthma, talk to your doctor.

– Always keep sheets and other bedding clean. Whenever you can, extend the bedding stored for a long time on the clothesline to sunbathe.

– To reduce the risk of allergy, give preference to using natural cleaning products instead of chemical products to clean your house or apartment. To clean your house or apartment, you should use a vacuum cleaner, if possible, with a particle filter to properly remove all dust.

– Try to lose weight, you know that being overweight can make asthma worse

– Limit respiratory infections like bronchitis, pneumonia or cough. These infections can make asthma worse by blocking the airways.

– Air conditioning can be beneficial for asthma by reducing air humidity (a risk factor). In hot countries, air conditioning allows you to close the windows to prevent the entry of allergens (pollen, for example.). You can also use a fan, in this case, close the windows tightly.

– If possible, avoid using large rugs or curtains, as they can retain a large amount of dust and can facilitate the presence of mites.

– Asthma and vitamin D
A study published in October 2016 in the Cochrane Review showed that the intake of vitamin D as a food supplement in cases of people with asthma, in addition to conventional asthma treatment, significantly reduced the risk of severe attacks of asthma without causing side effects. The research, which went through a sieve of 9 clinical studies, was carried out by an asthma specialist, Prof. Adrian Martineau of Queen Mary University in London.

Breastfeeding
A study published in 2017, prolonged and exclusive breastfeeding of infants was associated with a reduced risk of developing atopic eczema after several years, such as in adolescence, but appears to have no protective effect on lung function and asthma. This research work was carried out in Belarus with 13 557 adolescents born 16 years earlier, when their mothers participated in an initiative that promoted breastfeeding in affiliated Belarusian maternity hospitals and clinics. This study was published on November 13, 2017 in the journal JAMA Pediatr . (DOI:10.1001/jamapediatrics.2017.4064).

– In addition to improving symptoms (read above in Tips ), a healthy diet rich in fruits and vegetables helps, according to a French study (DOI: 10.1183/13993003.02572-2017), to prevent asthma. Scientists found that men who had a healthy diet were 30% less likely to suffer from asthma symptoms, in women this figure was 20%. More information about this study in the Tips section on fruits and vegetables.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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