Bronchial asthma is a chronic inflammatory disorder of the airways (conducting tubes in the lungs). This inflammation results in symptoms of cough, chest tightness, wheezing and breathlessness, mainly at night and early morning. Symptoms during the daytime are also present in severe cases. Bronchial asthma is a common respiratory disorder and affects about 10 per cent of children and five per cent of adults in the general population. Among childhood asthmatics, around half outgrow it by early adulthood, however, increased sensitivity of the airways may persist, and they may get asthma symptoms later in life.
Childhood asthma is more prevalent in boys, but this trend is reversed in puberty and adulthood and the overall prevalence is greater in females. Inheritance, though complex, plays a role in the aetiology of asthma.
Environmental factors, both indoor and outdoor, play a major role in triggering and sustaining asthma symptoms with continuous exposure. Symptoms improve with the cessation of exposure.
Outdoor and indoor air pollutants not only exacerbate asthma symptoms but also play a role in enhancing the effect of inhaled allergens.
Main indoor triggers (allergens) are house dust, house dust mites, animal dander (cat, dog, rodents), cockroaches and mould (fungal) spores. House dust comprises insects, insects faeces, pollen grains, fibres, mites and mite faeces. Outdoor allergens are primarily pollens and mould spores.
Outdoor pollutants include industrial smog (sulphur dioxide particulate complex) and photochemical smog (ozone, nitrogen dioxide). Indoor pollutants include passive cigarette smoke exposure, cooking gas exhausts and exposure to odour of cleaning solutions and sprays.
Viral respiratory infections and atypical bacterial infections play an important role in triggering asthma symptoms. Nasal allergy is common in patients with Asthma.
Asthma presents with cough, wheezing, and breathlessness. All symptoms may not be present simultaneously. Some asthmatics perceive asthma symptoms poorly. This poor perception of symptoms sometimes leads to near-fatal attacks of asthma. Such patients benefit from home peak flow monitoring, asthma education and open-door policy/easy access to a caregiver.
Treatment of asthma depends on the careful assessment of patients' symptoms along with clinical examination, spirometry (lung functions), peak flow and exhaled NO (nitric oxide) monitoring. Bronchodilators and anti-inflammatory medicines are mainly in the form of inhalers or nebulisers that are tailored to a patient's asthma severity. Avoidance of exposure to pollutants and allergens is an important component of treatment.
Patient education about asthma, asthma medications, home monitoring of asthma control is a powerful tool in controlling asthma. Recent advances in patient education make use of mobile health and interactive learning, which in turn also encourages a strong patient-doctor partnership in the management of bronchial asthma.
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â€” Dr Suresh Puri is Consultant Pulmonary Disease and Consultant Internal Medicine, JTS Medical Centre, Dubai