WHAT IS ASTHMA?

Asthma (from the Greek ἅσθμα, ásthma , "panting") is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm.

Asthma is characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing.

Sputum may be produced from the lung by coughing but is often hard to bring up.

WHAT ARE ITS SYMPTOMS?

Symptoms are usually worse at night and in the early morning or in response to exercise or cold air. Some people with asthma rarely experience symptoms, usually in response to triggers, whereas others may have marked and persistent symptoms.

Common symptoms include:

▶Wheezing
▶Coughing
▶chest tightness
▶shortness of breath

WHAT CAUSES IT?

Asthma is caused by a combination of complex and incompletely understood environmental and genetic interactions. These factors influence both its severity and its responsiveness to treatment.

It is believed that the recent increased rates of asthma are due to changing epigenetics ( heritable factors other than those related to the DNA sequence) and a changing living environment.

IS IT CURABLE?

Asthma is an incurable illness. However, with good treatment and management there is no reason why a person with asthma cannot live a normal and active life.

WHAT HAPPENS DURING AN AT?

▶The muscles around your airways tighten up, narrowing the airway.
▶Less air is able to flow through the airway.

▶Inflammation of the airways increases, further narrowing the airway.
▶More mucus is produced in the airways, undermining the flow of air even more.

ASSOCIATED CONDITIONS

A number of other health conditions occur more frequently in those with asthma, including gastro-esophageal reflux disease (GERD), rhinosinusitis, and obstructive sleep apnea.

Psychological disorders are also more common, with anxiety disorders occurring in between 16-52% and mood disorders in 14-41%.

However, it is not known if asthma causes psychological problems or if psychological problems lead to asthma. Those with asthma, especially if it is poorly controlled, are at high risk for
radiocontrast reactions.

ENVIRONMENTAL

Many environmental factors have been associated with asthma's development and exacerbation including allergens, air pollution, and other environmental chemicals.

Smoking during pregnancy and after delivery is associated with a greater risk of asthma-like symptoms.

Low air quality from factors such as traffic pollution or high ozone levels,
has been associated with both asthma development and increased asthma severity.

Exposure to indoor volatile organic compounds may be a trigger for asthma; formaldehyde exposure, for example, has a positive association.

Also, phthalates in certain types of PVC are associated with asthma in children and adults.

GENETIC

Family history is a risk factor for asthma, with many different genes being implicated.

If one identical twin is affected, the probability of the other having the disease is approximately 25%.

Even among this list of genes supported by highly replicated studies, results have not been consistent among all populations tested.

Some genetic variants may only cause asthma when they are combined with specific environmental exposures.

PATHOPYSIOLOGY

Asthma is the result of chronic inflammation of the airways which subsequently results in increased contractability of the surrounding
smooth muscles. This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or without treatment.

Occasionally the airways themselves change. Typical changes in the airways include an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways' smooth muscle may increase in size along with an increase in the numbers of mucous glands.

HOW CAN IT BE DIGNOSED?

While asthma is a well recognized condition, there is not one universal agreed upon definition. It is defined by the Global Initiative for Asthma as "a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment".

There is currently no precise test with the diagnosis typically based on the pattern of symptoms and response to therapy over time.

A diagnosis of asthma should be suspected if there is a history of recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution.

Spirometry (best test for asthma) is then used to confirm the diagnosis.

In children under the age of six the diagnosis is more difficult as they are too young for spirometry.

HOW CAN IT BE PREVENTED?

The evidence for the effectiveness of measures to prevent the development of asthma is weak.

Some show promise including limiting smoke exposure both in utero and after delivery, breastfeeding, and increased exposure to daycare or large families but none are well supported enough to be recommended for this indication.

Smoking bans are effective in decreasing exacerbations of asthma.

Early pet exposure may be useful. Results from exposure to pets at other times are inconclusive and it is only recommended that pets be removed from the home if a person has allergic symptoms to said pet.

Dietary restrictions during pregnancy or when breast feeding have not been found to be effective and thus are not recommended.

Reducing or eliminating compounds known to sensitive people from the work place may be effective.

It is not clear if annual influenza vaccinations effects the risk of exacerbations. Immunization; however, is recommended by the World Health Organization.


HOW CAN IT BE MANAGED?

While there is no cure for asthma, symptoms can typically be improved.

A specific, customized plan for proactively monitoring and managing symptoms should be created. This plan should include the reduction of exposure to allergens, testing to assess the severity of symptoms, and the usage of medications. The treatment plan should be written down and advise adjustments to treatment according to changes in symptoms.

The most effective treatment for asthma is identifying triggers, such as cigarette smoke , pets, or aspirin , and eliminating exposure to them. If trigger avoidance is insufficient, the use of medication is recommended.

Pharmaceutical drugs are selected based on, among other things, the severity of illness and the frequency of symptoms. Specific medications for asthma are broadly classified into fast-acting and long-acting categories.

Bronchodilators are recommended for short-term relief of symptoms. In those with occasional attacks, no other medication is needed. If mild persistent disease is present (more than two attacks a week), low-dose inhaled corticosteroids or alternatively, an oral leukotriene antagonist or a mast cell stabilizer is recommended.

For those who have daily attacks, a higher dose of inhaled corticosteroids is used. In a moderate or severe exacerbation, oral corticosteroids are added to these treatments.


CONCIQUENCES OF NOT CONTROLING YOUR ASTHMA

If you don't control your asthma you will miss school or work more often and you will be less likely to be able to take part in some activities you enjoy. In the USA and Western Europe, asthma is one of the leading causes of school absenteeism.