By Dr Brighton Chireka
By popular demand I have managed to finish this article on asthma. I hope you will find it useful. The article looks at what asthma is, the symptoms, causes and will briefly cover treatment in particular a typical treatment plan for someone with asthma.
In addition to it being a popular request from my readership there are serious reasons why I also felt compelled to write about asthma.
Generally most people who have an asthma attack get help and get well, people can and do die from asthma attacks. The shocking fact is that asthma attacks kill three people every day.
While that is a worrisome statistic worry not, we can do something about asthma. Studies have shown that two out of three asthma deaths could be prevented with better routine care.
People with asthma will cut their risk of dying by taking their asthma medicines as prescribed, even if they feel well. This article hopefully will empower all adults and children with asthma.
What is asthma?
Asthma is a condition that affects the smaller airways of the lungs. These airways in people with asthma will become narrow from time to time leading to the symptoms that we see in people with asthma. The extent and duration of the narrowing does vary from person to person and also from episode to episode within the same person.
Who gets asthma?
Asthma can start at any age but it most commonly start in childhood . It also runs in some families but many people with asthma have no other family members that are affected.
What are the symptoms of asthma?
These symptoms are mostly found in untreated asthma as well as in treated asthma without much symptoms. This means that asthma can be treated allowing one to live a happy normal healthy life.
The common symptoms of asthma are coughing and wheezing. Some people may experience shortness of breath and chest tightness. These symptoms may last for an hour or so, or may persist for days or weeks if not treated.
Asthma severity can be classified into three categories; mild , moderate and severe asthma.
Mild untreated asthma
People with mild asthma tend to have no symptoms most of the time. Children with mild asthma tend to have an irritating cough each night but are often fine during the day. The parents may make several trips to the doctor and get reassurance that all is fine.
It is always advisable for parents to give a clear story about the cough and likewise the doctors to listen carefully to the history being given. The child will be fine when examined during the day but the clue is from the story that the parent will be narrating. It is worth trying asthma treatment in children presenting with persistent cough at night but are fine during the day.
Adults with mild asthma tend to develop symptoms from time to time. They may develop a mild wheeze and a cough when they get a cold or chest infection, or during the hay fever season. They are free of symptoms most of the time.
Moderate untreated asthma
People with moderate asthma present with episodes of wheezing and coughing from time to time. At times they become breathless. These people tend to be wheezy most of the time on most days . The symptoms are worse at night, or first thing in the morning and at times people wake up during the night coughing or with a tight chest.
In children the symptoms are confusing and may be difficult to tell the difference between asthma and recurring chest infections. Any recurrent cough or chest infections in children must be investigated, as asthma may be the cause.
Severe attack of asthma
One becomes very wheezy, tight chest and struggle to breathe properly. Talking becomes difficult due to breathlessness. People with moderate asthma develop asthmatic attacks from time to time. Occasionally those with mild asthma can also get an asthmatic attack. This can be life threatening so hospital treatment must be started without any delay.
What causes Asthma?
Let me first explain what happens in asthma so that we can fully understand this condition. Symptoms are caused by inflammation in the airways , which may be triggered by different things in different people. The inflammation causes the muscles around the airways to contract (squeeze ) leading to the narrowing of the airways.
It is then more difficult for air to get in and out of the lungs. This leads to the wheezing and breathlessness. The inflammation also causes the lining of the airways to make extra mucus which causes coughing and further obstruction to the flow of air into the lungs.
What makes asthma symptoms worse?
Asthma symptoms may flare up from time to time. At times there is no obvious reason why symptoms may flare up. However some people find that symptoms are triggered or made worse, in certain situations.
Things that may trigger asthma symptoms include the following:
1 – Infections particularly colds, cough and chest infections.
2 – Pollen and moulds- asthma is often worse in the hay fever season.
3 – Exercise – doing exercises or playing sports is good if you have asthma . However there are certain people whose asthma is triggered by exercising and this is called exercise-induced asthma. Studies have shown that exercise-induced asthma often represent under-treated asthma.
This can be prevented by using an inhaler before exercising to stop the symptoms from occurring. This may also mean the treatment one will using needs reviewing if there are getting symptoms when exercising.
4 – Medicines – certain medicines such as aspirin can trigger symptoms of asthma. Anti- inflammatory painkillers such as ibuprofen, diclofenac etc and Beta-blockers such as propranolol, atenolol or timolol can trigger asthma or make it worse.
5 – Smoking and cigarette fumes- smoking make asthma worse, this also include passive smoking ( fumes from others who smoke). Adults who smoke even away from children can make their children’s asthma worse by having smoke on clothes or hair etc.
It is advisable to avoid smoking in the house. Some think opening the windows as they smoke in doors will help. The message is if you have a child with asthma , please stop smoking.
If you have asthma it is obvious that you must not smoke. Sadly I know a lot of people with asthma who smoke. My advice is for anyone who needs help to stop smoking to go and see their doctor about smoking cessation programmes.
6 – Fumes and chemicals- fumes from paints , solvents and pollution can trigger asthma. The increase in air pollution is likely to be the reason why asthma is becoming more common.
7 – Certain pillows and Mattresses- do not be surprised that you buy a new bed or pillows and all of a sudden you are now coughing at night or wheezing as well as getting chest tightness. Feathers in pillows may trigger symptoms. Some chemicals are emitted from mattresses that can trigger asthma.
8 – Emotion – let me make it clear that asthma is not due to nerves or anxiety. However stress, emotional upset , excitement or laughing may trigger symptoms. When I was a medical student I could not believe it when an elderly patient told us that his asthma attack had happened when he was making love to his young wife. It is always good to make sure that those close to you are aware of your medical problems and know what to do when you get a flare up of your medical condition.
9 – Animals- certain animals such cats , dogs , and horses can trigger symptoms.
10 – House dust mite – this is a tiny creature which lives in mattresses and other fabrics around the home. People allergic to it find that their symptoms of asthma worsens.
There is a test to find out if one is allergic to house dust mite. Once confirmed one needs to work a plan with their doctors on how to deal with this problem.
11 – Food – it is very rare for food to trigger asthma. If you suspect it, then see your doctor for further assessment.
12 – Work – some people develop asthma for the first time when they start certain jobs or find that their asthma flares up each time they are at work. This is occupational asthma caused by breathing in chemical fumes, gases , dust or other substances on the job.
How is asthma diagnosed?
Asthma is diagnosed commonly from the symptoms so it is very important to tell your doctor a good story about your symptoms. Remember all the symptoms. Do not forget to mention what makes the cough or symptoms worse and what makes the cough better.
You must include the severity of the symptoms and how often you are getting them and whether your sleep or daily activities are affected by the symptoms. Do not forget the times you are getting the cough. Have a diary where you write each time you get worsening of your symptoms as this will help to narrow down the triggers of your cough.
If there is any doubt from the symptoms your doctor may carry out a peak flow meter test and or spirometry to confirm the diagnosis of asthma. Remember that if these tests are done when you do not have any symptoms then the results may be normal.
The message here is that asthma is diagnosed from the story you tell your doctor so the ball is in your court as the patient. “Tell your doctor the whole truth “
How is asthma treated?
For most people with asthma , the symptoms can be prevented most of the time with treatment. This means that people with asthma are able to get on with normal life , school , work and sport etc.
It may be surprising to some to know that the following famous people have asthma:
Sports people – David Beckham, Frank Lampard , Dennis Rodman
Entertainment – Eminem, Pink , Sharon stone , DMX, Coolio
Politics – Bill Clinton , John F. Kennedy , Rev Jesse Jackson
I have just mentioned a few but not surprisingly there are very few or no known famous people from Africa. One of the main reason is we are secretive about our medical conditions and also we have a lot of problems with stigma when it comes to medical issues.
Treatment of asthma
If one can identify the triggers of their asthma then avoiding those triggers will lessen the symptoms of asthma. If it is workplace problem then it is advisable to visit your occupational health department for advice and assessment.
Most people are treated with inhalers . Inhalers deliver a small dose of medicine directly to the airways. This is good in that very little amount gets to the rest of the body so side effects are unlikely or minor. There are different types of inhalers to suit different people.
Make sure that the type of inhaler you use suits you and you know how to use it. You must let your doctor or nurse watch you using the inhaler so that you can be corrected if you are doing it the wrong way. A lot of people do not know how to use their inhaler and end up giving up on medication as they think it is not working. Get your inhaler technique sorted.
This article will be too long if I go into the details about the inhalers used to treat people with asthma. I will just summarise and advise people to visit their doctors or nurses for further personalised advice on treatment.
There are two main types of inhalers – one is a reliever used to ease the symptoms and the other one is a preventer use to prevent symptoms. Medication can be given as tablets as well. In severe asthmatic attack , steroid tablets are use to ease off the symptoms.
A typical treatment plan may look like:
A preventer inhaler to take daily to prevent symptoms
A reliever inhaler to use if symptoms flare up
If they exercise they may advised to take a reliever inhaler before the exercise
The dose of the reliever inhaler may need to be increased during a cold or hay fever season
Some people may need long-acting inhalers or tablets if the above treatment is not helping.
What is an asthma action plan and why do you need one?
This is a plan that you agree with your doctor or nurse. The plan enables you to make adjustments to the dose of your inhalers depending on your symptoms. The plan is tailored to individual symptoms so do not follow someone’s action plan.
The plan must be written down so that it is ease to follow. Those that have used an asthma plan have felt empowered and are living normal lives so I suggest that if you have asthma and you do not have an action plan , please go and get one.
Does asthma go away or get cured?
There is no cure for asthma but about half of children who develop asthma grow out of it by the time they are adults. For adults, asthma is variable with some good spells and some not so good but having regular treatment increases those good spells.
I hope you have managed to read through this article. Let me end by saying that it is vital to learn how to use your inhaler correctly. You must see your doctor if your symptoms are not fully controlled for example , if:
A night-time cough or wheezing is troublesome
Sport is being affected by symptoms
Your peak flow readings are lower than normal
You need a reliever inhaler more often than usual .
Please see your doctor urgently if your symptoms are not relieved by your reliever inhaler especially when you have difficulty talking due to shortness of breath. An asthmatic attack can be life threatening so call an ambulance if your symptoms gets worse.
It is also advisable to have the seasonal flu jab to prevent you from getting influenza during the winter season.
Please share with as many people as possible but do not forget to leave a comment about this article. Please remember this article is for educational purposes only to get you to go and see your doctor.
Dr Brighton Chireka is an International Health Consultant, GP Partner & Clinical lead of SKC CCG. He is a Fellow of the Faculty of Medical Leadership and Management. Dr Chireka is the Founding Chairperson of Zimbabwean Diaspora Health Alliance (ZDHA) and also a Founder Trustee of CC Foundation in Zimbabwe which offers scholarships to students from deprived backgrounds.