Bronchial Asthma

bronchial asthma

Bronchial asthma commonly known as “asthma” is an inflammatory disease involving airways that cause periodic attacks of coughing, wheezing and shortness of breath. It can be associated with tightness of chest. In bronchial asthma patient airways becomes inflamed and swollen, narrow and produce excess mucus making breathing very difficult. It triggers coughing and wheezing. It can be mild asthma which is only a nuisance and can be effectively managed with ease. In few cases, it can be a major disease with high severity and interfere daily activities. It can even lead to life threatening attack if not managed well in time. Some of the risk factors for asthma include family history (parents, brothers, sisters), any other allergic skin disease, overweight, smokers, working in chemical or other industries handling chemicals, pharmaceuticals etc.   

Bronchial asthma cannot be cured but symptoms can be well controlled and regular follow up with the doctor is helpful to adjust the treatment and thus help prevent any acute serious complication.

Factors that may trigger Asthma:

  1. Pollen, dust, pet dander (allergens)
  2. Respiratory viral infections
  3. Physical activity (Exercise)
  4. Smoke and air pollution
  5. Emotional stress
  6. Acid reflux from stomach
  7. Certain drugs like pain killers, antihypertensive drugs etc.             

Symptoms of Asthma:

The symptoms of asthma vary from person to person. Few patients may have infrequent asthma attacks that develop only after triggers like pollens, exercise, smoke, stress etc. While other patients may have asthma symptoms almost all the times. The usual symptoms of asthma are:

  1. Shortness & difficulty in breathing
  2. Coughing
  3. Wheezing or whistling sound while exhalation
  4. Chest tightness or pain.

Some of the indicators for worsening disease are:

  1. Increased frequency of asthma attack
  2. Increased difficulty in breathing as assessed by peak flow meter
  3. Increased usage of inhalers

The patient with worsening symptoms of asthma should immediately consult his doctor for assessment and treatment.

Prevention of Acute severe attack:

    There is no precise method of asthma prevention, however, certain plans and actions can reduce the frequency of attack and prevent life threatening complications.

  1. Take the treatment as per doctor’s advice and follow at regular intervals.
  2. Identify and avoid triggers like smoke, pollen, exercise etc.
  3. Vaccination for influenza and pneumonia can significantly alter the frequency and severity of asthma
  4. Monitoring the breath by peak flow meter on regular interval.
  5. Keep in touch with your doctor for adjusting treatment plan as needed.

Treatment:

Bronchial asthma can be treated by drugs administered by oral inhalation, oral ingestion or injection (IM or IV) depending on the stage of the disease and severity of symptoms. The mainstay of treatment of bronchial asthma is use of bronchodilators i.e. drugs which dilates the air passage to facilitate and restore the normal breathing. These bronchodilators are categorized into various groups based on their mechanism of action. Further, these drugs are classified as short acting (quick onset and short duration of action) or long acting (delayed onset and longer duration of action) depending on their individual profile. Short acting drugs are usually given for immediate relief in moderate to severe asthma whereas long acting drugs are used mainly in stable cases for maintenance. The maintenance treatment in asthma is given to reduce the risk of acute attack of the disease. Another class of drug used in bronchial asthma is glucocorticoids generally known as steroids. The steroids have anti-inflammatory actions and also reduce the sensitivity of mucus lining of airway for allergens. Therefore, these drugs are also an important component in asthma treatment Steroids can be given as single agent but mostly these are a given along with bronchodilators. Steroid can also be classified as short acting or long acting based on their onset and duration of action.      

Inhalation Treatment:

The inhalation therapy can be given by various types of inhalation devices that contain drugs in liquid or powder form. Liquid form of medicines is delivered in form of aerosol spray and powder form of medicines are delivered in form of dry powder inhalation. Both these devices may contain same medicine and is prescribed as per the decision of the doctor. The drugs for asthma are also delivered by nebulization through nebulizers. Nebulizers are used mainly in acute severe symptoms to deliver drug faster and deep into the respiratory system.

Oral Treatment:

Oral tablets of bronchodilators and steroids both are used in acute conditions with high severity of symptoms. Oral administration of anti-asthma drugs is not a preferred route in most of the cases due to higher risk of side effects. However, this can be used in acute cases for a short-term period. The common side effects with bronchodilators drugs are tremors, palpitations, cardiac symptoms, dryness of mouth, and visual disturbances. The reported side effects with steroids are weight gain, acne, blurred vision, increased blood pressure, weakness of muscles and bone. In patients with acute severe attack of bronchial asthma (status asthamaticus), intravenous drugs (bronchodilators & steroids) are administered for quick relief of symptoms. This condition is a medical emergency and requires immediate hospitalization.