Let’s make it easy for them to breathe

World Asthma Day (May 7)

Asthma is the result of an allergy. The airways that carry air from the nostrils to the lungs are affected by the allergic condition. This results in inflammation and swelling in the inner regions of the airway tube. Consequently the cavity of the airway tubes narrows. Secretions of the airway tract further reduce the volume of the airway tract. The smooth flow of air is obstructed thereby causing a difficulty in breathing. This of course leads to dire consequences if the condition is negligently ignored. The Health Capsule spoke to Dr. Pradeep Kumarasinghe, Consultant Physician of the Colombo National Hospital to shed more light on this topic in honour of world asthma day. 

“Asthma is a very common condition. This can be attributed to various reasons that could trigger allergic conditions and inflammatory responses. The increasingly worsening kevels of environmental pollution, various infections, exposure to the cold can worsen the allergic conditions that lead to asthma,” said Dr. Kumarasinghe.

He continued by saying that asthma has many degrees. “There are milder versions of the condition as well as more severe ones that could even be fatal. Milder degrees of asthma are more common. This form of asthma is not dangerous. However more severe forms of asthma can be fatal if not treated. Therefore it is important to identify and treat the condition accordingly,” he mentioned.

Signs and symptoms
The first symptom is the wheeze. “People might generally tend to refer to asthma as the wheeze. However wheezing is a symptom of asthma itself and not a condition,” he indicated. Wheezing occurs when air flows through the narrowed airway tubes, which produces a wheezing sound. Wheezing often indicates mild or non-severe forms of asthma. However in very severe cases of the disease a wheezing sound is not produced. As the tube becomes exceedingly narrow, no air is able to flow through the airways at all.  The consultant physician warned that this indicates silent asthma which is a critically severe condition. 

Due to the allergic conditions, the inner layers of the airways tubes become swollen and secretions of the respiratory tract get accumulated. Accumulation of fluid leads to phlegm accompanied with a longstanding cough. Night coughing is a main symptom of asthma. 

Difficulty in breathing is of course another symptom for asthma. 

“When the asthmatic attack gets severe, the patient may experience symptoms such as pain in the neck muscle, discomfort in the breathing tube, the stethoscope will not be able to detect the wheezing sound, the eyes and tongue might become blue due to the lack of oxygen transported due to difficulty in breathing. This is a symptom of a very severe form of asthma,” he stated.

If the patient suffers from a mild case of asthma, then the patient would not be short of breath and will be able to complete talking in a sentence. This condition is not very severe. However if the patient can’t speak without panting and is short of breath this indicates that  patient might be suffering from severe asthma and has to be immediately taken to the hospital as it could get fatal if left untreated. 

Wheezing often indicates mild or non-severe forms of asthma. However in very severe cases of the disease a wheezing sound is not produced

There are many myths that revolve around the use of an inhaler. He explicated that people falsely believe that an inhaler can get addictive

Inhalers and Treatment
Since the problem of asthma lies in the respiratory airways, the treatment should address the airways. Asthma is treated through drugs. “The inhaler is an important device when it comes to the treatment of asthma. The inhaler provides an effective method of delivering the drug directly to the required target location (which in this case is the respiratory airways). The drug would aid in expanding the narrowed airways dispelling the difficulty to breathe,” Dr. Kumarasinghe explained.

There are many myths that revolve around the use of an inhaler. He explicated that people falsely believe that an inhaler can get addictive. “This is not true. In fact inhalers cut down the dosage of the drug by one tenth than when it is used as a tablet. Of course the inhaler would have to be used routinely if the person is a persistent asthma patient.  High doses of drugs for asthma treatment could cause a raise in heartbeat, shivering amidst other effects. Using an inhaler minimizes these effects,” he implied. 

An inhaler is particularly important and has to be used routinely in more severe forms of asthma where the patient experiences difficulty in breathing. Hence in the cases where the asthmatic attacks are not mild, the use of an inhaler is prescribed. “Inhalers could be either relievers or preventers. Relievers are used to relieve the symptoms of asthma when the patient is inflicted with it. However in the cases where the patient repeatedly succumbs to asthmatic attacks, a preventer is used in addition to the reliever. This is to prevent the occurrence of another asthmatic attack. Therefore patients with persistent asthma are prescribed to use the preventer twice a day irrespective of the fact whether they are currently suffering from asthma or not. If the patient gets infrequent asthma attacks, the medication may only be limited to the use of the reliever as there is no need for a preventer,” Dr. Kumarasinghe elaborated. Asthma may also be caused due to infections in the upper respiratory tract. In that case the treatment would address the infection is treated as well.

In the case of an allergic attack, steroid tablets are given for 4 days in the case of acute asthma. “If the steroid medication is prolonged, the dosage has to be gradually reduced and then ended as it can produce side effects. However if the steroid medication is only prescribed for 4 days, the patient is in no danger of experiencing side effects,” he said. 

When patients suffer from asthma more severely they are subjected to nebulization which performs the same function as that of an inhaler. The drugs are delivered into the airways in a more forceful and effective manner. In the case of life threatening asthma, patient would find it difficult to talk in one breath. Talking and breathing would be challenges to such a patient. The patient would have to be admitted to the hospital. 

Preventive precautions
In order to prevent asthma, it is important to prevent cold exposure, exposure to conditions that may trigger allergies and habits like smoking. 

“Asthma is more commonly seen in children. Their allergies may be triggered due to house dust, pets.  Eczema which is a manifestation of an allergy may also indicate asthma. Therefore it is important to maintain environments free of dust and provide proper ventilation to minimize the exposure to factors that trigger allergies,” mentioned Dr. Kumarasinghe.

The proper use of the inhaler adopts a specific technique. The pharmacist will demonstrate how to use an inhaler. “However in spite of using an inhaler if the patient shows no improvement in recovery, it may be that the patient adopts an improper technique of administering the inhaler. Therefore the patient should consult a physician on the technique. After using an inhaler it is important to wash the mouth,” he advised. According to the consultant physician, the use of an inhaler is the best method in treating and preventing asthmatic attacks.