Asthma – Causes, Types and Diagnosis

What is Asthma?

Asthma is a complex syndrome of chronic airway inflammation associated with recurrent, reversible, airway obstruction. Airway inflammation also leads to airway hyper-reactivity, which causes airways to narrow in response to various stimuli. Asthma is responsible for 1.5 million emergency visits to the hospital yearly. Over 3,300 Americans die annually from asthma.

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Difference Between Asthma and COPD

Asthma is characterized by changeable airway narrowing, while COPD (chronic obstructive pulmonary disease) typically has fixed airway narrowing. Some symptoms of COPD are similar to asthma like shortness of breath, wheezing and cough. The cough in COPD produces more mucus than asthma, and patients with severe COPD may require oxygen supplementation.

COPD is majorly caused smoking of cigarette – either directly or secondhand smoke. Severe asthma can evolve to COPD over time. Medications used to treat COPD include inhaled corticosteroids, bronchodilators, inhaled corticosteroid/bronchodilator combinations, long-acting muscarinic antagonists, and oral steroids.

Causes of Asthma

Asthma is a result of the complex interactions between an individual’s inherited genetic makeup and their interactions with the environment. The factors that cause a genetically predisposed individual to become asmatic are poorly understood. The following are risk factors for asthma:

  • Personal history of hay fever
  • Family history of allergic conditions
  • Viral respiratory illness, such as respiratory syncytial virus (RSV), during childhood
  • Exposure to cigarette smoke
  • Obesity
  • Lower socioeconomic status

Different types of Asthma

Asthma in most cases starts in early childhood from 2-6 years of age. The cause of asthma in the early age is often linked with exposure to allergens, such as dust mites, tobacco smoke, and viral respiratory infections.

In very young children, less than 2 years of age, asthma can be difficult to diagnose with certainty. Wheezing at this age often follows a viral infection and might disappear later, without ever leading to asthma. The disease can develop again in adulthood.

There are two basic types of asthma; allergic (extrinsic) and non-allergic (intrinsic) asthma.

Extrinsic Asthma

Extrinsic or allergic asthma, is more common and develops in childhood. Approximately 70%-80% of children with asthma also have allergens.

Also, other allergic conditions, such as nasal allergies or eczema are often present too. Allergic asthma often goes into reduction in early adulthood. However, the disease tends to reappear in adulthood in many cases.

Intrinsic asthma

This represents a small amount of all cases that usually develops after the age of 30 and is not characteristically associated with allergies. Women are more frequently affected and many cases appear to follow a respiratory tract infection. Obesity also appears to be a risk factor for this type of asthma. Intrinsic asthma can be difficult to treat and symptoms are often chronic.

Signs and Symptoms of Asthma

The symptoms of asthma are high-pitched wheezing, shortness of breath cough and chest tightness. It is important to note that these symptoms are episodic, and individuals with asthma can go long periods of time without any symptoms.

Common triggers for asthmatic symptoms include exercise, viral infections and exposure to allergens like (dust mites, cockroach, molds, pets and pollens). Cigarette smoking and exposure to secondhand smoke is a common trigger too.

Asthma Diagnosis

The diagnosis of asthma begins with a detailed history and physical examination. Primary-care givers are familiar with the diagnosis of asthma, but experts such as allergists or pulmonologists may also be involved. A typical history is an individual with a family history of allergic conditions or a

personal history of allergic rhinitis who experiences coughing, wheezing, and difficulty breathing, especially with exercise or during the night. The following are diagnostic procedures that can be used to help with the diagnosis of asthma:

  • Lung function testing with spirometry: This test measures lung function as the patient breathes into a tube. If lung function improves expressively following the administration of a bronchodilator, such as albuterol, then it confirms the diagnosis of asthma. It is important to note, however, that normal lung function testing does not rule out the possibility of asthma.
  • Measurement of exhaled nitric oxide (FeNO): This can be performed by a quick and relatively simple breathing maneuver, similar to spirometry. High levels of exhaled nitric oxide indicates allergic inflammation seen in conditions such as asthma.
  • Skin testing for common aeroallergens: The presence of sensitivities to environmental allergies surges the possibility of asthma. Skin testing is usually more useful than blood work for environmental allergies. Testing for food allergies is not indicated in the diagnosis of asthma.
  • Other potential but less commonly used tests include provocation testing such as a methacholine challenge, which tests for airway hyperresponsiveness – a the tendency of the breathing tubes to constrict or narrow in response to irritants. A negative methacholine challenge makes asthma much less likely. Specialists sometimes also measure sputum eosinophils, another marker for “allergic” inflammation seen in asthma. Chest imaging may show hyperinflation, but is often normal in asthma. Tests to rule out other conditions, such as cardiac testing, may also be indicated in certain cases.
  • Blood testing can sometimes help differentiate between different types of asthma. Helpful blood tests include checking for the level of allergic antibody (IgE) or specialized white blood cells called eosinophils, which are often associated with allergic or extrinsic asthma.

Lifestyle and home remedies

Although many people with asthma rely on medications to prevent and relieve symptoms, you can do several things on your own to maintain your health and lessen the possibility of asthma attacks.

Avoid your triggers

You should take necessary steps to reduce your exposure to asthma triggers:

  • Use your air conditioner: Air conditioning reduces the amount of airborne pollen from trees, grasses and weeds that finds its way indoors. Using AC also lowers indoor humidity and can reduce your exposure to dust mites. If you don’t have air conditioning, try to keep your windows closed during pollen season.
  • Decontaminate your decor: Minimize dust that may aggravate symptoms at night by replacing certain items in your bedroom. Cover pillows, mattresses and box springs in dust-proof covers. Remove carpeting and install hardwood or linoleum flooring. Use washable curtains and blinds.
  • Maintain optimal humidity: Discuss with your doctor about using a dehumidifier if you live in a damp climate.
  • Prevent mold spores: Avoid mold spores from developing by cleaning damp areas in the bath, kitchen and around the house. Dispose moldy leaves or damp firewood in the yard.
  • Reduce pet dander: If you’re allergic to dander, avoid pets with furs and animals with feathers. Having pets regularly bathed or groomed also may reduce the amount of dander in your surroundings.
  • Clean regularly. Clean your home at least once a week. If you’re likely to stir up dust, wear a mask or have someone else do the cleaning.
  • Cover your nose and mouth if it’s cold out: Putting on a face mask may help if your asthma is worsened by cold or dry air.

Also, Maintain a healthy weight because being overweight can worsen the symptoms of asthma and expose you to other health challenges.

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