Asthma

Overview

Asthma is a chronic disease that inflames the airways in the lungs and affects the smooth floor of air in and out of the lungs. The airways become swollen and the muscles around them may tighten when something triggers the symptoms. When the airways swell, it becomes difficult for air to move in and out of the lungs and that causes common symptoms such as wheezing, coughing, chest tightness, and shortness of breath.

Several asthma sufferers experience the symptoms when they engage in physical activities. In fact, some healthy people might develop asthma symptoms when exercising. This is called exercise-induced asthma (EIA) or exercise-induced bronchoconstriction (EIB). However, that should not stop you from staying active and being healthy. Once you experience EIB or EIA, talk to the doctor who will develop a good management plan to keep the symptoms under control.

Facts and Figures

World Health Organization reports that about 235 million individuals suffer from asthma globally. The report released in 2016 shows that there were over 383, 000 deaths reported in 2015 caused by asthma.

Asthma affects people in both high and low income countries even though most of them occur in low and middle income nations. Kenya is not an exception because asthma cases in the country are on the rise and unfortunately, children are the most casualties.

According to Kenya Association for the Prevention of Tuberculosis and Lung Diseases (KAPTLD), asthma rates in children aged 13 and 14 has increased in the country with the highest rates witnessed in Nairobi and Eldoret. Wesley Tomno, the co-ordinator at the Ministry of Health Lung Health Diseases reported that more than 1.3 million children in Kenya are forced to stay out of school because of asthma and poor diagnosis of the condition.

Symptoms

The symptoms of asthma vary from one person to another. Those with infrequent asthma attacks have symptoms only at specific times such as when exercising. Asthma signs and symptoms include:

  • Chest pain or tightness
  • Shortness of breath
  • Coughs and wheezing attacks
  • Trouble sleeping caused by wheezing, coughs or shortness of breath
  • A wheezing or whistling sound when exhaling especially in children
  • Coughing attacks worsened by a respiratory virus such as flu virus

Signs that the asthma is getting worse include:

  • Frequent signs and symptoms that are bothersome
  • The need to use a quick-relief inhaler more frequently
  • Increasing difficulty breathing – measurable with a peak flow meter

Causes

Asthma is generally caused by a combination of genetic (inherent) and environmental factors.

Environmental Factors and Other Triggers

Exposure to diverse substances and irritants that prompt allergies can trigger signs and symptoms of asthma but this differs from one person to another. The common triggers include:

  • Physical activity (EIA)
  • Airborne substances such as dust mites, pollen, mold spores, particles of cockroach waste or pet dander
  • Cold air
  • Respiratory infections such as the common cold
  • Air pollutants and irritants such as smoke
  • Certain medications that include aspirin, beta blockers, naproxen, and ibuprofen
  • Strong emotions and stress
  • Gastro-esophageal reflux disease (GERD)

Risk Factors

  • Being overweight
  • Being a smoker
  • Having a blood relative with asthma – a parent or sibling
  • Having allergic conditions such as allergic rhinitis or atopic dermatitis
  • Exposure to exhaust fumes and other forms of pollution
  • Exposure to secondhand smoke
  • Exposure to occupational triggers such as chemicals used in hairdressing, farming, and manufacturing

Diagnosis

Physical Exam: The doctor conducts a physical exam to rule out other possible conditions such as chronic obstructive pulmonary disease (COPD) or respiratory infection. The doctor will take you through a series of questions to substantiate your signs and symptoms.

Test to Measure Lung Function

The doctor may conduct lung pulmonary function tests that include:

  • Spirometry: Test that estimates the narrowing of bronchial tubes by checking on the amount of air one can exhale after a deep breath and how fast one can breathe out.
  • Peak Flow: Measurement of how hard one can breathe out using a peak flow meter.

These tests are done before and after taking medications such as albuterol that help to open airways.

Other tests include imaging tests, allergy testing, nitric oxide test, methacholine challenge, sputum eosinophilis, and provocative testing for exercise and cold-induced asthma. These tests help determine the cause of the asthma and the best approach to controlling it.

Treatment

Prevention and long-term control are critical to stopping asthmatic attacks before they start. Treatment process often involves learning to recognize the triggers, taking steps to evade them, and tracking one’s breathing to ensure daily asthma medications keep symptoms under control. In case an asthma flare-up emerges, one is advised to use a quick-relief inhaler such as albuterol.

Medications

Medications are issued depending on a person’s age, asthma triggers, symptoms, and what works best to keep one’s asthma under control. Preventive, control medications minimize the inflammation in the airways that lead to symptoms. Quick-relief inhalers (bronchodilators) swiftly open up the swollen airways that hinder smooth breathing process. In few cases, allergy medications may be necessary.

  • Long-term asthma control medications: They are normally taken daily and keep asthma under control by making it less likely to have asthmatic attacks. Types of long-term control medications include:
  • Leukotriene modifiers: They include montelukast (Singulair), zileuton (Zyflo), and zafirlukast (Accolate) – they help relieve asthma symptoms for 24 hours. Note that these medications are linked to some side effects (in rare cases) mostly psychological reactions such as aggression, agitation, depression, hallucinations, and suicidal thoughts. In case of such reactions, seek medical advice immediately.
  • Inhaled corticosteroids: These are majorly anti-inflammatory drugs that include beclomethasone, budesonide, flunisolide, fluticasone furoate, and mometasone. A patient is required to use these medications for several days to weeks for them to hit their maximum benefit. These medications are highly safe for long-term use.
  • Long-acting beta agonists: These are inhaled medications that open the airways during asthma attacks. They include formoterol (Foradil, Perforomist), and Salmeterol (Serevent). Make sure you take them in combination with an inhaled corticosteroid.
  • Combination inhalers: These medications contain a long-acting beta agonist alongside a corticosteroid. They include formoterol-mometasone (Dulera), budesonide-formoterol (Symbicort), and fluticasone-salmeterol (Advair Diskus).

Since they contain long-acting beta agonist, these medications can increase the risk of a severe asthma attack.

  • Theophylline: Theophylline refers to a daily pill that is significant in keeping the airways open through relaxing the muscles around the airways. It includes Theor-24, Elixophyllin among others.

All these medications are available in Kenya. Consult your doctor for further directions on which, how, and when to use them.

Prevention

Even though there is no direct way to prevent asthma, working together with the doctor through designing a systematic plan for living with the condition can help prevent asthma attacks.

  • Follow your asthma action plan: Work with your doctor and health care team to develop a detailed plan for taking medications and managing asthma attacks.
  • Get Vaccination for Pneumonia and Influenza
  • Monitor your breathing to recognize warning signs of an impending attack
  • Identify and avoid asthma triggers such as outdoor irritants and allergens that range from mold and pollen to air pollution and cold.
  • Identify and treat attacks early
  • Take medication as prescribed without fail 

Sources

https://www.standardmedia.co.ke/article/2000161199/most-asthma-cases-in-kenya-are-misdiagnosed

https://www.who.int/news-room/fact-sheets/detail/asthma

https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

https://www.medicalnewstoday.com/articles/323523.php