Asthma is a common chronic lung disease in which the airways become inflamed. This inflammation causes the airways to become hypersensitive to environmental triggers. In reaction to these triggers, an asthma attack occurs. The muscles around the bronchial tubes tighten the lining of the airways swells and overproduce mucus, making it difficult to breathe.
A person may develop Asthma at any period of lifetime .The prevalence of asthma increased steadily worldwide over the last several decades. On a global scale, about 235 million people have asthma, according to the WHO.

It's unknown what exactly causes asthma, but scientists believe that a combination of genetic and environmental factors plays a role in the development of the disease. Asthma tends to run in families, suggesting an inherited component to the disease. If anyone  has a predisposition toward certain allergic reactions ,more likely to develop  asthma. Asthma and allergies often go hand in hand.

Having respiratory infections during infancy or early childhood, before the immune system is fully matured is another risk factor for asthma. In addition, a pregnant woman's diet and exposure to allergens or smoke may affect her child's risk of developing asthma later in life.

Asthma may be allergic or nonallergic.Allergens are a common trigger of asthma in some people called allergic asthma. Common allergens associated with allergic asthma include: Cockroaches, Household dust mites, Pet dander (skin flakes) & hair, Pollen, fungi & respiratory infections, airborne irritants such as dust, smoke, industrial emissions, vehicle exhaust etc. Some foods and food additives, strong emotional states such as stress, anxiety, depression, or fear certain medications, like  beta blocker, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate asthma.

The most common typical symptoms of asthma include: wheezing (a whistling, almost musical-like sound during breathing), shortness of breath, cough, and chest tightness which are generally worse at night or early in the morning. Not everyone with asthma experiences symptoms the same way and asthma symptoms can differ between attacks. Some patients may have only severe dry cough and no other classical symptoms-known as cough variant asthma.

Asthma attacks vary in severity. During severe attacks, which require immediate medical attention, patient may experience extreme difficulty in breathing, very rapid breathing with the skin pulling in between the ribs and chest plate during inhalation, rapid nostril movement, cyanosis, anxiety or panic, uncontrollable coughing, severe wheezing, sweating etc.

As many as 90 percent of people with asthma will experience asthma symptoms while exercising, according to the Asthma and Allergy Foundation of America. Previously known as exercise-induced asthma, this condition is now called exercise-induced bronchoconstriction or EIB.

People without asthma, particularly those who are in poor shape, may also experience EIB. Exercising in cold, dry air is more likely to cause EIB than exercising in warm, humid air.

Usually doctor diagnoses asthma based on patients detailed medical and family history, physical examination and some lung function tests. Spirometry is the standard test to diagnose asthma which conveys information about the narrowing of bronchial tubes. Patient can use a peak flow meter at home, which may help to determine whether condition is getting better or worse over time. Doctor may recommend a number of other tests to rule out other causes of symptoms.

Asthma is not curable but controllable. Without proper treatment, asthma may get worse with age, with asthma attacks increasing in frequency and severity.

Asthma medications falls into two general categories: quick-relief and long-term control medication. Quick-relief medication relaxes the smooth muscles around the airways and reduces swelling of the lining of the airways provide immediate relief of symptoms. Long-term control medication helps to prevent asthma symptoms by reducing the inflammation that makes  airways more sensitive to asthma triggers.

Now  a days inhalers are synonymous with asthma. This is an essential step to ensure that the medicine is inhaled into lungs, the main goal of inhaled therapy.
To decrease the chance that the medicine stays in mouth, we can attach a holding chamber called a spacer to inhaler, which hold the released medicine, allowing to inhale slowly, deeply, and at patients own pace to get the full dose into lungs. A nebulizer may be better options in severe asthma when patient become unable to use an inhaler.

A Bronchial asthma patient should do the following:
Take  medication properly
Avoid asthma triggers unrelated to physical activity, such as allergens and  
Airborne irritants
Quit smoking  or not to start
Track your asthma control & respond to worsening symptoms
To maintain a healthy diet & weight, as being overweight can worsen asthma symptoms.
Avoid exercising in cold, dry air.

Dr. Rawshan Arra Khanam
United Hospital Ltd