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Asthma
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Asthma is a serious global health issue.
People of all ages in countries worldwide suffer from this chronic respiratory
disorder, which,when uncontrolled, can lead to limitations in daily life and
sometimes even to a fatal outcome.Asthma is a chronic inflammatory disorder of the airways. Chronically inflamed airways are hyperactive: there is obstruction inside them, and the airflow is limited (by bronchopulmonary obstruction, mucosa plugs and increased inflammation) after exposure to different risk factors.
General risk factors are exposure to allergens (such as dust mites, animal hair, cockroaches, pollen and mold), irritants at the workplace, cigarette smoke, respiratory (virus) infections, physical effort, strong emotions, chemical irritants and medications (such as aspirin and beta blockers).
Asthma attacks (or deteriorations) occur from time to time, but the inflammation in the airways is constant.
Diagnosis of asthma is commonly based on the symptoms of the disease and the data from the anamnesis. The existence of any of these signs and symptoms is due to raise suspicion of asthma:- High tonality whistles (wheezing) during exhaling - especially with children (normal results of the lung testing do not exclude asthma)
- Anamnesis on the following:
- Cough, worsens at night
- Recurrent wheezing in the chest
- Recurrent heavy breathing
- Recurrent narrowness in the chest.
- Symptoms occur or worsen at night and wake the patient up.
- Symptoms occur or worsen seasonally.
- Patients often have eczema, hay fever or family anamnesis of asthma and atopic diseases.
- Symptoms occur or worsen in the following
situations and contacts:
- Furry animals
- Chemicals in aerosol
- Temperature changes
- Dust mites
- Medications (aspirin and beta blockers)
- Physical effort
- Pollen
- Respiratory (virus) infections
- Smoke
- Expressing strong emotions
- Symptoms react to antihistamine therapy.
- Colds “come down on” patient’s lungs or it takes more than 10 days for it to pass.
Investigating pulmonary function makes it possible to assess the severity, reversibility and variability of the airflow limitations and helps to confirm and diagnose asthma.
Spirometry is measuring method to determine the degree of airflow limitation and its reversibility when diagnosing asthma.
Measuring of the peak expiratory flow can be significant in diagnosing and monitoring asthma.
Additional diagnostic tests:
- With patients who have symptoms of asthma, but also a normal pulmonary function, examining bronchial reactivity can help diagnosing asthma.
- Skin tests with allergens and determination of specific IgE in serum.
Classification of asthma:
The goal of asthma treatment is achieving and maintaining control over the clinical manifestations in a longer period of time. When asthma is held under control, the patients can prevent majority of the attacks, avoid uncomfortable symptoms during the day and the night and stay physically active. According to the occurrence and the frequency of daily symptoms, limitation of activity, nocturnal symptoms, the need for medications for symptom relief and pulmonary function, asthma is divided into: controlled, partially controlled and uncontrolled asthma.
For gaining and maintaining control over asthma it is necessary to:
- establish a partnership-like relationship between the doctor and the patient
- discover the risk factors and reduce exposure to the risk factors
- evaluate, treat and monitor asthma
- treat exacerbations.
Treatment for gaining control over asthma:
Every patient is recommended a treatment depending on the evaluation of disease control, and it is reduced after the so called controlled asthma is achieved or is increased with every worsening.
Through every step of the treatment, medications to facilitate breathing (short-term beta 2 agonists, anticholinergics) should be applied when necessary to relieve the symptoms.
Besides that, the majority of patients need one or more medications to control asthma, which prevent symptoms and attacks. Inhalation corticosteroids are the most efficient medications available. Long-term beta 2 agonists, antileukotrienes, slowly weakening theophylline, sodium cromoglycate, nedokromil and immunomodulators are also applied.
With a lot of patients rhinitis and asthma are often conjoined and the treatment for rhinitis can improve symptoms of asthma. Both acute and chronic sinusitis can worsen asthma and have to be treated. With adults, the nasal polyps are conjoined with asthma and rhinitis and there often exists sensitivity to aspirin.
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