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Asthma - Sign & Symptoms, Causes, Diagnosis, Precautions, Treatment and Home Remedies of Asthma

Asthma is a common chronic inflammatory condition of the airways the airways whose cause is not completely understood yet. Oxygen is essential for us to live. We receive it through breathing. If we don't get it, we cannot live for more than few minutes. When we breathe, oxygen reaches the lungs traveling through Trachea. Bad blood coming from the heart to the lungs gets purified in the lungs by oxygen and the purified blood goes back to the heart and from there to all parts of the body.

The remaining impurities come out in the form of carbon­ dioxide when we breathe out. Even if we breathe through the mouth, it is the same situation or to be precise, we get more oxygen when we breathe through the mouth. That is why asthma patients breathe through the mouth only to obtain more oxygen.

Asthma is a disease of the lung that affects the bronchial tubes or airways. The term "asthma" comes from the Greek meaning, "to breathehard." It is disease of the lungs or respiratory organs characterised by difficulty of breathing with wheezing and dreadful sense of tightness across the chest. It occurs when the small bronchial passages in the lungs get swollen with inflam­mation. They are obstructed by phlegm and narrowed when the muscles surrounding the air tubes become tight causing the wheezing sound.

Around 0.5-2 percent of the population suffers from asthma. Bronchial asthma is clinically characterized by widespread reversible functional narrowing of the airways that varies in severity. The tracheobronchial tree reveals increased responsiveness to several factors, both immunological and non­imrnnological. Immunological mechanisms are precipitated by several organic and other dusts, fumes, chemicals and so on. Non-immunological stimuli include thermal, chemical or psychological factors. when an asthmatic person has an asthma attack the membranes inside the bronchial tubes release mucus and become inflamed. The inflammation causes the muscles to contract and create spasms. These muscle spasms are responsible for wheezing. Wheezing is the sound that can be heard as the bronchial tubes constrict and air tries to escape.

Types of Asthma

Asthma is broadly classified into the extrinsic and intrinsic ( cryptogenic ) types.

In the former an external precipitating factor is identifiable, whereas in the latter it is not. The antigens include ingested, inhaled or parenterally administered substances. The serum of such individuals may show elevated levels of specific antibodies belonging to the IgE and sometimes IgG classes. Persons developing extrinsic asthma have other atopic manifestations like eczema. The dermatological and respiratory manifestations show a see-saw relationship. In many cases family history of bronchial asthma may be present. Extrinsic asthma generally sets in by the age of 10-15 years.. This type has a better prognosis from the point of response to therapy and mortality.

The age of onset for intrinsic asthma is after 30 years. Precipitating causes or raised antibody levels are not evident but these patients show a higher frequency of eosinophilia, aspirin sensitivity, and nasal polyposis.

Common stimuli which precipitate extrinsic asthma are inhaled allergens like house dust, pollens, fungi, animal hairs, insect scales and industrial fumes, and foods and drugs which are consumed in day-to-day life. Once sensitization occurs, these antigens release chemical mediators from the mast cells by interacting with the IgE molecules on their surface.

Exercise-induced asthma is a condition in which bronchospasm is provoked by various forms of exercise such as running or climbing stairs, but others such as swimming may not do so. Provocation of bronchospasm by cold inspired air is. a possibility in such cases. There may be several other mechanisms which operate in exercise-induced asthma. In many cases the attacks are brought on straight by the exercise, but in the others asthma sets in several hours after the exercise.

Respiratory infection and psychological stress play important roles in precipitating asthmatic paroxysms in both types. Both viral and bacterial infections may trigger off a paroxym and the episodes tend to recur as long as the infections persist. In children asthma may he the presenting symptoin in primary tuberculosis, so also in adults asthma may be aggravated.by coexistent pulmonary tuberculosis. Cigarette smoking and air pollution act as aggravating factors in many affec.ted individuals. The role of psychological stress is more in perpetuating the asthma than initiating the condition.

Signs/ Symptoms of Asthma

The attacks start with dyspnea (often at rest), expiratory wheeze, and cough. The onset is abrupt in most cases. These attacks may occur seasonally or during all times of the year (perennial asthma). The attacks may last for several hours if untreated. Severity of the paroxysm varies. In the moderately severe case the patient is orthopneic and cyanosed, and the accessory muscles of respiration are active. There may be ineffective cough with only very scanty and tenacious mucoid expectoration. The asthmatic paroxysm in many individuals is ushered in by a bout of coughing and sneezing on exposure to the allergen. The pulse is rapid. Blood pressure is normal or elevated. In severe cases pulsus paradoxus may occur. Expansion of the chest is considerably diminished, often to less than 2 cm during the attack. The diagnostic feature of bronchial asthma is the presence of expiratory wheeze heard all over the chest.

Once asthma occurs, the tendency is for the condition to persist for varying periods, even lifelong, with remissions and exacerbations. About 50-60% of patients get cure or very considerable relief by altering their life style, and appropriate medication. 20-30% of patients are not free from asthma but still attacks can be suppressed considerably by drugs. About 10% have severe disability despite active treatment.

Once asthma occurs, the tendency is for the condition to persist for varying periods, even lifelong, with remissions and exacerbations. About 50-60% of patients get cure or very considerable relief by altering their life style, and appropriate medication. 20-30% of patients are not free from asthma but still attacks can be suppressed considerably by drugs. About 10% have severe disability despite active treatment.

Causes of Asthma:-

Asthma may be caused by respiratoty infec­tion which may result in the inflammation of the bronchial tubes. It may be due to irritation of the nerves of respiration resulting from a de­ranged digestion, change of atmosphere, dust, smoke or other poisonous materials floating in the air breathed. Asthma may follow chronic bronchitis, dyspepsia, flatulence, constipation, fatty heart, elongated uvula. Very often it is a heriditary disease and tends to run in families. These triggers irritate the airways in your lungs and can include:

• infections such as colds and flu.
• irritants such as dust, cigarette smoke, fumes.
• chemicals found in the workplace - this is called occupational asthma.
• allergies to pollen, medicines, animals, house dust mite or certain foods.
• exercise - especially in cold, dry air.
• emotions - laughing or crying very hard can trigger symptoms, as can stress.

Diagnosis of Asthma

In most cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination. A physical examination of your upper respiratory tract, chest and skin generally follows the history. Using a nasal speculum, your doctor may look inside your nose for signs of allergic disease such as increased nasal secretions, swelling or polyps. These signs may suggest that allergies are responsible for triggering your suspected asthma.

Your doctor also may use a stethoscope to listen to the sounds your lungs make as you breathe. Wheezing sounds indicate one of the main signs of asthma: obstructed airways.

Finally, your doctor may examine your skin for signs of allergic conditions such as eczema or hives, which are often associated with asthma.

Spirometry
This noninvasive test, which takes 10 to 15 minutes and measures how well you breathe, is the preferred test for diagnosing asthma. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer.

Spirometry measures three values that are important in diagnosing asthma:

Vital capacity, which is the maximum amount of air that you can inhale and exhale

Peak expiratory flow rate, also known as the peak flow rate, which is the maximum flow rate you can generate during a forced exhalation

Forced expiratory volume, which is the maximum amount of air you can exhale in one second

If certain key measurements are below normal for a person your age, it may be a sign that your airways are obstructed. Your doctor may ask you to inhale a bronchodilator drug used in asthma treatment to open obstructed air passages. Then you retake the spirometry test. If your measurements improve significantly, it's likely that you have asthma.

Spirometry isn't foolproof. Your doctor may still suspect that you have asthma even if your initial spirometry measurements are normal. If so, he or she may recommend the next test - a challenge test.

Challenge test
During this test, you deliberately trigger airway obstruction and asthma symptoms by inhaling an airway-constricting chemical or taking several breaths of cold air. If you appear to have exercise-induced asthma, you may bring on symptoms by doing vigorous physical activity.

After inhaling the symptom-producing substance or engaging in physical activity, you retake the spirometry test. If your spirometry measurements are still normal, it's likely that you don't have asthma. But if your measurements have fallen significantly, it may be an indication that you have asthma.

Peak expiratory flow
This test, an alternative to spirometry, also measures how well you breathe. What you do is exhale forcefully into a peak flow meter, a small, hand-held device that measures the rate at which you can force air out of your lungs.

Although peak expiratory flow is less accurate than spirometry in measuring airway obstruction, it can still play a role in asthma diagnosis. If your spirometry and challenge tests are normal but your doctor still suspects asthma, he or she may send you home with a peak flow meter and a trial prescription for asthma medications.

Over a six- to eight-week period, you record your peak flow readings before and after taking your medications. If your readings improve significantly, it may be the evidence your doctor needs to make an asthma diagnosis.

Asthma is strongly suspected if a patient suffers from eczema or other allergic conditions-suggesting a general atopic constitution or has a family history of asthma. I t is often difficult, especially in young children, to be entirely certain that asthma is the diagnosis. After a careful physical examination, your pediatrician will need to ask you specific questions about your child's health. The information you give your pediatrician will help determine if your child has asthma. Your pediatrician will need information about

• Your child's symptoms, such as wheezing, coughing, and shortness of breath.
• What triggers the symptoms or when the symptoms get worse.
• Medications that were tried and if they helped.
• Any family history of allergies or asthma.

It is very important that your pediatrician test your child's airway function. One way to do this is with a pulmonary function test using a device called a spirometer. This device measures the amount of air blown out of the lungs over time. Your pediatrician may also want to test your child's pulmonary function after giving her some asthma medication. This helps confirm that the blockage in the air passages that shows up on pulmonary function tests goes away with treatment.

Some children do not find relief from their symptoms even after using medications. If that is your child, your pediatrician may want to test your child for other conditions that can make asthma worse. These conditions include allergic rhinitis (hayfever), sinusitis (sinus infection), and gastroesophageal reflux disease (the process that causes heartburn).

It is important to remember that asthma is a complicated disease to diagnose, and the results of airway function testing may be normal even if your child has asthma. Also keep in mind that not all children with repeated episodes of wheezing have asthma. Some children are born with small lungs, and their air passages may get blocked by infections. As their lungs grow they no longer wheeze after an infection. This type of wheezing usually occurs in children without a family history of asthma and in children whose mothers smoked during pregnancy.

Precautions in Asthma:-

• Stay out of smoke-filled rooms. People with asthma shouldn't smoke, but a recent study done in Canada found that people around asthmatics shouldn't smoke either. "This is particularly important in the winter months, when houses are closed up," says Brenda Morrison, Ph.D., a researcher and associate professor at the University of British Columbia, who conducted a study on the effects of cigarette smoking on asthma. "If someone in the house smokes, it leads to a worsening of asthma, especially in children."
• Don't light a fire. Throwing another log on the fire, or in the wood stove, will also fuel asthma. "Wood stoves and fireplaces can cause significant trouble for people with asthma," says John Carlson, M.D., an allergist from Virginia Beach, Virginia. If you must make a fire, be sure the wood stove and chimney are airtight in order to reduce the amount of particulates released into your room-and lungs. Also, make sure the room is well ventilated and the fireplace draws well.
• Take an antacid at bedtime. Going to sleep on a full stomach might also feed your asthma. "Asthma can be caused by stomach reflux," a condition in which acid backs up into your esophagus from your stomach. "Your stomach contents may leak out a little and drip down into your airway while you're lying down," says Dr. Creticos. "Prop your bed up and elevate the pillow to prevent the dripping, and take an antacid before bedtime to cut down on your stomach's acidity."

Treatment / Home Remedies of Asthma:-

Dietary considerations:The patient should avoid the common dietic errors. Ideally, it should contain a limited quantity of carbohydrates, fats and proteins which are acid-forming foods, and a liberal quantity of alkaline foods consisting of fresh fruits, green vegetables and germinated gram. Foods which tend to produce phlegm such as rice, sugar, lentils and curds as well as fried and other difficult-to-digest foods should be avoided. Asthmatics should always eat less than their capacity.

• Elecampane: Helps tone lungs. Used in bronchitis, asthma treatment and emphysema. A stimulating and anti-inflammatory expectorant which helps dry up mucus secretions.
• Honey (shahad) : Honey is one of the most effective home remedies for asthma. It is said that if a jug of honey is held under the nose of the asthmatic patient and he inhales the air that comes into contact with honey, he starts breathing easier and deeper. The effect lasts for about an hour or so. Honey usually brings relief, whether the air flowing over it is inhaled or whether it is eaten or taken either in milk or water. It thins out accumulated mucus and helps its elimination from the respiratory passage.
• Garlic, Ginger & Mustard: These herbs help remove or prevent the accumulation of mucus in the lungs. They also contain quercetin, which have been shown to inhibit and enzyme that aids in releasing inflammatory chemicals.
• Turmeric (Haldi) : Turmeric is valuable in asthma. The patient should be given a teaspoon of turmeric powder with a glass of milk, two or three times daily. It acts best when taken on an empty stomach.
• Linseed (Alsi): A decoction made from linseed is considered useful in curing congestion in asthma and to prevent recurrence of attacks. Simultaneously; linseed poultice should be applied externally at the lung bases for reducing internal congestion.
• Banana with Pepper: - Take one ripe banana, heat it on the lamps flame, thereafter peel it off, sprinkle pepper on it and have it to get relief.
• Juices:- Drink a glass of 2/3 carrot juice, 1/3 spinach juice, 3 times a day . Put 4-5 drops of carrots juice into the nostrils to get relief in breathing.
• Basil :- Add 30-40 leaves of Basil in a liter of water, strain the leaves and drink the water throughout the day effective for asthma.

General Home Care in Asthma

• Sip a warm drink to alleviate a mild bout of wheezing caused by inhaling very cold air.
• Do not lie down if it makes breathing difficult.
• Avoid use of dairy products as they increase the muscus.
• Loosen your robes and take rest on your cot.
• Keep more pillows under your head. Supply of oxygen will increase then.