Bronchial  Asthma

What is Asthma?

Bronchial Asthma is a chronic inflammatory disease of the airways that causes periodic attacks of coughing, wheezing, chest tightness and shortness of breath.  It is associated with mast cells, eosinophiles and T lymphocytes.  Mast cells are allergy-causing cells releasing chemicals like histamine which causes nasal stuffiness, constriction of airways, itchy areas in skin allergy, etc.  Eosinophiles and T lymphocytes are white blood cells associated with allergy and inflammation.  These and other inflammatory cells create airway inflammation leading to airway hyper-responsiveness, airflow limitation, respiratory symptoms and chronic disease.  Some suffer chest tightness and breathlessness at night and in the early morning time (nocturnal asthma) and others feel these symptoms when they exercise (exercise-induced asthma) 

Types of Asthma

Allergic Asthma

Allergic rhinitis or hay fever in which the inside lining of the nose is inflamed is also called allergic asthma.  A constant running nose, continuous sneezing, swelling of nasal passages, etc. might lead to cough, which is an asthmatic symptom,and other asthmatic symptoms.

Exercise-induced Asthma

Exercise or physical exertion triggers this type of Asthama.  People without asthma experience this type of asthma only during exercises and exertions. Generally, the airway narrowing peaks five to twenty minutes after exercise begins.  Wheezing and coughing add to the symptoms of an asthma attack.

Cough-variant Asthma

Severe coughing with asthma is the main symptom of this type of asthma. Postnasal drip, chronic rhinitis and sinusitis or GERD (heartburn) also cause this type of asthma.

Occupational Asthma

In this type of asthma, breathing difficulty and other asthmatic symptimes appear only during the working days.  Patients suffer running nose and congestion or eye irritation or coughing instead of typical asthma wheezing.

Nightime (Nocturnal) Asthma

This is the most common type of asthma.  As asthma is influenced by the circadian rhythms (sleep-wake cycle), nighttime wheezing, cough and breathing trouble are common and dangerous during night time. Most asthma-related deaths occur during night time.

Asthma mimics

There are several illnesses and health conditions that show symptoms same as that of asthma. Cardiac asthma is a sort of heart failure in which the symptoms are that of regular asthma. Vocal cord dysfunction causes wheezing that is frequently misdiagnosed as asthama.  

Causes of Asthma

There are many agents that trigger asthma.  The effect of each trigger on the lungs and the reaction of individual patients to each trigger vary in each specific case. The severity of the disease depends upon the number of agents activating the onset and the degree of sensitiveness of the lungs to them.
There are two types of triggers:

Allergens

 

Pollens, dust mites, molds, pets, and insect parts

     
  Foods such as fish, egg, peanuts, nuts, cow's milk, and soy
     
  Work-related agents such as latex
     
  Additives such as sulfites

Irritants

Tobacco smoke, diesel fumes, smog, paints, detergents, deodorants, chemicals, perfumes, etc.
Non-steroidal anti-inflammatory drugs, beta blockers used for blood pressure control and heart disorders and drugs like aspirin
Respiratory infections caused by colds, bronchitis, sinusitis, etc. and GERD
Work-related factors, such as chemicals, dusts, gases, and metals
Laughing, crying, yelling, distress and such other emotional factors
Premenstrual syndrome and such other hormonal factors
Exercise, especially under cold and dry conditions
Nighttime

Stages of Asthma

The frequency of the symptoms and their severity together with the results of pulmonary function tests determine the classification of Asthma.

 

Mild attacks with a frequency of less than twice a week and normal breathing tests qualify for the least severe classification.  30% of all patients fall in this.

     
  Mild persistent attacks with more than two episodes per week with normal or abnormal breathing tests qualify for classification as more severe. 30% of all patients fall in this.
     
  Moderate or severe attacks persisting on a daily once or continuous frequency, combined with abnormal breathing tests, qualify for the most severe category.  40% of all patients fall in this category.

Symptoms

There are four major symptoms of asthma recognized worldwide as sure signs.  These are
 

Breathing difficulty or shortness of breath at night or during exertion

     
  Wheezing, audible as a whistling sound when breathing out
     
  Coughing, often chronic and worse at night, in the early morning hours, after exercise or when exposed to cold and dry air
     
  Chest tightness, with or without the above symptoms

Diagnosis

Generally, diagnosing asthma involves a thorough study of the medical history of the patient, physical examination and lung function (breathing) tests. Histories of occurrence of the symptoms, allergies if any and the family history relating to asthma and allergies are studied and analyzed. Then the upper respiratory tract, chest, skin, nose, etc. are examined.  Stethoscope is used to listen to wheezing sound when breathing out.  Skin diseases like eczema and hives are often associated with asthma and signs of these may be examined. If asthma is suspected, medications to reduce symptoms are prescribed and the effect studied to confirm the diagnosis.  In some cases, other tests are done to make sure.

Doctor may have recourse to breathing tests like spirometer test and/or challenge test.  In the noninvasive test using spirometry, deep breaths into the lungs and forceful exhalation into a hose connected to a spirometer are deployed to measure FVC (Forced Vital Capacity) which is the maximum amount of air you can inhale and exhale at a time and FEV-1 (Forced Expiratory Volume) which is the maximum amount of air you can exhale in one second. Comparing these two measurements an obstruction may be presumed and a bronchodilator drug given.  If the measurements improve after inhaling the drug, asthma can be confirmed.  In the challenge test, airway obstruction is deliberately triggered by inhaling airway-constricting substances or cold air. If the spirometry test is normal even after such triggering, asthma is not the case.
Conditions other than asthma that can show similar symptoms are COPD, airway tumors, bronchitis, pneumonia, pulmonary embolism, congestive heart failure, vocal cord dysfunction, etc.
Measuring the presence of a chemical marker of asthma – nitric oxide – in the exhaled air, instead of using spirometry, is being used to make sure that the diagnosis is correct, as spirometry results are not always accurate.  Higher levels of nitric oxide in the exhaled air correspond with higher levels of asthma severity.  Although results are promising, this test is costly, requires specialized equipment and is still being evaluated.

Prevention

If you have allergies and/or asthma, you must avoid dust, fibers, molds, dander from dogs and other animals, dust mites, etc. and other triggering agents like smoking and passive smoke. You must make at least your bed-room free of dust. 
There are several medications used for prevention of asthma like cromlyn, intal, fisoneb, nasalcrom, crolom, gastrocrom, nalcrom, opticrom, etc.  These can be used under medical supervision only.

 Methods of Treatments

As in the case of any other disease, prevention is always better than cure.  Avoiding the causes or triggers of your asthma attacks and taking preventive medications indicated above are the best methods. 
A combination of long-term control medications and quick relief medications, taken with a hand-held inhaler, is advised.  As asthma changes in the long run, you may need to make needed adjustments in the strength, measurement, frequency, etc. of your medicine or even change your medicines.  Long-term control medications include inhaled corticosteroids, long-acting beta-2 agonists, leukotriene modifiers, cromolyn and nedocromil (tilade) and theophylline.  Quick relief (short-term) medications include short acting beta2 agonists, ipratropium (atrovent), oral and intravenous corticosteroids, etc.
In the case of asthma symptoms triggered by airborne allergens, you may also need allergy treatment simultaneously with the asthma medications.
Natural methods of prevention and cure include eating oily fish, whole grain products, fruits and vegetables.  Mothers whose intake of fish during pregnancy is higher have children with lower incidence of asthma.  Carrots, tomato juice, spinach and other vegetables contain carotenoids and flavonoids which help ameliorate asthma and other allergic conditions. Warm liquids like hot soup and tea help in reducing the severity of the attacks. Weight loss also helps in reducing attacks. Transfats found in pastries, cookies, cakes, etc. and omega-6 oils such as corn, safflower and sunflower increase the severity and incidence of the attacks.
For those who find it difficult to take these as regular food, there are supplements like fish oil capsules, flavonoids in the form of genistein and quercetin, boswelia as supplement, vitamin C, magnesium, ginkgo biloba, sylimarin, alphalpoic acid and butterbur extract.  Yoga is also helpful in fighting Asthma.

Ayurvedic  Treatments

There are several ways of treating asthma according to the type of asthma and the stage to which it has advanced in the patient.  Mental and physical exercises, dietary restrictions, massaging, application of oils, etc. can sometimes outdo intake of medications in effectiveness.

In the case of dry type of asthma, the main requirement is to increase the intake of fluids.  The head, chest and back should be covered on cool days to avoid exposure to wind.  Dairy products and nuts should be avoided.  Daily massage of the whole body with sesame oil to add moisture to the body is advised. Food items that are moist and warm rather than cold, raw and dry should be preferred.

In the case of infection type asthma, eating late in the night should be avoided as it will accumulate toxins in the body due to digestive malfunctions. Plenty of water should be taken.  Fruits and vegetables should be preferred to meats and dairy items and deep fried food should be totally excluded from the menu. Exertion in the cold and high temperature should be avoided.  The immune system should be boosted with the intake of Echinacea in the form of tea and dandelion.  As stress and anger have a part to play in this type of asthma, breathing exercises and meditation are recommended.

In the case of congestive type asthma, wheat products, refined sugar and dairy products should be avoided together with food items that are over-sweet, over-sour and over-salty.  In order to prevent congestion, bitter, astringent and spicy foods should be eaten to increase circulation.  Massaging chest and back with mustard oil will promote circulation. Balm of Gilead may be rubbed on the chest to increase warmth, prevent pneumonia and dilate the bronchial tubes enabling deeper breathing.  Daily exercise, including some cardio exercise, for fifteen minutes is recommended. Eating between 10 am and 9 pm should be avoided to be free from digestive problems which are causes of this type of asthma.  They should also avoid walking in the rain, leaving head and torso bare, drinking cold water and ice creams, etc. to prevent the mucus from becoming clogged.
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In all type of asthma, and in chest problems in general, deep breathing exercises and intake of small measures of spices are helpful.  Black pepper, cumin seed, ginger and turmeric may be ground together and mixed with honey to make a paste and taking a teaspoon of this paste, at least once a day, would be very helpful in keeping the chest clear.  External application of Gilead balm, cinnamon oil, eucalyptus oil, or clove oil will also help improve breathing. One of the above oils should be mixed with a base oil.  For those with congestion type asthma, the best base oil would be mustard oil and for those with other types of asthma, it would be sesame oil.