Asthma

 

Asthma 

Bronchial asthma is a disease that causes the bronchial tubes within the lungs to swell and become narrow, making it difficult to breathe.  Some individuals can also produce excess mucus, with increased coughing and expelling of phlegm.  Asthma affects more than 25 million Americans, which also includes 5 million children (Asthma, 2022, Cleveland Clinic). 

            When breathing normally the bronchial tubes relax allowing air to flow freely.  An asthma attack can be caused from bronchospasms, where the muscles within the airways constrict, or become inflamed.  Common symptoms of asthma are chest tightness, angina, pressure in chest, coughing, shortness of breath, and rhonchi.

Types of Asthma

Asthma can be caused by several factors and have different categories.  Intermittent asthma only occurs some of the time, whereas asthma that is persistent means there are continuous symptoms, then it can be categorized as mild, moderate, and severe.  Non- allergic asthma is triggered by activities like exercise, illnesses, and weather.  Individuals with allergies to mold, pollen, and pets can also be triggers to asthmatic symptoms.  Nocturnal or nighttime asthma occurs often because sleeping on your back increases the pressure on your chest and lungs.  Individuals can have excess sinus drainage, as well as the air in the home can be too hot or cold (Asthma, 2022, Cleveland Clinic).  Other triggers for asthma symptoms can be toxins, fumes, air pollution, dust mites and cigarette smoke.  Eosinophilic asthma is associated with having high levels of eosinophils (white blood cells) which can cause blockages of excesses mucus and produce inflamed airways, sinuses, and nasal passages (Dresden, 2017).

Inheriting asthma from a close family member is very common.  Also, early life events like being born prematurely, having a low-birth weight, exposure to tobacco smoke and contracting viral respiratory infections increase the risk of developing asthma (Asthma, 2022, WHO).

 

Diagnosing Asthma

A primary care physician can order chest x-rays to rule out other complications that mimic asthma, like pneumonia.   CT scans allow the doctors to view the bronchial passages and lung densities, along with determining the severity of the disease (Grimm, 2020).  Although there are no blood tests to diagnose asthma, doctors can run tests for allergens, to see if allergic conditions are the cause of the asthmatic symptoms.

A respiratory therapist can conduct pulmonary function tests to measure lung volume and capacities.  The Vital Capacity is the maximum amount of air that one can inhale into or exhale out of their lungs.  A peak expiratory flow measurement indicates how fast you can force air out of your lungs.  A spirometer measures how much air your lungs can hold and how much air you can exhale in 1 second after you’ve taken a deep breath.  This measurement is called forced expiratory volume (FEV1) and is compared to other’s FEV1 who do not have asthma (Asthma treatment: 3 steps to better asthma control, 2021).  Another test that can be performed is the exhaled nitric oxide test, it measures the amount of nitric oxide gas in your breath, high levels present can mean the bronchial tubes are inflamed, signaling towards asthma.

 

Risk and Complications

There are several risks and complications associated with this disease.  Children can have growth delays and have an increased risk of learning disabilities.  Adults have more frequent sick days and an increased risk of depression.  Both can have permanent narrowing of bronchial tubes, medication side effects, increased emergency room visits, increased risk of obesity, and a lingering coughing (Caltamanchi, 2019).  Side effects of medication include tachycardia, hoarseness, throat irritation and oral yeast infections (caused by inhaled corticosteroids), insomnia, and gastroesophageal reflux. 

Studies have shown that long-term use of corticosteroids is associated with serious side effects like multi-organ toxicities and immunosuppression (McMaster University, 2018).  “Patients with the most severe form of asthma produce special substances in their airways when taking medication during an asthma attack that blocks the treatment from working”.  In some cases, the use of corticosteroid inhalers promotes the secretion of these growth-factors in the bronchi.  There is research to find ways to block these growth-factors, allowing the rescue medication to work effectively (MacPherson, 2022).

Another chronic condition that can occur in severe cases is with airway remodeling, which is permanent structural changes including alterations to the structural cells and tissue.  This condition can reduce lung function, produce chronic coughing, bronchial thickening, increased mucus production, and an increased blood supply in airways (Caltamanchi, 2019).

A severe risk of asthma is respiratory failure, which is a life-threatening event when not enough oxygen travels from the lungs into the blood.  The largest risk of asthma is death.  “CDC reports that 9 Americans die from asthma every day.  There are more than 4000 asthma-related deaths a year in America.  But many of these deaths are preventable with proper symptom and emergency care” (Caltamanchi, 2019).

Treatment and Prevention of Asthma

            There are several options available to individuals that suffer with asthma symptoms.  Inhalation therapies and oral medications are common prescriptions that people take to help manage and control their symptoms.  Long-term anti-inflammatories like corticosteroids are used every day to control and prevent chronic asthma.  Their purpose is to reduce swelling and mucus production.  Bronchodilators, which provide a metered dose of aerosol medication, that helps relax the bronchial muscles and relieve the symptoms immediately. 

            Biologic medication is referred as an active antibody that is given as a subcutaneous (under the skin) injection.  This newer method was developed to treat severe asthma.  “In a study of over 200 participants with severe asthma, the new treatment was shown to have improved asthma symptoms and lung function, while reducing the need for corticosteroids by up to 70%” (McMaster University, 2018). 

An antibody called dupilumab treats asthma by blocking 2 specific proteins that are associated with inflammation in the airways (McMaster University, 2018).  Dupixent is an injection, that was approved by the FDA in 2018.  It is given twice a month to help treat severe asthma, eosinophilic asthma, and for those who are corticosteroid dependent.  The clinical trials showed 81% fewer asthma attacks and their lung functioning improved by 21-23% (Williamson, 2022).  Tezspire is another medication that was approved by the FDA in 2021 to treat all forms of asthma, which is also given by injection every four weeks (Marshall, 2022).

            Individuals with asthma have looked for other ways to manage their asthma.  “According to the National Center for Complementary and Integrative Health (NCCIH), complementary therapies involve using nontraditional practices in combination with traditional medicine, whereas alternative treatments are used instead of traditional medicine”.  NCCIH reports more than 30% Americans have turned to complementary or alternative therapies.  Some remedies may help manage symptoms, but they are not meant to replace prescribed medications from doctors (Rodriguez, 2021). 

            Although exercise can trigger asthma attacks, it still does improve the cardiovascular system, thus improving the individual’s quality of life.  A recommended 30 minutes of aerobic exercise three times a week, along with strength training helps control asthma symptoms.  Along with exercise, yoga and breathing exercise have been shown to lessen symptoms of asthma.

Holistic approaches have also been studied to help individuals manage their asthma.  Turmeric supplements have anti-inflammatory and antioxidant properties, which can be very beneficial for this disease.  A study of adults taking 500 mg daily showed to reduce inflammation (Rodriguez, 2021).

Future Research

Asthma is often under-treated in low- to middle- income countries causing individuals and their families to suffer the burden of the disease.  Access to medications is limited in lower income countries, leaving many people unable to manage their disease.  With proper treatment and management individuals can live a normal and active life.  “WHO [World Health Organization] is committed to improving the diagnosis, treatment, and monitoring of asthma to reduce the global burden of NCDs [non-communicable diseases] and make progress towards universal health coverage” (Asthma, 2022, WHO). 

Without research we would not be able to find medications and promising treatments for asthma.  The American Lung Association is committed to funding research to understand how asthma is caused and the best treatment options.  They are investigating the immune system’s role in asthma, effects of mold on severe asthma, improving severe asthma in children, and studying genes and their role in controlling the immune response (Asthma research, 2020).  In the future we can hope to lessen the burden on individuals living with asthma, and possibly find a cure.

Medical Term Definitions

Bronchial Tubes	Airways that enter the lungs
Bronchospasm	Muscles that line the airways tighten
Angina	Chest pain
Dyspnea	Difficult, labored breathing
Rhonchi	“Wheezing” -whistle or rattle sound in the lungs when the airways are partially blocked
Eosinophils	White blood cells responsible for fighting disease
CT Scan	Type of imaging that allow you to see bones, muscles, organs, and blood vessels
Tachycardia	Rapid heartbeat
Insomnia	Sleep disorder where you have trouble falling or staying asleep
Gastroesophageal reflux	When stomach acid flows back from the stomach into the esophagus.
Corticosteroid	A steroid that reduces inflammation
Immunosuppression	A weakened immune system

 

References

Asthma. (2022, January 19). Cleveland Clinic.  https://my.clevelandclinic.org/health/diseases/6424-asthma

Asthma. (2022, May 11). WHO.  https://www.who.int/news-room/fact-sheets/detail/asthma

 

Asthma research. (2020, October 23). American Lung Association.  https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/asthma-research

Asthma treatment: 3 steps to better asthma control. (2021, September 16). Mayo Clinic.  https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-treatment/art-20044284

Cattamanchi, A. (2019, January 10). Complications of Asthma. Healthline.   https://www.healthline.com/health/asthma-complications

Dresden, D. (2017, September 20). What to know about eosinophilic asthma. Medical News today.   https://www.medicalnewstoday.com/articles/319466#what-is-eosinophilic-asthma

Grimm, L. (2020, December 28). Asthma imaging and diagnosis. Medscape. https://emedicine.medscape.com/article/353436-overview

MacPherson, K. (2022, May 31).  Scientists Solve Long-Standing Mystery: Why Do Some Asthma Patients Respond Poorly to Treatment? Rutgers. https://www.rutgers.edu/news/scientists-solve-long-standing-mystery-why-do-some-asthma-patients-respond-poorly-treatment

Marshall, H. (2022, May 4). Tezspire. Medical News Today.  https://www.medicalnewstoday.com/articles/drugs-tezspire#about

McMaster University. (2018, May 22). New treatment for severe asthma. ScienceDaily. Retrieved June 30, 2022 from www.sciencedaily.com/releases/2018/05/180522170052.htm

Rodrigues, D. (2021 April 28). Do Natural Remedies and Treatments Work for Asthma? Everyday health. https://www.everydayhealth.com/asthma/natural-remedies-for-asthma.aspx

Williamson, J. (2022, May 7). Dupixent. Medical News Today.  https://www.medicalnewstoday.com/articles/326617