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