Dr. Shyam P Lohani

ASTHMA is a chronic disease of the lungs. Being an inflammatory disease of the airways, it causes difficulty in breathing and makes physical activities challenging or sometimes even impossible. The inflammation of the airways causes narrowing inside the lungs that restrict air supply. A person suffering from asthma may exhibit symptoms such as tightness in the chest, wheezing, breathlessness, coughing, and increased mucus production.

In 2019, about 262 million people were affected by asthma and out of which 4, 61,000 deaths were associated with it (WHO, 2021). The most common symptom of asthma is wheezing. This is a squealing or whistling sound that occurs during the breath. Symptoms of asthma may include coughing, especially at night, when laughing, or during exercise, tightness in the chest, shortness of breath, difficulty talking, anxiousness or panic, fatigue, chest pain, rapid breathing, frequent infections and causes trouble sleeping.

Asthma develops in many different ways and for many different reasons, but the triggers are often the same for a particular person. Symptoms seen during asthma attack are not similar to everyone and not also similar in the same person during two different asthma attacks. The symptoms may vary from one asthma attack to another, being milder during one attack and severe during another. Some people with asthma may not show any symptoms for a long period. In addition, some people may have asthma attack only during exercise or when suffering from viral infections like colds.

Exact cause unknown
The exact cause of asthma is still unknown, but both genetic and environmental factors seem to play a crucial role. The triggers include allergens, including dander and pollen, irritants, such as smoke and chemicals, exercise, other health conditions, weather, certain medications, and also strong emotions. When a person is sensitive to a known allergen, it can be both a cause and a trigger.
The other causes and triggers include pregnancy, obesity, allergies, smoking, and environmental factors. Some allergens inside the house include mold, dust, animal hair and dander, fumes from household cleaners and paints, cockroaches, and feathers.

Triggers for asthma attack in the home and outdoors include pollen, air pollution from traffic and other sources, ground-level ozone, and stress. Stress as well as several other emotions can give rise to asthma symptoms. Strong emotions such as joy, anger, excitement, laughter, and crying are all implicated as a trigger to an asthma attack. There have been evidences that certain mental health conditions, such as depression and anxiety are linked to asthma. Genetic and hormonal factors have also been linked to asthma.

There is no cure for asthma at this moment. However, there are many effective treatments that can decrease asthma symptoms and improve quality of life. The best approach in the management of asthma is to improve quality of life with lifestyle changes and some medications.
There are certain medications that help in preventing asthma. Allergen immunotherapy is a type of treatment that may help alter our immune system. With routine shots, our body may become less sensitive to any triggers that are being encountered.

An asthma attack can get worse quickly. So it is important to treat these symptoms immediately. During an acute asthma attack, without immediate treatment, such as with asthma inhaler or bronchodilator, it becomes harder to breathe. Without proper treatment during an acute asthma attack, it causes us unable to speak. Patients may also get a bluish colouring around lips. This colour change known as cyanosis meaning we have less than required oxygen in our blood. The cyanosis can cause a loss of consciousness and even death.

Prevention
It is often suggested to avoid triggers. It is advised to make households clear of chemicals, smells, or products that may have caused breathing problems in the past. People, who are allergic to identified allergens such as dust or mold that trigger an asthma attack, should avoid them as far as possible.

In addition to using maintenance medications, there are several other lifestyle changes that make us healthier and reduce the risk for asthma attacks. One approach is to maintain a healthy and balanced diet that improves overall health. Nutrient-rich foods are vital to help reduce symptoms, but it is also found that food allergies can trigger asthma symptoms. Maintaining a moderate weight is another strategy in preventing asthma. Asthma often tends to be worsened in people who are overweight and obese. Losing weight is healthy not only for our heart, joints, and lungs but also reduces the incidence of asthma.

Cigarette smoke contains hundreds of chemical irritants that can trigger asthma and also increase the risk for chronic obstructive pulmonary disease (COPD). It is advised to quit smoking and also refrain from secondhand smoke to reduce asthma attacks. Any activity may trigger asthma attacks but regular exercise may actually help reduce the risk of breathing problems. Stress can be a trigger for an asthma attack and it is recommended to avoid stress in order to reduce asthma.

The take-home messages in managing asthma attacks are to adhere to lifestyle modifications that include dietary changes, exercise, or stress management, avoid known allergens and quit smoking.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Center. lohanis@gmail.com)