Asthma

Asthma is a chronic lung disease that affects adults and children of all ages and represents a serious global health problem. During an asthma attack, airways within the lungs (bronchial tubes) become narrow, interfering with the normal movement of air in and out of the lungs. Inflammation, often in response to one or more triggers (such as viral illnesses, pollen and smoke), is the most important factor to cause narrowing of the bronchial tubes as inflamed tissue produces excessive amounts of mucus that can clump together and clog the small airways. The muscles around the bronchial tubes may also constrict during an asthma attack (bronchospasm), causing the airways to narrow further.

It is this narrowing of the airways that causes symptoms such as wheezing, shortness of breath and coughing, which may range in severity from mild to life-threatening. Most individuals with asthma tend to feel well between asthma episodes but may remain short of breath after exercise for longer periods of time than people without asthma.

Signs and symptoms

The symptoms of asthma vary from person to person and from episode to episode. It is important to remember that many of these symptoms can be subtle and similar to those seen in other respiratory conditions and some heart disorders.  This makes identifying the settings in which the symptoms occur and diagnostic testing very important in recognizing this disease.

The four major recognized symptoms of asthma are:

• Shortness of breath: especially with exertion or at night
• Wheezing: a whistling or hissing sound when breathing out
• Coughing: may be chronic; usually worse at night and early morning; may occur after exercise or when exposed to cold, dry air
• Chest tightness: may occur with or without the above symptoms

The symptoms of severe asthma are persistent coughing, the inability to speak full sentences or walk without shortness of breath, chest tightness and bluish tinted lips. In addition, patients may feel agitated, confused and unable to concentrate. Patients may also strain their abdominal and neck muscles as they change their posture in an attempt to breathe more easily.

Treating asthma

Identification and avoidance of triggers is clearly a fundamental aspect of asthma management.   However since this is often difficult or impossible, most patients rely on medication for symptom control and prevention.
 
The specific medical treatment recommended to patients with asthma depends on the severity and frequency of symptoms. Treatments for asthma are broadly classified as relievers (rapid-acting agents for a quick reverse of bronchoconstriction and quick relief of symptoms), controllers (medications taken on a regular basis to keep asthma under clinical control, primarily through their anti-inflammatory effects) and emergency treatment for when attacks become particularly severe and fail to respond to usual measures.  In recent years, relief and control medications have been combined in one inhaler device and use of these treatments is now widespread.

All current asthma guidelines recommend a stepwise approach to therapy based on how well controlled asthma symptoms are.  For example, the Global INitiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention recommends a five-step therapeutic approach that starts with reliever treatment alone at step one and works its way up through combination therapy with inhaled corticosteroids and long-acting beta-two (β2) agonists, with a wide range of alternatives and additional combinations at steps three and four, ending with additional oral glucocorticosteroids at step five.

References

• Gillissen A.  Managing asthma in the real world.  International Journal of Clinical Practice 2004; 58: 592 – 603
• http://www.mayoclinic.com/print/asthma/DS00021/DSECTION=     all&METHOD=print  Last accessed 30.10.07
• http://www.medicinenet.com/asthma/article.htm  Last accessed 23.01.08
• Pruitt B, Jacobs M.  Caring for a patient with asthma.  Nursing 2005; 35: 48 – 51
• Global Initiative for Asthma (GINA). Global Strategy for Asthma and Prevention 2006; p55
• Global Initiative for Asthma (GINA). Global Strategy for Asthma and Prevention 2006; p58 - 63
• Sennhauser FH et al. The burden of asthma in children: a European perspective. Paediatric Respiratory Reviews 2005; 6:2-7