What is Asthma?
During breathing, air goes through the nose or mouth into parts of the body called airways. This air then goes into the lungs.
Asthma is a non-contagious allergic condition where these airways are inflamed, making them more sensitive. When these sensitive airways are exposed to certain triggers, they overreact, releasing mucus into the airways. This reduces the amount of air that can pass through the airways into the lungs, and causes breathing to become constricted and difficult. Asthma can affect daily life activities, such as exercising and sleeping. If this condition is not well managed, it could lead to life-threatening asthma attacks.
Usually, asthma starts in childhood, but some do develop it during adulthood. Asthma affects about one in five children in Singapore. In adults, asthma symptoms appear only after 20 years of age.
Currently, there are no known causes of asthma. However, there are some factors that may increase one’s chances of developing asthma:
History of Asthma in the Family
Family history of asthma, especially in immediate family members. People who have parents with asthma are at least thrice as likely to develop the condition as compared to someone whose parents did not have asthma.
Asthma has been found to be more common in overweight individuals.
People who have allergic conditions such as a sensitive nose (allergic rhinitis) or eczema (atopic dermatitis) are more likely to develop asthma as well. This is especially so in children. In Singapore, there is a rising trend in the number of children developing allergies, implying more children may be afflicted with asthma as well.
Being exposed to environmental triggers for asthma e.g. cigarette smoke.
Childhood asthma occurs more frequently in boys, but for adults, asthma affects women more, especially for individuals beyond the age of 40.
Childhood Viral Infection
If an individual has a history of severe viral infections in childhood, they are more likely to develop asthma.
It is suspected that if babies are not exposed to enough bacteria in their early months and years, they will find it more difficult to fight off asthma and other allergic conditions – this is known as the Hygiene hypothesis.
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Types of Asthma and Asthma Triggers
The types of asthma are categorised according to their triggers, as listed below:
This is the most common type of asthma, whereby the bronchi (the passageways to the lungs) are affected.
Allergic Asthma (Extrinsic Asthma)
Caused by allergens, allergic asthma is often triggered by pet dander from animals like cats and dogs, food, mold, pollen, and dust. It is often seasonal as it is associated closely with seasonal allergies.
Nonallergic Asthma (Intrinsic Asthma)
Nonallergic asthma refer to asthma caused by irritants in the air not related to allergies. These may include burning wood, cigarette smoke, air pollution, air fresheners, household cleaning products, and perfumes to name a few.
Occupational asthma is a type of asthma induced by substances found at the workplace, which trigger the condition. These could include dust, dyes, gases and fumes, industrial chemicals, rubber latex and more. Oftentimes, these irritants are found in manufacturing, woodworking, textile and farming industries.
Exercise-Induced Bronchoconstriction (EIB)
Previously known as exercise-induced asthma, this is a type of asthma caused by exercise. It often affects individuals within a few minutes of starting exercise and up to ten to fifteen minutes after physical activity.
Aspirin-Induced Asthma (AIA)
The trigger for AIA is consuming aspirin or other nonsteroidal anti-inflammatory drug (NSAID), like naproxen or ibuprofen. This can be fatal, and symptoms begin within minutes or hours. It usually develops suddenly in adults between the ages of 20 and 50.
Nocturnal asthma sees worsened symptoms during night time. Triggers for this type of asthma are thought to be related to sleep, some of which include heartburn, dust mites, pet dander, and the body’s natural sleep cycle.
Cough-Variant Asthma (CVA)
This type of asthma does not have typical symptoms of asthma, but instead presents as a persistent, dry cough. If it is not treated, CVA can lead to full-blown asthma which will present with the other more common symptoms of asthma
Foods such as ice cream, chocolate, and cold drinks do not trigger asthma.
Symptoms surface when the individual comes into contact with an asthma trigger. These include:
This symptom is usually worse at night and in the morning. It can happen after exercising as well. Coughing spells could be a short encounter, or over a more prolonged period.
Wheezing refers to the whistling sound one may sometimes hear when breathing in and out. This happens when air has to squeeze through constricted airways, as in the case of asthma.
Shortness of Breath
Breathlessness happens as airways get smaller or blocked, and the individual may feel like they have to breathe more to get enough air.
This happens when the muscles around the airways tighten up, leaving a sensation of the insides being squeezed.
The frequency and occurrence of symptoms may vary over time, depending on how well the asthma condition is managed.
To see if it is asthma, the doctor or asthma specialist will have to find out more about the individual’s symptoms, family and medical history, then rule out other conditions which may present similar to asthma.
The doctor may also perform a physical examination and conduct some tests, such as a breathing test (lung function test), peak expiratory flow test and allergy test.
Conditions Associated With Asthma
There are some conditions commonly associated with asthma, due to their similarity in presentation. They can also co-occur with asthma. These are:
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a lung disease usually affecting older people. It is caused by damage to the lungs over many years, and gets worse over time. Like asthma, COPD makes it difficult to breathe. Someone with COPD may have a symptom where the lungs are not able to stretch fully and result in shortage of breath (emphysema), which looks like a symptom of asthma. COPD may also cause chronic bronchitis, which is when the lungs’ airways get inflamed and blocked by excessive mucus, reducing airflow.
Heartburn Caused by Gastroesophageal Reflux Disease (GERD)
Heartburn is when stomach acid goes up into the food pipe or the throat. With GERD, lying down can increase heartburn and cause someone to present with night time asthma symptoms. Treating GERD can help with reducing some of the night time asthma symptoms experienced by someone with both GERD and asthma.
Sinusitis (Sinus Infection)
This is when the tissues lining the sinuses swell or become inflamed, causing symptoms like a runny, stuffy nose. Sinusitis often occurs together with asthma, and those with both conditions tend to get more severe asthma symptoms.
Allergic Conditions Like Eczema or Allergic Rhinitis (Hay Fever)
Asthma is more common in people with a history or family history of allergic conditions such as eczema or hay fever.
When asthma symptoms get increasingly worse, this is known as an exacerbation or an asthma attack. Breathing gets very difficult as the airways are swollen and the air tubes have become narrower. Symptoms of an asthma attack include:
- Shortness of breath
- Increased heart rate
- Increasing agitation
A severe asthma could have the following symptoms:
- Inability to speak
- Struggling for breath, gasping for air
- Chest pains
- Chest palpitations
- Blue lips and/or fingertips
Asthma attacks can be transient or they can last for a long while. The longer an attack continues, the more it can affect breathing and may result in an emergency. If someone is having an asthma attack, here are some steps to take:
- Remain calm and if the person has an inhaler, have them use it.
- Keep them comfortable by loosening their clothing, getting them to sit upright, and opening windows or letting fresh air into the room.
- In the case of a severe attack, inhalers may not help to provide relief to the individual. This can become life-threatening if not treated properly. Do call for an ambulance or bring the individual to the doctor immediately.
Asthma attacks can be prevented by taking medication to help manage symptoms.
Asthma Treatment & Management
Asthma treatment is usually long term. Treatment involves medication, and the use of monitoring devices to check lung function and degree of asthma control.
Medication can help by reducing airway inflammation, or by causing the muscles around the airways to relax, relieving airway constriction. Medications prescribed by the doctor can do either one of these, or help with both areas, depending on the severity of asthma. It is important to note that medication can come with risks or side effects.
There are a few types of medications the doctor may issue to someone with asthma:
Quick Relief Medicine
These are used to relieve sudden asthma symptoms, and often work by relaxing the muscles around the airways to help the individual with breathing. Short-acting beta2-agonists (SABAs), a type of quick relief medicine, is often used for this purpose. It is consumed through an inhaler. It is important to keep track of how often the quick relief medicine is being used, as increased usage of this may indicate worsening asthma. Generally speaking, quick relief medicine should not be used more than twice a week.
Long-term Control Medicine
Long-term control medicine is used to prevent asthma symptoms. They usually work by reducing airway inflammation, and are taken daily regardless of whether or not the individual has symptoms. Some long-term control medicine may work by regulating the immune system. Some examples of long-term control medicine are anti-inflammatories, or bronchodilators.
If asthma symptoms are not well managed by long-term control medicine, combination medicine may be prescribed by the doctor. Combination medicine helps treat asthma by using more than one medication at a time, and is often taken daily for symptom prevention. They may be taken through an inhaler device, and are different from the inhalers used in taking quick relief medicines.
Sometimes, other medicines such as prednisone (a corticosteroid) are prescribed by the doctor to assist with managing asthma. It is important to check with the doctor on the side effects and risks of consuming such medication. For example, long-acting beta2-agonists (LABAs) are sometimes ordered by the doctor for asthma to help prevent asthma symptoms, but do come with an increased risk of death from asthma problems.
Medications are usually given through a delivery device, which helps the user to take the medication. Some examples of delivery devices are dry-powder inhalers, spacers, nebulizers, and metered-dose inhalers. They all help with administering the medication so that it reaches the lungs.
Besides treatment with medication, ensuring asthma control is important as well. Asthma control is achieved when asthma symptoms become less frequent, and do not hold an individual back from participating in life’s activities. Monitoring devices can help indicate the level of asthma control by measuring how strongly one can exhale, and are used by doctors and the individual in managing asthma. Examples of monitoring devices include:
This measures the rate and volume of air flowing out of the lungs when someone exhales. It helps to assess how well the lungs are working.
Peak Flow Meter
This device checks how fast air can move out of the individual’s lungs. Readings from these help to determine whether changes to the present asthma management plan is needed, e.g. changing medications.
In addition to prescribed medications, there are steps an individual can take in reducing the risk of asthma attack. These steps generally focus on improving the overall health of the individual:
- Eat a healthy, balanced diet to improve overall health.
- Ensure that weight is within the healthy range – asthma tends to be worse in obese individuals.
- Quit smoking. Cigarette smoke is one of the triggers of asthma.
- Manage stress, as stress can be a trigger for asthma symptoms, or make stopping an attack even more difficult.
Some strategies to prevent asthma attacks are:
- Avoiding triggers, to prevent an attack.
- Staying away from chemicals, scents, or products which have caused difficulties breathing
- Staying away from known allergens.
- Considering allergen immunotherapy, which involves getting allergy shots to help change the immune system to be less sensitive to any triggers encountered.
- Taking medication to prevent asthma attacks, which are prescribed by the doctor.
Asthma attacks anytime, anywhere when one is not careful and aware of its possible triggers. Knowing the triggers and how to prevent these attacks is crucial in avoiding any health complications it may cause. Prevention, as always, is better than cure.
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- Asthma & Allergy Association. (n.d.). Asthma & Allergy Association | About Asthma. Retrieved May 27, 2021, from http://www.aaa.org.sg/about-asthma/
- Asthma Singapore. (n.d.). Asthma Control Singapore | Coping Is Not Controlling. Asthma Singapore. Retrieved May 27, 2021, from http://www.asthmasingapore.com/
- Healthhub. (2021, May 25). Asthma (Common Childhood Illnesses). https://www.healthhub.sg/a-z/diseases-and-conditions/695/common-childhood-illnesses-asthma
- Healthline. (2020, May 28). What Do You Want to Know About Asthma? https://www.healthline.com/health/asthma#types