What is asthma?
To understand asthma, it is very helpful to know how the respiratory tract. These are tubes that carry air in and out of the lungs. People who have asthma have inflamed airways, so they are swollen and very sensitive. Because of this, they tend to react strongly to certain inhaled substances, tensing the muscles that surround them. When this happens, the airways narrow and therefore there is a decrease in airflow at the lung level. In addition, the cells of these ducts responsible for the production of mucus will increase their work, so that the lumen of the respiratory tract will decrease even more.
This obstruction can be generated by various circumstances or by exposure to different substances in the environment. The course of the disease is variable, alternating periods with intense symptoms with others without discomfort.
Prevalence
According to WHO data, asthma currently affects 235 million people, making it the seventh most prevalent disease in the world.
How and why does it appear?
The initiation of the mechanism is not fully known, but it is known that substances known as chemical mediators of asthma are involved in its appearance, which are produced by eosinophils (a type of white blood cell), which in collaboration with lymphocytes and mast cells (another type of cells), are deposited in the bronchi causing inflammation. This inflammation causes a narrowing and irritation in the bronchial walls, making it difficult for air to escape.
It is necessary that there is a genetic predisposition and come into contact with substances that cause bronchial inflammation to suffer from this pathology. The bronchi of an asthmatic person are very sensitive, so a crisis can be triggered by multiple circumstances (for example, exercise, laughter, tobacco...).
Symptom
The symptoms of the disease are more frequent at night or when exercising. The most frequent are
- Dyspnea: Choking or difficulty breathing. Which can be mild or intense.
- Repetitive episodes of cough, usually dry and persistent.
- Wheezing: Whistles or noises in the chest produced when air comes out through the bronchi narrowed by inflammation.
- Tightness or tightness in the chest.
These symptoms may appear at the same time or not, depending on each patient.
Asthmatic exacerbations or crises are episodes of worsening caused by increased inflammation of the bronchi, which implies greater difficulty for air to escape.
There are differences with childhood asthma that will be dealt with in a different section.
Diagnosis
When a person suffers from any of the symptoms described above, they may have asthma, so it is convenient to perform a spirometry.
Spirometry is a non-invasive, simple, cheap, standardized, reproducible and objective test that measures airflow limitation. It must be performed by a trained professional both for the use of the instruments and for the technique, thus ensuring that the test has a good quality and therefore results with clinical value.
It consists of taking as much air as possible and quickly blowing through a tube until the lungs are as empty as possible. Among other data, this test measures lung capacity (Forced Vital Capacity or FVC) and the volume of air expelled in the first second (Maximum Expiratory Volume in the first second or FEV1), which are essential to assess asthma.
If the person performing the spirometry has inflamed bronchi, the air will take longer to leave the lungs than under normal conditions, which is detected by the spirometer. If this is the case, a bronchodilator test will be performed, which consists of doing another spirometry after the administration of a bronchodilator drug. Once performed, both tests are compared and whether a reduction in obstruction is observed. If this is the case, it is very possible that it is a case of asthma since this pathology is characterized by the reversibility of bronchial obstruction.
Sometimes it is advisable to carry out other tests such as:
- Bronchial hyperresponsiveness tests: It is evaluated if there is an exaggerated response of the bronchi after the controlled inhalation of substances that can cause bronchial obstruction.
- Measurement of the fraction of exhaled nitric oxide (FENO): It informs us of the degree of bronchial inflammation
disease control
By using a PEF meter (Maximum Expiratory Flow) you can control your lung function since with it you can assess whether there is a greater or lesser pulmonary obstruction. The data obtained is recorded on record sheets, along with the medication taken and the symptoms, which will help to have a good control of the disease.
Classification
It can be classified based on:
- La gravity, that depends of:
- Symptom intensity.
- Need to use reliever medications.
- Results of lung function tests.
- Limitations in daily activities.
- Existence of periods of worsening, exacerbation or crisis.
Depending on the duration and intensity of its manifestations:
- Intermittent: Has disease-free periods
- Persistent: Lacks disease-free periods
- Marginal
- Moderate
- Grave
- According to controls that is, depending on whether or not it allows you to lead a normal life. To determine this control, regular follow-up medical visits are necessary. To assess this control, the Asthma Control Test and the Asthma Control Questionnaire are used. It's divided in:
- well controlled
- partially controlled
- Not controlled
Allergy
Allergy is a disproportionate response of the body to a substance, called an allergen, which is harmless to other people. The organism has to be sensitized for this reaction to occur. There are many allergens that can trigger asthma, but not all people with asthma have an allergy and not all allergy sufferers have asthma.
How can asthma be controlled?
If asthma is treated correctly, it can be controlled, which will allow us to lead a normal life. Care must be taken to avoid allergens and asthma triggers and use medications when necessary.
When asthma symptoms appear it is because a narrowing of the bronchi is taking place. To alleviate this situation, relievers or bronchodilators will be used, which relieve discomfort by dilating the bronchi but do not improve asthma. To decrease inflammation and make the bronchi less sensitive, anti-inflammatory medications must be taken continuously. If these medications are stopped, the bronchi become inflamed again and discomfort appears. For this reason it is essential not to leave the medication.
How to avoid crises?
It is very important that each person knows which are their triggers that increase inflammation of the bronchial tubes (allergens, tobacco smoke, viral infections...) and those that narrow them without increasing inflammation (physical exercise, laughter...), and know how to avoid them .
Some of the triggers are:
- Tobacco: it is the main trigger to avoid, as it increases inflammation of the bronchi. Asthmatics should not smoke or allow smoking in their presence. The child of a mother who smokes during pregnancy has a higher risk of being asthmatic. Control of the asthmatic smoker is more complicated.
- Pollens: it is convenient to know the pollination season of the responsible allergen, because outdoor activities should be avoided on the days or hours when pollen is most present in the environment.
- Mites: For patients allergic to mites it is advisable to carry out special cleaning measures to reduce exposure
- Pets: Patients with allergies to these animals should avoid living with them.
- Fungi: It is advisable to reduce the environmental humidity (<50%), avoid humidifiers and use anti-fungal paints on the damp walls.
- Cockroaches: can be associated with a worsening of asthma. It is convenient to avoid chemical insecticides and use poisons such as boric acid.
Other treatments
- Flu and pneumococcal vaccination.
- The flu medicine has not shown efficacy in preventing asthma attacks, although its administration is recommended in people over 65 years of age and in people with severe asthma under 65 years of age.
- Anti-pneumococcal is not recommended in asthmatics under 65 years of age.
- Alternative medicines. There are no scientific studies that have shown that these types of treatments have real benefits in the treatment of asthma. They can be used as long as the normal treatment prescribed by the doctor is not abandoned.
What to do in case of an exacerbation?
If symptoms and lung function worsen, a crisis is beginning. It is very important to take a quick action and not wait for it to pass on its own.
There are three different types of crises, against which the mode of action is also different:
- Mild: Mild discomfort that does not prevent the performance of activities of daily living. It is treated by taking the relief medication and carrying out the self-treatment plan prescribed by the doctor.
- If there is improvement in symptoms, no other measures will be necessary.
- If there is no scheduled plan or there is no response to treatment, you should go to the Emergency Department. Here fast-acting bronchodilators will be applied every 20 minutes. If he improves, he is sent home and if the protocol for moderate crises is not followed.
- Moderate: Discomfort is more intense and prevents you from doing some usual activities, they can even appear without doing anything. The treatment in this case is to take the relief bronchodilator (4 inhalations followed with an inhalation chamber and repeat it every 20 minutes).
- If the response is not good or there is no self-treatment plan, you will go to the Emergency Department, where the same treatment as in serious crises will be applied.
Serious: Discomfort that appears at rest, even prevents you from speaking normally. If they are very severe, the lips will turn blue and you may lose consciousness. Treatment will begin with a relief bronchodilator (4 inhalations in a row with an inhalation chamber and repeat it every 20 minutes) and the other medications that are prescribed in the self-treatment plan and you will go to the hospital. Once there, oxygen will be put on and relief bronchodilators and glucocorticoids will be administered. Depending on the response to treatment, the patient will be discharged or admitted to the hospital.
More Information
SEPAR Foundation. Publication “Controlling Asthma” http://www.separ.es/biblioteca-1/bibliotecaparatodos
European Lung Foundation. http://www.europeanlung.org/
Associations
Catalan Asmatological Association (AAC)
La Palma St. Genís, 1
08035 Barcelona
Telephone: 934 510 993 / 609 166 166
Contact: asthmatics@asmatics.org
Web: www.asmatics.org
Association of Allergy and Asthmatics of Jaén (ALERJA)
C/ Architect Berges, 34 A, Low
23007 Jaen
Telephone: 675 82 87 15.
Contact: asalerja@yahoo.es
Web: www.alerja.es
Association of Allergy and Asthmatics of Malaga (ALERMA)
C/ Góngora, 28 Low
Málaga 29002
Telephone: 657 57 52 24
Contact: alerma2009@gmail.com
Web: www.asalerma.es
Association of Asthmatics of the Principality of Asturias (AAPA)
Avda. de Galicia, 10, 7th
33005 Oviedo (Asturias)
Telephone: 608 471 472
Contact: palicio@telecable.es
Association of Asthmatics of Palma de Mallorca
Portugal Avenue
07001 Palma de Mallorca
Telephone: 977 717 102
Association of Asthmatics of Madrid (ASMAMADRID)
C/ Moreto, 4, 1st floor, Classroom 1
28014 Madrid
Telephone: 618 515 101
Contact: asmamadrid@asmamadrid.org
Web: www.asmamadrid.org
Association of Asthmatics and Allergies of the province of Huelva
Via Paisagista, s/n
21003 Huelva
Telephone: 959 280163
Web: www.asmaler.galeon.com
Spanish Association of Allergy to Food and Latex
Manzanares Avenue, 58 28019 Madrid
Phone: 915 609 49
Contact: aepnaa@aepnaa.org
Web: www.aepnaa.org/aepnaa.html
Galician Association of Asthmatics and Allergies (ASGA)
C/ Mayor Abella, 24, low
15002 A Coruna
Telephone: 981 228 008
Contact: maeve@mundo.com
Web: www.accesible.org/asga
Navarra Association of Allergy and Asthmatics (ANAYAS)
C/ Sancho el Fuerte, 26, 1º, office 9
31008 Pamplona (Navarre)
Telephone: 948 277 903
Outdoor Asthmatics Association
PO Box 2094 Granada
Telephone:958 441 240
Contact: rafagarciaga@terra.es
Web: www.airelibre.org
Catalan Asmatological Association
C/ La Palma de Sant Genís, 1
08035 Barcelona
Telephone: 93 451 09 93 and 609 166 166
Contact: asthmatics@asmatics.org
Web: www.asmatics.org/
European Federation of Allergy and Airways Diseases Patients' Associations (EFA)
35 Rue du Congres
1000 Brussels (Belgium)
Telephone: +32 (0) 2 227 2712
Fax + 32 (0) 2 218 3141
