Dr Vaibhav Rahim on bronchial asthma, what causes it, what are it’s symptoms and the treatment guidelines
What is Bronchial Asthma?
Asthma is a disease characterised by airflow obstruction that varies both spontaneously and with specific treatment.
Chronic inflammation of the airway leads to it’s hyper responsiveness to various triggers, leading to breathing difficulty.
Asthma is a disease of the respiratory system which basically causes cough, difficulty in breathing and chest pain (on and off).
it is a common disease of elderly as well as young people.
Patients may have intermittent symptoms , varying with the seasonal changes.
In long standing asthmatic patients, the symptoms become more persistent and patients start having relatively longer periods of discomfort.
Gradually, the acute attacks of asthma, become chronic and patients start suffering from repeated attacks of respiratory discomfort.
Incidence
The prevalence of asthma has increased significantly over the past few years.
In developed countries, approximately 10% of adults and about 15% children have asthma.
Many of the patients have a history of asthma since childhood.
What causes asthma?
There may be multiple factors which are involved in development of asthma.
These can be genetic & environmental
They are mainly pollen, smoke, pollution, house dust, mites, moulds & fungus, fur of animals, etc.
Humid or cold weather can also exaggerate the attacks.
Food preservatives may also cause asthma attacks.
4. Emotional stress & acute anxiety may precipitate asthma.
What complaints (symptoms) does an asthmatic patient present with?
● The common symptoms of asthma include cough, difficulty in breathing, tightness in chest, and if some respiratory infection is present patient may present with fever, cough and expectoration.
Most of the patients complain of having these symptoms usually in late evening or night and in early hours of the day.
These spells may get triggered due to smoking, inhaling polluted air, perfumes, smell of cooking masala etc.
● Seasonal asthma is quite common (commonly during the spring season) and the patient usually the remains asymptomatic during rest of the year.
Important: If the symptoms are very severe, there may be low amount of oxygen reaching to the lungs. In such cases, the patient must be immediately hospitalised!
(but this is seen only in 5 to 10% of total cases.)
● During the child bearing years there may be hormonal variations which can cause peri menstrual asthma and in post menopausal females, the asthmatic attacks usually improve.
What are the clinical findings of an asthmatic patient?
During the examination of an asthmatic patient, the doctor usually rules out an Upper respiratory tract infection, throat congestion or pharyngeal congestion.
(If the etiology of viral origin is suspected, then patient may have fever along with the respiratory signs, seen in patients of COVID19, SARS, and MERS infections)
There will be shallow breathing along with wheeze.
2. Lungs may have a peculiar sound which is known as ronchi.
A ronchi may be evenly heard all over the chest or there may be Variable intensity of ways.
(The ronchi may not be heard if the bronchospasm is very severe as there is no significant air entry in the Lungs.)
4. In a condition known as status epilepticus, the patient will present with excessive and continuous respiratory difficulty, and requires immediate hospitalisation.
What Investigations will a doctor suggest to an asthmatic patient?
Investigations suggested by the consulting physician, are useful in finding out the underlying cause of bronchospasm or asthmatic attacks.
1. Complete blood picture to see the total WBC count, and eosinophils.
(sometimes the x-ray may also show pneumo-thorax due to rupture of emphysematous bullae)
7. Allergy test can be done to rule out a specific cause for asthma, allergy tests are done for various type of food, dusts, mites, fungus and animal furs.
How to go about treating an asthmatic patient? (Treatment guidelines)
The agents can be pollution, allergens or any other factors.
8. Hospitalisation is mandatory if patient has severe attack, severe cough & infection which is not improving by routine opd treatment.
(Oxygen requirement is essential for such patients)
Take away points
Asthma is a chronic disease which needs regular care & medications.
This disease has been affecting a large population of almost all ages.
Severity of the disease and its acute attacks, may vary from mild to severe.
Nowadays with a wide variety of medications & availability of different therapies, a patient can lead a comfortable life.
If the source of allergy is recognised, almost half the battle is fought.
