Dr Vaibhav Rahim on bronchial asthma, what causes it, what are it’s symptoms and the treatment guidelines

Aairah KhanOctober 13, 2021

4 minutes read

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

1. A wide variety of allergens can be held responsible for triggering the attacks of asthma.

They are mainly pollen, smoke, pollution, house dust, mites, moulds & fungus, fur of animals, etc.

Humid or cold weather can also exaggerate the attacks.

2. Food allergies, can lead to hypersensitivity reactions, thereby causing bronchospasm and an acute attack of asthma. Most common food allergies include, consumption of sea food (prawns, crabs) , peanut, etc.

Food preservatives may also cause asthma attacks.

3. Few patients are hypersensitive towards medicines like aspirin, antibiotics, anti inflammatory, & beta blockers.

4. Emotional stress & acute anxiety may precipitate asthma.

5. Chronic acidity or acid peptic disease can also produce reflux of food into throat and trigger asthmatic attacks.

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.

● The coughing spells maybe for shorter or a little longer period of time, but they usually improve by taking medication and rest.

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)

1. There will be increased respiratory rate and effort for taking deep breaths.

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.)

3. The patient may present with nasal congestion or eye congestion if the asthma is allergic in origin.

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.

2. X-ray chest to see the condition of lungs and if there is patchy pneumonia coexisting with asthma. in longstanding asthma the chest may show emphysema.

(sometimes the x-ray may also show pneumo-thorax due to rupture of emphysematous bullae)

3. If an elderly patient comes with a recent history of asthma like attack, then a CT scan has to be done to rule out any malignancy.

4. Pulmonary function tests may show obstructive pattern in spirometry.

5. Sinus x-ray can be done to rule out sinusitis.

6. ENT check up is necessary to confirm sinuses disease.

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)

1. Finding out the underlying cause (an allergen) has proven effective in proceeding the treatment of an asthmatic patient.

The agents can be pollution, allergens or any other factors.

2. An asthmatic should avoid sudden change of weather

3. If the patient has an underlying viral or bacterial infection, it should be treated by appropriate antibiotics.

4. Bronchodilators & mucolytics have proven useful for clearing airways in patients.

5. In severe cases, cortico-steroids can be used.But are not recommended for prolonged usage.

6. Various inhalers for treatment are available in the market, which contain bronchodilator drugs or combination with steroids. Inhalers are very easy & convenient to use.Proper use of inhaler may avoid the attacks.

7. Nebulization has also been proven as an effective form of treatment, specially for small children & elderly which can not take inhaler in a proper way.

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.