Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments. Airway inflammation and resulting narrowing air passages lead to symptoms like wheezing, cough - chronic or recurring that is worse at night and in the early hours of the morning, pain or a tight feeling in the chest, shortness of breath, flaring of the nostrils when breathing in, interrupted talking, agitation and hyperinflation i.e appearance of hunched shoulders or not preferring to lie down.
A thorough physical examination and medical history of the patient, chest x-rays, laboratory tests (blood and allergy tests) and repeated careful measurement of the exhalation using spirometers and peak flow meters will help in the diagnosis of asthma. The first step in asthma management is environmental control. By keeping the house clean, avoiding pets, washing the bedding weekly in hot water, using dust proof covers for mattress, pillows, replacing upholstered furniture with leather or vinyl, removing carpets and keeping the humidity low one can avoid or eliminate some of the common allergens like dust mites, molds, animal dander, pollen etc that trigger an asthmatic response.
The second step is to monitor lung function with the help of the peak flow meter. A decreased lung function (down by 20pc or more) is an indicator of an impending attack. The third step in managing asthma involves the use of medications. There are two major groups of medications used in controlling asthma, anti-inflammatories and bronchodilators.
Anti-inflammatory drugs reduce the number of inflammatory cells in the airways and prevent blood vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the spontaneous spasm of the airway muscle. Leukotriene inhibitors like Zafirlukast and zileuton are a class of anti-inflammatories that work by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle cells lining the airways. These drugs prevent rather than reduce symptoms and are intended for long-term use. Cromolyn sodium and nedrocromil are inhaled anti-inflammatories. Corticosteroids are also used to treat inflammation and are given as inhalers or oral tablets. Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases to and from the lungs. The short-acting bronchodilators such as metaproterenol, ephedrine, terbutaline and albuterol are inhaled to relieve symptoms during acute asthma attacks. The long-acting bronchodilators like salmeterol, metaproterenol and theophylline control symptoms in special circumstances, such as during sleep or when intensive exposure to a particular irritant can be predicted.
Knowing early warning signs or mild symptoms is helpful as treatment and other interventions can begin early. Early treatment is most effective. If severe symptoms are present, it is vital to begin the appropriate treatment immediately.
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