Asthma is a long-term condition that is characterized by periodic, usually frequent and persistent, attacks of shortness of breath. The cause is a partial blockage of the bronchi and bronchioles caused by constriction of the muscles of their walls. Unlike bronchitis, in which there is constantly “playing” in the chest, asthmatic attacks come and go with great differences in the degree of “blockage” at different times. Although the condition is incurable, each attack can facilitate a treatment or, if untreated, usually passes by itself.
Asthma usually begins in childhood or adolescence, although in rare cases the first seizure can occur in middle age or later. Some seizures occur for unknown reasons. Seizures can cause allergic reactions to, for example, pollen, cat or dog hair, house dust; they can be caused by some infections (especially respiratory tract infection), certain medications, inhaled irritant, physical activity and emotional or mental disorders.
The main symptom is shortness of breath accompanied by a sense of painless tension in the chest, and ”playing” in the chest (the intensity is very different). Sometimes only a stethoscope can catch the sound of “playing”, and sometimes it can be so loud that you can hear in a room full of people. In severe cases the effort on the exhale (when “playing” the most expressive) can cause sweating, rapid pulse and a strong sense of anxiety. The patient often feels better if he/she sits upright torso, stiff arm to support the chest. With the increasing loss of breath, breathing becomes shorter and faster, and “playing” in the chest louder. During the severe attacks, the face and lips may turn blue (cyanosis) due to lower supply of oxygen to the bloodstream, and the skin can become very pale, cold and sticky.
Some asthma attacks are accompanied by moist cough due to accumulation of mucus (phlegm) in the lungs.
Asthma is very common among British school children, among whom 10% have at least occasional mild asthma. Most children are relieved of this condition while growing up until puberty, but in a small percentage of them asthma comes up again in adulthood.
The odds that you will get the asthma are highest if one of your closest relatives had asthma, hay fever or eczema and, of course, if you are suffering from some allergies, for example, hay fever or eczema.
A series of consecutive asthmatic attacks can be quite disabling for the patient. In the UK, about 2,000 people dies yearly during those seizures (although these are mostly elderly people and people who are already suffering from other diseases). Thanks to the modern advances in medicine, the risk of permanent disability or death is small if a patient takes the problem seriously and regularly goes to the doctor. Frequent severe attacks of asthma in children can prevent their growth and cause a bulge of the chest (which is popularly called the “chicken breast”), but also create an affinity for emphysema at a later age.
What to do?
Do not indifferently accept asthmatic attacks as an inevitable burden. Examine your disease, follow the instructions written in self-help paragraph below and contact your doctor whenever you suffer from heavy and persistent shortness of breath. Asthma is a disease easily kept under the control by a doctor, but only with your cooperation. Since you can never be sure whether the symptoms that you have suffered from at home will be present half-hour later, when a doctor puts a stethoscope on your chest, you will need to describe clearly the cause and type of shortness of breath. If, for example, you already have chronic bronchitis, then the shortness of breath can be attributed to bronchitis – sounds that can be heard with a stethoscope similar – unless if you do not tell the doctor that the shortness of breath occurs but disappears, as opposed to the constant heavy breathing which is a symptom of chronic bronchitis.
Self-help: since asthma usually occurs due to some form of allergy, the first thing you need to do is to discover the allergen (a substance or substances that cause allergies) that bothers you. Your doctor can help by sending you to the skin tests that will examine the allergens to which you suspect, but you can probably make a good part of the ”detective” work alone. Does your asthma changes with regard to annual periods, and do you have and hay fever? If so, allergens are probably pollen grains. Are they occuring more frequently on certain days of the week? This probably means there is a connection with the dust on the job (for example, flour in the bakery) or hobby (for example, flowers in a greenhouse). Is the situation worsening when you’re in particular room? Many asthmatics are allergic to fur or feathers, pet or house dust mites (mites live on the skin apostate).
Other possibilities to think about are food or drink allergies. It has been proven that, for example, shellfish, eggs and chocolate provoke seizures in susceptible people.
No matter what you suspect, you can examine your assumptions by keeping the track of the frequency and severity of asthma attacks, and thus discover the extent to which they occur simultaneously while exposuring to a suspected allergen or allergens. The severity of seizures is best measured by small-meter maximum speed expiratory flow of air. By measuring the maximum volume of air in a gasp, such gauges can help asthmatics to keep an accurate record of the narrowing of the airways in the lungs.
When you discover the allergen, the ideal solution is to avoid further exposure to the allergen. It will be easy if the allergen is a food or a domestic animal, but the problem becomes very difficult if the allergen is pollen; during the days when the content of pollen in the air is high, there is no way to avoid it but to stay all day in the house. In collaboration with a doctor, you will need keep most of the symptoms under control.
Even if you can’t detect the allergen, you can lower the number of seizures by reducing the amount of dust in the house. Replace feather-stuffed pillows and mattress which can be full of mites should be covered with impermeable plastic trim. Remove dust from the cracks and buy vacuum rugs and carpets from which is easy to clean dust. Beware and other factors that may cause asthma, for example, some physical activity or psychological stress.
Professional help: as soon as the diagnosis is set (accurate records of your symptoms and possible allergens can help the doctor make a diagnosis with no allergy test), it can help you significantly. In recent years the treatment of asthma has significantly advanced with the introduction of new drugs that can be taken as pills, liquid or as inhalants. Some medicines (known as prophylactics) are taken regularly to prevent asthma attacks. Corticosteroid prophylactics are inhaled three or four times daily.
Since the drug is inhaled, it acts directly on the lungs (and only in the lungs); thus avoiding the side effects of general tablets or injections. Other drugs (e.g. bronchodilators) are best for those people who get seizures only occasionally, and are taken only when the attack begins. Your doctor will decide which type of drug will be determined by your description of appearances of difficulty breathing.
The best way of applying the prophylactic or bronchodilator is inhalation because the inhalation acts directly on the location of obstruction; however, people who find it difficult to inhale can take them by mouth. If no pills, nor liquid nor the inhalation does not alleviate the severe asthma attack, the drug can be injected into the bloodstream and it usually always helps. If it is clear that your asthma attacks occur due to an allergen such as, for example, grass pollen, lungs can desensitize against that allergen by long injection therapy. But, already mentioned drugs have proven to be so effective that doctors rarely recommend desensitization to treat asthma, mainly because the success rate is rather low and somewhat unpredictable.
However, despite the success of modern drug therapy, sometimes asthma attack can be so strong that the patient receives is justified in the hospital where the treatment is easier than at home. Some types of drug therapy are most effective when applied as a fine mist through a breathing apparatus, which requires proper handling and maintenance. If necessary, the patient will be in the hospital to get medication for muscle relaxation, and will be connected to a mechanical respirator. This form of treatment disappear spasms in the lung airways and soothe the muscles of the chest, since the breathing is performed by machine. The presence of medical staff 24 hours a day can alleviate anxiety that makes the attacks even harder.
What to do during the severe asthma attack?
A sudden, severe attack of asthma may be frightening for patients and their families. In most cases, the physician will determine the inhalation remedy (corticosteroid or bronchodilator). If one inhalation does not ease the breathing quicky, the dose should be repeated. If the second dose does not help, inhalation should not be used anymore (overdose can be dangerous). Instead, someone from the family should immediately react as follows:
– If the patient has turned blue or pale, and if it’s a cold sweat beaded, call the emergency. The patient should immediately go to the hospital.
– If the patient has not turned blue, or pale and not in a cold sweat, phone the doctor or the duty hospital. Gather the medicines and inhaler, and record the time when the patient is taking the first dose.
In any case help the asthmatic, while waiting, to find the most comfortable position. Patients are usually most comfortable when sitting upright and slightly leaned forward, relying on the hands. Ensure fresh air. If there are worried people arround, do not allow them to come near the patient because that will increase his/hers anxiety. A reasonable person should be with the patient.