Breathing is a complex process. The air we inhale travels through our nose and mouth and passes through the wind pipe also called as trachea. Trachea then divides into two braches called as bronchi or airways or bronchial tubes. These bronchi pass through the lungs and divide into smaller tubes called bronchioles. These bronchioles further divide and end in sac like balloons called alveoli. Your body has around 300 million alveoli. These alveoli are surrounded by mesh like blood vessels called capillaries where oxygen from the air is passed on to the blood and waste gases such as carbon dioxide and water vapor are collected and passed out when you exhale. The oxygen is carried to all the cells of the tissues and organs in the body through blood.
Asthma is an incurable, long-lasting disease of the lungs affecting the bronchial tubes or the airways. During normal breathing, the bands of the muscle that enclose the airways are relaxed and facilitate free flow of the air. Following changes take place during the episode or attack of the asthma.
- Bronchospasm: The muscular bands that encase the airways become constricted and tighten the airways obstructing the free flow of the air. This is called bronchospasm.
- Inflammation: The inside layer of the airways become inflamed and get swollen.
- Mucus: The cells of inner layer of the airways produce sticky, thicker than the normal and more mucus.
All of the above issues namely bronchospasm, inflammation, and mucus production can result in breathing problems such as breathlessness, panting, coughing, wheezing (whistling sound during breathing), intolerance of daily activities and sometimes fatality.
Asthma treatment
Though asthma cannot be cured, it can be controlled or managed by taking proper medications. The right medications depend on numerous factors such as your age, symptoms and asthma triggers. Asthma medicines are classified into two kinds. Medicines that stop symptoms of asthma which are called quick-relief medicines or rescue medicines and the other kind of medicines are those that prevent occurrence of asthma which are termed as long-term control medicines or controller medicines. Quick relief medicines provide quick relief of the swollen airways that cause breathing problems and controller medicines decrease the inflammation of the airways causing symptoms of asthma.
Asthma controller medicines
Controller medicines need to be taken regularly every day to prevent asthma symptoms from being manifested. There are various types of controller medicines and each type works in a unique and special way to prevent asthma symptoms. These include:
- Inhaled corticosteroids (ICS): These medications are synthetic steroid hormones that have anti-inflammatory properties. They are effective, safe, and are mainly prescribed for children and adults suffering from asthma. Some of these medications are beclomethasone, fluticasone, budesonide, mometasone, flunisolide and others. These medications need to be used for a long-term for obtaining maximum results.
- Lieukotrien antagonists: Lieukotrien is a fatty substance produced by immune system that causes inflammation and swelling of the airways. These drugs block lieukotriens from causing the inflammation and used along with corticosteroids to relieve the symptoms of moderate to severe asthma. These include medications such as montelukast, zafirlukast and zileuton.
- Long-acting beta agonists (LABAs): These medications cause relaxation and dilation of the smooth muscles that encircle airways and allow free passage of the air flow. These inhaled medications include salmeterol and formoterol
- Immunomodulators: These medications bring about the changes in the responses of the immune system to the asthma triggers by reducing the response of antibody IgE (antibodies are various types of substances produced by the white blood cells) responsible for the asthmatic episode. An example of this immunomodulator is omalizumab (brandname Xolair).
Asthma rescue medicines
These are also termed as quick relief medicines and used for immediate and quick relief of symptoms during episodes of asthma or may be before you resort to exercise as advised by your doctor. With quick relief medicines, you may feel better or relieved for a shorter period. These medications may stop the episodes. If you use quick relief medications every day, it means that you are in need for medications for long-term control of asthma.
These medications include:
- Short-acting beta agonists: These medications dilate the bronchi and when inhaled provide immediate symptomatic relief. These include albuterol, levalbuterol and pirbuterol. These medications act within minutes of inhalation and effects last for many hours.
- Ipratropium: Ipratropium dilates the bronchi, making breathing easier. Your doctor may prescribe this inhaled medication for quick relief of your symptoms. This medication is used for in the cases of inflammation of the bronchi, emphysema (obstructive lung disease) and to treat episodes of asthma.
- Oral and intravenous corticosteroids: These include synthetic steroid hormones, prednisone and methylprednisolone. These medications alleviate inflammation of the airways induced by severe asthma. As these cause severe side effects if used for a long-tem, these are only prescribed for short term relief of asthma symptoms.
Managing asthma
You can manage asthma attacks by following simple steps. Make a plan. As asthma is an ongoing disease, consult your doctor and medical team, and formulate an action plan as to what you should do in case of asthmatic attack and strictly adhere to the plan. Revise the plan in case of any shortcomings. Exposure to various asthma triggers such as pollens, dust, fumes, polluted air, molds and various allergens and irritants can result in asthmatic attack. Hence, you need to identify these triggers first and take necessary steps to avoid them as far as possible.
Monitor your breathing and take a note whether you have any breathing problems such as wheezing, cough or breathlessness. These initial symptoms may indicate an impending attack of severe asthma. May be sometimes you need to use peak airflow meter. When you identify an impending attack of asthma, act fast to take quick relief medicines to get prompt relief. If possible, keep yourself away from any exposure to the irritant that caused the asthma attack. Even if you feel that the symptoms have improved, you must continue to follow the instructions of your doctor and take the controller medicines as advised in the correct dosage and frequency. If you are increasingly using quick relief medicines or relying more on them, you must see your doctor as you may need to take medicines for long-term prevention.
Using a Spray Inhaler
Asthma medicines may be taken through inhalers. Following are the basic steps as to how you can use spray inhalers.
- Hold the inhaler upright after removing the cap
- Shake the inhaler
- Bend your head backwards and exhale
- Keep the inhaler 1 or 2 inches away if you are not using a spacer. If you are using a spacer then put the exposed end of the spacer into your mouth, and wrap your lips around it.
- Push the inhaler down to release the medicine as gently as possible for 3 to 5 seconds
- Once you inhale the medicine, hold your breath for 10 seconds so that the medicine can reach your lungs
• Repeat as many times as recommended by your doctor
Asthma emergency
If you do not get better, inform your doctor and if needed be get an emergency help. In case of the following signals and signs, call for emergency medical care right away.
- When you fail to get response from taking your quick relief medicine.
- Breathing becomes suddenly difficult, hard and fast
- If you exert increased efforts to talk or walk
- If your face, lips or fingernails turn blue
- When you breath, if your nose opens wide
- If the skin around your rib cage and neck gets tightened when you breath
- If your heart beat and pulse is elevated.
Summary
Asthma is a life-long disease of the airways of the lungs which cannot be cured. It is manifested by difficulty in breathing, coughing, wheezing and production of sticky thick mucus. Around 22 million Americans suffer from asthma including 6 million children. Asthma can be managed with the help of controller medicines for long-term treatment and for immediate relief with rescue medicines. You should make a plan as to how you should manage your asthma in consultation with your doctor and medical staff. If you observe any worsening symptoms, then call your doctor or emergency for immediate medical aid.
