Asthma: Causes, Symptoms, Diagnosis, and Treatment

Asthma is a chronic disease of the respiratory tract that makes sufferers difficult to breathe. Asthma disrupts the airways, which causes the airway muscles to contract, narrow and become inflamed or produce mucus.

Based on the 2013 Basic Health Research, the prevalence of asthma in Indonesia is 4.5% of the population, with a cumulative number of asthma cases of around 11,179,032. Asthma affects disability and premature death, especially in children aged 10-14 years and parents aged 75-79 years. Beyond this age, early mortality is reduced, but it has more disability effects.

Causes of Asthma

The exact cause of asthma is unknown, but asthma is often the result of a strong immune system response to allergens in the environment.

The following are the factors that cause asthma, including:

1. Genetics/Heredity

The first cause of asthma is genetics. If parents suffer from asthma, you are more likely to experience asthma later in life. Several genes are involved in how the immune system responds to allergens. These genes can cause stronger reactions in the airways.

2. Immune System

Asthma symptoms occur when the airways to the lungs constrict, making it harder for sufferers to breathe. This narrowing is usually caused by inflammation that makes the airways swell and cause airway cells to make excess mucus.

Bronchospasm or tightening of the muscles around the airways also make the airways narrow and cause difficulty breathing. Over time, if asthma remains active, the airway wall can become thicker.

3. Allergy

A study published in the Annals of Asthma, Allergy, and Immunology shows that more than 65 percent of adults with asthma over the age of 55 also have allergies, and that number is close to 75 percent for adults between the ages of 20 and 40 years.

Common sources of allergens in the room include animal protein, mostly from cat and dog hair, mites, dust, cockroaches, and mold.

4. Smoking

A study conducted by the Partners Asthma Center revealed that cigarette smoke is associated with an increased risk of asthma, wheezing, respiratory infections, and death from asthma. In addition, children of parents who smoke have a higher risk of developing asthma.

Smoking makes the effects of asthma in the airways worse by adding coughing and shortness of breath to the symptoms, as well as increasing the risk of infection due to excess mucus production.

5. Environmental Factors

Air pollution both inside and outside the home can have an impact on the development and triggers of asthma. Allergic reactions and asthma symptoms often occur because indoor air pollution comes from mold, cleaning, or paint.

Other triggers for asthma in the home and environment include:

  • Sulfur dioxide.
  • Nitrogen Oxide.
  • Ozone.
  • Cold temperature.
  • High humidity.

6. Obesity

A study conducted by the National Institutes of Health revealed, there is a relationship between obesity and asthma. The research shows that the inflammatory mechanism that drives asthma is also linked to obesity.

7. Stress

People who experience stress have higher levels of asthma. The increase in behavior associated with asthma during stress — smoking — might explain why this is related. In addition, emotional responses including laughter and sadness can also trigger asthma attacks.

8. Menstrual Cycle

One type of asthma known as perimenstrual asthma causes acute symptoms during the menstrual cycle and certain sensitivity to aspirin.

Sex hormones circulating during menstruation, such as luteinizing hormone (LH) and follicle-stimulating hormone (FSH), have an impact on immune activity. This increased immune action can cause hypersensitivity in the airways.

Triggers of Asthma

In addition to several causes as above, here are some conditions that can trigger asthma, including:

  • Airborne substances such as pollen, mites, dust, pet dander or cockroach waste particles.
  • Respiratory infections, like the common cold.
  • Physical activity (asthma due to exercise).
  • Cold air.
  • Air pollutants and irritants, such as smoke.
  • Certain medications, including beta blockers, aspirin, ibuprofen and naproxen.
  • Sulfites and preservatives are added to some foods and drinks.
  • Gastroesophageal reflux disease, a condition where stomach acid returns to the throat can trigger asthma.

Risk Factors

A number of factors are considered to increase your chances of developing asthma, including:

  • Have other allergic conditions, such as atopic dermatitis or allergic rhinitis (hay fever).
  • Become a passive smoker.
  • Exposure to chemicals used in agriculture, hairdressing and manufacturing.

Asthma Symptoms

How often asthma signs and symptoms occur depends on how severe, or intense asthma is, and whether you are exposed to allergens. Some people have symptoms every day, while others have symptoms only a few days a year.

For some people, asthma can cause discomfort but does not interfere with daily activities. However, if you suffer from more severe asthma, it can interfere with daily activities.

When asthma is well controlled, it may not cause symptoms. When symptoms worsen, it is called an asthma attack, exacerbation, or relapse. Over time, uncontrolled asthma can damage the lungs.

The following are the characteristics of asthma, among others:

  • Asphyxiate.
  • Coughing, especially at night or early morning.
  • Shortness of breath.
  • Wheezing, a condition that causes whistling sounds when exhaling.

Asthma attacks are episodes that occur when symptoms worsen. Asthma attacks can occur suddenly and can be life threatening. People who suffer from severe asthma experience asthma attacks more often.

The pattern in asthma symptoms is important and can help doctors make a diagnosis. Watch when symptoms occur:

  • At night or early morning
  • During or after exercise.
  • During certain seasons.
  • After laughing or crying.
  • When exposed to ordinary asthma triggers.

When is the Right Time to See a Doctor?

Severe asthma attacks can be life threatening. Therefore, signs of emergency asthma include:

  • Rapid worsening of breath or wheezing.
  • There is no improvement even after using an inhaler like albuterol.
  • Shortness of breath when doing minimal physical activity.

Asthma diagnosis

Doctors can diagnose asthma based on medical history, physical examination, and the results of diagnostic tests. A history of asthma symptoms will help your doctor determine whether you have mild, moderate, or severe asthma. Severity is used to determine the treatment to be received.

1. Physical examination

To rule out other conditions such as respiratory infections or chronic obstructive pulmonary disease (COPD), the doctor will do a physical examination and ask questions about signs and symptoms and other health problems.

2. Lung Function Test

You may also be given a lung function test to determine how much air enters and exits when you breathe. These tests may include:

  • Spirometry This test estimates the narrowing of the bronchial tubes by checking how much air you can exhale after taking a deep breath and how fast you can breathe.
  • Peak flow. Peak flow meter is a simple tool that measures how hard you can breathe. A lower than normal peak flow reading is a sign that the lungs may not function properly and asthma conditions that may get worse. Your doctor will give you instructions on how to track and handle low peak flow readings.

3. Other tests

The following are other tests that can be done to diagnose asthma, including:

  • Methacholine challenge

The methacholine challenge is an asthma trigger test that will cause mild airway narrowing. If you react to methacholine, chances are you have asthma. This test can be used even if your initial lung function test is normal.

  • Nitric oxide test

Although not widely available, this test can measure the amount of gas, nitric oxide, that you have in your breath. When the airways get inflamed, you may have higher than normal levels of nitric oxide.

  • Imaging test

Chest x-ray and high-resolution computerized tomography (CT) of the lungs and nasal cavity (sinus) can identify any structural abnormalities or diseases (such as infections) that can cause or worsen respiratory problems.

  • Allergy test

This test can be done with a skin test or blood test. Allergy tests can identify allergies to pets, dust, mold, and pollen. If important allergens are identified, it can lead to recommendations for allergen immunotherapy.

  • Sputum eosinophils

This test looks for certain white blood cells (eosinophils) in a mixture of saliva and phlegm (phlegm) that you throw away when coughing. Eosinophils are present when symptoms develop and become visible when colored with rose coloring.

  • Provocative tests for exercise and asthma caused by cold

In this test, the doctor will measure airway obstruction before and after you engage in strong physical activity or breathe cold air several times.

Asthma Complications

Asthma complications include:

  • Permanent narrowing of the bronchial tubes (airway renovation) that affects how well you breathe.
  • Enter the emergency room or hospitalization for a severe asthma attack.
  • Side effects from long-term use of several drugs used to stabilize severe asthma.

So that complications do not occur, proper treatment makes a big difference in preventing short-term and long-term complications caused by asthma.

Asthma Treatment

The severity of an asthma attack can increase rapidly, so it is very important to treat it as soon as possible. The medicine for asthma attacks is a bronchodilator or widening airway muscle inhaler.

Early and aggressive asthma treatment is the key to relieving symptoms. Here are ways to treat asthma that can be done, including:

1. Asthma Medication

Asthma medication can work quickly to stop coughing and wheezing by thinning the airway mucus and opening the airway muscles. Consult with a doctor regarding dosage and drug use. Usually, this asthma medication that is taken is as a “symptom controller” and is not used when a disorder occurs.

2. Asthma Inhalers

Inhalers can be used alone at home. Pressing the inhaler button should be done when the asthma attack and after exhaling. When sprayed while exhaling, the next moment is when the patient inhales so that the medicine will actually enter. If sprayed while inhaling, pressing the button may be too late and the medicine is actually wasted.

3. Nebulizer for Asthma

The next way to treat asthma is to use a nebulizer. Nebulizer is a device to give steam medicine when someone has an asthma attack. This tool can change liquids.

4. Controlling Asthma Triggers

What makes asthma symptoms arise? Learning more about asthma triggers can help sufferers reduce the chance of having an asthma attack. Everyone has different triggers, which can be dust, cold air, cigarette smoke, fatigue, depressed thoughts, foods such as seafood, eggs, and others. Note what triggers it so that it can be avoided at a later date.

Asthma Prevention

Because the cause of asthma is not yet known with certainty, it is difficult to know how a person can prevent inflammatory conditions.

The following are steps that can be taken to prevent asthma, including:

  • Avoid triggers. Avoid chemicals or strong-scented products that have caused respiratory problems in the past.
  • Reducing allergen exposure. If you have identified allergens, such as dust or mold, that trigger asthma attacks, avoid them as best as possible.
  • Get an allergy injection. Allergen immunotherapy is a type of treatment that can help change the immune system. With regular injections, your body may become less sensitive to the triggers you encounter.
  • Take medicine as prescribed. Just because asthma seems to be improving, don’t change your drug consumption without first talking to a doctor. It’s a good idea to talk about the medications you take each time you visit the doctor, so your doctor can double check whether you are taking the medicine correctly and taking the right dose.

Source:

  • Felman, Adam. 2018. What is asthma?
  • Healthline Editorial Team and Kimberly Holland. 2018. What Do You Want to Know About Asthma

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