Focus – Asthma

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes frequent periods of wheezing, chest tightness, shortness of breath and coughing. The coughing often occurs at night or early in the morning. Asthma affects people of all ages, but it most often starts during childhood.

What causes asthma?

The exact cause of asthma is unknown. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

• • An inherited tendency to develop allergies

• • Parents who have asthma

• • Certain respiratory infections during childhood

• • Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing.

What triggers asthma?

Many things can trigger or worsen asthma symptoms. They may include:

• • Allergens from dust, animal fur, cockroaches and mould, and pollens from trees, grasses and flowers

• • Irritants such as cigarette smoke, air pollution, chemicals or dust in the workplace, compounds in home décor products and sprays (such as hairspray)

• • Medicines such as aspirin or other non-steroidal anti-inflammatory medicine

• • Sulphites in foods and drinks

• • Viral upper respiratory infections, such as colds

• • Physical activity, including exercise.

Your health provider can help you find out which things may cause your asthma to flare up when you come into contact with them.

Other health conditions can make asthma harder to manage, for example a runny nose, sinus infections, reflux disease, psychological stress and sleep apnoea.

How is asthma treated and controlled?

Asthma is a long-term disease that can’t be cured. The aim of asthma treatment is to control the disease. Good asthma control will:

• • Prevent chronic and troublesome symptoms, such as coughing and shortness of breath

• • Reduce your need for quick-relief medicines

• • Help you maintain good lung function

• • Let you maintain your normal activity level and sleep through the night

• • Prevent asthma attacks that could result in an emergency room visit or hospital stay.

How can asthma be prevented?

Currently, asthma can’t be prevented. However, you can take steps to control the disease and prevent its symptoms:

• • Learn about your asthma and how to control it

• • Work with your doctor and decide on an asthma management plan

• • Use medicines as prescribed by your doctor

• • Identify and try to avoid things that make your asthma worse. However, one trigger you should not avoid is physical activity. Physical activity is an important part of a healthy lifestyle. Talk with your doctor about medicines that can help you stay active

• • Keep track of your asthma symptoms and level of control

• • Get regular check-ups for your asthma. Asthma differs from person to person. Talk with your health provider about the things that seem to make your asthma worse. The important thing is to realise that you can still have a healthy, active life when living with asthma.

Sources:

http://asthma.about.com
http://www.nhlbi.nih.gov

Childhood asthma is often quoted as the number one reason for children missing school and being hospitalised. However, new medications and treatment strategies have changed this bleak outlook. Today, asthma flare-ups/attacks can be avoided, controlled and managed successfully. Here’s how…

Asthma basics

Knowledge is power and knowing the basics of this condition is a prerequisite to managing it successfully.

Asthma is a chronic, inflammatory lung condition that causes the airways to narrow and tighten to such a degree that breathing becomes difficult.

Asthma flare-ups or attacks are usually caused by changes in the airways such as:

• • Inflammation of the airways

• • Excessive mucus production that may act as “plugs” in the narrowed airways

• • Bronchoconstriction when the muscles lining the airways tighten up and further narrow the airways.

During a flare-up/attack the child may experience the following:

• • Insistent coughing, especially at night

• • Wheezing (a whistling sound) when breathing

• • Tightness in the chest (like an elephant standing on your chest)

• • Breathlessness (shortness of breath that makes speaking difficult)

• • Increased heart rate

• • Perspiration due to the effort to breathe and fatigue.

The things that trigger asthma flare-ups/attacks differ from child to child.

The following are some of the more common triggers:

• • Exercise

• • Allergies

• • Viral infections such as colds and the flu

• • Environmental triggers such as air pollution, smoke, chemical odours, pollen, dust, grasses, etc.

• • Indoor allergens such as cigarette smoke, mould, dust mites, animal dander, cockroaches, air fresheners, aerosols, hair spray, perfume, food dyes, etc.

• • Weather changes especially when breathing in cold air.

There are four main categories of children’s asthma:

Mild intermittent, when the typical symptoms of asthma (coughing, wheezing and shortness of breath) occur briefly, no more than twice a week and maybe twice a month at night.

Mild persistent, when typical symptoms occur more than twice a week but less than once a day. Night time awakenings (due to coughing, wheezing and shortness of breath) may occur at least twice a month. Normal physical activity may/may not be affected.

Moderate persistent, when typical symptoms occur daily and flare-ups occur more than twice a week, sometimes lasting days. Night time awakenings may also occur more than once a week and normal physical activity will most probably be affected.

Severe persistent, when symptoms and flare-ups/attacks occur frequently and continuously and also at night. This is a severe, difficult form of asthma that may require emergency treatment and sometimes hospitalisation. Normal physical activity may be severely affected.

Asthma management plan

Asthma flare-ups or attacks often seem to happen unexpectedly, one minute the child is fine and breathing normally and the next an attack starts. Although it seems unexpected, these attacks actually develop over time and can be anticipated, avoided where possible and effectively treated with fast-acting medications and a long-term asthma management plan.

Managing your child’s asthma begins with the proper diagnosis by a doctor or asthma specialist and may also involve the help of an allergy specialist. With their help a personalised asthma management plan for your child can be set up.
An asthma management plan may include the following steps:

Avoiding and controlling the triggers
It may take time to figure out what triggers your child’s asthma, apart from the most common causes. As soon as you know you can start taking the necessary steps to minimise and avoid your child’s exposure to these triggers. Start by banning smoking in your home and thoroughly cleaning your home and the child’s living space of all known allergens/triggers.

Anticipating and preventing flare-ups
Learn to monitor your child’s breathing and lung health daily with the use of a peak flow meter. It is a simple tool that will give advance warning that a flare-up/attack may be brewing. Make this a no-fuss, daily activity for smaller children, the same as brushing teeth. Older children and teenagers will quickly master its use and can keep their own asthma diary and even learn how to prevent flair-ups/attacks when peak flow measurements reach a certain level. Some action plans include nifty peak flow measurement and symptom zone charts characterised by the colours green, yellow and red to show whether the child’s asthma is under control, somewhat controlled or poorly controlled. It is of the utmost importance to monitor these zones because it may entail adjusting (lowering or stepping up) treatment and medication.

Treating symptoms promptly and effectively
Use the right medicine as prescribed by your doctor. Asthma medication usually includes both short-term, quick-working rescue type medication to open up swollen airways during an attack, as well as long-term medication taken daily to reduce inflammation in the lungs and prevent the build-up of such an attack. Both are necessary to help manage your child’s asthma. Babies, infants and toddlers may need a face mask attached to a metered dose inhaler or nebuliser to get the correct dose of medicine. Older children and teens may be able to self-administer these medicines as they usually come in the form of inhalers. It is, however, very important to teach them how to use the inhaler properly. Other medications may have to be taken orally. Allergy shots and other forms of allergy therapy may also be necessary.

Childhood asthma can be controlled

The well-documented good news is that most childhood asthma cases can be successfully controlled when monitored carefully, assessed frequently and by using a self-management asthma action plan drawn up by the child’s doctor or specialist.

Although children with asthma sometimes feel depressed, left out and different because flare-ups/attacks keep them out of school or limit participation in some forms of physical activity, parents and caregivers should encourage them not to give up. Well-controlled asthma should not prevent a child from having fun, living a full life and taking part in sport and other physical activities. Asthma control may take some time to master but it is definitely worth the effort!

In fact, many Olympic athletes such as Bill Koch, American medallist in Nordic and cross country skiing (not usually recommended for asthmatics); Ann van Dyke, swimming champ with four gold medals (definitely recommended); and Paula Radcliff, winner of seven marathons (not recommended at all) were diagnosed with asthma as children, learned to control their asthma and achieved acclaim anyway!

Sources
Childhood asthma. Retrieved from: http://www.mayoclinic.com/health/childhood-asthma/DS00849/DSECTION=treatments-and-drugs
Managing asthma. Retrieved from: http://www.kidshealth.org/parent/healthy/asthma_mgmt.html
Tips for managing asthma. Retrieved from: http://www.kidsource.com/kidsource/content2/news2/asthma.4.t.p.k.html
Roth, E. 2012. Childhood asthma. Retrieved from: http://www.healthline.com/health/asthma/pediatric#Outlook

Asthma

Asthma, the Greek word for “panting”, refers to a condition that causes inflammation and obstruction of the airways making it difficult to breathe (shortness of breath). During an attack the person may make a whistling or wheezing sound while panting for breath. Other symptoms may include either a chronic dry cough or a “productive” cough accompanied by lots of mucus/phlegm. Although it is a different, separate disease a lot of people with COPD also have asthma.

COPD

COPD, on the other hand, refers to not one but a combination of conditions that obstruct the airflow to the lungs. These include chronic (persistent) bronchitis or emphysema or both.

Chronic bronchitis, an inflammation and irritation of the bronchial tubes (the airways of the lungs). is usually caused by viruses, bacteria, cigarette smoke, air pollution or when a cold or upper respiratory infection does not heal properly. It is characterised by tightness in the chest and an overproduction of mucus that forms sputum (phlegm) in the lungs and thus triggers the typical “productive” cough.

Emphysema is a condition that occurs when the smaller airways and air sacs (alveoli) of the lungs are damaged causing an even greater and more serious narrowing of the airways and obstruction to the airflow to the lungs.

Although a small percentage of people with a rare protein deficiency that may lead to lung, liver and blood disorders are classified as having a genetic/hereditary risk of developing COPD, most COPD patients are or have been heavy smokers! Non-smokers rarely develop COPD except if they may have been exposed to secondary smoke from spouses or other smokers.

Symptoms of COPD

Symptoms of COPD include the following:

• • Smokers’ cough that later becomes a chronic cough

• • Overproduction of mucus. The damaged airways produce more and more mucus that forms sputum that has to be coughed up

• • Breathlessness and wheezing that become progressively worse and later quite distressing and may end in fatal, respiratory failure

• • Chest infections such as pneumonia, colds and flu become more frequent and cause flare-ups of the symptoms

• • Heart failure due to reduced levels of oxygen in the blood and changes in the lung tissue that may result in strain on the heart muscle. This may worsen the already existing breathlessness and cause fluid retention

• • Depression and anxiety

• • Deterioration of mobility and general quality of health.

Differences between asthma and COPD

Some of the symptoms are similar and can be confused during diagnosis, especially the shortness of breath and typical cough. There are also similarities between the co-morbidities, diseases and conditions that co-exist with asthma/COPD, such as cancer, high blood pressure, sinusitis, migraine, depression, stomach ulcers, insomnia and impaired mobility.

However, there are various, very clear differences between the two conditions and these are used to make the proper diagnosis and plan appropriate treatment regimes.

Differences include:

• • Age of onset. People with asthma are usually diagnosed with the disease as children/young adults while COPD symptoms usually surface in older adults (40+)who are current or former smokers. Tragically many are only formally diagnosed after 60 years of age

• • Lung function after treatment (except in rare cases) is often fully reversible in asthma patients who usually also respond well to treatment while COPD treatment may ease symptoms but will not cure the condition as the airways are often permanently damaged

• • Different triggers cause the flare-up of symptoms, e.g. asthma is worsened by allergens, exercise and cold air. The main cause of COPD is smoking and flare-ups are mostly caused by respiratory tract infections and sometimes by environmental pollutants

• • Night time awakenings with breathlessness is common in asthma patients but not in those with COPD

• • Atopy, a history of allergies, hayfever and eczema, is common in asthma patients only.

Breath of life

Managing but not reversing COPD is possible. Medication and inhalers mayhelp reduce inflammation and open up the airways to ease breathing. Viral and bacterial infections can be prevented by being immunised against the pneumococcus germ that causes serious chest infections and by having an annual flu shot. Regular mild exercise is recommended to help improve breathing and losing extra weight will help ease breathlessness.

The moral of the story is that it is critical for those with COPD to try and preserve lung functioning and prevent early respiratory failure. This is only possible if they are correctly diagnosed as early as possible when damage to the lungs is not too far gone. Current and past smokers are most at risk as COPD is usually caused by smoking and although symptoms are unlikely to become better if they stop smoking, it will definitely become much, much worse if they do not!

Sources
Chronic Obstructive Pulmonary Disease. Retrieved from: http://www.patient.co.uk/health/chronic-obstructive-pulmonary-disease-leaflet
Exercising safely with COPD. Retrieved from: http://www.aarc.org/patient_resources/tips/exercise.html
Jovinely, J. Asthma vs. COPD: how to tell the difference. Retrieved from: http://www.healthline.com/health/copd/asthma

The prevalence of obesity and asthma has increased drastically over the past decade but did you know that there is also a subtle link between the two?

Epidemic on the home front
There has been an epidemic of both asthma and obesity in the western world over the past decade and concerted efforts are being made to try and prevent both conditions from escalating out of control. South Africa has been placed third in the world obesity ranking according to Compass Group Southern Africa’s 2011 report, and has been referred to as the “junk food” nation. Asthma, on the other hand, has also been increasing due to environmental, lifestyle and other triggers, and allergens in the air we breathe, the food we eat and the places we work in. What is interesting though is the subtle, as yet not fully documented, link between obesity and asthma.

Ten facts about obesity and asthma

1. 1. Being obese may put you at increased risk of developing asthma, for example obese children and teens are twice as likely to develop the condition in comparison with children of the same age who are not overweight
   2. Obese people often exhibit airway hyper-responsiveness and asthma-like symptoms such as breathlessness and wheezing
   3. Obesity may worsen asthma symptoms and flare-ups and make it more difficult for the body to respond to asthma medication and treatment
   4. Obesity may influence sleep patterns and may cause night time awakenings due to breathing difficulties similar to those experienced by asthmatics, although the triggers and causes may be different
   5. Obesity and asthma may both lead to bouts of depression and low self-esteem, especially in children who may be teased, rejected and even bullied
   6. Obesity and asthma symptoms both make it difficult to partake in certain physical activities and sport; the former much more than the latter though!
   7. Weight loss in obese people and asthmatics has demonstrated very positive outcomes such as a +48% remission of symptoms and severity of symptoms, much better asthma control, improved lung function and decreased hospital visits
   8. Young, obese women with asthma are also linked to a more hormone-related pattern of airway inflammation; they have flare-ups before menstruation and during pregnancy when oestrogen levels are out of balance. Oestrogen simulates the hormone that regulates hunger but also causes inflammation of the airways that trigger asthma.
   9. Obesity is an important factor that should be considered when identifying elements that need to be part of an asthma control and management plan. Although you can’t always control all the triggers of asthma you can control and even reverse obesity. Millions of people have done so and so can you!

Sources
Asthma linked to oestrogen and obesity. 2013. Retrieved from: http://www.abc.net.au/news/2013=04-03/asthma-linked to oestrogen-and-obesity/4607608
Barranco, P. et al. 2012. Asthma, obesity and diet. Retrieved from: http://www.ncbi.nim.nih.gov/pubmed/22566313
Gavin, ML. 2012. Overweight and obesity. Retrieved from: http://kidshealth.org/parent/general/body/overweight_obesity.html
Rodriguez, D. Obesity and asthma: what’s the connection? Retrieved from: http://www.everydayhealth.com/asthma/obesity-connection.aspx