ASTHMA

Prepared by:
Rose Marie B. Lagasca, MAN
What is asthma?
•Asthma is a long-term condition affecting the
airways. It involves inflammation and narrowing
inside the lungs, which restricts air supply.
•Asthma is a chronic inflammatory condition
that causes swelling in the airways. It can affect
people of any age, and the symptoms can range
from mild to severe.
Bronchial Asthma
Bronchial asthma is a medical condition which causes the
airway path of the lungs to swell and narrow. Due to this
swelling, the air path produces excess mucus making it hard
to breathe, which results in coughing, short breath, and
wheezing. The disease is chronic and interferes with daily
working. The disease is curable and inhalers help overcome
asthma attacks. Bronchial Asthma can affect any age or
gender and depends upon environmental and hereditary
factors at large. When ignored, disease proves fatal claiming
lives in many cases.
• A person with asthma may experience:

• tightness in the chest

• wheezing
• breathlessness
• coughing
• increased mucus production
• With bronchial asthma, you may have one or more of the
following signs and symptoms:

• Shortness of breath
• Tightness of chest
• Wheezing
• Excessive coughing or a cough that keeps you awake at
night
Types
•Asthma can occur in many different ways
and for many different reasons, but the
triggers are often the same. They include
airborne pollutants, viruses, pet dander,
mold, and cigarette smoke.
• 1.Childhood asthma
• Asthma is the most common chronic condition in children. It can develop at any age, but it
is slightly more common in children than in adults.
• According to the American Lung Association, some common triggers of childhood asthma
include:
respiratory infections and colds
• cigarette smoke, including secondhand tobacco smoke
• allergens
• air pollutants, including ozone and particle pollution, both indoors and outside
• exposure to cold air
• sudden changes in temperature
• excitement
• stress
• exercise
• It
is vital to seek medical attention if a child starts
to experience asthma, as it can be life
threatening. A doctor can advise on some of the
best ways to manage the condition.

• Insome cases, asthma may improve as the child

reaches adulthood. For many people, however, it
is a lifelong condition.
• 2. Adult-onset asthma
• Asthma can develop at any age, including during adulthood. According to
one 2013 study, adults are more likely than children to have persistent
symptoms.
• Some factors that affect the risk of developing asthma in adulthood
include:
• respiratory illness
• allergies and exposure to allergens
• hormonal factors
• obesity
• stress
• smoking
3. Occupational asthma

Occupational asthma results from exposure to an allergen or

irritant present in the workplace.

In the following workplaces, allergens may cause asthma in

those with a sensitivity or allergy:
bakeries, flour mills, and kitchens
hospitals and other healthcare settings
pet shops, zoos, and laboratories where animals are present
farms and other agricultural settings
• in
the following occupations, irritants can trigger asthma
symptoms:

• car repairs and manufacturing

• engineering and metalwork
• woodwork and carpentry
• electronics and assembly industries
• hairdressing salons
• indoor swimming pools
• Those with a higher risk include people who:

• smoke
• have allergic rhinitis
• have a history of asthma or environmental allergies
• A person’s work environment can trigger a return of
childhood asthma or the start of adult-onset
asthma.
• Those with a higher risk include people who:

• smoke
• have allergic rhinitis
• have a history of asthma or environmental allergies
• A person’s work environment can trigger a return of childhood
asthma or the start of adult-onset asthma.
• 4. Seasonal asthma
• This type of asthma occurs in response to allergens that are only in the
surrounding environment at certain times of year. For example, cold air in the
winter or pollen in the spring or summer may trigger symptoms of seasonal
asthma.

• People with seasonal asthma still have the condition for the rest of the year, but
they usually do not experience symptoms.

• Asthma does not always stem from an allergy, however. Learn more about the
difference between allergic and nonallergic asthma
• Extrinsic asthma and intrinsic asthma are subtypes of asthma.

• The symptoms of these subtypes are the same, but they have different triggers:

• Extrinsic asthma symptoms occur in response to allergens, such as dust mites,

pollen, and mold. It is also called allergic asthma and is the most common form of
asthma.
• Intrinsic asthma has a range of triggers, including weather conditions, exercise,
infections, and stress. People may call it nonallergic asthma.
Causes and triggers
•Some factors, such as sensitization to an allergen, may be both causes and triggers.
The sections below list some others.
•Pregnancy
•According to one study, smoking during pregnancy appears to increase the risk of the
fetus developing asthma later in life. Some women also experience an aggravation of
asthma symptoms while pregnant.
Obesity
•One article from 2014 suggested that there seem to be higher levels of asthma in
people with obesity than those without it. The authors note that, in one study, children
with obesity who lost weight also saw improvements in their asthma symptoms.

•Thereis now a growing body of evidence suggesting that both conditions involve a
chronic inflammatory response, and this could explain the link.
• Allergies
• Allergiesdevelop when a person’s body becomes sensitized to a
specific substance. Once the sensitization has taken place, the
person will be susceptible to an allergic reaction each time they
come into contact with the substance.

• Not every person with asthma has an allergy, but there is often a
link. In people with allergic disease, exposure to specific allergens
can trigger symptoms.

• One 2013 study found that 60–80% of children and young adults
with asthma are sensitive to at least one allergen.
• Smoking tobacco
• Cigarette
smoking can trigger asthma symptoms, according to
the American Lung Association.

• Asthma, even without smoking, can cause damage to the lungs.

This can increase the risk of developing various tobacco-related
lung conditions, such as chronic obstructive pulmonary disease,
and it can make symptoms more severe.
• Environmental factors
• Air
pollution, both inside the home and outside of it, can affect
the development and triggers of asthma.
• Some allergens inside the home include:
• mold
• dust
• animal hair and dander
• fumes from household cleaners and paints
• cockroaches
• feathers
• Other triggers in the home and outdoors include:

• pollen
• air pollution from traffic and other sources
• ground-level ozone
• Stress
• Stress can give rise to asthma symptoms, but so can several other
emotions. Joy, anger, excitement, laughter, crying, and other
emotional reactions can all trigger an asthma attack.

• Scientists have also found evidence to suggest that asthma may be

more likely in people with mental health conditions such as
depression.

• Others have suggested that long-term stress may lead to epigenetic

changes that result in chronic asthma.
• Genetic factors
• There is evidence to suggest that asthma runs in families. Recently, scientists have mapped out some of
the genetic changes that may play a role in its development.

• In some cases, epigenetic changes are responsible. These occur when an environmental factor causes a
gene to change.

• Hormonal factors
• Around 5.5% of males and 9.7% of females have asthma. In addition, symptoms may vary according to a
female’s reproductive stage and point in the menstrual cycle.

• For example, during their reproductive years, symptoms may worsen during menstruation, compared with
other times of the month. Doctors call this perimenstrual asthma. During menopause, however, asthma
symptoms may improve.

• Some scientists believe that hormonal activity may impact immune activity, resulting in
hypersensitivity in the airways.
Treatment:
• Asthma is a chronic condition that leads to dangerous swelling in the
airways that lead to the lungs. It requires ongoing management using
medication, and a person will often administer these medications
using a range of devices, including inhalers and nebulizers.
• Managing asthma requires two main approaches. The first is to
control the chronic inflammation on an on-going basis, and the
second is to be prepared for the effects of asthma attacks.

• These
are severe flare-ups of symptoms that might lead to
emergency treatment.
• Medicines
• A range of both quick-relief medications for attacks and long-term control drugs are available for the treatment of
asthma.
• Quick-relief medications
• People with asthma often take medication through an inhaler.
• Take quick-relief medications called bronchodilators at the first sign of asthma symptoms to provide a rapid
response.
• A doctor prescribes bronchodilators to expand the airway passageways and help clear mucus from the lungs.
These drugs can relieve symptoms but do not control the inflammation that drives asthma.
• Beta2-agonists are a class of drug that also relieves asthma symptoms quickly. They reduce allergic reactions
and form the basis of many allergy medications. As the asthmatic reaction in the airways has links to the
mechanisms that cause allergy, they can be helpful in reducing the effects of acute flare-ups.
• Do not take these drugs more than twice a week. Taking them more often is a sign of poorly controlled asthma,
so visit a doctor to discuss better ways to control the condition. It is important to carry a quick-relief inhaler at all
times for urgent relief when the symptoms of an attack first occur.
• Using quick-relief medicines to control asthma symptoms long-term is not effective, as they usually do not
reduce inflammation
• The following medications are effective beta2-agonists
for people with asthma:
metaproterenol (Alupent)
• epinephrine,a powerful anti-allergic medication that an
individual might purchase in the form of EpiPen or
EpiPen Jr., Adrenalin, and Epinephrine Mist
• albuterol,
which stores may sell as Ventolin HFA
(hydrofluoroalkane), Proventil, or Proair
• levalbuterol (Xopenex, Xopenex HFA)
• Long-term control medications
• The daily use of long-term asthma control drugs is the best way to reduce the risk of a
severe attack.
• Inhaled corticosteroids are extremely effective for long-term asthma relief. These relieve
inflammation and limit sensitivity to allergens that could set off a reaction in the airways.
• However, the medicines might lead to certain side effects, including a fungal infection of
the mouth known as thrush.
• The risk of thrush increases if corticosteroids come into contact with the mouth and
throat. Spacers or holding chambers are available as attachments to an inhaler. They can
reduce corticosteroid contact with the area and reduce the risk of thrush.
Rinsing the mouth can similarly help to prevent the side effects of corticosteroids.

• Inhaling corticosteroids over an extended period can increase the risk of cataracts and
osteoporosis.
• People with asthma might use the following long-term medications:
• anti-inflammatory drugs, including cromolyn
• immunomodulators, including omalizumab, available as an injection once
or twice monthly that reduces immune reactions to allergens, such as
pollen and dust mites.
• inhaled long-acting beta2-agonists, which differ from quick-relief beta2-
agonists and soothe the airways to support a course of corticosteroids
• medications that block the inflammation reaction in the airways, known as
leukotriene modifiers
• theophylline, which a person takes orally to open the airways
• Devices
• People
will often use devices to effectively deliver
asthma medication to the airways. Inhalers and
nebulizers are the most common devices for
administering asthma drugs.

• A peakflow meter is another device that can

help a person with asthma monitor how their
lungs are working.
• Inhalers
• An inhaler is a handheld device that turns asthma medicine into a spray, similar to that of
an aerosol can, making it more efficient at reaching the airways.
• There are two different types: Metered dose inhalers and dry powder inhalers.
• Metered dose inhalers (MDIs)
• A metered dose inhaler deliver a specific amount of medicine.
• These released a pre-measured puff of medicine to ensure that a person with asthma
gets the exact dose they need. Some machines have a counter that displays the
remaining number of doses, but people with those that do not should keep track of how
many they use.
• Younger inhaler users might also benefit from a spacer attachment. Aside from reducing
the risk of side effects from corticosteroids, they can reduce the need to squeeze the
inhaler while inhaling. The user can inhale the medication when they are ready.
• A spacer can make using an inhaler more effective. The spacer will help the medicine
reach the lower airways where it can have the most powerful impact in treating asthma.
• Infants and very young children will place a plastic cup called a facemask
over the mouth and nose to receive inhaled medicine. Older children may
use a smaller mouthpiece.
• Taking a dose of asthma medication through an inhaler should take
between 2 and 3 minutes.

• Dry powder inhalers

A dry powder inhaler delivers asthma medication in the form of a powder,
not a spray.
This requires more force when inhaling the medication. Many children can
supply enough force by the age of 5 or 6 years.
• Nebulizers
• These are electronic devices that transform asthma drugs into a
fine mist and do not require forceful inhalation.
• They are generally bulkier than inhalers and sometimes require
a power supply. They may also be battery-powered.
• An individual takes the mouthpiece and breathes in and out for
around 10 minutes.
• If a child is distressed or crying during a dose, the nebulizer
may reduce in effectiveness, as the child will absorb less
medicine.
Tips for use
• Usingan inhaler or nebulizer in the correct way is vital, as
an accurate dose can greatly reduce the frequency and
impact of attacks.

• Inhaler
• There are many different brands of inhaler. Read
instructions thoroughly for efficient use.
• Apply the following tips:
• Remove the cap of the inhaler, shake it, and “prime” the inhaler by spraying or pumping it. The
manufacturer instructions will advise how best to achieve this. Do not shake a dry powder inhaler
before use.
• Make sure the person receiving the dose is standing up or sitting up straight.
• Breathe in deeply, tilt back the head a little, and sharply breathe out to empty the lungs.
• Form a close, tight seal by squeezing the lips shut around the mouthpiece.
• Push down on the top of the canister while breathing in slowly for between 3 and 5 seconds.
• Count to 10 while holding a breath.
• Remove the inhaler and breathe out slowly.
• People who need two puffs should wait for one minute between the first and second.
• Rinse the mouth with water if taking corticosteroids through an inhaler.
• As inhalers can save lives during respiratory distress, make sure using one becomes second
nature. Speak to a doctor if the type of inhaler is causing difficulties
•Peak flow meter
• To obtain an accurate peak flow reading, take the following steps:
• Assume a comfortable position, sitting up or standing. Either is fine but do it the same way each time.
• Pull the counter back all the way to reset the meter.
• The meter should be horizontal. Make sure the measurement scale is visible.
• Breathe deeply, filling the lungs completely.
• Bring the meter to the lips, forming a tight seal on the mouthpiece.
• Blow as fast as hard as possible into the device.
• Repeat three times for accuracy and write down the highest figure in a peak flow diary. The three
readings should be about the same.
• Be sure to take peak flow measurements at the same time each day for consistency. The highest peak
flow at this time will indicate the personal best. This will be the target peak flow, and the further the peak
flow falls from this figure, the higher the risk becomes of an attack.
• When a person replaces their peak flow meter, they should find a new personal best, as different meters
might show different readings. Allowing for growth in children is also essential, so find a new personal
best every 6 months to represent this change.
Nebulizer
• This will also come with instructions, which anyone using a nebulizer should read
closely.
• Wash the hands thoroughly before use.
• Follow manufacturer instructions to assemble the machine, tube, cup, and
mouthpiece.
• Place the medicine into the medicine cup. Open any pre-measured capsules and
empty the contents into the cup.
• Seal the lips around the mouthpiece, or make sure a facemask fits closely around
the nose and mouth. Avoid holding the mouthpiece away from the face.
• Switch on the machine. A mist should start to form at the base of the tube.
• Breathe normally through the mouth until the medicine cup is empty. This might take
around 10 minutes.
• Remove the mouthpiece or mask and power down the machine.
• Rinse the mouth after using corticosteroids.
• Wash the hands, medicine cup, and mouthpiece or mask well
after use, but do not wash the tubing. Shake off any remaining
moisture and air-dry the components on a tissue or paper towel.

• Disinfect the different parts of the nebulizer once a week to

sterilize the device. The packaging should provide precise
instructions.

• Store
the nebulizer in a clean, dry plastic bag, and keep
mouthpieces or masks separate if more than one person in the
house uses the machine to treat asthma. Replace any broken
or malfunctioning parts as soon as possible.
Takeaway
• A variety of medications are in involved in the long-term management
of asthma and the treatment of attacks.
• Quick-relief medications, such as bronchodilators, help to address
respiratory distress during an asthma attack. Long-term control drugs,
such as corticosteroids, help to moderate asthma and reduce airway
inflammation.
• A variety of devices can help deliver these medications to the lungs.
Inhalers turn the medication into a spray or deliver a powder. Some
inhalers deliver a specific amount and keep track of remaining doses.
Be sure to follow the tips on using each for the most accurate doses
and the most efficient delivery.
• Nebulizers turn the medications into a fine mist and
require less effort on behalf of the person taking the
drugs. However, they often require a power a source
and are less portable than inhalers. Speak to a doctor
about which delivery method would be best.

• Monitor the progress of asthma using a peak flow meter

and record the highest value in a diary to show the
target lung function after asthma treatment.
References:
• 1. Types, causes, and diagnosis of asthma
• https://www.medicalnewstoday.com/articles/323523
• 2. Medicines and devices for treating asthma
• https://www.medicalnewstoday.com/articles/323531