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| Asthma, Definition, Symptoms, Causes, Diagnosis, Treatment, Prevention, Complications |
Definition of Asthma
Asthma is a chronic disease of the respiratory tract characterized by shortness of breath due to inflammation and narrowing of the airways. Asthma can affect all age groups, both young and old.
People with asthma have more sensitive airways than normal people. When the lungs are exposed to asthma triggers, the muscles in the airways stiffen, making the passages narrow. In addition, the production of phlegm also increases. The combination of these conditions makes sufferers experience asthma symptoms.
Based on the report of the Indonesian Ministry of Health in 2018, it is estimated that 2.4 percent of the entire population of Indonesia suffers from asthma. Meanwhile, according to WHO data in 2019, asthma sufferers worldwide reached 262 million people, with the death rate from asthma reaching 461,000 people.
Causes and Symptoms of Asthma
Although the cause is not known for certain, there are several things that often trigger asthma, namely:
- Cigarette smoke
- Dust
- Animal hair
- Cold air
- Viral infections
- Exposure to chemicals
A number of these triggers can cause complaints in asthmatics, such as difficulty breathing, coughing, wheezing, and pain or tightness in the chest.
Asthma Treatment and Prevention
Asthma treatment can be tailored to the patient's condition. The goal is to relieve asthma symptoms, prevent recurrence of symptoms, and reduce swelling and narrowing of the airways. The method can be in the form of medication or surgery.
Although difficult to prevent, there are efforts that can be made to avoid asthma attacks, including by:
- Undergo influenza and pneumonia vaccinations regularly
- Knowing the triggers for asthma symptoms and avoiding them
- Do an examination to the doctor if the symptoms do not improve after undergoing treatment
Causes of Asthma
Asthma occurs when the muscles in the airways narrow and tighten. This condition causes the respiratory tract to become swollen or inflamed and produce excessive mucus or thick phlegm. As a result, people with asthma will have difficulty breathing.
The exact cause of asthma is still unknown. However, it is suspected that this condition is related to genetic and environmental factors.
The triggers of asthma itself can be different in each patient, including:
- Respiratory tract infections, such as the flu
- Allergens (allergenic substances), such as animal dander, mites, dust, and pollen
- Exposure to chemical fumes, cigarette smoke and air pollution
- Weather conditions, such as storms, cold or heat, humid or windy weather, and drastic changes in temperature
- Humid, moldy, or dusty room conditions
- Stress
- Excessive emotions, such as prolonged sadness, uncontrollable anger, or laughing out loud
- Physical activity or exercise that is too strenuous
- Medications, eg nonsteroidal anti-inflammatory pain relievers (such as aspirin or ibuprofen) and beta-blocking drugs
- Food or drink containing additives, such as jam, shrimp, processed food, ready-to-eat food, packaged fruit juice, beer and wine
- Food allergies, eg to shrimp or nuts
- Acid reflux disease (GERD)
Asthma Risk Factors
There are several factors that can increase a person's risk of developing asthma, namely:
- Male gender in children, and female in adolescents or adults
- Family history of asthma or atopic allergies, such as food allergies, allergic rhinitis, or eczema
- Overweight or obesity
- Childhood history of bronchiolitis or lung infection
- Born with a weight below normal
- Premature birth, especially if needing a ventilator
- Smoking habits, including pregnant women
- Exposure to cigarette smoke as a child
- Occupations at risk of exposure to chemicals, such as farmers, hairdressers, or factory workers
Asthma Symptoms
Asthma can be characterized by a variety of symptoms. These symptoms can last continuously, come and go, or only occur at certain times, for example when you are exercising. The severity of the symptoms also varies, from mild to severe.
The main symptom of asthma is respiratory distress, which can include:
- Difficulty breathing
- Cough
- Chest feels tight, painful, and like pressure
- Wheezing or wheezing
The above complaints can resemble symptoms of other diseases. However, the complaint can be suspected of being caused by asthma if it has the following characteristics:
- Gets worse in the morning or at night
- Disappear on the same day
- Occurs or gets worse when the patient is infected with a virus, such as a cold
- Triggered by exercise, allergies, cold air, or excessive breathing when laughing or crying
In addition, there is also the term asthma attack, which is characterized by worsening of symptoms. Asthma attacks can last suddenly or over a few days. This condition is characterized by more serious symptoms, such as:
- Symptoms of cough, wheezing, and tightness in the chest that are more frequent and worse
- Impaired speech, eating, or sleeping due to difficulty breathing
- Lips and fingers that look blue
- Need to use the inhaler more often
- Heart rate increases
- Dizziness, tiredness, or sleepiness
- Faint
When to go to the doctor
Immediately see a doctor if you or your family experience symptoms of an asthma attack, especially if accompanied by the following conditions:
- Cannot be relieved by using an inhaler
- Very fast breath
- Shortness of breath and wheezing that worsens very quickly
- Cough that is difficult to stop or wheezing that sounds quite loud when breathing
- Shortness of breath when doing light activities
- Anxiety and panic
- Fingers, lips, and gums turn bluish or pale
- Chest pain or pressure
- Difficulty speaking
- Pale face and cold sweat
Severe asthma attacks can be life-threatening. Immediately seek medical attention to the ER to get further treatment.
It is also necessary to see a doctor if you:
- Suspected having asthma
- Experiencing asthma that gets worse
- Suffering from asthma so it is necessary to have regular check-ups to ensure the effectiveness of the treatment that is being undertaken
Asthma Diagnosis
To diagnose asthma, the doctor will ask questions about the symptoms and medical history of the patient and family, followed by a physical examination, namely by:
- View the nose, throat and upper respiratory tract
- Listening to the patient's breath with a stethoscope to detect asthma symptoms, such as wheezing
- Look at the patient's skin to detect allergic conditions, such as eczema and hives.
To confirm the diagnosis, the doctor will check the patient's lung function through the following tests:
Spirometry
In spirometry, the doctor will ask the patient to take a deep breath and exhale as quickly as possible into the spirometer. This test aims to measure the performance of the lungs based on the volume of air and the total amount of air exhaled.
Peak flow meter test
This test uses a device called a peak flow meter (PFM), to measure the velocity of air from the lungs in one breath.
Airway provocation test
In this test, the patient will be asked to inhale a substance that can trigger asthma, such as histamine or methacholine. Although it can confirm the diagnosis, this test carries the risk of triggering an asthma attack so it should only be done under the supervision of a doctor.
Nitric oxide test
This test is done to measure the level of nitric oxide that is exhaled when breathing. If the test results show high levels, it can be suspected that the patient's respiratory tract is swollen.
If needed, the doctor will also perform some follow-up tests, which include:
- Allergy test, to detect any allergies that may cause asthma
- Scans, such as X-rays, to detect diseases that can trigger respiratory problems
- Test for eosinophils in sputum, to detect the presence of one of the white blood cells (eosinophils) in saliva and phlegm secreted when coughing
- Provocative tests with exercise or exposure to cold air, to measure airway obstruction before and after strenuous physical activity or inhaling cold air
- Gas and diffusion tests, to determine the ability of the blood to absorb oxygen and other gases from the respiratory process, by measuring the level of gases exhaled when breathing
Asthma Treatment
Asthma treatment aims to relieve symptoms and prevent asthma attacks. The doctor will adjust the method of treatment according to the cause of the asthma, as well as the age, severity of the condition, and the patient's response to treatment.
Asthma treatment can be short-term or long-term. The following is an explanation of each method and its treatment:
Short Term Treatment
Short-term treatment methods aim to quickly relieve asthma attacks while they are occurring and prevent recurrence of symptoms. There are three types of drugs that can be used in this method, namely:
1. Short-acting beta2-agonist inhaler
Inhalers can be used to quickly relieve symptoms during an asthma attack. This medicine can open narrowed airways so that air can come back in.
Although inhalers can easily relieve asthma symptoms, they should only be used as directed by your doctor. This is because its use should not be too frequent and should be recorded every week. In addition, the patient should understand very well how to use this asthma drug properly, so that the results are maximum.
2. Oral or intravenous corticosteroids
The doctor will prescribe corticosteroids to relieve inflammation in the respiratory tract.
3. Anticholinergic drugs
Anticholinergic drugs, such as ipratropium and tiotropoium, are used to relax the airways so the patient can breathe easier.
Long Term Treatment
Long-term treatment aims to relieve symptoms by reducing inflammation and preventing airway constriction. This method is done by taking drugs regularly, such as:
- Corticosteroids in inhaled or pill form, to reduce the body's response to inflammation
- Injectable biologic drugs, such as omalizumab, mepolizumab, reslizumab, and benralizumab, which reduce the body's response to allergens in people with severe asthma
- Leukotriene-modifying drugs, such as montelukast, zafirlukast, and zileuton, to reduce inflammation and keep the airways open
- Mast cell stabilizers, such as cromolyn, to prevent inflammation of the respiratory tract when exposed to allergens or other asthma-causing agents by preventing immune cells from producing inflammation-inducing signals
- Immunotherapy, in the form of inhalation, tablets or syrup, to reduce the body's response to allergens that cause asthma
- Long acting beta agonist bronchodilator inhalers, such as salmeterol, to prevent airway constriction
Emergency Handling
An asthma attack is a life-threatening emergency. In these conditions, the doctor will give drugs through a nebulizer or infusion. If needed, the doctor can also provide oxygen therapy or breathing apparatus, such as a ventilator or oxygen cylinder.
Bronchial Thermoplasty
Bronchial thermoplasty is surgery to treat severe asthma that cannot be treated with other treatment methods. Even so, not all asthmatics are suitable for this procedure.
This procedure involves inserting a thin, flexible tube into the lung to heat the muscles around the airway. The goal is to damage these muscles so that narrowing of the airways and asthma attacks can be reduced.
Asthma Complications
Severe asthma can cause status asthmaticus. This condition occurs when people with asthma do not respond to usual treatment and need to be treated in a hospital.
Status asthmaticus can cause a number of complications in asthmatics, namely:
- Respiratory failure, due to dilated respiratory tract and full of mucus
- Cardiac arrest, which occurs due to lack of oxygen
- Hypoxemia, ie brain damage or death due to not having enough oxygenated blood for a long time
- Respiratory alkalosis, which occurs when the body lacks carbon dioxide due to breathing too fast
- Hypercarbia, especially in ventilator users, due to the inability of the lungs to remove carbon dioxide so that it accumulates in the body
- Pneumothorax, which is when the lung collapses or is damaged so air leaks into the space between the lung and the chest wall
- Pneumodiastinum, which occurs when air leaks from the lungs into the chest cavity.
Asthma can also cause sufferers to often enter the emergency room or undergo treatment in hospital due to asthma attacks. In addition, patients can also experience other complications that affect the quality of life, such as:
- Disturbances in daily activities, such as sleeping, working, and going to school
- Permanent narrowing of the airways that affects the ability to breathe
- Side effects from long-term use of asthma medications
- Impaired growth and learning disorders in children
- Higher risk of stress, anxiety and depression in adults
Asthma Prevention
Asthma is difficult to prevent, because the cause is not known with certainty. Even so, there are some efforts that can be done to avoid asthma attacks, namely:
- Undergo asthma treatment that has been prescribed by a doctor, including taking medicines for asthma on a regular basis and according to the doctor's instructions
- Have regular flu and pneumonia vaccinations
- Knowing the triggers for asthma symptoms and avoiding them
- Watch for asthma symptoms, such as coughing, wheezing, or shortness of breath
- Treat asthma symptoms as early as possible by taking drugs or stopping activities that can trigger attacks
- Consult and check with a doctor if medication is not able to relieve symptoms
- Live a healthy lifestyle by eating a balanced nutritious diet, exercising regularly at light intensity, and not smoking
- Lose weight if you are obese
- Manage stress well
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