By Josephat Chiripanyanga
ASTHMA is an allergic chronic inflammatory disease of the lung airways. Most of the time asthma is triggered by some allergen (something that triggers an allergic response). It is also hereditary; meaning it runs within family lines.
Once an allergen is inhaled it causes your body to send some immunoglobulins (body soldiers) to fight the allergen. But as the soldiers try to fight the allergen they also stimulate the mucous membranes (linings of the lung airways) and they get inflamed. Once there is inflammation the airways become narrow and limit air entry into the lungs resulting in the classical symptom of asthma, wheezing.
About 360 million people suffer from asthma annually and of these about 400 thousand die annually. More patients die of asthma in developing countries compared to developed countries. This is mainly attributed to poorly equipped hospitals and absence of essential medications in the former compared to the later.
The symptoms of asthma are normally first noticed in childhood. The key symptom is wheezing. A wheeze is a breathing sound that comes out as if someone is whistling as they breathe. This is caused by the obstruction of the airways. When we talk of airways we mainly refer to the tubes that transmit inhaled air to the lungs namely the trachea, bronchi and bronchioles. Asthma mainly affects the lower airways that are the bronchioles. The other symptoms include persistent coughing, chest tightness and shortness of breath.
When it comes to risk factors, asthma is mainly triggered by allergens which could include dust, pollen, carpets, fur, pets and even strong scents from perfumes and colognes. So to minimize chances of asthmatic attacks we encourage that one observes which allergen could trigger their asthma and actively avoid it. Obesity generally worsens asthma. So if you are asthmatic we encourage that you exercise and avoid eating junk food to minimize the number as well as the severity of attacks. Asthma can also be drug induced. Drugs like aspirin and beta blockers like atenolol can also trigger asthma. We need not mention the effects of cigarette smoke in triggering asthma as we all know cigarette smoke either actively or passively inhaled will trigger an attack.
Asthma is a chronic condition. This means that it affects people for a very long time of their lives. Most people who suffer from asthma will be affected by the condition for their entire life. But the condition generally gets better with age. Also the severity of attacks are less as you get older. Unlike most conditions asthma is fairly easy to treat and most of the time treatment is only instituted for a week or so and one would have recovered. With asthma there is no need for treatment on a daily basis like we do with other chronic conditions like hypertension (BP) and diabetes mellitus (sugar).
To make a diagnosis of asthma we mainly depend on clinical features. By clinical features we mean the signs and the symptoms. Symptoms are what the patient feels and tells the doctor. Signs are what the doctor elicits from the patient on physical examination. So the main symptoms that the patient will complain of are cough, shortness of breath, chest tightness and even wheezing. When the doctor examines the patient the most important signs they look for is the respiratory rate (asthmatic patients normally have an elevated respiratory rate during an attack), shortness of breath and coughing can also be signs on examination. But the most important sign is wheezing breath sounds as heard by a stethoscope during auscultation. Auscultation is simply the process of listening with the stethoscope.
Like I said earlier, the treatment of asthma is fairly easy. But it has no cure. There is no drug that can eradicate asthma permanently. All the medication we use to treat asthma can only clear it at that particular moment but when you get exposed to a trigger later on in life the attack will come back. On that note allow me to clear the air that there are no herbs that have been proven to cure asthma. So please do not stop taking your medication when you are in an attack assuming you have been healed with herbs.
Asthma can be mild, moderate or severe. So these general categories help us to make a decision on how to treat it. Mild asthma usually has very minor symptoms that can just be managed as an outpatient without any need for admission. Usually at this point in time we just give you a bronchodilator like salbutamol and you are well. The best is to give it as an inhaler and once the patient has recovered they can discontinue the use of the inhaler. If the attack is moderate normally we can also add a steroid inhaler like beclamethasone and maybe an oral beta blocker like salbutamol tablets. In severe attacks the patient generally needs admission and treatment with intravenous steroids for a quicker relief. Oxygen therapy may also be needed. Same applies to nebulisation.
Complications from asthma mainly come if the patient is not treated in time. As such we implore that if you are asthmatic please always stay with your pump and tablets near you all the time to minimize delay in treatment. Especially in winter like now we encourage you to make sure you have all your medications nearby and that they are not expired. Be in the habit of checking the expiry dates of your medications. Do not wait to get sick to visit your doctor, you can just visit to restock your medicines if they have run out or they have expired. Once you get an attack do not wait to get to hospital or to the doctor to start using your medicines, you have to start using them as soon as you feel an attack has come. This helps minimise hospital stay and also duration of treatment before life gets back to normal. It is also good to be in support groups with other asthmatic patients where you discuss your conditions as counterparts.
Lastly I always get asked the question should I be vaccinated against covid19 doc I’m asthmatic? The answer is an overwhelming YES as we all know asthmatics just like people with other chronic conditions like diabetes mellitus are more susceptible to the virus. As such we encourage asthmatic patients to please go and get vaccinated against covid19.
Remember a healthy you, a healthy me to a healthy world.
Josephat Chiripanyanga is a medical doctor based in Harare. He can be contacted at firstname.lastname@example.org