Asthma can be fatal if you do not take asthma symptoms seriously. Read further what our health experts say about diagnosis of asthma to prevent asthma attack.

Asthma

Asthma, known as "دمہ" in Urdu, is a chronic respiratory condition that affects the airways. It is characterized by inflammation and narrowing of the air passages, leading to symptoms such as wheezing, coughing, shortness of breath, and chest tightness. Understanding the meaning of asthma in Urdu can help raise awareness about this common condition and facilitate better communication regarding its management and treatment options.

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Asthma can be fatal if you do not take asthma symptoms seriously. Read further what our health experts say about the diagnosis of asthma to prevent an asthma attack. 
Inflammation causes narrowing of the air passages, leading to asthma symptoms which include<a href="https://www.merisehat.pk/article/natural-remedies-for-the-cold-flu-and-cough"> cough</a>, difficulty breathing, wheezing, and tightness of the chest.<a href="#accordion">[1]</a> People usually experience a worsening of symptoms at night or while exercising. Since the airways are more sensitive in asthma sufferers, common triggers such as dust, strong perfumes, animal fur, and weather changes can worsen symptoms.

In recent decades, the long-term respiratory diseases have become more common among adults, especially in low- and middle-income countries. This increase in incidence can be largely linked to increasing urbanization, a rise in pollution, and a lack of disease awareness among the population. Moreover, the rising incidence has also led to a higher morbidity rate for asthma, thereby, increasing the global disease burden. According to the World Health Organization (WHO), asthma was the cause of death in 455,000 people in 2019<a href="#accordion">[2]</a>.

 
The estimated prevalence of asthma in Pakistan varies between 4.3% and 31.6%<a href="#accordion">[1]</a>. Unfortunately, these numbers are only expected to increase further with time. Lack of proper healthcare facilities, poor patient compliance, low socioeconomic status, incorrect use of inhalers, and lack of awareness about the disease are the likely underlying causes of the rise in asthmatic cases in Pakistan.&nbsp;

Furthermore, the disease is also very common among children, affecting around 20% of the country&#39;s pediatric population<a href="#accordion">[3]</a>.

Till date the causes of asthma have not been elucidated, however, research indicates that a combination of genetic and environmental factors might be involved. Also, this chronic disease has no definitive cure, but symptomatic management is possible through use of medications and reduced exposure to triggers. Therefore, it is important that patients work closely with their doctor and track their signs and symptoms.&nbsp; 
&nbsp;

There are several different types of asthma.&nbsp; 
&nbsp;

<ul>
	<li>Childhood Asthma:&nbsp;It is the most common chronic childhood respiratory disease and symptoms typically begin at an early age. Family history of allergic diseases and early weaning are considered risk factors of childhood asthma.</li>
	<li>Adult-Onset Asthma:&nbsp;Although it can begin at any age, most cases begin before 40 years.</li>
	<li>Allergic Asthma:&nbsp;This is the most common type of asthma and occurs from exposure to allergens, such as pet dander, mold, dust, pollen, or food.</li>
	<li>Non-Allergic Asthma:&nbsp;This more commonly occurs in response to weather changes or emotional stressors.</li>
	<li>Exercise-Induced Asthma:&nbsp;Constriction of the airways occurs due to physical activity and symptoms can last for 10-15 minutes after stopping exercise. The condition can also occur in people without asthma.</li>
	<li>Occupational Asthma:&nbsp;Workplace exposure to dyes, chemicals, latex, animal proteins, wood dust, etc. can cause or worsen asthma.</li>
	<li>Nocturnal Asthma:&nbsp;As the name implies, this type of asthma worsens at night and is typically triggered by heartburn. Dust mites and pet dander may also worsen symptoms at night.</li>
	<li>Aspirin-Induced Asthma:&nbsp;Approximately 9% of people with asthma have aspirin-induced asthma. Within minutes or hours of ingestion of aspirin, people develop a cough, runny nose, and sneezing.</li>
	<li>Cough-Variant Asthma:&nbsp;This particular type does not present with the classic symptoms of wheezing or breathing difficulty. Instead, the person will generally present with a long-term dry cough.&nbsp; 
	&nbsp;</li>
</ul>

Signs and Symptoms

Common symptoms of asthma include:

<ul>
	<li>Wheezing, a high-pitched whistling sound produced during breathing</li>
	<li>Cough, which is worse in morning or at night</li>
	<li>Shortness of breath</li>
	<li>Chest tightness or pain</li>
	<li>Fatigue</li>
	<li>Trouble sleeping</li>
	<li>Recurrent infections 
	&nbsp;</li>
</ul>

The severity and duration of symptoms varies from person to person. Some people experience episodes in response to specific triggers, while others face continuous symptoms throughout the day. The type of asthma can also alter the signs and symptoms experienced.&nbsp; 
&nbsp;

An asthma attack, or exacerbation of asthma, is characterized by tightening of the muscles surrounding the airways, also called bronchospasm. As a result, the airway becomes inflamed and narrow, and the cells lining the airways start producing more mucus and of a thicker consistency. Although such severe attacks are less common, they last longer than mild attacks and require immediate attention. Therefore, it is important to be on the alert for warning signs of an asthma attack and remain compliant with medications.&nbsp; 
During an asthma attack a person may have the following signs and symptoms: 
&nbsp;

<ul>
	<li>Difficulty speaking and breathing</li>
	<li>Blue lips and face due to lack of oxygen entering blood</li>
	<li>Gasping for air</li>
	<li>Rapid pulse</li>
	<li>Confusion, dizziness, or decreased alertness</li>
	<li>Sweating</li>
	<li>Panic or severe<a href="https://www.merisehat.pk/disease/anxiety/" target="_blank"> anxiety</a></li>
	<li>Tightening of neck and chest muscles 
	&nbsp;</li>
</ul>

If the use of an inhaler does not improve the symptoms, medical help should be sought immediately as the attack can often turn fatal. Moreover, recurrent asthma attacks can lead to long-term damage to the lungs and airways. 
&nbsp;

Common complications of asthma include:

<ul>
	<li><a href="https://merisehat.pk/disease/pneumonia">Pneumonia</a></li>
	<li>Pregnancy complications, such as preterm delivery or loss of pregnancy</li>
	<li>Permanent narrowing or obstruction of airways</li>
	<li>Lung Fibrosis</li>
	<li>Lung Collapse</li>
	<li>Respiratory Failure 
	&nbsp;</li>
</ul>

Causes

The body&#39;s immune system is responsible for protecting the body against any foreign invaders, such as bacteria, dust, and chemicals. This is typically accomplished by the release of cells that produce inflammation around the foreign substance and help destroy it. However, such inflammatory responses don&rsquo;t generally occur in the airways due to its constant exposure to dust, pollen, and germs. But in asthmatics, the airways are hypersensitive and the immune system reacts to these irritants by increasing inflammation in the airways. This results in inflammation of the airways, tightening of surrounding muscles, and mucus glands in the airways producing thick mucus. Thus, causing difficult breathing, coughing, and wheezing.&nbsp; 
&nbsp;

Previously asthma was considered to have an environmental cause alone, however, recent research now points towards a combination of multiple factors that are listed below.&nbsp;&nbsp; 
&nbsp;

Environmental&nbsp;Factors - Exposure to irritants such as airborne allergens (dust, pollen, pet fur), air pollutants, cold causing viruses, and weather changes can lead to the development and exacerbation of asthma.

Hygiene Hypothesis - The hygiene hypothesis states that reduced childhood exposure to bacteria and viruses in childhood results in the weakening of the immune system and leaving it vulnerable to asthma and other allergic conditions later in life.

Genetic Factors - Researchers have identified 25 different genes that are associated with the development of asthma. It has been established that asthma has a genetic predisposition i.e. if you have a parent or a sibling with asthma, your chance of developing the condition is higher.&nbsp;&nbsp;

Medical Conditions - An history of atopic disease such as eczema or allergic rhinitis also increases the risk of asthma occurring later in life.&nbsp; 
&nbsp;

Asthma triggers include:

<ul>
	<li>Air pollutants, such as cigarette smoke</li>
	<li>Physical activity, such as exercise</li>
	<li>Respiratory infections, such as the<a href="https://www.merisehat.pk/disease/cold-flu" target="_blank"> common cold</a></li>
	<li>Allergens, such as dust, pollen, spores, pet fur</li>
	<li>Medications, such as aspirin, beta blockers, or nonsteroidal anti-inflammatory drugs (NSAIDs)</li>
	<li>Stress and strong emotions</li>
	<li>Food preservatives</li>
	<li>Pesticides</li>
	<li>Weather changes</li>
	<li><a href="https://merisehat.pk/disease/gerd-56">Gastroesophageal reflux disease (GERD)</a> 
	&nbsp;</li>
</ul>

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Diagnosis

There is no definitive diagnostic test for asthma. Doctors rely on a combination of symptoms and a variety of tests for diagnosis. Asthma is generally suspected if the individual has a history of cough, shortness of breath, and wheezing. Spirometry is then conducted to help confirm the diagnosis.

Usually, doctors perform the following tests to diagnose asthma: 
&nbsp;

<ul>
	<li>Complete History - A complete history involves questions regarding the person&#39;s symptoms, duration of symptoms, medical history, environmental exposure to common allergens, and a family history of diseases (including eczema, asthma and hay fever).</li>
	<li>Physical Exam - A stethoscope is used to listen for any abnormal breathing sounds, such as wheezing. Moreover, a physical exam will also include observing the skin for signs of eczema or other allergic diseases. Some doctors may also perform a skin test for allergies.</li>
	<li>Spirometry - This simple breathing test helps determine how well a person&#39;s lungs are functioning. It involves breathing into a device that measures how fast they can breathe out and how much air they can exhale after a deep inhale.&nbsp;</li>
	<li>Peak Flow Meter -&nbsp;This simple device can be used at home and helps determine whether the person&#39;s asthma is improving, reacting well to medications, and whether they need to see a doctor. The test measures how hard they can exhale.&nbsp; 
	&nbsp;</li>
</ul>

Doctors may also perform additional tests:

<ul>
	<li>Methacholine Challenge - Methacholine is an asthma trigger. The test involves inhalation of the chemical before and after spirometry. If the results decrease by at least 20%, doctors suspect asthma. Medication that reverses methacholine&#39;s effects is given after the test.</li>
	<li>Chest X-ray - A chest X-ray generally helps rule out other diseases or abnormalities that can trigger or exacerbate breathing problems.</li>
	<li>Nitric Oxide Test - Asthmatics have higher than normal nitric oxide levels due to inflammation of airways. Therefore, the test measures the amount of nitric oxide in a person&#39;s exhaled breath. However, the test isn&#39;t very common.</li>
	<li>Sputum Eosinophils - The test looks for levels of eosinophils (a type of white blood cell) in a sputum sample collected during coughing. The sample contains a mixture of saliva and mucus. This test is usually used to determine allergic asthma.&nbsp;&nbsp; 
	&nbsp;</li>
</ul>

Lung function tests, such as spirometry, are often done before and after administering bronchodilators. Diagnosis of asthma depends on whether the lung function improves with the drug or not. In young children, it is difficult to conduct breathing tests; therefore, doctors typically prescribe asthma medications and look for an improvement of symptoms. An improvement of symptoms points to an asthma diagnosis.&nbsp; 
&nbsp;

Treatment

Prior to administering any type of treatment, a doctor classifies a person&#39;s asthma based on the severity of their symptoms. The four general classifications of asthma include: 
&nbsp;

<ul>
	<li>Mild Intermittent - People have mild symptoms with a frequency of less than twice a week or less than 2 nights per month. Their symptoms don&#39;t interfere with their daily activities.&nbsp;</li>
	<li>Mild Persistent - Symptoms might interfere with daily activities and frequency is more than twice a week, but not daily, while nighttime symptoms do not occur more than 3-4 times a month.</li>
	<li>Moderate Persistent - A person will have daily symptoms and at least nightly episode per week.&nbsp;</li>
	<li>Severe Persistent - Daily day and nighttime symptoms limit daily activities. 
	&nbsp;</li>
</ul>

Based on a person&#39;s classification of asthma, their age, type of asthma, and triggers, a doctor may prescribe a combination of different treatments. Asthma medications usually fall into two general categories: quick-relief asthma medications and long-term asthma control medications.&nbsp; 
 
&nbsp;

<h5>Quick-Relief Asthma Treatments</h5>

These medications help provide rapid, but short-term relief of asthma symptoms. Doctors may prescribe their use prior to exercise or for relief of an asthma attack. They include: 
&nbsp;

<ul>
	<li>Short-Acting Beta Agonists - Also called rescue inhalers, these bronchodilators (such as salbutamol) work by relaxing the muscles surrounding the airways. They&#39;re the first-line treatment for asthma symptoms and provide immediate ease of symptoms during an asthma attack. These medications&nbsp; are taken via a hand-held inhaler or a nebulizer.</li>
	<li>Anticholinergic Agents - Similar to beta agonists, anticholinergics also relax the airway, providing relief of asthma symptoms. Ipratropium and tiotropium are the two common anticholinergic bronchodilators used during an asthma attack. They are either taken via a nebulizer or an inhaler.</li>
	<li>Corticosteroids - These medications include prednisone and methylprednisolone, taken either orally or via intravenous injections. They help reduce airway inflammation associated with severe asthma. However, due to adverse outcomes, these drugs are only taken for short term treatment of symptoms.&nbsp; 
	&nbsp;</li>
</ul>

<h5>Long-Term Asthma Medications</h5>

Doctors generally prescribe these medications for use on a daily basis to help keep the asthma under control. These include:

<ul>
	<li>Inhaled Corticosteroids - Fluticasone, Beclomethasone, and Budesonide are the most commonly used inhaled corticosteroids. They are taken daily and help prevent and control airway inflammation. Moreover, they also cause the cells lining the airways to produce less mucus, hence, improving breathing. Inhaled corticosteroids have lower risk of adverse outcomes compared to oral and intravenous corticosteroids.</li>
	<li>Leukotriene Modifiers - These oral pills (such as Montelukast, Zafirlukast) block leukotrienes&nbsp; that trigger asthma attacks.&nbsp;</li>
	<li>Combination Inhalers - These include a combination of an inhaled corticosteroid and a long-acting beta-agonist. The most common ones are fluticasone-salmeterol, formoterol-mometasone, budesonide-formoterol, and fluticasone furoate-vilanterol.</li>
	<li>Theophylline - This daily pill helps relax the muscles surrounding the airways, thus easing the chest tightness associated with asthma. It is taken either alone or in combination with an inhaled corticosteroid. However, due to its severe side-effects they are not used frequently. 
	&nbsp;</li>
</ul>

<h5>Biologics</h5>

Biologics disrupt inflammatory pathways involved in causing asthma by targeting specific antibodies in the body. They are generally prescribed for severe asthma that doesn&#39;t respond to other medications. Most common ones are Omalizumab, Dupilumab, Reslizumab, Benralizumab, and Mepolizumab.&nbsp; 
&nbsp;

<h5>Allergy Medications</h5>

When asthma is triggered or worsened by allergies, allergy shots are given once a week for a few months. They are then gradually decreased to once a month for a period of 3-5 years. They help reduce the immune system&#39;s reaction to asthma triggering allergens. 
&nbsp;

<h5>Bronchial Thermoplasty</h5>

This is generally reserved for severe asthma that is unresponsive to inhaled corticosteroids or other long-term asthma medications. Using electrodes, doctors heat the airways inside the lungs. The heat reduces the smooth muscles surrounding the airways and in turn prevents the muscles from tightening. Thus, reducing asthma attacks and providing relief in breathing difficulty. However, this minimally invasive procedure is not yet widely available.&nbsp;&nbsp; 
&nbsp;

Certain things increase a person's risk of having asthma. These include:<ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Family History:&nbsp;People with parents or siblings with asthma have higher chances of developing asthma.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Ethnicity:&nbsp;Certain ethnicities, such as African Americans and Puerto Ricans, have higher incidence of asthma.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Gender:&nbsp;In early childhood, boys are generally more at risk of developing asthma. However, in adolescence and adulthood, the condition is more common among females.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Job:&nbsp;A person's occupation can expose them to several occupational triggers, such as wood dust, chemicals, and dyes.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Health:&nbsp;A person's health status, which includes weight, presence of lung infections, and history of allergies, also increases the risk of asthma.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Environment:&nbsp;Environmental allergens, such as dust and pollen, are a common cause of asthma. </li></ul>

Doctors generally work with patients to create an asthma action plan best suited to the patient's disease severity and needs. Along with medications, a doctor might also include a list of triggers to avoid and recommend tracking of symptoms as well as use of a peak flow meter to track the treatment progress.&nbsp; Doctors recommend the following measures for prevention of asthma attacks:<ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Avoiding Triggers - Patients are advised to stay away from things that may have worsened their asthma symptoms in the past. These include certain chemicals, products, food additives, or medications.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Taking Asthma Medications - Doctors advise staying compliant with asthma medications and any prescribed preventive medications.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Lifestyle Modifications - These include eating a healthy diet, maintaining a healthy weight, quitting smoking, exercising regularly to increase lung functioning, and learning to manage stress.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Reducing Allergen Exposure - If a person's asthma is triggered by certain allergens, such as dust, pollen, pet dander, or mold, then they must avoid them as much as possible.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Allergy Shots - Routine allergy shots can help the immune system become less sensitive to triggers, thus, reducing frequency of asthma attacks.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Treat Medical Conditions - Certain medical conditions, such as GERD (gastroesophageal reflux disease), can trigger asthma attacks. Therefore, they should be treated accordingly.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Vaccines - Since infections such as pneumonia, flu, and COVID-19 can trigger asthma attacks, patients must talk to their doctors about getting vaccines against them.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Others - Some people may also benefit from other treatments, such as yoga, supplements, herbal medications, or acupuncture. However, a doctor should always be consulted before trying any of these.&nbsp; </li></ul>

Key Points

<ul>
	<li>Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways. Along with hypersensitive airways, asthma also causes airway lining cells to increase production of mucus. As a result, people experience symptoms such as coughing, wheezing, shortness of breath, and chest tightness. The cough is mostly worse at night or upon waking up in the morning.&nbsp;</li>
	<li>However, the symptoms of asthma vary from person to person depending on the type of asthma and triggers.&nbsp;</li>
</ul>

<ul>
	<li>There are many different types of asthma, with allergic asthma accounting for a huge majority of cases. Moreover, certain triggers can exacerbate the symptoms and lead to an asthma attack. The most common asthma triggers include allergens such as pollen and dust, air pollutants (e.g., cigarette smoke), weather changes, cold or flu infection, and even medications (e.g., aspirin).</li>
</ul>

<ul>
	<li>A pulmonologist and/or an allergy specialist diagnose the condition based on the person&#39;s severity of symptoms, frequency of symptoms, physical exam, and various lung function tests. Spirometry is a breathing test used to diagnose and confirm asthma.&nbsp;</li>
</ul>

<ul>
	<li>Treatment of asthma typically depends on the person&#39;s type of asthma, their age, and triggers. Doctors prescribe a combination of short-term and long-term medications. Inhaled bronchodilators are the first-line treatment of an acute asthma attack and provide immediate relief of symptoms.</li>
</ul>

<ul>
	<li>Although there is no cure for the disease, a number of prevention strategies can help keep the symptoms in check. These include avoiding triggers, staying compliant with asthma medications, monitoring symptoms, quitting smoking, managing stress, and practicing a healthy lifestyle. 
	 
	&nbsp;</li>
</ul>

[1] Masoli, M.,Fabian, D., Holt, S. & Beasley, R., 2004. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy, May.pp. 469-78.

[2] Asthma. World Health Organization. Accessed May 30, 2023.

[3] Razzaq, S. et al., 2018. Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi. BMC Pulmonary Medicine, p. 184.