Diagnosis and treatment of asthma 

Diagnosis

Diagnosis of asthma is based on the patient’s history and respiratory functions tests. When a patient’s history reveals repetitive, seasonal, mostly nocturnal shortness of breathing and cough that are induced by allergens or environmental factors, asthma should be considered. Making a definitive diagnosis of asthma is based on respiratory function tests and allergic tests. Respiratory function test is an important step in both diagnosis and in determining the severity of asthma.¹ In respiratory function tests, the amount and speed of inspired air are measured during a forced breathing, thus any alteration in respiratory function of the patient is calculated. Diagnosis of asthma is made after all results were evaluated, and required treatments are applied.²

Treatment

Current treatment of asthma comprises of prevention from environmental factors and drug therapy. Drugs used in asthma treatment are divided into two groups as controllers and relievers (symptomatic);

• Controller drugs mainly remove the inflammation of airways and enable control of asthma. These agents should be used on daily basis for a long-time. 
• Reliever drugs are fast-acting bronchodilators and are used just in case.

The main problem in asthma disease involves airways, thus it is preferred to administer any drug directly into airways. Besides inhalers, there are oral and injectable drugs.³ In addition to drug therapy, today, many patients prefer…

• Buteyko method (breathing technique),
• Yoga, 
• Hypnosis, 
• Acupuncture, 
• Homeopathy, 
• Nutritional and dietary supplements, in order to relieve symptoms of asthma as complementary treatments. 

Studies demonstrated that alternative and complementary therapies were also effective in reducing symptom severity and increasing quality of life in asthma patients.^4,5

Another important issue in treatment is asthma education. An effective treatment of an asthma patient requires high level compliance and cooperation of the patient and his/her family (if the patient is a child) with the physician. The purpose of cooperation is to provide self-control and competency in self-treatment. 

Asthma education can be defined as the education of patient, his/her family and all healthcare providers to the patient. It enables asthma patients to understand their own disease, risk factors, differences between controller and reliever drugs, and using inhaler and PEFmeters. It also increases awareness and quality of life of the asthma patients.⁶

1.http://ginasthma.org/local/uploads/files/GINA_Pocket2013_May15.pdf
2.http://www.webmd.com/asthma/guide/lung-function-tests-asthma
3.http://www.toraks.org.tr/uploadFiles/book/file/4102011173256-ASTIM-ILACLARI.pdf
4.http://www.tuberktoraks.net/managete/fu_folder/2006-02/2006-54-2-189-196.pdf
5.http://www.asthma.org.uk/knowledge-bank-treatment-and-medicines-complementary-therapies 
6.http://www.toraks.org.tr/uploadFiles/book/file/4102011173359-HASTA--HEKIM-ISBIRLIGI-HASTA-EGITIMI.pdf

Pediatric asthma and treatment

Asthma occurs frequently during childhood. Recent studies showed that asthma occurrence rate has been increasing in children in time. The most common symptoms of asthma in children are cough and wheezing. Diagnosis of asthma in children who are not convenient for respiratory function tests (i.e. younger than 5 years of age) can be made based on family history, allergic status, and shortness of breathing during playing games. 

In children, asthma treatment includes controller and reliever drugs. Aims of treatment include relieving symptoms, maintaining lung functions within normal limits and keeping the child in active and normal life.

A concerned family is very important for prevention of life-threatening conditions and attacks in asthmatic children. Avoiding allergens, adequate medical treatment and regular follow up, are fundamental measures to prevent dangerous asthma attacks and hospitalizations. 

Asthma under special conditions

• Exercise and asthma

Exercise-induced asthma is characterized by difficulty in breathing during or after activities that require physical power, chest tightness, pain and wheezing. As asthma patients may show asthma symptoms during exercise, there are many people who develop asthma symptoms only during exercise.

As far as asthma is under control, i.e. if asthma treatment is adequate and sufficient, an active life style, exercise and sports can be performed. There are many asthmatic athletes who won olympic medals. Symptoms especially occur during short and intense exercise, whereas slow and longtime exercise may lead to milder symptoms. For example, walking is safer than running.

• Use your inhaler drugs before exercise.
• Take your time to warm up before exercise and cool down after exercise.
• If the weather is cold, prefer indoor exercise or use a mask to protect your mouth and nose.
• Avoid outdoor exercise in case of high amount of pollution or pollens.
• Reduce your exercise program if you are having a viral infection.
• Prefer exercise types matching your physical condition.

Frequently asked questions about asthma

• What is the relationship between allergic rhinitis and asthma?
  

Asthma and allergic rhinitis are comorbid diseases. Allergic rhinitis is present in 75% of asthma patients, and asthma is present in 10 to 40% of allergic rhinitis patients. Lower and upper airways are in horizontal and vertical interaction. Both diseases show a parallel course. Rhinitis may precede asthma development, and also presence of rhinitis in asthma patients is an important risk factor for severity of asthma.

Reference: http://www.toraks.org.tr/uploadFiles/book/file/2322011174111-Ozel-durumlarda-astim-.pdf

• Is there a cure for asthma?
  

• Asthma symptoms such as cough, shortness of breathing, and wheezing are prevented.
• The need for reliever inhaler drugs is decreased.
• Sustained improvement of respiratory function tests is obtained.
• Daily activities improve and nighttime awakenings are reduced. 
  

• What are the diagnostic tests of asthma?

There are several important tests which may be used by your physician to diagnose asthma. These tests include respiratory function tests (spirometry) which measure lung capacity and functions, allergy tests (skin prick test etc) which determine sensitivity to a certain allergen (pollen, food), and certain special blood tests (IgE test) to measure antibodies that play important role in development of asthma.

Reference: http://www.webmd.com/asthma/guide/diagnosing-asthma-tests

• What is the importance of respiratory function tests in asthma?

The most prevalent respiratory functions tests for asthma are spirometry and methacholine challenge test. Spirometry is an easy method that provides information about the speed and amount of air movement into and out of the lungs. At the same time, these tests provide information about air limitation and obstruction in asthma patients besides evaluation of treatment response.

Methacholine challenge test is used to detect airway hypersensitivity in laboratory in patients who have history in accordance with asthma, and no obstruction in respiratory function tests. It is very important in diagnosis of asthma.

Reference: http://www.webmd.com/asthma/guide/lung-function-tests-asthma

• What is the effect of smoking on asthma?

Smoking leads to sustained airway inflammation. Smoking is highly toxic and contains carcinogenic substances and leads to damage in airway cells in mid- and long-term.¹ Airways are exposed to many harmful and toxic agents recurrently during smoking, and the disease becomes worse.²Smoker asthma patients, when compared to non-smokers, have higher risk of death, heavier asthma symptoms, worsening respiratory function tests, and increased hospitalization.³

References: 

1. Hoffmann D, Hoffmann I. The changing cigarette, 1950-1995. J Toxicol Environ Health 1997;50:307-64

2. Hargreave FE, Parameswaran K. Asthma, COPD and bronchitis are just components of airway disease. Eur Respir J 2006;28:264-7.

3. http://www.toraks.org.tr/uploadFiles/book/file/2422011121534-terj12021.pdf

• Can we have pet animals?

Some of the asthma patients develop allergy to pets. Animals such as cat, dog, budgie (lovebird) affects asthma patients negatively. When treating such patients, pet animals should be removed from house and exposure to people who have pet animal should be avoided.

Reference: Erdinç M, et al. Astım ile yaşam. İstanbul. Aves Yayıncılık.2009. 51 pp.

• What is the relationship of body weight and asthma?

Obesity and overweight are abnormal and excess fat accumulation that affects health. Body mass index (BMI), is a simple index of weight for height, and is frequently used to define overweight and obesity. BMI, is calculated by body weight (kg) divided by square meter of height. World Health Organization, defines overweight with a BMI equal to or higher than 25, and obesity with a BMI equal to or higher than 30.¹

Studies suggested that obese children and adults (especially women) are more prone to asthma than normal individuals. Higher risk of asthma development in patients with obesity may depend on genetic background and alterations in lung functions.² 

References:

• Do anxiety and stress trigger asthma attacks and symptoms?

Asthma is a chronic disease and has impact on physical, emotional and social life of the patient. It may lead patient to remove from school and working life.^1,2 Especially in uncontrolled asthma, emotional factors are prominent.³Stress may provoke breathing problem and increase its severity. Worried individual may interpret his/her shortness of breathing more negative,⁴ which forms a vicious cycle. In other words, stress triggers asthma, asthma triggers anxiety.