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Asthma

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Asthma

Introduction

Asthma, a disease that afflicts at least 300 million of the worlds population, is

characterized by wheezing, chest tightness, coughing and difficulties in breathing either at

night or early morning (Akinbami, Moorman, Bailey, Zahran, King, Johnson, & Liu, 2012).

In general, asthma is a chronic disease and has no known cure. There are options in its

management that facilitate the improvement of the quality of life. Education of patients in

order to aid in the understanding of the disease triggers is important in reducing the burden of

asthma. Effective management of asthma involves medications that control inflammation or

relieve symptoms.

The airways of a person suffering from asthma are swollen and sore rendering them

sensitive and may react strongly to allergens. The wheezing, difficulties in breathing,

coughing and chest tightness are caused by the narrowing of the bronchial tubes (spasm) that

is a result of the muscles surrounding the airways being inflamed. This inflammation

constricts the airways, hence, the difficulty breathing in and out.

Urbanization has greatly contributed to the increasing cases of allergic diseases such

as asthma in the last 50 years. According to the Center for Disease Control and Prevention,

2011, children post the highest cases of asthma as compared to other groups (Akinbami,

Moorman, Bailey, Zahran, King, Johnson, & Liu, 2012). The most common type of asthma is

known as Allergic Asthma. This type of asthma results from the inhalation of allergens such

as pollens, pet dander, dust mites etc. The allergens will cause the swelling and inflammation

of airways which will in turn result to chest tightness, wheezing and coughing.

Pathology
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Bronchoconstriction

When an asthma attack occurs, inflamed airways respond to certain triggers in the

environment such as pollen, dust or smoke. These airways then constrict and produce mucus

in excess. This will lead to difficulties in breathing. Generally, asthma occurs due to certain

immune responses in the bronchial airways.

Asthma patients have airways that overly react to certain triggers. This

hypersensitivity is largely referred to as type 1 hypersensitivity. The bronchi, in response to

this exposure, contract leading to the asthma attack. Inflammation follows causing the

airways to narrow further and also leading to the production of excess mucus that results to

coughing in addition to other difficulties in breathing. The bronchospasm can spontaneously

resolve in 1 or 2 hours or as is the case in about 50% of asthma attacks, may result in a

further inflammation and broncho-constriction (Barrios, Kheradmand, Batts, & Corry, 2006).

The normal quality of the bronchus is facilitated by a balanced and proper operation of the

autonomic nervous system, an operation that is reflexive by nature. The afferent nerve

endings, whose origin is the inner lining of the bronchus, form the parasympathetic reflex

loop. Their stimulation, for example by fumes, cold air or dust, leads to the propulsion of

impulses to the brain stem vagal center, vagal efferent pathway and finally to the bronchial

small airways. The efferent nerve endings release acetylcholine which results in the increased

production, in the bronchial smooth muscles, of inositol 1, 4, 5-triphosphate (IP3). IP3

production causes the shortening of muscles, which then triggers bronchoconstriction.

Bronchial inflammation:

The causal factors of allergic asthma are important in understanding allergic asthma

mechanisms. Antigen presenting cells (APCs) ingest any inhaled allergens that are present in

inner airways of both people with asthma and those without it. These APCs then pass on the
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parts of the allergen to the other cells of the immune system. In people without asthma, these

other cells (T helper cells), normally ignore the allergen molecules after the initial check.

However, in asthma patients, and for reasons yet to be well understood, the t helper cells

(TH0) change into a different cell type (TH2)

The TH2 cells then activate the humoral immune system which generates antibodies

that target the allergen. In subsequent exposures to the same allergen, the antibodies will

recognize it and stimulate a humoral reaction. Inflammation results due to the production of

chemicals that lead to the thickening of the airway. There is also a proliferation of cells that

produce scarring causing cells that produce mucus to increase and eventually lead to the

production of not only more but thicker mucus. All these activities cause the activation of the

immune systems cell-mediated component. Airways that are inflamed will always be hyper-

reactive and are subject to bronchospasm.

Etiology

It is not yet clear as to why some people suffer from asthma while others do not.

Generally though, the greatest risk factors for asthma development are a mixture of the

environment and genetics (Beasley, Crane, Lai, & Pearce, 2000). There are different asthma

triggers for different persons and this may include: Air that is cold, Irritants and air pollutants

e.g. smoke, Tobacco smoke, Both outdoor and indoor allergens e.g. mould and dust mites,

Stress and strong emotions, Physical activity that can lead to asthma induced by exercise,

certain medications like aspirin can trigger asthma, preservatives and sulfites that are part of

some beverages and foods.

Epidemiology
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By the year 2011, 235 million people suffered from Asthma and around 250,000

asthma-related death cases are reported every year, with 80% of these mortality figures

coming from the low and middle-income countries. Although rates are different between

countries, the prevalence is normally between 1 and 18%, with developed countries posting a

higher rate than the developing ones. Lower rates are therefore reported in Africa, Asia and

Eastern Europe (Subbarao, Mandhane, & Sears, 2009). The economically disadvantaged in

developed countries post higher rates while in the developing countries, the disease is more

prevalent amongst the affluent. Boys are more likely to suffer from asthma compared to girls

with a ratio of 2:1 but severe asthma is found in equal rates. Contrastingly, adult men have a

lower rate of asthma compared to women. The young have also been found to have a higher

rate of asthma compared to the old.

IgE antibody is the main reason for Asthma attacks. The antibody is produced by the

body in reaction to exposure to allergens. This antibody in combination with the allergens

causes the release of harmful chemicals. There has been a significant increase in the rates of

asthma between 1960 and 2008 and it has been listed as a major public health concern.

Urbanization has greatly contributed to the increasing cases of allergic diseases such as

asthma in the last 50 years. According to the Center for Disease Control and Prevention,

2011, children post the highest cases of asthma as compared to other groups (Subbarao,

Mandhane, & Sears, 2009). There are no clear reasons for this rise in asthma cases in urban

populations, especially amongst children, although crowded living conditions, air pollution,

exposure to second-hand smoke etc can be contributing factors.

Drug treatment

Asthma treatment generally involves one understanding their triggers, instituting the

necessary measures to avoid them and keeping track of ones breathing to ensure that daily
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medications are controlling the symptoms (DiMatteo, 2004). Medications are dependent on

various things e.g. symptoms, asthma triggers, what is effective in keeping asthma under

control and age. Inhalers that offer quick relief, quickly dilate the airways that are swollen

while the preventive and long-term medications serve to reduce the inflammation.

Long term medication used in the control of asthma is taken daily and it helps reduce

the chance of an asthma attack. These drug types include:

Leukotriene Modifiers: They are taken orally and they help manage the symptoms for

up to twenty-four hours. These drugs include Zileuton, Zafirlukast and Montelukast. As a side

effect and in very rare cases, they can lead to hallucinations, aggression, depression, agitation

and suicidal tendencies.

Inhaled Corticosteroids: These include; fluticasone furoate, ciclesonide, flunisolide,

mometasone, fluticasone and beclomethasone. The side effects associated with these drugs is

lower compared to the oral corticosteroids and are safer for use in the long term although one

has to use them for several days before they can achieve their maximum benefit.

Combination inhalers: These types of drug contain both a corticosteroid and a long

acting beta agonist, and as such, can increase ones risk of having a severe asthma attack. The

drugs include formoterol-mometasone, fluticasone-salmeterol and budesonide-formoterol.

Long-acting beta agonists: These medications are inhaled and include formoterol and

salmeterol. There is a possibility of a user developing a severe asthma attack so one should

combine them with an inhaled corticosteroid. This drug type can also camouflage the

deterioration of asthma so it is not advisable to use them for acute asthma attacks.

Theophylline: This is a pill that is taken daily and helps in opening the airways. Its

usage has reduced recently.


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Quick-relief asthma medication is necessary for the short term and fast relief of

symptoms of an asthma attack. Upon a doctors recommendation, they can also be used

before an exercise. These type drugs include:

Intravenous and Oral Corticosteroids: These lessen the airway inflammation that is a

result of severe asthma. If used in the long term, they can cause serious side effects. They

include methylprednisolone and prednisone.

Ipratropium: This is a bronchodilator that quickly relaxes the airways making it easier

for one to breathe. It is mostly used for chronic bronchitis and emphysema but can also be

used sometimes to treat asthma.

Short-acting beta agonists: They are inhaled bronchodilators and serve as quick relief

medicines by rapidly reducing the symptoms of an asthma attack. These drugs include

levalbuterol and albuterol. They can be either in a nebulizer or hand-held inhaler and are

therefore inhaled either through a mouthpiece or a face mask.

Non-Drug Treatment

Breathing exercises:

These exercises help in general relaxation and also aid in breathing in a controlled and

calm way during an asthma attack. Yoga relaxation techniques can help prevent asthma

symptoms (Chalmers, Macleod, Little, Thomson, McSharry, & Thomson, 2002). Data on the

effects of these techniques is scanty and should be handled with caution.

Sports and exercise:

People suffering from asthma can greatly benefit from sports and physical activity

since when done on a regular basis can help improve both lung and heart functions. The
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uptake of oxygen is greatly increased during exercises. Research has proven that exercise and

sports can in the long term, reduce asthma symptoms.

Avoiding allergy triggers:

If there is a family history of asthma, then children should be prevented from coming

into contact with the risk factors and the allergy triggers as much as possible. These allergy

triggers may include allergy causing foods, dust mites and animal fur.

Quitting smoking

Tobacco is a contributing factor to a number of medical conditions. Since asthmatic

patients have highly sensitive airways, smoking is not recommended for them. Cigarette

smoke contains various substances that are directly deposited on one's airway (Chalmers,

Macleod, Little, Thomson, McSharry, & Thomson, 2002). Some of these substances might be

toxic and can cause further worsening of the airway inflammation. Cigarette smoke can also

cause chronic bronchitis.

Dieting:

A BMI that is over 30 can worsen asthma. Studies have revealed that losing weight

can help control asthma.

Complementary medicine:

Although complementary medicine offers an alternative route to asthma management,

there is a lack of adequate scientific data that clearly explains how this works:

Acupuncture: Studies have yet to conclusively reveal whether acupuncture can

effectively relieve asthma.


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Herbal medicine: There are some studies that have explored the effects of herbal

medicines on asthma relief but they are not yet conclusive. Herbal medicines can also have

side effects.

Salt cave therapy: This is a treatment whereby one spends several hours in a cave or

mine that has special conditions like mineral content, climate, air pressure or clean air. No

scientific data supports this method as an alternative to asthma management.

Alexander Technique: Here one is taught to improve their breathing through correct

postures and favorable movements.

Conclusion

To sum up, the paper has provided information on Asthma. Asthma is a chronic

respiratory ailment which can be identified by wheezing, chest tightness, coughing and

difficulty in breathing. It is not yet clear as to why some people suffer from asthma while

others do not. The airways of a person suffering from asthma are swollen and sore rendering

them sensitive and may react strongly to allergens. The wheezing, difficulties in breathing,

coughing and chest tightness are caused by the narrowing of the bronchial tubes (spasm) that

is a result of the muscles surrounding the airways being inflamed.

Asthma is controlled by two types of medications namely quick relief medications

that aim to stop the symptoms associated with asthma and long-term medications that prevent

the symptoms. Allergic asthma is controlled by anti-allergy medications, avoiding allergens

and use of allergy injections.

The risk factors associated with asthma range from ingestion or inhalation of

pollutants and allergens, exercises, cold weather exposure, occupational factors and

infections. Chronic conditions of asthma affect a persons social, psychological and physical
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wellbeing. Education of patients in order to aid in the understanding of the disease triggers is

important in reducing the burden of asthma.

It is impossible for one to fully avoid allergens. IgE antibody is the main reason for

Asthma attacks. The antibody is produced by the body in reaction to exposure to allergens.

This antibody in combination with the allergens causes the release of harmful chemicals.

Therefore, IgE is the main culprit for Allergic Asthma and new treatments are focusing on

binding the IgE antibody in order to prevent it from switching on the allergic response.
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References

Akinbami, L. J., Moorman, J. E., Bailey, C., Zahran, H. S., King, M., Johnson, C. A., & Liu,

X. (2012). Trends in asthma prevalence, health care use, and mortality in the United

States, 20012010. NCHS data brief, 94(94), 1-8.

Barrios, R. J., Kheradmand, F., Batts, L. K., & Corry, D. B. (2006). Asthma: pathology and

pathophysiology. Archives of pathology & laboratory medicine, 130(4), 447-451.

Beasley, R., Crane, J., Lai, C. K., & Pearce, N. (2000). Prevalence and etiology of asthma.

Journal of Allergy and Clinical Immunology, 105(2), S466-S472.

Chalmers, G. W., Macleod, K. J., Little, S. A., Thomson, L. J., McSharry, C. P., & Thomson,

N. C. (2002). Influence of cigarette smoking on inhaled corticosteroid treatment in

mild asthma. Thorax, 57(3), 226-230.

DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: a meta-

analysis.

Subbarao, P., Mandhane, P. J., & Sears, M. R. (2009). Asthma: epidemiology, etiology and

risk factors. Canadian Medical Association Journal, 181(9), E181-E190.


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