New Telegraph

The Asthma season

Over the last couple of weeks, there has been a surge in Asthma related symptoms that presented to a hospital (personally witnessed), hence, this re-visitation.

The scene

Miss BTF has been experiencing cough, shortness of breath and wheezing over the last 2 weeks. The pattern is more pronounced at night (nocturnal) and usually brought up by cold, dust and whenever she is around where things are being fried. These symptoms were initially noticed two years ago and since then it’s been a history of regular, unpleasant hospital visits.

What it is

Asthma is a chronic (long-term) disease that causes airways in the lungs to become irritated and inflamed (swollen) making it hard to breathe. Asthma, sometimes referred to as bronchial asthma, can start at any age but commonly begins in childhood. Many children grow out of asthma by their teens. Others first develop asthma in adulthood (adult-onset asthma). Asthma often runs in families and can be associated with allergic conditions such as eczema and hay fever.. In essence it can be gotten by Nature (inherited) or Nurtured (from the environment).

Historical Background

The term Asthma comes from the Greek verb aazein, meaning to pant, to exhale with the open mouth, sharp breath. The Corpus Hippocraticum, by Hippocrates, is the earliest text where the word asthma is found as a medical term. Hippocrates said spasm linked to asthma were more likely to occur among anglers, tailors and metalworkers. Aretaeus of Cappadocia (100 AD), an ancient Greek master clinician, wrote a clinical description of asthma. Galen (130-200 AD), an ancient Greek physician, wrote several mentions of asthma which generally agreed with the Hippocratic texts and to some extent those of Aretaeus of Cappadocia. He described asthma as bronchial obstructions and treated it with owl’s blood in wine. At the beginning of the 20th century asthma was seen as a psychosomatic disease – an approach that probably undermined any medical breakthroughs at the time. Asthma was described as psychological, with treatment often involving, as its primary component, psychoanalysis and other ‘talking cures’. A child’s wheeze was seen as a suppressed cry for his or her mother. Psychoanalysts thought that patients with asthma should be treated for depression. This psychiatric theory was eventually refuted and asthma became known as a physical condition. Asthma, as an inflammatory disease, was not really recognized until the 1960s when anti-inflammatory medications started being used.

The likely causes

The exact cause of asthma is not fully understood. It is believed to be caused by a combination of genetic (inherited) and environmental factors. It may be related to modern living, including environmental changes, diet or exposure to some infections. It is known that most people with asthma constantly have some degree of inflammation in their airways. Their airways are also sensitive to certain irritants, known as triggers. Triggers can cause tightening or constriction of the already inflamed airways, thus provoking an asthma attack. Each individual tends to have different asthma triggers. Common asthma triggers include: Pollens or moulds, House dust mites, Animals, Air pollution, Certain foods or food additives, Strong perfumes/odours, Exercise, Cigarette smoke, Some medicines eg: aspirin, non-steroidal anti-inflammatory drugs (a type of pain killer), beta blockers (a type of antihypertensive), Respiratory infections such as colds/flu, Changes in temperature and humidity, Psychological influences eg: extremes of emotion, Workplace irritants eg: paint and varnish fumes, flour, wood dust.

What may give it away

With asthma the airways in the lungs are sensitive to certain irritants. When exposed to these irritants the small airways in the lungs (the bronchioles) become irritated and swollen and the muscles surrounding the bronchiole walls narrow (bronchoconstriction). Excess mucous is produced inside the airways and it becomes difficult for air to travel to and from the lungs, making breathing difficult and producing the cough, wheeze and shortness of breath that are characteristic of asthma. Asthma attacks are characterised by difficulty breathing – especially exhaling. The severity of asthma symptoms varies between individuals. Some experience only mild symptoms while others have very severe symptoms. Attacks can happen suddenly and can occur after periods of being relatively symptom free. A severe asthma attack can be life threatening if treatment is not sought immediately. Common manifestations of asthma include: Coughing – which may worsen at night (norturnal), Wheezing, Chest tightness, Shortness of breath, Difficulty speaking (in more severe attacks), Blueness around the mouth (in more severe attacks).

The catch

A diagnosis of asthma should be suspected if there is a history of recurrent wheezing, coughing or difficulty breathing and these symptoms occur or worsen due to exercise, viral infections, allergens or air pollution. Spirometry is then used to confirm the diagnosis. In children under the age of six the diagnosis is more difficult as they are too young for spirometry. Chest xray and sputum tests can also be done.

Treatment

While asthma cannot be cured, it can be controlled by avoiding triggers and through the use of medications. Drugs used are broadly classified into Preventers, Relievers, Symptom controllers and Combination inhalers (contain both preventers and symptom controllers).

Prevention

Asthma education is the core and lifestyle modification is the anchor. The most effective plan for preventing asthma is identifying triggers, such as cold, dust, cigarette smoke (active and passive), pets, or aspirin (and all others), and eliminating exposure to them.

Life saving advice

Please go everywhere with your inhaler! (places of worship inclusive). Ladies should have as many inhalers as their bags so as to forestall the chances of being forgotten in one!

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