Asthma

What is Asthma?

Asthma is a chronic condition that narrows the airways in the lungs. This narrowing of the airways is known as Bronchoconstriction and it often leaves asthma suffers with difficulty breathing. Asthma is a life long condition that can go through periods of dormancy and flares. There is no current cure for asthma, yet the condition can be successfully managed effectively by a wide range of treatments.

Asthma is very common, affecting 2.7 million or 11% of Australians. Severity can vastly differ depending on asthma control and the amount of exposure to triggers.

Asthma Symptoms

The symptoms experienced from asthma vary based on the severity. Mild to moderate symptoms can include:

• Shortness of breath - being short of breath while not physically exerting yourself can be a sign the airways have narrowed, making breathing difficult.
• Wheezing - Air flowing through a narrowed space can often lead to an audible wheeze when breathing.
• A tight feeling in the chest - this is from the airway constriction
• Fatigue - the body not receiving enough oxygen can lead to a lack of energy.

Getting severe symptoms of asthma is what’s known as having an asthma attack. This serious form of asthma can be a medical emergency as breathing becomes constricted. Warning signs/ symptoms for asthma attacks are:

• Perfuse coughing - coughing can be the body’s attempt at opening or clearing blocked airways.
• Extreme duress - panic from the person experiencing an asthma attack can be a sign they are unable to breathe.
• Fainting - going limp or passing out is a sign the body is not receiving enough oxygen.

This type of asthma can be a medical emergency if severe enough. If you experience symptoms like this call emergency services and seek treatment as soon as possible.

What Causes Asthma?

Who develops asthma and who doesn’t comes down to a large number of factors. It is known that genetics play a role, with those who have a family with asthma also being more likely to experience the condition. Being a smoker increases the risk of having more severe and regular asthma symptoms as it causes irritation in the lungs.
It’s also known that babies who are born prematurely or exposed to air pollutants from a young age are more at risk of developing asthma.

By far the most common trigger for asthma is exposure to allergens, particularly when they are breathed directly into the lungs. Common allergens include:

• Pollen
• Dust
• Chemicals - cleaning products, aerosols, perfumes
• Air pollutants - fire smoke, cigarette smoke, industrial pollution

Exercise-Induced Asthma

This type of asthma trigger is known as exercise-induced bronchoconstriction (EIB) and occurs during vigorous exercise when the airways in the lungs become red, swollen and blocked with mucus.

Allergic Asthma

This type of asthma flares when the lungs are exposed to an allergen such as pollen or dust. Due to the seasonal nature of the major common allergens, it is also known as seasonal asthma.

Thunderstorm Asthma

This is an uncommon but potentially very serious trigger, as proven by the tragic 2016 Melbourne thunderstorm that claimed the lives of 10 asthmatics and sent thousands to the emergency room. Thunderstorm asthma occurs when grass and pollen are drawn up into the clouds when a thunderstorm forms. This pollen then absorbs water and bursts causing high levels of allergens throughout the air.

Medicine Induced Asthma

Some blood pressure medicines can cause a worsening of asthma. If your asthma symptoms worsen after starting a treatment you should talk to your doctor about your options.

Asthma Diagnosis

Before seeking treatment for asthma you should first be diagnosed. To do this you should talk to your doctor who will conduct a spirometry test. This test uses a peak flow meter to assess the lung capacity of people with asthma. This test is not suitable for children under 5 so doctors usually try treating asthma and assessing for improvements in follow-ups. 

As asthma is largely caused by allergies, allergy testing may also be conducted to diagnose patients who experience more seasonal or allergic asthma.

Asthma Treatments

Asthma treatments are structured in a step-up therapy structure based on how often you experience asthma and the severity. This is based on what’s known as an Asthma Action Plan.

Asthma Action Plan

An asthma action plan is a personalised plan written by the patient, doctor, and or carer. It is imperative that it is written as soon as possible after diagnosis and updated regularly as symptom control changes. It outlines what the patient should do when feeling well, when not well, or if their symptoms are getting worse. This structure allows the patient to easily know how much they should be using each inhaler as well as monitoring for changes in symptom control.

Reliever Asthma Puffers

These puffers provide quick relief from asthma symptoms by opening up the constricted airways. These medicines generally use metered-dose inhalers (MDI) to deliver the medicine directly into the lungs. They only take around 30 seconds to a minute to work and generally last up to four hours.

Begin Assessment

Common side effects of these treatments are an increased heart rate, restlessness, and shaking/ trembling.

To increase the amount of medicine reaching the deep lungs a spacer device can be used with MDIs. To use this device you spray your MDI into the device while taking normal breaths on the other side. These are particularly useful in adults and children with masks, eliminating the need for coordinating the press and breath technique.

Preventer Asthma Puffers

These medicines work to prevent asthma symptoms from developing. They do this by the use of inhaled corticosteroids. These steroids lower airway inflammation from the body’s inappropriate immune reaction to allergens and asthma triggers.

Some preventers include a second active ingredient which is a long-acting medicine that opens up the constricted airways for up to 8-12 hours.

Common side effects of these treatments are oral thrush, hoarseness, and an increase in heart rate.

Corticosteroid Tablets

When asthma symptoms become uncontrolled/ severe or post asthma attack, a short course of corticosteroid tablets may be prescribed in order to settle down the asthma flare.

Possible side effects for short term use of these medicines include insomnia, stomach upset, and increased appetite.

Avoiding Triggers

Taking note of known triggers for each person and avoiding them can greatly help in controlling asthma. Although this cannot always be done, taking steps to minimise exposure can greatly reduce the need for reliever inhalers.

Written by Clinical Pharmacist Tyson Wilkman