What is Asthma? Bronchial Asthma Information: a gradual introduction

What are alternative names of bronchial asthma?
Asma, Astma, Asthma, Status asthmaticus, Intrinsic asthma, Bronchial asthma, Exercise induced asthma, Allergic asthma, Nocturnal asthma.

History of asthma
History of asthma dates back to thousands of years when the symptoms of asthma were first recorded. Ayurveda, the world’s oldest science of health care has a reference about asthma remedy. The written tradition of Ayurveda dates back around 5000 years, but the oral tradition in India is timeless. Throughout the history various traditional medical practices such as Homeopathy, Reiki, Chinese medicine and others have reported remedies for the airway narrowing during asthma. The word Asthma has been cited in Egyptian manuscript Ebers Papyrus and Homer’s Iiiad as well.

Asthma is a Greek word meaning “panting”. The word Asthma was first put into use by the well known Greek physician Hippocrates.  The Romans treated asthma by giving sufferers Owl’s blood in wine.

Asthma has been documented in the Arabic manuscript, Treatise on Asthma, written by a Jewish medical doctor Moses Maimonides in the 12th century. He was physician to Sultan Saladin, an Egyptian ruler.  In his book Maimonides highlighted dietary and drug recipes and climate rules suitable for asthmatics. He stated that the dry Egyptian climate was effective for asthma sufferers and warned against the use of very powerful remedies. He considered fresh air, clean water, and a healthy diet to be of paramount importance for preserving the health of body and soul.

The clinical characteristics of Asthma such as narrowing of airways came to be realized by modern medicine folks only during the seventeenth century. Asthma attacks then came to be known as epilepsy of the lungs due to unpredictable behavior of their occurrence.

It was not until the late 20th century that the researchers discovered that asthma was an inflammatory disease by nature where the immune system becomes extra sensitive to the trigger factors. This discovery has led to better drug development because now the drugs catered to not just the airway narrowing but the underlying inflammation as well.

Despite the rich and lengthy background history of asthma the complete cure of asthma has proven to be elusive. At the threshold of the 21st Century many landmark medical advances have taken place, one of them being the completion of the human genome project. Asthma being has a genetic correlation; we hope that the genetic research in future will result in complete cure of asthma through development of better personalized asthma drugs for all asthmatics to lead normal healthy lives.

Asthma definition
Asthma is a disease of the lung. It is characterized by difficulty in breathing. Asthma can be defined as a chronic (a condition that has a long duration), reversible breathing problem that affects the airways (tubes leading from the windpipe to the lungs).

Asthma causes airway narrowing because of airway inflammation and bronchoconstriction. Airway narrowing process basically involves,

  • tightening of the smooth muscles around the airways,
  • swelling of the airway and,
  • collecting of thick mucus secretions in the airways

People with asthma have extra sensitive or hyper-responsive airways. The airways react by narrowing when they become irritated (by asthma triggers). This makes it difficult for the air to move in and out of the lungs. Usual symptoms of asthma include shortness of breath, increased work in breathing, wheezing, chest tightness, cough and phlegm.

Asthma often occurs in episodes called asthma attacks. An asthma attack is usually caused by triggers or changes in the environment. Common triggers include infections, changes in the weather, exercise, allergens and irritants in the environment.

Asthma is neither a contagious disease nor a psychological reaction. Asthma is not an illness in which patients typically report daily symptoms. The intensity of asthma symptoms can vary from person to person and from one day to the next. The asthma symptoms are sudden and unpredictable which makes it problematic for asthma patients to manage it.

Asthma and Breathing in Respiratory System
Respiratory system involves breathing process of moving air in and out of the lungs. Breathing process is an effortless motion that is critical for all other bodily functions. Breathing requires little or no exertion from an individual with healthy lungs. The function of breathing is unique; it is the only activity in the body that is predominately an unconscious process, yet it can also be controlled by the individual.

People with asthma are intimately aware of how unreliable and uncontrollable the process of breathing becomes when an attack ensues. Asthmatics commonly describe their inability to freely move air in and out of their lungs as a state of not being able to catch their breath or a circumstance that takes their breath away.

During the breathing process, air is inhaled through the mouth or nose and travels through the trachea (windpipe). The trachea branches off into two large airways called the right and left bronchus. These airways divide again into smaller airways called bronchioles where they finally end in little air sacs called alveoli. There are millions of alveoli in which the exchange of oxygen and carbon dioxide occurs. Oxygen is transported to all of the cells in the body and carbon dioxide is exhaled to maintain balance and equilibrium in the body. If this exchange is not achieved, there is a buildup of carbon dioxide (hypercarbia) and a reduction in available oxygen (hypoxia).

Asthmatic airways are more hyperresponsive (sensitive) to certain events or substances called triggers. Hyperresponsiveness may be inherited from parents. Asthmatic airways when exposed to known and unknown triggers, such as, allergens, irritants, exercise, stress and extreme weather changes, usually initiate the inflammatory process and may elicit asthma symptoms immediately or up to 20 hours after the actual exposure.

Why a person breathes?
It appears as if a solution to curing asthma is to stop breathing! But alas, breathing is vital for our life. Breathing is required for transporting oxygen from lungs via blood to other body organs (e.g. heart, kidney, liver and others), which is crucial for their functioning. The process of breathing also ensures that carbon dioxide from these organs are transported to lungs and removed from the body as waste.

What causes asthma?
Though actual causes of asthma are unknown, it is associated with atopy (genetic predisposition to asthma) and exposure to environmental allergens. Both of these factors contribute to the cause of asthma.

In some cases, it may be difficult for patients to identify the cause of an asthma attack. Our immune system (the body’s defense system) though easily recognizes triggers and begins producing antibodies (special proteins that set up the internal mechanisms to cause an allergic reaction) to work against them. The special proteins that are produced are called IgE antibodies. These IgE antibodies cause histamine (a compound that plays a major role in allergic reaction) to be released, which in turn causes the inflammatory process to begin. The severity of this reaction can vary from one exposure to the next. The degree of airway narrowing, the tightening of the muscles around the airway and the increased mucus production result in the classic asthma symptoms of shortness of breath, wheezing, coughing, chest tightness and an increase in the amount of work needed to breathe.

Who is prone to asthma?
Almost anyone! Asthma is overwhelmingly widespread and does not discriminate among cultures, continents or generations. Asthma is more likely to occur in children by the age of five, and in adults in their 30s. In children, asthma is a major cause of school absenteeism. Older adults too can develop asthma – about 10% of new asthma cases are diagnosed in people who are 65 years or older. Those living in polluted or pollen rich places are more likely to have asthma than people living elsewhere. Certain factors increase your chance of developing asthma. For example, if one of your parents have asthma, then you are more likely to have it. If you have allergy, you’re more likely to develop asthma as well. As a matter of fact, at least 80 percent of children and 50 percent adults with asthma also suffer from other allergy diseases.

What is the process of airway narrowing in asthma?
Airway narrowing occurs due to the collective effect of constriction of smooth muscle, collection of thick mucus secretions and swelling. These three constrictive mechanisms are primarily caused by an airway inflammation. This fact was discovered just two decades back. The process of inflammation starts when a body part is hurt, and is seen as swelling. The trigger factors hurt the airways of an asthmatic patient and cause inflammation. It is the root cause for constriction of airways. Inflammation can be seen in airways by observing biopsy samples under a microscope. An airway biopsy done even in an asymptomatic asthmatic patient shows the marked inflammatory structural changes while the airways of non-asthmatics show no inflammation.

How asthma interferes in breathing?
In asthma patients airways get narrowed and thereby causing obstruction in the oxygen supply to the body and removal of carbon dioxide from it. In order to maintain the required oxygen level in the body, lungs work faster and harder to overcome airway barrier. Fast movement of air through narrowed airways creates whistling sound called wheezing. Cough starts in attempt to overcome the obstruction. It causes fatigue and distress to asthmatic patient. As asthma attack becomes more severe, carbon dioxide levels in blood builds up because it can no longer be eliminated by lungs. Deficiency of oxygen and increase in carbon dioxide levels interfere with normal body functions and cause headache, difficulty in concentration, leading to coma and in fatal cases even death.

How does asthma attack manifest?
Asthma attack manifests itself in varied degree of severity in different asthma patients in response to different asthma triggers. The frequency of asthma attack may vary drastically between individuals – some may have asthma attack once in a while whereas others may have regularly. Common symptoms of asthma are shortness of breath, wheezing sound in breathing and cough. These symptoms are aggravated during the nighttime. In asthma patients, thick thread like mucus comes out from lungs generally in the morning hours after having bed tea. The patient feels much relieved after coughing out the mucus.

What precipitates asthma?
Asthma symptoms may be precipitated or triggered by one or more of several trigger factors. However, these factors may not be obvious in many cases. Some of the asthma triggers include:

  • Occupational irritants (gases, fumes, vapors, dust, tobacco or other smoke, air pollution of any kind)
  • Microscopic droppings of dust mites and cockroaches, airborne pollens and molds, plants and plant proteins, enzymes, and pet dander (minute scales of hair, feathers, or skin)
  • Viral, sinus infections such as a cold
  • Exposure to an allergen (for which the person is allergic)
  • Moderate exercise
  • Change of weather, cold air
  • Psychological factors such as mental tension and anxiety
  • Gastroesophageal reflux disease (GERD)
  • Pregnancy
  • Menstruation
  • Medications: beta-blocker, painkiller drugs used to treat high blood pressure (hypertension), heart disease, and glaucoma. Some patients get asthma symptoms on consuming certain drugs such as aspirin, ibuprofen, indomethacin, and naproxen. Others may react to sulfites (chemicals commonly used to preserve foods such as tuna, salads, dried apples and raisins, and beverages such as lemon juice, grape juice, and wine).
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