"I can't breathe!" (A Case of Asthma)

I live with asthmatics.  It's really worrisome to see our loved ones during an asthma attack.  Shortness of breath, coughing and chest tightness are some of the symptoms.   It's like they can't catch their breath literally.  Coughing occurs any time of the day and is usually one of the early signs.

What happens inside the lungs during an attack?  There is obstruction of the airways, that is why the person has difficulty in breathing.  The air tubes react to certain substances which act as triggers to the disease process.  The air tubes are laden with muscles which can undergo spasm leading to decrease in the diameter.  Next, there will be increase in mucus production inside the tube, this also serves as an obstruction.  Inflammation also sets in, causing swelling of the tubes thus further limiting air entry and exit.  Unless this process is stopped, the obstruction will continue and will deprive the person with oxygen.  Once oxygen level in the brain is low, the patient will collapse.  Continued hypoxia (deficiency of oxygen) will result to death.

In the hospital setting, when the patient becomes unconscious because of asthma, we insert a tube to the airway to deliver air directly.  That is the worst case scenario. Please don't take for granted anyone who is suffering from an asthma attack.  They might have tolerance with a little hypoxia but their condition can get worse anytime if not treated.  Offer some assistance whenever you can, just by calling his/her doctor or the E.R would be a great help.

If you know the triggers then you may prevent an attack.   There are some triggers we can avoid, some, we simply can't.  1. Strong emotions (unavoidable? wink) can definitely start an attack. 2. Physical exercise can also cause an attack.  You can start with a few routines first and observe if your body can handle the workout.  If you will not have an attack with the less strenuous exercise then you can slowly increase the intensity of your routines.  3. Infections:  cold, cough and sinusitis.  4.   Tobacco smoke and strong perfumes  5. Allergy to food, common culprits include shrimps, crabs, squids and food additives.  6.  Allergy to medicine:  aspirin, ibuprofen and naproxen.  7. Dust mites thrive in mattresses, carpets, bedding, pillows, blankets or anywhere in the bedroom and/or kitchen. It is the enzyme from the mite's feces which can trigger an attack.  It is advisable to wash these linens with hot water.  Change the bedding and pillow case more often. 8. Smoke (from burning wood or grass) and pollution (from factories and cars).  9. Pets.  Be sure to keep pets away from the bedroom.  10. Heartburn or Gastroesophageal Reflux Disease (GERD) surprisingly can cause asthma.  Most adult onset asthma is caused this condition.  The upper part of our stomach has a valve which prevents acid from going up to the esophagus.  When the valve is defective, the acid goes up and eventually reaches the airways.  The acid will irritate the air tubes and start an asthma attack.

Asthma may or may not be hereditary.  If your parents are asthmatic, there is a high likelihood that you will develop asthma.  If there is no family history of asthma, you can still develop asthma due to environmental factors, some of which are discussed above.

If you develop the symptoms mentioned in the first paragraph then possibly you have asthma.  You will undergo additional tests, like chest xray and lung function tests to clinch the diagnosis.

Avoidance is the key to prevent asthma attack.  As I have said before, some triggers cannot be avoided.  Internal Medicine specialists divide the treatment of asthma according to its severity.  It is divided into steps 1-5 according to the GINA protocol.  Treatment usually starts with short acting beta agonist, an example is salbutamol inhaler.  More severe symptoms should be given inhaled corticosteroids plus salbutamol inhaler.  Review of the efficacy of the treatment will be done after 2-3 months.  The doctor will either add additional medication or discontinue one medication depending on the patient's response.  Regular visit with a doctor is a must for all patients diagnosed with asthma.

There are minimal side effects with inhaled corticosteroids contrary to the oral counterpart. This is because the inhaled steroids will go directly to the lungs and only very minimal amount enters the blood stream.  Hoarseness of voice (and not weight gain) is a common complaint.  Short acting beta agonist, like salbutamol, can cause dry mouth, dizziness and altered taste sensation.  Just take note that not all patients will experience the side effects.

Asthma can be very troublesome, but it can be controlled with strict compliance with the medications and regular check up.  Don't let it be a hindrance in achieving your goals.   That is what I always tell my wife and my eldest son.

Leave a comment if you have additional questions. :)


Dr. A