Asthma is a type of long term or chronic disease of the respiratory tract characterized by inflammation and narrowing of the airways that cause shortness or difficulty breathing. In addition to difficult breathing, people with asthma can also experience other symptoms such as chest pain, coughing and wheezing. Asthma can be suffered by all age groups, whether young or old. Although the exact cause of asthma is not known clearly, there are some things that often trigger it, such as cigarette smoke, dust, animal dander, physical activity, cold air, viral infections, or even exposure to chemicals.
For someone who has asthma, the respiratory tract is more sensitive than others who do not live with this condition. When the lung is irritated on the trigger above, the respiratory tract muscles of the asthma will become stiff and make the channel narrow. In addition, there will be an increase in the production of sputum that makes breathing more difficult.
Diagnosis of asthma
To find out if a patient has asthma, then the doctor needs to do some tests. But before the test is done, the doctor will usually ask patients questions about what symptoms are felt, the timing of the symptoms, and the patient's health history and family.
If all the information given to the patient leads to asthma, then the doctor can then perform tests to confirm the diagnosis, for example:
- Peak Flow Test (APE)
- Bronchial Provocation Test
- Measurement of Allergy Status
- CT Scan
Treatment of asthma
There are two goals in the treatment of asthma, ie relieve symptoms and prevent symptoms of relapse. In order to support this goal, a doctor's treatment plan is tailored to suit the patient's condition. Treatment plans include ways to recognize and deal with worsening symptoms, as well as what medications to use.
It is important for patients to recognize things that can trigger their asthma in order to avoid it. If asthma symptoms appear, a commonly recommended medication is a reliever inhaler.
Whenever an asthma attack develops with symptoms that continue to worsen (slowly or rapidly) even if treated with an inhaler or other medication, the patient should be treated promptly at the hospital. Although rare, asthma attacks can be life-threatening. For chronic asthma sufferers, long-term and repeated airway inflammation can lead to a permanent narrowing.
Complications of asthma
The following are the effects of asthma that may occur:
- Psychological problems (anxiety, stress, or depression).
- Decreased performance at school or at work.
- The body often feels tired.
- Impaired growth and puberty in children.
- Asmatic status (severe asthma condition not responding to normal therapy).
- Failed breathing.
- Damage to some or all of the lungs.
If you happen to have asthma or live with asthma for a long time, do not worry about this condition because asthma is a disease that can still be controlled as long as you:
- Recognize and avoid asthma triggers.
- Following the asthma-handling plan made with the doctor.
- Recognize asthma attacks and take appropriate treatment steps.
- Use asthma medicines recommended by doctors on a regular basis.
- Monitor your airway condition.
Symptoms Of Asthma
The main symptoms of asthma include difficulty breathing (sometimes it can make people gasp), coughing, chest that feels tight, and wheezing (sound produced when air flows through narrowed airways). When these symptoms recur, often people with asthma become difficult to sleep.
The severity of asthma symptoms varies, ranging from mild to severe. The worsening of symptoms usually occurs at night or early morning. Often this makes asthma sufferers difficult to sleep and the need for more frequent inhalers. In addition, worsening of symptoms can also be triggered by allergic reactions or physical activity.
Significantly worsening asthma symptoms is called an asthma attack. Asthma attacks usually occur within 6-24 hours, or even days. Even so, there are some sufferers whose asthma symptoms worsen very quickly for less than that time.
In addition to difficult breathing, chest tightness, and wheezing that worsen significantly, other signs of severe asthma attacks may include:
- Inhaler no longer effective in relieving symptoms.
- The symptoms of cough, wheezing and tightness in the chest are getting worse and often.
- Difficult to talk, eat, or sleep due to difficulty breathing.
- Lips and fingers that look blue.
- Increased heart rate.
- Feeling dizzy, tired, or sleepy.
- The existence of the peak current decreases expiration.
Causes Of Asthma
The exact cause of asthma is still unknown. However, there are some things that can trigger the appearance of symptoms of this disease, including:
- Lung and respiratory infections commonly invade the upper airway such as flu.
- Allergens (animal dander, dust mites, and flower powder).
- Exposure to substances in the air, such as chemical fumes, cigarette smoke, and air pollution.
- Weather conditions, such as cold weather, windy weather, hot weather with poor air quality, damp weather, and drastic temperature changes.
- The interior conditions of the room are damp, moldy, and dusty.
- Excessive emotion (sadness that is protracted, excessive anger, and laugh out loud).
- Physical activity (eg sports).
- Drugs, such as non-steroidal anti-inflammatory painkillers (aspirin, naproxen, and ibuprofen ) and beta-blocking drugs (usually given to people with heart problems or hypertension).
- Foods or beverages containing sulfites (natural substances sometimes used as preservatives), such as jams, shrimp, processed foods, fast food, fruit juice, beer and wine drinks.
- Food allergies (eg beans).
- Gastroesophageal reflux disease (GERD) or disease in which stomach acid returns up into the esophagus so that it irritates the upper gastrointestinal tract.
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Risk factors for asthma
Respiratory tracts of people with asthma are more sensitive and susceptible to inflammation compared with normal people when irritated by the above mentioned triggers.
When asthma symptoms appear, the respiratory tract will narrow and the muscles around the channel tighten. In addition, there is an increase in inflammation in the lining of the respiratory tract and the production of sputum which further adds to the narrowing of the respiratory tract.
By narrowing the parts of the respiratory tract, then the air will be harder to flow and the patient becomes more and more difficult to breathe.
According to the study, there are several factors that can increase a person's risk for developing asthma, including:
- Have a family with a history of asthma or
- atopic allergy (allergy-related conditions, such as food allergies and eczema ) .
- Have bronchiolitis or lung infection as a child.
- Born underweight, ie less than two kilograms.
- Premature birth, especially if you need a ventilator.
- Exposed to cigarette smoke as a child. In the case of mothers who smoke during pregnancy, the risk of children suffering from asthma will increase.
Diagnosis Of Asthma
To find out if a patient has asthma, doctors need to do a number of tests. But before the test is done, the doctor will usually ask questions about perceived symptoms, such as whether the patient likes to experience shortness of breath, chest pain, wheezing, difficulty speaking, and the condition of lips or nails change color to bluish.
If the answer is positive, then the next doctor will ask about the time of appearance of the symptoms. For example, whether during the night or early morning, when exercising, when smoking, when near the furry animals, when laughing, when feeling stressed, or unpredictable. In addition, doctors also need to ask if the patient has a family with a history of asthma or allergies.
If all the information given by the patient leads to asthma, then the next physical examination and laboratory tests. Laboratory tests can be done to strengthen the evidence. The most common test is spirometry. In this test, the patient will ask the doctor to take a deep breath and exhale it as quickly as possible to a device called a spirometer. The purpose of this test is to measure lung performance by referring to the volume of air the patient can breathe in one second and the total amount of air released. The presence of resistance to the respiratory tract leading to asthma can be detected by the physician after comparing the data obtained with a size that is considered healthy in people the same age. In addition to a healthy size measure, asthma can also be detected through spirometry by comparing preliminary data with data after the patient is given an inhaler drug. If after the inhaler is given the result becomes better, then the patient most likely suffers from asthma.
The next test that can be used to diagnose asthma is a peak expiratory flow test. In a test assisted by a device called this peak flow meter (PFM), the air velocity of the lungs in one breath that can be exhaled by the patient will be measured to obtain peak expiratory flow rate data (PEFR). Doctors usually advise patients to purchase a PFM for home use, as well as make a PEFR note each day. In addition, patients will also be advised to record any symptoms that appear so that doctors can tell when asthma worsens.
If the patient feels that respiratory symptoms are often recovered while not working, the chances of the patient suffering from asthma are related to the condition of the job. Possible where the patient works there are substances that trigger recurrence of asthma symptoms. This usually happens to people who work as nurses, employees of chemical processing plants, laboratory staff, painters, welders, woodworking workers, caretakers, and food processing workers. To support the diagnosis, the doctor usually asks the patient to perform peak expiratory flow (PEFR) tests using a peak flow meter (PFM), either at work or outside the workplace. From the data obtained, doctors can estimate whether patients suffering from occupational asthma.
If you are diagnosed with asthma due to exposure to substances in the work environment, inform the diagnosis to the company where you work, especially in the occupational health services. The company has a responsibility to ensure the health of employees.
For example, if your asthma is triggered by the substance present in the production raw material, then ask the company to provide you with equipment that can protect itself from exposure to the substance or move you to another division that does not involve processing directly. This can be done if the company does not allow to replace the production materials with safer materials.
If within a year you remain frequently exposed to asthma while at work, then consider finding a new job.
In addition to spirometry and peak expiratory flow test, some other tests may require patients to strengthen the alleged asthma or help detect diseases other than asthma. Examples of such tests are:
- Test to see inflammation of the airways. In this test, the doctor will measure the levels of nitric oxide in the breath when the patient breathes. If the levels of these substances are high, then it could be a sign of inflammation in the respiratory tract. In addition to nitric oxide, the doctor will also take a sample of sputum to check whether the lungs of the patient are inflamed.
- Respiratory airway responsiveness (bronchial provocation test) . This test is used to ascertain how the patient's respiratory tract reacts when exposed to one of the asthma triggers. In this test, the patient will usually be asked to inhale the dry powder (mannitol). After that the patient will be asked to exhale into the spirometer to measure how high the rate of FEV1 and FVC changes after the trigger. If the results fall dramatically, then it can be estimated that patients suffering from asthma. In children, other than mannitol , the media that can be used to trigger asthma is exercise.
- Examination of allergy status . This examination is performed to determine whether the symptoms of asthma felt by the patient caused by allergies . For example allergies in food, mites, dust, pollen, or insect bites.
- CT Scan. This examination can be done by a doctor if suspected that the symptoms of shortness of breath in the patient is not caused by asthma, but infection in the lungs or abnormalities of the nasal cavity structure.
- X-rays. The purpose of this examination is the same as a CT scan, to see if the respiratory problems are caused by other conditions.
The goal of asthma treatment is to control symptoms and prevent the onset of attacks. For most people with asthma, drugs and treatment methods that exist today have been proven effective in keeping asthma symptoms remain controlled.
To get effective results, doctors need to adjust the treatment with asthma symptoms that appear. In addition, patients should also undergo routine checkups (at least once a year) to ensure appropriate treatment and asthma disease is in control. Sometimes patients need higher levels of treatment for a certain period of time.
Asthma management plan
Information on medicines should be included in the asthma management plan. This handling plan can also help you know when symptoms can get worse and what steps to take. At least once a year, your asthma treatment plan should be reviewed with your doctor. Even a more regular review needs to be done if symptoms of asthma have reached a severe level.
You may be advised to purchase a peak flow meter (PFM) or peak expiratory flow meter as part of the treatment. This way you can monitor your own asthma so you can find out more early asthma attacks and take the necessary treatment steps.
Recommended asthma medicines
Usually asthma drugs are administered through a device called an inhaler (inhaled medication for asthma). This device can send the drug into the respiratory tract directly by inhalation through the mouth. Taking asthma medication by inhalation is considered effective because the drug goes directly to the lungs. However, each inhaler works in different ways. Usually doctors will teach you how to use the tool and do checks at least once a year.
In addition to the inhaler , there is also a spacer. It is a metal or plastic container equipped with a suction funnel at one end and a hole at the other end for paired inhalers . When the inhaler is pressed, the drug will enter into the spacer and inhaled through the spacer funnel itself. Spacers can also reduce the risk of canker sores in the mouth or throat due to side effects of inhaled asthma medicines.
Spacer is able to increase the amount of drugs that reach the lungs and reduce its side effects. Some people even find it easier to use spacers instead of inhalers . In fact because it can increase the distribution of drugs into the lungs, spacer use is often recommended.
As part of good asthma management, it is important for you to ensure that your doctor or pharmacist teaches you how to use the inhaler properly.
There are two types of inhalers used in the treatment of asthma, namely:
- Inhaler reliever. The relieving inhaler is used to relieve asthma symptoms quickly while the onset is ongoing. Usually these inhalers contain drugs called short-acting beta2-agonist or beta2-agonist that have a rapid reaction (eg terbutaline and salbutamol). This drug is able to relax the muscles around the narrowed respiratory tract. That way, the respiratory tract may open up wider and allow asthma to breathe again more easily. The medicines contained in the peralogic inhaler rarely cause side effects and are safe to use as long as it is not excessive. The relieving inhaler does not need to be used anymore if the asthma is well controlled. For people with asthma who should take this drug more than three times a week, then the whole treatment needs to be reviewed.
- Inhaler prevention. In addition to preventing the occurrence of asthma attacks, preventive inhalers can also reduce the amount of inflammation and sensitivity that occurs in the airway. Usually you should use a preventive inhaler every day for a while before feeling the full benefit. You may also need a relief inhaler to relieve symptoms when an asthma attack occurs. However, if you are constantly in need of a relief inhaler, your treatment should be reviewed in its entirety. Generally preventive treatment is recommended if you experience an asthma attack more than twice a week, should use a reliever inhaler more than twice a week, or wake up at night once or more a week due to asthma attacks. Preventative inhalers usually contain steroid drugs such as budesonide, beclometasone, mometasone, and fluticasone. Smoking can degrade the performance of this drug.
If asthma does not subside by the above treatment, the doctor may increase the dose of a preventive inhaler . If this step can not control asthma symptoms, doctors will usually give you additional drugs called long-acting reliever or long-acting bronchodilator / long-acting beta2-agonist or LABA. Â Use the same thing as a fast-acting reliever, it's just that its performance takes a longer time and its effect can last up to 12 hours. Examples of slow-reaction inhalers are salmeterol and formoterol.
Because LABA also does not relieve inflammation of the respiratory tract of asthma, this drug can aggravate asthma while hiding the symptoms. This increases the likelihood of a severe asthma attack that may endanger the life of the patient. Therefore, always use combination inhalers or inhalers combined with inhaled steroids and long-term bronchodilators in one device.
Side effects of inhaler and preventive inhalers
As long as its use does not exceed the dose, a pereda inhaler is a safe treatment that does not have many side effects. Side effects that may arise in the use of high doses include headaches , muscle cramps, and a little tremor (tremors) in the hand. These side effects usually last only a few minutes.
Just like a relief inhaler, the treatment of asthma with a reliever inhaler also proves to be very safe at regular doses. Side effects usually occur in high-dose use and in long-term use. These side effects are a fungal infection in the mouth or throat, also called oral candidiasis. Another side effect is your voice becomes hoarse. However, these side effects can be prevented if you use a spacer . In addition, it is recommended to rinse with clean water after using a preventive inhaler .
For the use of slow-down relief inhalers , side effects that may arise are headache, muscle cramps, and slight tremors in the hands. Your doctor will usually tell you about the benefits and risks of the treatment. Usually your condition will be monitored early in treatment and regularly reviewed. If the use of a slow-reaction inhaler does not relieve your asthma, stop it as soon as possible.
Steps to control asthma attacks with inhalers
If your asthma symptoms suddenly recur, do the following three things. The first is immediately remove the inhaler type of pereda and suction 1 or 2 times. After that, do the second step by sitting quietly and try to breathe stably. If the symptoms of asthma still have not subsided, then do the third step by sucking your inhaler back as much as 2 times (or up to 10 times if required) every two minutes.
If all these steps still do not relieve symptoms of asthma and you are worried the condition can get worse, then immediately call an ambulance or ask the people around you to take you to the hospital. Before you actually get the hospital handling, keep repeating the third step.
Other asthma medications
In addition to inhalers, asthma management can also be done with drugs such as:
- Oral steroids. Steroid tablets may be prescribed by your doctor if your asthma is not manageable. This treatment is usually monitored by a pulmonary specialist who treats people with asthma because if taken long-term (eg more than three months), the risk of causing certain side effects, such as hypertension, weight gain, weakened muscle, bone loss, thinning skin and easy bruising . In addition, more serious side effects that could happen are cataracts and glaucoma. Therefore treatment with oral steroids is only advisable if you have done any other treatment, but have not succeeded. Most people only need to use oral steroids for 1-2 weeks and as an additional drug to deal with additional infections (such as lung infections). Usually they will return to previous treatment after asthma can be controlled. We recommend that you regularly check yourself to avoid osteoporosis, diabetes , and high blood pressure.
- Theophylline tablet . Drugs that can function as a remedy for asthma symptoms work by helping to dilate the airways by relaxing the muscles around them. In some people, theophylline tablets are known to cause side effects, such as nausea , headache, vomiting, insomnia , and stomach disorders. However this can usually be avoided by dose adjustments.
- Tablet l eukotriene re ceptor antagonist (montelukast) . This drug works by inhibiting the part of a chemical reaction that causes inflammation in the respiratory tract. Just like theophylline , this drug is used to prevent asthma symptoms. Leukotriene receptor antagonist can cause side effects such as headaches and stomach upset.
- Ipratropium . Although more prescribed in cases of chronic bronchitis and emphysema, ipratropium can also be used to combat asthma attacks. This drug is able to facilitate the flow of breathing by relaxing the muscles of the respiratory tract that tighten when symptoms of asthma relapse.
- Omalizumab . This drug can reduce the risk of inflammation of the respiratory tract by binding to one of the proteins involved in the immune response and reduce the level of blood. Generally, omalizumab is recommended for people with asthma due to allergies and frequent asthma attacks. As a drug usually only prescribed by a specialist, omalizumab is given by injection every 2-4 weeks. The use of omalizumab should be stopped if the drug does not manage to control asthma within sixteen weeks.
- Bronchial thermoplasty . This is a new asthma treatment procedure that is still being studied and not yet available in Indonesia. In some cases, this procedure is used to treat severe asthma by damaging the muscles surrounding the airways which can reduce the constriction of the respiratory tract. There is some evidence to suggest that this procedure can reduce asthma attacks and improve the quality of life of people with severe asthma. However, long-term gains and losses are not yet fully known.
Complementary treatment methods
Breathing exercises are the most recommended method of complementing the treatment of asthma. And there is evidence that this method can reduce the symptoms of asthma and the need for relief medicines in some people. Breathing exercises may include yoga, Buteyko breathing techniques, and breathing techniques taught by physiotherapists.
In addition to breathing exercises, other complementary methods of treatment are:
- Traditional Chinese herbal medicine
- Oral supplement therapy
- Ionization therapy
However, among all the aforementioned complementary treatments, only breathing exercises are proven effective in reducing the symptoms and needs of patients with asthma medications. For other complementary therapies, further research on its effect on asthma is required.