Asthma

Overview of Asthma

• Asthma is a chronic inflammatory disorder of the airways, in which many cells and cellular elements play a role.
• The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night and in the early morning.
• Current estimates suggest that asthma affects 300 million people worldwide, with a predicted additional 100 million people affected by 2025.
• Although the development and course of the disease, and the response to treatment, are influenced by genetic determinants, the rapid rise in prevalence implies that environmental factors are critically important in the development and expression of the disease.

Reason of Asthma :

• To date, studies have explored the potential role of indoor and outdoor allergens, microbial exposure, diet, vitamins, breastfeeding, tobacco smoke, air pollution and obesity but no clear consensus has emerged.
• These episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible, either spontaneously or with treatment. [1]
• For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.
• Asthma can’t be cured, but its symptoms can be controlled.
• Because asthma often changes over time. [2]

Cause of Asthma

No single cause has been identified for asthma. Instead, researchers believe that the breathing condition is caused by a variety of factors.

Genetics:

• If a parent has asthma, you’re more likely to develop it.

History of viral infections:

• People with a history of viral infections during childhood are more likely to develop the condition.

Hygiene hypothesis:

• This hypothesis proposes that babies aren’t exposed to enough bacteria in their early months and years.
• Therefore, their immune systems don’t become strong enough to fight off asthma and other conditions.

Early allergen exposure:

• Frequent contact with possible allergens and irritants may increase your risk for developing asthma.

Certain conditions and environments may also trigger symptoms of asthma:

illness:

• Respiratory illnesses such as the flu and pneumonia can trigger asthma attacks.

Exercise:

• Increased movement may make breathing more difficult.

Irritants in the air:

• People with asthma may be sensitive to irritants such as chemical fumes, strong odors, also smoke.

Allergens:

• For instance; Animal dander, dust mites, and pollen are just a few examples of allergens that can trigger symptoms.

Extreme weather conditions:

• Conditions such as very high humidity or low temperatures may trigger disease.

Emotions:

• For example; Shouting, laughing, and crying may trigger an attack. [3]

Types of Asthma

Risk Factors

A number of factors are thought to increase your chances of developing asthma.

These include i.e.:

• Having a blood relative (such as a parent or sibling) with same disease.
• Having another allergic condition, such as atopic dermatitis or allergic rhinitis (e.g. hay fever).
• Being higher-weight person,
• Being a smoker or exposure to secondhand smoke.
• Exposure to exhaust fumes or other types of pollution.
• Exposure to occupational triggers, such as chemicals used in farming, hairdressing also manufacturing.

Pathophysiology

• Airway hyper-reactivity (AHR) the tendency for airways to narrow excessively in response to triggers that have little or no effect in normal individuals is integral to the diagnosis of asthma and appears to be related, although not exclusively, to airway inflammation.
• Other factors likely to be important in the behavior of airway smooth muscle include the degree of airway narrowing and neurogenic mechanisms.
• Besides this, the relationship between atopy (in other words the propensity to produce IgE) also asthma is well established, and in many individuals there is a clear relationship between sensitization and allergen exposure, as demonstrated by skin prick reactivity or elevated serum specific IgE.

Allergens i.e.:

• Common examples of allergens include house dust mites, pets such as cats and dogs, pests such as cockroaches, and fungi.
• Inhalation of an allergen into the airway is followed by an early and late-phase broncho constrictor response.
• Allergic mechanisms of an array of cytokines, chemo-kines and growth factors.
• Examination of the inflammatory cell profile in induced sputum samples demonstrates that, although asthma is predominantly characterized by airway eosinophilia, neutrophilic inflammation predominates in some patients, while, in others, scant inflammation is observed: so-called ‘pauci-granulocytic’ asthma.
• With increasing severity and chronicity of the disease, remodeling of the airway may occur, leading to fibrosis of the airway wall, fixed narrowing of the airway additionally a reduced response to bronchodilator medication. [1]

Clinical Features of Asthama

Sign and Symptoms of Asthma

Asthma symptoms vary from person to person.

You may have infrequent asthma attacks, have symptoms only at certain times such as when exercising or have symptoms all the time.

Asthma signs and symptoms i.e.:

• Shortness of breath.
• Chest tightness or pain.
• Trouble sleeping caused by shortness of breath, coughing or wheezing.
• A whistling or wheezing sound when exhaling (generally wheezing is a common sign of asthma in children).
• Either Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.

Signs that your asthma is probably worsening i.e.:

• Asthma signs and symptoms that are more frequent and bothersome.
• Increasing difficulty breathing (especially, measurable with a peak flow meter, a device used to check how well your lungs are working).
• The need to use a quick-relief inhaler more often.

For some people, asthma signs and symptoms flare up in certain situations i.e.:

• Exercise-induced asthma, which may be worse when the air is cold also dry.
• Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust.
• Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (specifically pet dander) [2]

Asthma is commonly mistaken for a cold or chest infection which is taking time to resolve (e.g. longer than 10 days).

Classical precipitants include exercise, particularly in cold weather, exposure to airborne allergens or pollutants, and viral upper respiratory tract infections.

Wheeze apart, there is often very little to find on examination.

An inspection for nasal polyps and eczema should be performed.

Occasionally, a vasculitic rash may suggest Churg– Strauss syndrome.

Patients with mild intermittent asthma are usually asymptomatic between exacerbations.

Individuals with persistent asthma report ongoing breathlessness and wheeze, but these are variable, with symptoms fluctuating over the course of one day, or from day to day or month to month.

Asthma characteristically displays a diurnal pattern, with symptoms and lung function being worse in the early morning. [1]

Physical Examination

Physical examination may be normal or can be characteristically present with a loud polyphonic expiratory wheeze.

Vitals

Pulse Rate

• Increased heart rate in acute severe episode

Strength

• Pulsus paradoxus (a fall of SBP between 10-20mmHg during inspiration) in moderately severe episode
• Pulsus paradoxus (a fall of SBP greater than 20-40 mmHg during inspiration) in acute severe episode and imminent respiratory failure

Respiratory Rate

• Increased respiratory rate greater than 30 cycles per minute in moderately severe and acute severe episodes

Skin

• Profuse sweating in imminent respiratory failure
• Severe hypoxia resulting in central cyanosis and hypoventilation in imminent respiratory failure

Eyes

• Conjunctival congestion as a consequence of constant rubbing are suggestive of associated allergic rhinitis.

Nose

• Nasal examination is mandatory to rule out associated conditions such as, aspirin sensitivity or allergic rhinitis.
• Transverse crease on nose as a consequence of constant rubbing and pale swollen nasal mucosa are suggestive of associated allergic rhinitis.

Lungs

Mild Episode

• Prolong end-expiratory wheeze
• In between attacks, chest is clear and no abnormal physical signs may be detectable.

Moderately Severe Episode

• Use of accessory muscles of respiration such as sternocleidomastoid and scalene muscles
• Hyper-resonant lungs
• Loud prolonged expiratory wheeze with a reduced inspiration to expiration ratio
• Vesicular breath sounds with prolonged respiration

Acute Severe Episode

• Patient has to sit upright with arms extended to support the upper chest (tripod position) that assist the use of accessory muscles of respiration
• Use of accessory muscles of respiration

Imminent Respiratory Failure

• Paradoxical thoraco-abdominal breathing
• Wheeze and breath sounds are typically absent secondary to severe airway obstruction, representing a silent chest which is an ominous sign.

Chronic Asthma

• Persistent scattered rhonchi

Other Associated Findings

• Triad of asthma, nasal polyps and rash is indicative of aspirin sensitivity.
• Presence of clubbing in asthma may be secondary to interstitial lung disease.[6]

Diagnosis of Asthma

Physical examination:

To rule out other possible conditions such as a respiratory infection or chronic obstructive pulmonary disease (in other words, COPD); physical examination & history of symptoms is necessary.

Tests to measure lung functions:

You may also be given lung (in other words, pulmonary) function tests to determine how much air moves in and out as you breathe.

These tests may i.e.:

Spirometry:

• This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out.
• A spirometry test can provide an indication of lung function.
• A spirometry can help assess lung function.
• Spirometry is a non-invasive test that requires deep breaths and forceful exhalation into a hose.
• The hose links to a machine called a spirometer that displays two key measurements:
• Forced vital capacity (FVC), or the maximum amount of air a person can both inhale and exhale.
• Forced expiratory volume (FEV-1), the maximum amount of air a person can exhale in one second.
• The doctor then compares these measurements against what would be normal for another person of the same age.
• In general, Measurements below normal indicate obstructed airways and probable asthma.
• A doctor will often administer a bronchodilator drug to open air passages before retesting with the spirometer to confirm the diagnosis.
• If results improve after using the drug, the risk of an asthma diagnosis increases.
• Besides this, Children under 5 years of age are difficult to test using spirometry, so asthma diagnoses will rely mostly on symptoms, medical histories, and other parts of the physical examination process.
• In younger children, doctors commonly prescribe asthma medicines for 4 to 6 weeks to gauge physical response.

Peak flow:

• A peak flow meter is a simple device that measures how hard you can breathe out.
• Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse.
• Your doctor will give you instructions on how to track and deal with low peak flow readings.
• Lung function tests often are done before and after taking a medication called a bronchodilator, such as albuterol, to open your airways.
• If your lung function improves with use of a bronchodilator, it’s likely you have asthma.

Other tests to diagnose include:

Methacholine challenge:

• Methacholine is a known trigger that, when inhaled, will cause mild constriction of your airways.
• If you react to the methacholine, you likely have asthma.
• This test may be used even if your initial lung function test is normal.

Nitric oxide test:

• This test, though not widely available, measures the amount of the gas, nitric oxide, that you have in your breath.
• When your airways are inflamed a sign you may have higher than normal nitric oxide levels.

Imaging tests:

• A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that can cause or aggravate breathing problems.

Allergy testing:

• This can be performed by a skin test or blood test.
• Allergy tests can identify allergy to pets, dust, mold and pollen.
• If important allergy triggers are identified, this can lead to a recommendation for allergen immunotherapy.

Sputum eosinophils:

• This test looks for certain white blood cells (eosinophils) in the mixture of saliva and mucus (sputum) you discharge during coughing.
• Eosinophils are present when symptoms develop and become visible when stained with a rose-colored dye (eosin).

Provocative testing for exercise and cold-induced asthma:

• In these tests, your doctor measures your airway obstruction before and after you perform vigorous physical activity or take several breaths of cold air.

How asthma is classified ?

To classify your severity, your doctor considers your answers to questions about symptoms (such as how often you have asthma attacks and how bad they are), along with the results of your physical exam and diagnostic tests.

Determining your asthma severity helps your doctor choose the best treatment.

severity often changes over time, requiring treatment adjustments.

It is classified into four general categories:

[2]

Differential Diagnosis of Asthma

• Chronic obstructive pulmonary disease (COPD),
• Congestive heart failure,
• Gastroesophageal reflux disease,
• Mechanical obstruction of the airways (e.g., tumors, foreign bodies), and
• Vocal cord dysfunction.

Infrequent causes of wheezing include i.e.

• Pulmonary embolism,
• Pulmonary infiltrates with eosinophilia, and
• Some medications (e.g., angiotensin-converting enzyme (ACE) inhibitors)[8]

Complications

Investigation of Asthma

The main tests used to help diagnose asthma are:

• FeNO test – you breathe into a machine that measures the level of nitric oxide in your breath, which is a sign of inflammation in your lungs
• spirometry – you blow into a machine that measures how fast you can breathe out and how much air you can hold in your lungs
• peak flow test – you blow into a handheld device that measures how fast you can breathe out, and this may be done several times over a few weeks to see if it changes over time

After you’re diagnosed with asthma, you may also have a chest X-ray or allergy tests to see if your symptoms might be triggered by an allergy.[7]

Treatment

It is is a chronic condition but may be controlled with appropriate treatment in the majority of patients.

The goal of treatment should be to obtain and maintain complete control, but aims may be modified according to the circumstances and the patient.

A variety of tools/questionnaires have been validated to assist in assessing control.

Written action plans can be helpful in developing self management skills.

Avoidance of aggravating factors:

• This is particularly important in the management of occupational asthma but may also be relevant in atopic patients, when removing or reducing exposure to relevant antigens, such as a pet, may effect improvement.
• House dust mite exposure may be minimised by replacing carpets with floorboards and using mite impermeable bedding.
• So far, improvements in control following such measures have been difficult to demonstrate.
• Many patients are sensitised to several ubiquitous aeroallergens, making avoidance strategies largely impractical.
• Measures to reduce fungal exposure and eliminate cockroaches may be applicable in specific circumstances, and medications known to precipitate or aggravate asthma should be avoided.
• Smoking cessation is particularly important, as smoking not only encourages sensitisation, but also induces a relative corticosteroid resistance in the airway. [1]

Prevention of Asthma

Homeopathic Treatment of of Asthma

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines of Asthma:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Homeopathic remedies 

Natrum Sulphuricum:

• It is aggravated by damp weather, the severe cough that makes a person hold his chest while coughing.
• Greenish expectoration.

Ipecac:

• It is with nausea also vomiting.
• There is constant cough with vomiting also gagging.

Antimonium Tartaricum:

• It is associated with a lot of rattling in the chest especially with little expectoration.

Sambucus Nigra:

• Childhood asthma.
• The attack is generally worse at midnight making child wake up from sleep.

Blatta Orientalis :

• It is from a damp environment.
• There can be an allergy to mildew, rotting leaves, mounds.
• Aggravation especially from exertion also ascending.

Senega:

• Wheeze also cough end in a sneeze.
• Furthermore, There is a pain in back on coughing.
• Rattling in the chest.

Ocimum sanctum:

• Generally, Pain in the chest while coughing sneezing, can’t be quiet in bed during the attack.

Lobelia inflata: 

• It is without cough also expectoration.
• It is worse after any exertion.

Medorrhinum: 

• It is better by bending his head on a pillow and the patient desires fast fan even in winter especially with a craving for ice.

Lycopodium: 

• Flapping of alae nasi also rapid abdominal movement.

Some Postures:

• Bending head backward ameliorates: i.e. Spongia Tosta
• Must rise up and bend the head backward: i.e. Hepar Sulph
• Sitting with head bend forward on knees, amel: i.e. Kali Carbonicum
• Sitting with head bend forward and rocking: i.e. Kali Carbonicum
• Leaning backward, agg: Psorinum
• Bending forward, amel: e.g. Arsenicum Album, Cinchona, Kali Bichromicum, Kali Carbonatum, Lachesis, Spongia Tosta
• Difficult sitting bend forwards: e.g. Digitalis, Rhus Toxicodendron, Sepia
• Lying on back ameliorates: Cactus Grandiflorus
• Better lying on the right side: e.g. Spigelia, Colchicum [5]

Diet And Regimen

Food should eat i.e.:

1. Vitamin D-rich foods, such as milk and eggs
2. Beta carotene-rich vegetables, such as carrots and leafy greens
3. Magnesium-rich foods, such as spinach and pumpkin seeds

Food should avoid i.e.:

1. Sulfites, which are found in wine and dried fruits
2. Foods that can cause gas, including beans, cabbage, and onions
3. Artificial ingredients, such as chemical preservatives or other flavorings[9]

DON’Ts for Asthma:

References

1. Davidson’s Principles and Practice of Medicine (22nd edition) Ch. 19
2. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
3. https://www.medicalnewstoday.com/articles/323523.php
4. https://www.healthline.com/health/asthma
5. https://hompath.com/blog/10-homeopathic-medicines-asthma/
6. https://www.wikidoc.org/index.php/Asthma_physical_examination
7. https://www.nhs.uk/conditions/asthma/diagnosis/
8. https://www.atsdr.cdc.gov/csem/asthma/differential_diagnosis_of_asthma.html
9. https://www.healthline.com/health/asthma/asthma-diet#foods-to-avoid
10. Epidemiology of asthma in India (Paramesh, H., 2002)
11. Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in adults (INSEARCH) (2003)
12. Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study (2022)
13. Prevalence of asthma among children in India: A systematic review and meta-analysis (2022)
14. Robbins & Cotran Pathologic Basis of Disease (10th edition, 2021)
15. Harrison’s Principles of Internal Medicine (21st edition, 2022)
16. Murray & Nadel’s Textbook of Respiratory Medicine (7th edition, 2023)
17. Middleton’s Allergy: Principles and Practice (9th edition, 2020)
18. Global Initiative for Asthma (GINA) guidelines (2023 update)
19. Asthma: Clinician’s Desk Reference (1st edition, 2014, Routledge)

Asthma  Also Search As :

• Homeopathic remedies for asthma
• Homeopathic asthma management
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• Homeopathy for wheezing and breathlessness
• Homeopathic approach to allergic asthma
• Homeopathic medicines for childhood asthma
• Asthma and miasmatic treatment (homeopathic)
• Individualized homeopathic treatment for asthma
• Constitutional homeopathy for asthma

Allopathic Perspective Also Search As :

• Bronchial asthma treatment guidelines
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• Asthma diagnosis and testing
• Severe asthma complications
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• Allergen immunotherapy for asthma
• Asthma in children and adults (differentiating factors)

There are several ways to search for articles on asthma, depending on the resources and tools you have access to. Here are some methods:

1. Academic Databases

• PubMed: A free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics.
• Google Scholar: Provides a simple way to broadly search for scholarly literature across many disciplines and sources.
• Cochrane Library: A collection of high-quality, independent evidence to inform healthcare decision-making.
• Scopus: A large abstract and citation database of peer-reviewed literature.
• Web of Science: Another comprehensive research database providing access to multiple databases that reference cross-disciplinary research.

2. Library Resources

• University Libraries: Many university libraries provide access to a range of databases and journals, often accessible through the library’s website.
• Public Libraries: Some public libraries offer access to databases and journals through their online portals.

3. Medical Websites and Journals

• American Thoracic Society (ATS): Offers articles and guidelines on respiratory health.
• Journal of Asthma: A peer-reviewed journal dedicated to the study of asthma.
• British Thoracic Society (BTS): Provides guidelines and articles on respiratory conditions, including asthma.

4. Government and Health Organizations

• Centers for Disease Control and Prevention (CDC): Offers a wealth of information on asthma, including statistics, guidelines, and research articles.
• World Health Organization (WHO): Provides global health data and publications on asthma.
• National Heart, Lung, and Blood Institute (NHLBI): Offers information and research articles on asthma.

5. General Internet Search

• Google Search: You can use specific keywords to find articles and information on asthma. For example, search for "asthma research articles" or "latest asthma treatment guidelines."

6. Professional Networks and Social Media

• ResearchGate: A social networking site for scientists and researchers to share papers and results.
• LinkedIn: Professionals and experts in the field often share articles and insights on medical topics, including asthma.

7. Medical Conferences and Seminars

• Attending conferences and seminars can provide access to the latest research and articles presented by experts in the field.

8. Direct Subscriptions

• Subscribing to specific journals or publications that focus on respiratory health and asthma can provide regular updates and access to articles.

People can search for information on asthma in various ways:

Online Resources:

• Search engines: Use Google, Bing, DuckDuckGo, or other search engines to search for terms like "asthma," "asthma symptoms," "asthma treatment," "homeopathic asthma treatment," or other relevant terms.
• Health websites: Consult reputable health websites such as the Mayo Clinic (https://www.mayoclinic.org/diseases-conditions/ asthma/symptoms-causes/syc-20369653), Cleveland Clinic (https://my.clevelandclinic.org/ health/diseases/6424-asthma), WebMD, or healthline.com for comprehensive information on asthma.
• Specific organizations: Look for information from organizations specializing in asthma, such as the Asthma and Allergy Foundation of America (AAFA) or the Global Initiative for Asthma (GINA).
• Academic databases: If you need more in-depth, scientific information, search academic databases like PubMed or Google Scholar for research articles and studies on asthma.

Offline Resources:

• Books: Consult medical textbooks, health encyclopedias, or books specifically focused on asthma.
• Libraries: Visit your local library for books and resources on asthma.
• Healthcare professionals: Talk to your doctor, allergist, or respiratory therapist for personalized information and advice on asthma.

Tips for Effective Searching:

• Use specific keywords: Instead of just searching for "asthma," use more specific terms like "asthma triggers," "asthma in children," or "natural remedies for asthma."
• Consider the source: Make sure the information you find comes from reputable sources, such as medical organizations or trusted health websites.
• Consult a professional: If you have specific questions or concerns about asthma, always consult a qualified healthcare professional for personalized advice.