Asthma Management

Asthma Management

Asthma management involves a combination of medication, following a written asthma action plan, and lifestyle adjustments like avoiding triggers. Inhalers, including preventers and/or reliever inhalers, are the primary treatment. A good management plan includes regular check-ups, staying active (with appropriate precautions), quitting smoking, maintaining a healthy weight, and managing other conditions like GERD or allergies.  

Medication

• Inhalers: The main treatment is breathing in medication through an inhaler.
  • Reliever inhalers: Used only when symptoms occur. 
  • Preventer inhalers: Used daily to help prevent symptoms. 
  • Maintenance and reliever therapy (MART): One inhaler used for both daily maintenance and when symptoms flare up. 
• Other medications: Depending on the severity, other drugs like leukotriene modifiers or biologics may be prescribed. 
• Inhaler technique: Proper technique is crucial for effective drug absorption, which involves inhaling deeply while pressing the inhaler and holding your breath for about 10 seconds afterward. 

Asthma action plan

• Work with a healthcare provider to create a personalized, written asthma action plan. 
• This plan provides instructions for routine management and what to do if symptoms worsen or an emergency occurs. 
• Regular check-ups to review your symptoms, lung function, and action plan are essential. 

Lifestyle adjustments

• Avoid triggers: Identify and avoid personal asthma triggers, which can include smoke, dust mites, and certain allergens. 
• Exercise: Engage in regular physical activity, which can strengthen lungs. Talk to your doctor about a safe level of exercise and use medication as needed to prevent symptoms during activity. 
• Healthy weight: Maintain a healthy weight, as being overweight can worsen asthma symptoms. 
• Quitting smoking: Stop smoking and avoid all forms of tobacco and e-cigarette vapor. 
• Other conditions: Treat other health issues that can impact asthma, such as hay fever, allergies, GERD, and sleep apnea. 
• Sleep: Ensure you get enough quality sleep by establishing a regular sleep schedule and creating a calming bedtime routine. 

Definition of Asthma

Asthma is a chronic lung condition that causes inflammation and narrowing of the airways, leading to recurring episodes of wheezing, coughing, shortness of breath, and chest tightness. Symptoms can vary from mild to severe and are often triggered by factors like allergens, exercise, or cold air. While there is no cure, asthma can be managed and controlled through medication, avoiding triggers, and having an action plan.  

Causes of Asthma

Asthma is caused by a combination of genetic and environmental factors, leading to inflammation and narrowing of the airways. Risk factors include a family history of asthma or allergies, childhood respiratory infections, and exposure to secondhand smoke or air pollution. Triggers that can cause symptoms include allergens like pollen and dust mites, irritants like smoke and strong odors, respiratory infections, physical activity, and weather changes.  

Genetic and environmental factors

• Family history: A family history of asthma or allergies increases your risk. 
• Childhood factors: Lower birth weight, premature birth, and certain early childhood illnesses are linked to a higher risk of developing asthma. 
• Environmental exposure: Early-life exposure to factors like secondhand smoke, air pollution, and certain substances at work can contribute to its development. 
• Obesity: Being overweight or obese is a risk factor for developing and having more severe asthma. 

Common triggers for asthma attacks

• Allergens: Airborne allergens like pollen, dust mites, mold spores, pet dander, and cockroach waste. 
• Irritants: Air pollutants, smoke from tobacco or wood fires, and strong fumes or odors from chemicals, perfumes, or cleaning products. 
• Respiratory infections: Illnesses like the common cold, flu, or COVID-19. 
• Weather: Cold, dry air, sudden changes in weather, or high humidity. 
• Physical activity: Exercise, particularly in cold air. 
• Medications: Certain drugs, including some pain relievers like aspirin and other NSAIDs, and some beta-blockers. 
• Strong emotions: Stress or other strong emotional responses can trigger symptoms. 
• Food additives: Sulfites and other preservatives added to some foods and beverages. 

Clinical Feature of Asthma

The clinical manifestations of asthma are the cardinal symptoms of cough, wheezing, shortness of breath, and chest tightness. These symptoms can range from mild to severe and often occur in episodes, which may be triggered by factors like exercise, allergies, or cold air. Symptoms can also worsen at night or in the early morning. During a severe asthma attack, symptoms intensify and require immediate medical attention.  

Common symptoms

• Coughing: Often worse at night, a cough can be a primary symptom. 
• Wheezing: A high-pitched whistling or rattling sound, particularly when breathing out. 
• Shortness of breath: Difficulty breathing, which can range from mild to severe, and may occur after exercise. 
• Chest tightness: A feeling of pressure or squeezing in the chest, as if a rope is tightening around it. 

Other manifestations

• Worsening symptoms at night or early morning: These episodes can disrupt sleep. 
• Symptoms triggered by exercise: An asthma attack can be triggered by physical exertion. 
• Difficulty talking: In severe cases, talking may be difficult. 
• Signs of a severe attack: In addition to the cardinal symptoms, severe attacks may involve rapid breathing, a pale or sweaty face, and changes in skin color around the lips, fingertips, or nail beds, which may appear bluish or gray/white. 

Diagnosis of Asthma

Asthma is diagnosed through a combination of medical history, physical exam, and lung function tests, primarily spirometry, which measures how much air you can breathe out. A doctor will also consider your symptoms, family history, and may perform other tests like allergy tests, a peak flow test, or a FeNO test to confirm the diagnosis and identify triggers.  

Key diagnostic tools and tests

• Spirometry: This is the most common and recommended test. You breathe forcefully into a device called a spirometer, which measures the amount of air you can inhale and exhale, and how fast you can do so. 
• Peak flow test: You blow into a device called a peak flow meter to measure how fast you can exhale. This can help monitor asthma over time. 
• FeNO test: A test that measures the level of nitric oxide in your breath, which can indicate airway inflammation and certain types of allergic asthma. 
• Challenge test: If other tests are inconclusive, a doctor may have you breathe in a substance that irritates the airways. This test is done in a hospital and shows how sensitive your airways are. 
• Allergy tests: Skin or blood tests can help determine if allergies to things like pollen, dust mites, or animal dander are triggering your symptoms. 
• Treatment trial: Your doctor may have you start an asthma treatment to see if your symptoms improve, which can help confirm a diagnosis. 

What to expect during diagnosis

• Medical and family history: Your doctor will ask about your symptoms, how often they occur, and any family history of asthma or allergies. 
• Physical examination: A doctor will listen to your lungs for wheezing or other sounds and check for other signs like chest tightness. 
• Symptom patterns: Your doctor will analyze the pattern of your symptoms, such as if they worsen at night or with exercise. 

Important considerations

• Other conditions: Asthma symptoms can overlap with other respiratory conditions, so it’s important for a healthcare professional to rule out other diagnoses. 
• No single test: There is no single test that can diagnose asthma; diagnosis is based on a combination of factors. 
• Consult a doctor: Only a healthcare professional can provide an accurate diagnosis. If you are concerned you may have asthma, contact your doctor. 

Investigation for Asthma

Asthma investigation involves a combination of medical history, physical exam, and lung function tests like spirometry and peak flow measurements. Blood tests for eosinophils, a FeNO test to measure airway inflammation, and sometimes an allergy or CT scan of the sinuses may also be performed. Doctors also use a treatment trial, observing if asthma medications improve symptoms. 

Medical history and physical exam

• Your doctor will ask about your symptoms, when they occur, and potential triggers.
• They will perform a physical exam, which includes listening to your lungs. 

Lung function tests

• Spirometry: You will breathe forcefully into a machine that measures how much air you can breathe out and how fast. A bronchodilator may be given, and the test repeated to see if your lung function improves. 
• Peak flow meter: This is a handheld device that you use at home to measure how fast you can blow air out of your lungs. You may use it for several weeks to track your lung function and identify patterns. 
• FeNO (fractional exhaled nitric oxide) test: This test measures the level of nitric oxide in your breath, which can indicate inflammation in your airways. 

Other potential tests

• Blood test: Checks for a high number of eosinophils, a type of white blood cell associated with airway inflammation. 
• Allergy testing: Can help identify triggers like pollen, dust mites, or pet dander. 
• CT scan of sinuses: May be ordered if the doctor suspects a sinus infection (sinusitis), which can worsen asthma. 
• Treatment trial: Your doctor may prescribe asthma medication and see if it improves your symptoms. 

Important considerations

• There is no single test for asthma; diagnosis relies on a combination of factors. 
• Diagnosing asthma in very young children can be difficult, and lung function tests are not possible for those under 5. 
• Spirometry is not suitable for all patients, so your doctor will choose the most appropriate test(s) for you. 

CT scan of the sinuses

A sinus CT scan is a non-invasive imaging test that uses X-rays to create detailed cross-sectional pictures of the paranasal sinuses, the air-filled cavities in the bones of the face. This scan is the most reliable way to diagnose problems like sinusitis, inflammation, polyps, fluid, and anatomical blockages, helping doctors determine the best course of treatment. The procedure is quick and painless, though you may feel a slight warming sensation and a metallic taste if a contrast dye is used.  

What it is

• Imaging technique: A CT scan takes multiple X-ray images from different angles to create detailed cross-sectional views of the sinuses, unlike a standard X-ray. 
• Purpose: It is used to diagnose and evaluate a variety of sinus problems, including chronic sinusitis, inflammation, fluid buildup, polyps, and structural abnormalities. 
• Accuracy: It is considered the most accurate and best imaging method for evaluating the sinuses. 

What to expect

• Preparation: You should wear loose-fitting clothing and remove all metal jewelry, including hairpins and hearing aids, beforehand. You may be asked to avoid eating or drinking for a few hours, especially if contrast dye will be used. 
• During the scan: You will lie on a table, and a scanner will rotate around your head to capture the images. The procedure is painless and usually takes less than 5 minutes, although the total appointment may take longer. 
• Contrast dye: In some cases, a contrast material is injected through an IV to help highlight structures. This can cause a brief feeling of warmth and a metallic taste. 
• After the scan: If contrast dye was used, you may be advised to drink extra fluids. You can return to your normal activities immediately. 

Why it’s used

• Diagnosis: It helps diagnose sinus issues with high accuracy. 
• Surgical planning: It is an integral part of planning for sinus surgery, providing a detailed “road map” of the anatomy for the surgeon. 
• Treatment guidance: The detailed images help doctors create a tailored treatment plan for you. 

Why CT scan is important for Asthma Patient

A CT scan is important for asthma patients, especially those with severe or uncontrolled asthma, because it provides more detailed imaging than a chest X-ray, allowing doctors to identify structural changes in the airways. It can help diagnose complications like mucus plugs or bronchiectasis, rule out other conditions, and provide a better understanding of air trapping. This helps in making a correct diagnosis and developing a more effective treatment plan. 

Key reasons for importance

• Detailed imaging: CT scans offer a much higher-resolution view of the airways and lung tissue compared to standard X-rays.
• Diagnosis of complications: They can identify structural changes associated with severe asthma, such as thickened airway walls, mucus impaction, and bronchiectasis.
• Differential diagnosis: CT scans help differentiate asthma from other conditions that may have similar symptoms or be mistaken for asthma, such as allergic bronchopulmonary aspergillosis (ABPA), eosinophilic granulomatosis with polyangiitis (EGPA), or COPD.
• Assessment of disease severity: In severe asthma, CT can reveal patterns of remodeling and air trapping that correlate with functional decline and disease severity.
• Treatment planning: By identifying the specific structural issues, doctors can create more targeted treatment strategies for difficult-to-treat asthma cases. 

Why CT scan of sinuses is important for Asthma Patient

A CT scan is important for asthma patients to identify or rule out underlying chronic rhinosinusitis (sinusitis) and nasal polyps, which can worsen asthma control. It helps doctors diagnose and manage co-existing sinus conditions by showing inflammation, mucosal thickening, or polyps that require specific treatment. Identifying these issues is crucial for selecting the correct treatment, particularly certain types of biologics for severe, eosinophilic asthma with CRSwNP. 

Key reasons for CT scans in asthma patients

• Diagnosing and assessing sinus disease: CT scans are the best tool for evaluating the paranasal sinuses and nasal cavity to find conditions like chronic rhinosinusitis (CRS) or nasal polyps, which are common in patients with severe asthma.
• Identifying “treatable traits”: The scan can identify specific issues like nasal polyps that are linked to a type of inflammation (type-2-predominant) that responds well to certain medical treatments, like biologic therapies.
• Improving treatment decisions: By clearly showing the extent of sinus inflammation or obstruction, a CT scan helps doctors choose the most effective treatment plan, which may include a combination of therapies for both the sinuses and the lungs.
• Monitoring treatment response: The scan can be used to monitor how well treatment for sinusitis is working, as demonstrated by improvement in CT scores over time.
• Managing “upper and lower airway” disease simultaneously: The scan allows doctors to address both upper (sinus) and lower (lung) airway inflammation at the same time, which is crucial for achieving better asthma control. 

Why CT scan of lungs is important for Asthma Patient

A CT scan is important for asthma patients because it provides detailed anatomical information that helps identify structural changes, diagnose complications, and differentiate asthma from other conditions, especially in severe or difficult-to-treat cases. It can reveal issues like airway wall thickening, mucus plugs, air trapping, and bronchiectasis, which may not be visible on a standard chest X-ray. 

Detailed assessment of the lungs

• Visualizes structural changes: CT scans show details like bronchial wall thickening and narrowing, which are key findings in asthma.
• Identifies complications: It helps identify complications that worsen asthma, such as mucus plugs or bronchiectasis.
• Detects air trapping: High-resolution CT (HRCT) can show signs of air trapping, indicating how effectively air is moving in and out of the lungs. 

Differential diagnosis

• Rules out other conditions: CT scans help distinguish asthma from other diseases with similar symptoms, like emphysema, chronic bronchitis, or allergic bronchopulmonary aspergillosis (ABPA).
• Diagnoses comorbid conditions: It can identify other conditions that may be contributing to a patient’s poor asthma control, such as chronic rhinosinusitis or eosinophilic granulomatosis with polyangiitis (EGPA). 

Monitoring and treatment planning

• Assesses severity: CT scans can provide a more detailed assessment of asthma severity and disease progression over time.
• Evaluates treatment response: Quantitative CT techniques are being studied to monitor the effectiveness of treatments by measuring changes in airway structure. 

How Pet dander trigger Asthma

Pet dander triggers asthma when a person’s immune system mistakenly identifies the allergens in dander, saliva, or urine as harmful, leading to inflammation and tightening of the airways. The immune response releases chemicals that cause symptoms like coughing, wheezing, and shortness of breath, which are characteristic of an asthma attack. The microscopic dander particles can remain airborne, stick to furniture, and travel on clothing, making them difficult to avoid. 

The immune system’s response

• Allergen identification: For someone with pet allergies, the immune system creates antibodies that incorrectly flag proteins in pet dander (tiny flakes of skin), saliva, or urine as dangerous.
• Inflammatory response: The next time these allergens are encountered, the immune system overreacts and releases chemicals like histamine into the bloodstream.
• Airway constriction: This chemical release leads to swelling in the airways and causes the muscles around them to tighten, which is the physical response that causes asthma symptoms. 

How dander affects the body

• Airborne particles: Dander is very small and can stay airborne for long periods, especially with air circulation.
• Surface contamination: It sticks to surfaces like clothing, carpets, and furniture, making it hard to get rid of.
• Inhalation: When inhaled, these particles can trigger asthma symptoms such as coughing, wheezing, chest tightness, and shortness of breath. 

What you can do

• Reduce exposure: Keep pets out of the bedroom and off upholstered furniture.
• Improve air quality: Use HEPA air cleaners and vacuum carpets and furniture regularly with a vacuum that has a HEPA filter.
• Maintain cleanliness: Wash your hands after touching pets, wash bedding and clothes in hot water, and have someone else brush the pet outside to minimize dander release. 

পোষা প্রাণীর খুশকি হাঁপানির কারণ হয় যখন একজন ব্যক্তির রোগ প্রতিরোধ ব্যবস্থা ভুল করে খুশকি, লালা বা প্রস্রাবের অ্যালার্জেনকে ক্ষতিকারক হিসেবে শনাক্ত করে, যার ফলে শ্বাসনালীতে প্রদাহ এবং টানটান ভাব দেখা দেয়।রোগ প্রতিরোধ ক্ষমতা এমন রাসায়নিক পদার্থ নির্গত করে যা কাশি, শ্বাসকষ্ট এবং শ্বাসকষ্টের মতো লক্ষণ সৃষ্টি করে, যা হাঁপানির আক্রমণের বৈশিষ্ট্য। ক্ষুদ্র খুশকির কণাগুলি বাতাসে থাকতে পারে, আসবাবপত্রে লেগে থাকতে পারে এবং পোশাকের উপর ভ্রমণ করতে পারে, যার ফলে এগুলি এড়ানো কঠিন হয়ে পড়ে। 

রোগ প্রতিরোধ ব্যবস্থার প্রতিক্রিয়া

• অ্যালার্জেন শনাক্তকরণ: পোষা প্রাণীর অ্যালার্জি আছে এমন ব্যক্তির ক্ষেত্রে, রোগ প্রতিরোধ ব্যবস্থা অ্যান্টিবডি তৈরি করে যা পোষা প্রাণীর খুশকি (ত্বকের ক্ষুদ্র খণ্ড), লালা বা প্রস্রাবে থাকা প্রোটিনকে বিপজ্জনক হিসাবে ভুলভাবে চিহ্নিত করে।
• প্রদাহজনক প্রতিক্রিয়া: পরের বার যখন এই অ্যালার্জেনের মুখোমুখি হওয়া হয়, তখন রোগ প্রতিরোধ ব্যবস্থা অতিরিক্ত প্রতিক্রিয়া দেখায় এবং রক্তপ্রবাহে হিস্টামিনের মতো রাসায়নিক পদার্থ ছেড়ে দেয়।
• শ্বাসনালী সংকোচন: এই রাসায়নিক নিঃসরণের ফলে শ্বাসনালীতে ফুলে যায় এবং তাদের চারপাশের পেশীগুলি শক্ত হয়ে যায়, যা হাঁপানির লক্ষণগুলির কারণ শারীরিক প্রতিক্রিয়া। 

খুশকি কীভাবে শরীরকে প্রভাবিত করে

• বায়ুবাহিত কণা: খুশকি খুবই ছোট এবং দীর্ঘ সময় ধরে বায়ুবাহিত থাকতে পারে, বিশেষ করে বায়ু সঞ্চালনের সময়।
• পৃষ্ঠ দূষণ: এটি পোশাক, কার্পেট এবং আসবাবের মতো পৃষ্ঠের সাথে লেগে থাকে, যার ফলে এটি অপসারণ করা কঠিন হয়ে পড়ে।
• শ্বাস-প্রশ্বাস: শ্বাস-প্রশ্বাসের মাধ্যমে নেওয়া হলে, এই কণাগুলি হাঁপানির লক্ষণগুলি যেমন কাশি, শ্বাসকষ্ট, বুকে টান এবং শ্বাসকষ্টের সৃষ্টি করতে পারে। 

তুমি কি করতে পারো

• এক্সপোজার কমান: পোষা প্রাণীদের শোবার ঘর থেকে দূরে রাখুন এবং আসবাবপত্রের আসবাবপত্র থেকে দূরে রাখুন।
• বাতাসের মান উন্নত করুন: HEPA এয়ার ক্লিনার এবং ভ্যাকুয়াম কার্পেট এবং আসবাবপত্র নিয়মিত ব্যবহার করুন যাতে HEPA ফিল্টার আছে এমন ভ্যাকুয়াম ক্লিনার ব্যবহার করুন।
• পরিষ্কার-পরিচ্ছন্নতা বজায় রাখুন: পোষা প্রাণী স্পর্শ করার পর আপনার হাত ধুয়ে নিন, গরম জলে বিছানা এবং কাপড় ধুয়ে ফেলুন, এবং খুশকি কমাতে অন্য কাউকে পোষা প্রাণীটিকে বাইরে ব্রাশ করতে বলুন।