ASTHMA

 

Asthma causes narrowing of the airways.  This is caused by swelling with increased mucus production and a tightening of the smooth muscles encircling the airways, usually in response to some type of trigger.

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HEALTHY LUNGS

Inside the lungs there are branching airways (bronchi) that get narrower in diameter until ultimately ending up at the air sacs (alveoli).  Bands of smooth muscle encircle the airways, helping to make them responsive to different demands that may be placed on them (relaxing vs. running).  In healthy patients, these mechanisms work properly and the airways accommodate whatever demands are placed on them appropriately.

The air you inhale contains oxygen. As the air moves through your airways it ultimately ends up in tiny air sacs (alveoli).  These tiny air sacs have capillary beds around them that are full of blood from the right side of your heart.  These capillary beds bring oxygen into the blood stream and push carbon dioxide out of the blood stream into the lungs.  Oxygenated blood then travels out to tissues throughout the body to aid in cellular metabolism.  The carbon dioxide, which is a waste biproduct of cellular metabolism, is then exhaled out of the body.

 

 

SYMPTOMS

People with Asthma have very sensitive airways that can be reactive to different triggers such as pollen, dust, or smoke.  When this happens, the airways become swollen and narrowed due to an inflammatory response and a tightening of the smooth muscle encircling the airways.  The tightening of these smooth muscles is referred to as bronchoconstriction or bronchospasm.  This is usually a chronic problem but proper treatment can help to reduce the duration and frequency of symptoms.

Symptoms of asthma: 

  • Coughing

  • Chest tightness

  • Shortness of breath

  • Wheezing (a whistling noise heard on exhalation)

  • Fatigue

If not treated properly, the chronic inflammation caused from asthma can lead to permanent scarring and loss of lung function.

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MODERATE SYMPTOMS

When exposed to a trigger, the asthmatic patient will experience bronchospasm in addition to airway swelling and thick mucus production which can obstruct air movement. This causes the patients work of breathing to increase manifesting as a faster respiratory rate and use of accessory muscles to aid in breathing.

Moderate symptoms:

  • Coughing

  • Shortness of breath with minimal exertion

  • Wheezing

  • Chest tightness

  • Faster breathing when at rest

 

SEVERE SYMPTOMS

This can be a life-threatening situation. In a severe Asthma attack, the patient will experience the same symptoms as a moderate Asthma attack but with a far greater intensity.  The airways will become so constricted that air movement into and out of the lungs will become minimal.  When this happens, the exchange of oxygen and carbon dioxide into and out of the bloodstream will be significantly reduced.  As your tissues become starved for oxygen and carbon dioxide builds up your bloodstream, your body will be telling you to breath faster, which makes the problem worse.  This is a very dangerous situation that requires medical intervention as soon as possible.  Call 911 if you have any of these symptoms and they are not being alleviated by your rescue inhaler:

  • Severe shortness of breath:  unable to talk or walk

  • Lips and/or fingers turning blue

  • Feeling lightheaded or dizzy

  • Peak flow less than 50% of your personal best, if you use peak flow monitoring

DIAGNOSIS

The best place to start for diagnosing and treating Asthma is a review of symptoms with your physician. 

Some helpful tests include:

  • Pulmonary Function Test (PFT):  This test involves measuring different aspects of the lungs and can be performed in the office to diagnose and quantify the extent of the problem.  Asthma most often shows airway obstruction and larger volumes than normal.

  • Arterial blood gas:  Blood is taken from an artery.  Measurements are performed to evaluate how well your lungs are able to get oxygen into the bloodstream and carbon dioxide (CO2) out of the bloodstream.

  • Chest X-ray:  Chest X-rays can be useful in evaluating the size of the lungs and the density of tissues within the lung.  Often, people with Asthma will show enlarged or "hyperinflated" lungs on imaging.  This is a result of "air trapping" that is caused by airway obstruction.

  • Advanced imaging (CT Scan/MRI):  Advanced imaging can be used to rule out other disease processes.

 

 

TREATMENT

Although there is no cure for Asthma, with proper treatment and a commitment to a healthy lifestyle you can minimize your symptoms and frequency of exacerbations.  Treatments include:

  • Inhaled respiratory medications which include:

    • Beta agonists:  Albuterol is an example of a beta agonist.  These medications cause the smooth muscle encircling the airways​ to dilate.  This opens up the airway and allows air to pass easier, reducing the work of breathing and alleviating symptoms like wheezing.  Short acting beta agonists are RESCUE MEDICATIONS!

    • Anticholinergics:  Atrovent is an example of an anticholinergic.  These medications prevent the smooth muscle encircling the airways from returning to a relaxed state.  This helps to keep the airway open.  Anticholinergics work best in conjunction with a beta agonist.

    • Steroids:  Pulmicort is an example of an inhaled steroid.  These medications reduce the inflammation within the airways to help air move easier and reduce the work of breathing.  Steroids work best when paired with a long acting beta agonist and/or a long acting anticholinergic.

    • Mucolytics:  Mucinex is an example of a mucolytic.  These medications help to thin secretions so that they are easier to cough up.  This helps to keep the lungs clear and prevent chronic infections.

    • Flu and pneumonia shots:  It is very important for people with Asthma to get their yearly shots.  Asthma puts them at a higher risk for more frequent infections but also a greater severity when infected.  Staying up to date with these shots will help to prevent more severe illness.

    • Oxygen:  If testing shows that you have a low oxygen saturation (SPO2)

  • Smoking cessation:  If you are a smoker, this is the most important step for you to take.  Your physician can help you develop a plan for quitting in addition to helping you find resources to be successful.

  • Identifying and minimizing triggers:  People with Asthma often have sensitive airways.  They will find that certain things may cause them to have difficulty breathing.  The smell of bleach or strong perfumes are good examples.  Identifying triggers and then either removing them or minimizing contact with them is paramount.

  • Maintaining a healthy weight:  The lungs job is to get oxygen into the body so that the cells can make energy and carbon dioxide out of the body as it is the waste produced from the creation of that energy.  The more mass you have, the more cells require oxygen and the more cells produce waste that needs to be expelled.  Therefor, the more mass you have the harder your lungs have to work to do their job.

  • Pulmonary Rehab:  If you have more advanced Asthma, you may qualify for pulmonary rehab.  Pulmonary rehab takes place in a fitness center/gym setting and is overseen by medical professionals.  They will help you determine the proper place to start, in terms of activity and intensity level, and help you make a plan to improve your cardiopulmonary performance.  Not only does this help to optimize your lung function while attending, but gives you the tools to maintain that function after it has ended.

 

 

Asthma is a long-term condition and it is very important to get on a treatment regimen and follow it as prescribed.  If you smoke, talk to your physician about getting help with quitting.  Identify your triggers, and work to minimize your exposure to these triggers.  Learn to control your breathing utilizing deep breathing and relaxation techniques.