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BRONCHIAL  ASTHMA  (reversible hyperreactive  lung  disease)

 

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Asthma is a chronic disease in which the air passages, or bronchi, over-react to normally harmless substances or circumstances. When these triggering factors enter the bronchi, the airways constrict to hinder the flow of air in and out of the lungs. Very soon, the bronchi become inflamed, and the membranes lining them begin secreting a sticky mucus. The result is wheezing, coughing and difficulty in breathing. A severe attack can in fact prove to be life-threatening. Asthma triggers may vary from person to person; some of the most common are allergens such as pollen from grass, trees & weeds; dander from pets or domesticated animals; house dust, dust mites & mould; air pollution, tobacco smoke, perfumes;  chemical fumes or vapours; cold and or extremely dry air; certain foods & food additives; aspirin & some related medicines; anxiety & stress; vigorous exercise; colds, the flu or other illnesses; weather conditions (sudden changes), and wet or windy weather etc.

No one knows why some people develop hyperreactive lungs, although an inherited predisposition does appear to play a role. Many people think that emotional problems may be may be a major cause, but this remains unsubstantiated by clinical research. Asthma is indeed a difficult disease and it may eventually well lead to emotional  emotional problems, and stress can certainly provoke a flare-up, but it isn't in itself a psychological disorder. Although asthma differs from an allergic reaction, allergies are often involved and can also trigger attacks.

Most common in children, asthma often subsides during adolescence, but never really truly disappears. It isn't unusual for adults to suffer a recurrence after going years  without a flare-up. Such return may often be consequent to a respiratory infection. Asthma Symptoms include coughing, shortness of breath, chest tightness, wheezing - a whistling or squeaky sound in the chest when someone breathes, especially while exhaling air.

If you frequently experience shortness of breath or you hear a whistling or wheezy sound in your chest when you breathe, you may have asthma — a chronic condition that causes inflammation and narrowing of the bronchial tubes, the passageways that allow air to enter and leave the lungs. If people with asthma are exposed to a substance to which they are sensitive or a situation that changes their regular breathing patterns, the symptoms can become more severe. Asthma symptoms affect an estimated 26 million Americans — 19 million adults and 7 million children — and are one of the leading causes of absences from work and school. Asthma often runs in families; according to the World Health Organization, about half the cases are due to genetic susceptibility and half result from environmental factors. Although there is no cure for asthma, effective treatments are available. Asthma can be best managed by seeing an allergist. There are two types of asthma: allergic (caused by exposure to an allergen) and non-allergic (caused by stress, exercise, illnesses like a cold or the flu, or exposure to extreme weather, irritants in the air or some medications).



Prevention of symptoms is the best strategy to counter an oncoming asthma attack A person prone to asthmatic attacks should know what conditions trigger an attack, and should avoid these as far as possible. If asthma attacks are severe or unpredictable or flare up more than twice a week, consultation with an allergist must be sought - only such a specialist can help determine the triggering cause and provide long-term treatment that controls or eliminates the symptoms for a reasonable period of time.

Studies show that people with asthma who see a specialist, such as an allergist, reduce their symptoms, emergency room visits, hospital stays, visits to the doctor because they are sick, missed days from work or school, health care costs If asthma is left unmanaged or is misdiagnosed, it can be deadly: Asthma is among the most common chronic childhood illnesses, accounting for 10.5 million missed school days a year. It also accounts for 14.2 million lost workdays for adults. Every year, about 14 million Americans see a doctor for asthma. About 1.4 million patients visit a hospital outpatient department for asthma; almost 1.75 million go to a hospital emergency room.

The number of people in the U.S. diagnosed with asthma is increasing. The greatest rise in asthma rates is among black children, with an almost 50 percent increase from 2001 through 2009. Researchers estimate asthma-related costs, including the direct cost of health care and indirect costs such as decreased worker productivity, at around $60 billion annually. Many people with asthma manage the condition well and can live a healthy and productive life by avoiding triggers and following their allergists’ instructions. If left unmanaged or misdiagnosed, asthma can be fatal; about 3,300 people die from it annually.
 

 

Wheezing and other symptoms may point to asthma, but lung function tests will still be necessary to distinguish it from other disorders likely to produce almost similar symptoms. Testing usually begins with routine spirometry to measure the amount of air that is breathed in and out of the lungs under different circumstances. Spirometry is sometimes combined with challenge testing to identify the specific asthma triggers and to measure the effectiveness of the medications being administered. In a challenge test, the patient is exposed to a suspected trigger and its effect is then measured by spirometry.Asthma patients are also taught to use a peak-flow meter - a simple hand-held device that measures the amount of air that can be exhaled after taking a deep breath. A drop in the normal peak-flow reading suggests an imminent attack, whereas an increase indicates that the administered therapy (and other possible preventive measures) are working well. Prompt treatment with bronchodilator drugs to open the airways during an asthma attack can usually stop it before it becomes an emergency.

A very common and useful gadget to assess the severity of an asthma attach is the commonly available 'pulse oxymeter' - to get to know as to how poor (or otherwise) is the oxygen levels in a patient's peripheral circulation.

Those working in Indian kitchens may be especially prone to asthma triggers as there are various types of fumes (some quite pungent) in open-flame type of oil-based cooking or deep frying, kitchen chimneys are still not in use in many a traditional homes, whether rural or urban.

Another very efficient bronchodilator-drug administration equipment is the the 'drug neubeulizer' shown below. It provides fairly quick relief if 'bronchodilator-drug administration' is considered as the issue of priority in one's asthma management - either as routine, or during an attack.

Preventive medication for asthmatics : Montair or Montair-LC (that is Montain combined with a general anti-allergic, levocetrizine) tablets contain the active ingredient montelukast sodium, which is a leukotriene receptor antagonist that prevents leukotriene-mediated inflammation that causes allergic rhinitis. Leukotrienes are released in the nasal passages after exposure to an allergen like, and such drug=action helps reducing symptoms of allergic rhinitis like nasal congestion, runny nose, puffy eyes and sneezing etc. Levocetirizine blocks the action of certain chemical messengers that are responsible for inflammation, congestion, itching, and other allergic reactions. These tables are used for treatment of asthma, including management of chronic asthma, prevention of frequent exacerbations of asthma, day-time & night-time symptoms and exercise-induced asthma, and to prevent but not treat asthma attack. Montelukast sodium, which is a selective and orally active leukotriene receptor antagonist, implying that it binds to specific receptors on the cells of the airways and also cells in the airways that are involved in the inflammatory process (like macrophages), and inhibits the action of leukotrienes (chemicals produced by inflammatory cells like mast cells that mediate inflammation) on these cells. Leukotrienes are involved in the pathophysiology of asthma and allergic rhinitis. In asthma leukotriene-mediated effects cause bronchoconstriction (narrowing of the airways), inflammation, swelling and mucous secretion. In allergic rhinitis leukotrienes are released in the nasal passages after exposure to an allergen like pollen or house dust mites and cause irritation and inflammation. Thus Montair tablets reduce asthma symptoms including coughing, wheezing and tightness of the chest, as also the symptoms of allergic rhinitis. One should not use Montair tablets as a “reliever” or “rescue” medication for bronchospasm or if one having an asthma attack, for this more aggressive and faster-acting bronchodilator inhaler are rquired, available upon a physician's prescription. One can of course take Montair and other asthma medication, including inhaled bronchodilators and corticosteroids, if recommended by the physician. The most common side-effects of Montair may be abdominal pain & headache. These may also include increased bleeding behaviour and mood related changes, diarrhoea, dyspepsia, nausea, vomiting, dizziness, drowsiness, pins and needles or numbness. One should not use Montair tablets 10mg if one is allergic to montelukast sodium. Druginteraction inlcude Phenobarbital, which interacts with the absorption of Montair.  One should continue to take Montair tablets for asthma management even if one begins to feel better, as it is intended as a long-term management medication for overall improved control of asthma.

As asthma is fairly common amongst children, they must be encouraged to used the "spacer' device for efficient and almost effortless inhalation of the prescribed drugs. For adults prone to particulate allergies, one of the most useful itms if the nasal mask, like the following 3M N95 Particulate Respirator 8210 mask.

The most common prescription medications for asthma are Beta-2 Agonists - these drugs both prevent & stop an attack, and are the most widely used asthma medications in the United States. Included in the list are albuterol (Proventil & Ventolin), Isoetharine (Bronkometer), metaproterenol (Alupent & Metaprel), and terbutaline (Brethine). Available in pills, liquid, and aerosol forms, they work by relaxing the muscles that control the airways. They also reduce the flow of mucus by inhibiting by inhibiting histamine production, and help to clear mucus from the lungs. However, their side-effects may include shakiness (tremors), increased heart rate (tachycardia), palpitations, cardiac arrhythmias in susceptible patients, and their long-term use can even cause anxiety & restlessness.