Common Triggers of Asthma and How to Manage them

Overview

Asthma is a long-term and the most common chronic respiratory tract infection which can affect both adults and children. During this condition, the air passages in the lungs become narrow due to the inflammation and tightening of the muscles around the small airways. The patient complaints of breathing difficulty associated with wheezing of breath sounds.

Types of Asthma:

Asthma can be categorized into various types. They include:

• Allergic asthma
• Exercise-induced asthma
• Aspirin-induced asthma
• Occupational asthma
• Steroid-resistant asthma
• Cough-variant asthma
• Nocturnal asthma
• Seasonal asthma

Triggers of Asthma:

Asthma can be caused due to various reasons, a few of them include:

• Airborne allergens, dust mites, pollen, pet dander, mold spores, particles of cockroach waste
• Physical activity
• Air pollutants and irritants such as a smoke
• Strong emotions and stress
• Respiratory infections
• Physical activity
• Gastroesophageal reflux disease
• Cold air
• Certain medications including beta blockers, ibuprofen, NSAIDs, aspirin, etc.
• Sulfites and preservatives are added to some food items which include fruits, fruit juices, beer, wine, and processed potatoes
• Exposure to certain toxins, perfumes, active or passive smokers, and exposure to certain allergens, and chemicals.
• Genetics- Family history of having asthma
• Respiratory infection- which includes respiratory syncytial virus (RSV), can damage the children’s developing lungs.

Risk factors for Asthma

The risk factors associated with asthma are listed below:

• Family history of asthma
• Chronic smoker
• Passive smoker
• Exposure to certain toxins and pollutants
• Extreme weather conditions
• Occupational exposure to certain chemicals, dust, farming, hairdressing, and manufacturing.
• Being overweight 
• Hormonal factors

Symptoms of Asthma

The signs and symptoms of asthma vary from person to person. The signs and symptoms that are associated with asthma are listed below:

• Breathing difficulty
• Shortness of breath
• Wheezing during exhalation is a common sign of asthma in children
• Coughing, increase in frequency in the nights, during exercise, laughing
• Difficulty in lying in a supine position
• Confusion
• Chest tightness, pain, or pressure
• Fatigue
• Rapid breathing
• Increased mucus production
• Recurrent infections

Diagnosis of Asthma

The diagnosis of asthma can be done by advising the patient to undergo a couple of tests. They include:

• Physical examination- During the physical examination, the doctor will examine the lungs of the patient thoroughly. The doctor initially will record the history of the patient carefully. The doctor will record the patient’s history of allergy to any substances. The doctor will auscultate the lungs of the patient through the stethoscope. During auscultation, the doctor will notice if there are any signs of wheezing sounds present or any kind of abnormalities in the lungs. During a physical examination, the doctor might also check for a runny nose, swollen nasal passages, or any abnormal growth inside the lungs.
• Laboratory tests- they include complete blood count, ESR levels, CRP levels, sputum tests, etc. Tests to measure lung function are:

a) Spirometry test- Spirometry test will help us to estimate the narrowing of the bronchial tubes by checking how much amount of air is exhaled after a deep breath and how fast the patient can breathe out.

b) Peak flow test- This test will help us to estimate how hard the patient can breathe out.

c) Pulmonary function test- It can help us to measure in and out of the airflow of the lungs.

• Investigational scans- They include chest X-rays, which will help us to identify any structural abnormalities or diseases that can aggravate or cause breathing problems.
• Allergy testing- Allergy tests can be done either by blood test or by skin test. If a patient has developed asthma due to some allergy-triggering agents, then this test will help us to identify and confirm the cause of asthma.
• Methacholine challenge test- this test is done when the initial lung function test is normal. Methacholine is one of the agents which is known to trigger asthma.
• Nitric oxide test- this test will help us to measure the amount of nitric oxide gas we inhale. However, the test is not used widely these days.
• Proactive testing for exercise and cold-induced asthma

Treatment for Asthma

The treatment plan for asthma varies from person to person. It depends on the type of asthma the person is suffering from, signs and symptoms, the severity of the condition, the age of the patient, co-morbidities associated with the condition, and the overall condition of the patient. The treatment modalities include:

• Medications- medications help in relieving the symptoms of the patient. Medications can be classified into long-term medications, quick-relief medications, and allergy medications. Choosing the right medications for the patient depends upon the age of the patient, their symptoms, and other co-morbidities associated with asthma. Medications advised for the patient include-

a) Quick-relief (rescue) medications- These medications will help in giving short-term symptomatic relief during an asthmatic attack. The lists of medications include:

• Anticholinergic agents- they include ipratropium and tiotropium. These medications can help in giving spontaneous relief to the symptoms associated with asthma. Anticholinergic drugs help in relaxing the airways and make the patient breathe easily. Anticholinergics are advised for patients who are suffering from emphysema, or chronic bronchitis, and can also be used to treat asthma.
• Short-acting beta blockers- they include albuterol and levalbuterol. These drugs act as a bronchodilator which will help in giving quick relief and ease symptoms during an asthma attack.
• Oral and intravenous corticosteroids- they include methylprednisolone and prednisone. Corticosteroids will help in relieving airway inflammation caused due to asthma attacks. Long-term usage of corticosteroid drugs will result in causing some serious side effects. Hence these drugs are advised only for a short period of time.

b). Long-term asthma control medications- these drugs are usually advised to take for a long term daily in order to keep asthma under control. The types of long-term medications include:

• Inhaled corticosteroids- they include budesonide, beclomethasone, ciclesonide, fluticasone propionate, mometasone, fluticasone furoate. They are advised for these patients on a long-term basis, unlike oral corticosteroids, inhaled corticosteroids have fewer side effects.
• Theophylline- theophylline helps in relaxing the muscles around the airways and keeps the airway open. Theophylline requires regular monitoring of blood tests; hence it is not used as often as other anti-asthma drugs.
• Leukotriene modifiers- they include montelukast, zileuton, and zafirlukast. Leukotriene modifiers help in giving symptomatic relief to the patient.
• Combination inhalers- they include budesonide-formoterol, fluticasone furoate-vilanterol, and fluticasone-salmeterol. It is a combination of long-acting beta-agonist and corticosteroids.
• Allergy medications- these medications are advised in cases where asthma is caused due to some allergens. They include:
• a) Immunotherapy
• b) Biologics- they include dupilumab, reslizumab, benralizumab, omalizumab, and mepolizumab. These drugs are advised only in case of severe asthma.
• Bronchial thermoplasty- bronchial thermoplasty is advised only in cases where the patients do not respond to any of the above-mentioned medications. However, this procedure is not advised for everyone who is diagnosed with asthma. During this procedure, the doctor passes an electrode inside the airway of the lungs and heats it. The heat reduces the smooth muscles which are present inside the airway and limits the ability of the airway to tighten, making the patient breathe easily and minimizing the asthma attack

Prevention of Asthma

Although asthma cannot be prevented completely. However, there are a few risk factors that can minimize the worsening of the condition. They are listed below:

• Avoid the triggering agents which can increase the severity of asthma such as exposure to harmful chemicals.
• Reducing exposure to allergens
• Avoid smoking
• Getting allergy shots
• Taking preventive medications
• Eating a healthy diet
• Exercise regularly
• Maintain a healthy weight
• Manage stress levels 
• Getting vaccinated for pneumonia and influenza.

FAQ

1) What is the prevalence of asthma worldwide?

It is estimated that asthma can affect about 5-10% of the population. According to the research studies, it is estimated that about 23.4% million people are affected including 7 million population

2) Can asthma be cured?

Asthma is a chronic respiratory condition that cannot be cured completely. Although, it can be managed conservatively. Children may outgrow asthma as they get older.

References

1. "Asthma-symptoms and Causes" Mayoclinic
2. "Asthma: Symptoms, Treatment, and Prevention" Healthline
3. "Types of Asthma" American Lung Association
4. "Asthma: Symptoms, Treatment, and Prevention" Healthline
5. " Asthma" Medscape