Today out of many respiratory system diseases, there is one that affects almost one out of every 10 children in Nepal and it is bronchial asthma. The question is, has it always been prevalent or has it increased due to the lifestyle we’ve chosen to live with? The general public will also have questions such as, what kind of disease this is. Is it contagious? How do I know whether I have asthma or not, and what precautions can I take to prevent having bronchial asthma? An attempt has been made to explain all that you need to know about the disease without the details that medical science puts in its textbooks in this piece.
So what is bronchial asthma? In most medical literature it is defined as reversible obstructive airway disease characterised by airway hyper responsiveness and chronic airway inflammation leading to episodic attacks of wheeze (which is a high pitched musical sound while breathing), cough, tightness around the chest and shortness of breath. It is caused by having an allergic reaction to certain airborne particles which consists of a two part process, the first being sensitisation in which the body is exposed to the allergic particle and signals the immune system to mount an inflammatory response against it if it’s exposed to it again. The second part is the reactive phase in which Immunoglobulin E from the immune system is released in response to the presence of the allergen releasing a substance known as histamine which initiates the hypersensitivity reaction. Now this intense immediate inflammatory reaction constricts the airways, congests blood vessels and a secretion of mucus occurs due to irritation.
There are a number of factors that may cause one to have bronchial asthma. The most common being genetic predisposition, meaning that the person inherited the sensitivity from his/her parents or grandparents. The others are exposure to harmful airborne particles at work or out in the open in Kathmandu or other cities, some medicines that are legally prescribed by your doctor, infections, exercise and anxiety.
There are a number of investigations that a doctor will do before confirming if one has bronchial asthma. Some of these are pulmonary function tests which will require the patient to breathe in and out into a machine to assess the levels of air that goes in and out of the lungs. The next investigation will usually be a chest X-ray and then an assessment of arterial blood gas. But most often, before all of this, almost all doctors will require a hematological screen, a complete blood work up before doing anything else. It’s important to rule out other diseases such as bronchiolitis and pneumonia before starting treatment for bronchial asthma.
While living in Kathmandu or other places in Nepal it’s important to protect your airways in whatever way you can. Dust and pollution that we are exposed to outdoors and the industrial chemicals that the workers are exposed to in their workplaces, are some of the major culprits in manifesting and exacerbating the disease. Therefore, do not forget to wear a mask while you’re on the road or outdoors. Industrial workers should be equipped with high end masks with respiratory units in them. Known asthmatics should have their rescue medicines with them at all times, inhalers or rotahalers. Regular checkups should be a part of your routine to assess your lung function once every couple of months or whatever the number of times your doctor advises you to visit him/her.
It’s very difficult even for experienced doctors to conclude whether one has bronchial asthma the very first time they present with the symptoms and may require the patient to visit the hospital or clinic several times. Therefore, it is very important to not self diagnose the condition and medicate oneself without consulting an expert since it is very easy to go to a pharmacy here and buy medicines for asthma without a prescription. The severity of symptoms in a number of cases changes and in that a majority begin only to have mild symptoms as the patient grows older. Ultimately bronchial asthma should not limit the quality of life one may have and not restrict many of the recreational activities that many people enjoy.
For children and adults who already have asthma the treatment you’re given will vary from person to person, but the ultimate goal is for you to have your symptoms appear no more than twice a week during the day time in which you may or may not need to take the interventional medication given to you. Your symptoms should not get worse once you are under treatment and you should have normal lung function without it stopping you from doing your most enjoyable recreational activities.
The most effective means of therapy is to eliminate the causative agent altogether but in many cases that is not possible. So the first line of treatment is something known as a short acting beta 2 agonist salbutamol or albuterol. Other medications may include an inhaled corticosteroid which can also be given intravenously; an immunomodulator which limits the release of Immunoglobulin E as the first signaling unit to begin the reaction and in cases of emergency doctors will use an array of treatment options such as a high flow of oxygen, anticholinergics, potassium, magnesium, antibiotics, theophyllines and adrenaline to resuscitate a patient in case of a serious asthmatic attack.