AA is an 8-year old boy. He was taken to the clinic with complaints of cough, noisy breathing, and difficulty with breathing. This had occurred on most nights for about 4months. His mother initially thought he was having nightmares as he often woke up at night breathless. His symptoms reduce moderately with cough syrups but reoccur mostly at nights. He was diagnosed as having asthma. He manages it with medications and avoidance of triggers of asthma.
Asthma is a chronic, often reversible, disease of the airway. It results from obstruction (narrowing) of the airway. The individual experiences cough, wheezing (noisy expiration), chest tightness, and difficulty with breathing. It is a serious form of allergic reaction.
Risk factors: The most common risk factor (why one person would have asthma and the other would not) for asthma is a positive family history of asthma or allergic conditions. Other risk factors include, but not limited to
- A history of viral respiratory tract infection in the first one year of life.
- Environmental pollution.
During an asthma attack, the individual’s body defence mechanism is hyper-responsive to allergens (substances that trigger an allergic reaction like an asthma attack). This leads to narrowing of the airway and increased mucous secretion which results in asthma symptoms: coughing, wheezing, chest tightness and difficulty with breathing.
These symptoms are initially reversible but can become irreversible and often life-threatening.
Diagnosis: The diagnosis is made by the doctor from a history of the symptoms above and examination for signs of asthma. In some cases, special tests (spirometry, peak flowmetry) may be required to make or support the diagnosis of asthma.
Management: Asthma is managed with a COMBINATION of
- Medications: These could be by mouth, by inhalation or through the vein depending on the severity of symptoms. They reverse the narrowing of the airway and allow the individual to breathe better. In certain cases, depending on the frequency of symptoms, some patients have to take inhalational medications daily (controller medications) to reduce the airway hyper-responsiveness (overactive immune system), thereby preventing asthma attack. The other class of medications are called relievers, which work to stop an ongoing asthma attack.
- Environmental control (removing potential triggers of asthma attacks): Avoiding dust, removing carpets, cleaning curtains, mopping floors, avoiding smoke or fumes, avoiding pollens, etc help reduce the frequency of asthma attacks in an individual.
Asthma, if not effectively treated, can progressively worsen, and can lead to death!
Below are myths and facts about asthma.
Myth: Asthma is contagious. Fact: Asthma is not contagious but can be hereditary.
Myth: Using inhalers for asthma means the disease is very severe. Fact: Inhalers are used to treat asthma attack whether it is mild, moderate, or severe in intensity. They deliver the medicine where it is needed (the airway) and lead to faster improvement of symptoms.
Myth: Asthma can be cured. Fact: There is currently no scientifically and consistently proven cure for asthma.
Myth: Patients with asthma must have asthma attacks frequently. Fact: With appropriate environmental control and preventive medication, patients with asthma can live a normal life without having asthma attacks.
Myth: People outgrow asthma. Fact: People do not outgrow asthma. The tendency to have asthma attack is life-long among affected individuals. If environmental control is done appropriately, attacks may reduce or be absent for months to years. This gives the wrong belief that the individual has outgrown the disease.
Call To Action: If you cough repeatedly, especially at night, and have difficulty with breathing, chest tightness and/or noisy breathing, it could be asthma. Consult your physician or paediatrician immediately.
Dr Olagoke Ewedairo is a consultant family physician with over a decade experience as a clinician. He obtained his MB: BS degree from the University of Lagos. He completed a post-graduate training in Family Medicine and was awarded the Fellowship in Family Medicine by the National Post-graduate Medical College of Nigeria. He also has a Master of Public Health degree from the Harvard School of Public Health. He is passionate about improving patients’ health outcome as well as patient education. He can be
reached via email at firstname.lastname@example.org.