Asthma Treatment in Delhi, India

Asthma is characterised by the narrowing and swelling of airways, often accompanied by increased mucus production. This can result in difficulty breathing, coughing, audible wheezing during exhalation, and a sensation of breathlessness. While some individuals experience asthma as a minor inconvenience, for others, it can pose a significant challenge, disrupting daily activities and potentially leading to a severe, life-threatening asthma attack.

Asthma is categorised based on both its frequency and severity of symptoms. Healthcare professionals classify asthma as:

1. Intermittent: Asthma symptoms occur, allowing individuals to experience normalcy between flares.
2. Persistent: Symptoms are present frequently, varying degrees of severity—ranging from mild to moderate or severe. Severity is determined by the frequency of symptoms and how well individuals can perform daily activities during an asthma attack.

Asthma can also be classified according to the causes, including:

1. Allergic: Asthma attacks can be triggered by mould, pollen, and pet dander.
2. Non-allergic: External factors like exercise, stress, illness, and weather can induce asthma flares.

Asthma can also be characterised as:

1. Adult-onset: This form of asthma emerges after the age of 18.
2. Paediatric: Commonly known as childhood asthma, it often begins before age 5, affecting infants and toddlers. Children may outgrow asthma, and decisions regarding the necessity of an inhaler should be discussed with a healthcare provider.

Additionally, there are specific types of asthma, such as:

1. Exercise-induced asthma: Triggered by physical activity, also called exercise-induced bronchospasm.
2. Occupational asthma: Primarily affects individuals working around irritating substances.
3. Asthma-COPD overlap syndrome (ACOS): Occurs when both asthma and chronic obstructive pulmonary disease (COPD) are present, making breathing challenging.

Asthma can have various triggers, and understanding these factors is crucial for effective management. Common culprits contributing to asthma include:

• Animals: Pet hair or dander.
• Dust: A pervasive trigger in many environments.
• Changes in weather: Fluctuations in weather conditions.
• Mould: Presence of mould spores in indoor spaces.
• Pollen: Seasonal allergies triggered by pollen.
• Respiratory infections: Such as the common cold.
• Tobacco smoking: A well-established risk factor.

Asthma exhibits noticeable symptoms, which may share similarities with various respiratory infections. These signs and symptoms often include:

• Chest tightness, pain, or pressure: Manifestations that indicate potential asthma episodes.
• Coughing, especially at night: A common occurrence associated with asthma.
• Shortness of breath: An unmistakable sign of compromised respiratory function.
• Wheezing: Audible whistling sounds during breathing.

It's important to note that not all symptoms manifest simultaneously during every asthma flare-up. The nature and intensity of symptoms can vary over time in individuals with chronic asthma. Furthermore, symptoms may fluctuate between different asthma attacks.

Complications associated with asthma encompass a range of challenges, including:

• Signs and symptoms disrupting daily life: Asthma can significantly impact sleep, work, and other activities.
• Absences from work or school: Asthma flare-ups may lead to sick days, affecting regular commitments.
• Permanent constriction of bronchial tubes: Prolonged asthma may result in a lasting narrowing of the air passages, influencing breathing capacity.
• Emergency room visits and hospitalizations: Severe asthma attacks may necessitate urgent medical attention, leading to emergency room visits or hospitalizations.
• Long-Term medication side effects: The extended use of certain medications to manage severe asthma may pose side effects, requiring careful consideration and monitoring.

Diagnosing asthma involves a comprehensive assessment to confirm the presence of the respiratory condition. Healthcare professionals typically follow a systematic approach that includes the following:

• Medical history review: Gathering information about the patient's medical background, including family history of asthma or allergies.
• Physical examination: Evaluate respiratory symptoms, such as wheezing, coughing, and shortness of breath, through a thorough physical examination.
• Lung function tests: Tests like spirometry measure how much air the lungs can hold and how effectively they can expel it.
• Allergy testing: Identifying potential allergens through skin or blood tests to understand if allergic triggers contribute to asthma symptoms.
• Peak flow measurement: Monitoring peak expiratory flow rates to assess variations in lung function.

Asthma treatment involves a multifaceted strategy. This includes identifying triggers and prescribing the most effective asthma medications. In the event of an asthma attack, immediate asthma attack treatment is provided.

Identifying Triggers

Individuals learn to recognize and avoid triggers while monitoring breathing to ensure medications effectively control symptoms. In the event of a flare-up, a quick-relief inhaler may be necessary.

Medication Types

The selection of appropriate asthma medications depends on age, symptoms, asthma triggers, and individual responsiveness. Two main categories include:

• Preventive, long-term control medications: These medications address airway inflammation and are taken regularly to minimise the likelihood of asthma attacks. Examples include inhaled corticosteroids and leukotriene modifiers.
• Quick-Relief (rescue) medications: These are used as needed for immediate relief during asthma attacks and include short-acting beta-agonists and anticholinergic agents.
• Combination inhalers: Medications containing a long-acting beta-agonist and a corticosteroid for comprehensive control.
• Theophylline: A daily pill that helps keep airways open by relaxing muscles, though it requires regular blood tests.

Monitoring and Adjusting Medications

Keeping track of medication usage helps assess its effectiveness. If quick-relief inhalers are used more frequently than recommended, adjustments to long-term control medications may be necessary.

Allergy Medications

Allergy shots (immunotherapy) and biologics are options for those whose asthma is triggered or exacerbated by allergies.

Advanced Treatments

In severe cases, bronchial thermoplasty may be considered, which involves controlled heating of the airway walls to reduce smooth muscle, making breathing easier.

Key preventive measures include:

• Maintaining a clean environment: Regular cleaning practices, including dusting, vacuuming, and air purification, reduce the presence of airborne particles that can exacerbate asthma symptoms.
• Healthy lifestyle choices: Maintaining a well-balanced diet, engaging in regular physical activity, and managing stress can positively impact respiratory health.
• Smoking avoidance: Steer clear of tobacco smoke and second-hand smoke exposure. Smoking is a significant asthma trigger and can worsen symptoms, making it crucial for individuals to live in smoke-free environments.
• Vaccinations: Keeping up with vaccinations, especially flu and pneumonia vaccines, is vital. Respiratory infections like the flu can exacerbate asthma symptoms, so preventive measures can help minimise these risks.
• Regular medical check-ups: Routine visits to asthma specialists allow for monitoring respiratory health and adjusting management plans as needed. This collaborative approach ensures timely interventions to prevent worsening symptoms.

1. Is Asthma a chronic disease?

Yes, asthma is considered a chronic respiratory condition characterised by inflammation and narrowing of the airways, leading to symptoms such as wheezing, coughing, and shortness of breath.

2. Who can get Asthma? 

Asthma can affect people of all ages, from children to adults. It may develop due to genetic as well as environmental factors, such as exposure to allergens or respiratory infections.

3. What are common Asthma attack triggers?

Common asthma attack triggers include allergens (pollen, pet dander), respiratory infections, physical activity, air pollution, smoke, certain medications, and exposure to irritants like solid odours or chemicals.

4. Are Asthma and bronchitis the same?

No, asthma and bronchitis are different respiratory conditions. Asthma involves chronic inflammation of the airways, while bronchitis is inflammation of the bronchial tubes, often caused by infection.

5. What is Asthma control?

Asthma control is managing the condition effectively to minimise symptoms and prevent asthma attacks. This involves taking medications as prescribed, identifying and avoiding triggers, and regularly monitoring and adjusting treatment as needed.

6. How do you monitor Asthma symptoms?

Monitoring asthma symptoms involves keeping track of daily peak flow measurements, recording signs like coughing and wheezing, and noting any triggers or changes in medication effectiveness.

7. How can I prevent an Asthma attack?

Preventing asthma attacks involves identifying and avoiding triggers, taking prescribed medications regularly, maintaining good air quality at home, and having an asthma action plan.

8. What should I do if I have a severe Asthma attack? 

If experiencing a severe asthma attack, it's crucial to use a rescue inhaler (such as albuterol) as directed, seek emergency medical help, and follow the steps outlined in your asthma action plan.

9. Can Asthma be cured?

While asthma cannot be cured, it can be effectively managed with proper treatment and lifestyle adjustments, allowing individuals to lead a normal, active life.

10. Why is my Asthma worse at night?

Asthma symptoms may worsen at night due to circadian rhythms, reclining position, increased exposure to allergens in bedding, or reflux triggering respiratory symptoms.

11. Can depression cause Asthma?

While there is a connection between mental health and asthma, depression itself may not directly cause asthma. However, emotional factors can influence asthma symptoms and management.

12. Can I live a normal life with Asthma?

Yes, with proper management, most individuals with asthma can lead normal, active lives. Following an asthma action plan, taking prescribed medications, and identifying triggers are critical to effective management.

13. How does inflammation of the airways affect my Asthma?

Inflammation in the airways is a key component of asthma, leading to swelling and increased mucus production. This inflammation narrows the airways, making breathing difficult and causing symptoms.

14. What are the side effects of my bronchodilator medicine?

Side effects of bronchodilators may include increased heart rate, jitteriness, and, in some cases, tremors. It's important to discuss any concerns with your healthcare provider, as side effects can vary depending on the specific medication.

Reviewed by Dr. Inder Mohan Chugh - Senior Director, Pulmonology on 18 Jan 2024.

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