What is Asthma and Why It More Dangerous Than You Think

Definition of Asthma

Asthma is a long-term disease that can cause sufferers to have diffic ulty breathing, cough, and experience wheezing when relapsing. In each person, the severity of this disease is different, and generally can be controlled well.

Asthma occurs when the airways or bronchi become inflamed. Bronchi are shaped like small tubes that function to carry air in and out of the lungs. The bronchi of asthmatics are generally more sensitive than other people and more prone to inflammation.

Overview of asthma symptoms

When a sufferer's lungs are irritated by something that triggers asthma, the airways become narrowed, the surrounding muscles tighten, and the production of phlegm increases. After that, some symptoms arise such as chest tightness, difficulty breathing, wheezing, and coughing.

Severe attacks of these symptoms are known as asthma attacks or acute asthma exacerbations. People with asthma attacks may require hospital treatment. Although rare, asthma attacks can be life-threatening. For people with chronic asthma, inflammation of the airways that has lasted for a long time and repeatedly can cause permanent narrowing.

If a person is diagnosed with asthma as a child, the symptoms may disappear as a teenager and reappear as an adult. However, asthma symptoms that are classified as moderate or severe in childhood, will tend to remain even though they can also reappear. However, asthma can appear at any age and does not always start in childhood.

A little about the causes of asthma

Asthma is a hereditary disease. A person has a high chance of developing asthma if one or both of his parents also suffer from asthma. However, the underlying cause of this disease is still not fully understood.

Factors that are common triggers of asthma

The definition of a trigger here is anything that can irritate the airways, that is, anything that later leads to the appearance of asthma symptoms. Common triggers of asthma in each sufferer are different.

Several things can be common triggers of asthma, including animal dander, cold air, dust mites, cigarette smoke, pollen, lung infections, and exercise. Certain activities, such as work, can also worsen asthma. This is termed 'occupational asthma' or work-related asthma. For example, construction workers who have asthma due to frequent exposure to dust or sand.

An overview of the diagnosis of asthma

Your doctor will likely be able to make a diagnosis if you have typical asthma symptoms. Your doctor will usually ask you about when and how often you experience these symptoms, and if you know anything that might be causing them. Doctors will usually perform some tests to confirm the diagnosis.

Steps to treat asthma

So far, there has not been a cure for asthma itself, but there are many treatment steps that can be applied to help control asthma. The treatment is based on two important goals, namely relieving symptoms and preventing asthma attacks. The two goals also involve a combination of medications, identification and avoidance of asthma triggers, and lifestyle advice.

Living with asthma

If you happen to be an asthmatic or a person living with asthma, don't worry or worry about your illness. Asthma is a condition that can be controlled as long as you apply discipline, both in terms of handling and prevention.

Some of the steps you can take to prevent asthma attacks include:

Identify and avoid asthma triggers.
Follow your asthma management plan made with your doctor.
Recognize an asthma attack and treat it as soon as possible.
Use asthma medications as recommended by your doctor regularly.
Monitor your breath.
It is recommended to carry out influenza and pneumonia vaccinations to prevent complications from asthma attacks.
If the use of quick-relief inhalers is increasing, consult your doctor immediately so that your asthma management plan is readjusted.

Asthma Symptoms

Asthma symptoms range from mild to severe. A significant worsening of asthma symptoms is known as an asthma attack. There are several symptoms of asthma, including:

Coughs usually occur at night and early in the morning.
Difficulty breathing makes the sufferer gasp for air.
Chest tightness.
Wheezing is the sound produced when air flows through narrowed airways.
Asthma attacks are triggered by allergen exposure or physical activity.

Patients may experience one or more of these symptoms. Symptoms that get worse at night or when a person is physically active may indicate that their asthma is getting worse and is getting out of control. You should immediately consult a doctor if you experience this.

Severe asthma attacks usually occur slowly, although a small percentage of sufferers experience rapidly worsening symptoms. Generally, it will take 6-24 hours for ordinary asthma conditions to develop into severe asthma.

In addition to chest tightness, difficulty breathing and worsening wheezing, other signs of a severe asthma attack include decreased peak expiratory flow, difficulty speaking (due to difficulty breathing), restlessness, blue lips and nails, increased pulse, and inhalers. (inhaled medicine for asthma) reliever which is no longer effective in treating symptoms.

Don't ignore it if you experience these signs. You should immediately consult a doctor.

Causes of Asthma

The exact cause of asthma is still unknown. However, several things can increase the risk of developing the disease, including:

Having bronchiolitis or a lung infection as a child.
Have a family history of asthma or other related allergies (known as atopic diseases) such as food allergies, pollen allergies, and eczema.
Exposure to secondhand smoke as a child, especially if your mother smoked while pregnant.
Born with a weight below normal, which is less than two kilograms.
Premature birth, especially if you need a ventilator.
Have other atopic health problems such as food allergies.

Factors that trigger asthma attacks

There are several triggers for asthma symptoms, but these triggers are different for each patient. If you already know what triggers your asthma, try to avoid it. The following are some asthma triggers:

Allergens, such as animal dander, dust mites, and pollen.
Lung and respiratory tract infections are generally caused by cold and flu viruses.
Medications such as non-steroidal anti-inflammatory drugs (painkillers) such as aspirin and ibuprofen. Of note, aspirin should not be given to children under 16 years of age.
Air irritants, such as chemical fumes, cigarette smoke, and air pollution.
Weather factors, such as cold weather, windy weather, hot weather supported by poor air quality, humid weather, and drastic temperature changes.
Foods or drinks containing sulfites (a natural substance that is sometimes used as a food preservative) such as jams, shrimp, processed foods, undercooked foods, packaged fruit juices, and certain wines only trigger vulnerable people.
Exercise (sometimes asthma symptoms get worse when the sufferer does exercise).
Indoor conditions, such as damp or moldy rooms, flooring materials, carpet chemicals, and dust mites.
Emotional factors such as stress or laughter.
Certain food allergies are also known as anaphylactic reactions. An example is asthmatics who are allergic to nuts. An anaphylactic reaction can trigger an asthma attack that is worse in the sufferer.

The condition of the patient when has asthma

When asthma symptoms appear (asthma attack), usually the muscles around the airways tighten. In addition, there is increased inflammation (swelling) in the lining of the respiratory tract and increased production of phlegm which further adds to the narrowing of the airways.

With the narrowing of the parts of the respiratory tract, the air will be more difficult to flow so the sufferer has more difficulty breathing. This condition is usually accompanied by the appearance of a wheezing sound, although not all people with asthma experience it. Even in a life-threatening asthma attack, the wheezing sound may not be present.

Asthma attacks know no time and can happen at any time. But before that happens, there are usually warning signs a few days in advance. These warning signs include worsening symptoms (especially at night) and the patient's constant need to use a reliever inhaler.

Call 911 immediately for an ambulance if you have or see someone else having a bad asthma attack that makes it hard to breathe.

Asthma Diagnosis

Spirometry test to check the condition of the lungs

To measure how well your lungs are working, a breathing test called spirometry is performed. Through this test, you will be asked to breathe into a machine called a spirometer.

There are two measurements made by the spirometer machine, namely the volume of air you can exhale in one second (also known as the forced expiratory volume in one second or FEV 1) and the total amount of air you can exhale (also known as the forced vital capacity or FVC). ). Usually, you are asked to breathe several times inside the machine to get consistent data.

To find out if your airway is obstructed, the data obtained is then compared with the average measurement for people your age.

Sometimes the initial measurements are taken first. After that, the doctor will give you medicine to open your airways (relief inhaler) to see if the medicine can restore your breath. After that, data collection was carried out again. If the result is higher after you are given the drug, then the data can strengthen the diagnosis.

Peak expiratory flow rate test to measure the rate of exhaled air

To measure how fast you can exhale air from your lungs in one breath, your doctor may also use a device called a peak flow meter (PFM). This test is usually called a peak flow test or peak flow test to obtain data on the level or level of peak expiratory flow (PEFR).

Doctors usually advise you to buy a PFM for home use, as well as keep a daily PEFR record. You are usually also advised to record each symptom that appears so that the doctor can know when your asthma worsens.

Other asthma diagnostic tests

Some other asthma tests may be needed by some people, such as tests to measure airway responsiveness, tests to see the presence of inflammation in the airways, and allergy tests. These tests can confirm the diagnosis of asthma or help diagnose other diseases. Of course, the results will make it easier for you and your doctor to make a treatment plan.

Airway responsiveness test via mannitol challenge

This test is used to determine how your respiratory tract reacts when exposed to a trigger. Usually, you will be asked to undergo a mannitol challenge test, in which you are asked to inhale a dry powder that can be increased in quantity as the test progresses. In this way, the test intentionally triggers asthma symptoms and causes the airways to constrict. In children, in addition to dry powder of mannitol, asthma triggering medium that can also be used is exercise.

You are then asked to exhale into the spirometer to measure how much your FEV1 and FVC change after being hit by the trigger. If in the measurement there is a drastic decrease, then chances are you have asthma.

Tests to see the presence of inflammation in the airways

Nitric oxide concentration. Your doctor will measure the level of nitric oxide in your breath when you breathe in. If the nitric oxide level is high, then it may be a sign of inflammation in the airways.
Sputum sample. Your doctor will usually take a sample of your sputum to check if your lungs are inflamed.

Allergy test with blood or skin test

To find out if your asthma symptoms are caused by allergies, such as food allergies, dust mites, or pollen, your doctor will usually do a blood test or skin test.

Asthma caused by work

If you feel that your symptoms are improving when you are not working or on leave, you may have “occupational asthma.” This type of asthma can be diagnosed if you work in a field or industry where there is a high risk of asthma, such as:

Nurse
paint sprayer
Chemical worker
Welder
Animal caretaker
Cake or bread maker
woodworker
Food processing workers

To facilitate the diagnosis of occupational asthma, your doctor will usually ask you to do a peak expiratory flow (PEFR) test using a peak flow meter (PFM), both at work and outside.

Through this test, your doctor can see if you have occupational asthma due to allergies or sensitivity to certain substances. Then the doctor will likely refer you to a specialist to confirm the results of the diagnosis.

Asthma Treatment

Controlling asthma in the long term is the main goal of its treatment. Every person with asthma should be able to live life to the fullest without being limited by the disease. For the majority of sufferers, the available treatment proves to be effective and allows them to be free from asthma symptoms.

Good asthma management

Your doctor will tailor treatment to your asthma symptoms. Sometimes you need a higher level of medication over a while. In good treatment, the patient is also given regular check-ups to make sure his asthma is under control and the medication is appropriate. This review is carried out at least once a year.

As part of good asthma management, you must make sure that your doctor or pharmacist teaches you how to use your inhaler properly.

Asthma management plan

Information about your asthma medications should be included in your asthma management plan. This treatment plan can also help you know when your symptoms may worsen and what steps to take. You will also usually be given information about what to do if you have asthma.

At least once a year, you should review your asthma management plan with your doctor. Even more regular reviews need to be done if your asthma symptoms are severe.

You may be advised to purchase a peak flow meter (PFM) or a peak expiratory flow meter as part of your treatment. This way you can monitor your asthma.

Suggested asthma medications

Overcoming asthma with inhalers

Usually, asthma medicines are given through a device called an inhaler (inhaled medicine for asthma). This device can deliver drugs directly into the respiratory tract by inhalation through the mouth. Using asthma medication by inhalation is considered effective because the drug goes directly to the lungs. However, each inhaler works differently. Usually, the doctor will teach you how to use the device and perform an examination at least once a year.

A spacer as a complement to the inhaler

A spacer is a container made of metal or plastic, equipped with a suction funnel at one end, and a hole at the other for attaching the inhaler. When the inhaler is pressed, the drug will enter the spacer and be inhaled through the mouthpiece of the spacer itself. Spacers can also reduce the risk of thrush in the mouth or throat, a side effect of inhaled asthma medications.

When pressed, some inhalers emit an aerosol jet. However, this aerosol jet may perform better if given through a spacer. Spacers can increase the number of drugs reaching the lungs and reduce side effects. Some people even find it easier to use a spacer than just an inhaler. Because it improves drug distribution into the lungs, the use of spacers is often recommended, even for those who have had success with inhalers.

Relief type inhaler

As the name implies, reliever inhalers are used to quickly relieve asthma symptoms during an attack. Usually, these inhalers contain drugs called short-acting beta2-agonists or beta2-agonists which have a fast reaction. This drug can relax the muscles around the narrowed airways. That way, the respiratory tract can open wider and make asthmatics able to breathe again more easily. Generally, reliever inhalers are blue and are given to each person with asthma.

Examples of relieving drugs are terbutaline and salbutamol. These drugs have few side effects and are generally safe to use if not overdone. However, these drugs are usually rarely used if asthma is well controlled. For people with asthma who must use this drug more than three times a week, the overall management needs to be reviewed.

Preventive type inhaler

Besides being able to prevent asthma attacks, preventive inhalers can also reduce the amount of inflammation and "convulsions" that occur in the airways. Usually, you have to use a preventative inhaler every day for a while before you feel the full benefits.

You may also need a reliever inhaler to relieve symptoms during an asthma attack. However, if you are in constant need of a relief inhaler, then your treatment should be thoroughly reviewed.

Preventive inhalers usually contain medications called inhaled corticosteroids. Smoking is something that must be avoided because it can reduce the performance of the preventer inhaler.

Examples of asthma-preventing drugs include budesonide, beclometasone, mometasone, and fluticasone. Usually, preventive inhalers are orange, red, or brown.

Generally, preventative treatment is recommended if you:

Have asthma attacks more than twice a week.
Must use the reliever inhaler more than twice a week.
Waking up at night or more once a week due to an asthma attack.

However, sometimes inhaled corticosteroids can cause oral thrush or fungal infection of the lining of the mouth. Therefore, after each inhalation of this drug, the patient is advised to rinse his mouth with water until clean.

Various other drug therapies

Overcoming asthma with slow-relief inhalers

If your asthma doesn't go away with your previous medication, your doctor may increase the dose of a preventative inhaler. If these steps do not control asthma symptoms, the doctor will usually give the patient an additional medication called a long-acting reliever or a slow-acting asthma reliever (long-acting bronchodilator/long-acting beta2-agonist or LABA).

Alternatively, the patient will be given a combination inhaler or an inhaler combined with inhaled steroids and a slow-acting bronchodilator in one device. Efficacy is the same as quick reaction reliever drugs, it's just that the performance takes longer and the effect can last up to 12 hours. Examples of slow-acting inhalers are salmeterol and formoterol.

Always combine a slow-acting inhaler with a preventer and never use it alone. Research has shown that using a slow-acting inhaler on its own can increase the risk of asthma attacks and even death. Examples of inhaler combinations are Seretide, Symbicort, and Fostair. Usually, they are purple, red, and dark red, respectively.

Other preventive drugs

Your doctor will usually suggest that you try additional preventative medications if your asthma is still not well controlled. Two medications that may be used are:

Theophylline is a tablet that helps widen the airways by relaxing the surrounding muscles.
Leukotriene receptor antagonist (montelukast), is a tablet that blocks part of the chemical reaction that causes inflammation in the respiratory tract.

Steroid tablets may be prescribed by your doctor if your asthma is still not under control. This treatment is usually monitored by a respiratory specialist. However, long-term use of oral steroids can cause serious side effects. Therefore, this method of treatment is only recommended if the patient has taken other treatment methods, but has not succeeded.

Occasional use of oral steroids

Most people only need to take oral steroids for one to two weeks. Usually, they will return to their previous medication once their asthma is under control.

Omalizumab as a new drug

Omalizumab is a new category of drugs. This drug is also known as Xolair. This drug binds to one of the proteins involved in the immune response and reduces its level in the blood. In other words, these drugs lower the chances of an immune reaction or inflammation occurring.

In general, omalizumab is recommended for people who have frequent asthma attacks and require emergency treatment or hospitalization.

As a drug that is usually only prescribed by specialists, omalizumab is given by injection every two to four weeks. Omalizumab should be discontinued if this drug does not control asthma within sixteen weeks.

Bronchial thermoplasty treatment procedure

Bronchial thermoplasty is a new asthma treatment procedure that is still being researched and is not yet available in Indonesia. In some cases, this procedure is used to treat severe asthma by reducing the narrowing of the airways.

There is some evidence to suggest that this procedure can reduce asthma attacks and improve the quality of life for people with severe asthma. However, the long-term advantages and disadvantages are not yet fully known.

Side effects of various medications

Inhaler side effects relieve and prevent

As long as you don't exceed the dosage, reliever inhalers are a safe treatment that doesn't have many side effects. Common side effects of this medication include headaches, muscle cramps, and slight shaking of the hands. However, these symptoms usually only occur with high doses of the reliever inhaler and only last for a few minutes.

As for preventive inhalers, this medication is very safe at regular doses, although at high doses it can cause some side effects, especially in long-term use. The main side effect of preventive inhalers is a yeast infection in the mouth or throat which is also known as oral candidiasis. Your voice may also be hoarse. However, this side effect can be prevented if you use a spacer. In addition, it is recommended to rinse your mouth with clean water after using the preventative inhaler.

The doctor will usually explain what treatment is appropriate for your asthma along with the side effects, such as explaining how to minimize these side effects.

Side effects of additional drugs

The side effects of using a slow-acting inhaler may be the same as that of a fast-acting inhaler, namely headaches, muscle cramps, and slight shaking of the hands. Your doctor will usually explain to you the benefits and risks of the treatment. Usually, you will be monitored early in treatment and reviewed regularly. If using a slow-acting inhaler doesn't relieve your asthma, stop immediately.

In some people, theophylline tablets are known to cause side effects, such as nausea, headache, vomiting, insomnia, stomach upset, and irritability. However, this can usually be avoided by adjusting the dose.

Leukotriene receptor antagonists generally do not cause side effects, although there are reports that these drugs can cause asthmatics who take them to experience headaches, stomach upset, and feel thirsty.

Side effects of steroids

Steroids can cause side effects if taken more than three months or frequently (three to four courses of treatment in a year). Side effects include:

High blood pressure or hypertension
Weight gain
Bones become porous
Muscle weakness
Skin thinning
Easy bruising
Cataracts and glaucoma

There are several things you can do to minimize the risks of using oral steroids, including regular exercise, not smoking, and eating healthy foods with high calcium levels. You should also regularly check yourself to avoid osteoporosis, diabetes, and high blood pressure.

Asthma due to work

If you suspect you have work-related asthma, consult your doctor to confirm a diagnosis. Share your diagnosis with the company, as well as with the company's health and safety officer in the occupational health services department.

Companies have a responsibility to protect you from the causes of asthma. And where possible, companies replace ingredients that contain asthma-inducing substances with safer ones. Many steps can be taken to minimize the impact of asthma triggers in the work environment. Ask the company to move you to another department as soon as possible. If you can't, you should consider looking for a new job.

Asthma attack management

Through an asthma management plan, you will be able to find out the early symptoms of asthma, how to deal with them, and know when to see a doctor.

Asthma attacks are usually treated with one or more doses of pain relievers. If the symptoms of an asthma attack worsen, you may need to be treated in a hospital. At the hospital, you will be given oxygen and asthma reliever drugs in combination with preventive drugs so that your asthma can be controlled again.

After an asthma attack, your treatment plan should be reviewed with your doctor. The goal is that you and your doctor can find out the cause of your asthma attack, and not repeat it in the future.

Complementary therapies to treat asthma

Some of the complementary therapies suggested to treat asthma include:

Acupuncture
Chinese traditional medicine
Breathing exercises
Homeopathy
Dietary Supplements
The Alexander Technique is an exercise program designed to change the way you move your body
An ionizer is a device that can clean air molecules using an electric current

It is unlikely that any of the above forms of treatment can provide effective results, except for breathing exercises. There is strong evidence that breathing exercises, such as yoga, the Buteyko method (techniques regarding shallow breathing), and breathing techniques taught by physiotherapists, can reduce asthma symptoms and the need for reliever medications in some people.