ASTHMA

This week’s article will be based on a common but often mismanaged condition, asthma. Yesterday evening while I was at home, I got a call from a distressed nurse in our emergency department about a young man with a severe asthma attack.

I rushed to hospital to find this young man sweat profusely and gasping for air. This was such a stressful moment for all of us involved. Thankfully for this young man, through the combined efforts of my team, we were able to assist him, and he is making a recovery. I therefore found it fitting to start off the New Year by discussing this condition.

Asthma is a medical condition that causes the airways to narrow, swell and produce extra mucus. This then leads to the cardinal symptoms of asthma which are wheezing (noisy or whistling chest), coughing, shortness of breath and chest tightness. The symptoms also vary with time, and usually get worse in the mornings and evenings.

There are other conditions that can cause wheezing that need to be excluded by the doctor. Not all that wheezes is asthma. These conditions can include blockage of the airways outside the chest and airways inside the chest.

Asthma is a genetic condition, and the cause is unknown. However, there are certain individuals with asthma symptoms related to certain conditions such as exercise induced asthma, which gets worse with exercise. Other individuals have what is termed, occupational asthma. Their symptoms are triggered by workplace irritants such as chemical fumes, gases or dust.

These individuals are usually symptom free when outside work. Lastly we have individuals with Allergy-induced asthma which is triggered by airborne substances, such as pollen, mould spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet dander).

The treatment of asthma can be complicated. The initial management is usage of inhalers which give medications which help to dilate the airways and to control the swelling of the airways. It is important to have the right technique when using these inhalers otherwise the medications will not be delivered appropriately.

Another important aspect in the management of asthma is environmental control. This involves the avoidance of out- door/indoor allergens, irritants, and home environment cleanliness (e.g. steam cleaning and vacuuming). Pets should also be kept outdoors and its important to stop smoking. Individuals with asthma are advised to have vaccinations for influenza and pneumococcal vaccine to prevent chest infections that could worsen asthma.

Severe asthma attacks can be life threatening. It is important to know when to see the doctor when symptoms are not improving. Signs of an asthma emergency include; rapid worsening of shortness of breath or wheezing, no improvement even after using a quick-relief inhaler and shortness of breath when you are doing minimal physical activity. Last but not least patients with asthma must have an action plan drawn up by their doctors on what to do when faced with an emergency.