Specialty: Respiratory Conditions/ Pulmonology/Allergology/Immunology
Author: Praneesh Chandrasekhar
Editor: Abidemi Oseni
Social Media Summary
Asthma is a common condition related to the human immune system. It presents itself as,
most commonly, difficulty breathing. Oftentimes to improve breathing and open the airway,
people use inhalers. Asthma is considered a condition that is best dealt with on a preventative
basis rather than reactive one. There are several treatment options available for asthma,
including medicinal as well as environmental and external control. Asthma presents with
some very commonly known symptoms of other diseases, which may create confusion in
diagnosis, hence why it is often misdiagnosed or underdiagnosed or in some instances over
diagnosed. The following guide has been designed for the public population and is not
intended for a professional audience.
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Overview
Asthma is considered a common respiratory condition that primarily targets children,
leading up to 40% of children to have a wheeze (Hashmi, Tariq & Cataletto., 2022). It is
caused by excessive activity of the immune system and results primarily in difficulty
breathing and airway occlusion (Hashmi et al., 2020). The severity of asthma varies heavily
and can even be considered life threatening if the situation escalates. Medical practitioners
employ a series of tests and examine a variety of different aspects of patients to determine if a
patient has asthma. Asthma has also been proven to be caused by a mix of environmental and
genetic factors as well as some lifestyle factors (Quirt, Hildebrand, Mazza, Noya & Kim.,
2018). Variety of medicinal options are available to patients suffering from asthma, choices
are often based on the severity of the asthma. As well, lifestyle and environmental changes
are also considered in the treatment of asthma (Hashmi et al., 2020). Asthma is often over
diagnosed in patients, with over a 45% overdiagnosis rate having the condition (Yang et al.,
2017).
Causes
Asthma is an immune system response associated with immune system cells known as
T-helper cells (type 2) (Quirt et al., 2018). Asthma can be triggered by allergic and non-
allergic conditions which lead to airway inflammation (Quirt et al., 2018). A high amount of
type 2 T-helper cells leads to a build-up of an immunoglobulin known as IgE
(immunoglobulin E) (Quirt et al., 2018).
excess IgE then leads to the development of thecommonly known symptoms of asthma such as difficulty breathing (Quirt et al. 2018).
Asthma can be non-allergic through means of infection (Dahat, 2021). Asthma has also been
considered to be brought on due to psychological factors such as anxiety or extreme stress
(Dahat, 2021).
Symptoms
● Wheezing
● Breathlessness
● Chest tightness
● Cough
● Airway inflammation
● Nasal congestion (Quirt et al. 2018)
Risk factors
● Vitamin D deficiency
● Risk factors during early life
○ Lack of exposure to environment during early life
○ Tobacco exposure
○ Air pollution
○ Genetic
○ Viral exposure
● Risk factors during later life
○ Stress
○ Sex Hormones
○ Occupational hazards
○ Tobacco smoke
○ Obesity
(Stern, Pier & Litonjua., 2020), (Kuruvilla, Vanjicharoenkarn, Shih, Lee., 2019)
How does my doctor know I have?
Doctors perform a thorough medical history exam, physical exam, and a series of objective
assessments for those greater than 6 years of age (Quirt et al. 2018). The medical history
involves assessing the patient for symptoms of asthma and checking for symptom patterns, as
in checking to see if the patient has had recurrent episodes of asthma (Quirt et al. 2018).
Some key questions during a medical history exam include:
● Age of onset of symptoms
● Timing of symptoms
● Other comorbidities
(Quirt et al. 2018)
The physical examination involves checking for wheezing by listening for
sounds from the chest area as well as examining the respiratory system. Not all
patients with asthma are symptomatic however, so a physical examination can neither
exclude nor conclude the presence of asthma (Quirt et al. 2018). Examining the skin is
also important as the allergic reactions can lead to rhinitis, dermatitis, and nasal
polyps (Quirt et al. 2018). In the paediatric population, a test known as PRAM
(paediatric respiratory assessment measure) can be applied and has a maximum score
of 12.
The testing measures:
● Suprasternal retraction
● Scalene muscle contraction
● Air entry
● Wheezing
(Quirt et al. 2018)
Objective measurements used in diagnosis of asthma include the use of spirometry, a
device that measures airflow in patients. Airflow is measured through FVC and FEV 1 (Quirt
et al. 2018). FVC (forced vital capacity) measures the maximum volume of air that can be
exhaled, meanwhile, FEV 1 is the forced expiration that can occur in 1 second (Quirt et al.
2018). The ratio of FEV 1 /FVC provides a measure for airflow obstruction. In place of
spirometry, PEF (peak expiratory flow) monitoring can be used but is not recommended for
diagnosing children (Quirt et al. 2018).
A difficulty that arises with diagnosing asthma, is during the case of an anaphylactic
attack (Quirt et al. 2018). The most confused condition with asthma, as it presents a similar
set of symptoms however, for an anaphylactic attack, the patient may also present with
swelling around the face and mouth as well as a rash and/or itching (Quirt et al. 2018).
Treatment
Treating asthma typically involves managing the condition to prevent exacerbation of
the condition. Pharmacological treatments are divided into either controllers or relievers.
Controller medication:
● Inhaled Corticosteroids (ICS)
● Leukotriene receptor antagonists (LTRA)
● Long-acting beta agonists in combination with ICS
● Long-acting muscarinic receptor agonists (LAMAs)
● Anti-IgE
(Quirt et al. 2018)
Controller medication is for regular use and contains anti-inflammatory effects. One
common method is the prevention inhaler. Used on a regular basis and employs a steroid
medicine (NHS., 2021).
Reliever medication:
● Rapid acting inhaled beta-2-agonists
● Inhaled anticholinergics
Reliever medication is used to immediately treat the effects of asthma and decrease
bronchoconstriction (Quirt et al. 2018). One major goal of controller medications is to reduce
the need for reliever medications (Quirt et al. 2018).
Medical therapy is provided along five different stages and depends heavily on the
severity of the asthma. In the first step, a controller is provided in low doses. The second step
involves applying rapid acting beta-2-agonist alongside the low dose controller. The third
step involves applying long-acting beta-2-agonists and potentially rapid acting beta-2-
agonists alongside the low dose controller.
The fourth step is applying long-acting beta-2-agonists and potentially rapid acting beta-2-agonists alongside the medium dose controller.
Finally, the fifth step involves using a high dose of controller alongside long-acting beta 2
agonists and long acting muscarinic antagonist/anti-IgE (Hashmi et al., 2020).
Certain conservative measures may also be taken as well, for example, environmental
control to remove any allergens (Hashmi et al., 2020).
Other conservative measures include:
● Weight reduction
● Allergen immunotherapy
● Monoclonal antibody therapy
● Bronchial thermoplasty
(Hashmi et al., 2020)
COVID-19
In 2020, it had been thought that of patients admitted with COVID-19, the population
consisting of asthma are overrepresented among them (Abrams, Jong & Yang., 2020). In
addition, it was reported that a major risk factor for COVID-19 is asthma itself (Abrams,
Jong & Yang., 2020). However, more recently, studies disprove these statements and say that
asthma is not a risk factor for COVID-19, nor does it contribute to the severity of COVID-19
(Adir, Saliba, Beurnir & Humbert, 2021). However, taking the necessary steps to protect
oneself against COVID-19 is vital and everyone is encouraged to get vaccinated and maintain
social distance.
References
Asthma – Treatment – NHS. (n.d.). Retrieved June 20, 2022, from
https://www.nhs.uk/conditions/asthma/treatment/
Abrams, E. M., Jong, G. W., & Yang, C. L. (2020). Asthma and COVID-19. CMAJ, 192(20),
E551–E551. https://doi.org/10.1503/CMAJ.200617
Adir, Y., Saliba, W., Beurnier, A., & Humbert, M. (2021). Asthma and COVID-19: an
update. European Respiratory Review, 30(162).
https://doi.org/10.1183/16000617.0152-2021
Dahat, A. B. (2021). An overview of asthma and its miasmatic classification. International
Journal of Homoeopathic Sciences, 300(1), 300–303.
https://doi.org/10.33545/26164485.2021.v5.i1e.331
Hashmi, M. F., Tariq, M., & Cataletto, M. E. (2022). Asthma. StatPearls.
https://www.ncbi.nlm.nih.gov/books/NBK430901/
He, Z., Feng, J., Xia, J., Wu, Q., Yang, H., & Ma, Q. (2020). Frequency of Signs and
Symptoms in Persons with Asthma. Respiratory Care, 65(2), 252–264.
https://doi.org/10.4187/RESPCARE.06714
Kuruvilla, M. E., Vanijcharoenkarn, K., Shih, J. A., & Lee, F. E. H. (2019). Epidemiology
and risk factors for asthma. Respiratory Medicine, 149, 16–22.
https://doi.org/10.1016/J.RMED.2019.01.014
Stern, J., Pier, J., & Litonjua, A. A. (2020). Asthma epidemiology and risk factors. Seminars
in Immunopathology 2020 42:1, 42(1), 5–15. https://doi.org/10.1007/S00281-020-
00785-1
Yang, C. L., Simons, E., Foty, R. G., Subbarao, P., To, T., & Dell, S. D. (2017). Misdiagnosis
of asthma in schoolchildren. Paediatric Pulmonology, 52(3), 293–302.
https://doi.org/10.1002/PPUL.23541
