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Allergic asthma
Asthma is a disease characterised by intermittent narrowing of the airways (bronchi) which makes breathing difficult. Asthmatic bronchi have two specific features:
- a general over-sensitivity (bronchial hyperreactivity); probably genetic in origin, that makes them prone to narrowing.
- an inflammation usually caused by airborne allergens. Usually allergic inflammation worsens the bronchial hyperreactivity making the bronchi even more sensitive to narrowing.
Constriction of the bronchi (that causes asthma attacks) can be provoked by a large variety of factors.
Specific factors
True allergic asthma results from bronchial hyperreactivity plus allergic hypersensitivity. Allergens are the specific triggers of allergic asthma attacks, the most common being inhaled allergens such as house dust mites, animal allergens, moulds and pollens. Chemical substances which cause allergy at the work place can also be a cause of allergic asthma. However, asthma attacks can also occur in people allergic to foods, insect venoms or drugs (in these cases, allergens do not reach the bronchi from the outside but through the blood that irrigates them).
Non-specific factors
Non-specific factors irritate the bronchi, causing their narrowing in people with hyperreactivity thus provoking an asthma attack. They are not allergens and they trigger bronchi narrowing via a different mechanism than the allergens do. The commonest non-specific irritants include cigarette smoke, car exhaust gases, industrial fumes, strong perfumes, and cold air. In addition, exercise, strong emotions and stress are also frequent triggers of asthma attacks.
Symptoms of asthma
When an attack happens, the asthmatic bronchi become obstructed due to:
SPASM:Involuntary contraction of the smooth muscles lining the bronchi
OEDEMA: Swelling of the bronchi caused by accumulation of liquid in the bronchial mucous membrane
EXCESSIVE MUCUS PRODUCTION: Accumulation of a thick, viscous phlegm in the bronchi
INFLAMMATION: Cells from the immune system accumulate in the airway lining, and pass into the sputum. They contribute to the stickiness of the sputum.
These factors narrow the bronchi, making it difficult for the air to pass through.
The symptoms experienced during an asthma attack reflect the changes in the bronchi.
The most important symptom is a difficult, hampered breathing, especially when breathing out, called dyspnoea. You may feel that you can’t empty your lungs properly when breathing out which seems to leave very little space for your next breath.
The air passing through the narrowed bronchi makes a wheezing sound which very often is heard with every breath.
Cough is another symptom of asthma. It is the attempt your bronchi make to get rid of the phlegm excess. However, asthma cough is usually dry because the mucus is very thick and adherent to the bronchi walls. Cough is generally associated with dyspnoea and wheezing but in some people or in some situations it can be the only sign of asthma.
Practical advice for asthma sufferers
- Identify and avoid allergens and non-specific triggers that make your asthma worse
- Make sure that you know which drug is for daily use and which for treating asthma attacks
- Work out an asthma management plan with your doctor and stick to it
- Most asthma drugs are inhaled. Are you familiar with their use? Administering them in the wrong way is as bad as not taking them. Without a spacer device, only 10% of an inhalation reaches the bronchi, this can be doubled or tripled by adding a spacer.
- Don’t avoid taking part in sports! Rather than being discouraged, sport can actually help your disease get better
- Sport helps in keeping the lungs healthy which has positive and beneficial effects on asthma (particularly in asthmatic children). Deep breathing reduces the spasm of the bronchi making them more elastic
- Breathing through your nose filters, warms and humidifies air before it reaches your lungs - if you have rhinitis make sure it is effectively treated.
All asthmatics have bronchial hyperreactivity but not all asthmatics are allergic.
Bronchial hyperreactivity also occurs in rhinitis patients who do not have asthma.
Non-specific factors can trigger asthma attacks in all people with asthma, however, allergens can only trigger attacks in those with allergic asthma.
Common colds are never simple in asthma
Viruses, i.e. those that cause common colds and flu, are one of the most frequent non-specific triggers of asthma attacks at all ages. It is not that you are allergic to them; they cause an inflammation of your respiratory organs which adds to the underlying allergic inflammation exacerbating the situation.
Virally triggered attacks are severe and usually need higher doses of drugs than normal to control.
Did you get it right?
The doctor will probably have given you two types of drugs: some used just to relieve the attacks and some that prevent the attacks if used all the time. The two drugs are completely different. If you use them in the wrong situation you will get no effect from them.
Swim, run or play ball, but don’t forget 5 simple rules:
Rule 1: Always consult your doctor before deciding to practise any sport.
Rule 2: Which sport? Remember that you have to stay away from allergens. So don’t exercise in a place where allergens are abundant.
Swimming in an indoor pool is an ideal choice for all allergic asthmatics, because there are no allergens and the warm, moist air is perfect for the bronchi. Moreover, swimming tones up the whole body and helps develop better breathing. But be careful, some swimming pools contain too much chlorine which could act as an irritant.
Rule 3: Help your bronchi to stay open! Take a dose of your bronchodilator drug before exercising (ask your doctor about the best timing and the best way to do it).
Rule 4: “Warm up” your bronchi: always start with a gentle effort and increase it progressively.
Rule 5: Pay attention to your warning signs! Stop immediately when you feel that an attack might occur and take another dose of your bronchodilator drug (or follow the attack management plan that your doctor has given to you).