Asthma: Recognising the triggers

By Carolyn Kavita Tauro, CNS
May 7, 2013

Globally, asthma is one of the major causes of morbidity and mortality. Cases have increased in the past 20 years especially in children. Asthma is one of the most common chronic diseases with over 200 million suffering from it worldwide. If urgent action isn't taken, the deaths due to asthma will increase in the coming decade. Although asthma cannot be cured, good control and management lies in early and proper diagnosis, treatment and patient education.

For those of us who are unfamiliar with the disease, Asthma causes wheezing, breathlessness, coughing and chest tightness. It is a chronic disorder caused by inflammation of the airways. These airways are respond in an exaggerated manner and hyper responsive, and obstruct airflow, when they are exposed to risk factors.

What are these trigger factors?
Trigger factors are several and not specific to the condition, in other words, a patient with asthma may not be affected by all of the factors. A patient with asthma may have unique triggers too. The risk factors include allergens such as pollens and moulds, house dust mites, animal fur and even cockroaches. Asthma patients who also smoke tobacco have worse asthma "attacks" than nonsmokers. The airways are less sensitive to corticosteroid (which is sometimes the best medicine to control the attack) and quitting smoking has shown to improve lung function along with overall symptoms. Studies show a modest positive relation between traffic pollution and non-allergic asthma in children of up to the age of 12 years. Although still under study, it may be good to be mindful of the outdoor as well as the indoor air pollution around us in the form of fumes from vehicles, factories, and smoke from cooking fuels in rural kitchens. One study conducted in Spain also showed adolescent boys affected thrice as much with severe or exercise-induced asthma if they lived in streets with heavy goods vehicles constantly passing than those who did not.

EXERCISE IS HEALTHY PROVIDED WE MANAGE ASTHMA WELL
"Exercising is not a trigger for asthma for everybody. I think it does not trigger asthma with all asthmatics and generally we recommend children to do exercise because you can have other health issues if you do not do any exercise. It can bring out poor health in other ways. It is important that people must do some exercise. What is important is that when people with asthma exercise they should have 'releaser' and 'inhaler' with them. While exercising if you have symptoms you can take a pause and wait for 5 minutes and then go again. So, if people’s asthma is properly controlled then they can exercise just like the way normal people do. So, you should be able to do your daily activities including exercise", says Dr Karen Bissell, Deputy Coordinator, Asthma Drug Facility (ADF), International Union Against Tuberculosis and Lung Disease (The Union) to Citizen News Service – CNS.

Other triggers include occupational irritants such as adhesives, metals and latex, respiratory (viral) infections, emotional stress, chemical irritants, foods such as dairy products, eggs, peanuts, and drugs such as aspirin. These factors and ways to look out for them are seldom explained to parents in detail. Mrs Laveena D'souza, the mother of a child with asthma in Mumbai, recalls the ordeal she faced in the initial years of her son's struggle with asthma. She says to CNS, "I always thought my baby will only get affected by things that could be inhaled, like dust. No one told me that fruits like pineapples could trigger asthma in my child, or that he could get attacks if he had a birthday cake with food colour in it. I learnt that from watching my child go through the attack, before I started reading labels on every food item I bought".

How is asthma managed?
Asthma is treated in a stepwise approach to control the attack and prevent further attacks. Attacks are episodic although the airway inflammation is chronic in nature. According to the Pocket Guide for Asthma Management and Prevention (for adults and children over 5 years of age), published by the Global Initiative for Asthma (GINA) in 2011, there are broadly two kinds of medicines used in asthma: Controller medicines which need to be used daily to prevent symptoms and improve lung function and prevent attacks and Reliever medicines which need to be taken to treat acute symptoms such as wheezing, chest tightness and coughing.

"Inhalers," Mrs D'souza says, "are scary tools for a mother to use on her child. We are familiar with tablets and tonics, but an inhaler is something else. It is not easy to place that on your child's mouth while he is gasping for air". According to Christophe Perrin, Pharmacist and Coordinator, Asthma Drug Facility (ADF), International Union Against Tuberculosis and Lung Disease (The Union), "The inhalers have the ingredient which when taken by the patient are in form of little drops, that reach the lungs. The turbohalers contain a powder and the size of the powder particles plays a very significant role in turbohalers. So, it is a complex technology that matters in the asthma medicines. We need to master the manufacturing of these devices and then scale up."

In the pocket guide by GINA, special considerations for the control for asthma have been mentioned. These include Pregnancy when the mother-to-be is treated with the same medicines but with more care, as maternal asthma has shown to increase the chances of spontaneous abortion. In Occupational asthma, exposure to the relevant trigger must stop since drug therapy is no substitute to this. Many people take drugs from over the counter (OTC) and some of the more common OTC drugs are Aspirin and other Non steroidal anti-inflammatory drugs (NSAIDs). Up to 28 percent of adults with asthma suffer from asthma exacerbations in response to these drugs. An aspirin challenge is required to confirm this diagnosis, which must be conducted in a facility with cardiopulmonary resuscitation capabilities. It is but obvious to say that these drugs must be completely avoided. Weight loss also reduces asthma symptoms.

Asthma leads to absent days at school, college and at work, due to the breathing difficulties it causes. Some children cannot enjoy playing or swimming to the fullest due to the same, especially if they do not have their inhalers with them at that time to relieve them from the symptoms. However, Olympic athletes and sportsmen like David Beckham, famous leaders, celebrities and musicians like Kenny G, and ordinary people, all live successful lives with asthma. How do they do it? The trick lies in knowing your trigger factors, avoiding them, and being prepared with the medicines that could help you prevent future asthma attacks and control an attack before it gets exacerbated.

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Posted on: May 07, 2013 08:50 PM IST