ASTHMA

This post is only for education purposes , always contact a registered physician or professional for any medical advice. Asthma is a common lung disease that sometimes makes it hard to breathe. This occurs as the breathing airways of the lungs become inflamed, increase mucus production, whilst the muscles in the airway tighten. People with asthma wheeze, have trouble breathing, feel tightness in the chest, and cough at night or early mornings. Asthma impacts 25 million people in the U.S. currently. This total includes more than 5 million children. Asthma can be life-threatening if you don’t get treatment. If you have asthma, you always suffer from the condition especially in exacerbations named; asthma attacks. These asthma attacks, usually happen whenever something irritates your respiratory system.

Local prevalence

Just about 1 in 10 Maltese over 16 suffer from or have suffered from asthma as stated by 2014 European Health Interview Survey (EHIS) data was used. In the southern harbour region (Marsa, Cospicua, Valletta, Zabbar, and Paola), 11.8% of inhabitants have asthma. As of 2019, there were at least 26,429 diagnosed chronic asthma patients in Malta according to research published by the ministry of health. Whilst it is estimated around 40,000 people are asthmatics in Malta.

Causes

Researchers don't know everything that might induce asthma, but we do know that genetic, environmental, and occupational factors have been strongly associated to it.

Having asthma is more likely if someone in your family members has it. There exists an inherited tendency to get an allergic disease, might be a big reason why some can get allergic asthma. Although not every case of asthma is induced by allergies.

Asthma has been associated to being exposed to mould or high humidity in the environment, allergens like dust mites, and second-hand cigarette smoke. Asthma can also be caused by breathing in dirty air or getting a viral infection in the respiratory system.

When someone who doesn't have asthma before gets it because of something they are exposed to at work, this is termed occupational asthma. This can happen if you are allergic to something at work, like mould, or if you are exposed to irritants like wood dust or use chemicals at work over and over at low levels or all at once at elevated levels.

Asthma happens to people of all ages. It usually starts in childhood, but it can also start in adult humans. Simple treatments can help keep the symptoms in check so that it doesn't stop you from enjoying your life.

Diagnosis

It can be hard to figure out if someone has asthma, especially if they are younger than 5 years old. Regular check-ups that include tests for allergies and lung function, can be good for your healthcare provider to come to the right diagnosis.

During a check-up, the doctor or nurse will ask you about how often you cough, especially at night, and if your breathing problems get worse when you exercise or at a certain time of the year. Doctors will also ask about other signs and symptoms, such as chest pain, wheezing, and colds that last more than 10 days. They'll ask you about home environment or if you're exposing, you’re self to poor air quality such as pollution, second hand smoke, pollen, dampness, mould or other allergens.

They will ask if any of their family members have or have had asthma, allergies, or other breathing problems. The doctor or nurse will also ask why you missed school or work, and any trouble you might be having with certain things.

A lung function test, called spirometry, is another way to figure out if someone has asthma. A spirometer (spy-rom-e-ter) measures how much air you can breathe out at once after taking in a very deep breath. The spirometer can measure airflow before and after you use a medicines for asthma.

Treatments

Asthma treatments that can help keep the condition under control exists, so that you can lead a healthy, active and normal life.

The mainstay of treatment is inhalers, which are tools that let you inhale in medicine. Sometimes you may also need pills and other treatments, if your physician/doctor believes that they may help you, especially of your condition is bad.

Thus it is important, to contact your doctor or nurse to help you make a personal action plan. As there are various treatment therapies such as the following.

Treatment therapies

Always follow your doctor’s and pharmacist's advice and read the instruction leaflet that comes with the medicine. Generally, inhalers are prescribed to see how to use them check out our; (inhaler blogpost).

The following are the main forms of asthma management:

• Relievers: short acting bronchodilators/anticholinergics

• Controllers: inhaled steroids & long acting bronchodilators.

• Combinations: inhaled steroid and a long-acting reliever together in one inhaler

• Leukotriene receptor antagonists (LTRA)

• Oral Steroids

Relievers

Relievers work by relaxing the muscles around the airway making them less tight allowing them to open up, relieving the work done for breathing.

These are generally Short-acting (act quickly and for a short time) providing immediate relive .Short-acting relievers (bronchodilators) are also referred to as the ‘blue inhaler’ and should be taken when you have asthma symptoms/attack.

-Short-acting relievers (bronchodilators) are also referred to as the ‘blue inhaler’ and should be taken when you have asthma symptoms/attack.

-If the short-acting reliever inhaler is needed to relief symptoms more frequently usually more than 2 times per week, consult with your doctor. These are known as Short acting beta antagonist and another class called , anti-cholinergic inhalers which works by relaxing the muscles along the airway .

Examples of short-acting relievers are Bricanyl®, Salamol® Ventolin® and Atrovent®.

Controllers

Preventers/controllers (inhaled steroids) work for a longer time frame than relievers and are aimed to decrease any negative side effects. -Some steroid inhalers are commonly referred to as the ‘brown inhaler’. They reduce inflammation and swelling along the lining of the airways. They do not provide immediate relief from symptoms however; they play a very important role in preventing symptoms.

Examples : Beclazone® and Beclamethasone® Side effects: change of taste or voice. -Other types of controllers include long acting beta-antagonists, these work by relaxing the muscles of the airway for a longer period , decreasing the frequency of airway spasms.

Examples : Salmeterol®

Side effects: tremor, rapid heartbeat and headache. (Generally side effects won’t last too long)

Combinations

These inhalers contain both an inhaled preventer(reducing inflammation) and a long acting reliever (open airways for 12 hours). Combined medications are taken regularly and ensure a simple and effective treatment regime.

Examples are Seretide® and Symbicort®.

Side effects: throat irritation ,and changes in your voice.

Leukotriene receptor antagonists

These are medications that reduce inflammation and spasm in the airways. They are available in tablet form, which can be chewable, or in granules for smaller children.

Examples include Montelukast®.

Side effects: headache, gastrointestinal disorders, pharyngitis, fatigue, upper respiratory tract infection, skin rash

Oral steroids

Sometimes asthma becomes worse patients may be prescribed a course of steroid tablets. Short courses of oral steroids rarely cause problems. They are very effective at bringing asthma under control and can prevent hospitalization.

Examples include Prednisolone®.

Side effects: Fluid retention, High blood pressure, Problems with mood swings, memory, behaviour, and other psychological effects, Upset stomach(thus ideally taken with food),Weight gain.

Preventing Asthma attacks

As stated before asthma attacks are acute exacerbations of asthma where the airway tightness as a response to some irritant/allergen, such as ;

Smoking pollutants Smoking and combustion engines are known to create toxic fumes ,harm the lungs and irritate sensitive lungs of patients whom suffer from asthma. If you smoke it would be best to stop smoking. If you're family members ,friends or work members smoke, kindly ask them not to smoke next to you or in an environment you stay in, as second hand and even third hand smoking may cause an asthma attack. If you live near a busy road try to keep the inside environment closed from the outside air pollutants especially during heavy traffic(check out environment blog).

Dust mites

Dust mites may be a cause to trigger asthmatic attacks, to prevent such mites its best to keep dust levels low by cleaning regularly, changing pillow and bed covers frequently and avoiding having a lot of stuffed animals in ones bedroom.

Mold

A prevalent problem in Malta due to it's high humidity in the air .It is suggested to aim to keep humidity levels between 35-50%,to decrease mould from forming. Use dehumidifier and air-conditioning to decrease such humidity in more frequented rooms such as bedrooms. Check for mould regularly and paint with anti-moulding paint if needed.

Pets

Some pets especially those with a thick fur coat may pose a risk to people with asthma . Whilst it suggested to avoid such pets if you suffer from asthma , keeping its fur shaved and the pet clean may help to decrease side effects.

Cockroach allergen

Some cockroach allergens may trigger asthma attacks, always check out for such critters and ensure you don't leave food scraps around by cleaning regularly. If you note an infestation contact pest control or apply cockroach traps.

Stress This feeling of being under pressure or under threat from the outside world generally tends to create “stress”. Whilst some form of stress is important to ignite our passions and drive us to act during a day, the excess of it may be detrimental to one’s heal. Certain breathwork techniques and exercise can also help mitigate overthinking and stress. For more information on a few techniques how to manage stress contact a psychologist and check out our tips here. Exercise Exercise-induced asthma is when the airways in the lungs get narrower because of working hard. It makes you short of breath, wheeze, cough, and have other symptoms when you exercise or after. This is called exercise-induced bronchoconstriction, that is the preferred term. The above term is more accurate since exercise does start causing bronchoconstriction, which is a narrowing of the airways. For people with asthma, exercise is probably just one of many things that can make it hard to breathe. Most people with exercise-induced bronchoconstriction can continue to exercise and stay active as long as they take asthma medications to treat the symptoms and take precautions to avoid such symptoms

Monitoring your asthma

Asthma like any other condition would require one to monitoring. Since asthma is a respiratory condition being mindful of one's breathing is essential to maintain good respiratory health. This can be done through various methods by being aware of the breath and also using monitoring apparatus such as a Peak Flow Meter (PFM). This inexpensive monitoring device is an essential tool to monitor your asthma.

Peak flow measures lung airflow quickly. Peak expiratory flow rate (PEFR) is measured. Peak flow shows how much and how quickly air can be exhaled forcibly. After inhaling fully, and exhaling forcibly begin measuring. Repeat the step 3 times and see to take the highest scoring.

The test involves blowing hard into a mouthpiece. PFMs are commonly used. Plastic portable gadget. A PFM is tiny and lightweight enough to use anyplace. Always utilize the same PFM. Different meters have different readings. It is best that the meter is used in a doctor's office or hospital with a spirometer is preferable. Peak flow zones are significant in measuring peak flow. Peak flow meter zones measure flow. Peak flow zones suggest early asthma worsening symptoms. Individual peak flow zones vary. Your doctor will define peak flow zones. Green indicates 80-100% peak flow, yellow 50-80%, and red less than 50%. Asthma is also monitored with the frequency of your symptoms. The frequency of your asthma attacks, the need for use of relievers and more should be an indicator to see if your asthma is under control. You can use this website to check your asthma. Preventing exacerbations

Controlling the environment, you live in can be done in various steps. Wearing a N95 mask can help prevent pollutants such a PM2.5 from car pollution and pollen from entering the respiratory system and triggering an asthma attack. There are also various methods to clean the air through air purifiers . For more information kindly look at this page. Creating an Action Plan Now that you know how to manage your asthma it is best for you to discuss some of these points with your physician and other professionals to create an action plan that is suited for you. This action plan will help you to be mindful of your lung’s health and what/ when certain triggers are and how you can control them. Together with your doctor you may create a action plan to note when you are at your best and healthiest which means you are having the least symptoms (coughing, wheezing, trouble sleeping). You may also include your peak flow rate readings and also your spirometer test with your action plan to so as you become more aware of your asthma condition. The American Nation Hearth Blood and Lung institute created an free online downloadable action plan, which you can download from here for. Try to show this your physician and if they suggest it fill it together to become more aware of your asthmatic condition. Also remember to take your asthma medications and avoid health triggers. Citations 1-Scullion, J., & Robinson, T. (2009). Oxford Handbook of Respiratory Nursing. Oxford university press. 2-England, K., Calleja, N., & Gauci, D. (2014). European Health Interview Survey (EHIS) 2014/2015 Summary Statistics. deputyprimeminister.gov.mt. https://deputyprimeminister.gov.mt/en/dhir/Documents/European%20Health%20Interview%20Survey%202014-15%20Summary%20Report%20for%20Malta.pdf 3-(2020). Your asthma action plan. asthma. https://www.asthma.org.uk/advice/manage-your-asthma/action-plan/

4-Ring, N., Sheikh, A., Pinnock, H., Hiskons, G., Dixon, D., MacGillivray, S., Wyke, S., & Malcolm, C. (2007). Promoting the use of Personal Asthma Action Plans: a systematic review. Primary Care Respiratory Journal. https://doi.org/pcrj200749 5- Kassinos, S., Backman, P., Hickey, A. J., & Conway, J. (2021). Inhaled Medicines. Academic Press.