Taking Control of Asthma
Asthma is a disease of airways. Airways are the pipe/tube-like structures through which you breathe. In asthma, airways get swollen and secrete a sticky substance called as mucus. Thus, the airway becomes narrow and you find it difficult to breathe. 1
Asthma is generally hereditary, which means it is passes through families. It does not spread from one person to other. it has nothing to do with how you were raised or your relationships or your social status. Asthma is treatable and you can keep symptoms well under control. This booklet helps you to understand asthma and its management in detail. 1
What happens when you have asthma?
Normal airways are not swollen and the air can pass easily through them.2
In asthma, the airways are swollen and narrowed, so breathing is not easy. Thus, patients develop episodes of coughing, shortness of breath, and wheezing.2
In asthma attack, wind pipes are swollen, narrowed, and full of mucus, which makes airways tight, and air gets trapped in the alveoli. Thus, there is wheeze, cough, and difficulty in breathing.2
Asthma: Causes and Triggering Factors
Exact cause of asthma is not known. It is more common if there is a family member with asthma or allergy. Symptoms of asthma may develop at any age. The difficulty with asthma symptoms varies depending on the age at which asthma develops.3
Most asthma patients have mild symptoms and they do not have long-term effect on the body. If the asthma is there for long-term, it may affect lung function. When asthma is there for long-term, it may bring in emotions such as anger, fear, inferiority, depression and guilt. However, you should know that asthma is not an illness which you should be guilty of of scared of; if you take treatment as suggested, you should be OK.3
Triggering Factors for Asthma
- Allergens: Some substances like pollen from flowers, animal dander, hair of pets like cat and dog, etc. can trigger asthma 4
- Dust: Dust and dust mite are important risk factors 4>
- Paint: Inhaling chemicals present in paints can trigger asthma in some people 5
- Exposure to cigarette smoke: Cigarette smoke is an important trigger to asthma. Cigarette smoke can not only directly increase risk of asthma but can also make a person more prone to viral infections and make airways more sensitive 4
- Occupational factors: Exposure to things like grains, flours, cleaning agents, metals, irritants, woods, etc. at work place may trigger asthma 4
- Overweight and obesity: Incidence of asthma is higher among patients who are overweight 5
- Pesticides: Exposure to pesticides and insecticides is associated with increased risk of asthma5
- Viral infections: Some viral infections which cause common cold can trigger asthma4
- GERD: GERD/gastroesophageal reflux disorder – a disease in which there is possibility of regurgitation of stomach ingredients into wind pipe can trigger asthma5
- Other triggers: Other triggering factors include stress, exercise and air pollution4
Asthma: Symptoms and Feelings1
Symptoms of Asthma
Symptoms of asthma vary from patient-to-patient. In addition, the severity of symptoms may vary from patient-to-patient or depending on the severity of disease pathology. Everyones feeling about his condition or disease are different, they depend on their threshold of addressing challenges. Many patients describe their breathing as “breathing from the straw”.
In asthma attack, you may experience one or more of the following:6
- Your reliever medicine may not help you and you may need to use the medication more often
- Your get a lot of wheezing, the chest is tight and you get a lot of cough
- You are breathless and you may find it difficult to walk or talk
- You breathe faster and you feel as if you are not getting enough air
- Although rare, finger tips may become blue because of non-availability of sufficient oxygen
If you get asthma attack:6
- Situ up straight
- Take your quick relief medication
- Call an ambulance to reach the hospital or arrange a transport to nearby hospital
How do you feel when you have asthma?
You may feel discouraged when you are diagnosed with asthma. With asthma, you may have difficulty doing your regular work, exercise and it can hamper your sleep because of symptoms.8 Don’t be discouraged, asthma can be kept under control with proper medication and you can have normal life and perform you daily activities without much problem.7
Asthma is not an old age disease or a childhood disease or a smokers disease or wrath of God, it is just a condition where immune system of your body over reacts to a trigger. It is important not get guilty or stigmatised by asthma.9
It is important that you educate yourself about the condition and take medicine without having any social stigma. After all, asthma is a condition that can be managed well with regular and effective medications.9
Correct Medication Use in Asthma
You are lucky, effective medicines are available
Luckily, with medical advancements, we doctors know much more about asthma and its management now than ever before. Although asthma can’t be completely cured, with better drugs available today, it surely can be kept under control for life-long and with control you can lead life like non-asthmatic people. With good asthma control, like non-asthmatic people, you can:6
- Have freedom from symptoms both during day and night
- Have best possible lung function
- Can you do any physical activity of your choosing
- Can attend school or work more or less every day
- Have fewer asthma attacks
- Have no or minimal medicine related side-effects
To keep your asthma under control, you have to follow some rules. Here are a few of them:
- Discuss with your doctor about asthma and how to keep it under control. Educate yourself about the conditions.
- Make a plan for your asthma control in discussion with your doctor.
- Visit your doctor regularly as suggested by him.
- Learn which medicine to take, how to take, when to take and the correct method of taking medication.
- In case if you are using a quick-relief inhaler, ask your doctor if you can add a spacer, as it will make use of drug easy.
- Take all medicines as prescribed by your doctor.
- Identify the things that bring asthma symptoms in you and avoid them or at least reduce exposure to them.
- Keep a watch on changes in asthma. Learn to identify symptoms of asthma attack, so that you can quickly take required steps.
It is important that you properly use inhaler to ensure that the drug reaches the lugs. Following is the right inhaler technique.
Metered dose inhaler (MDI)
Dry Powder inhaler (MDI)
Inhaler with Spacer
- Open the inhaler
- Shake the inhaler well
- Connect the spacer keeping the cap towards you
- Breath out completely
- Put the tip of the spacer inside your mouth, press down the inhaler and breath in
- Hold the breath for 10 sec
- Breath out
- Remove the spacer and cap the inhaler
Using Steroid Inhaler
- Open the inhaler
- Shake the inhaler well
- Breath out completely
- Breath in deeply through the inhaler
- Hold the breath for 10 sec
- Breath out
- Cap the inhaler
- Wash your mouth
Management of Asthma
Lifestyle changes are very useful in keeping asthma under control. Here are some do’s and don’ts with regards to lifestyle in asthma.
Here are some dietary changes that are helpful in asthma management:
Have food rich in vitamin A and Vitamin D. Vitamin A and D make lung tissue stronger and thus helps to fight inflammation and allergy, which are characteristic of asthma. The foods rich in vitamin A include carrots, lettuce, sweet potatoes, fish, milk products, egg, etc. Fish and milk are rich in vitamin D. Vitamin D is also produced by our body on exposure to sunlight.15,16
Have diet rich in Vitamin E. Vitamin E is an antioxidant which helps to fight inflammation.17 It is abundant in food like seeds, nuts and vegetables.18
Have polyunsaturated (very) long-chain fatty acids such as omega-3 PUFAs linolenic acid, eicosapentaenic acid (EPA) and docohexaenoic acid (DHA), and the omega-6 PUFAs are found to have beneficial effects in asthma.17 These are mainly found in sea food.19
Avoid saturated fatty acids such as meat, cheese, ice cream and dairy fat. They can trigger asthma and inflammation.15
Avoid food with medium-chain fatty acids such as coconut oil, palm oil, etc. they are found to trigger asthma.16
Exercise in Asthma
Breathing exercises, especially those which involve holding breath are very helpful in asthma. Breathing exercises are done to decrease rate and volume of breathing, to increase use of lower abdominal muscles, to improve chest movements, to use nose for breathing and to induce relaxation. Breathing exercise benefits you by decreasing over-breathing, decreasing breathlessness, decreasing inflammation, decreasing changes in pattern of breathing and decreasing anxiety.20 Commonly used breath retaining exercises are as follows:
- Pursed-lip breathing21
- Diaphragmatic breathing21
- Inspiratory muscle training (IMT)17
Pursed Lip Breathing: Sit upright, breathe in through nose and slowly breathe out by making pursed lip (like how you make your lips to blow a candle). Duration of breathing out should be at least twice as breathing in. The technique helps you to decrease number of breaths taken in and keeps the airways open for longer duration.22
Diaphragmatic breathing: Lie-down on your back; keep your body relaxed; gently place your hands on your belly; breathe in slowly and breathe out slowly; breathe using your belly instead of chest; observe raise and fall of belly as you breathe in and breathe out. Remember you should only use your belly to breath; so, keep your shoulders, chest and neck relaxed while doing this exercise.22
Inspiratory muscle training (IMT): Inspiratory muscle training is aimed at increasing the strength and stamina of accessory respiratory muscles and diaphragm. It usually involves breathing through a device. IMT helps to decrease oxygen consumption and to increase strength of respiratory muscles. Please consult a therapist to learn this exercise.17
Yoga for Asthma
Yoga is useful in various ways to improve asthma. Here are 8 yoga poses that are helpful in asthma management.23
Peak Flow Meter
Peak expiratory flow (PEF) is the measure of how forcefully you can blow from your lungs. PEF helps to evaluates the extent of the airway obstruction. Peak flow meter is measured using simple instrument useful in measuring the functioning of your lung. The device has a mouth piece, a cursor and a measuring scale. PEF is useful in asthma diagnosis, to evaluate improvement, to evaluate how asthma medicines are working and to adjust the medication by your doctor. PEF is useful for the following purposes.24
- For day-to-day recording of asthma severity
- To evaluate progress of asthma
- During an asthma attack
- After taking asthma drug
To measure Peak Expiratory Flow Rate (PEFR), you have to do the following steps:24
Step 1: Set the cursor to 0
Step 2: Stand up and take a deep inhalation. Close your lips tightly around the mouth piece to ensure there is no leak.
Step 3: Breathe out as hard and forcefully as you can.
Step 3: Notice and record the reading (indicated by cursor) on the measuring scale.
Step 4: Repeat step 1 to 3 for 2 more times to take best of the 3 readings.
You have to maintain the values in a book or paper. Your doctor will interpret and tell you the findings of PEF.
Maintaining an asthma diary helps you to keep track of your asthma control and medicines that you are taking. You can download an asthma diary from internet, take printout and maintain it.25
Myths and Facts about Asthma
Unfortunately in our country, many consider asthma as a taboo and the patients get stigmatised and guilty about the condition. There are several myths about asthma, which you should not believe. Here are some myths and facts.
Asthma is a condition which can be well controlled with medication and you can lead a normal life like any other person. However, you have to take medicines as suggested by doctor, visit the doctor regularly, do yoga, do exercise, follow healthy lifestyle, follow healthy diet and keep a watch on your asthma and its symptoms. If you do all these, there is very high possibility that you would lead a normal, active and productive life as anyone else.
- Controlling asthma. Patient education guide. American College of Chest Physicians. Available at http:// www.med.umich.edu/1info/FHP/practiceguides/asthma/chestpt.pdf.
- Lynn SJ, Kushto-Reese K. Understanding asthma pathophysiology, diagnosis, and management. American Nurse Today. 2015;49–51. Available at https://www.americannursetoday.com/wp-content/uploads/2015/07/ant7-Asthma-622.pdf.
- Undestanding Asthma. National Jewish Health. Available at https://www.nationaljewish.org/NJH/media/pdf/UnderstandingAsthma-12-2017.pdf?ext=.pdf.
- Asthma Attacks. Asthma UK. Available at https://www.asthma.org.uk/advice/asthma-attacks/.
- Dougherty RH, Fahy JV. Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype. Clin Exp Allergy. 2009 Feb;39(2):193–202.
- What to expect if you have asthma. Asthma Canada. Available at https://asthma.ca/get-help/asthma-3/aboutasthma/expect/.
- Clinical practice guideline. Management of asthma in adults. Joint guidelines of Ministry of Health Malaysia, Malaysian Thoracic Society and Academy of Medicine Malaysia. Available at https://goo.gl/SzmkPN
- So you have asthma. A guide to patient and family. NHS. Available at https://www.nhlbi.nih.gov/files/docs/public/lung/ SoYouHaveAsthma_PRINT-reduced-filesize.pdf.
- Asthma study finds children being stigmatised in India. The University of Sidney. Available at http://sydney.edu.au/news/ 84.html?newsstoryid=11550&utm_source=feedly.
- Thoren CT, Petermann F. Reviewing asthma and anxiety. Respiratory Medicine. 2000;94:409–415.
- Cabana MD, Slish KK, Lewis TC, et al. Parental management of asthma triggers within a child’s environment. J Allergy Clin Immunol. 2004;114:352–357.
- Young C. Avoiding Asthma Triggers: A Primer for Patients. JAOA. 2011;101(suppl. 7):s30–s32.
- García Martínez J. [Importance of environmental and preventive measures in the control of asthma in the child]. [Article in Spanish]. Allergol Immunopathol (Madr). 2000;28(3):158–162.
- Cipriani F, Calamelli E, Ricci G, et al. Allergen Avoidance in Allergic Asthma. Front Pediatr. 2017; 5: 103. doi: 10.3389/ fped.2017.00103
- Julia V, Macia L, Dombrowicz D. The impact of diet on asthma and allergic diseases. Nat Rev Immunol. 2015 May;15(5): 308–322.
- National Institute of Health. Vitamin D Fact sheet for health professionals. Available at https://ods.od.nih.gov/factsheets/ VitaminD-HealthProfessional/
- Shei RJ, Paris HL, Wilhite DP, et al. The role of inspiratory muscle training in the management of asthma and exerciseinduced bronchoconstriction. Phys Sportsmed. 2016 Nov;44(4):327-334.
- Mène-Saffrané L. Vitamin E Biosynthesis and Its Regulation in Plants. Antioxidants (Basel). 2017 Dec 25;7(1). pii: E2. doi: 10.3390/antiox7010002.
- Garg ML, Wood LG, Singh H, et al. Means of delivering recommended levels of long-chain n-3 polyunsaturated fatty acids in human diet. Journal of Food Science. 2006;71:R66–RR71.
- Thomas M, Bruton A. Breathing exercises for asthma. Breathe. 2014;10:312–322.
- Laurino RA, Barnabé V, Saraiva-Romanholo BM, et al. Respiratory rehabilitation: a physiotherapy approach to the control of asthma symptoms and anxiety. Clinics (Sao Paulo). 2012 Nov;67(11):1291-7.
- American Lung Association. Breathing exercises to protect lung. Available at http://www.lung.org/lung-health-and-diseases/ protecting-your-lungs/breathing-exercises.html
- 10 effective yoga poses. https://www.artofliving.org/in-en/yoga/health-and-wellness/overpowering-asthma-with-yoga
- Adeniyi BO, Erhabor GE. The peak flow meter and its use in clinical practice. African Journal of Respiratory Medicine. 2011;5–8.
- Asthma diary. http://asthma.chestnet.org/wp-content/uploads/sites/21/2016/08/Asthma-Diary.pdf
- Sodhi R, Prasad R, Kushwaha RAS, et al. A study to know the knowledge, attitude, and practices of patients of bronchial asthma. International Journal of Medicine and Public Health. 2013;3(3):159–162.
- Ranaut V, Kaur S, Kaur S, et al. Compliance and myths regarding use of Metered Dose Inhaler amongst caregivers of children suffering with asthma. Nursing and Midwifery Research Journal. 2014;10(1):1–7.
- Prasad AR, Gupta R, Verma SK. A Study on Perception of Patients about Bronchial. Indian J Allergy Asthma Immunol 2003;17(2):85-87.
- Busting common asthma myths. https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/Busting-commonasthma-myths/articleshow/47203515.cms
- The asthma milk myth – busted! https://www.nationalasthma.org.au/news/2016/asthma-milk-myth