Asthma

Overview

Asthma is a chronic inflammatory disease of the airways characterized by variable,
reversible airflow obstruction and bronchial hyperresponsiveness resulting in recurrent
episodes of wheezing, shortness of breath, chest tightness and cough.

Causes

Asthma is a multifactorial condition influenced by genetic predisposition and environmental
exposures that lead to chronic airway inflammation and hyperresponsiveness.

• Genetic factors affecting immune response and airway sensitivity
• Airway inflammation triggered by immune system overreaction
• Environmental exposures that initiate or worsen airway irritation

Risk Factors

Genetic & Personal History

Family history of asthma or allergies, personal history of allergic conditions
(eczema, allergic rhinitis).

Early Life Factors

• Viral respiratory infections in childhood
• Premature birth or low birth weight
• Exposure to smoke during pregnancy or early childhood

Lifestyle & Other Factors

• Obesity
• Cold air or weather changes
• Exercise-induced triggers
• Stress and strong emotional responses

Asthma develops due to a combination of genetic susceptibility and environmental triggers,
and identifying risk factors is essential for prevention and long-term control.

Symptoms

Common Symptoms

• Wheezing (a whistling sound while breathing, especially during exhalation)
• Shortness of breath (dyspnea) often worse with exertion
• Chest tightness or pressure
• Persistent cough particularly at night or early morning

Typical Symptom Pattern

• Symptoms may come and go
• Often worsen at night or early morning
• Triggered by allergens, exercise, cold air, or infections
• May improve spontaneously or with inhaler use

Signs of Worsening Asthma

• Increasing difficulty in breathing
• Frequent use of rescue inhaler
• Reduced ability to perform daily activities
• Disturbed sleep due to breathing problems

Asthma Emergency Symptoms

• Severe breathlessness at rest
• Difficulty speaking full sentences
• Bluish lips or fingernails (cyanosis)
• Rapid worsening of symptoms despite medication

Diagnosis

Asthma is diagnosed through a combination of clinical evaluation and objective lung function
testing, focusing on identifying variable and reversible airway obstruction.

1. Clinical Assessment

• Detailed history of recurrent wheezing, cough, chest tightness and shortness of breath
• Symptoms that vary over time and are often worse at night or early morning
• Identification of triggers such as allergens, exercise, or infections
• Personal or family history of allergies or asthma

2. Lung Function Testing (Key Diagnostic Tool)

• Spirometry (Gold standard test)
  • Demonstrates airflow limitation and reversibility
  • Improvement in lung function after bronchodilator supports diagnosis
• Peak Expiratory Flow (PEF) monitoring
  • Shows variability in airflow over time

3. Bronchodilator Reversibility Test

Spirometry is performed before and after an inhaled bronchodilator. Significant improvement
in airflow confirms reversible airway obstruction.

4. Additional Investigations (if needed)

• Allergy testing (skin prick or blood tests)
• Chest X-ray to exclude other conditions

Diagnosis is based on typical symptoms plus evidence of variable and reversible airflow
limitation, rather than a single test alone.

Treatment

Asthma can be effectively controlled with a combination of medications, trigger avoidance
and long-term management strategies.

1. Quick-Relief (Rescue) Treatment

Used for immediate relief of acute symptoms. This includes short-acting beta2-agonists
(SABA) such as salbutamol/albuterol.

• Rapidly relaxes airway muscles and relieves wheezing and breathlessness
• Used as needed during asthma attacks

2. Long-Term Control (Preventive) Treatment

Daily medications to reduce airway inflammation and prevent symptoms, including:

• Inhaled corticosteroids (ICS) — first-line therapy
• Long-acting beta2-agonists (LABA) — always used with ICS
• Leukotriene receptor antagonists (e.g., montelukast)
• Biologic therapies for severe or uncontrolled asthma

3. Combination Therapy

ICS + LABA inhalers for moderate to severe asthma. This helps improve symptom control
and reduce exacerbations.

4. Trigger Avoidance & Lifestyle Measures

• Avoid allergens (dust, pollen, mold, pet dander)
• Stop smoking and avoid second-hand smoke
• Reduce exposure to pollution and irritants
• Manage exercise-induced symptoms with preventive inhaler use

5. Management of Severe Asthma

• Oral corticosteroids for acute exacerbations
• Emergency care for severe attacks
• Biologic therapies for difficult-to-control asthma

6. Patient Education & Monitoring

• Proper inhaler technique training
• Personalized asthma action plan
• Regular follow-up and lung function monitoring

When to Seek Medical Advice

Asthma requires prompt medical attention when symptoms worsen or become difficult to control,
as early intervention helps prevent severe attacks and complications.

Routine Medical Review

Seek a routine review if you notice:

• Frequent wheezing, coughing or shortness of breath
• Nighttime or early morning symptoms affecting sleep
• Increased use of rescue inhaler
• Reduced ability to perform daily activities or exercise
• Symptoms not fully controlled with prescribed medication

Urgent Medical Care

Seek urgent care if you experience:

• Severe shortness of breath or chest tightness
• Difficulty speaking full sentences due to breathlessness
• No improvement after using a rescue inhaler
• Rapid worsening of symptoms over hours or days
• Significant wheezing or persistent coughing

Emergency Care

Call emergency services immediately if you experience:

• Extreme breathing difficulty or gasping for air
• Bluish lips or fingernails (cyanosis)
• Drowsiness, confusion or exhaustion due to breathing effort
• Rescue inhaler not providing any relief