Among India¡¯s 1.37 billion people, about six percent of children and two percent of adults have asthma. Medication, other appropriate therapeutic routes and avoiding asthma triggers can control asthma and reduce the severity of it.?
The only hindrance in managing asthma is certain misconceptions that people often fall prey to. People believe that asthma is a childhood disease and individuals grow out of it as they age, it is infectious, asthmatics should not exercise, and asthma is only controllable with high dose steroids. The truth is asthma can occur at any age in children, adolescents, adults, and elderly.?
It is not infectious, however, viral respiratory infections such as flu and common cold can cause asthma attacks. When asthma triggers are controlled, asthmatics can exercise and even play sports. And asthma can be managed with low dose inhaled steroids.?
Asthma is a chronic condition that affects the airways and causes wheezing, making it hard to breathe. Some triggers include exposure to an allergen or irritant, viruses, exercise, and emotional stress among others. When an asthma attack occurs, the airways swell, the muscles around them tighten, and it becomes difficult for air to move in and out of the lungs.?
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A person with asthma experiences tightness in the chest, breathlessness, wheezing, coughing and increased mucus production. When symptoms become severe, an asthma attack occurs. Attacks can begin suddenly and range from mild to life threatening. In certain cases, swelling in the airways prevents oxygen from reaching the lungs. Due to this, oxygen cannot enter the bloodstream or reach vital organs. Therefore, people who experience severe symptoms require urgent medical attention.?
Asthma is the most common chronic condition in children. It can develop at any age, but it is slightly more common in children than in adults. It is imperative to seek medical attention if a child starts experiencing asthma as it can be life threatening. For some children, asthma may improve as they grow to adulthood. However, for some, it is a lifelong condition.?
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Asthma can also develop during adulthood. Some factors that increase the risk of developing asthma in adulthood include allergies and exposure to allergens, respiratory illness, stress, obesity, hormonal factors, and smoking. A person¡¯s work environment can trigger a return of childhood asthma or the start of adult-onset asthma.
According to Dr. Prince James, MBBS, MD, FCCP, HERMES Diplomate Senior consultant, Head of Dept of Interventional Pulmonology & Respiratory Medicine, Naruvi Hospital, Vellore, ¡°Smoking during pregnancy appears to increase the risk of the foetus developing asthma later in life. Some women also experience an aggravation of asthma symptoms while they are pregnant. There are also higher levels of asthma in people with obesity than those without it. Air pollution, both inside the home and outside of it, can affect the development and triggers of asthma. Stress can give rise to asthma symptoms, but so can several other emotions like anger, joy, excitement, laughter, crying, and other emotional reactions can trigger?an asthma attack. Some people have severe symptoms and for reasons that are not directly linked to asthma. For example, they may be using the inhaler incorrectly. Others have severe refractory asthma. In these cases, the asthma does not respond to conventional treatment ¡ª even with high dosages of medication or the correct use of inhalers.¡±
For decades, newer injectable drugs are being designed and developed against molecular targets of asthma, to control inconsistent response of an allergen and to help in reducing the frequency of severe asthma exacerbations and given people a better quality of life.?
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According to Brig Dr. Sarvinder Singh, Head of Department, Pulmonary Medicine, Army Hospital (Research & Referral), New Delhi, ¡°For patients who do not respond to either to these treatments (inhalers and biologicals), Bronchial Thermoplasty (BT) - a minimally invasive and advanced treatment that helps to reduce asthmatic attacks in patients with uncontrolled asthma, is used. It is imperative to note that the procedure can only be carried on patients who are already on oral steroids for asthma exacerbations, the ones who use inhalers more than twice a week and the ones who have physical activity limitations due to asthma.¡±?
BT therapy is scheduled three weeks apart and carried in three parts. Each session is performed under moderate sedation and takes less than an hour to complete. The procedure is not for patients who have an active implantable electronic device.?
During the therapy, a thin catheter that gives heat energy, is introduced to the patient¡¯s airway using a bronchoscope. The catheter is pushed to the end of the airway to reduce the expanded muscles. The process is withdrawn after every 10 seconds to slowly heat up the area and contract the muscles. When the airways broaden, it becomes easy for the person to breathe, reducing asthma attacks.
Asthma was first recognised by physicians over 1800 years ago. Over the last three decades, its definition and treatment has evolved remarkably. Credit it to the years of research involved in innovating technologies, today, patients who never got a respite from asthmatic effects of stress and living in the fear of getting a sudden attack, now see a ray of hope. On this World Asthma Day, let us focus on revoking all myths surrounding asthma and spread awareness around the technologies such as BT.?
About the authors:?
Dr. Prince James is a Senior Consultant at Dept of Interventional Pulmonology & Respiratory Medicine at Naruvi Hospital, Vellore. Prior to this, Dr. James was a professor of Pulmonary Medicine in prestigious CMC Vellore. He has extensive experience in diagnostic and therapeutic, flexible and rigid bronchoscopy and thoracoscopy procedures.
With over 20 years of experience in interventional pulmonary spaces, Brig Dr. Sarvinder Singh is currently the Head of Department of Department of Pulmonary Medicine at Army Hospital (Research and Referral), Delhi. His areas of interest are Interventional Pulmonology, Bronchoscopy and Thoracoscopy.
Opinion expressed here is authors' alone.?