Asthma is a chronic inflammatory disease of the airways , among the most popular worldwide. In detail, asthma is caused by the narrowing or obstruction, usually reversible, of the airways and bronchi .
Among the symptoms with which it occurs are: wheezing and wheezing, respiratory crisis, cough and tightness of the chest.
However, the symptoms of asthma can be occasional, but still with the presence of acute or persistent crises , depending on the stage of the disease.
However, asthma is a disease that can be treated and kept under control as long as the medications prescribed by the doctor (cortisone and anti-inflammatory) are taken and regular check-ups are carried out.
In addition, it is essential to avoid all those risk factors that can provoke or worsen symptoms , such as exposure to allergens or other triggers.
Asthma: what it is
The word asthma derives from ancient Greek and means “to pant”, that is to breathe with difficulty, which is one of the symptoms of the disease.
To explain asthma, we need to briefly explain our respiratory system.
The air you breathe in through your nose and mouth reaches your lungs through your larynx and then your trachea . These organs contain ramifications of the lower airways, called bronchi (larger) and bronchioles (smaller).
In addition, the walls of bronchi and bronchioles contain muscle fibers that can contract and change their size. Finally, they are coated with a thin layer of mucus which serves to retain harmful air impurities, including viruses and bacteria.
Thus, air normally enters the airways through the nose and mouth and reaches the pulmonary alveoli unhindered. The latter are small elastic balloons located at the end of the bronchioles that have the function of exchanging the oxygen that we breathe with the carbon dioxide that we exhale.
However, in people with asthma, the walls of the bronchial tract are made thicker and swollen by inflammation.
In addition, there is an increased production of mucus and all this hinders the passage of air. Added to this is the fact that the muscle cells surrounding the airways contract by shrinking them – due to the effect of the so-called bronchospasm – making the passage of air even more difficult.
In summary, asthma and the symptoms with which it occurs are the consequence of a narrowing of the diameter of the bronchi and bronchioles.
This disease was already known in China in 2600 BC and was defined as a disorder characterized by noisy breathing .
The Babylonian Code of Hammurabi, around 1750 BC, also spoke of symptoms related to shortness of breath . But the first to use the term “asthma” was Hippocrates, in 400 BC to describe the respiratory disorder. He is also believed to have been the first to identify the relationship between the environment and the disease , to the point that many consider him the first allergist.
Instead, it was Alexander the Great to discover, when he invaded India, that in this country they used the stramonium plant to relax the lungs. In fact, this herb is still used in inhalers today.
Finally, among the Romans, doctors described asthma as a breathlessness and the inability to breathe without making a sound and Pliny the Elder observed that pollen could be a triggering agent .
While in South America, Incas and Aztecs used special herbs to treat asthma , with the introduction of tobacco in Europe in 1500, this was used to induce coughing and expectorate mucus.
The first cures
But it was not until 1900 that the first truly effective treatments were experienced. In the 1940s and 1950s, therapy consisted of:
- epinephrine injections (adrenaline)
- aminophilin tablets.
But we must wait until the 70s for the use of bronchodilator drugs for severe crises and corticosteroids to keep inflammation under control.
In the end, despite the fact that asthma has been known for over 2500 years, it has not yet been possible to fully understand its cause and find a definitive cure. However, the drugs available today allow you to effectively control the disease .
According to the World Health Organization ( WHO) , there are between 100 and 150 million people worldwide who suffer from this disorder.
The allergic form affects 50% of adults and 80% of children. Unfortunately, deaths related to this disease are around 180,000 every year, according to WHO data.
Despite being one of the most common chronic conditions in childhood, asthma can also affect adults , even in old age. In particular, among young people it is more frequent in boys of puberty age and in girls after puberty .
However, in some cases, in children, asthma resolves with growth , although it can reappear a few years later.
Asthma: growing data worldwide
However, there is an increase in asthma cases worldwide, which, according to the WHO , depends mainly on the phenomenon of urbanization , or on the fact that more and more people live in the city.
In fact, living in urban areas means spending more time in closed spaces with little air circulation , more exposed to:
In addition, according to some experts, this increase in cases would also be due to the increase in the level of hygiene in developed countries . Hence, this phenomenon would have affected our immune system , leading it to a greater allergic reaction.
Finally, other factors could also be related to the increase in the incidence of asthma, such as obesity and poor exercise .
There are two mechanisms by which asthma occurs.
We all react to the presence of irritants for the respiratory system by activating the mechanisms of inflammation in several ways:
- increase in the number of inflammatory cells that have the role of eliminating microorganisms
- mucus hypersecretion, i.e. increased mucus secretion which traps impurities in the air in order to eliminate them
- bronchospasm, i.e. contraction of the muscle fibers of the bronchi and bronchioles : this process hinders the penetration of microorganisms into the alveoli.
Hence, in asthmatics, these responses are exaggerated, to the point of preventing the passage of air into the lung , both in and out.
Furthermore, if not properly treated, asthma, with time, can cause the wall of the bronchi and bronchioli to thicken and consequently reduce the air flow in a chronic way . In detail, this process is called airway remodeling .
Hyperactivity is the exaggerated reaction to the presence of irritants or allergens and which induces bronchospasm . In fact, if exposure to irritants in all people causes the airway to shrink, this reaction is excessive for those with asthma .
Asthma: risk factors
Asthma is caused by several genetic and environmental factors and the specific role has not been well clarified for all. In particular, some of these, such as genetic predisposition and exposure to sensitizing substances present in the environment, cause the appearance of the disease. Instead others, such as viruses, allergens, physical activity, etc. they contribute to worsen its symptoms.
So here are the risk factors that expose you more to the disease.
If you have a close relative who suffers from asthma, you are more likely to develop the disease . For example, children of asthmatics have a greater risk , although not the certainty of getting asthma.
The genetic predisposition to develop certain allergic diseases, such as bronchial asthma, is also called atopy.
In fact, it is a phenomenon characterized by the excessive production of immunoglobulins E, also called IgE. Hence, these IgEs target the most common allergens present in the environment , such as:
- mushroom spores
- dust mites
- animal hair
- some animal proteins.
Therefore, when our body comes into contact with these allergens, the already sensitized antibodies activate the inflammatory response . For this reason, atopy is the greatest risk factor for the appearance of bronchial asthma and other allergic forms.
Worsening asthma is often caused by substances you are allergic to . In this case, we speak of allergic bronchial asthma and asthmatics are atopic subjects.
However, it is good to clarify that not all asthmatics are also allergic and not all allergy sufferers are asthmatic.
In detail, the most common allergens that can trigger asthma are:
- pollen : grasses (wheat and corn), urticaceae (parietaria officinale), composite (ambrosia)
- dust mites
- allergens to animals, including domestic ones.
But exposure to allergens such as pollen can cause worsening of asthma only in a certain period, i.e. during the season in which these pollens are spread in the air . That’s why in this case we speak of seasonal and / or episodic asthma .
Both viral and bacterial infections , such as colds and flu, can often worsen asthma , triggering the appearance or increase in symptoms. Also for this reason the flu vaccination is indicated for all adults with asthma .
Some medicines can worsen asthma in adults . These include aspirin, but also non-steroidal anti-inflammatory drugs (NSAIDs), drugs to treat glaucoma or cardiovascular diseases.
Asthma and physical activity
Physical activity can cause so-called exertional asthma , a condition in which symptoms worsen during physical activity, especially in the case of children. Indeed, sometimes attacks only appear during physical exertion.
It is a condition in which the contents of the stomach rise up along the esophagus, and being acidic, it causes irritation of the respiratory system.
Although it is a very rare cause , it can be avoided by taking anti reflux medications .
Other risk factors
- active and passive smoking
- environmental pollution, both indoors and outdoors: both the frequency and the quantity of symptoms increase
- presence of mold in the environment in which you live
- excessive environmental humidity
- hormones : many women find they have worsening asthma before and during menstruation
- body weight : some studies have shown a correlation between body weight and an increased risk of asthma . In any case, obesity contributes to worsening symptoms and overall quality of life.
The symptoms are quite typical and therefore easily traceable to this disorder. The most common are:
- cough, usually dry
- wheezing or whistling
- wheezing, difficulty breathing (wheezing)
- chest tightness.
Asthmatic crisis: how it occurs and what to do
When the symptoms are particularly intense, we speak of asthma crisis , which is manifested by:
- constant hissing while breathing
- accelerated and excited breathing
- sense of suffocation, which many patients define as “air hunger”
- constant cough
- chest pain
- heavily contracted neck muscles with difficulty speaking
- profuse sweating.
In the presence of an asthma crisis, you should immediately use a bronchodilator . If this action is insufficient to make the crisis go away, you must immediately contact your doctor or go to the emergency room .
Furthermore, the crisis does not necessarily appear immediately after exposure to the factor that triggers it, but it can also appear after a few hours or days .
Finally, even after the crisis has regressed, bronchial inflammation is still active , so it is necessary to cure it, otherwise, there will be relapses.
To make the diagnosis, the doctor takes into account several aspects :
- patient-reported symptoms
- any seasonality of symptoms (which could suggest allergy asthma)
- link between the appearance of symptoms and the triggers
- familiarity with asthma or allergic diseases
- possible prolonged exposure to toxic or polluting substances.
Asthma: tests to do
To confirm the diagnosis of asthma, the doctor must ascertain if the airways are blocked and then evaluate lung function. To do this, he will perform spirometry , an examination that also allows to evaluate the severity of asthma and the response to therapy. In practice, it is ascertained that the symptoms are reversible after the administration of the bronchodilator and / or anti-inflammatory drugs.
In addition to these tests, tests for allergies , such as prick test and rast test, may also be needed to identify any triggering allergens.
Spirometry: what it is and how to do it
It represents the fundamental test to diagnose asthma and is performed with a spirometer. In fact, this instrument is used to measure the percentage variation of the inhaled and exhaled air , that is, how much the lung can fill and empty itself during breathing.
So in case the airways are blocked, the amount of air will be less than normal.
In any case, it is a simple and painless examination, in which the patient must inhale and exhale in a mouthpiece connected to a machine (the spirometer in fact).
Asthma as a consequence of other diseases
In addition, the doctor will rule out other diseases that may have similar symptoms , such as:
- gastroesophageal reflux
- panic attacks
- some heart diseases
- obstructive pulmonary disease.
Prognosis: the four stages of asthma
Based on the severity of the symptoms, four stages of the disease have been defined and the most suitable therapy can be identified for each stage.
- Mild intermittent : at this stage the symptoms occur less than once a week. The exacerbations are short and there are no symptoms between attacks. In addition, nighttime symptoms appear no more than twice a month.
- Mild persistent : symptoms occur more than once a week but less than once a day, while nocturnal ones appear more than twice a month.
- Moderate persistent : there are daily symptoms and exacerbations that can limit daily life and night rest, also because the night symptoms appear more than once a week.
- Severe persistent : in this stage the symptoms are continuous daily, with frequent exacerbations and limitations on physical activities. Nighttime symptoms are also common.
Importance of early diagnosis
However, as it is a variable disease, asthma has phases during which symptoms or worsening crises (the so-called asthma exacerbations ) are alternated with periods in which there are no symptoms.
In particular, in asthma exacerbations, the symptoms worsen and it is necessary to seek medical attention . However, this deterioration can sometimes be caused by exposure to some triggering factors , while in other cases the causes are not yet known.
For this reason, in cases of severe asthma, the doctor, in agreement with the patient , develops an asthma monitoring and management plan. For example, this plan involves frequent measurement of airway patency (i.e. the possibility of air passing through the respiratory tract), so that the asthmatic can check for obstruction.
As needed, patients can take steroids or drugs such as injected adrenaline, to cope with a serious crisis waiting to be rescued in hospital.
It is good to underline that an asthmatic crisis can be fatal and that death does not concern only those who suffer from a form of severe asthma, but also from a mild one. However, in most cases, death occurs when people have poor adherence to therapy , that is, they do not take the drugs in the doses and times recommended by the doctor , or they only follow therapy with symptomatic and non-maintenance drugs.
Still, many expose themselves, consciously or not, to allergens or crisis triggers , instead of avoiding or reducing these situations as much as possible.
To date, there is still no definitive therapy that will heal this chronic disease, this does not mean that by keeping it under control with the appropriate drugs , it is possible to lead a normal life.
Hence, it is necessary to follow regular therapy and continue with medicines whose dosage can be adapted to the different stages of the disorder.
However, there are two types of asthma medications . But most patients take both types of medications.
Those suffering from asthma must always have the medicines to use in case of crisis.
Background (or maintenance) antiasthmatics
The underlying antiasthmatic agents are to be used regularly , because they are used to keep the disease under control, avoiding the onset of symptoms. In fact, these drugs act on inflammation and bronchospasm and must always be taken, as is done with other chronic diseases.
They belong to this category:
- inhaled cortisones : reduce inflammation and protect the airways from irritants or allergens
- systemic corticosteroids : to be used in case of severe crisis.
- long-acting bronchodilators : they are used in combination with corticosteroids to improve the result of therapy, since they help prevent seizures and also nocturnal and physical exertion symptoms.
- oral antileukotrienes: block the response to some triggering factors, reducing both symptoms and exacerbations.
- oral antileukotrienes: block the response to some triggering factors, reducing both symptoms and exacerbations.
- chromons : they are less strong anti-inflammatory than cortisone and for this reason they are mainly used in children, also because they can prevent symptoms caused by physical activity.
Symptomatic antiasthmatics (or as needed)
The symptomatic asthma are to be used in case of need , ie in case of symptoms or crises, because they help to relieve symptoms.
However, they don’t solve the causes of long-term asthma. In fact, they are fast-acting bronchodilators that relax the muscles of the bronchi, and cortisone by mouth, to be taken in case of serious crises.
Bronchodilators for the treatment of asthma
As for bronchodilators, they are administered by inhalation because in this way the drug acts only where it is necessary, that is, in the bronchi, and does not cause side effects . This type of medication includes:
- spray cans : it is the most common system. The drug is contained under pressure in the can, then it is sprayed into the mouth as you breathe in, to get it up to the bronchi. Each press releases the can of a quantity of drug. These drugs are used for both background and symptomatic therapy.
- Pre-dosed aerosol : this type of regulator activates automatically when you breathe, so there is no need to press the can, because the inhaler delivers the drug when you breathe in with sufficient force.
- Powder drug dispensers : the drug is dosed in the form of a powder and is mainly used for background therapy (or maintenance). Thanks to the fineness of the powder, it manages to settle in the most distant parts of the lung, going to act where it is needed.
- Nebulizers : they are tabletop devices that produce a mist of medicine, to be inhaled through a mouthpiece or a mask to the mouth. For suspended drugs, compressed air nebulization is used, for solution medicines, ultrasonic nebulization is used instead.
In particular, these tools are used for very young children and the elderly , who are unable to use sprays or inhalers.
It is important to know what are the factors that trigger or worsen the symptoms, so that you can avoid them or minimize them. On the one hand, therefore, prevention can reduce the asthma crisis and on the other the progression of the disease.
In fact, if you continue to be exposed to bronchial irritants, the inflammation remains active . Here are some of the main triggers and actions to take to avoid them .
Mites are microscopic microorganisms that nest in mattresses, rugs, curtains, stuffed animals and dust. In addition, they multiply in humid environments and produce allergens.
So it is important to ventilate all rooms well , especially the bedrooms. Also, use hypoallergenic covers for mattresses and pillows .
Wash bed linen every week, do not have carpets and rugs in the house , reduce upholstered and upholstered furniture and cushions, clean with a vacuum cleaner with special filters for mites , and keep the house temperature below 22 ° C.
Unfortunately in this case, the only solution is not to have pets (dogs and cats or others with fur, such as rabbits) because it is the hair and urine that cause allergy. Otherwise, the alternative is to clean the house thoroughly and often, and not to let the animals stay in the rooms where you sleep.
Mushrooms and molds
Since they facilitate the recurrence of asthma , it is necessary that the humidity inside the home or workplace is less than 50% . So it is necessary to ventilate the rooms often and eliminate any mold, to then also remove the causes of their formation.
This is the most difficult allergen to keep away from . By consulting pollen calendars, you should avoid spending a lot of time outdoors or in the countryside during peak periods. In addition, it is useful to keep the windows closed early in the morning and in the evening because they are the times when there is the maximum concentration of pollen.
In these cases an air conditioner can be useful in order not to have to open the windows often, as long as the filters are cleaned and changed regularly.
There are some triggers related to the work done, such as:
- bakers: flour dust, some contaminants and additives are among the main causes of the so-called “bakery asthma” or “baker’s”, one of the most common professional asthma
- hairdressers: for bleaches and hair dyes
- painters and body repairers: for isocyanates, compounds used in polyurethane foams and hardeners of spray paints
- who cares for animals: for contact with animal hair and urine
- carpenters: for isocyanates, as in the case of painters.
In this case it is good to talk to your doctor, to evaluate if it is possible to implement protective measures , knowing that compensation is also provided in case of professional asthma .
Cigarette smoke, but also the fumes produced while cooking can cause asthma attacks . So you need to quit smoking and not be exposed to secondhand smoke , and use extractor hoods while you are in the kitchen .
In periods where there are levels of smog above the norm , it is good not to spend a lot of time outdoors, especially not to do physical activity outdoors.
Respiratory tract infections
The flu vaccine is recommended for adult asthmatics and in any case avoid coming into contact with people who have a cold or fever , because they could worsen the symptoms.
Although there are no exact data on this aspect, in fact some additives, especially sulphites , can, although rarely, worsen the symptoms. Sulphites are additives present in preserved foods such as snacks and biscuits, chips, tomato purée, but also in wine and dried fruit. In any case, the law requires reporting its presence on the label.
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause asthma attacks. Beta blockers and ACE inhibitors can also cause severe exacerbations.
Physical exertion, in many asthmatics, can increase symptoms or provoke crises but does not mean that you cannot play sports, indeed, over time, by training, the situation improves.
In addition, it is important to warm up and plan for recovery times during training. While, in some cases, premedication is possible to avoid a crisis .
Asthma: recommended sports and sports not recommended
So, it is better to play sports that involve many short efforts, such as:
Sports that work on breathing, such as pilates and yoga are beneficial for asthma sufferers. Yes, even running and walking.
Instead, sports that pose a risk to life in the event of an asthma attack , such as:
- hang glider
- mountaineering, etc.
In general, however, it is good to learn to recognize the symptoms in time and therefore be able to manage both the disease in everyday life and in case of acute attacks.
Swimming and asthma
It would seem that in some asthmatic people the prolonged exposure to chlorine in swimming pools causes, once out of the pool, crises. In particular, these would manifest themselves in those who practice swimming assiduously or in a competitive way. Therefore it is good to evaluate, as happens for other sports, whether a therapy to be administered before the activity is effective in preventing the manifestation of symptoms. Otherwise, if you don’t want to give up this sport, you can choose pools that do not contain chlorine and take advantage of the summer to swim in the sea.
Asthma and diet
“There is no specific diet for people who show asthmatic symptoms, whether they occur in acute or chronic form,” says nutritionists. “However, there are some precautions to be applied, such as the consumption of 4-5 portions of fruit and vegetables a day,” continues the expert, providing us with other valuable tips:
• Vitamin C: abundant especially in strawberries, oranges and kiwis (if we think of these seasonal fruits), it has a strong supportive action for the immune system, which also intervenes in cases of airway problems.
• Antioxidants: such as beta carotene, polyphenols and xanthines, abundant in radicchio, carrots, broccoli and artichokes.
But how to combine these foods in our food day? “By respecting the dictates of the Mediterranean diet, a balanced diet, recognized as valid to combat certain acute forms of asthma”, explains our nutritionist.
Beware of harmful substances
In addition, Dr. Traversetti recommends paying particular attention to:
• additives and dyes: present in preserved products, but also in sugary drinks and spirits, as they have a high allergenic power and could make the asthma manifestation more aggressive.
• sulphites: present in wines, they can favor the appearance of asthma symptoms.
Allergic asthma: foods to avoid
“specific foods can trigger an allergic-asthmatic response if related foods are consumed ,” explained by nutritionists.
For example, as in the case of allergy to grass pollen, strictly cross-linked to the consumption of tomatoes, oranges, wheat, but also to other fruits such as apricots, plums and peaches or, among dried fruit, to peanuts.
Also in the case of the allergy to the parietaria, very common, there is a cross-reactivity with legumes such as peas, but also cherries, melon and basil.
Asthma: foods that reduce symptoms
“There are no beneficial foods for asthma” specifies nutritionists, “but there are foods that guarantee our body to manifest less aggressive symptoms“. Among these:
- omega 3 rich foods (such as oily fish, flax seeds and flax oil)
the main barrier to asthma is always provided by lifestyle. says experts
So, avoid drinking alcohol, keep active daily, not only with 2-3 hours of sport per week, but also walking, climbing stairs and interrupting a hypothetical daily sedentary lifestyle.
In fact, these actions have an impact on our body’s greater ability to cope with asthma symptoms.
Asthma and children: which diet?
For children, the same rules apply as for adults. As the nutritionists points out , “As children, it is easy to fall in front of the temptation of a packaged dessert, a sweetened drink or a long afternoon to spend sitting on the sofa playing in front of the PC or with a console”.
In addition, the aversion to the consumption of fruit and vegetables is also greater .
“So it’s mainly about active habits that need to be tackled in order to better cope with asthma,” warns nutritionists.
Pregnancy and breastfeeding: can diet prevent asthma?
In case of heredity, is it possible to prevent asthma by avoiding the consumption of potentially allergenic foods already during pregnancy and breastfeeding?
“At the moment there is no scientific evidence to prove it”, as there are no studies confirming this hypothesis.
However, the only relevant role shown is that related to the dosage of folic acid, which is normally given in pregnancy and the use of probiotics.
“So consuming a portion of whole white yogurt with lactic ferments and 2-3 servings of vegetables a day,” explains the nutritionist, “can lower the risk of asthma appearing in the unborn child.”
Finally, a final clarification from our consultant: ” Regarding vitamin D, there are specific studies that dispel the false myth that increasing the intake of this vitamin has an important role for asthma”.