What are the symptoms of asthma?
Typical asthma symptoms include a tight feeling across the upper chest, cough, breathlessness and wheezing.
A wheeze is a noise - a high pitched noise which comes from within the chest. Anyone can mimic this wheezing sound by tightening their throat muscles and breathing out forcibly. The wheezing in asthma is similar to this, but comes from within the chest, not the throat.
Asthma symptoms may be brought on by head colds, exercise, exposure to pollens or dust to which the person is allergic, or a whole host of other factors.
Not everyone with asthma has these typical symptoms. For instance, a frequent or persistent cough might be the only obvious feature of underlying asthma.
Conditions which can be confused with asthma
Occasionally, people who are elderly are told they have emphysema when, in fact, there may be at least some asthma present.
Hyperventilation - that is, "overbreathing" caused by an abnormal breathing pattern - can mimic asthma. Sometimes people have a combination of asthma and hyperventilation, both of which cause breathing difficulties and chest tightness.
Vocal cord spasm is another condition which is less common, but can also mimic asthma. Here, change in the quality of the voice is usually present, and the wheezes which are heard are generated from the throat, rather than from breathing tubes in the chest.
What causes asthma?
This is not properly understood. In most cases there is no obvious reason why one person develops asthma.
Asthma can be inherited or have a genetic cause, but this is only a factor in about 50% of people with asthma.
We also know that viral infections which attack the breathing tubes can, at times, set off asthma in someone who has never had asthma before. If this type of asthma is recognised in time (within, say, a couple of months) and fairly intensive treatment is given (usually with inhaled steroid and steroid tablets) good treatment has an excellent chance of producing a cure from this form of asthma.
In the work place there are a few substances recognised as causing asthma in people who have never had it before. Toluene di-isocyanate (TDI) is the best known. TDI is found in 2-pot paints (used by car body paint sprayers), and in a number of glues where two components have to be mixed together to form the glue. Persistent exposure to sawdust from Western red cedar can also cause asthma: here the offending substance is plicatic acid, which is a natural chemical found in this particular wood.
There is an important distinction between "causes" of asthma (two of which we have just discussed), and asthma "triggers", which make existing asthma worse.
Asthma triggers
Asthma triggers are things that make asthma worse. The most common asthma triggers include head colds, cigarette smoke, exercise, fumes, allergic substances (such as pollens, pets and dust), weather factors (weather change, cold or humid weather), and change in emotions (such as stress or excitement). Food factors may be important in some individuals but not others.
It is important to know about asthma triggers and to look out for those triggers that affect you. Regularly using a peak flow meter, with recordings morning and night, can help you track down triggers. If you are suspicious of a particular possible trigger factor, measuring the peak flow before and after exposure can help determine if that factor is important or not.
Though many trigger factors cause asthma soon after exposure, some only affect asthma hours later. Another complication is the fact that it sometimes takes a combination of several triggers to make asthma worse, with the individual triggers themselves not causing problems.
Tracking down asthma triggers is important, but it may be an exercise in frustration. You need to decide for yourself how much effort you want to put into finding things that make your asthma worse. Just remember, though, trigger avoidance is a fundamental aspect of good asthma care.
Asthma attacks
Surprisingly, it is not easy to define what is an asthma attack. What the medical profession regard as an asthma attack is worsening of asthma, with an important degree of respiratory distress, or with an important degree of fall in lung function.
Asthma attacks can be sudden and severe, in which case it is important to take extra medication straight away and to get medical attention. At other times, asthma can be mildly, but persistently worse over a period of days, or even weeks, with gradual deterioration. Thus, asthma attacks can have a sudden onset or a slow onset. Either way, when asthma becomes worrying, or distressing, it is time to get help.
Asthma attacks are important because they can result in death if they are not managed properly. Typically, people who are too busy, or just keep on putting off getting medical attention, are the ones who wind up in trouble. "A stitch in time saves nine" - early treatmentof attacks saves trouble; it saves lives.
Looking after asthma
1. How you feel about asthma is important
Most people with asthma can live normal lives if they look after asthma conscientiously. Up to 10% of people with asthma have problems which cause some interference with their life despite good treatment. But this interference can be minimised with good treatment.
How you feel about your asthma and the treatment is important. Some people feel angry because they have asthma, become frustrated because they can't stop problems occurring, and hate having to take medication. While these feelings are natural and normal, it is a fact that they are a source of unhappiness. More than this, these feelings about asthma can produce a significant amount of stress which, in turn, can make the asthma worse.
Behind all these negative feelings, I suspect that there lies a fear, or probably a number of fears. It may be that these fears become mixed up with a wider pattern of fears about other issues. If this feels familiar to you, it may be worth taking steps to manage stress, fear or anger, for instance, by reading books, attending courses, or considering a counsellor, for instance.
Be determined, calm and responsible in looking after asthma. The problems associated with the condition can be considered to be tests and trials to be overcome. If you are interested in developing yourself into a stronger, more effective person, asthma could be an ideal training ground! Surrendering to anger, annoyance or stress isn't the answer. Good help is available, good medications are available. Success in looking after asthma should be expected - there are plenty of people who can help.
2. Trigger avoidance
In the section on asthma triggers, it was made clear that trigger avoidance is one of the cornerstones of good asthma care. Some of the following may be appropriate for you:
At the first sign of a cold or flu, increase your preventer treatment (usually this will be the inhaled steroid - see below).
Don't smoke - this is the worst thing you can do if you have asthma, even if the asthma seems trivial.
Don't tolerate being a passive smoker - consider making a rule for your home (and work place): "No Smoking Here". If you just can't get away from smokers, try and sit in a smoke-free area or near an open window.
If exercise makes your asthma worse, take your reliever inhaler 10-20 minutes before exercise. Exercise is one trigger that needs to be controlled, rather than avoided, if at all possible. Warm up exercises may also reduce exercise-induced asthma.
House dust allergy is caused by tiny mites which eat the skin we shed. House dust mites are unavoidable in modern life, but exposure to house dust must be minimised. Here are some tips for avoiding them and other asthma triggers:
Put bedding items in direct sunlight every couple of weeks - direct sunlight kills the dust mite.
Wash bedding in warm water regularly.
Either avoid using sheepskins and electric blankets, or air them frequently in sunlight. Sheepskin can also be washed.
Vacuum frequently (perhaps twice a week) using a vacuum which doesn't expel dust into the air through its exhaust system.
Don't use a feather duster - use a damp cloth to dust other surfaces.
Don't allow pets into the bedroom and, if possible, keep them outside. Pets carry dust and dirt; it's not just allergy to their dander that is important.
Take extra medicine during the pollen season if pollens affect you.
Damp houses are associated with worsened asthma - keep your house warm and dry. Clean away mould straight away, checking wardrobes and cupboards.
Foods and drinks can be important trigger factors - metabisulphite and monosodium glutamate (MSG), as well as the colouring agent tartrazine, should be avoided.
Aspirin and the class of pain relievers called NSAIDS affect about 5% of people with asthma, making their asthma worse. If you are sensitive to them, they should be avoided. (If you change doctors, remember to let the new one know).
Principles of good asthma care
Trigger avoidance.
Don't ignore symptoms: when asthma gets worse, extra treatment is required. If it gets much worse, see your doctor.
Preventer treatment should be taken regularly - usually this means twice a day. Preventers reduce airway inflammation, which is the fundamental problem in asthma.
When you stop your preventer treatment inflammation automatically starts getting worse.
See your doctor and obtain an action plan. This will help you recognise an asthma attack and know what to do about it.
Have regular check ups with your doctor. The more troublesome the asthma, the more frequent the check-ups. Even people with very well-controlled asthma should see their family doctor at least twice a year.
Posted on 3/28/2006 3:21:20 PM
