Asthma
What is asthma?
Asthma is a chronic pulmonary disease characterized by episodes of shortness of breath caused by a narrowing of the respiratory tract (bronchi) as a reaction to triggering factors such as exposure to allergens, smoke, cold weather.
Patients who have no other symptoms than episodes, experience shortness of breath, coughing, wheezing and a feeling of chest tightness along with the episode.
Episodes usually occur at night towards dawn, during heavy workouts and emotional stress. They regress when the patient gets treated. The frequency and severity of episodes decrease in time in patients who undergo regular treatment.
How prevalent is asthma?
It is estimated that asthma affects approximately 300 million people in the world. In Turkey, this sum is around 3.5 million. Each year 250.000 people worldwide die of asthma. The median prevalence of the disease is 15% but varies from country to country. In other words, every 15 person in 100 have asthma. The risk of asthma is higher in residential areas where air pollution is high.
What are the risk factors of asthma?
Asthma can result from many genetic and environmental causes.
Genetic factors that play an important role in the development of the disease include allergic predisposition, obesity and being female.
Environmental factors include:
- Exposure to allergens, dust and chemical substances, smoke and air pollution
- Viral upper respiratory tract infections, some medications, gastroesophageal reflux
- House dust mites, pet hair (cat, dog), cockroaches, mold fungi and pollens
- Perfumes, detergents and food smells can also be triggers.
How is asthma diagnosed?
Asthma characteristically occurs through episodes (attacks). The patient experiences shortness of breath, chest tightness, wheezing, coughing and thick phlegm during the episode. While it is easy to diagnose the patient during an episode, diagnosis out of episodes require detailed medical history, chest radiography, pulmonary function tests, allergy and blood tests.
How is asthma treated?
In patients who receive regular treatment, asthma has little negative impact on daily life. However, sporadic treatment may cause a progression of the disease with episodes increasing in number and severity.
Medication used in the treatment of asthma are fundamentally taken orally and are classified in two groups:
The first group includes symptomatic medications that aim at relieving the symptoms of the disease. These are used via the respiratory tract and are taken with devices called inhalers. Their effects start within 1-2 minutes and help relieve symptoms as shortness of breath, wheezing and coughing which may cause much discomfort for the patient.
The second group includes medications that treat the disease in a long term and thus take it under control. A major part of these are also used via the respiratory tract. The regular use of the second group medications directly affects the course of the disease and the patient's quality of life, reducing the frequency and severity of episodes.
COPD
COPD (Chronic Obstructive Pulmonary Disease) is a chronic disease-causing destruction in the lungs. It is progressive and does not recover fully, however, it is preventable and curable.
The most important risk factor of COPD are all tobacco products, particularly cigarettes. It has been reported that there is an association between most professions with exposure to dust and smoke and the occurrence of COPD. Furthermore, lighting wood or turf fires for cooking or heating purposes in spaces that are not well ventilated and burning coal in an open fire pit or in malfunctioning heating stoves may cause high levels of indoor air pollution. The diagnosis for COPD should be taken into account in all people presenting with a history of exposure to risk factors and with cough, expectoration and shortness of breath manifesting with movement.
In COPD, as a result of exposure to risk factors, inflammation occurs in the lungs causing damage and triggering recurring repair mechanisms, the whole resulting in structural changes and limited airway, the latter usually presenting a progressive characteristic. Chronic airway limitation is characterized by small airways disease (obstructive bronchiolitis) caused by a long-term and recurrent inflammation and destruction in the pulmonary tissue (emphysema). As a result, thickening of airways, increase in the amount of phlegm in the airway lumen and narrowing of airways (obstructive bronchiolitis) occur.
Emphysema is the permanent thickening resulting from the destruction in alveoli which are the main regions where oxygen and carbon dioxide exchanges happen in the lungs. The limitation that comes with this destruction causes the adding of findings such as shortness of breath to the disease profile.
The objective of COPD treatment is to prevent the progression of the disease, alleviate symptoms, increase exercise tolerance, prevent and treat complications and decrease disease-related mortality.
Decreasing risk factors constitutes the first step of treatment. The most important factor to prevent decrease in pulmonary functions is to stop smoking and preventing exposure to tobacco smoke. Aside from that, preventing professional exposure and indoor and outdoor air pollution also play an important role in the decrease of risk factors.
The patient should understand that COPD is a treatable disease, what other characteristics it has, what the effects medications have and how doctor-patient relationship is important. Pharmacological treatment methods are used to prevent and control symptoms, decrease the frequency and severity of episodes, improve the state of the disease and increase the patient's exercise tolerance.
Treatment of COPD episodes is another crucial aspect of treatment. As opposed to normal progressive changes occurring in shortness of breath, coughing and expectoration observed at onset of the disease and happening in the natural course of it, COPD episodes (flare-up) are characterized at much higher levels. They start suddenly and usually require an increase of dose in medications used by COPD patients, or a complete change of their drugs.
Infection of the tracheobronchial tree and air pollution cause episodes the most. However, the cause of one third of episodes are not identifiable.
