Asthma is a chronic lung disease characterized by inflammation of the lower airways. This inflammation drives to airflow obstruction.
The correct and complete name is Bronchial Asthma.
Asthma is also defined as a wheezing disease because wheezing is the most important symptom.
Besides, another important feature of this health problem is its presentation like recurrent episodes, that means, patient has time free of asthma symptoms (no airway obstruction) and suddenly, he/she starts an asthma symptom (correlated with airflow obstruction).
This variability in airflow is a capital sign in asthma and it can be demonstrated with medical technics such as spirometry. Nevertheless, it is important to remember that a little percent of patients with asthma present symptoms all the time.
So asthma is a ...
- chronic disease
- inflammatory disease
- wheezing disease
- recurrent episodes disease (ussually)
- variable airflow obstruction disease
Asthma is a very frequent disease.
Ten percent of children and adolescents have got asthma, and males suffer this disease more than females, but in adult age, the opposite happens, and Asthma is more frequent in females (we do not know well the reason).
The prevalence (people who suffer asthma at the same moment) is on the rise, especially among children. This circumstance has been reported in a lot of countries and this increase in number of asthmatics is a worldwide problem.
Asthma can happen at an early age, since infants. It is vey important to know that there is no specific test for asthma, and at early ages there are other wheezing diseases.
So asthma is a
- high prevalence disease
- this prevalence is increasing
- during childhood, it is more frequent in males
- infants, children, adolescents and adults can suffer asthma
Nowadays we know well that asthma is a heritable disease.
A very important number of studies show there is a genetic predisposition to the development of Asthma. This fact explains that in one family there are several people suffering asthma, and it explains the probability of having asthma increases if one parent havs got asthma and its higher if both parents have it.
But genetic aspects of asthma are very complex, and it does not depend on one only gene like other well known diseases (cistic fribrosis...)
Asthma is a poligenic disorder, that means, an important number of genes are related with asthma and every gene explains the different faces of the disease. That explains how a family with twins, one can have asthma and another doesn´t
As a whole we know genetics set:
- age of start of asthma,
- inflammation degree of the airways,
- severity of symptoms,
- response to medicines,
- relationship beetwen asthma and allergies,
So it is easy to understand the importance of genetics in asthma and probably in the future, genetics will be the way for an early diagnostic and better treatments.
Airway inflammation is a key point in asthma management. Parents need to know that asthma is an inflammatory disease because nowadays the best treatments for asthma are oriented to improve the inflammation degree of the airway.
Children and adolescents with asthma have their airways inflammed. And this inflammation remains although asthma symptoms are not present for a long time.
This inflammation increases sensitivity to things that do not cause problems to other people. These hypersensitive airways, when a new contact with these things happen, drives a narrowing of the airways and subsequents symptoms. These things are known as "asthma triggers".
What things cause airway inflammation?
A lot of things are able to provoke asthma inflammation (and also work like asthma triggers). These things vary from person to person. The most common ones are:
- Allergens (organic substances that cause allergic reactions), for example: house dust mites, pollens (grass, trees..), molds, pet dander, and cockroaches.
- Tobacco (see section about it)
- Irritants and pollutants in the air, strong fumes or odors like household sprays, paints, gasoline, perfumes...
- Respiratory infections (common cold, influenza, sore throats...)
- Exercise and Sport. But it is important to know, children and adolescents with asthma are able to practise sport. (see section about it)
The most common symptoms of asthma are:
- Wheezing (the most characteristic symptom of asthma, but it is important to know that other diseases, specially during infancy (the first two years of life), can develop wheezing.
- Cough. Persistent cough at night and cough during exercise are two clear examples of asthmatic cough. But cough is a very frequent symptom during infancy and childhood. In fact, it is the most common symptom reported by parents, then it is very important to make a difference between asthmatic cough and cough caused by cold, influenza, etc.
Other asthma symptoms are:
- shortness of breath
- tightness of the chest
- waking up at night
These symptoms of asthma can appear like episodes (called exacerbations, asthma attacks and asthma crisis), that means, children have got time free of asthma sypmtoms and suddenly wheezing, cough and other symptoms appear.
A little number of people with asthma have got it all the time without free periods of symptoms.
Nowadays, we do not have a cure for asthma.
But it is important to understand what we mean by this statement.
We can offer people with asthma a life free of asthma symptoms. That is sure if patient and family follow medical recommendations: taking medicines, avoidance of triggers, quit tobacco...
But we cannot solve the problem that asthma is a heritable disease. We do not have treatments againts altered genes involved in asthma (we still need to know all genes related to asthma !).
Besides, it is a mistake believe asthma will disappear when children become an adult. In fact asthma remain as the most frecuent disease among teenagers and 5% of adults suffer asthma.
Our message is positive but it includes a warning:
children and adolescents with asthma can have a life free of asthma symptoms (that means, a life free of asthma), but really asthma remains, airways inflammation remains, and if family leaves correct asthma cares, asthma symptoms will come back again.
Asthma is NOT a contagious disease.
A lot of parents of children with asthma ask about this topic.
Asthma is not an infectious disease, and then it is not contagious.
The relationship between asthma and infectious diseases is like a trigger for asthma symptoms, that means, when a child or adolescent suffers asthma (genetic disease), common infections (cold, influenza, pneumonia...) can start asthma symptoms, causing more inflammation and narrowing of airways.
Besides, it is important to state that "bad cured cold" never drives to asthma. The fact that children with asthma have had a lot of cold during their first years of life is a way to express an special sensitivity of the airways.
Q&A: Is it possible to die from asthma?
Unfortunately the answer is YES.
There is a large checklist of factors related to the risk of dying from asthma.
- There are factors related to asthma characteristics: severity degree of the disease, loss of lung function...
- Other factors are related to the patient: compliance with the treatments, fears about some medicines...
- Other ones depend on healthcare system: accesibility, costs of care...
Parents can do a lot of things to prevent dying from asthma, and the most important one is to follow the medical recomendations.
If you have some doubts, you must ask your doctor about them, but PLEASE your child must never leave his/her medicines for asthma without having talked to your doctor.
The correct control of Asthma Triggers is an essential part in asthma management (obviously, the first step is to know what triggers the child has got).
Triggers control is really an asthma treatment because it helps to reduce contact with things that produce asthma inflammation and airways narrowing. In fact, the only use of medicines for asthma, without putting into practice these control measures is a wrong strategy, and it drives to a bad asthma control.
In conclussion, the best way for a correct control of asthma is to develop strategies for triggers control and combine it with asthma medicines (when these are necessary).
The most important measures for triggers control are:
- No smoking at home see our section about it
- In case of dust mite allergy: wet cleaning, hermetic cover for pillows and mattress
- In case of pollen allergy: be careful during pollen season (usually in spring and the beginning of summer), use pollen filter in the car. Travel always with car windows closed
- In case of cockcroaches: Ask for an expert in cock extermination
- In case of pet allergy: Put the pet away. Never allow it in the child bedroom. Wash pet every week.
- In case of asthma induced by exercise: see our section about it
This therapy tries to reduce the sensitivity degree with often injections containing allergen extracts. Immunotherapy is always involved in controversy related to its outcomes and its adverse effects.
The main recommendation is: immunotherapy must be prescribed by an specialist in allergy.
Asthma medication is divided into two general classes
Antiinflammatory medicines. Long-term control medications. Therapy to suppress the inflammation. Antiinflammatory therapy must be used for a long time. Bronchi Inflammation cannot cause symptoms. Anyway, we need to use these medications for a long time to suppress airways inflammation.
There are three types of antiinflammatory medications:
- inhaled glucocorticosteroids, a
- ntileukotrienes (like montelukast oral) and
- inhaled cromones.
Quick-relief medications. Used to provide prompt relief of bronchoconstriction and acute symptoms such as cough and wheezing. The most important type of medications are the short-acting beta2-agonists, and the best way to take this medicines is inhaled.
These medicines open airways in a few minutes. But bronchi remain inflamed and you need to continue with Long-term-control medications.
Asthma treatment, and overvie