Asthma   

  Chronic Lung Disorder  

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  The History of  Asthma 

Asthma is not a new phenomenon, as its recent insurgence would suggest.  - Asthma-like symptoms were first recorded around 3500 years ago in an Egyptian manuscript called the Ebers Papyrus. And a word with similar roots as Asthma was also seen in Homer's Iliad. The word comes from the Greek and means Labored Breathing. The word Asthma was first used to describe an illness 500 years later by the famous Greek physician, and father of Medicine,  Hippocrates. The Romans also recorded this condition and used various remedies to try and cure it.

The first manuscript specifically written about Asthma was by a Spanish doctor -  Moses Maimonides, in  1190 AD. He was a physician to the Kurdish Sultan, Saladin. Maimonides wrote that Asthma was characterized by sudden bouts of breathlessness, his treatments included chicken soup, various herbs and sexual abstinence. He also had the humility to admit defeat in finding any real cure.

Whilst it was around, it was also hereditary and followed, in most cases, family lines. During the Middle-Ages there were not a fraction of the chemicals that could trigger an episode off, but needless to say, it may have well laid dormant in our genes.

During  the seventeenth and eighteenth centuries, doctors realised that this breathlessness was due to tightening of the bronchi - The airways into the lungs. One doctor called Asthma an epilepsy of the lungs,  reflecting on the sudden and unpredictable nature of the attacks.

Throughout history there have been several reports of folk remedies, some that worked a little and some that had no effect. 

Some probably worked like today's Broncho-dilators, drugs that counteract the tightness of the airways, through relaxation. 

It is a logical mechanism really. There must be some element that makes these otherwise healthy muscles tighten up, and so it is logical that there may well be something that can un-tighten them.

It was not until the 1960's that physicians discovered that Asthma is mainly an inflammatory condition and swelling of the bronchi, as well as a muscular restriction, plays a part. The immune system of Asthmatics is overly sensitive to the triggers, such as aerosol spray, pollen, animal fur and hair and the faeces of the dust mite. This discovery started a revolution, commercial as well as medical, in the treatment of Asthmatics. Instead of just treating the constriction of the airways doctors now treat in tandem the underlying inflammation as well.

In these early years of the 21st Century it seems that doctors can do anything and their seemingly limitless arsenal of drugs and treatments grow daily. One day there may be a cure for Asthma, but this will be balanced against the many millions of dollars drug companies get from Asthmatic medicines.

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  WHY?                       

 Effects of Air Pollution on Health 

The disastrous fog and attendant high levels of sulphur dioxide and particulate pollution, and probably sulphuric acid,  that occurred in London in the second week, and the subsequent three weeks of December 1952, led to the deaths of more than 4,000 people. Many, but not all, already had chronic heart or lung disease, and they were not strong enough to weather this alien environment.

This episode spurred renewed attention to this problem, which had been intermittently considered since the 14th century in England, and finally the passage of legislation banning open coal burning, the main factor most for this pollution. This form of pollution, common in many cities using coal as heating fuel, was associated with excess mortality and increased prevalence of chronic bronchitis, respiratory tract infections in the young and old, and more likely cancer of the lung. Many industrial cities in Western countries now have legislation restricting the use of specific carcinogenic fuels.

In 1952 a different kind of air pollution was characterized for the first time in Los Angeles. The bowl-valley, and the large number of gasoline driven cars, together with the bright sunlight and frequent stagnant air, led to the formation of a photochemical smog. This starts with the emission of nitrogen oxide during the morning commuting hour, followed by the formation of nitrogen dioxide by oxygenation, and finally, through a complex series of reactions in the presence of hydrocarbons and sunlight, to the formation of ozone and peroxyacetyl nitrite and other irritant compounds. 

Eye irritation, chest irritation with cough, and possibly the exacerbation of Asthma occur as a result. It is now recognized that ozone is formed in many large cities of the world. Modern air pollution consists of some combination of the reducing form consequent upon sulphur dioxide emissions, and the oxidant form, which begins as emissions of nitrogen oxides. Ozone is the most irritant gas known. In controlled exposure studies it reduces the ventilatory capability of healthy people in concentrations as low as 0.12 parts per million. These levels are commonly exceeded in many places, including Mexico City, Bangkok, and São Paulo, where there is a high automobile density and the meteorological conditions favor the formation of photochemical oxidants. Although acute episodes of communal air exposure leading to demonstrable mortality are unlikely, there is much concern over the possible long-term consequences of brief but repetitive exposures to oxidants and acidic aerosols; such exposures are now common in the lives of millions of people. Their impact has not yet been precisely defined.

The indoor environment can be important in the genesis of respiratory disease, especially when there is no ventilation. In developing countries, disease may be caused by inhalation of fungi from roof thatch materials or by the inhalation of smoke when the home contains no chimney. In developed countries, exposure to oxides of nitrogen from space heaters or gas ovens may promote respiratory tract infections in children. Inhalation of tobacco smoke in the indoor environment by non-smokers impairs respiration and may cause lung cancer. A tightly sealed house may act as a reservoir for radon seeping in from natural sources.

Asthma can affect anyone, at any age, anywhere. But the good news is there's no need for asthma to prevent a person living a full and enjoyable life.

The concentration in natural gas is much lower. When the carbon monoxide concentration in the blood reaches 40 percent, that is, when the haemoglobin is 40 percent saturated with carbon monoxide, leaving only 60 percent available to bind to oxygen, the subject feels dizzy and is unable to perform simple tasks. Judgment is also impaired. 

Haemoglobin's affinity for carbon monoxide is 200 times greater than for oxygen, and in a mixture of these gases haemoglobin will preferentially bind to carbon monoxide; for this reason, carbon monoxide concentrations of less than 1 percent in inspired air seriously impair oxygen–haemoglobin binding capacity. The partial pressure of oxygen in the tissues in carbon monoxide poisoning is much lower than when the oxygen-carrying capacity of the blood has been reduced an equivalent amount by anaemia, a condition in which haemoglobin is deficient. The immediate treatment for acute carbon monoxide poisoning is assisted ventilation with 100 percent oxygen.     

Asthma  - a chronic disorder of the lungs in which inflamed airways are prone to constrict - reduce in size, causing episodes of breathlessness, wheezing, coughing, and tightness of the chest. This can range in severity from mild, to life-threatening. Inflamed airways become hypersensitive to a variety of stimuli, including dust mites, animal dander, pollen, air pollution, cigarette smoke, medications, weather conditions, and exercise. Stress can often exacerbate symptoms, and sometimes be the only cause.

Asthmatic episodes may begin suddenly or may take days to develop. The sufferer may go to bed fine, only to be awoken by some strange bad dream, that turns into a nightmare.

Although an initial episode can occur at any age, about 50% of all cases occur in persons younger than 10 years of age, with boys being affected more often than girls. Among adults, the incidence of Asthma is approximately equal in men and women. When Asthma develops in childhood, it is often associated with an inherited susceptibility to allergens, substances such as pollen, dust mites, or animal dander that may induce an allergic reaction. In adults, Asthma also may develop in response to allergens, but viral infections, aspirin, and exercise may cause the condition as well. 

Adults who develop Asthma may have nasal polyps or sinusitis. Adult Asthma is sometimes linked to exposure to certain materials in the workplace, such as chemicals, wood dusts, aerosol elements and grains. These substances provoke both allergic and non allergic forms of the disease. In most cases, symptoms will subside if the causative agent is removed from the workplace.

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Although the mechanisms underlying an Asthmatic episode are not fully understood, in general it is known that exposure to the trigger - an inciting factor stimulates the release of chemicals from the immune system that cause spasmodic contraction of the smooth muscle surrounding the bronchi, swelling and inflammation of the bronchial tubes, and excessive secretion of mucus. The inflamed, mucus-clogged airways act as a one-way valve—i.e., air is inspired but cannot be expired. The obstruction of airflow may resolve spontaneously or with treatment.

A number of medications are used to prevent and control the symptoms of Asthma and to reduce the frequency and severity of episodes. Asthma medications are categorized into three main types: anti-inflammatory agents; broncho-dilators, which relax smooth muscle constriction and open the airways. These are known as RELIEVERS,  Salbutamol is the main generic name and Ventolin is the most used of these products.

SALBUTAMOL  - Pulvinal Salbutamol inhaler contains the active ingredient salbutamol, which is a type of medicine known as a short-acting beta 2 agonist. NB. Usually VENTOLIN - Salbutamol is also available without a brand name, ie as the generic medicine.

Salbutamol works by acting on receptors in the lungs called beta 2 receptors. When salbutamol stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open, therefore mechanically reversing the symptoms of Asthma.

In conditions where there is narrowing of the airways, such as Asthma or a chronic obstructive pulmonary disease - COPD, e.g. emphysema or chronic bronchitis, it is difficult for air to get in and out of the lungs. Through the relaxation of the muscles, salbutamol makes it easier to breathe.

Salbutamol is most commonly taken using an inhaler device - a small aerosol container is a small holder. Inhaling the medicine into the lungs, allows it to act directly and almost instantly, where it is needed most. It also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.

Salbutamol when used as an inhaler is known as a reliever. This is because it works very quickly to relieve Asthma attacks, wheezing, chest tightness or shortness of breath. Salbutamol inhalers can also be used to open the airways shortly before exercising to prevent chest tightness.

ALSO Leukotriene modifiers, which interrupt the chemical signaling within the body that leads to constriction and inflammation. These medications may be taken on a long-term daily basis to maintain and control persistent Asthma - long-term control medications, or they may be used to provide rapid relief from constriction of airways - quick-relief medications. Long-term control medications include corticosteroids, which are the most potent and effective anti-inflammatory medications available, and cromolyn sodium and nedocromil, other anti-inflammatory medications that are prescribed for children; broncho-dilators, such as long-acting beta2-agonists and methylxanthines - e.g., theophylline; and leukotriene modifiers, such as zileuton and zafirlukast. 

Quick-relief medications include broncho-dilators, such as short-acting beta2-agonists and ipratropium bromide, and systemic corticosteroids. A prolonged Asthma attack that does not respond to medication is called status Asthmaticus; a person with this condition must be hospitalized to receive oxygen and other treatment.

Leukotriene Inhibitors Montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo) are used to control Asthma symptoms. They are often used in addition to inhaled corticosteroids to avoid the use of oral cortico-steroid.

LTRAs inhibit the effects of the cysteinyl leukotrienes, which represent three of a large number of chemical mediators of Asthma.   Leukotrienes are released by several types of cells and can cause broncho-constriction and inflammation

How leukotrienes work

Leukotrienes are powerful chemical substances produced by the body. They promote the inflammatory response caused by exposure to allergens. Leukotriene inhibitors block the action or production of these chemicals, thereby reducing inflammation.

Who should not use these medications

• Individuals who are allergic to leukotriene inhibitors should not take these drugs.
• Individuals with phenylketonuria (PKU) should not take the chewable tablets that contain aspartame because this artificial sweetener contains phenylalanine.

Use 

• Leukotrienes are available with a prescription as tablets, chewable tablets, and oral granules.
• Granules may be taken directly in the mouth, or they may be mixed in soft foods like pudding or applesauce.
• The drug is administered as a once-daily dose.

Drug or food interactions

No drug or food interactions have been reported.

Side effects

Leukotrienes are typically well tolerated and side effects are similar to those of patients taking a placebo (sugar pill). Reports of headache, earache, sore throat, and respiratory infections have been noted.

In addition to managing Asthma with medications, persons who suffer from the disease are advised to minimize their exposure to the substances that trigger Asthma. The ability to recognize the early warning signs of an impending episode is important, and individuals can monitor the level of airflow obstruction in their lungs by using a pocket-size device called a peak-flow meter.

Whilst it is difficult for a toddler or child to always avoid allergens or triggers to Asthma, they should and will learn to reduce the events of Asthma, by knowing what to avoid, in any interim the parent must safeguard the child's heath as much as possible. 

In developed countries, and especially in urban areas, the number of Asthma cases has increased steadily, and Asthma now affects about 10 - 15 percent of the population. Reasons for this dramatic surge in Asthma cases, particularly among children, are not entirely clear. Air pollution, crowded living conditions, smoking, exposure to secondhand smoke, and even cockroaches have been blamed for the increase.

Ironically, advances in medicine may have contributed to rising rates of Asthma. The incidence of allergies and Asthma tends to rise in countries where childhood immunization rates are high. Theoretically this occurs because vaccines, though lifesaving, may disturb the normal development of the immune system. Certain naturally acquired childhood infections, like measles, are thought to trigger protective immune reactions. When children are vaccinated and thereby protected from infection, they may become hyper responsive to normally harmless substances in the environment. 

Antibiotics may also interfere with immune development. Children who are given broad-spectrum antibiotics - effective against multiple microorganisms - before two years of age are three times more likely to develop Asthma than are children who are not given such antibiotics.

Influenza - also called grippe or flu an acute viral infection of the upper or lower respiratory tract that is marked by fever, chills, and a generalized feeling of weakness and pain in the muscles, together with varying degrees of soreness in the head and abdomen.

Influenza is caused by any of several strains of orthomyxo viruses, categorized as types A, B, and C. The type A virus is the most frequent cause of influenza; this type occurs in numerous strains that are differentiated on the basis of the viruses' surface proteins, their geographic origin, date of isolation, and other factors. The three major types of influenza viruses generally produce similar symptoms but are completely unrelated anti-genically, so that infection with one type confers no immunity against the others.

Influenza A tends to occur in annual pandemics. The subtype of influenza A known as H2N2, or Asian flu, for instance, apparently began in East Asia early in 1957, and by midyear it had circled the globe. After 10 years of evolution that produced annual epidemics, the Asian flu disappeared in 1968, only to be replaced by a new influenza A subtype, H3N2.

Influenza may affect individuals of all ages, though the highest incidence of the disease is among children and young adults. Influenza is generally more frequent during the colder months of the year. The influenza infection is transmitted from person to person through the respiratory tract, by such means as inhalation of infected droplets resulting from coughing and sneezing. As the virus particles gain entrance to the body, they selectively attack and destroy the ciliated epithelial cells that line the upper respiratory tract, bronchial tubes, and trachea. The incubation period of the disease is one to two days, after which the onset of symptoms is abrupt, with sudden and distinct chills, fatigue, and muscular aches.

The temperature rises rapidly to 38 to 40 °C (101 to 104 °F). A diffuse headache and severe muscular aches throughout the body are experienced, often accompanied by irritation or a sense of rawness in the throat. In three to four days the temperature begins to fall and the person begins to recover. Symptoms associated with respiratory tract infection, such as coughing and nasal discharge, become more prominent and may be accompanied by lingering feelings of weakness. Mortality from the disease is often high because so many people are infected. Death is caused, in most cases, by complications such as pneumonia or bronchitis, usually among older people who are weakened by other debilitating disorders.

The antiviral drug amantadine has a beneficial effect on cases of influenza involving the A virus type. A newer category of drugs, the neuraminidase inhibitors, was introduced in the late 1990s; these drugs inhibit both the influenza A and B viruses. Other than this, bed rest and the use of aspirin or other analgesics to control fever remain the standard treatment. Individual protection against influenza may be bolstered by injection of a vaccine containing two or more circulating influenza viruses. These viruses are produced in chick embryos and rendered non infective; standard commercial preparations ordinarily include the type B influenza virus and several of the A subtypes. Protection from one vaccination seldom lasts more than a year, and yearly vaccination may be recommended, particularly for those individuals who are unusually susceptible to influenza or whose weak condition could lead to serious complications in case of infection. Routine immunization in healthy people, however, is also recommended.

Influenza epidemics have a long history; the first clear description of one is perhaps that of the epidemic of 1610. The most severe outbreaks in modern times have been those of 1889–90 and 1918–19. The influenza epidemic of 1918–19 was the most destructive influenza outbreak in history and one of the most severe disease epidemics ever encountered. It is estimated that 25 million persons throughout the world died of the disease. Subsequent outbreaks of influenza have been much less severe.

Flu or Influenza is a highly infectious illness, which spreads very rapidly by coughs and sneezes from people who are already carrying the virus.  The virus circulates every winter, usually over a period of a few weeks, so that a lot of people get ill around the same time.

See your GP about the flu jab if you’re 65 or over, or if you have any of these problems (however old you are):

• a serious heart or chest complaint, including serious asthma,
• serious kidney disease,
• diabetes, or
• lowered immunity due to disease or treatment such as steroid medication or cancer treatment.

Your GP may also advise you to have the flu jab if you have serious liver disease.

If you’re the parent of a child (over the age of six months) with a long-term condition, speak to your GP about the flu jab. Your child’s condition may get worse if they do catch flu.

If you’re the carer of an elderly or disabled person make sure they’ve had their flu jab. You should also get the jab yourself if their welfare is at risk (i.e. you can’t look after them) if you fall ill. Ask your GP for advice

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If there is anything you do not understand about this page please ask. All or most of our pages, without being patronizing, are written in stages. 

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Always ask questions, to broaden you own knowledge, and not just from the Internet but from your GP. Asthma  - A disorder or condition, in which breathlessness and wheezing are aggravated by certain stimuli, which cause the air passages -bronchi - to become constricted. Bronchial asthma may be an allergic reaction,  it may occur as a result of a chest infection, or it may be brought on by exertion, certain drugs, or strong emotion. The most common treatment is by means of drugs that relax and widen the air passages, usually in the form of aerosol inhalers. But this does not cure the problem.

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How Can We Help?

You must ask your self, how bad is the condition? 

Asthma is classified into four categories: 

Mild Intermittent, Mild Persistent, Moderate Persistent, and Severe Persistent. 

In every condition or disease, there are differing degrees of intensities. Some may have just a small tightness of the chest, where others are in an Intensive Care Unit, in an Oxygen Tank. Severe Persistent. The dilemma here is that had the person in the ICU, know what to do in the past; known how to manage their complaint, and known what NOT to do, they might be having a better standard of life.

Mild Intermittent, is having some minor bouts of breathlessness now and again, and not really knowing why? These are warning signs. These maybe, for arguments sake, something to do with stress, or just the environment you are living, or working in. You may get over it, and live a healthy life. Or it is the start of something much worse. Remember that asthma is getting worse, and it is effecting more people every year. And whilst you are young and fit, you may be able to smoke 20 cigarettes a day, eat burger and chips daily, and work under unsavory conditions, with a stinking hangover. But you might also be building up problems for yourself in the future.

If we could only get the 45 year old and take him or her back in time, to speak to that head-strong 17 year old, they used to be. What would they say. If we could only take that 17 year old, with all the hope in the world forward in time to meet themselves as a 45 year old. What would they say; what would they think of themselves?

How long have you had it?

If you have had the problem quite a time, you may well know what causes it and how to look out for problems. In any event always go and see your doctor, and ask their advice. But look to prevention, as opposed to always relying on drugs. 

Do you know what to do, to avoid Asthma symptoms?

Do you stay away from the triggers that start you off? Do you take your drugs on a regular basis, or do you make sure you are fit? Are you overweight? A fat person is three times more likely to suffer shortness of breath that a slim person.

Could you have just an allergic reaction as opposed to Asthma?

Many people with tight chests and runny noses, are really just suffering from allergies, and do not have Asthma, just similar symptoms. See your doctor. 

Are you confident that you can manage your Asthma?

A lot of Asthma is stress related. You may have a mild Asthma, but stress is making it worse. You maybe stressed, worrying about Asthma and this is what is giving you Asthma, in the first place.

Stress might then even be the trigger. Stress may actually be coming out in you, not as a feeling of despair, or depression, but as Asthma. Manage the stress and the Asthma could go away.

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