India contributes to 11.1% of the global Asthma patients and 42% of its related deaths. This makes India the Asthma capital of the world. This disease affects 5-10% of the population worldwide and as many as 23.4 million people which includes 7 million children. Annually, the WHO estimates that 250,000 lives are lost worldwide due to Asthma.

Lack of awareness and numerous misconceptions add to the prevailing challenges around this disease, even though this is such a common disease in India.

We spoke to the Chief Medical Officer at Dhani Healthcare, Dr. Smita Dash, who enlightened us about the causes that aid in Asthma, its triggers, preventive measures, how to manage Asthma and addressed the popular misconceptions around Asthma. Dr. Dash is a family physician and a public health specialist. Before she began her practice in India, she worked for a year in the United Kingdom where she was a part of Royal College of Physicians and developed the clinical guidelines for NICE.

What is Asthma and how it affects our airways

Asthma, also called bronchial Asthma, is a medical condition where airways in the lungs narrow and swell and can produce extra mucus. This makes breathing difficult and can trigger coughing or a whistling sound (wheezing) when breathing out.

When we breathe, the air goes in from the nose or mouth through the airways into the lungs. These airways divide up into very small air passages and transport oxygen from the air to our blood. When a person has Asthma, the lining of these airways swell and tighten and mucus fills the airways, eventually blocking them. Due to this, less amount of air is able to pass through these airways, causing breathing problems.

Symptoms and severity

Asthma affects children and adults, both. However, the severity of its symptoms can vary from person to person. Some may experience it as a minor nuisance while others may find it a major hurdle that interferes with their daily life. In any case, Asthma can not be cured but can definitely be controlled so that you can lead a symptom free life ahead.
The symptoms of Asthma are:

• Shortness of breath
• Chest tightness or pain
• Wheezing when breathing out (especially in children)
• Difficulty in sleeping due to shortness of breath, coughing or wheezing
• Coughing or wheezing attacks which are worse when having a cold or the flu

Identifying with symptoms if Asthma is getting worse

Some symptoms do help in identifying if Asthma is getting worse. Here are the things one should look out for:

• Symptoms are more frequent and bothersome
• Increasing difficulty breathing – checked with a instrument called peak flow meter
• Frequent use of an inhaler

What causes Asthma

Generally, pollen and pollution are considered the main factors contributing to Asthma. However, it could be hereditary issues as well. Listing down some common causes:

Genetic

• More likely if other family members or close relatives also have Asthma
• More likely in people who have other allergic conditions, such as atopic dermatitis, eczema or hay fever

Environmental

• Urbanisation is associated with increased Asthma prevalence
• Exposure to environmental allergens increases the risk of Asthma such as air pollution, house dust mites, moulds
• Occupational exposure to chemicals, fumes, or dust

Congenital or birth related factors

• Low-birth weight, premature birth
• Exposure to tobacco smoke and other sources of air pollution, as well as viral respiratory infections

Being overweight or obese increases risk of Asthma
Being a smoker or exposure to second-hand smoke also increases the risk

Here are the top triggers for Asthma

Exposure to various irritants and substances that trigger allergies (allergens). The triggers can vary person to person. Here are some of them:

• Airborne allergens, such as pollen, dust mites, mould spores, pet dander or particles of cockroach waste
• Respiratory infections, such as the common cold
• Physical activity
• Cold air
• Air pollutants and irritants, such as smoke
• Certain medications, including beta blockers, aspirin, and NSAIDs e.g., ibuprofen, naproxen
• Strong emotions and stress
• Food preservative and sulfites added to some types of foods including seafood, dried fruit, processed potatoes, beer and wine
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

How to manage or treat this condition

Asthma is typically managed by a combination of medications and avoiding triggers. Medications to manage Asthma include:

• Short term relief medications – open swollen airways quickly that are limiting breathing; taken during acute attacks
  1. Short term beta agonists
  2. Anticholinergic agents
  3. Oral/parenteral steroids
• Long term control/preventive medications- reduce the swelling and inflammation in the airways; taken daily or regularly
  1. Inhaled corticosteroids
  2. Leukotriene modifiers
  3. Theophylline
• Allergy medications (needed in many cases)
• Bronchial thermoplasty-rare

Apart from this, it is very important to discuss and agree on an Asthma control action plan with your doctor. This will include:

• Listing of triggers and the steps to avoid them
• When to take certain medications
• When to increase or decrease the dose of your medications based on symptoms on the advice of your doctor
• Tracking Asthma symptoms or using a peak flow meter on a regular basis to monitor response to treatment

Preventive measure to control or prevent Asthma attacks

There are a few things that people with Asthma or allergies can do to prevent Asthma attacks:

• Follow your action plan – If you have an ongoing condition, it is important to monitor regularly and treat it as per requirement
• Monitor your breathing – Recognize warning signs of an impending attack; regularly measure peak airflow with a home peak flow meter
• Identify and treat attacks early – This will help to prevent severe attacks and would need less medication
• Take medications as prescribed by your doctor
• Monitor use of rapid relief inhaler – Frequent use may be a sign of worsening Asthma During such a case, please speak to your doctor at the earliest.
• Vaccination for flu and pneumonia
• Avoid your Asthma triggers
• Minimise dust and maintain optimal humidity, reduce mould and pet dander
• Regular exercise – This would help to strengthen your heart and lungs
• Maintain a healthy weight
• Control GERD

Uncovering Common Misconceptions

Lack of knowledge has led to the development of a lot of misconceptions related to Asthma. It is important to burst the bubble and help the one dealing with this disease, with the right information. Some common myths are:

• Asthma is a childhood disease, you can grow out of it as you age
• It is infectious
• If you have Asthma, you must not exercise
• Asthma can be controlled only with a high dose of steroids

In case you have a concern or query regarding Asthma, consult top doctors on the Dhani app. With Dhani doctor, you can speak to any of our doctors who will be able to help you with your health concerns. Get connected to Dhani doctor in just 10 seconds, available 24×7. Download today to try free consultations for 30 days.

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