What Is Asthma?

UNLIKE other common chromic illness such as diabetes or hypertension, which have a simple definition, asthma is a clinical condition that is defined by its clinical, physiological and pathological features.

Asthma is a chronic inflammatory disorder or the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airways hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing, especially at night or in the early morning.

These episodes are usually associated with widespread, but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

Clinical manifestations of asthma is controlled, there should be severe exacerbations should be rare.


Burden of asthma

Asthma is a major problem worldwide with almost 300 million people suffering from asthma. Poorly controlled asthma is also a major cause of morbidity and mortality as such it is a burden to the health care system.

The cost of asthma to any health care system depends on the individual patient's level of control and the extent to which exacerbations are avoided.
Point to note include:

- Emergency treatment is more expensive that scheduled treatment.
- The non-medical economic cost of asthma is substantial
- Guidelines have determined that asthma care can be cost effective
- Families can suffer from the financial burden of treating asthma

Based on these findings, from the perspective of both the patient and society, the cost of not treating asthma correctly is very much higher.

Thus using guidelines such as the GINA guidelines to deliver appropriate care based on the severity of the patient's asthma is probably the most cost efficient way to optimize asthma care.


Factor that cause asthma

Factor that influence the risk of asthma can be divided into those that cause the development of asthma and those that trigger asthma symptoms. The mechanisms by which they influence the development and expression of asthma are very complex and interactive.

Host factor that influence the development of asthma are genetic predisposition to atopy and airway hyper responsiveness. Environmental factors that cause asthma are allergens both indoor and outdoor, infections, occupational sensitizers, tobacco smoke, outdoor and indoor pollution.


Mechanism of asthma

Asthma is an inflammatory disorder that is driven by the inter-play of several inflammatory cells and multiple mediators which result in a wide and variable spectrum of manifestation of the disease.

There is an interaction between inflammatory cells and inflammatory mediators. The inflammatory cells are those which are found in allergic diseases such as mast cells and eosinophills. The list of known inflammatory mediators keeps growing and at the last count there are more that one hundred (100) known mediators, and the list keeps growing.


Diagnosis of asthma

A clinical diagnosis of asthma is made when a person has symptoms of episodic breathlessness, wheezing, cough and chest tightness. Measurement of lung function provides an objective assessment of the severity of airflow, its reversibility and help confirm the diagnosis.

Clinical control of asthma is defined as:

-Daytime symptoms not more than twice a week

-No limitation of daily activities

-No nighttime symptoms

-Using relive medications not more than twice in a week

-Normal or near-normal lung function

-No acute attacks.

Treatment of asthma

The goal of asthma treatment is to achieve and maintain clinical control. The drugs used can be divided into controllers and relievers. Controllers are drug that are taken on a daily basic to keep asthma under control. Examples include inhaled steroids, sustained release theophyllines, leukotrine modifiers, and combinations of long acting beta-agonist with inhaled steroids.
Relievers are drugs that are used on an as needed basic to rapidly reduce the symptoms of breathlessness, and include drugs such as short-acting beta-agonists.
Asthma medications can be given by the inhaled, oral and intravenous route. It is preferable that inhalation therapy is used in asthma so that the drugs are delivered directly into the lungs. This ensures that the drug is delivered directly to the airways, producing higher concentrations of the drug at target sites with reduced total dose, thus reduced total dose, thus reducing the occurrence of side effects.
Increased use of relievers is a warning sign of worsening asthma and any patient who uses his or her reliever more that two times in a week is in danger of having a life threatening attack of asthma.

Asthma management –Effective partnership between patient and doctor

Effective management of asthma requires the development of a partnership between the patient and the healthcare provider. The aim of this partnership is guided self-management-that is, to empower asthmatic individuals with the ability to control their own condition with guidance from health care professionals.
The patient must be given adequate education on the role of the various symptoms so that they are in a position to take the necessary steps to maximize the control of their asthma.