Breathing Freely: What You Need to Know About Asthma

Breathing Freely or Asthma is one of the world’s leading chronic inflammatory diseases . It affects both adults and children and, if left untreated, can be fatal. It is an inflammation of the lungs that causes the muscles around the airways to contract, making breathing very difficult.

The characteristic symptoms of asthma are: wheezing , coughing , shortness of breath and chest tightness .  They can vary from person to person and in their intensity.

What are the causes and types of asthma?

Breathing Freely or Asthma is a heterogeneous disease, so its origin and severity arise from several factors, such as genetic and environmental factors .  It is classified according to severity (such as mild, moderate and severe), and severity can also vary over time.

Among the types of asthma, there are two main groups: intrinsic asthma (non-atopic, non-allergic) and extrinsic asthma (atopic, allergic) .

These differences help in making decisions about treatment. However, it is not always possible to clearly distinguish the clinical manifestations of asthma based solely on these two criteria. This is because the disease can occur through several different mechanisms and varied clinical manifestations .

“Even within groups of patients with similar observable clinical characteristics, there may be variability , which shows the complexity of the disease”,  points out Dr. Maura Neves, Otorhinolaryngologist.

The mechanisms by which asthma can occur are important parameters for classifying the disease into two large groups, eosinophilic or non-eosinophilic asthma . Among these, there are several subgroups that classify patients according to:

  • severity of the disease;
  • triggers;
  • age of onset;
  • inflammatory patterns;
  • exacerbations;
  • airflow obstruction.

Eosinophilic asthma

There are several subtypes that affect both children and adults.  They are divided into three categories: early-onset allergic asthma; late-onset eosinophilic asthma; and aspirin-exacerbated respiratory disease .  Learn more about each one!

Early-onset allergic asthma

This is the standard type of asthma and can be mild or severe. It is usually associated with a family history of allergies and appears in response to substances present in the environment that cause allergies, such as:

  • mites;
  • animals with fur, such as dogs and cats;
  • fungi;
  • pollen;
  • cheap;
  • rodents, such as rats and mice.

Late-onset eosinophilic asthma

These patients are usually older, resistant to treatment with oral and inhaled anti-inflammatory drugs, and have a more severe condition with airflow obstruction. 6 Most have comorbidities such as rhinosinusitis with nasal polyps.

A subtype of this type of asthma is aspirin-exacerbated respiratory disease (AERD) .

 It is not yet known exactly how it occurs, but it worsens inflammation in the respiratory system. 8 This happens because aspirin activates the production of potent bronchoconstrictors, substances that cause a decrease in airflow.

Factors that aggravate this type of asthma

Some genetic and environmental exposure factors can worsen eosinophilic asthma and impair treatment with anti-inflammatory drugs. Among external factors, respiratory viruses, such as rhinoviruses, are a common cause.  The cause appears to be a deficiency in the defense against viruses.

Asthma can also be aggravated by pollution . This applies to both pollution from natural sources (dust, pollen and fungi) and pollution caused by human activities, such as cigarette smoke, vehicle smoke and industrial smoke.  Some pollutants, in fact, not only worsen symptoms, but can also cause the development of asthma.

Contact with small airborne substances has a strong association with the development of asthma in adults. In the case of women, exposure to these substances during pregnancy contributes to the occurrence of asthma after pregnancy.

Another important risk factor in the development and worsening of asthma is smoke from burning tobacco For women who smoked during pregnancy, the risk of developing asthma extends into the second generation!

Non-eosinophilic asthma

In this type, when there is inflammation, it is induced differently from eosinophilic asthma.  As for the subtypes, we can highlight two. The first is asthma associated with obesity , more common in middle-aged women. The symptoms are severe, although lung function is moderately preserved.

The second is asthma related to tobacco smoke , which causes inflammation and makes the individual more sensitive to substances that cause allergies .

A recent classification considers this subtype as an association between asthma and chronic obstructive pulmonary disease (COPD) , a syndrome known as ACOS.

It is characterized by affecting patients over 40 years of age and with a history of smoking and airflow obstruction, but who also present classic characteristics of asthma, such as reversibility of obstruction, allergic reaction and increased eosinophils (cells of the immune system). It is, therefore, a case of overlap.

Finally, late-onset asthma (>50–65 years) is associated with age-related declines in lung function and the immune system.

Exercise-induced asthma

Intense physical exercise can also induce bronchoconstriction, mainly affecting children and adolescents with asthma.  It usually begins in the first few minutes of activity and disappears spontaneously after 20-40 minutes. A response can also occur between 4-10 hours after exercise.

It is not known exactly how it occurs, but there are some hypotheses.  One of them considers that the inhalation of dry , cold air causes a cooling of the airways followed by reheating and that this thermal effect causes a reaction in the airways. Another assumes that dehydration in the airways stimulates the release of substances that cause obstruction.

An inflammatory response may be an additional mechanism in the activation of asthma. In samples from children, cells related to inflammation have been found, while no changes were observed at rest.

Occupational asthma

Although allergic asthma usually begins in childhood, in some cases it can manifest later in life. This occurs when we are faced with a new type of substance that causes allergies. One example is occupational asthma , that is, asthma that arises from exposure to substances that cause allergies present in the workplace.

This subtype of asthma can also be caused by irritating substances  and does not involve inflammatory reactions.  Thus, it can occur due to primary contact with the substance or when this substance, in particular, worsens symptoms in people who already have asthma. Some examples of substances that induce occupational asthma are:

  • wheat;
  • glues;
  • latex;
  • wood dust;
  • dyes.

What are the complications of asthma?

Over time, the lung capacity of people with asthma can decrease, even causing airway obstruction.  This occurs because the lung walls become thicker,  and this situation can become permanent.

Severe asthma attacks may require hospitalization, hospitalization, and ventilation to help with breathing.  With a persistent cough and symptoms that are worse at night or in the early morning , asthmatics may suffer from insomnia, feel fatigued throughout the day, and even miss work or other commitments.

Asthma and comorbidities

Some comorbidities can influence the condition and progression of asthma and the patient’s well-being, such as obesity, apnea, food allergy, allergic rhinitis , chronic rhinosinusitis and chronic diseases that require regular medical treatment, such as diabetes, cardiovascular disease , lung cancer and COPD.

People with diabetes have an increased risk of developing asthma, while diabetic asthmatics have more severe attacks.

Understanding these relationships is an important step when considering asthma control strategies. The use of anti-inflammatory drugs, for example, can increase the incidence of diabetes, leading physicians to consider their use in patients at increased risk for this condition.

Similarly, obesity is associated with an increased risk of asthma, while asthmatics are more likely to become obese. 12 Obese individuals have impaired lung function, and those with both conditions tend to have less control over their asthma symptoms.

Asthma also contributes to the occurrence of cardiovascular events, both chronic and acute. 12 On the other hand, among these diseases, only hypertension is a potential risk factor for asthma.

People with asthma and hypertension need to be careful, because non-selective beta-blockers, used to treat hypertension, can cause bronchoconstriction, a condition that reduces airflow. 12 Medications to control asthma are associated with an increased incidence of cardiovascular and cerebrovascular events.

Can asthma kill?

The incidence of asthma has decreased between 1990 and 2019.  Despite this, young adults and children are at risk of mortality, regardless of whether or not they have conditions that aggravate asthma or make treatment more difficult.

The specific cause of death in patients with asthma varies greatly. It includes diseases that affect the respiratory system, such as infections and cancer, as well as cardiovascular diseases, diseases of the digestive and endocrine systems, immune disorders, among others. In fact, asthma is a factor that increases the risk of death from any cause .

In addition to mortality, this disease has a significant impact on disability , which is measured by the DALY ( Disability Adjusted Life Years) indicator. It combines two parameters: the years lost due to premature death and the years lived with disability.

How to get an asthma diagnosis?

Although asthma is common, its diagnosis is not so simple. Although reversibility of airway obstruction and excessive sensitivity to different triggers are characteristics of asthma, the diagnostic criteria are still not very well defined .  Even so, it is characterized by the following symptoms and findings:

  • whistling sound when breathing, shortness of breath, coughing, tiredness and tightness in the chest;
  • symptoms that tend to be worse at night or in the morning;
  • symptoms that vary in intensity over time;
  • symptoms that worsen when the patient has a viral infection;
  • symptoms resulting from exposure to substances that cause allergies or irritation, exercise, climate changes and emotional factors.

In adults, diagnosis may involve clinical examination and lung function tests . An example of a low-cost and easy-to-perform test is spirometry .  Using a device called a spirometer, it assesses the airflow in the lungs and compares it to the values ​​of healthy people.

Even in people with asthma, this test may result in normal values.  In this case, it is possible to perform a bronchoprovocation test with methacholine or mannitol to assess whether there is excessive sensitivity of the airways. 5 In general, it is only performed in adults.

Complementary exams

In the initial evaluation, a chest X-ray may be requested , especially if the patient is a smoker. In the blood test , inflammation is investigated by counting the cells in our defense system.

Skin tests are used to assess specific sensitization to substances that cause allergies, with the advantages of low cost and immediate reading of results. 5 This allergy test can also be performed by measuring the level of a specific antibody that is produced in allergic processes.

Attention ! Not everyone can take this test, due to the risk of anaphylaxis (fatal allergic reaction), such as when the patient:

  • have moderate or severe atopic dermatitis ;
  • are taking medications that may interfere with test results, such as tricyclic antidepressants, antihistamines, and angiotensin-converting enzyme (ACE) inhibitors.

Differential diagnosis

The symptoms of asthma overlap with those of many other diseases, which makes it difficult to diagnose. Therefore, it requires a thorough history and physical examination . 5 Some examples are vocal cord dysfunction, chronic obstructive pulmonary disease, allergic bronchopulmonary mycoses, tuberculosis and heart failure .

Remember: some diseases can also be considered comorbidities that worsen symptoms, such as reflux and rhinosinusitis.

What are the treatments for asthma?

Several factors make asthma treatment difficult, from individual patient characteristics to incorrect use of inhalers.  Since the disease can increase the risk of mortality from any cause, control requires assessing comorbidities, especially since many of them can worsen asthma symptoms.

As we have said, asthma has no cure .  Therefore, the main objectives of treatment are:

  • control the disease;
  • reduce the risk of complications and deaths;
  • minimize the side effects of treatment with inhaled or oral anti-inflammatory drugs.

Standard treatment is with anti-inflammatory drugs , primarily inhaled corticosteroids and bronchodilators.  These are preferable because the dose of medication used is lower, has a more local effect and fewer side effects.

In conclusion,

“Breathing Freely” represents a commitment to enhancing respiratory health and overall well-being. By embracing innovative solutions like the 156 CRECTOR, individuals can experience improved airflow and comfort in their environments. Prioritizing clean air and effective breathing aids not only supports physical health but also contributes to a better quality of life. Embrace the freedom of breath and take proactive steps towards a healthier future.

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