Asthma - Cough & Rough breath
Definition
Asthma is a disease of the 'bronchi' that is a pathway to the lungs. When exposed to a specific causative agent, the bronchus is severely narrowed by inflammation of the bronchus, coughing, wheezing (his breathing), difficulty breathing, and chest tightness It is a disease that occurs. Bronchial mucous membranes are swollen due to inflammation of the bronchus, and as the bronchial muscles spasm, mucus is secreted and the bronchial tubes become clogged and breathless. If this is repeated, fibrosis and airway remodeling may occur, resulting in permanent lung function deterioration.
Cause
Usually, genetic and environmental factors play an important role, and the severity of symptoms or asthma varies depending on the patient.Host factor
-Genetic factors
-Obesity: Asthma is more common in obese people. Obese asthma patients have less lung function and more comorbidities than normal-weight patients.
-Gender: Males older than 14 years have twice the prevalence of asthma than women. However, as it grows, the differences between genders gradually decrease. In adults, the prevalence of asthma in women is higher.
Environmental factors
-Allergens: Allergens, both indoors and outdoors, that is, allergens, are well known to cause asthma. However, the direct cause has not been sufficiently confirmed to date.
-Infection: In childhood, various viruses are involved in asthma development.
-Workable sensitizer: A substance that can cause asthma when exposed in a working environment
-Smoking: Asthma suffers decreased lung function, worsens symptoms and reduces the effects of inhalation and systemic steroid treatment, making it difficult to treat asthma. In children, exposure to cigarette smoke increases the risk of developing asthma-like symptoms in childhood.
-Indoor / outdoor air pollution: The greater the air pollution, the worse the asthma. It is associated with an increase in contaminants or a bite of a specific allergen that is sensitive to the individual.
-Food: Infants with infants who are breastfed have less wheezing than infants who have milk or soy milk. Some studies have reported that westernized eating habits are associated with increased asthma and atopic diseases.
Symptom
Inflammation occurs in the bronchus, causing a lot of phlegm, and as a result of various stimuli, the bronchus contracts and the air is not easy to pass, resulting in asthma symptoms.Typical asthma symptoms include wheezing, difficulty breathing, chest tightness, and coughing. Symptoms may occur temporarily after exposure to allergens, and asthma is likely to occur if there are seasonal changes in symptoms and a family history of atopic disease.
Normally, most people live a normal life without disease, but sudden symptoms deteriorate due to various causes. This is called 'asthma attack' or 'acute exacerbation of asthma'. Signs of an asthma attack include symptoms that are rapidly becoming worse, not getting better after taking a bronchodilator, or having difficulty speaking due to dyspnea. In some cases, severe asthma attacks require immediate emergency and hospitalization. At this time, the patient feels fear of dying soon, and a severe asthma attack is actually life-threatening.
Many people complain of atypical symptoms. For example, if only a dry cough appears repeatedly, the person may complain of symptoms such as stuffiness in the chest or chest tightness, or sputum in the throat.
Diagnosis / Test
Difficulty breathing, wheezing, chest tightness, and cough, typical symptoms of asthma, can also be caused by other conditions.You may suspect asthma if you have any of the following symptoms:
-Two or more of the typical symptoms (difficulty breathing, wheezing, tightness in humidification, coughing) exist simultaneously
-The intensity of symptoms changes with time, mainly worsening at night or early morning
-Causes symptoms when exposed to the following factors: viral infections such as colds, exercise, allergen exposure, weather changes, laughter, irritating substances such as fumes or strong odors
If you have any of the following symptoms, you should also consider the possibility of other diseases.
-Cough without other symptoms
-Chronic cough with sputum
-Dizziness, dizziness or shortness of breath accompanied by numbness
-Chest pain
-Exercise-induced dyspnea with loud inspiring sounds
Pulmonary function tests are tests that objectively evaluate how narrow the bronchi is, how wide it is after drinking bronchodilators, and how large the variability is. Airway inflammation markers can be evaluated by observing eosinophils or neutrophils in sputum or by measuring nitric oxide.
Elderly asthma is difficult to diagnose. Older people often don't recognize symptoms well, and sometimes the hard symptoms are attributed to age. That's why you often don't notice your symptoms. In addition, it is difficult to diagnose because many diseases often occur together.
In children, pulmonary function tests are often difficult to perform, and diagnosis is not easy because diagnosis is made based only on symptoms and medical history.
Treatment
In some children, asthma can be completely cured, but adult asthma is difficult to cure. Even if there are no symptoms for a long time, asthma symptoms may recur due to triggers.Treatment of asthma is basically a combination of environmental and drug therapies, and the disease must be steadily controlled to prevent acute exacerbations and maintain quality of life. Environmental therapy is a method of recognizing and avoiding risk factors (allergens, dust, etc.) that cause asthma symptoms. Medication therapy includes inhalers, oral medications, and injections, but inhalants are the first to be used with less side effects and superior effect.
Drugs include controllers and relievers. Modulators are drugs that are used constantly to control asthma symptoms through anti-inflammatory effects. These modulators are used for the purpose of preventing frequent symptoms recurrence and severe respiratory distress by continuously reducing inflammation of the bronchus. Therefore, even if the symptoms disappeared, since the praise was not cured, the modulator should be continuously administered for a certain period of time. A symptom reliever is a drug that improves symptoms by expanding the bronchi and is used only when necessary. Controlling asthma while using prescribed medications is the most important treatment. Immunotherapy may be attempted if drug therapy is not sufficiently regulated, and recently biologic drugs have been developed and tried.
1. Drug therapy
Asthma treatment drugs are divided into symptomatic relievers that relieve narrowed bronchi in a short time and disease control agents that prevent asthma attacks by suppressing allergic inflammation of the bronchi. In the treatment of asthma, inhalants are preferentially used, because if inhalants are used, a sufficient therapeutic effect can be obtained even in a smaller amount than other administration methods, and the effect of the drug is fast and there are few side effects.
1) Symptom reliever
As typical symptom relievers, beta2 anti-inflammatory drugs (agonists), xanthine-based drugs represented by theophylline, and anticholinergics are widely used.
-Beta2 agonist : Bronze muscle spasm by reducing the spasm of the bronchodilator drugs are inhaled, oral, injectable. Inhalers are effective because they act directly on the bronchus, have a strong effect even in small amounts, and have little side effects, making them widely used. It is also used for the prevention of night asthma and exercise-induced asthma due to the long working time of the drug. However, anti-inflammatory drugs should be used regularly because they cannot eliminate the underlying inflammation.
Xanthin drugs: Antiallergic (anti-inflammatory) effects along with bronchial dilation help control asthma. There are no inhalants and there are oral and injectables.
-Anticholinergic drugs: drugs that broaden the bronchi by preventing the effects of the parasympathetic nerves that narrow the bronchi. It is not the primary treatment for asthma, but it can be effective when used with other medications in older asthma patients.
2) disease regulators
-Adrenal cortical steroids: Representative disease control agents (anti-inflammatory drugs) are inhaled and oral. Long-term use of oral steroids can cause serious side effects, such as elevated blood sugar, increased blood pressure, weight gain, mood swings, osteoporosis, stomach ulcers, and more. However, if an inhaler is used, there is little side effect because it is hardly absorbed systemically. However, side effects of inhalants may cause sore throat or mold in the mouth, so be sure to rinse your mouth after using the inhalant.
-Leukotriene modulator: improves lung function in asthma patients and reduces the number of symptoms and the number of beta2 anti-inflammatory drugs used.
Biological drugs: Biological drugs such as anti-IgE inhibitors and anti-IL-5 inhibitors are also used in poorly controlled patients.
2. Immunotherapy
It is a treatment that can be performed when the cause of allergy is certain but effective treatment is difficult only by environmental management. Typically, immunotherapy lasts for more than 1 year to take effect, and usually lasts for 3 to 5 years, but often requires longer treatment.Progress / Complication
While maintaining medication, if you don't have asthma symptoms and asthma attacks for a long period of time, you can reduce your medication by one step. If the asthma is controlled afterwards, the drug can be stopped. However, since asthma is not cured, it may worsen again, so do not arbitrarily stop and stop it.Even when asthma is well controlled, acute exacerbations can occur when exposed to various exacerbations such as colds, flu, antigens, and stress. Acute exacerbation of asthma is an emergency that can lead to life threats.
Signs of acute asthma exacerbation
-Symptoms get worse rapidly and do not improve even after inhaling bronchodilators
-Difficulty speaking due to difficulty breathing
-Maximum exhalation flow rate below 50% of normal
If there are signs of acute exacerbation of asthma as above, prompt treatment is required and an emergency room should be visited.
If asthma treatment is not performed properly and exacerbation occurs frequently, pulmonary function continuously decreases, making daily life difficult, and long-term oxygen treatment may be necessary.
Prevention method
To successfully manage asthma and prevent asthma from getting worse-You need to understand what kind of asthma is.
-Through environmental management, causative substances and deteriorating factors should be avoided.
-You should use the medicine prescribed by your doctor regularly and accurately.
-It is necessary to know and use the device of the therapeutic agent sufficiently.
-Even if symptoms are controlled, treatment should be continued to prevent recurrence and complications.
Diet / Life Guide
Asthma can be exacerbated by a variety of risk factors, including allergens, viral infections, pollutants, and drugs. Therefore, exposure to risk factors (smoking, secondhand smoke, occupational substances, food, additives, and drugs) should be reduced to prevent exacerbations. In addition, allergens, viral infections, and contaminants should also be avoided. You must stop smoking, and avoid going out on a day with a lot of fine dust and wear a mask when you go out. If you are allergic to pollen, it is helpful to wear a mask when you go out during the season when the pollen is blowing a lot. You should be vaccinated against flu and pneumonia and avoid going out on cold days to avoid respiratory infections. When cooking smoke in the house, indoor ventilation should also be taken into account when cleaning the room.When asthma is poorly controlled, exercise should be done with extreme exercise as it can worsen asthma symptoms. In order to exercise, you need to maintain a stable state through proper drug treatment and choose an exercise that does not cause asthma symptoms. In particular, it is not good to exercise in a hurry of cold and dry air. Therefore, exercise such as indoor swimming, which is relatively warm and humid, is more appropriate than outdoor exercise in which a lot of cold air is consumed in winter. You should also avoid outdoor exercise on fine dusty days. If you have asthma symptoms easily when you exercise, it is helpful to use a symptom reliever (a fast-acting bronchodilator) before starting exercise.
When the atmospheric fine dust concentration is high, the indoor fine dust concentration also increases. Therefore, it is recommended to close the window and stay indoors on a day when the concentration of fine dust is high. Indoor direct heating and cooking should also be avoided as they increase the concentration of fine dust.
Although it is not clear whether using an air purifier at home is effective in improving the symptoms of asthma, it is thought that it will help to prevent the exacerbation of asthma symptoms by reducing the concentration of indoor fine dust. If there is no other way to reduce exposure to allergens or irritants, you can try it. However, when using an air cleaner, keep the doors and windows closed.
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