WORLD ASTHMA DAY 2023
Asthma is a common disease and has a range of severity, from a very mild, occasional wheeze to acute, life-threatening airway closure. It usually presents in childhood and is associated with other features of atopy, such as eczema and hayfever and May 2nd is a day to remember them and their peculiarities and further embrace them.
Asthma as research proven is a very common childhood illness leading to multiple hospital admissions and increased healthcare costs. The key feature is airway hyper-responsiveness, which can be triggered by many factors. If not treated promptly, asthma has a high mortality.
Cause
Asthma comprises a range of diseases and has a variety of heterogeneous phenotypes. The recognized factors that are associated with asthma are a genetic predisposition, specifically a personal or family history of atopy (propensity to allergy, usually seen as eczema, hay fever, and asthma).
Asthma also is associated with exposure to tobacco smoke and other inflammatory gases or particulate matter.
The overall cause is complex and still not fully understood, especially when it comes to being able to say which children with pediatric asthma will carry on to have asthma as adults (up to 40% of children have a wheeze, only 1% of adults have asthma), but it is agreed that it is a multifactorial pathology, influenced by both genetics and environmental exposure.
Triggers for asthma include:
- Viral respiratory tract infections
- Exercise
- Gastroesophageal reflux disease
- Chronic sinusitis
- Environmental allergens
- Use of aspirin, beta-blockers
- Tobacco smoke
- Insects, plants, chemical fumes
- Obesity
- Emotional factors or stress
Patients sometimes, will give a history of a wheeze or a cough, worsened by allergies, exercise, and cold. There is often diurnal variation, with symptoms being worse at night. Patients may give a history of other forms of atopy, such as eczema and hay fever. There may be some mild chest pain associated with acute exacerbations. Many asthmatics have nocturnal coughing spells but appear normal in the day time Often, children with imminent arrest may appear drowsy, unresponsive, cyanotic, and confused. Wheezing may be absent, and bradycardia may occur, indicating severe respiratory muscle fatigue.
Life-threatening asthma is a type of asthma that does not respond to systemic steroids and beta 2 agonist nebulization. It is necessary to identify it early as it may lead to high mortality. It has the following characteristic findings on examination.
OCCUPATIONAL THERAPY INTERVENTION STRATEGY(S)/MEASURE
- Measures to take include calming the patient to get them to relax, moving outside or away from the likely source of allergen, and cooling the person. Removing clothing and washing the face and mouth to remove allergens is sometimes done, but it is not evidence-based.
- Environmental control is vital if one wants to avoid recurrent attacks. Allergen avoidance can significantly improve the quality of life. This means avoiding tobacco, dust mites, animals, and pollen.
- Weight reduction in obese asthmatics leads to improved control.
- Allergen immunotherapy remains controversial. Large studies have not shown any significant benefit, and the technique is prohibitively expensive.
There are five steps in the management of chronic asthma; treatment is started depending on the severity and then escalated or de-escalated depending on the response to treatment.
- Step 1: The Preferred controller is as needed low dose inhaled corticosteroid and formoterol.
- Step 2: The preferred controllers are daily low dose inhaled corticosteroid plus as-needed short-acting beta 2 agonists.
- Step 3: The preferred controllers are low dose inhaled corticosteroid and long-acting beta 2 agonists plus as-needed short-acting beta 2 agonists.
- Step 4: The preferred controller is a medium-dose inhaled corticosteroid and long-acting beta 2 agonist plus as-needed short-acting beta 2 agonists.
- Step 5: High dose inhaled corticosteroid and long-acting beta 2 agonist plus long-acting muscarinic antagonist/anti-IgE.
SIGNS FOR ADMISSION
If a patient has received three doses of an inhaled bronchodilator and shows no response, the following factors should be used to determine admission:
- The severity of airflow obstruction
- Duration of asthma
- Response to medications
- Adequacy of home support
- Any mental illness
Patients with life-threatening asthma are managed with high flow oxygen inhalation, systemic steroids, back to back nebulizations with short-acting beta 2 agonists, and short-acting muscarinic antagonists and intravenous magnesium sulfate. Early involvement of the intensive care team consultation helps to reduce mortality. In the case of near-fatal asthma, early intubation and mechanical ventilation are needed.
Other/Long Term
Weight loss, smoking cessation, occupational change, and self-monitoring are all important in preventing disease progression and reducing the number of acute attacks.
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