An asthma attack can make you suffer from severe shortness of breath, tightness in the chest, coughing, wheezing, and fatigue. In some cases, flare-ups of asthma can be traumatic and life-threatening. According to the 2016 Global Burden of Disease Survey, there are 339 million asthmatics in the world, of which 1/10^th are in India.

What is asthma?

When we breathe, oxygen flows from the mouth or nose to the lungs through a series of airways. Oxygen diffuses into the blood, which then carries it to every part of the body for it to function normally. 

But when the airways are blocked, narrowed, or get inflamed due to infections, injury, or allergies, the flow of air gets restricted. 

In case of asthma, the airways become overly sensitive to allergy-producing substances called allergens.  When allergens enter your airways, the immune system reacts aggressively against them. It releases cells and chemicals that cause inflammation, swelling and narrowing of the airways.

Tightening of muscles, secretion of mucous, and narrowing of airways make it harder for air to pass through. An asthmatic patient finds breathing out much more difficult than breathing in. 

Risk factors

Genetic predisposition, environmental allergens, viral infections, exercise, stress, and weather are some of the factors that can cause asthma. Let’s look into them a little more in detail.

1. Family history: According to the Centers for Disease Control and Prevention (CDC), individuals with one asthmatic parent are 3 to 6 times more likely to develop asthma than others.

2. Indoor and outdoor allergens: Inhaled allergens are the most common cause of acute asthma. If you’ve been exposed to specific allergens like dust mites, pollen, mold, pet fur, or some strong odors in childhood, you may have a higher risk of developing asthma. The more allergens you are sensitive to, the higher the risk. Cigarette smoke is a strong trigger as well. Environmental pollution is a leading cause for asthma in children, especially in urban areas.

3. Workplace triggers: Prolonged exposure to chemicals and fume can make your airways more sensitive over time. So, if you are working at a chemical plant, you are more at risk for asthma. And if you suffer from allergies or have a family history , you are more likely to develop asthma triggered by workplace allergens.

4. Cold and viruses: Flu is caused by respiratory viruses that affect your upper airways. When you have a cold, your airways are swollen, and you produce more mucus. This blocks the airway passage leading to difficulty in breathing.

5. Exercise: If you cough or have difficulty in breathing, or experience chest tightening during exercise, you may have exercise-induced asthma (EIA). These symptoms are often confused with obesity or low stamina. When you breathe normally, you breathe through your nose. The air is warmed and moistened in your nasal passage before it reaches your lungs. During exercise, you tend to breathe through your mouth, inhaling colder and drier air. These changes in temperature and humidity can sensitize the airways, thereby leading to EIA.

6. Medication: Many commonly used over-the-counter (OTC)  drugs like Aspirin, painkillers, and some medicines used for treating blood pressure, can trigger asthma.

7. Other factors: Intense emotions like anger or fear can activate the nervous system to narrow the airways and cause asthma.

Symptoms

1. Coughing, especially at night or early mornings, which makes sleep difficult

2. Wheezing (whistling sound while breathing)

3. Chest tightness (feeling of squeezing or pressure in the chest)

4. Shortness of breath (breathing out is more difficult than breathing in)

Diagnosis and tests

If you’ve experienced these symptoms, visit your physician without delay. 

X-rays and blood tests are routine tests, which will be conducted for diagnosis. Lung function tests such as asthma spirometry (measures the amount and volume of airflow you can exhale after a deep inhalation) and peak flowmetry (measures how fast you can blow air out of your lungs) may also be required.

If spirometry is normal or inconclusive, your doctor might recommend a sputum test and specialized tests, where substances are injected in the blood to induce symptoms of asthma.

How can you manage asthma?

Asthma cannot be cured, but it can be controlled. Medication, avoiding  known triggers, a healthy diet, and exercise can help you manage the condition. Every asthma patient can be given a curated treatment plan. Here are some common recommendations you can embrace to manage this condition, but only under medical supervision. 

a. Medication

Inhalers constitute the primary treatment. They contain medications that provide you with quick or long–term relief.  Preventive inhalers help manage asthma better by controlling long-term symptoms, and decreasing airway sensitivity and inflammation. Quick–relief inhalers are used in case of emergencies to ease symptoms. Oral medicines, which widen and relax airways to improve breathing, are also recommended in some patients. 

You must learn the correct technique of using an inhaler, so that the appropriate dose of drug is delivered to the airways. Also, never stop medication abruptly. It may cause severe adverse effects.

b. Diet

There is no specific diet for asthma. However, a recent study stated that patients, who followed a healthy diet and exercise regime, reported 50% improvement in their symptoms. Consider these dietary changes to manage the condition better.

1. Include plenty of brightly-colored fruits and vegetables such as carrots, tomatoes, apples, and dark green leafy vegetables. These are rich in phytonutrients, flavonoids and fiber, which can help manage the condition. 

2. A recent study observed that asthma patients are deficient in vitamin D. Vitamin D not only helps reduce the risk of exacerbation (swelling and inflammation of airways), but also boosts immune response. Sources include milk, eggs, salmon, oral supplementation, and sun exposure. 

3. Magnesium and essential vitamin-rich foods like pumpkin seeds, spinach, and broccoli can help improve airflow by providing antioxidants, which lower inflammation in airways.

4. Avoid pickles, wine, tinned fruits, and  shrimps as they contain sulfites, preservatives, artificial flavors, and colors that may trigger an attack.

c. Exercise

Working out and an active lifestyle go a long way in managing the condition.  

1. Breathing exercises open up your airways and can supplement medications. You can try diaphragmatic breathing, pursed-lip breathing, yoga breathing, and buteyko breathing (shallow breathing exercises similar to pranayama) under supervision.

2. Sports with short bursts of activity are best suited to avoid an attack. According to the American Academy of Allergy, Asthma, and Immunology, cycling, golfing, yoga, and  short-distance running can help.

3. Swimming is one of the best exercises to combat asthma. Use of upper body muscles, humid conditions, and the position of the body during swimming helps improve your respiratory function. However, cold water and chlorinated water may act as triggers.

4. Walking is another low–intensity exercise, which improves lung function. Do the “talk test” to know if you are walking at an optimal speed.  If you are able to talk without getting breathless on a walk, your speed is conducive to your body’s physical conditioning. You need to slow down and take rest if you get breathless when you talk while walking. Be cautious of stepping out in cold weather as it can trigger symptoms.      

Consult your doctor to draw up an asthma plan and stick to it. Supplement it with a healthy diet and fitness routine, and you’d be able to manage the condition without worry.  

References
1. Holland K. What Do You Want to Know About Asthma? Healthline. https://www.healthline.com/health/asthma (accessed Feb 26, 2021).
2. Asthma. NIH. https://www.nhlbi.nih.gov/health-topics/asthma (accessed Feb 26, 2021).
3. Asthma. Harvard Health Publishing. 2019. https://www.health.harvard.edu/a_to_z/asthma-a-to-z (accessed Feb 26, 2021).
4. You Can Control Your Asthma. Centers for Disease Control Prevention. https://www.cdc.gov/asthma/pdfs/asthma_brochure.pdf (accessed Feb 26, 2021).
5. Live well with asthma. Asthma UK. https://www.asthma.org.uk/197182a8/globalassets/health-advice/resources/adults/live-well-with-asthma-booklet.pdf (accessed Mar 04, 2021).
6. Asthma. NHS. https://www.nhs.uk/conditions/asthma/ (accessed Feb 26, 2021).
7. So You Have Asthma. National Heart, Lung and Blood Institute. 2007. https://www.nhlbi.nih.gov/files/docs/public/lung/SoYouHaveAsthma_PRINT-reduced-filesize.pdf (accessed Mar 04, 2021).
8. Every breath you take: the process of breathing explained. Nursing Times. 2018; published online Jan 08. https://www.nursingtimes.net/clinical-archive/respiratory-clinical-archive/every-breath-you-take-the-process-of-breathing-explained-08-01-2018/ (accessed Feb 26, 2021).
9. Why do you breathe? British Lung Foundation. https://www.blf.org.uk/support-for-you/how-your-lungs-work/why-do-we-breathe (accessed Feb 26, 2021).
10. Singh SK, Gupta J, Sharma H, et al. Socio-economic Correlates and Spatial Heterogeneity in the Prevalence of Asthma among Young Women in India. BMC Pulm Med 2020; 20: 190.
11. Bass P. No Is Your Immune System Making Your Asthma Worse? Verywell Health. https://www.verywellhealth.com/asthma-your-immune-system-200582 (accessed Feb 26, 2021).
12. Asthma Risk Factors. WebMD. https://www.webmd.com/asthma/asthma-risk-factors (accessed Feb 26, 2021).
13. Occupational Asthma. WebMD. https://www.webmd.com/asthma/guide/occupational-asthma-work-related-asthma (accessed Mar 04, 2021).
14. Colds and flu. Asthma UK. https://www.asthma.org.uk/advice/triggers/colds-and-flu/ (accessed Feb 26, 2021).
15. How Is Asthma Diagnosed? American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/diagnosing-treating-asthma/how-is-asthma-diagnosed (accessed Feb 26, 2021).
16. Cirino E. Spirometry: What to Expect and How to Interpret Your Results. https://www.healthline.com/health/spirometry#results (accessed Mar 04, 2021).
17. Asthma and Exercise. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/asthma/ (accessed Feb 26, 2021).
18. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1211–59.