An asthma patient using an inhaler
The harmattan season beckons and with it comes the cold dusty winds – major provocating stimuli for recurrent asthma attacks. Not surprising, the harmattan season usually witnessed an upsurge in the number of cases of asthma attack in the hospital. But for asthmatics well educated about this condition – the dos and don’ts, this is necessarily not the case.
Asthma is described as a chronic condition in which the airways undergo changes when stimulated by allergens or other environmental triggers that cause patients to cough, wheeze (musical notes arising from the chest), experience breathlessness and chest tightness.
The word asthma originates from an ancient Greek word meaning “panting”. This word essentially describes what usually occurred in asthma attack in affected individuals implying an inability to breathe properly. When we inhale, the air passes into the lungs through progressively smaller airways called bronchioles. The lungs contain millions of bronchioles, all leading to alveoli, microscopic sacs where oxygen and carbon dioxide are exchanged from the lungs into the blood and vice-versa.
Asthma appears to have two primary stages: hyper-reactivity (also called hyper-responsiveness) and the inflammatory response.
Here, smooth muscles in the airways constrict and narrow excessively in response to inhaled allergens or other irritants. It should be noted that the airways in everyone’s lungs respond by constricting when exposed to allergens or irritants, but people without asthma are able to breathe in deeply to relax the airways and rid the lungs of the irritant.
When asthmatics try to take those same deep breaths, their airways do not relax and the patients pant for breath. Smooth muscles in the airways of people with asthma may have a defect, perhaps a deficiency in a critical chemical that prevents the muscles from relaxing.
The hyper-reactive stage is followed by the inflammatory response, in which the immune system responds to allergens or other environmental triggers by delivering white blood cells and other immune factors to the airways. These so-called inflammatory factors cause the airways to swell, to fill with fluid, and to produce thick sticky mucus.
This combination of events results in wheezing, breathlessness, inability to exhale properly, and a sputum-producing cough. Inflammation, i.e. a reddened and swollen appearance, appears to be present in the lungs of all patients with asthma, even those with mild cases, and plays a key role in all forms of the disease.
Symptoms of asthma
Usually after exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. In some cases, the airways have become seriously obstructed by the time the patient even calls the doctor. Asthma is usually worse at night, and attacks commonly between 2AM and 4 AM – not palatable hours for doctors on call.
Asthma occurs primarily at night in as many as 75% of asthma patients. This night time propensity is due to a number of reasons: chemical and temperature changes in the body during the night increase inflammation and narrowing of the airways, delayed allergic responses can occur from exposure to allergens during the day, and toward the early morning, the effect of inhaled medications may wear off and trigger an attack.
As mentioned earlier, classic symptoms of an asthma attack are coughing, wheezing, and shortness of breath (dyspnea). Wheezing (i.e. musical notes arising from the chest) is usually present when breathing out is virtually always present during an attack. Usually the attack begins with wheezing and rapid breathing and, as it becomes more severe, all breathing muscles become visibly active, this include some muscles of the neck, intercostals muscles in-between the ribs and the muscles of the abdominal wall.
Irritation of the nose and throat, thirst, and the need to urinate are common symptoms and may occur before an asthma attack begins. Some people first experience chest tightness or pain or a non-productive cough that is not associated with wheezing. Chest pain, in fact, occurs in about three quarters of asthmatics; it can be very severe and its intensity is unrelated to the severity of the asthma attack itself.
The neck muscles may tighten and talking may become difficult or impossible. The end of an attack is often marked by a cough that produces thick mucus. After an initial acute attack, inflammation persists for days to weeks, often without symptoms. The inflammation itself must still be treated, however, because it usually causes relapse, this explains the reason why anti-inflammatory
medications like steroids are usually prescribed in asthmatic attacks.
Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that persists despite taking large doses of medication.
Signs of severe asthma
Without effective treatment during an attack, exhaustion may worsen respiratory function, and in rare cases, a life-threatening situation can occur. As the chest labours to bring enough air into the lungs, breathing often becomes shallow.
Lacking sufficient oxygen, the individual finds it difficult to complete a sentence when attempting to make a speech. In related cases, this insufficient oxygen can make the tongue, the inner lips and the skin become darkish and bluish.
Similarly, in an attempt to force out breath against overwhelming obstruction and constriction of the airway, the flesh (i.e. muscles) around the ribs of the chest appears to be sucked in, and the patient may begin to lose consciousness. This is an emergency situation that requires prompt medical attention.
Anyhow, an attack of asthma is potentially dangerous and it should be seen as such. Hence, the thing to aim for is to prevent a possible attack of asthma. Usually, the don’ts and dos for an asthma patient are normally spelt out at the time of diagnosis by the doctor and other attending health personnel.
More important here is to avoid and remember the following, especially during the harmattan season:
• Cold/chilly bath
• Dusty play
• Being beaten by rain
• Make your inhaler handy always
• Always remember that asthma is not a cause – you are one in millions of victims!
These must be abided with religiously.
I should however add that the list is inexhaustible in general terms; conversely, in some asthmatics, a number of the listed potential stimuli above hardly provoke symptoms in them. The key point is patient understanding of self and being educated about the medical condition.