The Ultimate Guide to Asthma
 
Asthma is a common concern for many families in Shanghai. WorldPath Clinic International’s Pediatrician and Asthma expert, Dr. Jeorge Ducha, gives us a helpful guide about asthma and how to manage it.  
 
WorldPath Clinic has what is Asthma?
Asthma CausesAs of 2011, around 300 million people worldwide have been diagnosed with asthma, which represents about 4% of the world’s population. Asthma is a chronic inflammatory disease of the  airway which is characterized by recurrent and variable airway obstruction and bronchospasms. The symptoms include shortness of breath, chest tightness, coughing and wheezing.
 
What causes Asthma?
Asthma is thought to be caused by caused by a combination of genetic and environmental factors. However, as of now the exact mechanism of asthma is not fully understood. Factors contributing to the incidence of the disease:
 
1. Environmental pollution and changing living conditions
Exposure to traffic pollution, smoking during pregnancy or exposure to indoor allergens such as dust mites, cockroaches or animal dander have all been shown to be important factors in the development of asthma
 
2. Genetics
There is a strong correlation between asthma and certain genes which are responsible for immune response and modulation of inflammation. However, as of now the research on this subject is still ongoing and in 2006 as many as 100 genes had been recognized as being responsible in the pathophysiology of asthma and this number continues to rise.
 
3. Specific Medical Conditions
People suffering from atopic diseases are more likely to develop asthma. This is because these people share some specific immunological deregulations that make it easier for the respiratory system to become hyper-sensitive and therefore asthmatic.
   
Mechanism of the Disease
Asthma is a chronic inflammation of the airway which leads to greater contractibility of the smooth muscles of the airway and therefore constriction of the airway. In the long run, the airway changes and has increased number of certain cells such as T-lymphocytes and eosinophils.
 
What is an asthma attack and what Triggers an Asthma Attack?
An asthma attack or an asthma episode is when the symptoms are more severe than usual and this exacerbation can be mild, moderate or even severe.
An asthma attack is easily initiated when a person suffering from asthma is exposed to an asthma trigger. These may differ from person to person and asthmatics should know what causes an aggravation of their symptoms and how to avoid them. Dust, tobacco smoke, pollutants and even emotional stress are all frequently encountered triggers.

Asthma LungsTreatment of asthma
The proper treatment for asthma in each case is based on the symptoms, age and asthma triggers of the patient. The medications available can be divided into fast-acting drugs which are used to relieve symptoms of acute asthma attacks and long-term drugs which are used to control asthma on a long term basis.
 
1. Fast-acting Drugs
 
Short-acting Beta-adrenoreceptor agonists (SABA) such as salbutamol are the first line treatment for asthma symptoms and they are recommended before exercise in those with exercise induced symptoms. Ipratropium Bromide is an example of an anticholinergic medication which is used in patients who cannot tolerate a SABA or used in patients with moderate to severe symptoms to provide better control.
 
2. Long-acting Drugs
 
Long-acting drugs for the treatment of asthma include corticosteroids, long-acting beta-adrenoreceptor agonists (LABA), leukotrienes antagonists and mast cell stabilizers. Long term corticosteroids require constant surveillance by a specialist doctor and can have adverse effects when used for a prolonged period of time.
 
Action Plans
  
Action Plans monitor symptoms and have a written plan to follow when symptoms change. Ask your doctor for a written asthma action plan.
Take the team approach to controlling asthma. This includes:
      - Trigger Avoidance
      - Education
      - Action plan
      - Medical Management
 
FREQUENTLY ASKED QUESTIONS

Q.  I stopped giving the medication because the baby seems better is that OK?
 
A.  Please talk to your child’s doctor before stopping any medication.  The baby may seem fine to you but there may still be airway inflammation and premature discontinuing of medication can have an adverse effect on the child’s recovery.
 
Q.  Will she/he out grow asthma?
 
A.  The answer is maybe. Evidence shows that in approximately two-thirds of children diagnosed with asthma, the asthma will “quiet down” by puberty. However, one-third of these who were asthma free at puberty have asthma symptoms in their mid- twenties.
 
Q.  What is exercise induced asthma?
 
A.  Children who have exercise-induced asthma (EIA) develop asthma symptoms after activity such as running, swimming, or biking. The time varies from 5-20 minutes post exercise before symptoms appear.  With the proper medications, kids with EIA can usually play sports without a problem. If exercise is the only asthma trigger, a medication that the child takes prior to exercising to prevent the airways from constricting may be prescribed, but usually exercise induced asthma is a sign of poorly controlled asthma.
 
Q.  What are the risks of untreated or poorly controlled asthma?
 
A.  Poorly-controlled asthma makes treatment more expensive.  Plus uncontrolled asthma increases the risk of developing severe asthma, anxiety and a host of other complications.
The following are the risks of untreated asthma:
Asthma Treatment1.  Severe Asthma:  Asthma that is not diagnosed and treated aggressively with asthma controller medicines can increase the risk for lung scarring.  This is permanent damage to your lungs that can make you always feel short of breath.  It also makes it so your asthma might not be reversible when you use your rescue medicine (Ventolin).  This type of asthma is called severe, persistent asthma.

2.  Steroid side effects:  Long term systemic corticosteroids use to control asthma, might cause serious side effects that can make it even harder to manage asthma.  Side effects include: fluid retention, increased blood pressure, mood swings, weight gain, high blood sugar, and thinning of skin.
3.  Anxiety/ stress/ depression 
4.  Muscle wasting 
5.  Respiratory Failure:  This is a serious complication that must be treated immediately.  It can lead to death.
This is the worst case scenario of long term untreated asthma. It’s not pretty but can happen.  Early correct diagnosis, aggressive treatment and adhering on the treatment plan can avoid frequent ER visits and asthma flares.  The research in the treatment of asthma is ongoing and is a global enterprise, however, as of now all asthma sufferers can do is control their symptoms and live life to the fullest.

If you believe you or your child is exhibiting asthma or asthma like symptoms, schedule a consultation visit at WorldPath Clinic for more information. For appointments email info@worldpathclinic.com or call 2020 7888.