Asthma

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.

Asthma signs and symptoms include:

• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu
• A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• Chest tightness or pain
• Shortness of breath

Signs that your asthma is probably worsening include:

• The need to use a quick-relief inhaler more often
• Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)
• Asthma signs and symptoms that are more frequent and bothersome

For some people, asthma signs and symptoms flare up in certain situations:

• Allergy-induced asthma: triggered by airborne substances, such as pollen, mold spores, cockroach waste or particles of skin and dried saliva shed by pets (pet dander)
• Occupational asthma: triggered by workplace irritants such as chemical fumes, gases or dust
• Exercise-induced asthma: which may be worse when the air is cold and dry

Children with asthma may exhibit symptoms such as:

• frequent colds that settle into the chest
• rapid breathing that pulls the skin around their ribs or neck tight
• Labored breathing
• coughing, especially at night
• a nagging cough
• panting during activities that shouldn’t leave them winded
• difficulty eating or sucking

Antibiotic use early in life has been linked to the development of asthma in childhood; it is thought that antibiotics make one susceptible to development of asthma because they modify gut flora, and thus the immune system.

Antibiotics are completely useless in case of viral/fungal infections. Antibiotics only act against bacterial diseases.

Among older children, the most common symptoms include:

• cough
• chest tightness
• feeling winded after physical activities
• wheezing, or a squealing sound, especially when exhaling

Asthma is of various types and the treatment depends on the asthma variant. 

• Allergic asthma - caused due to pollen, dust mites and so on, very common in childhood
• Non - allergic asthma - caused basically due to weather changes. Monsoon or cloudy weather generally triggers such kind of asthma.
• Other causes include cleaning products, strong odors like perfumes.
• Asthma caused due to infection with a certain type of fungus.
• Taking aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) triggers an asthma attack.
• Exercise induced asthma - generally in athletes when the airways narrow during or after exercise
• Waking up in the middle of the night due to asthma is sometimes called “nighttime asthma” or “nocturnal asthma.” 
  

Genetics and environmental factors are the main causes of development of Asthma in adults².

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

• Air pollutants and irritants, such as smoke
• Cold air
• Physical activity (exercise-induced asthma)
• Respiratory infections, such as the common cold
• Airborne substances, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste
• Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
• There is growing evidence that psychological stress is a trigger. It can modulate the immune system, causing an increased inflammatory response to allergens and pollutants
• Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
• Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat.
• Caesarean sections3 have been associated with asthma when compared with vaginal birth; a meta-analysis found a 20% increase in asthma prevalence in children delivered by Caesarean section compared to those who were not².
• Hormonal changes in adolescent girls and adult women associated with their menstrual cycle can lead to a worsening of asthma². 
  

Asthma is diagnosed generally by the medical history and using one of the below mentioned tests^4,6 -  

• Pulmonary function tests include Spirometry and peak flow which estimate the narrowing of the bronchial tubes and how fast an individual can breathe.
• Chest X-ray is useful in differentiating asthma from other lung diseases.
• Allergy tests helpful in finding the allergen causing the asthma.
• Methacholine challenge test and Nitric oxide tests are confirmatory tests in Bronchial asthma. 
  

• Controller medications are the most important because they prevent asthma attacks. When you use these drugs, your airways are less inflamed and less likely to react to triggers.
• Quick-relief medications - also called rescue medications - relax the muscles around your airway. If you have to use a rescue medication more than twice a week, your asthma isn’t well-controlled.  
  It is better to keep the medicine dose as low as possible since long term intake of high doses can lead to complications such as cataract and osteoporosis.

Inhalers, Nebulizers, and Pills as Asthma Medicine 
There are a few ways to take asthma medications. Some are inhaled, using a metered dose inhaler, dry powder inhaler, or a nebulizer (which changes medication from a liquid to a mist). Others are taken by mouth, either in pill or liquid form. They can also be given by injection. 
Some asthma drugs can be taken together. And some inhalers mix two different medications to get the drugs to your airways quicker. 

• Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.
• Take your medication as prescribed. Just because your asthma seems to be improving, don't change anything without first talking to your doctor. It's a good idea to bring your medications with you to each doctor visit, so your doctor can double-check that you're using your medications correctly and taking the right dose.
• When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed and immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.
• Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms.
• Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath. But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter.
• Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.
• Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.
• Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life in general.
• Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan.

When it comes to the treatment it is very well documented by Ayurveda that we should do the treatment in a different pattern, and here it is-

 स्नेह बस्तिमृते  केचिदूर्ध्व चाधश्च शोधनम ! मृदु प्रणयातं श्रेष्ठम श्वासदिनमादिशन्ति हि !!

As per the Ayurveda Bronchial Asthma is Vatakaphaja disease, it begins in the stomach, progresses to the lungs and bronchi. Hence the aim of treatment is to move the excess Kapha back to stomach and then eliminate it.  
For this purpose following methods are adopted.  
1. Swedana (Sudation)  
2. Vamana (Therapeutic emesis)  
3. Virechana (Therapeutic purgation)  
These procedures will be followed as per the need of the individual patient.  

For acute cases, medicines involve -  
Sameer Pannag Ras is an ayurvedic formulation. This formulation is known to be prepared from the mixture of herbs and minerals and available in the form of powder and tablet.  

For chronic cases, medicines involve -  

• Shwas kuthar ras - ayurvedic medicine in powder/tablet form given in the treatment of asthma
• Shwas kuthar chintamani ras - another ayurvedic medicine which consist of heavy metals and generally used in treating respiratory illness. 
  Both these medicines are to be taken under supervision.

Apart from the above medicines, some treatment common to both acute and chronic includes -

• Dhumapana⁷ is an Ayurvedic herbal smoking therapy for treating ailments (cough, bronchitis and asthma, etc). In this therapy, the person inhales herbal smoke for treating or preventing the diseases.
• Abhyanga - body massage with herbal oil, local application of kharpuradi oil and making ajwain potli. These treatment methods can be used for kids as well. 
  

Lifestyle measures 

• Aiming for a healthy weight. Obesity can make asthma harder to manage. Even a 5 to 10 percent weight loss can help symptoms.
• Being physically active. Even though exercise is an asthma trigger for some people, you should not avoid it. Physical activity is an important part of a healthy lifestyle.
• Heart-healthy eating. Eating more fruits and vegetables, and getting enough vitamin D, can provide important health benefits that may help you with asthma control.
• Managing stress. Learn breathing and relaxation techniques, which can help symptoms.
• Quiting smoking or avoiding secondhand smoke. Smoking tobacco and secondhand smoke make asthma harder to treat.  
  

With more natural ways of treatment available for asthma, the disease can be easily managed. Following the guidelines given and avoiding the triggers are some of the ways to prevent the exacerbation of the disease. 
 

References 

1. https://medlineplus.gov/asthma.html
2. https://www.nhlbi.nih.gov/health-topics/asthma
3. http://www.phcogrev.com/article.asp?issn=0973-7847;year=2009;volume=3;issue=6;spage=247;epage=258;aulast=prasad
4. https://www.aaaai.org/conditions-and-treatments/asthma
5. https://kidshealth.org/en/kids/asthma.html
6. http://www.ccras.nic.in/sites/default/files/viewpdf/faq/Bronchial%20Asthma%20article%20and%20FAQs%20for%20web%20site.pdf
7. https://www.naturalremediescenter.com/6239/dhumapana-herbal-smoking-cough-ayurvedic-therapy/