What is it?
The Asthma is an increasingly common disease among children and youth. It is estimated that suffers the 5 percent of the adult population and 10 percent of children and adolescents in industrialized countries, and in many cases the disease occurs in response to certain stimuli that produce allergies : pollen, dust mites, particles of cat and dog fur, smoke, cold air, certain foods or food additives. It is characterized by the appearance of episodes of respiratory distress(seizures or attacks), usually associated with other symptoms such as cough, wheezing when breathing and feeling of suffocation. The symptoms vary according to age.
In this way, cough prevails mainly in children , especially at night, while in adults the three main symptoms are stiffness in the chest, wheezing and fatigue at night. In recent years there has been a higher prevalence and a progressive increase in cases in children and adolescents, which highlights the need to take preventive measures. The cure of asthma can only be achieved in some cases of allergic asthma or related to the workplace of the patient, provided that the causative agent can be avoided.
Pollens : Although pollination occurs during the spring, there are variations according to the climates and types of plants. The symptoms of pollen allergy are usually detected with concentrations higher than 50 grains of pollen per cubic meter of air. The small size of the pollen favors being suspended in the air for a long time and travels long distances to penetrate the respiratory passages.
In Spain, the pollen of grasses prevails, the olive in the southern zone and the parietaria in the Mediterranean zone.
Mites of the dust : They are microscopic parasites that live in the dust of the houses and feed on dermal scales and other residues. They need precise conditions to develop: 25º C of temperature and 85 percent of humidity.
In Spain, the most important are Dermatophagoides pteronyssinus and Dermatophagoides Farinae.
Food : Episodes of asthma related to food are frequent during childhood and are accompanied by other symptoms such as hives and vomiting, so they tend to be confused with food poisoning. The products that provoke the greatest reactions are milk, eggs and fish. In adulthood this type of asthma is less frequent.
Fungi : Some fungi produce allergens that are deposited in their spores, and the release of these depends on humidity, temperature and the existence of organic matter in their environment, such as garbage or bathroom curtains. The most favorable times for its development are spring and autumn, and among the most common are the alternaria, cladosporium, penicillium, aspergillus and mucor.
During asthmatic crises, the bronchial mucosa lining the respiratory passages becomes inflamed and a thick mucus is produced that obstructs the ducts of the airways. As a consequence, the muscles that surround these ducts contract and narrow, decreasing their diameter, preventing the passage of air and complicate breathing. The basic characteristics of the disease are the following:
- Inflammation : Increases bronchial sensitivity and obstruction. Sometimes its origin is allergic. It produces an increase in secretions and contraction of the bronchial muscles.
- Increased bronchial sensitivity : After exposure to various stimuli (fumes, gases, odors, cold air or exercise), the bronchi of asthmatics contract resulting in narrowing of the airway.
- Bronchial obstruction : It is variable and reversible spontaneously or with treatment. During crises the air circulates with difficulty producing beeps and a feeling of fatigue or suffocation. At the moment when the crisis resolves, the air can normally move through the bronchi and the symptoms disappear.
Although asthma has no cure, a series of measures can be taken to prevent a crisis. These are some tips:
- When the cause of asthma is extrinsic, such as an allergy, it is advisable to avoid exposure to the agents that cause it. The main ones in Spain are pollen (grasses, olives, cupressaceae, arizónicas, plantain de sombra and parietaria), environmental fungi, dust mites and the epithelia of some animals (dogs, cats, horses and rodents commonly). The most frequent symptoms of pollen allergy are itchy eyes, sneezing and runny nose. In the event that a person is not diagnosed but has any of these symptoms, you should go to the allergist.
- Another precaution that allergy sufferers must take into account is to avoid intense exercises during the pollination season , as this can generate breathing difficulties that lead to an asthma attack.
- Patients with rhinitis should be especially careful because this disease often precedes asthma. It is recommended that the patient be observed to detect any indication of asthmatic principle.
- Due to their limitations in detecting and explaining the symptoms they present, children are a vulnerable group (remember that asthma affects 10 percent of the child and adolescent population). Parents should control children especially when they go through a viral process or if they suffer from obesity , paying special attention to the appearance of beeps, fatigue and other signs of bronchial obstruction.
- Asthmatics already diagnosed should strictly follow the treatment , even when they experience phases of improvement. According to the data provided by the Spanish Society of Pneumology and Thoracic Surgery on World Asthma Day (May 5) only 30 percent of patients make a correct adherence to treatment, which makes it difficult to control the disease and the crisis.
- People with asthma should refrain from smoking altogether , since tobacco smoke is an irritant that causes inflammation of the bronchi.
- In cases in which asthma is generated by the exposure of flours, woods or other products present in the work environment ( occupational asthma ), it is necessary to avoid contact through an adequate ventilation system and the use of protective masks. If the picture is severe, it is advisable to change jobs.
- It is always advisable that the asthmatic person remain alert to any indication of aggravation of symptoms . It is important that the specialist provides the patient with a written treatment plan with precise instructions on the administration of the medications he or she needs. These instructions can be modified depending on the severity of the symptoms, so it is advisable that the patient is able to perceive any change in the clinical picture, for example, greater need to resort to a bronchodilator, unusual discomfort at night, beeps when exercising, etc.
There are different classifications of asthma. Regarding its origin can be divided into intrinsic asthma and extrinsic or allergic asthma . The origin of intrinsic asthma is unknown and is detected more frequently in adulthood. It has a worse prognosis than the allergic one and tends to become chronic. Extrinsic asthma, on the other hand, consists of an antigen-antibody reaction that triggers the process. It mainly affects children and young adults, it is characterized by reversible and brief attacks of bronchospasm with wheezing and respiratory distress, and it is controlled with an adequate treatment.
The allergy is an alteration of the defense mechanism of the body consisting of an overreaction by means of a special antibody (immunoglobulin E), against substances which, in principle, are not harmful (pollens, mites, epithelia, food or medicine) . When these antibodies, which are fixed in certain cells, bind to allergens, there is the release of certain substances that, directly or through other cells, cause inflammation of the organ where they settle (bronchi, nose, eyes or skin). ). There is an inherited predisposition to suffer from allergy, but exposure to allergens is necessary to develop the disease.
Asthma can also be classified as mild, moderate or severe , depending on the frequency and intensity of the symptoms, the way in which it affects the daily activity and the degree of bronchial obstruction. Mild asthma can be controlled by pharmacological treatment and does not usually alter the daily life of patients; moderate asthma requires more severe treatments and interferes with patients’ daily activities; and severe asthma requires continuous control and can endanger the lives of people who suffer from it.
First, the clinical diagnosis must be made , based on the clinical history where the previously described symptoms are revealed. In addition, it is necessary to investigate the characteristics of the crises, presentation form, interval between the seizures, triggers, seasonal period, evolution of the disease and a general pediatric anamnesis in order to be able to make a differential diagnosis of other respiratory pathologies that may occur with the same symptoms as asthma. In order to be able to objectify airflow obstruction, a functional diagnosis is made , which consists of a respiratory function test (spirometry). It has the disadvantage that requires the collaboration of the child and therefore is performed in children over 6 years.
In all children with suspected bronchial asthma, baseline spirometry and a bronchodilator (giving the child to inhale a drug) should be performed in order to demonstrate that the obstruction of the airway is reversible (characteristic of asthma). Finally, an etiological diagnosis , aimed at finding the cause that triggers the symptoms; Identifying the cause is the most important step in controlling the disease.
The treatment of asthma should cover several fronts: inflammation of the bronchial mucosa, bronchospasm and allergies:
1. Inflammation of the bronchial mucosa:
In recent years it has been shown that the treatment of inflammation is the most important part of the treatment of asthma. Until now too much emphasis was placed on bronchodilation, but if inflammation is not treated, the effects of bronchodilators are ephemeral. There are several medications that have an anti-inflammatory effect on the bronchial mucosa, but the most potent and effective are inhaled corticosteroids (cortisone). By inhalation, the doses of corticosteroids used are very low and produce a topical effect without the side effects of oral, intravenous or intramuscular administration. Inhaled corticosteroids have become the most important medication in the treatment of asthma. They begin to be prescribed in patients with persistent asthma, that is, those in which symptoms occur several days a week, and in those in which nocturnal symptoms occur. For those whose symptoms occur sporadically, for example once or twice every 15 days, it is not necessary to start with corticosteroids and bronchodilators may suffice.
Inhaled corticosteroids do not act immediately, although when they take effect after a few days of treatment, bronchospasm remits. But for the immediate treatment of it, bronchodilators are used that are normally administered by inhalation. There are two fundamental types according to the duration of their action: long-acting bronchodilators are taken in the morning and at night every day, whether symptoms are present or not, while short-acting bronchodilators are usually reserved for taking if necessary (feeling of choking, cough, etc). The primary objective is that patients resort to short-acting bronchodilators on very rare occasions. If not, it is necessary to enhance the anti-inflammatory treatment. Obviously, there are patients with severe asthma who, despite receiving maximum anti-inflammatory treatment,
In patients in whom an allergic component is demonstrated, treatment with antihistamines may be beneficial. On the other hand, with certain allergies there are effective immunological treatments (vaccines) that can significantly help in the control of asthma. However, the most effective in the treatment of allergies is to avoid or reduce exposure to allergens as much as possible. For example, in the case of allergies to dust mites, with simple housekeeping measures, the presence of them can be considerably reduced.
Diseases associated with asthma:
The gastroesophageal reflux and chronic sinusitis can aggravate or cause asthma, so it is important to discard in asthma unresponsive to usual treatment.
This disease is a public health problem that affects 10 percent of children and young people, and 5 percent of the adult population in industrialized countries. In Spain two million individuals suffer from asthma, and in the world they exceed 150 million. With regard to the mortality rate due to this pathology, in our country 2 x 100,000 h / a die due to this cause, and 100,000 deaths per year occur in the world. The deaths are caused by acute attacks that can not be controlled, although there are other factors that prevent the approach of deadly crises.
A multicenter study sponsored by the Spanish Society of Respiratory Diseases (Separ) has shown that there is a relationship between death or suffering an almost fatal crisis for asthma and alexithymia, a psychological disorder that affects 10 percent of the healthy population and prevents perceive and express well the emotions and physical sensations. The study notes that asthmatics with alexithymia, about 38 percent of patients who took part in the research, suffer most often near-fatal crises, since not correctly perceive the symptoms of asthma are not able to act accordingly.
” Alexithymia could also be one of the causes of poor compliance with treatment that occurs among asthmatic patients,” said Vicente Plaza, of the Pneumology Service of the San Pablo Hospital in Barcelona. Asthma is the most frequent cause of emergency room visits in the pediatric age and the fifth cause of consultation in primary care. Sixty percent of the emergencies seen in pulmonology services are asthma exacerbations, most of the time due to lack of compliance with the prescribed treatment.
This confirms that the disease is not well controlled, since more than half of the asthmatics diagnosed, despite being under treatment, have to use rescue medication to relieve the exacerbation of their symptoms. The lack of compliance could be resolved with more comfortable drugs, better communication between doctor and patient and the education of the patient. “The patient should be informed about everything related to his illness and train him for the correct use of the medication, creating an active and continuous relationship between the doctor, the patient and their environment.
Thus, through the acceptance and understanding of the disease the patient is co-responsible for their treatment, and does not need to lie to the doctor or feel guilty for not following the treatment, “says Santiago Nevot, head of the Pediatric Service of the General Hospital of Manresa So far it has been found that compliance is better with oral drugs than inhaled, and increases if it is a single daily dose.
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