More than three million Canadians have asthma, and the number seems to be increasing. This increase may come from improved diagnosis, or perhaps people are more likely to seek help for their breathing symptoms these days.
An increase in our exposure to allergens or airborne particles may also be to blame, however, triggering more asthma symptoms.
Asthma is characterized by shortness of breath, chest tightness, wheezing, cough, and generalized difficulty in breathing. In childhood, asthma affects more boys than girls, but by age 30 everyone is affected equally.
If you think of your lungs like trees, the bronchi are the branches and the alveoli are the leaves. In asthma, the bronchi are more responsive to stimuli, and they react by narrowing the airways. The bronchial smooth muscle contracts, and a thick, sticky fluid is also secreted, which makes oxygen intake in the alveoli more difficult.
Asthma is classified as either allergic or idiosyncratic. Obviously, if you have allergic asthma, avoiding stimuli or allergens that cause the symptoms is key, for example plant pollen, feathers, animal dander, moulds, environmental pollution, dust mites, or even cold weather.
Idiosyncratic asthma does not seem to be linked to any specific allergen.
In general, if the onset of asthma is early in life, it is more likely to be allergic in nature. Later in life it is more often idiosyncratic.
Some factors can increase your risk for asthma. A family history of asthma and a medical history of other allergies such as hay fever are risk factors that you usually cannot alter, as are eczema, sensitivity to non-steroidal anti-inflammatory drugs like ibuprofen, and urban living.
However, you may be able to control other factors, such as smoking, including second-hand smoke, workplace exposure, obesity, low birth weight, history of heartburn or sinusitis, low vitamin D levels, and chronic respiratory infections.
The first step that is always recommended in treating asthma is to remove or avoid any allergens that cause asthma attacks, such as dust, animal dander, plant pollen, foods, mould, and dust mites. An asthma symptom diary can help you identify these offending stimuli, although the difficult part may be in avoiding them!
Respiratory infections and stress are also implicated in some attacks. Thus you will want to remain healthy and manage any stress.
When you breathe in allergens, it is your immune system that triggers the asthma response. Mast cells in your immune system rupture to release substances such as leukotriene and histamine, which in turn cause your airway obstruction.
Oral medications including leukotriene inhibitors (such as montelukast and zafirlukast) and antihistamines (such as loratadine and cetirizine) are taken to prevent symptoms. But remember, you need to take these regularly so they will be circulating in your body ready to prevent the immune system response.
Inhalers are the mainstay of asthma treatment because they deliver medication directly to the site of the breathing problem. Inhaled corticosteroids reduce inflammation and need to be used regularly to keep inflammation under control. Beta-agonists quickly reverse airway constriction, with the most commonly used agent being salbutamol.
If you use both types of inhalers, you want to use the broncholilator (such as salbutamol) first to open the bronchi, followed by the corticosteroid which then will be able to penetrate deeper to more effectively reduce inflammation.
A variety of inhalers exists, ranging from the “boot-shaped” ones which use propellants to expel the active ingredients to breath-activated designs which use your own breath to draw in the medication.
With asthma, breathing easier is possible, but remember to check and ensure your inhaler technique is correct. If you can’t draw in a suitable breath, consider using a spacer with your inhaler.
An asthma plan which gives you a game plan for managing your symptoms is also an excellent idea. You can download a sample from the Asthma Society of Canada.
Now, take a deep breath!
Marie Berry is a lawyer/pharmacist interested in health and education.