ASTHMA

Asthma is a chronic lung disease causing episodes of difficult lung breathing and often symptoms such as wheezing, chest tightness, shortness of breath and cough.

T h e s e s y m p t o m s a r i s e d u e t o co n st r i c t i o n o f t h e a i r w a y s a n d inflammation in the airway and lungs.

Asthma is common in industrialized nations; most cases of asthma are diagnosed before the patient is 18 yrs.

There are more than 1.5 million cases per year in Nigeria

RISK AND TRIGGER FACTORS OF ASTHMA

A l t h o u g h t h e fundamental cause of a s t h m a i s n o t w e l l u n d e r s t o o d , t h e following factors could be associated

1. Family history and genetics h a v e b e e n implicated as a major risk factor for the development of the condition.
2. Perinatal factors (pre maturity and increased maternal age; prenatal exposure to tobacco smoke)

TRIGGER FACTORS

1. Substances that irritate the airway. It has been found that t h e s t r o n g e s t r i s k factors/triggers are substances that irritate the airways thus provoking allergic reactions.
   Such substances include dust, smoke, dust mite, pollens, fur, insects, gums
2. Extreme emotions and extreme physical exercise can also trigger asthmatic attack.
3. Extreme cold air
4. Medications: certain medication such a s a s p i r i n , n o n s t e r o i d a n t i inflammatory drugs (NSAID) e.g diclofenac, hypersensitivity, sulphate sensitivity, beta adrenergic receptor blocker e.g propanol.
5. Obesity
6. Tobacco smoke
7. Household sprays, paint fumes. Industrial chemical causing occupational asthma

SIGNS AND SYMPTOMS

1. Wheezing : a high musical pitched, whistling sound produced by air flow turbulence
2. Cough : usually the cough is non productive and non purulent
3. Chest tightness/pain
4. Increased heart rate
5. Oxy haemoglobin saturation with room air is 91-95 % for mild to moderate asthmatic attack. In severe asthmatic attack, the oxy haemoglobin concentration is less than 91%
6. Breathles s n e s s a t rest

INVESTIGATION

• Chest Xray
• ECG
• A l l e r g i c s k i n testing
• P u l m o n a r y function test – s p i r o m e t r y a s s e s s m e n t should be done a n d Pe a k f l o w monitoring

TREATMENT
Asthma cannot be cured, however control is possible such that one can proceed to live a normal and healthy live free of symptoms and attacks. This is possible with good medical
management and lifestyle modifications.

Acute exacerbation of asthma should be treated promptly.

The mainstay of therapy for acute asthmatic attack is inhaled beta agonist which include the metered dose inhaler and spacer inhaler.

For people with frequent attack they may need inhaler which contain corticosteroids which they can use every day to prevent the frequency of their attacks

Nebulizer therapy
Oral / intravenous corticosteroids Sinusitis is usually treated with antibiotics to improve the asthmatic symptoms

Omalizumab: the injection is taken every two to four weeks to prevent allergic reactions that could provoke asthmatic attack

HOW TO USE AN INHALER CORRECTLY

• Shake the inhaler vigorously for a few seconds
• Remove the cap from the mouth piece and check for residue or blockages
• Take a deep breath and then exhale completely
• W h i l e sta n d i n g o r sitting upright, begin to breathe in slowly with the inhaler in place and p r e s s t h e m o u t h button,
• continue breathing in after pressing it. Hold breath for 5 to 10 seconds, and then breathe slowly with your mouth.

PREVENTION OF ASTHMATIC ATTACK

1. Avoid dust , pollens, mites, that could provoke allergy
2. E a t h e a l t h y n u t r i t i o n a l adequate diet, eliminating processed food, would cut down risk of asthmatic attack.
3. Avoid excessive exercise
4. Avoid extreme of emotions
5. Maintain healthy weight
6. Avoid taking drugs that can provoke symptoms.
7. Avoid smoking
8. Regular medical check up Asthma is a life threatening condition and can lead to death. Asthmatic patient should not hide their condition from people around them; they could be of help in times of attacks or crisis. They should always carry their inhaler around with them. They should promptly go to the clinic once they are ill and should not use any medication without informing the doctor that knows their medical history.

All students with history of asthma should kindly disclose this important diagnosis at the University Medical Center during their medical registration.