Causes of asthma

The causes of asthma are unknown, but it likely results from complex interactions between many genes, environmental conditions, and nutrition. Environmental conditions and circumstances around pregnancy, birth, and infancy have been associated with the development of asthma in childhood and later in adulthood.

Risk appears to be higher if a person’s mother became pregnant at a young age or had poor nutrition during pregnancy. Risk may also be higher if someone is born prematurely, had a low weight at birth, or was not breastfed. Environmental conditions such as exposures to household allergens (such as dust mites, cockroaches, and pet dander) and other environmental allergens have also been associated with the development of asthma in older children and adults.

Diets low in vitamins C and E and in omega–3 fatty acids have been also linked to asthma, as has obesity. There is no evidence that dietary supplements of these substances prevent the development of asthma; however, it has been shown that weight loss can reduce the risk and severity of asthma. Thus, obesity is an important modifiable risk factor for asthma.

Having smaller families with fewer children, cleaner indoor environments, and use of vaccinations and antibiotics in early life may decrease the body’s ability to develop resistance to allergens in the environment and may partly explain the increase in asthma in places where these conditions exist (the hygiene hypothesis).

Narrowing of the airways is often caused by abnormal sensitivity of cholinergic receptors, which cause the muscles of the airways to contract when they should not. Certain cells in the airways, particularly mast cells, are thought to be responsible for initiating the response. Mast cells throughout the bronchi release substances such as histamine and leukotrienes, which cause the following:

• Smooth muscle to contract
• Mucus secretion to increase
• Certain white blood cells to move to the area
• Eosinophils, a type of white blood cell found in the airways of people with asthma, release additional substances, contributing to airway narrowing.

In an asthma attack (sometimes called a flare-up or an exacerbation), the smooth muscles of the bronchi contract, causing the bronchi to narrow (called broncho-constriction). The tissues lining the airways swell due to inflammation and mucus secretion into the airways. The top layer of the airway lining can become damaged and shed cells, further narrowing the airway. A narrower airway requires the person to exert more effort to breathe. In asthma, the narrowing is reversible, meaning that with appropriate treatment or on their own, the muscular contractions of the airways stop, inflammation resolves so that the airways widen again, and airflow into and out of the lungs returns to normal.

In people who have asthma, the airways narrow in response to stimuli (triggers) that usually do not affect the airways in people without it. Such triggers include

• Allergens – Many inhaled allergens, including pollens, particles from dust mites, body secretions from cockroaches, particles from feathers, and animal dander, can trigger an asthma attack. These allergens combine with immunoglobulin E (IgE, a type of antibody) on the surface of mast cells to trigger the release of asthma-causing chemicals. (This type of asthma is called allergic asthma.) Although food allergies induce asthma only rarely, certain foods (such as shellfish and peanuts) can induce severe attacks in people who are sensitive to these foods.
• Infections – Infectious triggers are usually viral respiratory infections, such as colds, bronchitis, and, less commonly, pneumonia.
• Irritants – Irritants that can provoke an asthma attack include smoke from tobacco, marijuana, or cocaine; fumes (such as from perfumes, cleaning products, or air pollution); cold air; and stomach acid in the airways caused by gastro-oesophageal reflux disease (GERD). Air pollution has been linked to asthma attacks.
• Exercise (called exercise-induced asthma) – Some people who have asthma can develop airway narrowing when exercising. This type of airway narrowing may be due to breathing drier, colder air through the mouth while exercising. Crying or hearty laughing may trigger symptoms in some people.
• Stress and anxiety – Stress and anxiety can trigger mast cells to release histamine and leukotrienes and stimulate the vagus nerve (which connects to the airway smooth muscle), which then contracts and narrows the bronchi.
• Aspirin – Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) are triggers for almost 30% of people with severe asthma, but they are triggers in less than 10% of people with asthma overall.

Eosinophilic asthma

It is a rare, severe subtype of asthma in which very high levels of eosinophils are present in the blood. The higher the level of eosinophils the more severe the person’s symptoms.

Reactive airways dysfunction syndrome (RADS)

It is a rapid onset and persistent asthma-like disorder that occurs in people with no history of asthma. It is a form of environmental lung disease caused by a single large exposure to nitrogen oxide or volatile organic compounds (such as those in certain bleaches and cleaning products). People have symptoms similar to those of asthma, including cough, wheezing, and shortness of breath. Treatment is similar to usual treatment for asthma.

Symptoms of asthma

The attacks vary in frequency and severity. Some people are symptom-free most of the time, with only an occasional brief, mild episode of shortness of breath. Other people cough and wheeze most of the time and have severe attacks after viral infections, exercise, or exposure to other triggers.

Wheezing is a musical sound that occurs when the person breathes out. Coughing may be the only symptom in some people (cough-variant asthma). Some people with asthma produce a clear, sometimes sticky (mucoid) phlegm (sputum).

In some people, attacks occur primarily at night (nocturnal asthma). Attacks that occur during the night may indicate poorly controlled asthma.

Symptoms of an asthma attack

• Asthma attacks occur most often in the early morning hours when the effects of protective conventional drugs wear off and the body is least able to prevent airway narrowing.
• An attack may begin suddenly with wheezing, coughing, and shortness of breath. At other times, an asthma attack may come on slowly with gradually worsening symptoms. In either case, people with asthma usually first notice shortness of breath, coughing, or chest tightness. The attack may be over in minutes, or it may last for hours or days. Itching on the chest or neck may be an early symptom, especially in children. A dry cough at night or while exercising may be the only symptom.
• During an asthma attack, shortness of breath may become severe, creating a feeling of severe anxiety. The person instinctively sits upright and leans forward, using the muscles in the neck and chest to help in breathing, but still struggles for air. Sweating is a common reaction to the effort and anxiety. The heart rate usually quickens, and the person may feel a pounding in the chest.
• In a very severe asthma attack, a person is able to say only a few words without stopping to take a breath. Wheezing may actually diminish, however, because hardly any air is moving in and out of the lungs. Confusion, lethargy, and a blue skin colour (cyanosis) are signs that the person’s oxygen supply is severely limited, and emergency treatment is needed. Usually, a person recovers completely with appropriate treatment, even from a severe asthma attack. Rarely, some people develop attacks so quickly that they may lose consciousness before they can give themselves effective therapy. Such people should wear identification (such as a medical alert bracelet or necklace) and carry a cellular phone to call for emergency medical assistance.

Status Asthmaticus

The most severe form of asthma is called status asthmaticus.

It is an emergency and cannot be dealt with Homeopathy.

It is severe, intense, prolonged airway narrowing that is resistant to treatment. In status asthmaticus, the lungs are no longer able to provide the body with adequate oxygen or to remove carbon dioxide adequately.

Without oxygen, many organs begin to malfunction. The buildup of carbon dioxide leads to acidosis, an acidic state of the blood that affects the function of almost every organ. Blood pressure may fall to dangerously low levels. The airways are so narrowed that it is difficult to move air in and out of the lungs.

Status asthmaticus may require that an artificial airway be passed through the person’s mouth and throat into the main airway leading to the lungs (the trachea) and that a mechanical ventilator be used to assist breathing. Sometimes breathing can be assisted by a machine without inserting a breathing tube (called noninvasive ventilation). Higher-than-normal doses of several drugs are also needed.

Other symptoms

People with asthma often also feel tired, have problems sleeping, lose their appetite and/or taste for food, and lose weight. Their sex drive may decrease. These problems develop gradually.

Recurrent debilitating asthma attacks can prevent people from doing what they usually enjoy and starts to affect the mind as well. They may become depressed and anxious. They may stop their activities, withdraw socially, and become preoccupied with physical health. The mind-body complex is now fully affected and becomes a vicious circle which keeps an individual in suffering mode.

Diagnosis of asthma

A doctor’s thorough evaluation which includes physical; mental; emotional; social health and environmental influence. Through this evaluation doctors try to identify the causes, factors modifying and the impact of symptoms on the daily life quality of a person.

Doctors ask how the person feels; eats; sleeps and goes through a routine day. Identifying these changes is critical because they can make the situation better or worse and, if present, must be treated for the pain to be treated effectively.

Doctors diagnose asthma based largely when the symptoms are typical and results of a thorough examination are normal.

In some countries doctors confirm the diagnosis by doing breathing tests ( pulmonary function tests). The most important of these tests are measures of the amount of air a person can blow out in one second. These tests are done before and after giving the person an inhaled drug, called a beta-adrenergic drug (or beta-adrenergic agonist), that reverses airway narrowing. If test results are significantly better after the person receives the drug, asthma is thought to be present.

If the airways are not narrowed at the time of the test, a challenge test can help confirm the diagnosis. In a challenge test, pulmonary function is measured before and after the person inhales a chemical (usually methacholine, but histamine, adenosine, or bradykinin may be used) that can narrow the airways. The chemical is given in doses that are too low to affect a person with healthy lungs but that cause the airways to narrow in a person with asthma.

Repeatedly measuring lung function over time allows doctors to determine the severity of the airway obstruction and the effectiveness of treatment.

To test for exercise-induced asthma, an examiner uses pulmonary function tests to measure how much air the person can exhale in 1 second before and after the person exercises on a treadmill or stationary bicycle. If the volume of air decreases more than 15%, the person’s asthma can be induced by exercise.

Pulmonary function tests may also be useful when a diagnosis of asthma is not clear and wheezing and shortness of breath may be due to another disorder such as an interstitial lung disease, chronic obstructive pulmonary disease, or upper airway obstruction.

A chest x-ray is usually not helpful in diagnosing asthma. Doctors use chest x-rays when considering another diagnosis. However, a chest x-ray is often obtained when a person with asthma needs to be hospitalized for a severe attack.

Determining what triggers a person’s asthma is often difficult as it varies from person to person. Allergy testing is appropriate when there is a suspicion that some avoidable substance (for example, exposure to cat dander) is provoking attacks. Skin testing can help identify allergens that may trigger asthma symptoms. However, an allergic response to a skin test does not necessarily mean that the allergen being tested is causing the asthma. The person still has to note whether attacks occur after exposure to this allergen. If doctors suspect a particular allergen, a blood test that measures the level of antibody produced in response to the allergen (the radio allergo sorbent test [RAST]) can be done to determine the degree of the person’s sensitivity to the allergen.

Evaluating an asthma attack

Because people who are having a severe asthma attack commonly have low blood oxygen levels, doctors may check the level of oxygen by using a sensing monitor on a finger or ear (oximetry). In severe attacks, doctors also need to measure levels of carbon dioxide in the blood, and this test typically requires obtaining a sample of blood from an artery or, occasionally, a vein. However, carbon dioxide levels can sometimes be monitored in the person’s breath using a sensor placed in front of the nose or mouth.

Doctors may also check lung function, usually with a spirometer (a mouthpiece and tubing connected to a recording device that is used to measure air flow in the lungs) or with a peak flow meter. Usually, a chest x-ray is needed only when asthma attacks are severe, in order to rule out other serious conditions (such as a lung collapse).

Diagnosing asthma in older people

Older people are more likely to have other lung diseases that also cause shortness of breath (such as chronic obstructive pulmonary disease), so doctors have to determine how much of the person’s breathing difficulty is related to asthma and reversible. Often, in these people diagnosis involves a brief trial to see whether the person’s condition improves.

Homeopathic Treatment of asthma

An asthma attack can be frightening, both to the person experiencing it and to others around. Even when relatively mild, the symptoms provoke anxiety and alarm. A severe asthma attack is a life-threatening emergency that requires immediate, skilled, professional care. If not treated adequately and quickly, a severe asthma attack can cause death.

An acute attack in a person whose asthma has been controlled by drugs is called an exacerbation or flare-up. These can be significantly reduced and prevented by Homeopathy.

Mild attacks

After a thorough evaluation, each case is worked upon and a set of similar medicines is derived, from which one single medicine which fits the patient’s presentation at that time, in relevant intensity and repetitions is given.

The medicine for acute episode and symptom free period are different. As the improvement goes on you may need different medicine from the previous one, based on your presenting symptoms.

Some need only one medicine throughout the duration of treatment and some need few in sequence one after another across the treatment.

Timely follow-ups are essential to keep moving forward towards the goal of treatment and to identify, manage and overcome any obstacles to the outcome.

Severe attacks

People who have severe symptoms should typically go to an emergency department and may need hospitalisation.

People also are hospitalized if they have a seriously low blood oxygen level or a high blood carbon dioxide level. Antibiotics may be needed if a doctor suspects a bacterial lung infection. However, most such infections are due to viruses for which (with a few exceptions) no conventional treatment exists.

People experiencing very severe asthma attacks may need to have an artificial airway passed through their mouth and throat (intubation) and be placed on a mechanical ventilator.

Monitoring Asthma at Home

Some people use a handheld peak flow meter to evaluate their breathing and determine when they need intervention, before their symptoms become severe. People who experience frequent, severe asthma attacks should know how to reach help quickly.

Peak expiratory flow (the fastest rate at which air can be pushed out of the lungs) can be measured using a small handheld device called a peak flow meter. This test can be used at home to monitor the severity of asthma. Usually, peak flow rates are lowest between 4 AM and 6 AM and highest at 4 PM. However, more than a 30% difference in rates at these times is considered evidence of moderate to severe asthma. People with moderate to severe asthma, particularly those who need daily treatment to control symptoms, often use a peak flow meter to take measurements and compare them to their personal best to help identify signs of worsening asthma or the onset of an asthma attack.