Asthma

Question 1

What is Asthma?

Answer 1

Asthma is a chronic lung disease that causes inflammation in the airways, making it difficult to breathe.

There is some overlap between chronic asthma and COPD (chronic obstructive pulmonary disease), while acute asthma tends to encompass most presentations whether adult or child onset.

Acute
* Airway inflammation
* Intermittent airflow obstruction
* Bronchial hyperresponsiveness
* Oedema and mucus secretion

Chronic
* Inflammation becomes chronic
* Permanent damage to airways in the form of hyperplasia
* Greater possibility of symptoms even without direct exacerbation (i.e. not necessarily linked to asthma ‘attack’)”

Question 2

What causes Asthma? What and the impacts on wellbeing?

Answer 2

The aetiology of asthma can be broadly grouped into infective, allergic/irritant and medication induced.

**Infective **
* Viral respiratory tract infection
* Chronic sinusitis
* Chronic rhinitis

**Allergic/irritant **
* Environmental – dust, fungi, animal dander
* Second hand tobacco smoke
* Environmental pollutants

Medication
* Aspirin
* Beta blockers
* Non-steroidal antiinflammatories (e.g. ibuprofen)

Other aetiological factors include
* gastro-oesophageal reflux disease,
* exercise induced bronchoconstriction and
* perinatal factors including maternal smoking/ prenatal exposure to tobacco smoke,
* increased maternal age and
* premature delivery
* genetic predisposition is a key risk factor.

Question 3

What are the signs and symptoms of Asthma?

Answer 3

• Wheeze – a high pitched whistling sound notable especially on exhalation
• Cough – persistent, largely unproductive
• History of bronchitis, bronchiolitis, pneumonia, croup and recurrent colds in infants and young children
• Shortness of breath, dyspnoea
• Chest pain

Question 4

What is the pathophysiology of Asthma?

Answer 4

Pathophysiology
* Airway inflammation – mast cells and T-lymphocytes play a prominent role
following stimulation of the immune response by an antigen, airway oedema
and mucous secretion resulting from inflammation contribute to subsequent
airflow obstruction and airway hyperreactivity

• Intermittent airflow obstruction – IgE release causes acute
  bronchoconstriction, followed by airway oedema and then formation of mucous plugs made of serum proteins and cell debris; the persistent restriction of air outflow may lead to hyperinflation of the lungs to maintain correct balance but has detrimental effects on comfortable breathing
• Bronchial hyperresponsiveness – arising from the imbalance between ventilation (breathing) and perfusion (spread of oxygenated blood in target tissues) rather than irritated bronchi due to allergens etc its an attempt by the body to hypercompensate, and maintain adequate airflow in spite of obstruction

Question 5

What is usual diagnosis and treatment for Asthma?

Answer 5

Key diagnostic tests (UK):
* Spirometry
* Peak flow
* Chest x-ray
* Allergy tests

Conventional treatment
Usual medications include – reliever
inhaler (usually blue), preventer inhaler (brown inhalers) containing
steroid medication. Leukotriene
receptor antagonists and oral steroids may
also be used

Question 6

How can herbs help with asthma?

Answer 6

Key herbal actions to consider for asthma apart from bronchodilation for acute
episodes are –
* demulcent (e.g. althaea fol.)
* mucus membrane trophorestorative (e.g. plantago lanceolata)
* expectorant (thymus vulgaris is useful as the antiseptic action on expectoration assists in preventing secondary infection) and
* anti-inflammatory (ginkgo and matricaria are specifically active against mast cells)

Question 7

What about late (adult) onset asthma?

Answer 7

Although the majority of asthma cases tend to be in children, adult onset/late onset asthma is increasing and shows a slightly different aetiological background to childhood asthma:

• Less likely to be linked to allergy
• Female incidence higher than male – potential link to female hormones as male/female incidence in childhood is fairly equal
• A poorer prognosis and more severe lung function decline

Looking at general risk factors, environmental pollutants in the workplace and direct exposure to first-hand tobacco smoke become more prominent issues, as do obesity and emotional stressors

From a diagnostic viewpoint it is essential to
comprehensively assess persistent cough through case history and physical examination even if typical red flags for lung cancer are absent, given the poor prognosis for late onset asthma.

Diet can help here, eg reducing anything that causes inflammation