Every time she would gasp for breath, a whistling sound escaped from her lungs; little Preetha would then tightly clutch her mother’s hand. This used to be a regular scene for Preetha, now 18, who suffered from frequent bouts of asthma as a child. Over the years, inhalers made her life better.
Preetha has not had an asthma attack in the last three years and has protected herself from asthmatic triggers. She carries an inhaler and doesn’t step into any place where incense sticks are burned.
“It was incense sticks and mosquito coils she was allergic to. There were tense moments in our life when she had nocturnal coughs, which turned out to be wheezing. It affected her nursery education in the early days. It took us months to understand the trigger. It was diagnosed as asthma only when she was five. Her night coughs were always associated with fumes from the mosquito coils,” says Preetha’s mother, Mangala R, who lives in Bangalore.
How asthma affects your lungs and its symptoms
Dr Praveen Valsalan, consultant pulmonologist, Aster Medcity, Kochi, says that asthma is an inflammatory condition of the airways. “The airways become narrow and swell; that makes you breathe with difficulty,” he says.
The typical symptoms of asthma are:
- Chest heaviness
- Chest tightness
“It is a chronic condition, which means it will not go away. So, it needs ongoing management. There are a lot of times when the condition can go into remission – that is, people may not display the signs and symptoms,” says Dr Valsalan.
Dr Sindhura Koganti, pulmonologist, Fortis Hospital, Vadapalani, Chennai, says the absence of fever when the child is wheezing or has a cough is a hint of asthma.
“Asthma is purely an allergic reaction; whenever a person is exposed to an external allergen, the response will be seen immediately. Once a person avoids the allergen, there will be no symptoms and s/he will be allergy free,” says Dr Koganti.
But what is the cause of the strange noise that comes from the lungs?
“In those with asthma, since the airways become narrowed, it can make breathing difficult. When the air goes through these narrowed passages, it makes a wheezing sound,” explains Dr Valsalan.
People with asthma can have difficulty sleeping and doing their day-to-day activities are affected due to shortness of breath. Asthma attacks that are presented as coughs, wheezing and chest tightness can also happen during a viral infection. During a viral infection, the airways produce a lot of mucous which clogs them; sometimes the mucous comes out when the person coughs.
Causes of asthma
The usual cause of asthma is a concomitant allergy (allergy that occurs only in the presence of a particular allergen), says Dr Valsalan, adding that the allergen differs from person to person. He says that the most common allergens include:
- House dust
- Dust mites
- Pet dander
- Shellfish, eggs and drugs
The non-allergenic causes include
Dr Valsalan elucidates the case of an eight-year-old boy he treated in Kerala. The boy, slightly on the obese side, came to him when he was three years old with wheezing and a blocked nose. Nights and early mornings were tough for the family as he would frequently stir from his sleep. The parents would nebulise him and he would get temporary relief. There were also times he was taken to the hospital for injections that gave him some respite.
“The most important thing that I told them was the need for a regular inhaler. The second was to control his upper airway allergy with a nasal spray. The third was to be careful with allergens – the most common being house dust and house dust mites. The fourth was to reduce his weight. I advised him to do regular exercises like cycling and playing with his peers. Following all these, he has dramatically changed; his wheezing is now controlled and he has hardly missed school,” says Dr Valsalan.
Adults have more severe symptoms and smoking can aggravate the condition.
What parents can do
- Make sure asthmatic kids take medicines regularly
- Treat every flare-up promptly
- Ensure that the house is dusted regularly and that the mattress, curtains, sofas and carpets are cleaned regularly
- Asthma should not curtail the kids’ ability to go out and play. Exercises do help them a lot
Asthma underdiagnosed among many
Dr Koganti says that parents often mistake the asthmatic kids’ condition for a repeated cold. “If the parents have a history of asthma, be aware that the children may also have it and watch out for the symptoms. But sometimes parents think that the symptoms could be because of ice creams; they don’t know the actual concept of asthma,” says Dr Koganti.
“Children (vulnerable to asthma) who play with pets at home are unknowingly exposed to allergens. If they are very sensitive, they will have symptoms of wheezing and cough,” says Dr Koganti, adding that if the asthma is not controlled, they will have difficulty participating in physical activities.
How ice cream or anything cold could be the trigger
For kids, cold breeze, air conditioning, ice creams and cool drinks could cause flare-ups, says Dr Koganti. Symptoms resemble that of a cold after you eat ice cream, followed by breathing difficulty. “But people think that it is the ice cream that led to the cold,” she says.
Similarly, a cold breeze can also cause broncho spasms – sudden constrictions of the muscles that line the airways in the lungs. “The cold breeze that you inhale will directly go into your lungs. When you eat ice creams, the coldness will cause broncho constrictions wherein the air passage becomes narrow due to cold intolerance,” says Dr Koganti.
How asthma is treated
The treatment of asthma revolves around inhalers. “They are the best and most effective mode of treatment. The drugs usually consist of bronchodilators and anti-inflammatory medicines; this is the cornerstone of treatment,” says Dr Valsalan.
He says there are many myths about inhalers (like they are addictive) but they are just that – myths. “Inhalers contain the smallest dose of the drug possible and since it acts on the airways (directly), the dose needed is much less. When there is an exacerbation, people may require antibiotics and other drugs like oral steroids to control their flare-ups,” he adds.
Injectables, called biologicals, are now being used to control asthma. These are medications that are made from cells from living organisms that are further modified to target particular molecules in human beings. “Biologicals are used for people who have uncontrolled symptoms despite regular medications. Even though they are expensive, they are very effective in a subset of the population,” says Dr Valsalan.
Is asthma curable?
With age, once the body’s immune response improves, the allergic response might slightly get better. With proper medications, the usage of inhalers and avoiding the allergen, asthma can be controlled. But asthma cannot be cured, says Dr Koganti. She adds that avoiding allergens is vital in tiding over the condition.
“Asthma could be persistent (where symptoms continue for long) or intermittent (where the symptom come and go); so, you can feel normal in between flare-ups,” says Dr Valsalan.