The complete guide to understanding and managing asthma

Asthma is ranked as a major non-communicable disease across the world. According to the World Health Organization (WHO), in 2019, asthma affected an estimated 262 million people across the world and resulted in 461,000 deaths. In Kenya, it is estimated that about 4 million people could be living with asthma, with Nairobi and Eldoret recording the highest cases of asthma in children aged between 13 and 14 years. In 2018, a commission by the Ministry of Health listed asthma as the top priority non-communicable disease in Kenya. The WHO also ranks this condition as the most common chronic disease among children.

What is it?

According to Dr. Patrick Kihiu, a general medical practitioner in Makueni County, asthma is a non-communicable disease that is mainly characterized by a wheezing sound, shortness of breath, and cough. These effects come once the human airways are inflamed. Dr. Kihiu explains that when a healthy individual is afflicted by asthma, the air passages in the lungs become narrow. This is mainly due to the inflammation and tightening of the muscles that surround the small airways. Among children, asthma is more common in boys than girls. This changes during adulthood, where women are more likely to have asthma than men.

The triggers

Dr. Kihiu says that there are certain triggers that accelerate the occurrence of asthma. These include cold, dust, smoke, strong scents, and animal or carpet fur. “These are the basic triggers that act as irritants to the human airways,” he says. However, asthma is also genetic. This means that an individual’s genetic makeup can predispose them to have asthma. According to the Centre for Disease Control, CDC, if a parent has asthma, their child will be three to six times more likely to develop asthma as well. This puts the number of asthmatic cases that are estimated to be hereditary at about three-fifths of all asthma cases.

The symptoms and risk factors

The main symptoms of asthma include wheezing, coughing, tightness in the chest, and shortness of breath. “The symptoms will vary from one patient to the other. There are patients whose symptoms will get worse at night or early in the morning,” says Dr. Kihiu. In addition, the WHO cautions that if a person has asthma that is undertreated, they will tend to have sleep disturbances at night, feel overwhelmingly tired during the day, and suffer from poor concentration.

There are also certain risk factors that set asthma in motion. According to the WHO, these factors include:

• A baby that is born prematurely or with extremely low birth weight.
• An expectant woman who is exposed to tobacco or an expectant woman who exposes her pregnancy to tobacco or extreme air pollution that can affect the development of the baby’s lungs.
• A family history with asthma such as a close family member like a parent or sibling who has asthma.
• An individual who is overweight or struggling with obesity. 
• A person who has other allergic conditions such as hay fever or eczema.

There are certain over-the-counter medications that make asthma worse, and others that do not. If you have moderate to severe asthma, you’re advised not to take aspirin painkillers, and ibuprofen. At the same time, beta-blockers which are used to treat high blood pressure or angina have been known to make asthma worse. Angina is chest pain that is caused by reduced blood flow to the heart muscles. It points to the possibility of a heart attack or stroke.

Diagnosis

There are five main ways asthma is diagnosed. John Hopkins Medicine lists these diagnostic methods as:

Peak flow monitoring – this method measures the fastest speed at which air flows out of the lungs. Where there’s an asthma attack speed is reduced as large airways in the lungs slowly narrow.

Spirometry – this method measures the function of the lungs by determining the speed of the airflow and the amount of air that is flowing. This test is considered the simplest of all pulmonary function tests.

Allergy test – this method is used to determine whether a person has allergic reactions to certain substances.

Chest X-rays – these are secondary tests that are used to determine whether there may be any other form of lung disease in a patient.

Blood tests – these are used to analyse the amount of carbon dioxide and oxygen in the patient’s blood.

Treatment and management

The WHO lists two main types of inhalers for asthma patients:

1). Bronchodilators: These serve to open the air passages and relieve symptoms. They include salbutamol.

2). Steroids: These work by reducing inflammation in the air passages to reduce asthmatic symptoms. They include beclometasone. 

According to Dr. Mbuthia, one of the effective ways of managing asthma is identifying its triggers and keeping them off. “There are drugs such as antihistamines, beta-agonists, and steroids that help in reversing the narrowing of the airways to allow for sufficient passage of air into the lungs. But the main form of treatment is the avoidance of triggers,” he says. “You must know what sets your asthmatic condition off, at what point things escalate to serious, and learn how to avoid these triggers.”

Takeaway research: children and asthma

Children who suffer developmental disabilities and developmental delays are at a higher risk of getting asthma. This was found through a 2021 study that was conducted by the University of Texas Health Science Centre, Houston (UTHealth). This study showed that some of the developmental disabilities that appear to set children up for asthma include motor disabilities, attention deficit hyperactivity disorder, vision impairment, behavioral disorders, speech disabilities, hearing impairment, and cognitive disabilities. “Children with hearing loss appear to have the greatest likelihood of having asthma, followed by those with cerebral palsy and children with a learning disability,” said Dr. Sarah Messiah, a professor of epidemiology, human genetics, and environmental science who led the study. Dr. Sarah and her colleagues examined 71,811 children to come up with these findings.

According to the study, the presence of inflammation in some developmental disorders was a likely pathway for asthma. “In children with ADHD, inflammation is a potential causal pathway. Patients with ADHD have increased stress levels, which lead to a neuroimmunological response that eventually triggers the co-occurrence of asthma,” the study report said. “Certain developmental disorders such as ADHD have shared risk factors with asthma, which increases the susceptibility of concurrent conditions.” According to Dr. Sarah, these findings suggested that it is paramount for pediatricians handling children with developmental disorders to screen for asthma since children with asthma are often misdiagnosed.