Monday, April 17, 2017

Asthmatics - understanding, symptom, Cause, diagnosis, Treatment and complication

Understanding Asthma

Asthma is a type of long-term or chronic disease of the respiratory tract characterized by inflammation and narrowing of the airways that causes shortness or difficulty breathing. In addition to difficulty breathing, asthma sufferers can also experience other symptoms such as chest pain, coughing, and wheezing. Asthma affects all ages, whether young or old.

Although the exact cause of asthma is not known clearly, but there are some things that often trigger it, such as cigarette smoke, dust, animal dander, exercise, cold air, viral infections, or even exposure to chemical substances.
For someone who has asthma, respiratory tract more sensitive than other people who do not live with this condition. When the lungs become irritated trigger on, then the muscles of the respiratory tract of asthmatics will become stiff and makes the channel narrows. In addition, there will be increased production of mucus that makes breathing more difficult.
asthmatics -  understanding, symptom, Cause, diagnosis, Treatment and complication

Asthmatics in Indonesia

Basic health research report by the Ministry of Health in 2013 estimated the number of asthma patients in Indonesia reached 4.5 percent of the total population. Central Sulawesi Province was ranked the highest asthma sufferers as much as 7.8 percent of the total population in the area.
According to the data released by WHO in May 2014, the death rate from asthma in Indonesia reached 24 773 people, or about 1.77 percent of the total population mortality. After adjustment of the various population ages, these data once puts Indonesia at number 19 in the world regarding deaths due to asthma.

diagnosis of asthma

To determine whether a patient suffers from asthma, the doctor needs to perform a number of tests. But before the test, your doctor will usually ask a question the patient about any symptoms are felt, the time of appearance of these symptoms, and the patient's medical history and family.
If all the information given to patients leads to asthma, then the next doctor can perform tests to confirm the diagnosis, for example:
  • spirometry
  • Peak expiratory flow test (APE)
  • Provocation Test bronchus
  • Status Measurement Allergies
  • CT Scan
  • roentgen
If a person is diagnosed with asthma during childhood, symptoms may be absent when she was a teenager and come back when he was older. But the symptoms of asthma are classified as medium or heavy in childhood, will tend to remain there although it may also reappear. Nevertheless, asthma can occur at any age and do not always start from childhood.

treatment of asthma

There are two goals in the treatment of asthma, which relieve symptoms and prevent recurrence of symptoms. To support these objectives, required treatment from a doctor who plans tailored to the patient's condition. The treatment plan includes how to recognize and handle worsening symptoms, and drugs should be used.
It is important for patients to recognize the things that can trigger their asthma in order to avoid it. If the symptoms of asthma, medicines commonly recommended is the reliever inhaler.
When an asthma attack with worsening symptoms (slowly or quickly) despite being treated with inhalers or other medications, the patient should immediately seek treatment at the hospital. Although rare, asthma attacks may endanger lives. For patients with chronic asthma, inflammation of the airways longstanding and repeatedly can cause permanent constriction.

complications of asthma

Here are impacted by asthma can happen:
  • Psychological problems (anxiety, stress, or depression).
  • Declining performance in school or at work.
  • The body often feels tired.
  • Impaired growth and puberty in children.
  • Status asthmaticus (severe asthma condition that does not respond to normal treatment).
  • Pneumonia.
  • Respiratory failure.
  • Damage to the part or the entire lung.
  • Dead.

Controlling asthma

If you happen to suffer from asthma or living with asthma for a long time, do not worry about these conditions because asthma is a disease that is manageable as long as you:
  • Recognizing and avoiding asthma triggers.
  • Following asthma management plan created with your doctor.
  • Recognize an asthma attack and take action appropriate treatment.
  • Using asthma medication recommended by doctors on a regular basis.
  • Monitor the condition of your airways.
If you use your inhaler asthma reliever growing fast reactions, consult a physician immediately so that your asthma management plan readjusted. In addition, it is advisable to carry out the vaccination influenza and pneumonia regularly to prevent the worsening of asthma caused by both diseases.

Symptoms Of Asthma

The main symptoms of asthma include difficulty breathing (sometimes can make people gasp), coughing, chest tightness, and wheezing (sound is produced when air flows through narrowed airways). If these symptoms are recurrent, often with asthma become difficult to sleep.

The severity of asthma symptoms can range from mild to severe. Worsening of symptoms usually occurs at night or early morning. Often this makes asthmatics become difficult to sleep and the need for inhalers more often. In addition, the worsening of the symptoms can also be triggered by an allergic reaction or physical activity.
Asthma symptoms worsened significantly called asthma attacks. Asthma attacks usually occur within 6-24 hours, or even days. Even so, there are some patients whose asthma symptoms worsen very quickly less than that time.
In addition to difficulty breathing, chest tightness, and wheezing that is worsened significantly, other signs of severe asthma attack can include:
  • Reliever inhalers are no longer effective in dealing with the symptoms.
  • Symptoms of cough, wheezing and tightness in the chest more severe and frequent.
  • It's hard to talk, eat, or sleep due to difficulty breathing.
  • Lips and fingers look blue.
  • Increased heart rate.
  • Feeling dizzy, tired or sleepy.
  • Decrease in peak expiratory flow.
Do not ignore if you or your family have signs of asthma attacks over. See your doctor to get further treatment.

Causes Of Asthma

The cause of asthma is still unknown. Even so, there are some things that can trigger the onset of symptoms of the disease, including:
  • Infection of the lungs and respiratory tract that usually attacks the upper respiratory tract such as the flu.
  • Allergens (animal dander, dust mites, and pollen).
  • Exposure to airborne substances such as chemical fumes, cigarette smoke, and air pollution.
  • Factors weather conditions, such as cold weather, windy weather, hot weather supported poor air quality, damp weather, and drastic temperature changes.
  • Conditions were damp interiors, moldy and dusty.
  • Stress.
  • Excessive emotions (sadness protracted, excessive angry, and burst out laughing).
  • Physical activity (eg, sports).
  • Drugs, for example, analgesics anti-inflammatory drugs (aspirin, naproxen, and ibuprofen ) and beta blocker medications (usually given to people with heart problems or hypertension).
  • Foods or drinks that contain sulphites (a natural substance that is sometimes used as a preservative), for example, butter, shrimp, processed foods, ready meals, drinks bottled fruit juice, beer, and wine.
  • Food allergies (eg nuts).
  • Gastroesophageal reflux disease (GERD) or disease in which stomach acids back up into the esophagus sehngga irritate the upper gastrointestinal tract.
It's important to know what is often trigger symptoms if you are an asthma sufferer. Once informed, avoid these things because it is the best way for you to prevent asthma attacks.

The risk factors of asthma

Respiratory tract people who have asthma are more sensitive and susceptible to inflammation compared to normal people when irritated by triggers that have been mentioned above.
When the symptoms of asthma, respiratory tract will be narrowed and the muscles around the channel tightening. In addition, there is increased inflammation in the lining of the respiratory tract and sputum production are increasingly adding a narrowing of the respiratory tract.
By narrowing parts of the respiratory tract, then the air will be more difficult to flow and the patient becomes increasingly difficult to breathe.
According to research, there are several factors that can increase the person's risk for asthma, including:
  • Having a family with a history of asthma or
  • atopic allergy (allergy-related conditions, such as food allergies and eczema ) .
  • Bronchiolitis disease or lung infections as a child.
  • Birth weight below normal, which is less than two kilograms.
  • Premature birth, especially if it requires a ventilator.
  • Exposure to cigarette smoke as a child. In the case of mothers who smoke during pregnancy, the risk of a child to develop asthma will increase.

Asthma Diagnosis

To determine whether a patient suffers from asthma, the doctor needs to perform a number of tests. But before the test is done, the doctor usually will ask questions about your symptoms, such as whether the patient like experiencing shortness of breath, chest pain, wheezing, difficulty speaking, and the condition of the lips or nails change color to blue.

If the answer is positive, then the next doctor will ask about the timing of the onset of symptoms. For example, if when night or early morning, when exercising, when smoked, when it was near furry animals, when to laugh, when feeling stressed, or unpredictable. In addition, doctors also need to ask if the patient has a family with a history of asthma or allergies.
If all the information given by the patient leads to asthma, we then performed a physical examination and laboratory tests. Laboratory tests can be done to strengthen the evidence. The most frequently performed tests is spirometry. In this test, the patient will be asked the doctor to draw a deep breath and let it out as quickly as possible into a device called a spirometer. The purpose of this test is to measure the performance of the lung by sticking to the volume of air that the patient can exhale in one second and the total amount of air exhaled. Obstruction of the respiratory tract that leads to asthma can be seen by a doctor after comparing the data obtained with a size that is considered healthy at the age of the patient. In addition based on the healthy size, asthma can also be detected by spirometry by comparing the initial data with the data after the patient is given medication inhaler. If after a given inhaler result becomes better, then the patient is likely to suffer from asthma.
The next test that can be used to diagnose asthma is testing levels peak expiratory flow. In the tests assisted by a tool called a peak flow meter (PFM), the speed of air from the lungs in a single breath exhaled by the patient can be measured in order to obtain data peak expiratory flow rates (PEFR). Doctors usually advise patients to buy a PFM for use at home, and make a note PEFR every day. In addition, patients would be well advised to take note of any symptoms that doctors can know when asthma worsens.
If the patient feels that respiratory symptoms often recover when he is not working, patients have asthma related to working conditions. Possibilities in the patient work are substances that trigger a recurrence of the symptoms of asthma. This usually occurs in people who work as nurses, employees of a chemical processing plant, laboratory staff, painters, welders, workers of wood processing, animal caretaker, and food processing workers. To support the diagnosis, a doctor may ask the patient to test peak expiratory flow (PEFR) using a peak flow meter (PFM), both at work and outside the workplace. From the data obtained, the doctor can predict whether a patient suffering from occupational asthma.
If you are diagnosed with asthma due to exposure to substances in the work environment, inform the diagnosis to the company where you work, especially on the part of occupational health services. Companies have a responsibility to ensure the health of employees.
For example, if your asthma is triggered by substances that exist in the production of raw materials, then ask the company to give you the equipment to protect themselves from exposure to these substances or move you to another division that does not involve direct processing. It could be trying to ask if the company is not allowed to replace the production materials with materials that are safer.
If within a year you still often develop asthma when they are at work, then consider finding a new job.

other tests

In addition to spirometry and peak expiratory flow test levels, some other tests may be needed to strengthen the notion of asthma patients or help detect diseases other than asthma. Examples of such tests are:
  • Tests for the presence of inflammation in the airways. In this test, the doctor will measure the levels of nitric oxide in the breath when the patient is breathing. If high levels of these substances, it may be a sign of inflammation in the respiratory tract. In addition to nitric oxide, a doctor will take a sample of sputum to check whether the lungs of patients experiencing inflammation.
  • Test the responsiveness of the airways (bronchial provocation test) This test is used to ascertain how the patient's respiratory tract reacts when exposed to one of the triggers of asthma. In this test, the patient will usually be asked inhaling the dry powder (mannitol). After that the patient will be asked to breathe into a spirometer to measure how high the rate of change in FEV1 and FVC after exposure to a trigger. If the results fall dramatically, it can be estimated patient suffering from asthma. In children, besides mannitol , media that can be used to trigger asthma is exercise.
  • Examination of allergy status This check is performed to determine whether the symptoms felt by the patient's asthma is caused by allergies . For example, food allergies, mites, dust, pollen, or insect bites.
  • CT Scan. This examination can be performed by your doctor suspects that the symptoms of shortness of breath in the patient was not caused by asthma, but infection in the lungs or nasal cavity structural abnormalities.
  • X-ray examination. The purpose of this examination is the same as CT scan, which is to see if the interference pernapasandisebabkan by other conditions.

Asthma Treatment

Goal of asthma treatment is to control symptoms and prevent the recurrence of attacks. For most people with asthma, medicines and treatment methods that exist today have been proven effective in keeping your asthma symptoms under control.

To get effective results, physicians need to tailor the treatment to asthma symptoms appear. In addition, patients must undergo regular inspections (at least once a year) to ensure suitable and asthma treatment has to be in control. Sometimes patients require higher treatment levels in a certain time period.

Asthma management plan

Information about drugs should be included in the asthma management plan. The management plan also can help you know when the symptoms can worsen and what steps should be taken. At least once a year, the asthma management plan should reset your review with your doctor. Even more regular review needs to be done if the symptoms of asthma has reached severe levels.
You might be advisable to buy the peak flow meter (PFM) or peak expiratory flow measurement device as part of the treatment. This way you can monitor your own asthma so it can find an asthma attack early and take the necessary countermeasures.

Asthma medications recommended

Usually asthma medications are given through an instrument called an inhaler (inhaler for asthma). This tool can send drugs to the respiratory tract directly by means inhaled through the mouth. Using inhaled asthma medication in a manner considered effective because the drug directly to the lungs. Nevertheless, each inhalers work in different ways. Usually the doctor will teach you how to use these tools and checks at least once a year.
In addition to inhalers , there is also the so-called spacer. It is a container of metal or plastic which is equipped with a suction funnel at one end and a hole at the other end to be paired inhaler When the inhaler is pressed, the drug will enter into the spacer and inhaled through a mouthpiece spacer itself. Spacer can also reduce the risk of ulcers in the mouth or throat due to side effects from asthma medications are inhaled.
Spacer able to increase the amount of drug that reaches the lungs and reduce side effects. Some people even find it easier to use the spacer rather than an inhaler alone In fact, because it can improve the distribution of the drug into the lungs, the use of spacers are often advised.
As part of good asthma management, it is important to ensure that the doctor or pharmacist to teach how to use the inhaler correctly.
There are two types of inhalers that are used in the treatment of asthma, namely:
  • Reliever inhaler. Reliever inhaler used to relieve asthma symptoms quickly when an attack is in progress. The inhalers usually contain medicines called short-acting beta2-agonist or beta2-agonist which has a fast reaction (eg, terbutaline and salbutamol). This drug is able to relax the muscles around the airways are narrowed. By doing so, the respiratory tract can be opened wider and make people with asthma can breathe again more easily. Drugs contained in reliever inhaler rarely cause side effects and are safe to use as long as not excessive. Reliever inhaler does not need to be used more often if asthma has been well under control. For people with asthma should use these drugs by more than three times a week, then the whole treatment should be reviewed.
  • Preventer inhaler. Besides being able to prevent asthma attacks, preventer inhaler can also reduce the amount of inflammation and sensitivity that occurs in the airways. Usually you have to use a preventer inhaler every day for a while before the full benefit. You also may need a reliever inhaler to relieve symptoms during an asthma attack occurs. But if you are constantly in need of reliever inhaler, then your treatment should be reviewed in its entirety. Generally, preventive treatment is recommended if you have an asthma attack more than twice a week, had to use a reliever inhaler more than twice a week, or waking at night one or more times a week due to asthma attacks. Preventer inhalers usually contain steroids such as budesonide, beclometasone, mometasone, and fluticasone. Smoking can degrade the performance of this drug.
If asthma is not subsided by the above treatment, the doctor may increase the dose inhalers deterrent. If this step is also able to control asthma symptoms, a doctor may give you additional medicines called long-acting reliever or slow reactions asthma reliever medications (long-acting bronchodilator / long-acting beta2-agonist or LABA).  It works together with a fast reaction relievers, only performance takes longer and the effect can last up to 12 hours. Examples of reliever inhaler slow reactions are salmeterol and formoterol.
Due EARNINGS also not relieve inflammation in the airways of patients with asthma, these drugs may worsen asthma symptoms while hiding. This increases the likelihood of a severe asthma attack that may endanger the lives of patients. Therefore, always use the inhaler combination or inhaler combined with inhaled steroids and long-term bronchodilator in one device.

Side effects inhaler reliever and preventer

During its use does not exceed the dose, inhaler reliever is a safe treatment that does not have many side effects. Side effects that may arise in the use of high doses of which are headaches , muscle cramps, and a little shaky (tremor) on hand. These side effects usually only last for a few minutes.
Just as reliever inhalers, asthma management with a reliever inhaler also proven to be very safe in regular doses. Side effects usually occur at high doses and in long-term use. The side effect is a fungal infection in the mouth or throat, also known as oral candidiasis. Another side effect is your voice becomes hoarse. However, these side effects can be prevented if you use a spacer . In addition, it is recommended to rinse with clean water after using the inhaler deterrent.
To use the inhaler reliever slow reactions, side effects that might occur are headache, muscle cramps, and a little trembling in the hands. Your doctor will explain to you about the benefits and risks of the treatment. Usually, your condition will be monitored at the beginning of treatment and reviewed regularly. If the use of inhalers reliever slow reaction does not go to relieve asthma, stop immediately.

Mitigation measures with inhaler asthma attack

If suddenly your asthma symptoms recur, do the following three main points. The first is the type of reliever inhaler immediately remove and suck as much as 1 or 2 times. After that, do the second step in a way to sit quietly and try to breathe steadily. If your asthma symptoms still not eased, then do step three by sucking the inhaler you back as much as 2 times (or up to 10 times if necessary) every two minutes.
If all these steps still do not relieve asthma symptoms and you are worried conditions could be worse, then immediately call an ambulance or ask people around you to take you to the hospital. Before you actually get hospital treatment, keep repeating the third step.

Other asthma drugs

In addition to the inhalers, asthma management can also be done with medications such as:
  • Oral steroids. Steroid tablets may be prescribed by the doctor if your asthma is still not under control. The treatment is typically monitored by a doctor lung specialist who handles asthmatics because if used over the long term (ie over three months), the risk of causing certain side effects, such as hypertension, weight gain, muscle weakness, bone, skin thinning and easy bruising , In addition, the more serious side effects that could occur are cataract and glaucoma. Therefore, treatment with oral steroids is only recommended if you have done way more treatment, but has not succeeded. Most people only need to use oral steroids for 1-2 weeks and as an additional medicine to handle additional infections (such as an infection of the lungs). Usually they will return to the previous treatment after asthma can be controlled. We recommend that you regularly check themselves to avoid osteoporosis, diabetes , and high blood pressure.
  • Tablet theophylline . Drugs that can be used as drugs to prevent asthma symptoms it works by helping to dilate the airways to relax the muscles around it. In some people, the theophylline tablets are known to cause side effects, such as nausea , headache, vomiting, insomnia , stomach dangangguan. But this can usually be avoided by dose adjustment.
  • Tablet eukotriene re ceptor antagonist (montelukast) . This drug works by blocking a part of the chemical reaction that causes inflammation in the respiratory tract. Just as theophylline , a drug used to prevent asthma symptoms. Leukotriene receptor antagonist can lead to side effects such as headaches and stomach upsets.
  • Ipratropium . Although more widely prescribed in cases of chronic bronchitis and emphysema, ipratropium can also be used to combat asthma attacks. This drug is able to facilitate the respiratory flow by relaxing the muscles of the respiratory tract that tightens when the symptoms of an asthma attack.
  • Omalizumab . These drugs can reduce the risk of inflammation of the respiratory tract by binding one of the proteins involved in the immune response and reduce the levels in the blood. Generally, omalizumab is recommended for people who suffer from asthma due to allergies and often have an asthma attack. As a drug normally prescribed only by specialists, omalizumab is given by injection every 2-4 weeks. The use of omalizumab should be discontinued if these drugs do not successfully control asthma over a period of sixteen weeks.
  • Bronchial thermoplasty . It is a new asthma treatment procedures are still being studied and not yet available in Indonesia. In some cases, this procedure is used to treat severe asthma by destroying the muscles around the airways that can reduce the constriction of the respiratory tract. There is some evidence to suggest that this procedure can reduce asthma attacks and improve the quality of life of patients with severe asthma. Nevertheless, profits and losses in the long term is not yet fully known.

Methods of treatment that are complementary

Breathing exercises are complementary method of treatment of asthma is highly recommended. And there is evidence that this method can reduce asthma symptoms and the need for reliever medication in some people. Breathing exercises may include yoga, Buteyko breathing techniques and breathing techniques are taught physiotherapist.
In addition to breathing exercises, other complementary treatment methods are:
  • acupuncture
  • Traditional Chinese herbal medicine
  • Homeopathy
  • Oral supplementation therapy
  • Hypnosis
  • Ionization therapy
  • Chiropractic
However, among all the complementary medicine that has been mentioned, just breathing exercises that have proven effective to reduce the symptoms and the patient will need asthma medication. For other complementary therapies, further research is needed will be its effect on asthma.

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