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Asthma

This disease affects people of all ages, but younger people are more affected. In 2017-18, asthma led to almost 64,000 emergency room visits in Canada. This disease costs Canadians more than $ 2 billion a year in medical care and medication.

To date, there is no cure for asthma, however it is possible to control the disease and lead a busy, active life with virtually no symptoms. However, 65% of Canadians with asthma report that their asthma symptoms prevent them from exercising. This poor control of the disease leads to difficulties on a daily basis: increased medication intake; emergency room visits with frequent hospitalizations; absenteeism from work or school, and unfortunately, several deaths.

Causes

Asthma is a respiratory illness that cannot be cured, but can be controlled. It is characterized by inflammation and partial and reversible obstruction of the bronchi. Since the airways are hypersensitive, they are contracted and obstructed by thick secretions, which makes breathing difficult.

The exact causes of asthma are not completely determined, but it appears that the disease is the result of a complex interaction between several genetic (family predisposition) and environmental factors.

Mechanisms of Asthma

The obstruction is caused by three mechanisms:

  • Inflammation inside the bronchus;
  • The contraction of the muscles surrounding the bronchus (bronchoconstriction);
  • The production of excess mucus (thick secretions) that blocks the bronchi.

asthma

Triggering factors

From person to person, asthma triggers can be different. It is therefore important for anyone with Alzheimer’s to identify the things that can cause symptoms. The triggers fall into 2 categories:

  • Irritating factors

  • Inflammatory factors

People at risk

There are a few things that can make a person more likely to develop asthma:

  • People with a family history of asthma, allergic rhinitis or eczema
  • People born prematurely
  • People exposed to second-hand smoke
  • People exposed to air pollution
  • People with gastroesophageal reflux
  • Children who have had severe and repeated respiratory infections (e.g. pneumonia, rhinovirus or syncytial virus infection, etc.)
  • People suffering from obesity
  • People exposed to sensitizers in their workplace (occupational asthma)

Signs and symptoms

  • Shortness of breath
  • Chest tightness
  • Wheezing
  • Cough
  • Increased mucus production

When you experience one or more of these symptoms, you can call it an “asthma attack.” A severe asthma attack can be a terrifying experience accompanied by feelings of suffocation, shortness of breath, and loss of control. Thus, poorly treated or underestimated asthma can be life threatening.

Diagnostic

The respiratory tests frequently used in the diagnosis and monitoring of asthma are spirometry and peak expiratory flow (PEF). This simple test measures, among other things, the maximum amount of air you can breathe out and the speed at which you can do it.

Spirometry is done in a doctor’s office, clinic or hospital by a healthcare professional. It provides several measures and data that can help establish a diagnosis or even follow the course of the disease.

It is possible to do a peak expiratory flow rate (EPD) measurement yourself using an inexpensive and easy-to-use device. By keeping a regular log of PED measurements, you can check your asthma control and validate the effectiveness of your medication.

Treatment

People with asthma should be able to lead normal lives. To get there, there are different drugs that help manage and prevent symptoms. There are two main types of medication used in asthma: medications used on a regular basis (maintenance medication) and medications used in a crisis (rescue medication).

Maintenance medication

In order to provide constant prevention, maintenance medications are usually taken every day, even if there are no symptoms. These drugs do not immediately relieve the symptoms of an asthma attack, but taken daily, they provide better control of asthma symptoms and less use of the rescue medication.

They also make the bronchial tubes less vulnerable to triggers, which dramatically decreases the frequency and severity of asthma attacks.

Asthma maintenance medication is divided into the following classes:

  • Corticosteroids

  • Bronchodilators

  • Combined treatments

  • Leukotriene receptor antagonists

  • Anti-IgE Antibodies

  • Specific treatment for severe eosinophilic asthma

Relief medication

This medication is used to relieve occasional or immediate symptoms of tightening of the bronchi and should always be kept on hand in an emergency.

  • Short-acting bronchodilators

  • Combined treatments

Severe asthma

It is estimated that the number of people with severe asthma in Canada is approximately 250,000. Asthma is categorized as severe or severe when symptoms are persistent and worsen and attacks are more frequent despite adequate and regular intake of multiple medications and good control of exposure to triggers. Severe asthma or severe asthma requires more specific monitoring by a medical specialist rather than a general practitioner as in most cases.

In recent years, research on severe asthma has paid off, leading to specialized treatment. It is a therapeutic class called: monoclonal antibody against interleukin 5 *. It is a treatment given as a subcutaneous or intravenous injection at general intervals of one month. This substance, once injected, blocks interleukin 5, a protein already present in our system which by a cascade of chemical reactions causes inflammation in the bronchi. Thus blocked, the process of bronchial inflammation decreases. These specific therapeutic advances allow the reduction of asthma attacks as well as symptom relief.

Among these are:

  • Cinquair
  • Nucala
  • Fasenra

* It should be noted that these drugs are indicated for a specific asthmatic clientele.

Asthmatic child

Asthma is the # 1 cause of a child’s absenteeism from school and the # 3 cause of the parent’s absenteeism from work. Over 15% of children in Canada suffer from asthma and the number is increasing. Unfortunately, more than half of asthmatic children have poor control of their symptoms, making asthma the leading cause of pediatric hospitalization.

Children with asthma can have a variety of symptoms, such as a persistent cough from cold or difficult breathing during physical exertion, a run for the cold or exposure to an allergen. Others will experience daily coughing and shortness of breath. These symptoms can vary from day to day.

It is essential to identify and eliminate the triggering or aggravating factors of asthma in your child and therefore to clean up his environment. By doing so, you will improve your child’s quality of life, decrease the frequency and intensity of their symptoms, avoid school absenteeism and hospitalizations while reducing the need for medication.

Advice and prevention

More than 90% of people with asthma feel that their disease is well controlled when it is not. These people do not control their symptoms. This implies that they experience daily inconveniences related to their asthma, but do not know that their situation is unusual and that their doctor could correct it by optimizing the follow-up and the treatment.

How to control asthma?

Asthma specialists agree that the best therapy is to actively involve people in their treatment. Despite the fact that drugs are very effective in treating asthma, much of the success of treatment depends on understanding the disease, recognizing and eliminating the triggers and taking the prescribed medication properly.

Here are the main steps towards optimal care:

Get a quick and accurate diagnosis, based on your personal history and objective measurements of respiratory function (spirometry);

  • Learn to recognize and understand the symptoms of asthma;
  • Control your environment and avoid triggers;
  • Make sure you understand how your emergency medication works and use it as prescribed;
  • Make sure you understand how your daily maintenance medication works and use it as prescribed;
  • Make sure that the medication inhalation technique is adequate;
  • Develop a personalized action plan with your doctor;
  • Regularly reassess control of your asthma by the required respiratory tests (spirometry, peak expiratory flow, etc.);
  • Check the air quality index before planning an outdoor activity.

* Air quality also affects the breathing of people with asthma. This is calculated based on ozone, sulfur dioxide, nitrogen dioxide, carbon monoxide and fine particles in the air. Knowing the air quality index for your area allows you to better plan your outdoor activity schedule and prepare yourself adequately.

Here are the main criteria for a well-controlled asthma:

  • You experience daytime (daytime) symptoms less than 4 times a week;
  • You experience nighttime symptoms (at night) less than once a week
  • Your level of physical activity is normal;
  • Your exacerbations are infrequent and mild in intensity;
  • You do not have absenteeism from work or school because of asthma;
  • You use your emergency bronchodilator less than four times a week;
  • The readings for your peak expiratory flow (PED) are within the normal range recommended by your doctor.

Factors that can testify to poorly controlled asthma may include daily symptoms, more frequent use of emergency medication, emergency visits with frequent hospitalizations, and absenteeism from work or school.

Some triggers for your child’s asthma can be avoided while others can be minimized by taking proper precautions. Here are some practical tips. Remember that the triggers are different for each child.

Make sure everyone around you knows what triggers your child’s asthma attack, the symptoms, how to administer the medication, and what to do if you have an attack.

  • At home

  • At school

  • Allergies

  • Mold

  • Dust mites

  • Pollution

  • Animals

  • Physical activity and sport

  • Emotions

Action plan

Asthma should be treated as a chronic disease, and an action plan should be established with the doctor to prevent the onset of symptoms and promote disease management, reduce seizures, and avoid emergency room visits and hospitalizations.

In collaboration with your doctor, develop an action plan, which will help you to better manage your symptoms. This action plan will specify: the symptoms to watch for, how to adjust your medication according to these symptoms and when to see your doctor or go to the emergency room.

Did you know that

The Quebec Lung Association offers direct services to the population. For more information, visit our Patient Resources section.

 

 

Révision Juin 2019