ASTHMA

 

What is Asthma?

Most common misconceptions about asthma are:

  1. Asthma is a childhood disease; individuals will grow out of it as they age
  2. Asthma is infectious
  3. Asthma sufferers should not exercise
  4. Asthma is only controllable with high dose steroids

In the article below the correct information is included marked in italics.

Asthma is a chronic inflammatory condition that causes recurrent episodes of airway narrowing (bronchoconstriction), excess mucus production and thickening of the airway walls due to the underlying bronchial hyper-responsiveness, making it harder to breathe. 

Asthma can affect all ages but usually starts in childhood and only rarely presents with a new-onset in adults. Most cases of asthma diagnosed in adults usually had started in childhood whether or not unbeknownst to the individual. In many cases, childhood asthma subsides in adolescence, however it can recur in adulthood.

Asthma is the most common chronic non-communicable disease, affecting over 260 million people globally in 2019 (GINA).

In Europe, 30 million children and adults less than 45 years old have asthma. According to the epidemiological research study conducted by the Asthma team at the Hellenic Thoracic Society, the prevalence of asthma in Greece is 8.6%, in other words, approximately 900,000 children and adults have asthma.

Causes

While there is no known cause for asthma, it is certainly not infectious, nor transmissible. Asthma is the expression of an inflammatory disorder of the airways that depends on the interaction between the genetic predisposition of susceptible individuals and exposure to certain environmental factors such as pollution and Western lifestyle (ERS).

Asthma is characterized by hyper-responsiveness, an exaggerated reaction of the airways when exposed to irritative factors and triggers.

Symptoms

Asthma presents with episodic respiratory symptoms (flare-ups or attacks) characterized by one or more of the following:

  • Shortness of breath
  • Chest tightness/pain
  • Coughing
  • Wheezing (a whistle or wheeze sound when exhaling)
  • Difficulty sleeping from coughing/wheeze or shortness of breath
  • Intense cough or wheezing made worse by a viral cold or flu

Asthma is known to manifest by attacks of symptoms that can remit or relapse and are usually provoked by certain triggers. Symptoms vary in combination, frequency, severity and time course. Each person experiences asthma differently and it is therefore important to consult often with their physician.

Triggers

Often asthma attacks can be brought on by:

  • Exercise (exercise-induced asthma).

While exercise may trigger asthma, the individual may indeed exercise, provided that they consult their physician and comply with the regimen that best controls their symptoms

  • Occupationally-related irritants like chemical fumes, gases or dust (occupational asthma)
  • Allergens such as pollen, pet dander, mold or cockroach waste
  • Cold air
  • Stress
  • Viral respiratory infections i.e., the seasonal flu
  • Sulfites and preservatives
  • Gastro-oesophageal Reflux Disease (GERD)

Diagnosis

There is no specific test for diagnosis, however, the following criteria are used to aid in diagnosis of asthma:

  • Indicative medical history (i.e., episodic symptoms, flare ups)
  • Physical examination (i.e., wheezing)
  • Obstructive pattern (airflow limitation) on spirometry

LABORATORY EVALUATION

Lung Function Tests:

  • Spirometry: determines and measures the degree of airway obstruction

• Bronchodilator response: Spirometry pre- and post- bronchodilator administration evaluates the reversibility of the obstruction

• Broncho-provocation: an asthma trigger, such as inhaled metacholine, administered to individuals with normal spirometry, can reveal the characteristic bronchoconstriction of asthma.

  • Measurement of Exhaled nitric oxide: the concentration of NO in the exhaled breath increases in cases of eosinophilic inflammation of the airways.

Blood Tests: are used as an aid to diagnosis, they are not specific.

  • Complete Blood Count, eosinophils count, total serum IgE, allergen specific IgE (ELISA, RAST)

Allergy Skin Tests: do not diagnose asthma, but help reveal the triggers

Prevention

The aim is to:

  • Avoid exposure to known triggers and environmental pollution
  • Avoid smoking and exposure to passive smoke
  • Monitoring of symptoms and lung function
  • Ensure adherence to treatment
  • Ensuring proper treatment during pregnancy: all pregnant women should be asked about asthma and advised about appropriate treatment during their pregnancy

Treatment

Aims to:

  • Reduce frequency, duration and severity of attacks
  • Preserve a normal lung function
  • Minimize risk and avoid or reduce permanent adverse outcomes
  • Reduce hospital admissions

Treatment is adjusted for the individual patient once his asthma has been evaluated in regards to severity, frequency, precipitating factors and symptom control and according to the international guidelines. (GINA) Medication includes one or more of the following:

  • Combination of long-acting bronchodilators and corticosteroid inhalers
  • Oral corticosteroids
  • Oral theophylline,
  • Anti IgE therapy
  • Monoclonal antibodies

With the possible exception of acute exacerbations, maintenance treatment achieves control of asthma symptoms with inhaled corticosteroids usually in low doses. The attending physician will adjust the treatment, step medication up or down accordingly and help design an action plan for the individual patient. (GINA)

Asthma and COVID-19

  • Asthma does not increase the likelihood of SARS-CoV-2 infection
  • Well controlled mild to moderate asthma does not increase the likelihood of severe COVID-19 or death due COVID-19
  • Recent asthma treatment with oral corticosteroids and hospitalization with severe asthma, may increase the risk for COVID-19 related por outcomes.

Asthma and COVID-19 vaccines

Individuals with asthma should consult the attending physician regarding their eligibility for vaccination and best timing, considering medical history, asthma status, type of treatment (i.e. biologic agents) or any other medical aspects.

Some general considerations based on current data:

  • Although allergic reactions to vaccines against SARS-CoV-2 have been rarely reported, it is advised is to perform mRNA vaccinations in a hospital setting equipped to treat possible anaphylactic reactions.
  • Individuals with severe allergy to any of the vaccine ingredients including propylene glycol should not be offered the vaccine.
  • Anaphylaxis to food, insect venom, or other medication is not associated with increased risk for anaphylactic reaction due to COVID-19 vaccination.
  • In case of concurrent infection vaccination should be postponed

“At present, based on the benefits and risks, and with the above caution, GINA recommends COVID-19 vaccination for people with asthma”. Global Initiative for Asthma, April 26, 2021

ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST

References

World Asthma Day 2021

https://ginasthma.org/wad/
European Respiratory Society. “Adult Asthma.” In European Lung White Book, https://www.erswhitebook.org/chapters/adult-asthma/ (April 19, 2019)

Hellenic Thoracic Society
https://ginasthma.org/wp-content/uploads/2021/04/Whats-new-in-GINA-2021_final.pdf

https://ginasthma.org/wp-content/uploads/2021/04/GINA-2021-Main-Report_FINAL_21_04_28-WMS.pdf