Asthma

Introduction

Asthma is a relatively common disorder characterized by at least partially reversible airway inflammation and reversible airway obstruction due to airway hyperresponsiveness. It can be acute subacute or chronic [1] and/or exercise-induced

Asthma:

• is a major non-communicable disease (NCD) affecting children and adults.
• An estimated 262 million people were affected and 461,000 died in 2019 (1).
• It is the most common chronic disease in children.
• Inhaled medicines can control asthma symptoms and allow people with asthma to lead normal and active lives.
• Avoiding asthma triggers can also help reduce asthma symptoms.
• Most asthma-related deaths occur in low- and lower-middle-income countries, where underdiagnosis and treatment are a challenge. [2]

Epidemiology

Asthma is one of the most common chronic diseases in the world. It is a common condition, affecting about 15% to 20% of people in developed countries and 2% to 4% in less developed countries. It is more common in children. [3]

Image: Asthma deaths per million people in 2012. WHO statistics are grouped by deciles. Lightest yellow 0-10 to red 96-251

Asthma:

• An estimated 262 million people were affected and 461,000 died in 2019. [2]
• It can occur at any age (it is more common in children), and most people with asthma experience their first symptoms before the age of 5, and about 66% of patients are diagnosed before the age of 18.
• Almost 50 percent of children with asthma have less severe or no symptoms by early adulthood. [1]
• The prevalence is higher in extreme age groups due to lower levels of airway responsiveness and lung function [3].
• Asthma kills 1 in 100,000 people in many countries, including the United States.
• Resulting in millions of lost schools and workdays. In the United States alone, nearly 2 million people with asthma seek regular care in emergency rooms, which also adds to healthcare costs [3].

Aetiology

Inflammation plays a major role in asthma involving multiple cell types and mediators. The factors that trigger the inflammatory process are complex and are still being researched. Genetic factors (such as cytokine response profiles) and environmental exposures (such as allergen contamination infection Critical moments in the development of the immune system are known to involve microbial stress). [1]

Risk Factors

Include:

• You are more likely to develop asthma if other family members also have asthma — especially close relatives, such as parents or siblings.
• People with other allergic conditions such as eczema and rhinitis (hay fever) are more likely to develop asthma.
• Urbanization is associated with increased prevalence of asthma, which may be due to multiple lifestyle factors.
• Events early in life can affect the developing lungs and may increase the risk of developing asthma. For example, low birth weight premature infants are exposed to viral respiratory infections from tobacco smoke and other sources of air pollution.
• Exposure to a range of environmental allergens and irritants, such as indoor and outdoor air pollution, house dust mite, mold, and occupational exposure to chemical fumes or dust, is also thought to increase the risk of asthma.
• Children and adults who are overweight or obese are at greater risk for developing asthma.

Pathophysiology

Asthma is a fully reversible acute airway inflammation that usually occurs after exposure to environmental triggers. The pathological process begins with the inhalation of irritants (such as cold air) or allergens (such as pollen), and then causes respiratory tract hypersensitivity due to bronchial allergy. Inflammation and mucus production increase. This results in a significant increase in airway resistance, which is most pronounced during exhalation.

Airway obstruction occurs due to a combination of the following factors:

1. Inflammatory cell infiltration.
2. Hypersecretion of mucus with formation of mucus plugs.
3. Smooth muscle contraction.

These irreversible changes may become irreversible over time due to

1. Basement membrane thickening with collagen deposition and epithelial desquamation.
2. Airway remodeling occurs in chronic diseases with smooth muscle hypertrophy and hyperplasia.

If not corrected quickly, asthma can become more difficult to treat because mucus production prevents inhaled medication from reaching the mucous membranes. Inflammation also becomes more edematous. This process is resolved (theoretically asthma needs to be completely resolved, but in practice it is not check or test) with a beta2 agonist (such as albuterol salbutamol) and can be adjunct by a muscarinic receptor antagonist (such as ipratropium bromide), which acts to reduce inflammation and relax bronchial musculature as well as reduce mucus produce. [3]

Clinical Presentation

Typical symptoms of asthma are wheezing, shortness of breath, chest tightness or difficulty breathing, and coughing. These symptoms are usually variable, may resolve over a long period of time, and may flare up, often triggered by factors such as exercise allergens or irritants Exposure to cold air or viral respiratory infections.

The diagnosis of asthma is clinical and relies on the recognition of a characteristic pattern or respiratory symptoms and signs in the absence of other explanations. Features that increase the likelihood of asthma are:

• One or more of the following symptoms: wheezing cough dyspnea and chest tightness
• Episodic symptoms get worse at night and early in the morning and can occur with certain triggers, such as exercise, allergens, exposure to cold air
• Personal history of atopic disease or family history of atopic (allergic) disease and/or asthma
• Widespread wheeze on auscultation
• Pulmonary function tests may be used in the evaluation of patients with asthma to assess the presence, severity and reversibility of airflow obstruction. On spirometry, an FEV1/FEV ratio of less than 0.7 confirms obstruction. In asthmatic patients, there is often a greater bronchodilator response (Usually FEV1 increases by at least 12-15%) 3 And it is also often associated with abnormally high variability in peak expiratory flow. Normal spirometry, especially when the patient is asymptomatic, does not rule out the diagnosis of asthma [1]

When is asthma life-threatening?

• Difficulty to catch a breath
• Difficulty talking and concentrating
• Difficulty talking and walking
• Cyanotic skin, especially around the mouth and fingers
• Nasal flaring and constant wheeze

When these signs and symptoms occur, a person should be aware and advised to consult your GP as soon as possible.

Investigations and Diagnosis

The diagnosis of asthma is based on several factors [4]:

• Medical History
• Family history: People are more likely to have asthma symptoms if they have a family history of asthma or allergies.
• Physical Evaluation: The patient’s nose, throat, and upper airways will be examined for signs of asthma or allergies. Patient will be assessed with auscultatory S&S for respiratory rate and breathing pattern including: wheezing (sharp whistling sound when patient exhales) cough chest tightness shortness of breath (SOB) runny nose swollen nasal passages. [5].

Diagnostic Tests

The following tests are used to assess a patient’s breathing and to monitor the effectiveness of asthma treatment.

Pulmonary function tests [6]: Spirometry peak flow test

Other tests:

• Allergy testing
• Bronchoprovocation
• Chest X-ray
• Electrocardiogram (ECG)

Treatment

The goals of treatment are to control symptoms, prevent exacerbations and loss of lung function, and reduce associated mortality.

1. Medications used to control asthma depend on the severity of the disease. Short-acting β2-agonists can be used in patients with occasional mild symptoms. Inhaled steroids (oral steroids may be required in severe cases) and long-acting beta2-agonists are available for long-term control. oxygen Short-acting beta2-agonists, inhaled anticholinergics, and systemic steroids are used for exacerbations.

• Short-acting beta2-agonists (fast-acting or rescue drugs): These drugs are best used to treat sudden severe or new asthma symptoms because they open the airways and provide relief within 20 minutes and for 4 to 6 hours. Can also be used about 15-20 minutes before exercise Time to prevent exercise-induced asthma.
• Long-acting beta2-agonists: These drugs are not used to relieve asthma symptoms quickly, but to control symptoms and last for 12 hours.

2 Severe exacerbations unresponsive to medical therapy may require mechanical ventilation. Non-drug measures such as smoking cessation and avoidance of occupational sensitizers are also important.

3. Nonpharmacologic management including asthma education on inhaler technique and self-monitoring is critical. [7]

Prognosis

Asthma is a disease with variable progression and symptom severity over time. Prognosis depends on the severity of the disease and how well it is controlled by treatment. Some patients can be asymptomatic for a long time, while a small number of patients with severe persistent asthma will progress Loss of lung function. Death from asthma is very rare. [1]

Although asthma is a reversible disease, poor lifestyle and lack of management can lead to airway remodeling, which can lead to chronic symptoms that are disabling. [3]

Physiotherapy Management

Most patients with asthma seek physical therapy for dyspnea and hyperventilation [8]. Physiotherapists treat asthma in a number of ways aimed at improving breathing techniques. Physiotherapy techniques for asthma are complementary to medication and should never be used as However, alternative prescription medications may reduce the required dose.

1. Breathing Retraining Technique [9]

Breathing techniques may have additional benefits in mild to moderate asthma [10]. The goal of respiratory retraining is to normalize the breathing pattern by stabilizing the respiratory rate and increasing expiratory airflow. Physiotherapist gives instructions on how to perform this technique Has the following components:

• Reduced breath count (reduced breathing rate)
• Reduced breathing (decreased tidal volume)
• Deep breathing (diaphragmatic breathing through the use of the abdominal muscles and lower chest chest exercises)
• breathing through the nose (nasal breathing)
• relax (relax and control breathing)
• Reduced air exit (reduced expiratory flow through pursed lip breathing)
• These retraining techniques help control breathing and reduce airflow turbulence hyperinflation variable breathing patterns and anxiety.

Buteyko Breathing Technique[11]

• The Buteyko breathing technique is another breathing retraining technique. However, it is specifically designed to reduce hyperinflation. It was developed on the theory that asthmatic bronchospasm is caused by hyperventilation leading to low PaCO2 and thus all asthma symptoms. Narrowed airways cause “air starvation,” leading to a switch to mouth breathing, and increased respiratory rate leading to hyperinflation. According to Buteyko, this hyperinflation can also lead to bronchoconstriction. Buteyko technology is designed to reduce ventilation and Lung volume was subsequently used as a treatment for asthma and other respiratory diseases. Qualified practitioners are required to train patients [12].
• The Buteyko Technique[13]
  • Breathe normally through the nose for 2-3 minutes
  • Exhale normally with your fingers closed nose and hold
  • Record number of seconds
  • Release the nose and resume nasal breathing (controlled pause) at the first breath required
  • Wait 3 minutes
  • Repeat and hold your breath for as long as possible (maximum pauses)

Breathing pattern retraining and relaxed breathing techniques are two approaches to asthma physical therapy management. The purpose of breathing pattern retraining is to develop more efficient breathing patterns, thereby reducing dyspnea. This is usually achieved by slowing your breathing rate and encourage relaxed “belly” breathing (Bruton 2006). Another potential mechanism of breathing pattern retraining is that it reduces the effects of any static/dynamic hyperinflation by encouraging longer exhalation times.

People with mild asthma can hold their breath for up to 20 seconds, people with moderate asthma can hold their breath for 15 seconds, and people with severe asthma can hold their breath for up to 10 seconds. The purpose of this method is to increase the control pause time to 60 seconds and the maximum pause time to 2 minutes. practice twice a day Doctors there helped hold the breath and ensure safety. Its purpose is to reduce the minute ventilation by reducing the respiratory rate and increase the carbon dioxide level by breath-holding to reduce bronchospasm caused by hyperventilation in asthmatic patients.

2. Physical Training

• Physical activity is recommended for people with asthma and should not be avoided when appropriate precautions are taken. The American College of Sports Medicine (ACSM) guidelines provide tips and safety precautions for exercising safely in patients with asthma [14].
• Physiotherapists should prescribe physical activity for asthmatic patients to enhance physical fitness and cardiorespiratory fitness, reduce symptoms such as dyspnea, and improve quality of life [15]. Difficulty breathing, chest tightness, and wheezing when the patient is prevented from exercising Physical exertion [16]. Avoiding fear can lead to further deterioration in physical health and quality of life, leading to anxiety and depression. Studies have shown [17] that maintaining physical activity in asthmatic patients can improve disease symptoms and quality of life, thus making it a key management strategies.
• A study protocol suggested that a behavior change intervention focused on increasing physical activity participation may control asthma and quality of life [18].

3. Respiratory Muscle Training

• Hyperinflation in asthma leads to increased lung volumes, which lead to altered inspiratory muscle mechanics. Shortening of the inspiratory muscles results in a suboptimal length-tension relationship for contraction. Reduced ability to generate tension while breathing leads to assist The muscles of inspiration are being harnessed [19]
• Breathing exercises using external devices to make breathing more difficult. This helps strengthen the inspiratory muscles, making it easier to breathe in everyday life.
  Use the breathing apparatus to set the respiratory load. During inhalation, air is released only when the device’s valve is forced open using sufficient force. The respiratory muscles are forced to work harder, increasing their strength, causing diaphragmatic breathing to become easier Reduce hyperinflation.

4. Removal of secretions

• Percussions
• Shaking
• Vibrations,
• Postural drainage and
• Effective coughing

A randomized crossover study [20] examining the ability of physical therapy techniques in children and adolescents with asthma showed that specific physical therapy maneuvers may help collect mucus and produce the same amount of sputum as the gold standard technique (hypertonic saline). The study confirms that induction of sputum through physical therapy manipulation is safe for well-controlled asthmatics and enables physical therapists to mobilize secretions without causing patients to bronchospasm.

5. Range of motion exercises

• Exercises for patients who need to be hospitalized.

6. Education

• About condition
• use of bronchodilators and any other medications
• How to prevent chest infections from happening
• Proper standing and sitting posture helps manage asthma attacks, allowing the chest to expand properly and the lungs to function optimally

Evidenced-Based Physiotherapy Management

Due to the high prevalence of asthma and associated healthcare costs, it is important to identify low-cost alternatives to traditional drug therapies. One of these low-cost alternatives is the use of Inspiratory Muscle Training (IMT), a method designed to increase strength and Endurance of the diaphragm and accessory muscles of respiration. IMT typically involves voluntary inspiration at rest against a resistive load across the entire vital capacity range. In healthy individuals, the most pronounced benefit of IMT is increased septal thickness and Strength Reduces exertional dyspnea and reduces the oxygen cost of breathing. IMT has been shown to reduce dyspnea, increase inspiratory muscle strength, and improve exercise capacity in patients with asthma. [twenty one]