What is Asthma?

Although asthma literally means shortness of breath, it can be called a type of allergy that enters the bronchi and lungs, and the patient can have attacks of coughing or sputum or wheezing even without shortness of breath. It is patients, even if they hear wheezing and feel pressure on the chest or people with chest pain.
Asthma coughs can be dry at first and become phlegmatic after a few days, the cough is so severe that it leads to headache, nausea and belching or wetness in women.
Coughing at night is of particular importance, especially if it is after midnight and wakes the patient up, and if coughing or shortness of breath occurs with exercise, the possibility of asthma increases.
Nasal allergy diseases, sinusitis and gastric acid reflux play a significant role in the course of asthma.

• Asthma is a lifelong chronic inflammatory disorder of the airways with unstable structural changes that affects children and adults of all ages. It is associated with increased airway responsiveness and airflow obstruction, which is often reversible by itself or with treatment.
• Asthma, when uncontrolled, can lead to death and can significantly interfere with normal activity and seriously affect a person’s quality of life.
• Asthma is a major public health problem worldwide, especially in low- and middle-income countries, due to misdiagnosis and inadequate treatment.
• Atopy-genetic predisposition to IgE-mediated sensitization to common inhalant allergens is the most important identifiable predisposing factor for developing asthma, especially in children.
• The rapid increase in the prevalence, morbidity and mortality of asthma in the so-called “westernized” countries of the world began in the 1960s and 1970s.
• The prevalence of asthma varies greatly in different countries, but due to the increase in prevalence in low- and middle-income countries that have adopted a western-style lifestyle, and its stability in high-income countries, this difference is decreasing.
• Inhaled corticosteroids are currently the most effective anti-inflammatory drugs for the treatment of persistent asthma.
• The financial costs of asthma are significant and include direct medical and indirect costs. The latter is related to lost work time and premature death.
• National efforts to tackle asthma as a health problem, such as the program initiated in Finland, have had significant benefits, reflected in significant reductions in mortality and hospital admissions.
• There are many obstacles to reducing the global burden of asthma.
• There are many unmet diagnostic, therapeutic, educational and financial needs for better asthma control worldwide.
• More efforts are needed to focus on improving asthma treatment methods and emphasizing disease control rather than treating acute attacks. This concept should be included in health care programs.

Wheezing that has the following features:

• It often starts suddenly.
• It is an attack.
• Worse at night or early morning.
• Worse with cold weather and exercise.
• Food reflux aggravates symptoms
• (reflux refers to the return of food from the stomach to the esophagus due to the weakness of the esophageal sphincter).
• It will get better by itself
• The use of vasodilator drugs such as salbutamol spray improves symptoms.
• Cough with sputum without sputum. In some people, cough without sputum is the first symptom of asthma.
• Shortness of breath that worsens with exercise or activity
• Stretching of the intercostal muscles inward when breathing
• Cramps in neck muscles

More dangerous symptoms are: 

• severe shortness of breath
• Blue color of the face and lips
• Severe anxiety due to shortness of breath
• Rapid heartbeat
• sweating
• Decreased level of consciousness, such as drowsiness 

If these symptoms occur, you should immediately go to an equipped medical center

Asthma has grown a lot in the past decades in the world, especially in advanced industrial countries, but the main cause of this growth has not yet been determined. Most people with asthma have a history of allergies. Family history plays a very important role in the occurrence of this disease. Many people who have asthma have had a close relative with hay fever or eczema.
Several factors play a role in the development of asthma. These factors are: 

• Having a respiratory infection
• Eating some foods
• Hormonal changes in women
• allergenic substances; The most common allergens are:
• Domestic insects
• animal hair
• mold
• mushroom
• Fossil fuels such as oil and gas
• Perfume particles
• tobacco smoke
• Taking some drugs such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen and mefenamic acid
• exercise and activity; In this case, exercise causes coughing, wheezing and shortness of breath. This condition occurs mostly in teenagers and children and during exercise in cold and dry weather. 
• stress
• Food reflux

Psychological Complications People with asthma often fear an attack, which can have a negative impact on their quality of life.  
If the symptoms of asthma are different from its usual symptoms, the doctor should be informed.
Other factors may have caused asthma. If the chest pain, when the shortness of breath is very severe, is only on one side, or the color of the sputum has changed and there is a fever, more care should be taken.
One of the discomforts caused by asthma can be caused by persistent coughing that causes the ribs to crack, or air infiltration into the chest (pneumothorax), which may occur without a cause, as well as partial lung failure is another side effect. It is from asthma, which is often caused by partial obstruction of the airways as a result of thick sputum (atelectasis). Until now, most of the complications of asthma have been caused by infection, which ranges from the collection and suppuration of sputum under the airways to pneumonia. .
Sometimes, the body may become resistant to conventional treatment due to another complication during an acute asthma attack. In this case, imaging of the lung will be of great help in the diagnosis.
Factors predisposing to asthma
today it has been proven that heredity plays a major role in the occurrence of asthma.
Genetic transmission of the disease is related to many factors.
The predisposition to asthma is not simply a tendency to brown or blue eye color of the parents.
The predisposing factors of this disease are affected by various factors (such as allergies, infections, triggers and environment), but there is a genetic tendency in all conditions.
Infections such as whooping cough and bronchiolitis seem to increase the tendency to asthma.
In addition, parents’ cigarette smoke is one of the factors that cause attacks in children who tend to have asthma.
The results of children’s breathing tests have shown that children whose parents are addicted to smoking have a more inappropriate respiratory condition.

This is a very important question that patients ask their doctor or their child’s doctor, and it is wrongly assumed that if it is asthma, it means that it is a severe disease that cannot be treated or controlled.
If this matter is not carefully considered scientifically by doctors and patients, how much it can cause the disease to worsen and create false fear or false optimism for patients.
To begin with, a comparison between allergy and infection:
similarities with infection

1. Today, fortunately, allergy is considered one of the fields of medicine, as it is an infectious field
2. In both defenses, the human body’s immune system is involved, so that if it were not for the body’s defense, neither the person would be alive nor the disease would develop.
3. In both, they cause various diseases in every part of the body, which is increasing with the advancement of the science of identifying the number of allergic or infectious diseases of an organ.
4. Both are started by an external factor from the body (they have a specific etiology).
5. Allergy, like infection, refers to states of the human body when the person is out of balance (health) and the annoying symptoms reach such a level that the person is considered sick, or the person finds symptoms that are seen by the society (normal state). It is considered unnatural.
6. Both can appear acute-chronic-subacute or without symptoms.
7. The factors causing the two are different, diverse and uncountable.
8. The causative factors can be identified and divided.

The differences

1. Allergy and infection both go back to the body’s defense, which in infections, the defense is in place, but in allergies, it is unwanted.
2. Unlike infectious agents, allergy agents are not invasive and are considered harmless for many people.
3. Unlike infections, allergies occur in people with special genetics who have the necessary ability to break down the immune system, infection can happen to all people.
4. Infection, the aggressive power of the infectious agent is the most important factor in causing symptoms, but in allergy, the reaction of the body’s immune system is the main factor in causing symptoms, which way and with what intensity it is applied to the body.
   Just as there are different types of infectious agents such as viruses, bacteria, etc., non-invasive factors of allergies are also different, and just as many types can be identified from a virus, a harmless substance (for some people) which is later called an allergen It can have many components that cause different diseases in different people, even in one organ, and we can almost say that not only the human being but also the disease itself is unique, but we have to emphasize the similarities and for simple understanding. Let’s call them a type of disease and use this simplification in teaching.

Allergy in an organ can be caused in various ways, which are classically and clearly mentioned in four ways in medical books. (Gel and Coombs) but the large number of diseases that are a combination of these four methods or do not fit into the classical form are very large and require a new classification.
They also make another classification for allergies, if they have a specific family history or a higher serum IgE level and an identifiable allergen, they call it an atopic form, and otherwise, it is called non-atopic (which is very incomplete) just by asking about the family history. Although it is necessary to examine the human genetic system, it is not sufficient to use serum IgE as a criterion for allergy, which increases even in other infectious and non-infectious conditions, and on the other hand, some people who are definitely allergic, but their IgE does not increase even With a positive skin test, it shows that it is not a good support.
The abnormal presence of eosinophils can be seen both in the tissue and in the serum and in both cases, and this classification is further questioned.
Definitely, future developments will detect other substances in the serum other than IgE, and we will have better and more complete or newer tests, and the identification of allergens in the form of a skin or serum test, which is for a limited number of a huge number of harmless substances (for some) in the world. has that this limitation is very serious and in fact it can be said that the identification of allergens is still in the beginning.
As a result, this division of atopy and non-atopy cannot be complete, and on the other hand, since we have both forms of the above diseases in every part of the body, but they have the same treatment, it shows that the division is artificial and has remained uniform for years and has not helped significantly. And maybe the format and mentality that it has provided has caused us to neglect it.
We have atopic and non-atopic allergy diseases not only in the lung, but also in the skin and nose, etc., and the monopoly of the word allergy is not scientific in the form of atopy or only to a specific organ (nose) and factors such as infection, stress, exercise for atopy problems It creates problems for non-atopic patients as well, and in fact, the non-atopic form is part of the unknowns of allergy science today, and with all the advances in science, we must accept that we have many unknowns.
And what we call non-atopy and do not consider the work finished, maybe we can say that in fact, we have called the clear or simpler or more elementary part of allergy as atopy, which is a small part of the reality of allergy.
Asthma is a group of allergic diseases in the lung, and we said that the lung, like any other organ, has atopic and non-atopic allergy diseases.
Therefore, the form of non-atopic asthma is correct, not non-allergic asthma, although due to the monopoly of the word allergy to IgE (atopic form) in some medical books, the form of non-allergic asthma is still seen.
It can be said that we have non-atopic nasal allergy, hives or non-atopic eczema. Dear colleagues, there are many cases of these diseases that do not have high IgE, nor a positive skin test, and even besides anaphylaxis, we have a reality called anaphylactoid.
In fact, not all lung allergy diseases are called asthma, but specific cases of lung allergy are called, and in the upper part of the respiratory tract, we also have non-atopic allergies, and various diseases, and actually asthma is a collection of lung allergy diseases. and everyone believes that asthma is not a disease but one or more complexes.
The expression of atopic asthma or allergy does not indicate a disease, and it does not even have an effect on the drug treatment that is common today.
Allergy is a large group of diseases and affects all organs of the human body and is not exclusive to the upper airways, but the form of asthma is exclusive to the lower airways (lungs).
The question of asthma or allergy is more similar to questions like:
Tuberculosis or infection? Is it pneumonia or an infection? Is it diabetes or glandular disease?
Is it schizophrenia or mental illness? Is it a fracture or an orthopedic form?
So, it is better to know if the lung is affected, whether it is infection or allergy or both, and if the allergy is in the middle, is it asthma or another allergy in the lung (such as farmers’ lung, etc.) and if it is asthma, then we know it is atopy and Or otherwise – the issue of intensity is another category.
And very mild or very severe asthma may exist, whether atopic or non-atopic, as well as very mild or very severe nasal allergy, whether it is atopic or non-atopic, or for urticaria or eczema, the severity of the clinical symptoms of the attack and the number The frequency (attacks) and its duration together with the medical examination and spirometry itself is a good measure to determine the severity of the asthma disease and the combination of asthma with allergies in the nose and sinuses or the skin is also seen a lot, which needs to be taken seriously and even It can be taken as a factor for the deterioration of each of these conditions.

Asthma caused by allergy,
about 75 to 85% of patients with asthma suffer from some type of allergy. Sometimes the cause of asthma symptoms in children is a cold, influenza (the most common cause of asthma symptoms in children) or sports activities, but allergies and sensitivity will play a role in aggravating the symptoms. 
How can allergies lead to asthma attacks?
Children inherit allergies from their parents.
Allergy antibodies (known as immunoglobulin-E) are made in the body of these people with more than normal amounts.
These antibodies detect very small particles of allergens, such as molds and mites in house dust, which
have entered the body through different ways (mostly the respiratory system), and are responsible for the occurrence of allergic reactions to these particles, which are often harmless. .
These types of antibodies may also play a role in fighting parasitic infections in the body.
The said antibody binds to the surface of special cells called mast cells that are scattered in the connective tissues of the body. When allergens enter the body, these substances are attached to the antibodies located on the mast cells, forcing the cell to secrete a substance called histamine.
The release of histamine causes symptoms such as sneezing, runny nose and tears.
In fact, histamine is a substance that acts to defend the body against foreign substances, and in response to the above-mentioned reactions, the body tries to free itself from the nuisance of allergenic substances. In children with asthma, histamine can also cause the symptoms of the disease to flare up.
Allergists are able to detect any allergy in a child.
By identifying the allergen or allergens, the best treatment is to avoid contact with those substances as much as possible.
Compliance with environmental control methods at home can prevent the child from contact with allergens.
In situations where it is not possible to avoid the mentioned substance, the best way is to use antihistamine drugs to neutralize the free histamine secreted in the body.
The use of inflammation caused by the use of immunotherapy methods will gradually reduce or eliminate the body’s response to the desired allergen.
Cardiac asthma
is a term used for asthma-like symptoms caused by heart failure.
Elderly people are more prone to this condition.
Often, the patient has no history of asthma and these symptoms are completely new.
Patients who have cardiac asthma have wheezing because water collects in the lungs due to the failure of the heart to pump blood, causing wheezing.
Besides chest x-ray, there are other ways to diagnose heart failure, such as heart and liver enlargement, neck vein swelling, and ankle swelling. In some patients, the diagnosis of heart failure is given when the chest X-ray shows an enlarged heart and there is fluid in the pleural membrane. Of course, sometimes these signs are not present and the diagnosis is more difficult.
Correct diagnosis is very important, because the treatment of cardiac asthma is different from pulmonary asthma.
Diuretics are often prescribed to reduce water that has accumulated in the lungs.
If this treatment method is effective, the wheezing often goes away.
Asthma caused by sports activities
in children with this type of asthma, the symptoms of the disease appear after intense physical activities (such as running, swimming, cycling, etc.).
Some children with this type of asthma develop symptoms only after intense physical activity, while in others there may be other triggering factors.
With the use of appropriate medicines, these children can participate in sports activities like other children.
It is interesting to know that more than 10% of Olympic champions have this type of asthma, but they have learned how to control it.
Doctors can usually diagnose this type of asthma based on the child’s history, but sometimes more tests are needed to confirm the diagnosis, including pulmonary function tests after exercise.
Sometimes the doctor may want to measure the child’s tolerance for doing certain sports because different types and intensities of sports activities do not have the same effect on the occurrence of this type of asthma.
If physical activity is the cause of asthma symptoms in a child.
The doctor can prevent the child from doing activities by prescribing medicines.
Of course, sometimes even after taking medicine in this way, asthma attacks occur, therefore, parents or older children themselves should always carry the necessary medicines to get rid of asthma attacks in all games and sports activities, and the child’s coaches and teachers They should also be aware of the child’s illness.

One of the causes of asthma attacks is the workplace. The relationship between the work environment and asthma symptoms is a bit complicated due to delayed reactions, because asthma symptoms often appear a few hours after being in the work environment. One key to this is that symptoms improve on weekends or when you are on vacation. Even if working in the same environment for years does not cause asthmatic reactions, the stimulating substances of the work environment can cause these symptoms at any time.
Occupational Asthma:
Occupational asthma is a respiratory disorder caused by inhaling gases, dust or other harmful substances in the work environment. Asthma symptoms may appear for the first time in a healthy worker, or a person’s previous asthma may worsen in the work environment. Asthma symptoms include: wheezing, chest tightness, and coughing. Other symptoms include runny nose, nasal congestion, and red eyes. Cause It may be allergic or non-allergic, and this disease can remain for some time after the worker’s contact with the triggering agent is stopped.
Usually, the symptoms are severe during the work week and improve during the weekend, but worsen when returning to work. In many cases, a previous family history of allergies makes a person more prone to occupational allergies. Workers who smoke are also at greater risk of developing asthma following occupational exposures.
The length of time that an occupational exposure can cause asthma is highly variable. On the other hand, for many workers who develop occupational asthma in the workplace, their disease is mistakenly diagnosed as bronchitis. People who live around such factories may also suffer from the symptoms of this disease due to contact with harmful substances. If occupational asthma is not diagnosed correctly and quickly, it can be dangerous in the long term.
Prevalence:
Although there are no accurate statistics on the number of new cases of occupational asthma, occupational asthma is known as one of the most common lung diseases in the working environment in developing countries.
The incidence of occupational asthma is different in different industries. For example, in factories producing cleaning products, a special enzyme used in the production of laundry powders has caused respiratory complications in 25% of employees. In the printing industry, about 50% of employees have suffered respiratory complications due to contact with gum arabic, which is used in color printing to separate the printed pages and prevent them from being stained. Isocyanates are chemical substances that are widely used in many industries such as the production of colored sprays, production of plastic, foam, rubber, etc. These substances can cause occupational asthma in 10% of workers.
Causative mechanism:
Occupational asthma may be caused by one of the following three mechanisms:

• Direct stimulation effects:
  Stimulating substances that can cause occupational asthma include hydrochloric acid, sulfur dioxide and ammonia, which are used in petrochemical industries and chemical factories. Workers who are in contact with these substances intermittently develop wheezing and asthma symptoms immediately after contact with the irritant. Because the immune system is not involved in this reaction, this reaction is an irritant type and is not allergic. Workers who have a history of asthma or other respiratory disorders are mainly affected by the effects of this type of contact.
• “Prolonged contact” allergy
  is involved in many cases of occupational asthma. This type of asthma generally develops only after prolonged contact (months or years) with an occupational agent. Because a person’s immune system needs time to produce allergic antibodies or create an immune response to a specific substance.
  For example, workers who work in factories producing laundry powder may be allergic to enzymes produced by the bacteria “Bacillus subtilis”. Also, food industry workers may be allergic to castor beans or green coffee beans. Allergic occupational asthma can be caused in workers of plastic, rubber or resin industries after frequent contact with small chemical molecules dispersed in the air. Veterinarians, fishermen and animal caretakers in laboratories may also experience allergic reactions. Health system workers may also suffer from asthma due to inhalation of chemical powders in latex gloves.
• Medicinal mechanisms:
  inhalation of some substances in the air can directly cause the accumulation of some chemicals such as histamine or acetylcholine that are naturally present in the body inside the lungs, these substances lead to the occurrence of asthma. For example, insecticides used in agriculture can cause the production of acetylcholine, and this substance causes the muscles of the airways to contract and narrow these airways.
  Prevention:
  Once the triggering factor is identified, the amount of contact with it should be minimized. For example, the worker can be moved from one area to another. Before employing workers, it is better to ensure the health of their respiratory system, and this should be repeated at regular intervals. Work environments should be carefully monitored and workers’ contact with occupational allergens should be minimized.
  People with occupational asthma should see a doctor for follow-up. In some cases, prevention with some special drugs can reduce the side effects of substances in the workplace.

Occupational asthma is not necessarily related to allergies
Occupational asthma is not always related to allergic reactions. Allergenic substances in the workplace that stimulate the sensory nerves at the back of the throat cause asthma complications. In this way, some of the motivational reactions caused by the work environment are clarified. In addition, many asthmatic reactions related to the workplace are not yet known, and are in the early stages of research.

The risk of asthma is higher in people with allergies.
People with allergies are more prone to occupational asthma. People who are not allergic can also develop occupational asthma, but the severity of symptoms seems to occur after long periods of exposure to the irritant in the workplace.

The severity of the symptoms of a child with asthma can be divided into four main categories, each of which has its own characteristics and requires different treatment methods.
Mild asthma, occasional:
when the child experiences attacks of wheezing, coughing and shortness of breath more than 2 times a week. Such a child rarely has symptoms in the intervals of attacks and only one or two nights during the month may show mild symptoms.
Mild asthma should never be considered unimportant because there is no inflammation in the airways in the intervals of attacks.
Persistent mild asthma:
Children who have attacks of wheezing, coughing and shortness of breath more than twice a week but less than once a day are suffering from mild persistent asthma. Symptoms occur at least 2 times a month during the night and may lead to disturbances in normal activities.
Moderate persistent asthma:
Children with moderate persistent asthma have symptoms every day and therefore need to take daily medications.