Asthma

Asthma coughs can be dry at first and become phlegmatic after a few days, the cough is so intense 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 also 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.

The prevalence of asthma in different countries is very variable, but due to the increase in prevalence in low and middle income countries that have adopted a western style of life 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.

1. severe shortness of breath
2. Blue color of the face and lips
3. Severe anxiety due to shortness of breath
4. Rapid heartbeat
5. sweating
6. Decreased level of consciousness, such as drowsiness or confusion

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.

Having a respiratory infection

 Eating some foods

Hormonal changes in women

The most common allergens are:

• Domestic insects
• animal hair
• mold
• mushroom
• Fossil fuels such as oil and gas
• Perfume particles
• tobacco smoke

1. Taking some drugs such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen and mefenamic acid
2. 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.
3. stress
4. Food reflux

Psychological complications:

 People with asthma are often afraid of having an attack, and this fear can adversely affect their quality of life.  

Asthma complications

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 resulting from 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 failure of another part of the lung. It is one of the complications caused by asthma, which is often caused by the blockage of a part of the respiratory tract as a result of thick phlegm (atelectasis). Until now, the cause of most of the complications caused by asthma has been infection, which is caused by the collection and suppuration of phlegm under the respiratory tract. It is variable until 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.

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 influenced by various factors (such as allergies, infections, triggers, and the environment), but there is a genetic tendency in all conditions.

Infections such as whooping cough seem to increase the tendency to develop 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 test have shown that children whose parents are addicted to smoking have a worse respiratory condition.

The bronchial tubes of patients with asthma contract. Since it is difficult to inhale and exhale through these narrow tubes, patients with asthma suffer from symptoms of shortness of breath, wheezing, and a feeling of pressure in the chest. In addition, sticky phlegm is produced in these people, which comes up with coughing or causes chest tightness in the person.

Asthma or allergy?

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.
2) The human body’s immune system is involved in both, so that if it were not for the body’s defense, neither the person would be alive nor the disease would occur.
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, such as infection, refers to states of the human body when the person is out of balance (health) and the annoying symptoms reach such an extent that That person is considered sick, or the person has symptoms that are considered abnormal from the society’s point of view (normal state).
6) Both can appear acutely, chronically, subacutely or without symptoms.
7) The factors causing both 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, allergy occurs in people with special genetics who have the necessary talent to break down the immune system, infection can happen to all people.
4) Infection, the aggressive power of that infectious agent is the most important factor in causing symptoms, but in allergies, 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 various types of infectious agents such as viruses, bacteria, etc., the non-invasive factors of allergies are also different, and just as many types can be identified from a virus, a harmless substance (for some) 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 easier understanding Let’s call a type of disease and use this simplification in teaching.

Allergic Asthma

About 75 to 85% of patients with asthma suffer from some type of allergy. Sometimes the trigger of asthma symptoms in children is cold, flu (the most common trigger of asthma symptoms in children) or sports activities, but allergies and sensitivity are aggravated. Symptoms will play a role. 

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 that have entered the body through various ways (mostly the respiratory system) and are responsible for the occurrence of allergic reactions to these particles. are dangerous

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 with the occurrence of the aforementioned 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

It 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 a child 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 only by taking into account the child’s history, but sometimes more tests are needed, including pulmonary function tests after exercise, to confirm the diagnosis.
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 trigger 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 should always carry the necessary medicines to get rid of asthma attacks in all games and sports activities, and coaches and The child’s teachers should also be aware of the child’s illness.

Asthma and its relationship with work

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 the person’s previous asthma may worsen in the work environment. Asthma symptoms include: wheezing, chest tightness and runny nose, nasal congestion and red eyes. The cause 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 of occupational asthma:

 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.

Mechanism causing occupational asthma:

Occupational asthma may be caused by one of the following three mechanisms:

1- Effects of direct stimulation:

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.

2- “long-term contact” allergy:

In many cases of occupational asthma, allergies play a role. 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.

3-Pharmacological mechanisms:

Inhaling 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 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 of occupational asthma:

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 does not necessarily depend on 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 stimulus 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 allergic people

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 table below shows the types of occupational allergens and the industries related to them.

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:

It is when the child experiences attacks of wheezing, coughing and shortness of breath more than 2 times a week. Such a child is rarely symptomatic between attacks, and only one or two nights during the month may show mild symptoms. Mild asthma should never be taken lightly because there is inflammation in the airways during the intervals between attacks.

Mild persistent asthma:

Children who have attacks of wheezing, coughing and shortness of breath more than 2 times a week but less than once a day are suffering from stable mild 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 stable moderate asthma have symptoms every day and therefore need to take daily medications. Symptoms of night terrors occur more than once a week and last for several days