Asthma: Causes, Symptoms and Management in Children and Adults
Asthma, a chronic inflammatory disease of the airways, causes breathing difficulty in affected people. There is no cure for asthma; the only thing you can do is keeping it under control.
What is Asthma?
Asthma is a reversible airway disease, suggestive to cause by a number of genetic and environmental factors. It can be defined as the common chronic inflammatory disease of the airways that creates shortness of breath and results in breathing difficulties for an asthmatic.
How Asthma Affects the Body?
During an asthma attack, breathing becomes more difficult for an asthmatic. This can sometimes lead to hospitalization; in extreme cases, death may occur.
Two mechanisms primarily cause the tightening and swelling of the bronchial passages:
- Constriction - the contraction of the nasal muscles adjacent to the airways;
- Inflammation - the tenderness or redness, irritation and swelling of the bronchial pathways.
How Our Body Reacts to an Asthma Attack?
Normally, during respiration, the inner lining of our air tubes (airways) stays very thin, and the muscles surrounding these air tubes stay in a very relaxed mood. This helps the airways to open up widely and thus results in stress-free inhalation and exhalation from our body.
However, when an asthma attack occurs, the inner lining of the air tubes thickens due to inflammation. The muscles surrounding these bronchial tubes also tighten because of constriction. This leads to the production of excessive sticky mucus and eventual clogging of the air passages.
As a result, when an asthmatic breath, the airways open up narrowly than usual and thus less air passes through the airways, which eventually results in stressful respiration process.
Causes of Asthma in Adults
The exact cause(s) of Asthma is still unknown. Several recent studies suggest that many factors play a part for developing asthma, including environmental and biological factors. [1]
Environmental Factor
Our household environment plays an important role for developing asthma or asthma symptoms. Indoor pollutants like molds, cigarette smoke, noxious fumes, house dust mite and gas from stove can trigger an asthma attack.
Changes in weather are also a key environmental factor for arising asthma attacks and conditions. A sudden fall of temperature, cold air and windy cold air can lead to bronchial constriction, respiratory congestion and reduced mucociliary clearance (i.e., self-clearing mechanism of the airways). On the other hand, a sudden rise in temperature, hot and humid condition can also trigger asthma attacks.
Genetic Factor
Patients who have a parental history of asthma or other allergic conditions is more likely to inherit the disease. This inherited tendency to grow allergic conditions is known as atopic conditions. Studies have shown that patients with a family history of an atopic condition are more reactive to allergens as compared to normal persons.
Recent Update
Recently, a study done by Dr. Richard Locksley and his team suspected that asthma might be caused by a compound named ‘Chitin’ (pronounced KI-tin), a common compound found in most of the highly allergenic organisms. The team is still researching on the compound to establish their initial findings. [2]
Causes of Asthma in Children
There is no known cause of asthma in children. Like adults, both environmental and biological factors may play a role for developing childhood asthma. Researchers have also identified quite a few risk factors. These include nasal allergies or hay fever, frequent respiratory infections, low birth weight, being exposed to tobacco smoke before and after birth, black or Puerto-Rican ethnicity, and being raised in a low-income environment.
The biggest risk factor, however, is hereditary. If either parent suffers from asthma, chances are high that at least one of the children will develop asthma.
According to WHO, every year more and more children are being diagnosed with asthma worldwide. In the US, more than 10% -12% of children develop childhood asthma annually, and this percentage is gradually increasing for some unknown reasons.
Hygiene Hypothesis
The hypothesis provides some explanations for the dramatic rise in childhood asthma. According to the theory, over the past 20 years, the western lifestyle has changed rapidly, and the living condition has become more hygienic and sanitized. The use of antibiotics, vaccines and cleanlier lifestyle has created a germ-free environment, which eventually preventing the spreading of disease and infections.
The hypothesis suggests that most children these days are less exposed to infections than those in the past. The immune systems of these children are, therefore, not getting the early “Kick Start” to fight against bacteria or viral infections. [3] They are, as a result, having an increased sensitivity and overreaction of the immune system when exposed to allergens or airborne irritants. Although evidence is still limited in support of this theory, but many researchers agree that this might be one of the reasons for the increase in atopic conditions in children. [3, 4]
Common Asthma Triggers
Several triggers like infections, allergens and airborne irritants can stimulate an asthma attack.
Infections: Chronic infections, caused by cold and flu viruses, in our respiratory system (mainly, upper respiratory tract infections) are thought to be a vital factor for developing asthma or asthma condition.
Allergens: Molds, pollen, dust mites, cockroaches and animal dander (as an example, fur from cat or dog) can stimulate an asthma attack.
Airborne irritants: Exposure to atmospheric pollution, perfume, cigarette or wood smoke and chemical fumes can also trigger asthma conditions.
Signs and Symptoms of Asthma in Adults
Asthma symptoms usually vary from person to person and can range from mild to severe. The most common symptoms are shortness of breath, tightness in the chest, coughing, and wheezing. However, one may experience completely different symptoms than others.
One of the primary reasons for this is that each human being is unique in terms of biological make-up and lifestyle. As a result, some people may have an asthma attack with one or more symptoms, while others may not have any typical symptoms.
While not all people with the disease experience the same symptoms, but in most cases the early signs appear just before an asthma attack.
Common Signs and Symptoms of asthma include:
- Frequent nighttime cough,
- Shortness of breath,
- Restless sleep or breathing difficulty during sleep,
- Quick tiredness with any kind of physical work,
- Chest tightness or pain,
- Feelings of anxiety or panic,
- Decreased flow rate in Peak Expiratory Test of lung, and
- Hypersensitivity to common cold and allergies - inflamed skin, dark circles under the eyes, persistent runny nose, sneezing, wheezing, and coughing.
Symptoms of Asthma in Children
Asthma may begin at any age and can affect people of all ages. It is, however, more common among newborns and children, especially those who are born with a low birth weight, have been exposed to cigarette smoke, and are black. In most cases, symptoms of childhood asthma arise around the age five. Although childhood asthma symptoms are quite similar compared to adults, but children face some unique challenges.
These Symptoms Include:
- Frequent coughing spells - these can happen either day or night;
- A chronic cough, making the child less energetic, especially during daytime;
- Presence of intermittent or rapid breathing;
- Complains of tightness in the chest, or chest pain;
- A whistling sound while breathing;
- See-saw motions in the chest, which is typically present during labored breathing;
- Shortness of breath or loss of breath, or a tightening feeling in the neck and/or chest muscles; Or
- Feeling weak and/or tired.
Management of Asthma
Mild asthma attacks are usually more common and come up with mild to moderate signs and symptoms, so you may not find any difficulty continuing your daily activities. With right preventive measures, you can easily keep the symptoms under control.
Severe asthma attacks, however, are less common and can be life threatening. Your condition can get worse dramatically. Such attacks often create an emergency where you may need an immediate medical attention. Therefore, it is necessary for you to recognize the early signs and symptoms and take preventive measures before your asthma worsens.
When to See a Doctor
If you are having breathing difficulty and experiencing any of the asthma symptoms mentioned above, consider consulting with your GP or an asthma specialist. Your GP may prescribe some medications and may suggest an action plan to control and prevent further asthma attacks.
If your child is too young to use an inhaler, your GP may prescribe oral medications to help keep the airways open. Inhalers for older children may include a combination of salmeterol and corticosteroids such as Advair. A rescue inhaler may also be given for emergencies that need to be treated right away.
Medical References
1. Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, etiology and risk factors. Cmaj. 2009 Oct 27;181(9):E181-90.
2. Van Dyken SJ, Locksley RM. Chitins and chitinase activity in airway diseases. Journal of Allergy and Clinical Immunology. 2018 Aug 1;142(2):364-9.
3. Stiemsma LT, Reynolds LA, Turvey SE, Finlay BB. The hygiene hypothesis: current perspectives and future therapies. ImmunoTargets and therapy. 2015;4:143.
4. Scudellari M. News Feature: Cleaning up the hygiene hypothesis. Proceedings of the National Academy of Sciences. 2017 Feb 14;114(7):1433-6.
