Asthma

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Public attention in the has recently focused on asthma and allergy because of its rapidly increasing , affecting up to one in four urban children. According to the latest estimates, there are 38 millions allergy sufferers in Great Britain, and the numbers are increasing.

Mites cause several forms of allergic diseases, including hay fever, asthma and eczema and also aggrevates atopic dermatitis. Mites are usually found in warm and humid locations, including beds. It is thought that inhalation of mites during sleep exposes the human body to some antigens which eventually induce hypersensitivity reaction.Dust mite allergens are thought to be among the heaviest dust allergens.

Vacuuming helps remove the residue, as does washing, however, vacuuming does not generally kill mites because they cling to the surface. The application of frequent vacuuming as a dust control measure may aggravate allergic asthmatic conditions because conventional vacuum cleaners blow some dust through the cleaner's bag into the air. Dust collection by conventional vacuums results in a significant increase in airborne concentrations.

Inhaled allergens derived from house dust mite faeces play a major role in allergic disease, especially in asthma. The number of people affected is rising throughout Great Britain (and indeed Europe and also worldwide), now impairing the health and quality of life of a substantial proportion of children, as well as many adults, and placing a significant burden on health services.

Allergy and asthma sufferers aren’t the only ones to benefit: Within a very short time, Roboclean washes the air and noticeably improves room climate. Dirt will not find it’s way back in your home.

Asthma, from the Greek Aσϑμα (ásthma), meaning gasp, is a common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath.

Treatment of acute symptoms is usually with an inhaled short-acting beta-2 agonist (such as salbutamol). Symptoms can be prevented by avoiding triggers, such as allergens and irritants, and by inhaling corticosteroids. Leukotriene antagonists are less effective than corticosteroids and thus less preferred.

The prevalence of asthma has increased significantly since the 1970s. As of 2009, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths, although generally with treatment, prognosis is good.

Signs and symptoms

Common symptoms of asthma include wheezing, shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the early morning, or in response to exercise or cold air. Some people with asthma only rarely experience symptoms, usually in response to triggers, where as other may have marked persistent airflow obstruction.

Risk factors

Studying the prevalence of asthma and related diseases such as eczema and hay fever have yielded important clues about some key risk factors. The strongest risk factor for developing asthma is a history of atopic disease; this increases one's risk of hay fever by up to 5x and the risk of asthma by 3-4x. In children between the ages of 3-14, a positive skin test for allergies and an increase in immunoglobulin E increases the chance of having asthma. In adults, the more allergens one reacts positively to in a skin test, the higher the odds of having asthma.

Because much allergic asthma is associated with sensitivity to indoor allergens and because Western styles of housing favor greater exposure to indoor allergens, much attention has focused on increased exposure to these allergens in infancy and early childhood as a primary cause of the rise in asthma. Primary prevention studies aimed at the aggressive reduction of airborne allergens in a home with infants have shown mixed findings. Strict reduction of dust mite allergens, for example, reduces the risk of allergic sensitization to dust mites, and modestly reduces the risk of developing asthma up until the age of 8 years old. However, studies also showed that the effects of exposure to cat and dog allergens worked in the converse fashion; exposure during the first year of life was found to reduce the risk of allergic sensitization and of developing asthma later in life.

The inconsistency of this data has inspired research into other facets of Western society and their impact upon the prevalence of asthma. One subject that appears to show a strong correlation is the development of asthma and obesity. In the United Kingdom and United States, the rise in asthma prevalence has echoed an almost epidemic rise in the prevalence of obesity. In Taiwan, symptoms of allergies and airway hyper-reactivity increased in correlation with each 20% increase in body-mass index.

Asthma has been associated with Churg–Strauss syndrome, and individuals with immunologically mediated urticaria may also experience systemic symptoms with generalized urticaria, rhinoconjunctivitis, orolaryngeal and gastrointestinal symptoms, asthma, and, at worst, anaphylaxis. Additionally, adult-onset asthma has been associated with periocular xanthogranulomas.

Asthma

Asthma is the term which describes a specific type of breathing problem that arises due to narrowing of the airways. This narrowing is caused when certain natural chemicals within the body are released, usually in response to infection or when the patient comes into contact with something that they are allergic to. The same release of chemicals also leads to inflammation of the airways.

If the breathing tubes are narrow it is more difficult to get air in and out of the lungs. This causes a sensation of breathlessness and tightness in the chest. With the narrowed airways there may be wheezing and a dry irritating cough, which can sometimes be triggered in the cold, extreme heat, or with exercise. It can sometimes just occur at night, disturbing sleep. In some people (especially children), a cough may be the main symptom.

When do these symptoms arise?

One of the characteristics of asthma is that the symptoms are variable, with some days being better, and others worse. This will relate both to the treatment that is being given (to increase number of good days) and environmental exposure to triggers that may worsen asthma (increase number of bad days). In addition to this symptoms may vary spontaneously throughout the day. Everyone's airways are narrowest in the small hours of the morning so this will be the worst time in asthma. If the asthma is not well controlled with treatment, waking at night due to breathlessness, wheeze, chest tightness or cough is often present.

What triggers make asthma worse?

Some substances specifically trigger asthma; other substances just act as irritants when the airways are already over-reactive due to asthma. These irritants usually only transiently worsen the asthma (i.e. 30 - 60 minutes) whereas those specific factors that trigger asthma may do so for days or weeks.

Specific factors include allergens such as house dust mite droppings in dust, pets such as cats and dogs, pollens such as tree and grass, and moulds, as well as infection such as the common cold. The allergens mentioned will only worsen asthma if a person is specifically sensitive to that substance. Exposure to chemicals in the work environment can also lead to the development of asthma in some people.

Non-specific irritants include cigarette smoke, car exhaust fumes, perfumes, aerosol sprays such as hair lacquer or furniture polish, change in temperature, especially going from a warm to a cold environment, paint or cooking odours and exercise.

Who gets Asthma?

Asthma can arise at any age but about half of asthmatics develop symptoms before the age of 10 years. It then tends to become less severe in teenagers but can come back in later life. Much of the asthma in young children relates to cold viruses, and these are the most likely to 'grow out of it' as they get older.

Asthma is twice as common in boys than girls, perhaps because infant boys have smaller airways. It tends to run in families so if there is a family history of asthma or of other allergies such as hay fever or eczema, an individual may be more likely to develop asthma. In adults who develop asthma for the first time in their 30s, 40s and 50s (late onset asthma) allergy is much less common. In late onset asthma a proportion may have asthma related to exposure to chemicals in their work environment and some may be sensitive to chemicals in drugs or their diet (i.e. aspirin sensitive asthma or salicylate intolerance). In some it may follow a severe chest infection.

Is asthma serious?

It is important to understand that while asthma can be very troublesome, a majority of people with the condition either do not require treatment or have symptoms which are easily controlled on very little medication. There are many successful sportsmen and women who have asthma. If you have recently been diagnosed with asthma, you should not panic.

Symptoms may not present all the time and there may be no signs of the condition between attacks. If you attend your doctor when well, he or she may not find any evidence of the disease. However, he or she will be able to exclude other chest problems and arrange further tests for asthma.

There are some people whose asthma does not respond fully to treatment and this can result in some chronic symptoms despite regular medication. The majority lead active lives despite their condition. Usually it is possible to avoid troublesome asthma by avoiding trigger factors such as allergens and by using medication.

How is Asthma diagnosed?

The diagnosis of asthma is based on two main features; the presence of those symptoms already described; and the variability in the airway narrowing and symptoms. This variability is usually measured by home monitoring of lung function with a peak flow meter - a simple device to measure the flow of air out of the lungs. If over a period of time the morning and evening values vary by more than 15% or treatment for asthma improves the readings by more than this value this is indicative of asthma. As the airways are narrower at night the morning value is usually lower than the evening measurement.

Lung function tests are useful in assessing the breathing in more detail. These involve breathing into machines which record the air flow and volumes during various breathing manoeuvres. A reversibility test may be used to assess your response to an asthma inhaler such as salbutamol. In asthma there is usually a marked improvement in lung function measurements after a dose of medication. Your GP may be able to perform or arrange lung function tests but it is not always necessary. More complex lung function tests are only available in hospital laboratories and are indicated in special circumstances.

Allergy skin tests are vital in finding out whether your asthma is due to inhalant allergens. You may need a referral to a specialist centre although some GPs are able to offer these tests. Drops of a number of allergen extracts are placed on the skin (usually the forearm) and the skin is pricked lightly through the drops. A positive reaction will cause some itching and a bump at the site within 10 minutes. A blood test for allergic antibodies to various allergens is an alternative but in some cases can be less likely to detect an allergy than skin tests.

A chest X-ray may be indicated to confirm that there is no other cause for your symptoms.

How should asthma be treated?

The treatment of asthma is based on allergen avoidance and drug treatment.

Allergen avoidance should concentrate on reducing exposure to housedust mite, mould spores, animal danders and (in some people) pollens. Remember that many chemicals will irritate airways in the asthmatic patient, and exposure to cigarette smoke, traffic fumes, sprays, perfumes, solvents, paint fumes and cleaning chemicals should also be considered.

Drug treatment is directed towards the two main components of asthma, the airway inflammation and the muscle narrowing around the airways. For very mild asthma in which symptoms only arise occasionally, a reliever inhaler to relax the airway muscles when needed, is all that is required. If this is needed more than once a week then a regular steroid inhaler to suppress the airway inflammation should be used. If it is not possible to use inhalers then tablets may be available, but inhalers are more effective. In some people with persistent asthma more than one type of preventer therapy, and additional tablet medication, may be needed.

Many asthmatics also suffer from rhinitis ('hayfever' symptoms, either for part of the year, or all year). Proper treatment of their rhinitis can lead to an improvement in their asthma .

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