Is it asthma?

MANILA, Philippines – Wheezing, shortness of breath, and coughing. These are telltale signs of an asthma attack. Maybe you can personally relate, as an asthmatic, or know someone who has it. 

Asthma is a chronic disease that affects millions worldwide. That includes around 10.7 million Filipinos, or 12% of the population, according to a 2013 study. It adds up to almost 1 in every 8 Filipinos.

It’s a staggering number, but the good news is that asthma can be managed with the right medication and a few lifestyle changes.

But what exactly is asthma?

Defining asthma

According to the Global Initiative for Asthma’s (GINA) 2015 Global Strategy for Asthma Management and Prevention report, asthma is a “heterogeneous disease, usually characterized by chronic airway inflammation and history of respiratory symptoms, together with varying degrees of airflow limitation.” Heterogeneous means that this disease has a variety of symptoms.

Dr. Gene Ambrocio explains further what the symptoms are that can point to asthma. Dr. Ambrocio is a practicing pulmonologist, and currently employed as a Medical Affairs Manager in GSK. He is also a Fellow of the Philippine College of Physicians and a member of the Philippine College of Chest Physicians.

“[Asthma is] airway inflammation usually presenting itself with symptoms, which are wheezing, so in Tagalog, that’s huni, shortness of breath or hingal, tightness of chest or paninikip ng dibdib.” Dr. Ambrocio says, “Patients may also have a cough that can vary in both time and intensity.” 

Different kinds of asthma

Like other diseases, asthma comes in different forms known as phenotypes. Dr. Ambrocio lists the following from the GINA report:

• Allergic asthma – this is the most common of all. This phenotype often starts during childhood and is associated with a personal and/or family history of allergic diseases.
• Non-allergic asthma – this form of asthma has the same symptoms as allergic asthma but is commonly not associated with allergy.  
• Late-onset asthma – when some people, particularly women, get asthma for the first time later in life. They also tend to be non-allergic.
• Asthma with fixed airflow limitation – these patients develop permanently obstructed airways after structural changes in their lungs. These changes are the result of long-standing inflammation from asthma.
• Asthma with obesity – recent studies have shown a correlation between asthma and obesity. These patients show noticeable respiratory symptoms. 

While asthma is a chronic disease, which means that it persists for a long time and/or happens regularly, Dr. Ambrocio explains that asthma attacks are acute (or sudden) in nature. 

“Although [asthma] is chronic, you have acute symptomatic episodes which we call exacerbations. So you can have your asthma under control but at some point, because of triggers, allergens or the patient not taking their medications, the condition worsens.”

What causes an exacerbation? 

 Dr. Ambrocio says that an exacerbation is usually set off by a reaction to certain triggers. 

“[Asthma has] different triggers, the most common being dust mites. It can also be triggered by some pollen, animal dander, exposure to cigarette smoke, and exposure to outdoor pollution. Those are the common triggers.”

For some, their line of work can also play a part.

“Then there is what we call an occupational trigger. For example, someone who uses a photocopier, they’re exposed to toner. Sometimes, this can also be a trigger for asthma.”

Is it asthma or just an allergy?

While the symptoms of asthma may sound a lot like an allergic reaction, Dr. Ambrocio notes that there are some differences.

“[There are a few differences] in comparison to an allergic reaction, which is an immediate response to a triggering event like food intake. For example, if I’m allergic to shrimp, when I eat it usually the symptoms are cutaneous (affects the skin). It’s usually a rash or itchiness, then sometimes the lips swell too.”

Dr. Ambrocio says that the biggest difference between asthma and an allergic reaction is the way that the symptoms manifest, and the history behind them.

“Asthma presents a history of variable symptoms like wheezing, shortness of breath, chest tightness and cough.” He says, “Patients also usually have a family history of allergic diseases. Asthma is confirmed if the patient has a history of variations in lung function and airflow limitation.”

What can be done?

In terms of medication, patients with allergic asthma usually respond well to inhaled corticosteroid treatment on top of bronchodilators, but people with non-allergic asthma tend not to.* 

In addition to taking the right prescribed medication, Dr. Ambrocio also recommends a few personal adjustments to avoid serious exacerbations. 

“Asthma is a chronic disease. It cannot be cured but we can manage it and control the symptoms using appropriate medications and lifestyle adjustments.”

These lifestyle adjustments include recognizing your triggers and avoiding them.

“When a patient feels short of breath, they should take note if this is related with exposure to dust, dust mites or smoke.” He says. 

“So number one is avoidance of allergens. If the allergens are present at home with household dust mites, then we usually advise frequent changing of bed covers and pillow cases. We also advise avoidance of carpet and thick curtains because sometimes dust mites live there, too.”

Avoiding triggers also applies once you leave the house.

“When it’s pollen season, we advise patients to stay indoors and close their windows. When it’s an occupational trigger, it gets a bit difficult. We advise patients to change jobs if they experience frequent exacerbations as a result of their work.”

Life goes on

When they’re not experiencing an exacerbation, however, Dr. Ambrocio explains that asthma patients can experience a regular life.

“Asthma is a variable airway disease. That means, when patients are not having asthma attacks, they may feel very normal.”

Like with any medical condition, it’s always best to seek professional help. Dr. Ambrocio adds that visiting a doctor can not only help to treat asthma, but it can also help the patient to take control of the disease.

“Part of the consultation process for an asthmatic patient is education about the disease; the right medications and what triggers they should watch out for. So I think that’s very important for them to be able to get hold of the disease. So that the patient has control of the disease.” – Rappler.com 

*For proper diagnosis and prescription, please consult your doctor.

References:

Global Asthma Network: The Global Asthma Report 2014 http://www.globalasthmareport.org/resources/Global_Asthma_Report_2014.pdf 

Pediatric asthma control in Asia: Phase 2 of the Asthma Insights and Reality in Asia-Pacific (AIRIAP 2) survey

http://onlinelibrary.wiley.com/doi/10.1111/all.12117/full

Global Initiative for Asthma’s (GINA) 2015 Global Strategy for Asthma Management and Prevention report

http://www.ginasthma.org/local/uploads/files/GINA_Report_2015_Aug11.pdf

A Comparison Of Obese And Nonobese People With Asthma: Exploring An Asthma-Obesity Interaction. Pakhale S, Doucette S, Vandemheen K, et al. Chest. 2010;137(6):1316-1323.

http://journal.publications.chestnet.org/article.aspx?articleid=1086485&frame=header

 A Health Service Message brought to you by GSK

 PH/FP/0023/15

September 2015