It is a chronic inflammatory disorder of the small airways which is characterised by episodic, reversible bronchial obstruction due to hyper-responsiveness of trachea-bronchial tree to a multiplicity of intrinsic and extrinsic stimuli manifested clinically by paraoxysms of polyphonic wheeze, dyspnoea, and cough which may be relieved spontaneously or as a result of therapy.
According to WHO, over 80% of asthma deaths occurs in low- and lower-middle income countries.
Factors Precipitating Asthma –
- Cold air
- Dust, acrid fumes
- Tobacco smoke
- Emotional stress
- Respiratory infections (viral, bacterial)
- Drugs (NSAIDS esp aspirin, Beta blockers)
- Chemicals ( Sulfiting agents like Sodium or Potassium bisulfate, sulphur dioxide etc)
- Allergens (Ingested like fish, nuts etc, Inhaled like dust, pollen, house dust mite etc, Food additives, Occupational allergens like grain dust, wood dust etc)
Extrinsic Asthma – It is also called Atopic asthma or Early onset asthma. Its onset is in childhood. It occurs in those who produce excessive IgE antibodies in response to allergens.
Intrinsic Asthma – It is also called Non-Atopic asthma or or late onset asthma. It begins at any age especially in late childhood. There is no role for allergens in production of the disease.
Symptoms and Signs –
- Feeling of tightness of chest – dyspnoea. Patient assumes a upright sitting posture with back elevation.
- Widespread polyphonic, high pitched wheezing
- Inspiratory and expiratry wheezes are heard in moderate broncho-constriction. Expiratory wheeze is heard in mild broncho-contriction. Inspiratory wheeze is heard in severe broncho-constriction. In near fatal asthma, the chest is silent.
Nocturnal Asthma – It is an overnight fall of more than 20% in the FEV1 or PEFR
Gastric Asthma – Worsening of asthma after meals or dyspnoea occurring only after meals.
Exercise induced Asthma – Asthma is induced by exercise
Episodic Asthma – Patient has no respiratory symptoms between episodes of asthma.
Chronic Asthma – Symptoms are chronic. It may stimulate chronic bronchitis.
Acute severe Asthma ( Status Asthmaticus) – It is medical emergency. Patient is hypoxic and cyanosed due to severe bronchospasm. It is characterised by tachycardia (pulse rate > 120), tachypnoea ( RR >30/min), Sweating, Pulsus paradoxus, altered level of consciousness, and an inspiration – expiration ratio of 1:3 or 1:4.
Life Threatening Features –
- Patient cannot speak
- Central cyanosis
- Exhaustion, confusion, altered consciousness
- Silent chest
- Sever Hypoaexemia (< 8kPa)
- Unrecordable peak flow
- A normal or high CO2 tension (5-6 kPa)
- Disturbed pH.
Chest X-ray – It should be taken to rule out other causes of wheezing and also to rule out the presence of pneumothorax.
Peak Expiratory Flow (PEF) – Serial recordings of PEF may show overnight fall and subsequent rise during the day in asthma.
Pulmonary Funtion Tests (PFT) – PFT shows obstructive type of lung disease. FEV1 following 2 puffs of beta agonist shows an increase by 15% or greater than previous level.
Differential Diagnosis –
- Chronic bronchitis
- Cystic fibrosis
- Pulmonary embolism
- Pulmonary eosinophilia
- Viral bronchiolitis
- Bronchial stenosis
- Carcinoid syndrome
- Allergic bronchopulmonary aspergillosis
- Vocal cord dysfunction
- Drugs – ACEI, Beta blockers
- Cardiac failure
- Endobronchial tumour
- Foreign body aspiration
- Mechanical airway obstruction
- Superior vena cava syndrome
- Substernal thyroid
- Systemic vasculitis
Herbs and natural dietary supplements. Many people use herbs, plants, and supplements to treat asthma. Since there’s no proof they assist with asthma attack symptoms, they aren’t suggested. Studies have checked out omega-3 fatty acid, and inhibitor supplements like calciferol and vitamins A, C, and E for asthma attack symptoms. Again, there isn’t enough proof to advocate these natural therapies.
Yoga – Stress may trigger asthma symptoms. Breathing exercises used in yoga have been found to help few people.
Asthma diet. If you have a food allergy, avoiding foods that trigger an allergy attack may also help with some asthma symptoms.
The caffeine in black or green tea and coffee will facilitate to treat asthma. It works equally to popular asthma medicine ‘theophylline’, that unveils the airways.
Eucalyptus oil has been used for thousands of years as a natural remedy for a variety of conditions, and inhaling its vapor can aid those with respiratory problems like asthma or bronchitis.
Massage – A combination of warm mustard oil and salt into your chest many times daily till symptoms subside can be helpful.
Homeopathic Remedies Indicated – Homeopathy can diminish the hypersensitivity nature of the immune system of the allergy or asthma susceptible person. There are several homeopathic remedies indicated for asthma. Some of them are –
Arsenicum album –
- Attacks usually at night, breathlessness with burning sensation in the chest, periodical asthma, hay asthma, asthma from suppressed eruptions
- Restlessness, anxiety and fear
- Worse 2AM, lying on back
- Great debility and irritability
- Better heat and hot drinks
- Ailments from tobacco, decayed food
- Anaemia and chlorosis
- Gradual loss of weight from impaired nutrition
- Miserly, selfish person who lacks courage
- Unable to lie down, air passages constricted
- Dry cough, as if from sulphur fumes; after drinking
- Concomitant – with palpitations, cyanosis
Antimonium tartaricum –
- Rattling of mucous with little expectoration, It has characteristic Death rattle
- Drowsiness, debility and sweat
- Extreme dyspnoea on inspiration aggravated at 5AM
- Fear of being alone
- Burning sensation in chest
- Rapid, short difficult breathing; seems he would suffocate
- Bronchial tubes overloaded with mucous
- Pulse rapid and trembling
- Cough and dyspnoea better by lying on right side
- Constant disposition to take cold
- Relieves the congestion of lungs
- Catarrhal dyspnoea, humid asthma, bubbling rales
- Mucopurulent expectoration for lungs of old people
- Worse cold air, night and early morning
- Convulsive spasms
- Bluish face, nervous asthma, hay asthma
- Cold sweating and vomiting after attack
- Alternates with spasmodic vomiting
- Concomitant – with cramp, muscular spasms, cyanosis
Natrum Sulph –
- Dyspnoea at during damp weather, humid asthma
- Rattling in chest at 4 to 5 am
- Cough with thick greenish, ropy expectoration
- All gone sensation in chest
- Asthma in children
- Pain in lower left chest
- Aggravation cold air
- Aggravation eating plants growing near water, fish
- Amelioration warm, dry air
- Concomitant – with diarrhoea following
- Atony, malnutrition
- Aggravation 4 to 8 pm
- Intellectually keen people but with weak muscular power
- Debility in morning
- Lacks vital heat, poor circulation
- Sensitive to noise, odors
- Tickling cough, dyspnoea
- Tensive, constrictive, burning pain in chest
- Catarrh of chest in infants, seems full of mucous, rattling
- Nocturnal cough with gray, bloody, thick, purulent expectoration
- Concomitant – with gastric derangement
- Mental state is chief guiding symptom of Pulsatilla. It has mild, yielding and gentle disposition
- Amelioration open air
- Timid, weeps easily, likes sympathy
- Dry cough in evening and at night, loose cough in morning with copious mucous expectoration
- Dyspnoea with soreness of chest
- Short breathe, anxiety and palpitations especially lying on left side
- Expectoration is bland, thick, greenish and bitter
- Concomitant – with palpitations, gastric derangement
Sambucus Nigra –
- Acts especially on respiratory organs
- Dry coryza of infants, snuffles, nose dry and obstructed
- Child wakes up suddenly, nearly suffocated, sits up, turns blue
- Profuse sweating with dyspnoea accompanied by nausea
- Paroxysmal, suffocative cough coming on around midnight
- Millar’s asthma
- Worse sleep, during rest, eating fruit
- Better sitting up in bed, motion
- Concomitant – with cyanosis
Note – Please consume medicines after taking prescription from registered practitioner only.