Chronic asthma is a treatable condition

By Donya Betancourt

SANUR, Bali (JP): As the world develops, the incidence of noninfectious diseases such as asthma has risen. While asthma is the most common chronic illness of childhood, it can occur at any age.

People with asthma are among those most often visiting the emergency room, hospitalized and missing work or school. Asthma cannot be cured, but it is a treatable disease. It can be controlled with proper, long-term treatment, and most flare-ups can be prevented.

Asthma is a chronic inflammatory disorder that affects the airways. The breathing system is simple; we breathe air in through the nose or mouth, then the air goes into the windpipe (trachea) and through the main air passages of the lungs (the bronchial tubes) and into the lungs.

Asthma occurs when the bronchial tubes become inflamed. The muscles of the bronchial walls tighten (bronchoconstriction) and produce excess mucus, causing the airways to narrow, making it a lot harder for air to get in and out of the lungs. This condition can lead to everything from minor wheezing, coughing and tightness in the chest to severe difficulty in breathing.

Between asthma attacks (flare-ups), breathing can be totally normal. But when there is a flare-up, it is like breathing through a straw for the sufferer. The attacks last for hours if asthma medicine is not used. After an asthma flare-up, the airways return to normal, although it can take several days. This is a characteristic of asthma called "reversible airway obstruction".

An asthma flare-up is caused by three important changes in the airway: inflammation, excess mucus and bronchoconstriction. The symptoms vary from mild to severe, such as wheezing (a whistling sound when breathing) and coughing phlegm for prolonged periods of time. In severe cases, the breathing may be so labored it leaves the person gasping for air.

Most asthma flare-ups start slowly and most people can recognize the warning signs. You can stop an asthma attack when you recognize it early and take your medicine. If you fail to do this, your symptoms may worsen.

Warning signs for children are:

* An audible wheezing or whistling when the child exhales;

* Coughing phlegm, especially if the cough is frequent, and coughing in series (spasm), which may worsen at night;

* Waking at night with coughing or wheezing;

* Shortness of breath, increased heart rate or sweating;

* A tight feeling in the child's chest;

Warning signs for adults are:

* Increased shortness of breath or wheezing;

* Waking at night with shortness of breath, coughing or wheezing

* Chest tightness or pain;

* Increased use of bronchodilators (medicines that relax the bronchial muscles and open up airways);

* A fall in peak flow rates as measured by a peak flow meter, a simple device that you can use to monitor your lung function. Children who are older than 6 can be trained to use the device, though they should be supervised by their parents.

Asthma can develop at any age. If you are younger than 30 when you develop asthma, it is probably triggered by allergies. No one knows why one person's airway is more sensitive than others, but you are more likely to develop asthma if it runs in your family.

Other risk factors are low birth weight and living in the inner city, which increases exposure to many environmental pollutants, or triggers.

For older adults, respiratory allergies are not the major factor in asthma but exposure to any irritant, from viruses, cigarette smoke, cold air and even emotional stress, can trigger asthma.

In most cases, asthma is the combination of allergic and nonallergic responses. Some common triggers are:

* allergens such as pollen, cockroaches, mold and dust;

* exercise or physical exertion;

* exposure to smoke, animal dander;

* cold air;

* respiratory infections, including the common cold.

The second of three articles on asthma will appear next week. The author, a pediatrician based in Sanur, Bali, can be reached at dr.donya@hotmail.com or features@thejakartapost.com.