The Call-On-Doc Guide to Asthma

When it comes to discussing asthma symptoms, it is crucial to understand that the symptoms felt externally are caused mainly by what's going on internally.  

According to Asthma: Pathophysiology and Diagnosis, asthma is primarily related to issues with the lungs, such as:

• Airway inflammation: Asthma causes airway inflammation in the lungs as a result of the body's immune response to triggers such as allergens, irritants, or respiratory infections. This immune response causes the airways to become inflamed, leading to the narrowing of the airways and making it harder to breathe.
• Airway hyperresponsiveness: Airway hyperresponsiveness in asthma is caused by a complex interaction of immune cells, signaling molecules, and structural changes in the airways. When exposed to triggers such as allergens, irritants, or respiratory infections, the immune system in the airways releases various substances such as histamine, leukotrienes, and cytokines. These substances cause the smooth muscle surrounding the airways to contract, the airway walls to swell and produce mucus, and nerve endings in the airways to become more sensitive. 
• Mucous hypersecretion: The airways in the lungs secrete more mucus in asthma as part of the body's immune response to triggers such as allergens, irritants, or respiratory infections. Inflammation in the airways causes the lining of the airways to produce more mucus-secreting cells, called goblet cells, and also stimulates the submucosal glands in the airway walls to produce more mucus. The increased production of mucus, combined with inflammation and narrowing of the airways, leads to congestion and further obstruction of the airways, making it harder to breathe. 

On top of having more sensitive lungs or bronchoconstriction, those with asthma will be more reactive to external stimuli. As per the Asthma and Allergy Foundation of America, this isn’t necessarily isolated to asthma attacks or episodes but rather can occur regularly in a person’s daily life depending on their individual case in small to larger episodes. In instances where asthma symptoms are regularly felt, they can include:  

• Difficulty with physical labor/exercise: Due to the airways naturally being more restricted and sensitive, an increase in airflow will have a constant chance of irritating a person’s bronchial tubes or bronchi. 
• Exhaustion: While not present in all cases, some with asthma will be prone to getting fatigued more frequently due to the sensitivity of a person’s lungs. This does not necessarily mean they are having an asthma attack but that the condition might be contributing to an enhanced reaction to allergens. 
• Persistent coughs: Coughing normally is an indication of your body trying to get something out or in response to irritation. Those suffering from asthma may experience more frequent episodes of coughing due to the sensitivity of their lungs due to the condition. 
• Shortness of breath: When the airways remain tight, asthmatic people will sometimes struggle to breathe and find it difficult to do anything more than take shallow breaths. 
• Wheezing or whistling when breathing: The sound is produced by the vibration of the walls of the air passages as air moves through them, and can be heard when breathing in or out. In many cases, this can indicate an asthma attack or poorly managed asthma. 

Feeling these symptoms normally, patients with asthma vary in severity, with some not experiencing symptoms at all and others being restricted by them. However, the majority of cases with asthma are prone to asthma attacks. According to Asthma Basics by Children’s Healthcare of Atlanta, an asthma attack is most commonly defined by the airways becoming inflamed, swollen, and further narrowed. In some instances, an attack can build up in severity, while others can happen instantly. Symptoms of an asthma attack can be psychological as well as physical and can include some or all of the following:

• Anxiety or panic: A person may experience anxiety or panic during an asthma attack because the difficulty breathing and chest tightness can be extremely distressing and uncomfortable. This can trigger a natural fear response. Additionally, the hypoxia (low oxygen) that can occur during a severe asthma attack can affect the brain and cause symptoms such as confusion, dizziness, and agitation, which can also contribute to feelings of anxiety or panic.
• Chest pain: Chest pain during an asthma attack can occur because the inflammation and narrowing of the airways in the lungs make it more difficult for air to flow in and out of the lungs, causing increased pressure in the chest. This can result in a feeling of tightness, discomfort, or pain in the chest. Additionally, the increased effort required to breathe during an asthma attack can cause strain on the muscles and tissues in the chest, which can also contribute to the feeling.
• Coughing fits: As mentioned, coughing is the body’s way to clear up its airways or is a natural response to irritation. With the bronchial tubes tightening and producing more mucus, the body aggressively coughs to clear up the thick fluid. 
• Discoloration: In more severe cases, an asthma attack can restrict oxygen circulation to the point where parts of the body get a lack of oxygen. When the body is not receiving enough oxygen, it can cause a bluish discoloration, known as cyanosis, which is most noticeable in the lips, tongue, and fingertips. This is because these areas have a thinner layer of skin and are more sensitive to changes in oxygen levels. In severe cases of hypoxia, cyanosis can spread to other parts of the body.
• Extreme and sudden fatigue: In instances of an asthma attack, the body will receive less oxygen and be far less capable of physically moving or acting in any way considered productive. 

Instances of asthma are dependent on multiple factors in a person; however, the condition is not entirely understood in this regard. Allergies, genetics, and how your body responds to external stimuli all play a role in the severity of your asthma. However, gender also plays a role in your asthma symptoms throughout your life. 

As of now, it is not clear why there is a gendered difference when it comes to asthmatic patients. However, we do know the prevalence of asthma is higher in boys than in girls during childhood, but this trend tends to reverse after puberty, with females having a higher prevalence of asthma than males. 

According to “Mechanisms Driving Gender Differences in Asthma,” the disparity has to do with sex hormones or, more specifically, testosterone and 5-alpha dihydrotestosterone versus estrogen and progesterone. As boys progress to men, cases of even severe asthma are more likely to become much more manageable if not unnoticeable, while the opposite is true for when girls progress to women. 

Additionally, 30%-40% of women report experiencing harsher asthma symptoms during their menstrual cycles. Interestingly enough, that is not the case for women who are expecting, with many reporting a decrease in asthma symptoms while they're pregnant 

According to the American Lung Association, the causes of asthma are still unknown. However, what is known is that your family history and how your body reacts to allergies play a huge role. 

With many cases of asthma developing in adulthood, also known as adult-onset or late-onset asthma, it has been identified that these patients suffer more from asthma symptoms. Being overweight or obese, smoking or vaping, having allergies, and regularly being in an environment with irritating stimuli all play a role in asthma developing later on. 

According to the National Heart, Lung, and Blood Institute, asthma triggers share similarities to what causes a person’s allergies to flare up. Asthma triggers are substances or environmental factors that can worsen or trigger asthma symptoms in susceptible individuals. Common asthma triggers include allergens such as:

• Pollen 
• Dust 
• Mold
• Animal dander
• Smoke 
• Pollution
• Strong odors
• Respiratory infections
• Physical activity
• Weather changes
• Stress
• Certain medications

Identifying and avoiding asthma triggers can help reduce the frequency and severity of asthma symptoms, and may be an important part of an individual's asthma management plan.

Scientists are not exactly sure why asthma is worse during sleep, but a potential cause may be associated with the circadian sleep cycle. According to WebMD, the body naturally releases hormones that decide how a person sleeps, which may cause a reaction in an asthmatic patient's lungs. 

Similarly, people often underestimate the accumulation of dust in their vents, carpets, and beds. Those sensitive to dust will notice their allergies reacting to the dust and will then notice their asthma being more severe. Additionally, another indication that a person is reacting to environmental factors is the increase in mucus production, which will cause coughing and a noticeable need for drainage. 

To stop asthma triggers at night, it is important to first identify what triggers are causing the symptoms. As mentioned, common triggers at night include dust mites, pet dander, mold, and pollen. To reduce exposure to these triggers, take steps by: 

• Getting allergy-proof bedding
• Washing bedding in hot water weekly 
• Vacuuming carpets and furniture regularly
• Keeping windows and doors closed at night
• Replacing old or dirty HVAC air filters

Additionally, avoid eating heavy meals before bedtime, as this can exacerbate asthma symptoms due to the possibility of acid reflux or indigestion. Either condition can initiate or exacerbate asthma symptoms, possibly due to the nerve reflex being affected.

It may also be helpful to take any prescribed asthma medications before bedtime as directed by a healthcare provider. Call-On-Doc offers multiple options around the clock for those needing a prescription refill and asthma treatment so you or a loved one will never be without your needed medication. 

According to the Asthma and Allergy Foundation of America, asthma is diagnosed through a combination of medical history, physical exam, and lung function tests. A healthcare provider will often ask about symptoms, such as coughing, wheezing, and shortness of breath, and may perform a physical exam to listen to the lungs. Lung function tests, such as spirometry, can also help diagnose asthma by measuring how much air a person can exhale and how quickly they can do so. In some cases, additional tests such as allergy tests or chest X-rays may be used to rule out other conditions. 

To understand what type of asthma you have, it might be helpful to understand the different types of asthma that there are. According to the American College of Allergy, Asthma, & Immunology, there are seven:

• Adult-Onset Asthma: Adult-onset asthma is defined as asthma that develops in adults who have never had asthma before or as asthma that returns after a long period of remission. It is typically diagnosed in people over the age of 20 and is often associated with exposure to environmental triggers or irritants.
• Allergic Asthma: Allergic asthma is a type of asthma that is triggered by exposure to allergens, such as pollen, dust mites, or animal dander. Symptoms such as coughing, shortness of breath, and wheezing are more common with this asthma. 
• Asthma-COPD Overlap: Asthma-COPD overlap refers to a condition where individuals experience features of both asthma and chronic obstructive pulmonary disease (COPD), leading to increased symptoms, exacerbations, and impaired lung function. It is a complex and not entirely understood condition that requires careful evaluation and management.
• Exercise-induced Asthma: Exercise-induced asthma is a type of asthma that is triggered by physical activity or exercise. It causes difficulty breathing, chest tightness, wheezing, and other asthma symptoms during or shortly after exercise.
• Non-Allergic Asthma: Non-allergic asthma is a type of asthma triggered by factors other than allergens. It can be caused by irritants in the air, such as pollution, smoke, or strong odors, or by other factors like exercise, stress, or cold air.
• Occupational Asthma: Occupational asthma is a type of asthma that is caused by exposure to certain substances in the workplace. It can be caused by a wide range of substances, including chemicals, dust, and fumes.
• Pediatric Asthma: Pediatric asthma is a type of asthma that occurs in children and is characterized by wheezing, coughing, shortness of breath, and chest tightness. It can be triggered by allergens, irritants, infections, and exercise.

According to the University of Pittsburg Medical Center, there are four stages of asthma. The stages are based on the frequency and severity of asthma symptoms, lung function, and the frequency of asthma attacks. 

• Mild intermittent asthma 
• Mild persistent asthma
• Moderate persistent asthma
• Severe persistent asthma

According to WebMD, the best treatment for asthma varies depending on the severity of the condition but generally involves a combination of medications, such as albuterol, levalbuterol, singulair, and more. In addition to treatment, lifestyle changes such as quitting smoking or maintaining a healthy weight as well as avoiding triggers can help maintain and lessen the severity. It is important for individuals with asthma to work with a healthcare professional to develop a personalized treatment plan.

There are several methods to get quick relief from asthma, though most often, quick relief only coincides with mild to medium symptoms. According to WebMD and Insider, some of the most effective are: 

• Breathing exercises: Breathing exercises help manage asthma by improving lung function, reducing stress, and promoting relaxation, which can help prevent and manage asthma symptoms. Additionally, proper breathing techniques can improve the delivery of medication to the lungs, making them more effective.
• Coffee or tea: Coffee and tea contain caffeine, which is a natural bronchodilator that can help relax the airway muscles and improve breathing in people with asthma. However, it is not a substitute for asthma medication prescribed by a doctor.
• Exercise: While it might seem counterproductive in this instance, exercise can help improve lung function and reduce inflammation in the airways, which can help manage asthma symptoms. It can also improve overall fitness and cardiovascular health, which can reduce the risk of asthma attacks.
• Garlic and ginger: Garlic and ginger are natural anti-inflammatory agents that can help reduce inflammation in the airways. They may also help to relax the muscles around the airways, making it easier to breathe.
• Steam rooms: Steam rooms may help with asthma by moisturizing and opening the airways, making it easier to breathe.
• Sunshine: Getting enough sunshine can help with asthma by boosting vitamin D levels in the body, which has been shown to improve lung function and reduce asthma symptoms. However, it is important to note that excessive sun exposure can also trigger asthma symptoms in some people.
• Weight management: Managing weight helps with asthma by reducing the severity of asthma symptoms, as obesity is known to worsen asthma symptoms. Additionally, weight management can help improve lung function and reduce inflammation in the airways.

If asthma goes untreated, it can lead to ongoing inflammation in the airways, which can cause irreversible damage to the lungs over time. This can result in a decline in lung function, increased risk of respiratory infections, and potentially life-threatening asthma attacks.