What is asthma?

Asthma is a chronic lung disease that can affect people of all ages. There is no cure for asthma, but there are ways to manage and control asthma in order to minimize its impact on the quality of life of those affected.

Asthma is well characterized in the lungs by the presence of the following signs that may appear in response to those factors mentioned below or may worsen due to these same factors:

1. Inflammation: the lining of the respiratory tract becomes red and swollen; there is also an accumulation of mucus. This interferes with the circulation of air within the respiratory passages. Inflammation can also lead to bronchoconstriction.
2. Bronchoconstriction: the muscles that surround the respiratory tract contract and also interfere with the circulation of air within the respiratory passages.

Triggering or aggravating factors

Asthma is often triggered or aggravated by different factors, such as:

1. Allergies, and exposure to allergens: it is therefore important to identify the problematic allergens in someone suffering from asthma, since it is essential to enact environmental measures, and in turn, maintain control of one's asthma. It is also important to adequately treat the manifestations of allergic rhinitis, since this is a condition directly related to asthma.
2. Viral or bacterial infections of the respiratory tract
3. Atmospheric pollution
4. Second-hand smoke
5. Tobacco addiction
6. Cold
7. Exercise
8. Diverse respiratory irritants (strong odors: perfumes, molds; smoke from wood stoves and fireplaces)
9. Substances found in the workplace that may act as allergens (ex: animals, food) or as irritants (ex: paint, dust)
10. Elevated levels of humidity
11. Stress and strong emotions
12. Certain foods (example: sulfites)
13. Certain medications (example: aspirin)

Signs and symptoms of asthma

There are many signs and symptoms of asthma, and many of these may also be caused by diseases other than asthma. It is therefore important to consult your physician if you present with these symptoms and have never been investigated previously. Here are the most common signs and symptoms:

1. Cough
2. Wheezing
3. Chest tightness
4. Shortness of breath
5. Retractions of the rib cage

The symptoms may occur daily or less frequently. They may range from mild to severe.

Why are certain people more at risk for asthma?

When a family member suffers from an atopic condition (eczema, asthma, and allergic rhinitis), you have a higher risk of suffering from one of these conditions yourself. In addition, if you are already suffering from an atopic condition such as eczema or food or environmental allergies, you have a much higher risk of developing asthma.

How do you diagnose asthma?

When someone presents with the signs or symptoms suggestive of asthma, and if the diagnosis remains uncertain, it can be confirmed by means of different respiratory tests. These may be ordered by your physician if he or she suspects the diagnosis. In general, these types of tests are generally performed above the age of 6 years. In children younger than 6, asthma is often diagnosed depending on the presenting symptoms and the elimination of other problems that may cause similar signs and symptoms. It is difficult to predict if asthma in a young child will persist over the long term.

How do you treat asthma?

1. Environmental measures:
1. Avoid tobacco and all forms of second-hand smoke.
2. Recognize the allergens that may cause problems (examples: cats, dogs, dust mites) and put in place measures to avoid exposure to these allergens.
3. Avoid exposure to irritants (smoke from wood stoves and fireplaces).
4. Maintain a humidity level between 40 and 45 %.
2. Medications:
1. The treatment of asthma with medication is done in stages: usually a baseline treatment is recommended, and additional medications may be suggested by your physician if control is found to be inadequate.
2. Discuss with your doctor a plan of action to follow to ensure good control of your asthma. It is preferable to have a clearly written action plan which specifies treatment when you are well, and when you are unwell. The plan should also tell you when you need to go the emergency room.
3. Different medications can be used for asthma. The type of treatment depends on the severity of the asthma, the frequency of symptoms, and the age of the patient.
4. Most of the time, treatment involves the regular use of an inhaled anti-inflammatory medication (pump/inhaler) in order to treat the ongoing inflammatory process.
5. Most patients will also be prescribed a bronchodilator medication which relaxes the bronchial muscles and allows patients to breathe more comfortably. This type of treatment eases the symptoms of asthma, but has no effect on the inflammatory process that is the main cause of the problem.
6. Other medications exist that may be added if the asthma is inadequately controlled.
3. Immunotherapy may be indicated in certain cases of allergic asthma.

How do I know if my asthma is well controlled?

Here is a quick questionnaire that tells you if your asthma is under control:

1. Do you have a cough, wheezing, or chest tightness due to your asthma 4 days or more every week?
2. Does one or many of these same symptoms wake you during the night one or more times per week?
3. Have you had to stop yourself from exercising within the last 3 months because of asthma symptoms?
4. Have you been absent from work or school within the last 3 months because of asthma?
5. Do you use a bronchodilator (blue inhaler/pump) 4 or more times per week?

If you answered YES to one of these questions, it is preferable to see your doctor in order to find a means of improving the situation.

It is also important to ensure that your technique for using your inhalers is adequate. There are several "Centres d'enseignement de l'asthme au Québec" (Asthma teaching centres) that can go over your treatment of asthma with you and that can review your technique for using your inhalers. Inquire at your local CLSC.

See also: Mon enfant asthmatique peut-il retourner à l’école ou en milieu de garde?
Recommendations in the context of COVID-19 (fr).

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Simon Hotte, MD FRCPC
(translation Andrew Moore, MD FRCPC)