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Bronchial asthma is by definition a reversible obstructive airway disease. It is aggravated by seasonal factors, especially winter although it is not uncommon for some to get it more in summer. Some are caused by inhalants, smoking, pollen, pungent smells like pain and toxins. On exposure to these allergens, patients develop severe Bronchospasm that presents as wheeze which can be made out by difficulty in breathing, dry cough, chest pain that responds well to treatment.

Acceptance of Asthma

For a layman, asthma is a fearful term. He can accept any diagnosis other than asthma. Terms like Bronchitis, Eosinophilia, allergy, sinusitis are equally deliberating yet asthma is still not accepted. Acceptance of the disease reduces worry. This is more so in children. There is a general myth that childhood asthmatics get cured by 12 years or when they are mature. The reality is that they go into a phase of remission around that age. They do not develop serious problems during that period. But on further investigation with bronchial provocation they will test positive. This clearly proves that asthma is an inherited disease and that this cannot be cured but only controlled. There are a lot of alternative or complementary medications available for this disease. A lot of people take advantage of this lack of knowledge about treatment and dissuade people from using mainline medications like inhalers. If patients do not use inhalers, they tend to develop serious acute asthma attacks and hospitalisations that result in increased costs.

Symptoms and Causes

The symptoms of asthma are chest tightness, dry cough, breathlessness and occasional gastric symptoms. They have a coexisting illness like rhinitis and sinusitis and in some cases skin allergies. It is more often on exposure to dust or some food items like citric foods – lemon, tomato oranges, grapes etc. some develop more often in winter. Atmospheric pollution and industrialisation are one of the most important factors for increased incidence of asthma. Most of the independent houses with huge gardens are converted into apartment complexes and gated communities. This results in increasing pollution in the residence itself as the parking lot of the flats and gated apartments become a big source of petrol fumes and outdoor pollution. Exposure to smoking during pregnancy increases childhood asthma and so does junk foods. Increasing westernisation, urbanisation has significantly contributed to increased incidence of asthma in our country.

Treatment

Treatment for asthma is divided into two categories. One is to give symptomatic relief. Second is to address the inflammation in the airways. First is achieved by inhaler medications like asthalin or terbutaline. There are also deriphylin group of drugs that can be given orally to achieve symptom relief. But the first and preferred treatment is to start inhalers. This is an accepted mode of treatment that is recognised internationally and by GINA, an organisation that forms guidelines for the management of asthma. Steroid inhalers reduce inflammation. They have to be used on a long-term basis to get proper control of asthma and also to prevent recurrent admissions and thereby reduce the cost of the treatment to the individual and the society.

There is a lot of resistance to using inhalers among children and old people. Many people think that they should use inhalers only in severe attacks. Some feel that it weakens the heart. Some feel that it has an addiction potential. The truth is inhalers are safe, to be used regularly and does not weaken the heart. Steroid inhalers are the safest and prevent frequent attacks and also optimise the airways. By not using inhalers regularly, they go on to develop fixed airway abnormalities and proceed on to COPD, a more serious disease. Steroid inhalers can occasionally cause a hoarse voice and oral fungal infections that can be eminently controlled by gargling with warm water with salt or listerine solution. Last decade has seen a steady increase in the use of inhalers which is reflected in the hospital statistics showing a gradual decline in acute asthma admissions.

Bronchial Thermoplasty

There are some unfortunate asthmatic patients who do not respond to treatment despite being regular. They constitute about 5% of the total asthmatic population. They are the group of people who resort to alternate medications and deteriorate in health and develop complications like COPD.

There has been a research on how to handle this group of patients. Some patients have very high levels of IgE indicative of atopy. This can be effectively treated by giving anti-IgE antibodies. This is an injectable method of treatment that ranges from 6 to 12 months. With the intensity and frequency of attacks comes down. The latest in these efforts is the development of a modality called Bronchial Thermoplasty.

This is based on the fact that Asthma causes severe smooth muscle hypertrophy leading to severe bronchospasm resulting in wheeze that does not get controlled or remains symptomatic. This in turn leads to severe wheezing necessitating frequent doctor visits and admissions.

Bronchial Thermoplasty generates heat through catheter and burns the smooth muscle in the Bronchi. This is done through a Bronchoscope in three sittings in three months. The results across the world are more than satisfactory and approved in many countries. Apollo hospitals, Chennai has brought this equipment to the Department of Respiratory Medicine.

Bronchial Thermoplasty reduces the severity, intensity, need for frequent admissions and steroid dependency. Thus, it makes the procedure a very useful therapeutic tool for severe asthmatic patients who are desperate and looking for alternate methods of treatment. This is a scientifically proven therapeutic method and there are scientific publications to prove its utility. This is a great boon for severe asthmatic patients.

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