Pulmonology

Pulmonology

Asthma is a pulmonary (lungs) condition in which your airways narrow and swell, resulting in production of extra mucus, making it difficult to breathe. Asthma can start off as being just a minor problem in some people, while in others; it can result in life-threatening Asthma attacks.

The airways are tubes that transmit air in and out of the lungs. Individuals who have asthma have engorged airways. The inflammation causes the airways to swell and makes it very sensitive. The airways have a tendency to respond strongly to certain inhaled substances.

When the airways react, the muscles around them stiffen. This shrinks the airways, causing lesser inflow of air into the lungs. As a result, all body cells suffer from lack of oxygen. The inflammation also can aggravate, causing the airways to narrow further. Reduction in diameter of airways causes a musical sound in the chest called ‘WHEEZE’.

Cells in the airways might create increased amount of mucus. Mucus is a sticky secretion that can additionally constrict the airway passage. The outcome of this chain reaction could be asthma and all the below mentioned symptoms can occur every time the airways are swollen.

Symptoms:

  • Wheeze
  • Cough
  • Phlegm
  • Breathlessness
  • Chest tightness

Other allergic symptoms:

  • Sneezing
  • Blocked or running nose
  • Sore Throat
  • Itchy skin with or without lesions
  • Itchy eyes

Diagnosis:

  • X -Ray Chest PA
  • X- Ray Para Nasal Sinus
  • CBC (Complete Blood Count)
  • Spirometry (PFT)
  • Allergic skin prick testing
  • Blood testing for allergy

Spirometry

It is a test to detect the functional capacity of the lung. The test involves blowing out forcibly and completely in a computerized system .The readings for lung volumes and flow rate are obtained. This can help in concluding whether it is an obstructive or a restrictive lung disease.

We can also check for reversibility by giving a bronchodilator medication by inhalation. The tests can be interpreted to decide probability of Asthma, COPD, Interstitial lung disease etc.

6 minute walk test

This gives an idea of the capacity of physical exertion of a person and whether the oxygen level in the blood falls after or during doing the test the test. It is a marker of exercise capacity and is often done in various chronic lung diseases and for fitness evaluation prior to surgery.

Diffusion Capacity Studies-DLCO

This is an advanced spirometry test used to assess the capability of lung to inhale oxygen and exhale carbon dioxide, by using tiny quantities of carbon monoxide as a surrogate marker. It is often done in case of chronic lung diseases to evaluate severity and progression and also to check smoking induced lung damage.

Allergic Skin Prick Testing

This involves testing for allergic reactions in the skin in form of a wheal, using tiny quantities of allergens. These could be insect allergen, food allergen, fungi or mould allergens, pollen or airborne allergen. The test is compared with controls of histamine and normal saline and the allergic tendency is estimated.

Blood testing for allergy

Phadiatop assays estimate the degree of allergy to various allergens using a blood test. Various panels like asthma panel, allergic rhinitis panels etc are available to test it. In case of severe asthma, the total serum and specific IGE levels are also checked by means of a blood test to estimate the type of asthma. Tailored treatments like omalizumab injections help in certain types of severe allergic asthma.

*Your Doctor may advise any or all of the above tests to confirm the diagnosis and severity of bronchial Asthma.

Treatment

Treatment for Asthma is given on a short term and a long terms basis.

Short term (quick relief) medication:
  • Short acting beta agonists – quick relief bronchodilators
  • Oral and intravenous corticosteroids
  • Allergy shots (if it is an allergy induced attack)

Long term medication:
  • Inhaling corticosteroids
  • Leukotriene modifiers
  • Long acting beta agonists
  • Combination inhalers
  • Theophylline
  • Omalizumab – a drug that acts by altering the immune system

Triggering Factors:

Triggers often bring on asthma attacks. A trigger is a substance or condition that causes inflammation in the airways, which then leads to asthma symptoms. Few of the triggers are:

  • Outdoor allergens, such as pollens from grass, trees and weeds
  • Indoor allergens, such as pet dander, dust mites and mold
  • Certain drugs and food additives
  • Irritants in the air, such as smoke, chemical fumes, cigarette smoke and strong odors
  • Colds, the flu or other illnesses
  • Respiratory Infections
  • Exercise (although people with asthma can benefit from some exercise)
  • Stress
  • Weather conditions, such as cold air or extremely dry, wet or windy weather
  • Medications like aspirin, beta-blockers, NSAIDS prescribed for BP, heart diseases, pains, etc.

Asthma can be well controlled with modern medications. It is possible to live a normal symptom free life with asthma. Please consult your doctor for specific & personalized treatment advice.