Asthma means panting. It is a chronic inflammatory disease of
the air ways characterized by variable and recurring symptoms, reversible
airflow obstruction, and broncho-spasm. Wheezing, tightness in chest,
shortness of breath and cough are common symptoms of asthma. Asthma is classified
according to the frequency of symptoms, forced expiratory volume in 1 second
(FEV1 more than 80% mild, 60-80% moderate and less than 60% severe asthma) and
peak expiratory flow rate. Asthma is also classified as atopic (extrinsic) or
non-atopic (intrinsic).
Sign and symptoms - Recurrent episodes of wheezing,
shortness of breath, chest tightness and coughing characterize asthma. These
symptoms are often worse at night and in the early morning, from cold air and
physical exertion. These symptoms usually occur due to some triggering factors.
Symptoms may come as an acute attack or may persist continuously.
Rhino-sinusitis, sudden loss of breath during sleep (sleep apnea),
some psychological conditions and gastro-esophageal reflux disease (GERD) may
be associated with asthma.
Causes – Asthma is affected by many
factors. Allergic asthma is basically associated with sensitivity to allergens.
In a child tobacco smoking by mother during pregnancy and after delivery causes
risk to asthma. Pollution in air is responsible for occurrence and exacerbations.
Western style of housing causes more exposure to indoor allergens as dust
mites, cockroaches, animal dander and molds which are thought to be primary
cause of asthma. Studies show that exposure to cat and dog allergens during the
first year of life reduce risk to allergic sensitization and developing asthma.
Volatile organic compounds, formaldehyde, phthalates in PVC trigger asthma.
Viral respiratory infection is one of the leading trigger factors.
Mental stress modulates the immune system to increase the
inflammatory response of air tubes to allergens.
One theory termed as hygiene hypothesis is that there is a link
between asthma and degree of affluence. Modern society and modern hygienic
practices prevent childhood infections of wide variety of bacteria and viruses.
Lack of exposure to wide variety of the environmental factor in child hood
increases sensitivity of susceptible individuals who develop asthma in later
life. Children living in less hygienic environment have been found to have
lower incidences of asthma and allergic diseases. This is counter to the logic
that viruses are often causative to exacerbation of asthma. Some other studies
show that upper respiratory infections are protective against asthma while
lower respiratory infections tend to increase risk of asthma.
Antibiotics used in early life modify gut flora and immune system,
affecting negatively to beneficial bacteria and other immune system modulators
during development and cause increased allergy and asthma.
Caesarean section deliveries increase risk of asthma which is
attributed to the lack of healthy bacterial colonization in the new born which
results from passage through the birth canal.
One genetic study concluded that more than 100 genes were found to
be associated with asthma.
Eczema, atopic diseases and hay fever are related with asthma.
Obesity and factors related to obesity increase risk of non-eosinophilic
asthma. Deposits of fat in body leads to pro-inflammatory state beside the
adipose tissue depress respiratory function.
Asthma has been also associated with Churg-Strauss syndrome
(medium and small vessels inflammation – autoimmune vasculitis), may begin as
asthma. The person suffers from generalized urticaria, oro-pharyngeal and
gastro intestinal symptoms, rhino-conjunctivitis and asthma.
Different individuals respond differently to different factors
causing asthma. An acute attack may precipitate involving several triggering
factors. Sometimes asthma remains stable for several months.
Diagnosis – Diagnosis of asthma is made on
the basis of symptom pattern, spirometry and its response to therapy. There is
no diagnostic physiological, histological or immunological test for asthma.
Recurrent episodes of wheezing, breathlessness, chest tightness and cough worse
at night or in early morning signify asthma. Its reversibility excludes it from
the group of chronic obstructive pulmonary disease which includes chronic
bronchitis, emphysema (where alveoli are affected) and bronchiectasis.
Untreated asthma can lead to a state of irreversibility.
Deepened throat pit (due to use of accessory respiratory muscles),
over inflated chest, paradoxical pulse that is a pulse weaker during inhalation
and stronger during exhalation, in severe cases blueness of skin and nails due
to lack of oxygen are some of the diagnostic signs.
Status asthmaticus is a state where asthma does not responds to
standard treatment of bronchodilators and steroids. The nonselective
betablockers cause fatal status asthmaticus.
A sports person (cycling, running long distances, mountain biking
and also diving and weightlifting) may have exercise induced asthma. Exposure
to certain raw material and products can cause occupational asthma in sensitive
workers.
Differential diagnosis – There are many condition need
to be ruled out. It is important to assess the level of obstruction in the
respiratory tract.
In children and infant allergic rhinitis and sinusitis, foreign
body in trachea or bronchus, dysfuntioning vocal cord, tracheal stenosis,
laryngotracheomalacia or some growth should be ruled out. Also some infection,
broncho-pulmonary dysplasia, heart disease, aspiration or effect of some
medication should be ruled out.
In adult chronic bronchitis or emphysema, pulmonary embolism,
congestive heart failure, eosinophilia, some obstructive growth and medicinal
effect should be ruled out.
In elderly person breathlessness, cough and fatigue are the
symptom which some time are attributed to other disease and asthma may go
undiagnosed. It is important that a chronic obstructive pulmonary disease can
exist with asthma or may appear as a result of chronic asthma.
Prevention – Asthma being multi-factorial
disease is difficult to prevent except avoiding of the known allergen or
triggering factor and conditions.
Management and treatment – Conventional system of medicine accepts
that there is no cure for asthma but symptoms can be improved. Homoeopathy has
recorded many cures of asthma because homoeopathy treats the man in disease and
not disease in man.
Asthma is a problem of hypersensitivity or reaction out of
proportion. It is said to be multi-miasmatic condition but generally one miasm
is prominent at a time. Any abnormal tendency of body and mind (the
constitution) cannot be cured without treating the miasmatic state. Without
treating on homoeopathic principles even a homoeopathic medicine may fail to
relieve or cure. Relief should be accounted only when patient’s stamina and
working capacity improves otherwise symptoms may recur repeatedly.
It is important to identify triggering or exciting and maintaining
cause and the patient should be advised accordingly. Life style modification is
required to avoid allergens, smoke (tobacco and other), pollution, dust
(mites), pets and certain medicines as non selective beta blockers and foods containing
suphite. In some urgency patient may take allopathic medicine but even inhaled
glucocorticoids have side effect, as can cause cataract. Indoor management and
oxygen to alleviate hypoxia may be required.
Alternative therapies as breathing exercises, air ionizer,
acupressure and acupuncture, osteopathy, chiropractic, physiotherapy could be
tried.
Master A. 10
yrs. male hindu student vegetarian
Diagnosis – Allergic Asthma.
The patient was suffering from respiratory difficulty since
last 6 years used to get worst attacks during rainy weather. Every time he was
treated with bronchodilators and omnacortil.
For last six months he was regular on broncho-dilators. He had difficulty
breathing worse at night, on lying on back, during sleep wakes often, in
morning and evening.
He has sneezing in morning on rising, in rainy and cold
weather and obstruction in nose with sensation of lump in it. Breathe with open
mouth. He feels pain in chest after running.
White spots on face.
He craves green pepper, fat and deep fried things, kheer,
sweets, milk and has aversion to vegetables and roti. Perspire on forehead,
upper lip, neck and chest. He is hot patient. He sleeps on back which is restless.
Dreams that he was caught by dinosaurs, he and his mom fought with it and killed
it. He has violent anger, stops eating. He has many friends. When asked what
was his problem the child narrated that he feels similar to the trouble his
mother had. When asked to explain the trouble he demonstrated how his mother
was breathing during an attack of asthma.
Has history of face eruption removed by some local
application December 2010. Mother has hypertension and difficult respiration.
Paternal grandfather was having chronic bronchitis.
He had dry skin and earthy complexion.
Height – 4’ 7”. Weight – 39 kg.
06/ 02/11 Rx 1. Plumbum met. 30
two doses at 10 minutes interval
2. S. L. 30 two pills thrice a day for
one month.
28/03/11- Patient’s respiration no more noisy during sleep.
No snoring. Feels respiration difficult as medicine was finished. Sneezing
aggravates morning, from dust.
Rx
1. Plumbum met. 30 two doses at 10 minutes interval
2. S. L. 30 two pills thrice a day for
one month.
24/04/11 Better.
Rx
1. Plumbum met. 30 two doses at 10 minutes interval
2. S. L. 30 two pills thrice a day for one month.
21/07/11 Patient remained trouble free after finishing the
medicines but feeling recurrence since five days. He aggravates from exertion.
Cough dry off and on. Weight 40 kg. Chest was clear though the patient was
complaining that he has same difficulty as mother used to have. The patient was
a pampered child. Having a single child the parents were paying excessive attention
and care to him. Patient’s demanding and attention seeking nature, and what she
needs to do was explained to mother.
Rx
1. Plumbum met. 30 two doses at 10 minutes interval
2. S. L. 30 two pills thrice a day for
one month.
Patient got no attack for last one year after the last
medicine.
Dr. M. K. Tyagi
Research Officer, Sewa Mandir.
Email: 1.sewamandir@usa.net, 2.manju_mkt2003@yahoo.co.in
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