Definition

Asthma is a reversible (temporary) respiratory disorder caused by chronic airway inflammation. This chronic inflammation leads to airway narrowing, making it difficult for individuals with asthma to exhale. The narrowing of the airways also causes several typical asthma symptoms, including wheezing (high-frequency breathing sounds often called "wheezing"), coughing, and a feeling of tightness in the chest.

Asthma is a fairly common condition. The Basic Health Research of 2013 showed the prevalence of asthma in all ages in Indonesia to be 4.5%. Other studies using the ISAAC questionnaire indicated that the prevalence of asthma in children aged 6–7 years in Indonesia reached 3–8%, and in those aged 13–14 years, it was around 2.6–24.4%. Approximately 63.1% of diagnosed asthma patients experience asthma attacks.

Although asthma cannot be cured, its symptoms can be controlled to prevent disruption of daily life. Asthma symptoms may also change over time, so it's essential to consult your doctor for therapy adjustments.

Causes

Asthma is caused by chronic airway inflammation, involving a complex interaction between the cells composing the airway walls and inflammatory mediator cells, which initiate inflammation. Inflammation can be triggered by various factors, including household dust, pets, respiratory infections caused by viruses, physical activity, cold air, air pollution, cigarette smoke, certain medications (such as beta-blockers, aspirin, NSAIDs), emotions, and GERD (gastroesophageal reflux disease).

Exposure of the airways to these irritants triggers inflammation, leading to:

• Bronchoconstriction is the narrowing of the airways due to muscle contraction around them. This narrowing is reversible (temporary) and can improve spontaneously or spontaneously with bronchodilator drugs (to widen the airways).
• Excessive mucus production
• Swelling of the airway walls
• Thickening of the airway walls due to airway remodeling. If asthma persists without treatment, bronchoconstriction can become persistent and unresponsive to bronchodilator drugs.

Risk factor

Factors that can increase the risk of developing asthma include:

• Having a family history of asthma, such as parents or siblings.
• Having other allergies, such as atopic dermatitis or allergic rhinitis.
• Being overweight.
• Active or passive smoking.
• Exposure to irritants, such as strong odors and pollution.
• Exposure to occupational irritants, such as chemicals used in agriculture, working in salons, or the textile industry.

Symptoms

Symptoms of asthma vary from person to person. Some individuals only experience asthma attacks under certain conditions, such as during exercise or when experiencing strong emotions. Others may experience asthma symptoms throughout the day, disrupting their sleep.

Symptoms of asthma include:

• Shortness of breath and difficulty breathing.
• Chest pain or chest tightness.
• Wheezing sound when exhaling is the most common sign of asthma, often found in children.
• Difficulty breathing due to shortness of breath, coughing, or wheezing.
• Exacerbation of coughing or wheezing during upper respiratory tract infections

Signs of worsening asthma include:

• Asthma symptoms occur more frequently and disrupt daily activities.
• Increasing difficulty breathing, objectively measured by lung function tests.
• Increasing use of reliever medications.

For some individuals, asthma symptoms worsen in specific environments, such as cold and dry air, irritants (strong odors, gasses, or dust), and allergens (pollen, household dust, or animal dander).

Diagnosis

The doctor will diagnose asthma based on the symptoms you experience, physical examination, and additional tests. The doctor will inquire about your family history, how often you experience asthma symptoms, your history of asthma attacks, hospitalizations, and current medications. It's essential to differentiate asthma from other diseases, such as Chronic Obstructive Pulmonary Disease (COPD), respiratory infections, and bronchiectasis.

There are several supplementary methods to establish the diagnosis of asthma, including:

• Spirometry: Spirometry is a lung function test used to estimate the diameter of your airways. It involves measuring the volume of air you can exhale in one minute after taking a deep breath. This test can also be performed using a bronchodilator to differentiate asthma from COPD. If the spirometry results improve after using a bronchodilator, it indicates the reversible nature characteristic of asthma.
• Peak Expiratory Flow (PEF): PEF determines the reversibility and variability of breathing. This test is easier to perform than spirometry and is generally done in the emergency department.

Based on the symptoms and additional tests, the doctor will classify asthma based on the level of control and how often symptoms occur. The categories used include:

• Intermittent: asthma symptoms occur <1 time per week, nighttime symptoms occur ≤2 times/month, and lung function test results are ≥80% predicted.
• Mild persistent: asthma symptoms occur >1 time/week but <1 time/day, experiencing asthma attacks that disturb sleep, nighttime symptoms >2 times/month, and lung function test results are ≥80% predicted.
• Moderate persistent: asthma symptoms occur every day, experiencing asthma attacks that disturb sleep, needing to use reliever medication every day, nighttime symptoms >1 time/week, and lung function test results are 60–80% predicted.
• Severe persistent: asthma symptoms occur every day, asthma symptoms limit physical activity, nighttime symptoms are frequently experienced, and lung function test results are <60% predicted.

This classification aims to determine the asthma treatment plan.

Management

There are three types of treatments used to manage asthma symptoms:

• Reliever medications: These medications are used to alleviate acute symptoms or asthma attacks. They can also be used to manage exercise-induced asthma attacks. Examples of medications in this group include inhaled corticosteroids, oral corticosteroids, and leukotriene modifiers.
• Controller medications: These medications aim to control the inflammation in the airways. By reducing this inflammation, asthma symptoms and the risk of asthma attacks are also reduced. These medications include albuterol, formoterol, SABA (Short-Acting Beta Agonist), and ipratropium.
• Add-on medications: These are given to patients with persistent symptoms even after using high-dose reliever medications.

The doctor will prescribe medications based on the classification of asthma you experience. The treatment regimen will change based on the response and symptoms.

Complications

Complications of asthma include:

• Disruption of daily activities (school, work) and sleep quality.
• Frequent absence from school or work during asthma attacks.
• Permanent narrowing of the airways affecting breathing.
• Hospitalization due to severe asthma attacks.
• Side effects from long-term use of asthma medications.
• Life-threatening asthma attacks.

Prevention

Asthma can be prevented by knowing your allergies and avoiding triggers. Additionally, to prevent worsening asthma, you need to do the following:

• Follow the treatment plan prescribed by your doctor. Your doctor will provide a treatment regimen to control symptoms and reduce asthma attacks. You need to adhere to this plan diligently. Also, regularly visit your doctor, as adjustments may be required based on your symptoms.
• Influenza and pneumonia vaccination. Vaccination against respiratory infections can help prevent asthma attacks triggered by such infections.
• Recognize asthma attack symptoms. By recognizing asthma attack symptoms, you can act quickly to prevent exacerbation.
• Monitor your medication use. If you find yourself using reliever medications more frequently, consult your doctor. This may be an early sign of worsening asthma.
• Control your weight. Being overweight is one of the risk factors for asthma.
• Regularly clean your home to avoid household dust.
• Maintain indoor air humidity.
• Engage in regular physical activity.
• Prevent GERD by avoiding foods that cause acid reflux.

When to see a doctor?

Asthma attacks can be life-threatening. Seek immediate medical attention if you experience:

• Sudden shortness of breath
• Shortness of breath not relieved by reliever medication
• Feeling breathless after light activity

Additionally, see your doctor if you experience the above asthma symptoms. Your doctor will provide a treatment plan and symptom monitoring guidance to prevent the worsening of your condition.