The Repurposing Life

About Upper Respiratory Conditions

The respiratory system plays a major role in exchanging gases in the body – it brings oxygen to the lungs and disposes of carbon dioxide (CO₂).  Upper respiratory conditions affect this mechanism.

With every breath, air enters the body via the mouth or nose and moves down towards the lungs through the airway. The airway leads to the chest, where it splits into two – the bronchiole. Each of the bronchiole split into smaller tubes until they reach the nodes in the lungs. If the bronchiole are blocked, less oxygen reaches the lungs, resulting in respiratory problems.

Chronic Bronchitis

Bronchitis is when the airways in your lungs, your bronchi, become inflamed. This irritation can cause severe coughing spells that bring up mucus, wheezing, chest pain and shortness of breath. There are two main types, acute and chronic.

Unlike acute bronchitis, which usually develops from a respiratory infection such as a cold and goes away in a week or two, chronic bronchitis is a more serious condition that develops over time. Symptoms may get better or worse, but they will never completely go away. These extended periods of inflammation cause sticky mucus to build up in the airways, leading to long-term breathing difficulties.

Along with emphysema, chronic bronchitis is one of the lung diseases that comprise Chronic Obstructive Pulmonary Disease (COPD). There are a number of treatments available to help control symptoms and ease breathing problems.

Key Facts about Chronic Bronchitis

• Chronic bronchitis is included in the umbrella term COPD. Your doctor may refer to your disease as either chronic bronchitis or COPD.
• Cigarette smoking is a major cause of chronic bronchitis. Other factors that increase your risk of developing this disease include exposure to air pollution as well as dust or toxic gases in the workplace or environment. It also occurs more frequently in individuals with a family history of bronchitis.
• To diagnose chronic bronchitis, your doctor will look for a cough (producing mucus) that lasts at least three months and happens multiple times over the course of at least two years. Tests used to diagnose chronic bronchitis include pulmonary function tests, chest X-rays or CT scans.
• Chronic bronchitis is not curable but there are a number of treatments that can help you manage your symptoms. These include bronchodilators that open your airways, steroids to reduce inflammation, oxygen therapy and pulmonary rehabilitation.

Asthma

Asthma is a chronic inflammatory disease of the airways. The disease manifests as recurrent attacks of wheezing, coughing and shortness of breath. 

During an asthma attack, the muscles surrounding the airways contract, limiting the amount of air supply to the lungs. The lack of sufficient air supply results in a choking sensation. Asthma attacks induce the secretion of sputum and mucus, which cause the airway to constrict even more, worsening the asthma attack. Classic asthma symptoms include difficulty breathing, constant coughing and wheezing.

Asthma is a chronic inflammatory disorder of the airways in which many cells play a role; in particular mast cells, eosinophils, and T-lymphocytes. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night and/or in the early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible, either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli.

The Mechanism Behind Asthma

Asthma is an overreaction to various stimuli. This overreaction can happen extremely quickly. The lining of the bronchiole has a number of glands which secrete mucus. The asthma attack causes three reactions: constriction of the airways, thickening of the inner lining and secretion of sputum into the airways.

Together, these three reactions block the airways, making it difficult to breathe and resulting in a shortness of breath. Children’s airways are smaller than adults, which makes their asthma attacks more severe. Asthma can’t be cured, but its symptoms can be controlled. Asthma is caused by a combination of complex environmental and genetic interactions. These factors influence both severity of the attack and response to treatment.

During an asthma attack the bronchiole contracts (bronchospasm) while the lining expands and fluids build up, further constricting the airway.  In many cases, the asthma attack occurs after exposure to stimuli. These stimuli are called allergens. Sometimes, the attack is the result of exercise or other agents that are not directly connected to an allergic reaction. Viral infections also cause asthma attacks.

When a person with asthma suffers from an asthma attack, the attack happens in two stages. During the first stage, the muscles surrounding the airways contract, and mast cells are released. Afterwards, the second stage of inflammation begins. A large number of inflamed cells build up in the airway and release substances which worsen the constriction of the surrounding muscle, cause a build-up of fluid in the lining of the bronchiole. The inflammation worsens over time and if left untreated, can become chronic and cause irreparable damage to the airways.

Asthma patients are usually treated for the acute symptoms which occur during an attack as well as medication to treat the inflammation.

Symptoms

Asthma signs and symptoms include:

• Shortness of breath
• Chest tightness or pain
• Wheezing when exhaling (a common sign of asthma in children)
• Trouble sleeping caused by shortness of breath, coughing or wheezing
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Incidence (Prevalence) of Asthma

Asthma is considered to be the most common chronic diseases among children, affecting around 8%-10% of the population. The incidence of the disease is constantly growing, especially among Western countries and urban areas. The incidence of the disease varies among different populations. Asthma is more prevalent among city kids than children who live in suburbs or small towns. It is more prevalent among Jews, and affects people of European descent more than people of African descent.

Half of the children diagnosed with asthma develop the disease by age 3 and most children with asthma have developed the disease by age 8.  

There are a number of factors which affect the incidence of asthma among children. These include smoking (children who live in the house with a smoker), environmental factors, genetics, gender (more common among boys), allergies, and repeated inflammation of the respiratory system. There is a growing trend of children diagnosed with asthma. This trend is due in part to an increasing awareness of the disease, and the growing use of air-conditioning, believed to be a factor in the development of the disease. 

Causes of Asthma Attacks

Most asthmatic children are sensitive to a number of attack-inducing agents. However, the attack is dependent on a person’s sensitivity level, and the intensity of the exposure.

• Smoking – do not smoke in an enclosed space (i.e. a house) with an asthmatic child.
• Occupational Exposure (exhaust fumes, pollution, fur, chemical fumes and gases used in farming, hairdressing, and manufacturing) – these materials can induce an asthma attack.
• Physical Exertion – an attack induced by physical exertion can be prevented with the proper medication (prior to the work-out or with the first sign of an oncoming attack).
• Different physical or mental states – stress, excitement, laughter
• Allergies —triggered by airborne substances (pollen, mold spores, cockroach waste), or pet dander (particles of skin and dried saliva shed by pets)
• Inhaling dry, cold air or drinking an extremely cold beverage
• Extreme weather changes
• Viral infections of the upper respiratory system
• Certain medications —including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve)
• Gastroesophageal reflux disease (GERD) —a condition in which stomach acids back up into your throat
• Having another allergic condition —such as atopic dermatitis, which causes red, itchy skin; or hay fever, which causes a runny nose, congestion and itchy eyes
• Certain food colorings and additives —Sulfites and preservatives added to some types of foods and beverages (shrimp, dried fruit, processed potatoes, beer, and wine)
• Being overweight

An asthma attack is a serious event that disrupts a person’s normal routine. The attack manifests with wheezing, coughing, and shortness of breath. The symptoms subside after administering medication. The coughs at the beginning of the attack are dry but later on are accompanied by mucus. Not every patient experiences all the symptoms.

Classification

Asthma is clinically classified into one of three categories:

• Intermittent Asthma – this is the most common manifestation of asthma, affecting 75% of all children who suffer from asthma. Intermittent Asthma is characterized by relatively light asthma attacks, episodic attacks, and relatively more time in between attacks (one in every six weeks). In between attacks, pulmonary function is normal.

• Moderate Persistent Asthma – This manifestation affects around 20% of asthmatic children. The asthma attacks are more frequent for these children than they are for children who suffer from intermittent asthma. Additionally, the symptoms manifest in between attacks and pulmonary function is frequently abnormal.  

• Severe Persistent Asthma – This type of classification affects about 5% of all children suffering from asthma. This type of asthma is characterized by severe and frequent asthma attacks, and the child continues to suffer from certain asthmatic symptoms between attacks (shortness of breath, wheezing). Pulmonary function is constantly abnormal.

Complications

Asthma complications include:

• Signs and symptoms that interfere with sleep, work and other activities
• Sick days from work or school during asthma flare-ups
• A permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe
• Emergency room visits and hospitalizations for severe asthma attacks
• Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Treatment consists of self-care and bronchodilators. Asthma can usually be managed with rescue inhalers to treat symptoms and controller inhalers that prevent symptoms. Severe cases may require longer-acting inhalers that keep the airways open, as well as oral steroids.

Prevention

Asthma is an ongoing condition that needs regular monitoring and treatment. While there’s no way to prevent asthma 100%, you can take steps on your own, and with your doctor design a step-by-step plan for living with and preventing attacks.

Identify and avoid asthma triggers. A number of outdoor allergens and irritants — ranging from pollen and mold to cold air and air pollution — can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.

Seek Emergency Treatment

Severe asthma attacks can be life-threatening. Signs of an asthma emergency include:

• Rapid worsening of shortness of breath or wheezing
• No improvement even after using a quick-relief inhaler
• Shortness of breath when you are doing minimal physical activity

Note: Don’t take more medication than prescribed without first consulting your doctor. Overusing asthma medication can cause side effects and may worsen your asthma.

Don’t Fear Spring Allergies and Asthma

In spring asthma and allergy triggers make their seasonal appearance. Pollen is perhaps the most obvious springtime asthma and allergy offender. As flowers, weeds, trees, grass and other plants begin to bloom, they release pollen into the air. If you’re allergic to pollen, you know allergic reactions can cause symptoms in your nose, lungs, throat, sinuses, ears, lining of the stomach, or even on the skin.

Allergies can also trigger symptoms of asthma, making it more difficult to breathe. And pollen isn’t the only spring allergy and asthma trigger. Air pollution and temperature changes can also make your symptoms worse. No need to fear. You don’t have to wear a hazmat suit to venture outdoors. Follow these tips to ensure your spring is every bit as exciting.

1. Check your outdoor air quality. Every day. If you plan to move your physical activity outside, remember to scope out the environment first and be aware of any obvious triggers. The quality of the air we breathe outdoors affects each of us; it can be especially troublesome for people with asthma. Check daily air quality levels and air pollution forecasts in your area.
2. Lawn and garden maintenance. Before working in the yard, check your local pollen count. Consider gardening in the early morning, or evening, when the pollen count is at its lowest. Fertilizers and freshly cut grass can worsen asthma symptoms. When working in the yard, consider wearing a particle mask (available at hardware stores, or make your own) to keep you from breathing in tiny particles. Avoid commercial fertilizers and pesticides/herbicides altogether. Opt for a DIY organic fertilizer.
3. It’s a bug’s life. Citronella candles and bug spray may keep mosquitoes at bay but can also trigger an asthma episode. Instead, opt for aromatherapy essential oil diffusers, plant bug repellent plants in your yard, and use a homemade fertilizer. When using mosquito repellent, choose organic lotions that are unscented (not aerosol sprays). Other tips that may help you avoid using repellent products are to empty flower pot liners or other containers holding water, wear long-sleeved shirts, long pants and socks when outside, and stay indoors at sunrise and sunset when mosquitoes are most active.
4. Use medications as prescribed. While limiting exposure to triggers can be helpful, you can never eliminate contact from all potential items that cause asthma and allergy symptoms. If you have asthma, remember to keep your quick-relief medicine close at hand in case of a flare-up. Other tools that can help guide your outdoor plans include a peak flow meter and a written asthma action plan.

If asthma flare-ups are frequent during this time period, talk with your asthma care provider about getting tested for common allergens, with a simple blood test or skin prick test. Allergy testing may help you identify your triggers.

Condition	Description
Allergic asthma	Asthma triggered by exposure to the same substances that trigger allergy symptoms.
Acute Bronchitis	Inflammation of the lining of bronchial tubes, which carry air to and from the lungs.
Seasonal allergies	An allergic response causing itchy, watery eyes, sneezing, and other similar symptoms.
Chronic obstructive pulmonary disease	A group of lung diseases that block airflow and make it difficult to breathe.
Croup	An upper airway infection that blocks breathing and has a distinctive barking cough.
Sinusitis	A condition in which the cavities around the nasal passages become inflamed.
Allergy to mold	An abnormal allergic reaction to mold spores.
Pneumonia	Infection that inflames air sacs in one or both lungs, which may fill with fluid.

Sources:
American Lung Association
Chronic Bronchitis
https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/chronic-bronchitis/
THE HADASSAH MEDICAL ORGANIZATION – HOSPITAL IN ISRAEL
ASTHMA
http://www.hadassah-med.com/children-site/parents/chronic-deseases/asthma
Mayo Clinic
Asthma
https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653
Allergic Respiratory Inflammation and Remodeling
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793767/
Turk Thorac J., Kawa A. M. Amin, Published online 2015 Jul 1
Don’t Fear Spring Allergies and Asthma
https://www.lung.org/about-us/blog/2016/04/dont-fear-spring-allergies.html
Apr 14, 2016