Bronchial Asthma

Bronchial asthma is a chronic inflammatory disease of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning.

• Wheeze
• Shortness of breath
• Chest tightness
• Cough, often worse at night or early morning
• Symptoms triggered or worsened by exercise, allergens, cold air, or respiratory infections
• In severe attacks: marked breathlessness, inability to speak in full sentences, and use of accessory chest muscles to breathe

• A combination of genetic predisposition and environmental triggers.
• Common triggers include house dust, tobacco smoke, pollen, respiratory infections, exercise, and strong odours or fumes.

• Based on a history of recurrent, episodic symptoms together with examination findings of wheeze.
• Supported, where available, by evidence of variable and reversible airflow limitation on spirometry or peak flow measurement.
• A trial of bronchodilator response may help confirm the diagnosis.

For acute attacks, an inhaled short-acting beta-2 agonist such as salbutamol is given as reliever therapy, with oral or injectable corticosteroids added for moderate-to-severe attacks.

Oxygen is given for hypoxia, and attacks that do not respond to initial treatment are referred urgently to a higher level of care.

For long-term control, an inhaled corticosteroid is recommended as first-line maintenance therapy for anyone with persistent symptoms, with a long-acting bronchodilator added in a stepwise manner if control is not achieved on the inhaled corticosteroid alone.

Patients are given a written action plan and taught correct inhaler technique, which is reviewed regularly.

• Identify and avoid personal triggers where possible.
• Take maintenance (preventer) medicine consistently, even when feeling well.
• Seek prompt treatment for respiratory infections.
• Have inhaler technique checked regularly by a health worker.