This disease affects people of all ages, but younger people are more affected. In 2017-18, asthma led to almost 64,000 emergency room visits in Canada. This disease costs Canadians more than $ 2 billion a year in medical care and medication.
To date, there is no cure for asthma, however it is possible to control the disease and lead a busy, active life with virtually no symptoms. However, 65% of Canadians with asthma report that their asthma symptoms prevent them from exercising. This poor control of the disease leads to difficulties on a daily basis: increased medication intake; emergency room visits with frequent hospitalizations; absenteeism from work or school, and unfortunately, several deaths.
Asthma is a respiratory illness that cannot be cured, but can be controlled. It is characterized by inflammation and partial and reversible obstruction of the bronchi. Since the airways are hypersensitive, they are contracted and obstructed by thick secretions, which makes breathing difficult.
The exact causes of asthma are not completely determined, but it appears that the disease is the result of a complex interaction between several genetic (family predisposition) and environmental factors.
Mechanisms of Asthma
The obstruction is caused by three mechanisms:
- Inflammation inside the bronchus;
- The contraction of the muscles surrounding the bronchus (bronchoconstriction);
- The production of excess mucus (thick secretions) that blocks the bronchi.
From person to person, asthma triggers can be different. It is therefore important for anyone with Asthma to identify the things that can cause symptoms. The triggers fall into 2 categories:
Irritant factors cause the airways to contract (bronchoconstriction). Thus, due to the irritation, the muscles surrounding the bronchi are activated, tightening them and preventing the air from circulating correctly.
Symptoms of bronchoconstriction caused by irritants are usually immediate, short-lived and reversible through the use of rescue medications (bronchodilators). Among the irritants are:
- Emotions and stress;
- Strong odors (cleaning products, perfumes, aerosols, solvents, etc.);
- The temperature variation;
When it is HOT:
- Choose air-conditioned and cool places
- Drink enough water (unless directed by your doctor)
- Avoid overly exhausting activities
- Wear light clothing and a hat
When it is COLD:
- Dress warmly and cover your nose with a scarf
Inflammatory factors may appear more gradually. They can cause or increase asthma symptoms for several weeks or even months and are not as easily reversible.
Among the inflammatory factors, we find:
- Respiratory infections (colds, flu, sinusitis, bronchitis, pneumonia, etc.);
- Allergens (mites, food allergies, animals, mold spores, pollens, etc.);
- Occupational exposure to certain substances (isocyanates, crustaceans, seafood, flour, etc.).
Tobacco smoke, gastroesophageal reflux disease (GERD) and pollutants are also factors that may make asthma control more difficult.
It is very important to identify and avoid these factors as much as possible, especially those that are inflammatory, since the more inflammation there is in the bronchi, the more they become hypersensitive to the various triggers.
People at risk
There are a few things that can make a person more likely to develop asthma:
- People with a family history of asthma, allergic rhinitis or eczema
- People born prematurely
- People exposed to second-hand smoke
- People exposed to air pollution
- People with gastroesophageal reflux
- Children who have had severe and repeated respiratory infections (e.g. pneumonia, rhinovirus or syncytial virus infection, etc.)
- People suffering from obesity
- People exposed to sensitizers in their workplace (occupational asthma)
Signs and symptoms
- Shortness of breath
- Chest tightness
- Increased mucus production
When you experience one or more of these symptoms, you can call it an “asthma attack.” A severe asthma attack can be a terrifying experience accompanied by feelings of suffocation, shortness of breath, and loss of control. Thus, poorly treated or underestimated asthma can be life threatening.
The respiratory tests frequently used in the diagnosis and monitoring of asthma are spirometry and peak expiratory flow (PEF). This simple test measures, among other things, the maximum amount of air you can breathe out and the speed at which you can do it.
Spirometry is done in a doctor’s office, clinic or hospital by a healthcare professional. It provides several measures and data that can help establish a diagnosis or even follow the course of the disease.
It is possible to do a peak expiratory flow rate (EPD) measurement yourself using an inexpensive and easy-to-use device. By keeping a regular log of PED measurements, you can check your asthma control and validate the effectiveness of your medication.
People with asthma should be able to lead normal lives. To get there, there are different drugs that help manage and prevent symptoms. There are two main types of medication used in asthma: medications used on a regular basis (maintenance medication) and medications used in a crisis (rescue medication).
In order to provide constant prevention, maintenance medications are usually taken every day, even if there are no symptoms. These drugs do not immediately relieve the symptoms of an asthma attack, but taken daily, they provide better control of asthma symptoms and less use of the rescue medication.
They also make the bronchial tubes less vulnerable to triggers, which dramatically decreases the frequency and severity of asthma attacks.
Asthma maintenance medication is divided into the following classes:
Inhaled corticosteroids have the function of reducing and preventing inflammation in the bronchi and thus allow better control of asthma. To be effective, this medication must be taken regularly. Since the drug is absorbed directly into the lungs, inhaled corticosteroids cause fewer side effects than corticosteroids taken in tablet or syrup form.
- Arnuity® Ellipta®
Systemic corticosteroids (tablets or syrup)
Corticosteroids in the form of tablets or syrup also have the function of reducing inflammation in the bronchi. They are mainly used for a short time during exacerbation (worsening) of asthma. Occasionally they are used long term when asthma is not well controlled despite proper therapy.
- Prednisone (Deltasone)
- Prednisolone (Pediapred)
- Methylprednisolone (Medrol)
Long-acting bronchodilators help keep the airways open by relaxing the muscles around the bronchi. Their duration of action is 12 hours and are generally taken 2 times a day. This treatment is prescribed in addition to inhaled corticosteroids when asthma is not well controlled and should not be used alone as maintenance therapy, therefore the use of inhaled corticosteroids should be continued.
- Foradil ®
Long-acting muscarinic antagonist
Like long-acting bronchodilators, it keeps the airways open by relaxing the muscles around the bronchi. Its duration of action is 24 hours and should be taken only once a day. This treatment is generally used when the symptoms of asthma are not controlled despite the regular intake of an inhaled corticosteroid and a long-acting bronchodilator.
If you need to take an inhaled corticosteroid and a long-acting bronchodilator, your doctor may prescribe an inhalation device that contains these two drugs, this will make it easier to take your medication.
Leukotriene receptor antagonists
Leukotrienes are substances produced by the body in response to certain triggers of asthma such as pollen (in allergy situations) and which causes the airways to become narrowed and inflamed. This class of drugs, therefore, works by blocking the activity of leukotrienes present in the lungs. They are mainly used to control asthma and relieve the symptoms of seasonal allergic rhinitis.
In allergic asthma, when the body comes in contact with its allergen, the latter releases a chemical called immunoglobulin type E (IgE). The latter causes or accentuates the manifestations of asthma. The anti-IgE antibody-drug aims to block IgE. The latter is administered by subcutaneous injection to patients with moderate to severe allergic asthma in whom large doses of inhaled corticosteroids cannot control the disease.
- Xolair ™
Specific treatment for severe eosinophilic asthma
Despite all the control drugs available on the market, sometimes asthma cannot be controlled. In cases where there is a high level of eosinophils in the blood (a specific type of white blood cell), medicines acting on a substance called interleukin 5 (IL5), which is partly responsible for the inflammatory process in the bronchi, can help decrease the frequency of asthma exacerbations and improving control.
- Cinqair ™
- Fasenra ™
- Nucala ™
This medication is used to relieve occasional or immediate symptoms of tightening of the bronchi and should always be kept on hand in an emergency.
Short-acting bronchodilators help open the airways by relaxing the muscles around the bronchi. Its effect is felt quickly, but its duration of action is short about 4 to 6 hours. These drugs should be used only when needed, that is if symptoms are present: cough, tightness in the chest, wheezing, and shortness of breath. They can also be used before exercising. When asthma is well controlled, rescue medications should not be used more than 3 times a week. If you use your rescue medication more than 3 times a week, make an appointment with your healthcare professional and ask for help to better control your symptoms.
The combination of a corticosteroid and a long-acting bronchodilator is also considered to be a rescue medication. Symbicort, which combines an inhaled corticosteroid and a long-acting bronchodilator, is normally used as a maintenance medication, but it can also be used as a rescue medication. It is then taken as maintenance treatment in the morning and in the evening, and as rescue treatment if necessary. Ask your healthcare professional to find out if you are eligible for this method.
It is estimated that the number of people with severe asthma in Canada is approximately 250,000. Asthma is categorized as severe or severe when symptoms are persistent and worsen and attacks are more frequent despite adequate and regular intake of multiple medications and good control of exposure to triggers. Severe asthma or severe asthma requires more specific monitoring by a medical specialist rather than a general practitioner as in most cases.
In recent years, research on severe asthma has paid off, leading to specialized treatment. It is a therapeutic class called: monoclonal antibody against interleukin 5 *. It is a treatment given as a subcutaneous or intravenous injection at general intervals of one month. This substance, once injected, blocks interleukin 5, a protein already present in our system which by a cascade of chemical reactions causes inflammation in the bronchi. Thus blocked, the process of bronchial inflammation decreases. These specific therapeutic advances allow the reduction of asthma attacks as well as symptom relief.
Among these are:
* It should be noted that these drugs are indicated for a specific asthmatic clientele.
Asthma is the # 1 cause of a child’s absenteeism from school and the # 3 cause of the parent’s absenteeism from work. Over 15% of children in Canada suffer from asthma and the number is increasing. Unfortunately, more than half of asthmatic children have poor control of their symptoms, making asthma the leading cause of pediatric hospitalization.
Children with asthma can have a variety of symptoms, such as a persistent cough from cold or difficult breathing during physical exertion, a run for the cold or exposure to an allergen. Others will experience daily coughing and shortness of breath. These symptoms can vary from day to day.
It is essential to identify and eliminate the triggering or aggravating factors of asthma in your child and therefore to clean up his environment. By doing so, you will improve your child’s quality of life, decrease the frequency and intensity of their symptoms, avoid school absenteeism and hospitalizations while reducing the need for medication.
Advice and prevention
More than 90% of people with asthma feel that their disease is well controlled when it is not. These people do not control their symptoms. This implies that they experience daily inconveniences related to their asthma, but do not know that their situation is unusual and that their doctor could correct it by optimizing the follow-up and the treatment.
How to control asthma?
Asthma specialists agree that the best therapy is to actively involve people in their treatment. Despite the fact that drugs are very effective in treating asthma, much of the success of treatment depends on understanding the disease, recognizing and eliminating the triggers and taking the prescribed medication properly.
Here are the main steps towards optimal care:
Get a quick and accurate diagnosis, based on your personal history and objective measurements of respiratory function (spirometry);
- Learn to recognize and understand the symptoms of asthma;
- Control your environment and avoid triggers;
- Make sure you understand how your emergency medication works and use it as prescribed;
- Make sure you understand how your daily maintenance medication works and use it as prescribed;
- Make sure that the medication inhalation technique is adequate;
- Develop a personalized action plan with your doctor;
- Regularly reassess control of your asthma by the required respiratory tests (spirometry, peak expiratory flow, etc.);
- Check the air quality index before planning an outdoor activity.
* Air quality also affects the breathing of people with asthma. This is calculated based on ozone, sulfur dioxide, nitrogen dioxide, carbon monoxide and fine particles in the air. Knowing the air quality index for your area allows you to better plan your outdoor activity schedule and prepare yourself adequately.
Here are the main criteria for a well-controlled asthma:
- You experience daytime (daytime) symptoms less than 4 times a week;
- You experience nighttime symptoms (at night) less than once a week
- Your level of physical activity is normal;
- Your exacerbations are infrequent and mild in intensity;
- You do not have absenteeism from work or school because of asthma;
- You use your emergency bronchodilator less than four times a week;
- The readings for your peak expiratory flow (PED) are within the normal range recommended by your doctor.
Factors that can testify to poorly controlled asthma may include daily symptoms, more frequent use of emergency medication, emergency visits with frequent hospitalizations, and absenteeism from work or school.
Some triggers for your child’s asthma can be avoided while others can be minimized by taking proper precautions. Here are some practical tips. Remember that the triggers are different for each child.
Make sure everyone around you knows what triggers your child’s asthma attack, the symptoms, how to administer the medication, and what to do if you have an attack.
- Check the humidity level at home using a hygrometer (on sale in big box stores and hardware stores) and maintain a relative humidity between 35 and 45%;
- It is best not to use a portable humidifier, especially in the child’s bedroom. If you choose to use a humidifier, be sure to perform regular maintenance according to the manufacturer’s recommendations;
- If necessary, you can use a dehumidifier if the humidity exceeds 55%;
- Air out daily;
- Avoid exposing your child to second-hand smoke as it is one of the biggest triggers for asthma attacks. It is therefore important not to smoke in the house or in the car and to avoid contact with tobacco smoke;
- Avoid using a wood stove and do not store firewood in your home;
- Avoid exposing your child to irritants such as paint spray, cleaning products and perfumes;
- Make sure your child knows their illness, symptoms and treatment;
- Discuss with the teacher, the educator: inform them about your child’s illness, the triggers of the latter and the steps to follow in the event of a crisis;
- Make sure your child always has their emergency medication on hand.
- Avoid hanging your clothes outside, especially during allergies;
- Pull out ragweed before flowering;
- Remove the carpets, dust the furniture and wash the floors with a damp cloth (to avoid dispersing the dust);
- Avoid vacuuming or cleaning in the presence of the child;
- If possible, keep the windows of the house closed during allergies and favor indoor activities;
- Avoid your child playing in the freshly cut grass and after a period spent outside, have your child take a shower or bath and wash his hair to minimize the symptoms of allergies;
- Avoid pillows and feather quilts; prefer those that are hypoallergenic and washable.
- Turn on your bathroom fan during and after showers, making sure to leave the door closed. If your bathroom does not have a fan, you can open the window for a few minutes after the child has left the room;
- Operate your range hood or open the kitchen window when cooking;
- To avoid the presence of mold, promptly repair any water leaks and damaged materials;
- If there is mold, be sure to clean and repair the surfaces properly;
- Limit the number of plants in the house and avoid your child handling them;
- If there is mold on the plant soil, change the soil and if necessary, if the mold persists, discard the plant;
- Pick up dead leaves around the house before they get too wet and don’t let your child play in it;
- Clean washable bedding and lint with warm water every week. Cover the mattresses with a dust mite cover;
- Check the air quality index before planning an outdoor activity.
- If your child is allergic to animals, it is best not to keep animals or birds and avoid contact with them;
- Remember that there are no non-allergenic animals;
- If you cannot avoid contact with an animal (e.g. when visiting family or friends), keep your child outside as much as possible, prevent your child from petting the animal and do not sleep in the house where this animal lives.
Physical activity and sport
Most asthmatic children can practice their favorite sport without restriction, provided their asthma is well controlled. The child must progress at his own pace and respect his limits. If necessary, the child can take their bronchodilator (rescue medication) 15 minutes before exercise, which can prevent shortness of breath.
Asthma is not the result of psychological factors, but in some cases, strong emotions can trigger an asthma attack. When angry, calm the child; teach him to dialogue and verbalize his emotions. It is essential that the child learns to manage stress and emotions.
Asthma should be treated as a chronic disease, and an action plan should be established with the doctor to prevent the onset of symptoms and promote disease management, reduce seizures, and avoid emergency room visits and hospitalizations.
In collaboration with your doctor, develop an action plan, which will help you to better manage your symptoms. This action plan will specify: the symptoms to watch for, how to adjust your medication according to these symptoms and when to see your doctor or go to the emergency room.
Did you know that
The Quebec Lung Association offers direct services to the population. For more information, visit our Patient Resources section.
Révision Juin 2019