Asthma

What is Asthma?

Asthma is a chronic respiratory inflammatory condition that is associated with coughing, wheezing, breathlessness and chest tightness.

The severity of asthma varies from person to person. Most patients with asthma are able to control their symptoms well with or without medication.

Sometimes, you may notice the asthmatic symptoms gradually or acutely worsen — this is known as an ‘asthma attack’. In severe cases, asthmatic attacks may require hospitalization, or can even be life threatening (though less common).

What causes Asthma?

Asthma is due to inflammation of the lung bronchi (which are small connection respiratory passage tubes to carry air in and out of the lungs). When a person is having asthma, the bronchi is triggered by environmental factor and becomes sensitized and inflamed.

The airways become narrow, causing the airway muscles to tighten — this results in an increase in mucus production leading to difficulty of breathing and a productive cough.

Common cause/ triggers of Asthma include

  • Viral infection
  • Smoking
  • Exercise
  • Airborne triggers such as animal fur, dust mites, pollen, grass
  • Inhaled chemicals in surrounding environment

What are the signs and symptoms of Asthma?

The symptoms of Asthma can range from mild to severe. Some patients may only have occasional symptoms, while others may have persistent symptoms.

Common symptoms of asthma include:

  • Coughing
  • Wheezing
  • Breathlessness/ shortness of breath
  • Chest tightness

The symptoms tend to be worse at night or early in the morning. They can also be triggered by cold, exercise, infection or even allergens.

Lady suffering from Asthma

How common is Asthma in Singapore?

Asthma can develop at any age- including the young and the elderly group. Patients with family history of asthma has a higher risk of developing asthma. According to Healthhub, Ministry of Health Singapore, one in every 5 children in Singapore may have asthma. Although most patients outgrow the asthmatic symptoms when they grow older, some patients may have persisting asthmatic symptoms when they go into adulthood.

How is Asthma diagnosed?

Spirometry test

  • This is also known as a lung function test
  • You are advised to blow into a machine that will measure how much volume that you can retain in your lungs and how fast you can breathe out the air

Peak flow test

  • This is a simple test that can be done in clinic or at home/work place
  • You will be asked to blow into a handheld device that will measure how fast you can breathe out
  • You will be advised to repeat the test in different setting, time of the day over a period of weeks
  • This is useful to aid the diagnosis, understand any possible triggers and monitor the asthma condition

How is Asthma treated in Singapore?

Most people with asthma are able to lead a normal healthy lifestyle without restriction. There is effective treatment for most patients to control asthmatic symptoms.

Your doctor may discuss with you on various types of inhalers that can be used to manage the asthma symptoms.

Inhalers are devices that deliver the medication directly into the lungs when a person breaths. It is an effective way to control the inflammation in the bronchi and hence alleviate asthma symptoms. As the inhalers goes directly into the lungs, it is less absorbed into the body.

Some patients may have difficulty coordinating the use of inhalers and their breathing — your doctor may advise you to consider using the inhalers with a spacer. Speak to your doctor on treatment options. Your doctor can also demonstrate and guide you on how to use inhalers and spacers effectively.

FAQS

You should see a doctor if your cough symptoms are not improving and you notice wheezing (abnormal musical breathing sound), shortness of breath especially at night or early in the morning. If you are unsure, or experience persistent abnormal respiratory symptoms, you are advised to see your doctor for further evaluation.

Your doctor will take an appropriate history on your symptoms and will want to understand any triggers that cause your symptoms. Your doctor will want to know whether your symptoms are better or worse at work or during holiday. If you are unwell, with symptoms to suggest exacerbation of asthma, your doctor will prescribe you medication to manage to the symptoms.

No, Chest X-Ray does not usually show abnormal findings when a person is having asthma.

However, in severe uncontrolled asthma, findings from asthma complications can be seen on the chest X-Ray. Chest X-Ray is also useful to diagnose other differentials of respiratory symptoms such as chest infection, or even lung cancer.

In majority of the cases asthma can be diagnosed via a good history and physical examination clinically. In cases where the diagnosis is unclear, a lung function test can be useful to confirm or rule out the diagnosis of asthma.

You can speak to your doctor on the role and benefits of imaging scans such as chest X-ray, CT scan, lung function tests in your situation.

Airborne allergens such as dust mites can trigger atopic symptoms such as asthma, allergic rhinitis or eczema. Allergen immunotherapy is a safe targeted new treatment to reintroduce an allergen to the ‘allergic/affected’ patients. Over time, the ‘allergic/affected’ patients’ immune system will be re-educated, leading to de-escalation of the allergic response.

In asthma, allergen immunotherapy against dust mites has been clinically proven to alleviate clinical symptoms by reduce airway hypersensitivity. Allergen immunotherapy in the form of sublingual spray and tablets (SLIT) are available. You are encouraged to discuss with your doctor on allergy screening and the potential benefits of immunotherapy in management of asthma.

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