Understanding Asthma Better: on World Asthma Day 2023

The first Tuesday of May every year is observed as World Asthma Day. World Asthma Day 2023 shall be observed on 2nd May 2023. World Asthma Day is organized by the Global Initiative for Asthma (GINA), an organization founded in 1993, working in collaboration with the World Health Organization (WHO) World Asthma Day is celebrated to raise awareness of Asthma Worldwide.

The theme for World Asthma Day 2023 is “Asthma care for all”.  The Asthma Care for All message promotes the development and implementation of effective asthma management programs in all resource countries.

Importance of Awareness of Asthma

• Asthma is a major noncommunicable disease, that affects both children and adults. it is the most common chronic disease among children.
• Asthma affected an estimated 26.2 crore (262 million) people in 2019^[5] and caused 455,000 deaths. Most asthma-related deaths occurred in low- and lower-middle-income countries.

that is why World Asthma Day is celebrated every year to spread awareness on Asthma. under the theme for World Asthma Day 2023 “Asthma care for All”, GINA (organization) strives to reduce the burden of asthma by encouraging healthcare leaders to ensure the availability of and access to effective, quality-assured medications^[1].

let us have look at very basic question related to Asthma on the occasion of World Asthma Day 2023

What is Asthma

Asthma is a condition affecting the lungs in which air passages (tubes carrying air) become narrow and thus causes symptoms like cough, wheeze, Shortness of breath and chest tightness^[2].

How air passages become narrow:

Narrowing of air passages means airflow limitation is caused by a number of changes in airways^[3]:

• Airway hyper-responsiveness :
  • sometimes airways respond excessively to various stimuli that may appear normal to other people. it may be due to multiple factors like inflammation, dysfunctional neuro-regulation, and structural changes in airways.
• Bronchoconstriction, the main culprit :
  • Bronchoconstriction is the constriction of smooth muscles of air passages (bronchi and bronchioles).
  • Bronchoconstriction occurs in response to a variety of stimuli like irritants or allergens (house dust mites, moulds, and occupational exposure to chemicals, fumes or dust.).
  • At the Biochemical level, inflammation is the root cause which results from two pathways:
    1. IgE (an antibody) mediated release of inflammatory mediators- as seen in Allergens
    2. Non-IgE mediated release of inflammatory mediators- as seen in Aspirin and other non-steroidal anti-inflammatory drugs (also cause airflow obstruction)
  • Stress is also found to contribute to asthma, though the mechanism is not established yet.
• Airway Edema :
  • Persistent and progressive inflammation, results in hypersecretion of the mucus, formation of mucus plugs and hypertrophy & hyperplasia of smooth muscles of airways all contributing to airway edema.
• Airway remodeling :
  • is a permanent structural change that occurs in airways due to repeated insults.
  • structural changes includes:
    • subepithelial fibrosis,
    • airway smooth muscle hypertrophy and hyperplasia,
    • blood vessel proliferation and dilation, and
    • mucous gland hyperplasia (leading to hypersecretion of mucus)

Why air passages become narrow:

well, the exact answer that why some people are susceptible is still an area of investigation and research but the interplay of two major factors is considered to play the role:

• Host Factors– Particularly Genetics (It is well recognized that asthma has an inheritable component to its expression). Other factors like low birth weight and prematurity are also associated with an increased risk of developing Asthma^[4].
• Environment Factors– environmental exposure to individuals that occurs during the development of the immune system.
  • airborne allergens and viral respiratory infections are two major factors associated.
  • others are tobacco smoke, air pollution, and occupations, Events in early life affect the developing lungs and can increase the risk of asthma. These include, exposure to tobacco smoke and other sources of air pollution and diet have also been associated, although the association has not been as clearly established.

is there any Genetic Predisposition related to Asthma

yes, as we already discussed Genetics plays an important role and it is well recogonised that asthma has an inheritable component. to date, many genes have been found linked to asthma.

Six steps to keep your asthma under control^[1]

• Step 1: Make Your Medical Visits More Productive
  There are a number of resources available to help you ask the right questions about asthma management and treatment the next time you see your healthcare provider.
• Step 2: Create an Asthma Management Plan
• Step 3: Assess and Monitor Your Control
  Common asthma symptoms can include a cough, tight feeling in your chest, wheezing, activity limitation and feeling tired. Keeping track of your symptoms will help you stay in control.
• Step 4: Understand Your Medication
• Step 5: Reduce Asthma Triggers
• Step 6: Learn Asthma Self-Management Skills

coming soon: we shall try to provide you gist of ‘six steps to control the asthma’ in a separate article. for the time being, check out our article on ‘Non-drug management of asthma‘.

to read the same topic or to refer same information in Hindi, click here.

references:

[1global initiative for asthma (GINA)

[2]https://www.who.int/news-room/fact-sheets/detail/asthma

[3]]National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2007 Aug. Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7223/

[4] World Health Organization.

[5]  Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204-22