Asthma is inflammation in the airway. People that suffer with asthma, cells and tissues within the airway are prone to inflammatory reactions against normally harmless substances. This inflammation can cause swelling, mucous production and lead to airway narrowing. Airway narrowing can worsen asthma symptoms. When the airways are exposed to substances that trigger a reaction, immunoglobulin E (IgE) antibodies produced by B-cells help facilitate the release of inflammatory mediators including histamine and leukotriene’s from mast cells. 

These mediators cause the airway smooth muscles to contract or spasm, triggering airway narrowing (i.e. bronchoconstriction). Sensory nerves in the muscles become more sensitised, contributing to more bronchospasms. Structural changes in bronchial tubes can occur with chronic and uncontrolled asthma attacks. The epithelial cells (the layer of cells that line the airways and function as a barrier) can shed, allowing irritants or allergens to further penetrate into the inner muscle cells. Sensory nerves can also become exposed leading to reflex neural effects on the airway.

Frequently Asked Questions

  • Allergies and sensitivities

Allergies underlie many cases of asthma. An allergy is an inappropriate immune response against an innocuous compound. A wide variety of environmental allergens can cause an asthma attack, including food allergies. For those whose asthma is associated with environmental allergies, immunotherapy (e.g., “allergy shots” or sublingual immunotherapy) may help prevent exacerbations. In the case of food sensitivities, experimental research suggests that chronic, low-level inflammatory reactions triggered by an immune response to food particles may set the stage for airway inflammation. Some evidence suggests that IgG antibody testing is able to detect immune reactions less severe than an overt allergy, but that nonetheless may trigger inflammation.

  • Tobacco smoke

Studies have consistently shown a relationship between smoking and asthma. Smoking is also related to decreased asthma control, higher risk of asthma attacks and death. Improvements in lung function and asthma symptoms have been observed among those who quit smoking.

  • Occupational exposure

Occupations commonly associated with asthma include woodworking, detergent manufacturing, some health care professions and baking.

  • Infections

A variety of common viral infections acquired during infancy and early childhood appear to increase the risk of childhood wheezing episodes that may eventually lead to asthma. In contrast, other evidence suggests that childhood exposure to microbial pathogens and foreign peptides may protect against the development of childhood asthma – a theory known as the hygiene hypothesis.

  • Medications

Certain medications, including non-steroidal anti-inflammatory drugs (NSAIDs) and ACE-inhibitors can trigger an asthma attack in some people.

  • Exercise

Exercise can trigger asthma exacerbations, so people with asthma should exercise with caution (NHLBI guidelines). Other medical conditions commonly associated with asthma include chronic rhinitis, chronic sinusitis/rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), hormonal disorders, obesity, depression and anxiety.

  • Stress

Stress is associated with asthma as well. These conditions may share some pathophysiological mechanisms with asthma and may influence its expression. Associated diseases may also influence how a patient with asthma responds to treatment. Likewise, the asthmatic condition and the inflammatory processes in asthma may influence how these associated conditions develop or progress over time.

A comprehensive assessment is needed to differentiate between asthma versus an alternate disease or condition such as emphysema, early congestive heart failure or vocal cord problems. The physician makes a clinical diagnosis based upon symptoms, severity and results from lung/respiratory function tests. To make a thorough assessment and help the patient manage the disease, the physician obtains a detailed medical history.

Book a consult for Asthma at Health Renewal

People with persistent or seasonal asthma as well as a family history of allergies should have testing for airborne and food allergens. Because asthma and allergies frequently co-exist, treating the allergy symptoms may improve asthma. Patients should reduce their exposure to known allergens at home, school, work, or daycare. The patient’s allergist can suggest specific ways to remove the offending allergen(s) and keep the area(s) allergy-free. Patients with asthma are advised to exercise with caution because it can trigger an attack (NHLBI guidelines). They are also advised to avoid exertion when the level of air pollution is high as it can exacerbate exercise-induced asthma. Studies have shown, however, that supervised exercise and leisure-time physical activity reduced symptoms and improved the quality of life in some people with asthma. Brief warm-ups and use of short-acting beta-2 agonist medications before exercise or vigorous activity may help prevent or alleviate asthma. Preliminary evidence shows that yoga and breathing exercises may also help manage asthma.

A comprehensive assessment is needed where the Health Renewal doctor makes a clinical diagnosis based on the symptoms and results from lung function tests. Blood testing for allergens and food sensitivities which trigger inflammation ought to be done and act as an important diagnostic tool. Asthma needs to be managed even when symptoms are not present. Patients must be able to self-monitor their symptoms and recognise warning signs of an attack in order to respond quickly with medication. It is vital to manage your asthma triggers. 

Patients should reduce their exposure to known allergens. Sleep apnea can also be the reason for asthma attacks and therefore patient can undergo a sleep study to test whether sleep apnea is present. Asthma patients should exercise with caution and always under supervision. Yoga and breathing exercises may help to manage asthma. Stress should be managed well as this can also increase risk of asthma patients to eat healthy with a lot of fruits and vegetables. An anti-oxidant diet may also protect asthma patients from attacks.

  • Vitamin D: regulate the immune processes and anti-inflammatory reactions involved in asthma and play a role in reversing airway remodelling and airway inflammation in the lungs.
  • Vitamin C: can decrease airway hyper-reactivity and lower the inflammation as well as improve lung function in combination with Omega 3 fatty acids and Zinc.
  • Omega 3 and 6: can decrease the risks of asthma attacks.
  • Zinc: May have an effect on the allergy levels as well as decreases the airway hyper-responsiveness.
  • Magnesium: can relax bronchial smooth muscles and may improve lung function.
  • Selenium: may decrease asthma risk and may improve clinical significant. It may also improve asthma related quality of life and lung function.
  • Probiotic: may assist the body with the decreasing of inflammation.
  • Curcumin: can reduce airway hyper-responsiveness, prevent the activation of Nf-kB and reduce the number of leukocytes (white blood cells) in lung fluid.
  • Flavonoids have anti-oxidants and ant-inflammatory properties and may improve lung function. Flavonoids are supplements such as Quercetin, Proanthocyanidin (Pycnogenol), Ginkgo biloba.
Sharon Izak Elaine Chat staff