Bronchial
Asthma.
Dr. Sayeed Ahmad D.
I. Hom. (London)
INTRODUCTION
Asthma, disorder of the respiratory
system in which the passages that enable air to pass into and out of the
lungs periodically narrow, causing coughing, wheezing, and shortness of
breath. This narrowing is typically temporary and reversible, but in
severe attacks, asthma may result in death. Asthma most commonly refers
to bronchial asthma, an inflammation of the airways, but the term is
also used to refer to cardiac asthma, which develops when fluid builds
up in the lungs as a complication of heart failure. This article focuses
on bronchial asthma.
BREATHING
Every cell in the human body
requires oxygen to function, and the lungs make that oxygen available.
With every breath we take, air travels to the lungs through a series of
tubes and airways. After passing through the mouth and throat, air moves
through the larynx, commonly known as the voice box, and then through
the trachea, or windpipe. The trachea divides into two branches, called
the right bronchus and the left bronchus, that connect directly to the
lungs. Air continues through the bronchi, which divide into smaller and
smaller air passages in the lungs, called bronchioles. The bronchioles
end in clusters of tiny air sacs, called alveoli, which are surrounded
by tiny, thin-walled blood vessels called capillaries.Here, deep in the lungs, oxygen
diffuses through the alveoli walls and into the blood in the
capillaries, and gaseous waste products in the blood—mainly carbon
dioxide—diffuse through the capillary walls and into the alveoli. But
if something prevents the oxygen from reaching the alveoli, the body’s
cells do not receive a constant supply of vital oxygen, and carbon
dioxide builds up to harmful levels in the blood.
THE ASHTMA ATTACK
Asthma attacks occur when the bronchi
and bronchioles become inflamed, reducing the space through which air
can travel through the lungs. This causes the asthmatic to work harder
to move air in and out of the lungs. Asthma attacks usually begin with
mild chest pressure and a dry cough. As an attack intensifies, wheezing
develops and increases in pitch; breathing becomes difficult; and
coughing produces thick, stringy mucus. As the airway inflammation
prevents some of the oxygen-rich air from reaching the alveoli, the
cells of the body start to burn oxygen at a higher rate, actually
increasing the body’s demand for oxygen. The frequency of asthma
attacks varies considerably among asthma suffers. Some people have daily
attacks, while others can go months or even years without having an
attack.Inflammation of the airway occurs when
an irritant—such as pet hair or cigarette smoke—comes into contact
with the airway walls. Upon detecting the irritant as a harmful invader,
the body’s immune system sends special cells known as mast cells to
the site of irritation, in this case the airway walls. The mast cells
release histamine, a chemical that causes swelling and redness in a
process called the inflammatory response. Histamine also causes
bronchospasms, in which the muscles lining the airway walls contract
repeatedly, causing the airways to narrow even more. In addition, cells
that lubricate the airways with mucus—called goblet cells—overreact
to the inflammatory response by secreting too much mucus. This mucus
clogs the bronchioles, resulting in wheezing and coughing.
CAUSES
Asthma attacks are caused by airway
hyperresponsiveness—that is, an overreaction of the bronchi and
bronchioles to various environmental and physiological stimuli, known as
triggers. The most common causes of asthma attacks are extremely small
and lightweight particles transported through the air and inhaled into
the lungs. When they enter the airways, these particles, known as
environmental triggers, cause an inflammatory response in the airway
walls, resulting in an asthma attack.For some people the environmental
triggers are allergens. Allergens are usually natural substances, such
as plant pollen and mold spores, animal dander (tiny pieces of animal
hair and skin), and fecal material from dust mites and cockroaches.
Allergens produce an exaggerated response of the immune system in which
a specific antibody, immunoglobulin E, initiates the inflammatory
response. These same allergens may cause little or no reaction in
nonallergic people.Asthma also occurs in people who do
not have allergies. In these people, chemical irritants trigger an
inflammatory response that is initiated in a different way than in
allergen-triggered asthma. For example, some people are sensitive to
certain common chemical irritants, such as perfume, hairspray,
cosmetics, and household cleaners. Other chemical irritants include
industrial chemicals and plastics, as well as many forms of air
pollution, such as exposure to high levels of ozone, car exhaust, wood
smoke, and sulfur dioxide. Current research seeks to determine whether
indoor pollutants also contribute to the development of asthma.Not all triggers are environmental.
Aggravations from within the body are known as physiological triggers
and include exercise and infections, such as the common cold. Sometimes
substances that asthmatics eat or drink bring on attacks. Chemicals
found in food or medicine—such as food sulfites found in beer and wine—and
medications such as aspirin and ibuprofen are especially problematic for
many asthma sufferers. Intense emotion, such as crying, shouting, or
laughing, may provoke hyperventilation, a rapid inhalation of oxygen
that causes the airway to narrow. In asthmatics, hyperventilation often
results in an attack. Many asthmatics are especially sensitive to
physical exercise in cold weather.Research suggests that genetic factors may
increase the risk of developing the disorder. Children with a family
history of asthma are more likely to develop asthma than other children.
Despite this apparent genetic link, many people without a family history
of asthma develop the disorder, and scientists continue to investigate
additional causes.
DIAGNOSIS
Physicians typically diagnose asthma by
looking for the classic symptoms: episodic problems with breathing that
include wheezing, coughing, and shortness of breath. When symptoms alone
fail to establish a diagnosis of asthma, doctors may use spirometry, a
test that measures airflow. By comparing a patient’s normal airflow,
airflow during an attack, and airflow after the application of asthma
medication, doctors determine whether the medicine improves the patient’s
breathing problems. If asthma medication helps, doctors usually diagnose
the condition as asthma.Identifying the specific trigger of a
patient’s asthma is usually more difficult than the initial diagnosis.
Triggers may be easily recognizable and consistent; for example, a
patient may always develop an asthma attack when using a particular
cosmetic or household cleaning product. When the triggers are more
difficult to identify, doctors perform a series of allergy skin tests to
help determine whether allergy triggers are responsible. Skin tests are
not conclusive, however, because patients may have skin reactions to
substances that do not necessarily trigger an asthma attack. Doctors may
also use spirometry to evaluate a patient’s airflow before and after
exposure to common triggers. Triggers that decrease airflow may be
responsible for the patient’s asthma.
ALLOPATHIC TREATMENT
Although there is no cure for
asthma, effective treatment is available for preventing attacks and for
controlling and ending attacks soon after they have begun. Asthma
medications are taken orally or inhaled in vapor form using a
metered-dose inhaler, a hand-held pump that delivers medication directly
to the airways. There are two kinds of asthma medications:
bronchodilators, which reduce bronchospasm; and anti-inflammatory
medications, which reduce airway inflammation.Bronchodilators are the most widely used
medications for controlling sudden asthma attacks and for preventing
attacks brought on by physical activity or exercise. They work directly
on sites called beta-receptors that are attached to small muscle bands
encircling the airways. When these drugs attach to the beta-receptors,
the muscles relax and the airway dilates. Theophylline is a
bronchodilator that works by relaxing the muscles surrounding the
airways.Anti-inflammatory medications work mainly by
interfering with the activity and chemistry of immune cells, such as
mast cells, that cause inflammation in the airway walls.
Anti-inflammatory medications also help relax the airway muscles that
constrict during bronchospasm. Corticosteroids reduce asthma symptoms by
suppressing the immune response, and they often succeed when no other
asthma treatment works. Over time they reduce the sensitivity of the
airways to many common triggers. Long-term use of oral corticosteroids
may have severe side effects, including weakening of the bones and the
development of cataract, a clouding of the lens of the eye. Recent
studies suggest that small doses of inhaled corticosteroids taken in
combination with certain bronchodilators may work equally well while
significantly reducing the side effects. Leukotriene modifiers, another
type of anti-inflammatory medication, are taken orally as an alternative
to corticosteroids for the long-term treatment of mild asthma.Immunotherapy is a treatment option
for asthma caused by allergens. This form of therapy modifies a person’s
allergic response by repeated exposure to small amounts of allergens.
The asthmatic is injected periodically with known allergens, a procedure
that trains the asthmatic’s body to react to the allergens
differently. Immunotherapy is especially effective in reducing allergic
reactions to dust mites, animal dander, pollen, and fungi.To control asthma attacks before they
begin, asthmatics can measure their peak expository flow rate (PEFR),
which is a gauge of how fast a person can exhale air from the lungs. By
breathing into a small hand-held device called a flow meter, an
asthmatic can learn when their airways are first starting to narrow.
When the PEFR falls, asthma medication may be needed to prevent an
attack. PEFR and medication should be used under a physician’s
guidance.Asthmatics can also prevent and
control attacks by limiting their exposure to environmental triggers,
especially allergens. Frequently cleaning carpeting, bedding, and
household upholstery reduces levels of irritants and allergens in the
home. To prevent asthma attacks, asthmatics should wear a mask while
cleaning. Regularly bathing pets minimizes levels of animal dander in
the air. Asthmatics should take care to avoid pollutants and irritants
such as cleaning sprays and cigarette smoke whenever possible. Seasonal
allergies to pollen and mold spores can be reduced by avoiding the
outdoors during peak periods of activity.
HOMŒOPATHIC TREATMENT
Asthma is one of the distressing ailments which are
not easy to cure. After using palliative medicines to overcome an acute
attack, one should resort to constitutional treatment in order to give
permanent relief to the patient. The main constitutional medicines are:
- Tuberculinum
- Thuja
- Natrum Sulph.
- Medorrhinum
- Syphilinum
The above medicines are to be given inter-currently
in potency not below 200. No other medicine is to be given for 2 – 3
days before and after. If any of the above medicines have the desired
effect, further drugging of the patient should be avoided.Further, in Asthma the diet plays a very vital role.
Thus, the use of white flour, eggs, white sugar, meat, fish, milk, curd
and puddings should be avoided.
BREATHING :
Difficult getting air into the lungs. —– Brom.,
Iod.Difficult getting air out of lungs. —– Chlor.,
Sul.In rapid short breaths. —– Acon., Ant-t., Phos.
Shallow. —– Acon., Ant-t., Nux-v., Phos.
Wheezy. —– Ars-a., Cinch., Hep-s., Ipec., Phos.
Rattling. —– Seneg., Sil.
Rattling and wheezing. —– Ipec., Seneg., Sil.,
Squil.As if air passages were full of smoke. —– Brom.
With fear of suffocation. —– Ars-a., Ipec., Sul.,
Ver.
PERSPIRATION
Easy. —– Cinch.
Cannot perspire. —– Cham.
Profuse. —– Hyper.
COUGH
Chocking. —– Hep-s.
Loose. —– Dulc., Nat-s.
Dry. —– Acon., Ars-a., Bry., Med., Nux-v., Psor.
Violent. —– Kali-c.
Violent and incessant. —– Ipec.
Spasmodic. —– Aral., Cupr., Phos.
Paroxysmal. —– Nux-v., Samb.
Deep sounding, hoarse. —– Dros.
< After physical exercise. ----- Dulc.
With: desire but inability to cough. —– Cham.
With: vomiting. —– Kali-c., Ipec., Lob.
With: ending with vomiting. —– Ipec.
With: pain in chest under short ribs. —– Lob.
With: bleeding from the nose. —– Dros.
With: must hold chest when coughing. —– Nat-s.
With: caused by tickling in throat pit. —– Rumex
EXPECTORATION
Difficult. —– Alumen, Dulc.
Profuse. —– Blatta, Grind., Sul.
Worse from. —– Hyper.
Bloody. —– Nux-v.
None. —– Cupr.
BETTER FROM
Rapid walking. —– Lob.
Stool. —– Poth.
From being at seaside. —– Med.
WEATHER
< Change from warm to cold. ----- Dulc.
< Wet and damp. ----- Dulc., Nat-s., Sil.
< Dry cold air. ----- Hep-s., Rumex
< Foggy. ----- Hyper., Kali-c.
< Warm dry weather. ----- Syph.
< Damp weather. ----- Hep-s.
PAIN
In right lower chest. —– Kali-c
In left lower chest. —– Nat-s.
In right and then in left lungs. —– Lyc.
Through upper third of right lung. —– Ars-a.
Through lung to back. —– Kali-hyd.
In chest and mammæ. —– Med.
With burning feeling. —– Ars-a.
With a constrictive feeling in the chest. —–
Ars-a., Cupr., Ipec., Lach.With cramplike feeling in cardiac region. —– Ptel.
ASTHMA WITH
Painful larynx. —– Med., Phos.
Persistent nausea. —– Ipec.
Dyspnœa (Shortness of breath). —– Acon., Dulc.,
Euc., Ipec., Kali-p., Lach., Med., Psor., Sil., Sul.Hands and face blue. —– Squil.
Face pale. —– Sil.
Liability to get colds. —– Cinch.
TIMING
11 p. m. to midnight. —– Aral.
Midnight to 2 a. m. —– Ars-a., Samb.
2 to 3 a. m. —– Dros., Kali-ars., Samb.
2 to 4 a. m. —– Kali-c.
3 a. m. —– Samb.
4 to 5 a. m. —– Nat-s.
< In morning. ----- Lach.
> Day time. —– Med.
Always < at night. ----- Aral., Dros., Syph., Tub-bov.
SLEEP
On face in knee/chest position. —– Med.
Must sit up. —– Ant-t.
Must sit up as fears suffocation. —– Ars-a.
Must lie with head high. —– Ars-a., Cinch.
Must lie flat on back with arms outstretched. —–
Psor.Sleepless. —– Chlor.
< Lying down. ----- Grind., Kali-c., Sul.
> Lying down. —– Psor., Ver.
> From stool. —– Poth.
Awakes suddenly 3 a. m., nearly suffocated, has to
sit up. —– Samb.
TYPES OF PATIENTS
Fair haired, delicate-skinned. —– Brom.
Corpulent. —– Blatta
Easy perspiring. —– Cinch.
Old people particularly. —– Carb-v., Kali-c.
Sensitive, result of mental emotions. —– Coff.
Dark haired. —– Iod.
GENERAL MODALITIES
Better at seaside. —– Med.
Better in open air. —– Iod., Napth.
Worse for pressure on throat. —– Lach., Rumex
Worse for motion. —– Ars-a., Ver.
Worse for talking. —– Arum-t., Dros.
Worse in warm room. —– Iod.
Worse for food. —– Kali-p.
Worse with annual hayfever. —– Psor.
Worse due to exertion. —– Aspido., Coca, Ars-a.
Worse due to dust. —– Poth., Brom.
Worse going upstairs. —– Kali-p.
SUNDRIES
Sailor gets asthma on going to shore. —– Brom.
Attack of asthma due to mental or nervous emotions.
—– Coff., Kali-p., Succ-ac.
ASTHMA FOLLOWS
Eczema. —– Ars. Stibiatum
Measles. —– Carb-v.
Whooping cough. —– Carb-v.
NOTE :
Any information given above is not intended to be
taken as a replacement for medical advice. Therefore, it is very
important that the patients should avoid self-treatment and rather
consult the most abled and qualified classical homœopath and take the
treatment under his proper guidance and advice.
References:
MS Encarta Encyclopædia.
Asthma by N. W. Jollyman
Copyright © Dr. Sayeed Ahmad
2004