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Taking Control of Asthma Asthma • Asthma is a disease of airways. • Airways are the pipe/tube-like structures through which you breathe. • In asthma, airways get swollen and secrete a sticky substance called as mucus. Thus, the airway becomes narrow, and you find it difficult to breathe. • Asthma is generally hereditary, which means it is passes through families. • It does not spread from one person to other. • It has nothing to do with how you were raised or your relationships or your social status. • Asthma is treatable, and you can keep symptoms well under control. • This booklet helps you to understand asthma and its management in detail. What happens when you have asthma? Relaxed smooth Wall inflated and Air trapped Tightened muscles thickened in alveoli smooth muscle Normal Airway Asthmatic Airway Asthmatic Airway during attack Normal airways are not In asthma, the airways are swollen, and the air swollen and narrowed, In asthma attack, wind so breathing is not easy. pipes are swollen, can pass easily through Thus, patients develop them. episodes of coughing, narrowed, and full of shortness of breath and mucus, which makes wheezing. airways tight, and air gets trapped in the alveoli. 1 Thus, there is wheeze, cough, and difficulty in breathing.

Asthma: Causes and Triggering factors Causes • Exact cause of asthma is not known. • It is more common if there is a family member with asthma or allergy. • Symptoms of asthma may develop at any age. • The difficulty with asthma symptoms varies depending on the age at which asthma develops. • Most asthma patients have mild symptoms, and they do not have long-term effect on the body. • If the asthma is there for long-term, it may affect lung function. • When asthma is there for long-term, it may bring in emotions such as anger, fear, inferiority, depression and guilt. • However, you should know that asthma is not an illness which you should be guilty or scared; if you take treatment as suggested, you should be OK. Triggering factors for asthma Asthma Triggers CERTAIN MEDICATIONS COLD GASTROESOPHAGEAL VIRUSES AND (ASPIRIN, PAIN MEDICINES) AIR REFLUX DISEASE BACTERIA PET HAIR AND POLLEN DUST MITES AND DANDER MOLD Risk Factors ALLERGIC RHINITIS ATOPIC DERMATITIS SMOKING, SECONDHAND SMOKE OBESITY POLLUTION INDUSTRIAL CHEMICALS HEREDITY 2

Asthma: Symptoms and Feelings Symptoms of asthma • Symptoms of asthma vary from patient-to patient. • In addition, the severity of symptoms may vary from patient-to-patient or depending on the severity of disease pathology. • Everyone’s feeling about his condition or disease are different ; they depend on their threshold of addressing challenges. • Many patients describe their breathing as “breathing from the straw”. Asthma Symptoms CHEST TIGHTNESS SEVERE COUGHING LABORED BREATHING OR PAIN FEVER REDUCED ALERTNESS, RAPID PULSE DROWSINESS OR CONFUSION EXTREME DIFFICULTY SWEATING WHISTLING IN BREATHING PROFUSELY SOUND WHEN 3 BREATHING

Asthma attack In asthma attack, you may experience one or more of the following: • Your reliever medicine may not help you, and you may need to use the medication more often. • You get a lot of wheezing, the chest is tight, and you get a lot of cough. • You are breathless, and you may find it difficult to walk or talk. • You breathe faster, and you feel as if you are not getting enough air. • Although rare, finger tips may become blue because of non-availability of sufficient oxygen. If you get asthma attack: • Sit up straight • Take your quick relief medication • Call an ambulance to reach the hospital or arrange a transport to a nearby hospital How do you feel when you have asthma? • You may feel discouraged when you are diagnosed with asthma • With asthma, you may have difficulty doing your regular work, exercise, and it can hamper your sleep because of symptoms. • Don’t be discouraged, asthma can be kept under control with proper medication and you can have normal life, and perform you daily activities without much problem. • Asthma is not an old age disease or a childhood disease or a smokers’ disease or wrath of God; it is just a condition where immune system of your body over reacts to a trigger. • It is important not to feel guilty or stigmatised by asthma. • It is important that you educate yourself about the condition and take medicine without having any social stigma. • After all, asthma is a condition that can be managed well with regular and effective medications. 4

Correct Medication use in Asthma You are lucky, effective medicines are available Luckily, with medical advancements, we doctors know much more about asthma and its management now than ever before. Although asthma can’t be completely cured, with better drugs available today, it surely can be kept under control for life-long, and with control you can lead life like non-asthmatic people. With good asthma control, like non-asthmatic people, you can: Have freedom from Have best possible lung Do any physical activity of symptoms during day & function your choice night Can attend school/work Have fewer asthma attacks Have no or minimal almost every day side-effects of drugs Some Rules To keep your asthma under control, you have to follow some rules. Here are a few of them: Discuss with your doctor Visit your doctor regularly Take all medicines as about asthma, educate for check-up. Learn to take prescribed by the doctor. If yourself and make an you use a quick-relief inhaler medicines correctly. ask doctor if a spacer can be asthma control plan. 5 added.

Identify things that trigger Keep a watch on asthma. Learn to asthma and avoid them. identify symptoms of asthma attack so that you can take steps quickly Inhaler technique It is important that you properly use the inhaler to ensure that the drug reaches the lugs. Following is the right inhaler technique. Metered dose inhaler (MDI) Remove cap Breath out all Breath in and Hold your Slowly breath and shake the way press down on breath for a out count of 10 inhaler the inhaler Dry powder inhaler (DPI) Open the Breath Breath in Hold your Breath out Close the inhaler out deeply through breath for a count of 10 slowly inhaler the inhaler 6

Inhaler with spacer 1. Open the inhaler 2. Shake the inhaler well 3. Connect the spacer keeping the cap towards you 4. Breathe out completely 5. Put the tip of the spacer inside your mouth, press down the inhaler and breathe in 6. Hold the breath for 10 sec 7. Breathe out 8. Remove the spacer and cap the inhaler. Using rescue inhaler 1. Open the inhaler 2. Shake the inhaler well 3. Breathe out completely 4. Breathe in deeply through the inhaler 5. Hold the breath for 10 sec 6. Breathe out 7. Cap the inhaler 8. Wash your mouth. 7

Management of asthma DON’ts Lifestyle changes DO’s Do learn to handle stress and anxiety Avoid triggering factors Vacuum clean the house to completely remove Don’t smoke dust Avoid passive smoking as well Use special bedding that can avoid trigger Avoid use of NSAIDs (pain medications) if they Do wear filtration mask whenever appropriate trigger asthma To avoid dust, use impermeable or semi- Avoid exposure to animals – dander, hair or permeable covers on mattresses and pillows feather, skin, etc; better pet-proof the home Wash bed linen with hot water Avoid mold/fungus by keeping your home dry Keep windows closed to avoid pollen Avoid upholstered furniture to keep dust away Bath after coming from outside to wash off Avoid use of insecticides pollen Remove carpets, wallpaper, and woodwork which Consider air-filtration is infested with molds Be careful while exercising Maintain hygiene to avoid infections Diet in asthma Have food rich in vitamin A (Carrots, lettuce, sweet potatoes, fish, milk products, egg, etc.) and Vitamin D (fish, milk and exposure to sun), these make lungs stronger. Have diet rich in Vitamin E (Seeds, nuts and vegetables); Vitamin E fights inflammation. Have polyunsaturated (very) long-chain fatty acids such as omega-3 PUFAs linolenic acid, eicosapentaenic acid (EPA), docohexaenoic acid (DHA), and the omega-6 PUFAs, which are found to have beneficial effects in asthma. These are mainly found in sea food. Avoid saturated fatty acids such as meat, cheese, ice cream and dairy fat. They can trigger asthma and inflammation. Avoid food with medium-chain fatty acids such as coconut oil, palm oil, etc. they may trigger asthma. 8

Yoga for asthma Nadi Shodhan Kapal Bhati pranayama Ardha Matsyendrasana Pavanamuktasana pranayama (Alternate (Skull Shining Breathing (Sitting Half Spinal (Wind-Relieving pose) Twist) Nostril Breathing technique) This pose is good for technique) The Sitting Half Spinal people with asthma as it This breathing technique Twist opens the chest massages the abdominal Begin with this relaxes the mind and and improves the supply pranayama to calm energizes the nervous of oxygen to the lungs, organs and helps in system. It also clears thereby reducing the digestion and release of your mind and all the nadis (energy probability of asthma relieving the body of gas. accumulated stress. This channels) and improves restricting you. breathing technique blood circulation. has a healing effect on many respiratory and circulatory problems. Setu Bandhasana Bhujangasana (Cobra Adho Mukha Svanasana Badhakonasana (Bridge Pose) Pose) (Downward-Facing Dog (Butterfly Pose) The Bridge Pose opens The Cobra pose expands Pose) The Butterfly Pose up the chest and the chest, improves stimulates and improves lungs and reduces This asana calms the blood circulation and is mind and relieves stress the blood circulation, thyroid problem. It also highly recommended for and is suitable for people relieves fatigue, and has improves digestion and suffering from asthma a therapeutic effect on is very useful for asthma people with asthma. and sinusitis. asthma. patients. Peal flow meter Inhaler with spacer • Peak expiratory flow (PEF) is the measure of how forcefully you can blow from your lungs. • PEF helps to evaluate the extent of the airway obstruction • Peak flow meter is a simple instrument useful in measuring the functioning of your lung. • The device has a mouth piece, a cursor and a measuring scale. • PEF is useful in asthma diagnosis, to evaluate improvement, to evaluate how asthma medicines are working and to adjust the medication by your doctor. • PEF is useful for the following purposes : • For day-to-day recording of asthma severity • To evaluate progress of asthma • During an asthma attack • After taking asthma drug 9

Measuring PEFR To measure Peak Expiratory Flow Rate (PEFR), you have to do the following steps: Step 1: Set the cursor to 0 Step 2: Stand up and take a deep inhalation. Close your lips tightly around the mouth piece to ensure there is no leak. Step 3: Breathe out as hard and forcefully as you can. Step 4: Notice and record the reading (indicated by cursor) on the measuring scale. Step 5: Repeat step 1 to 3 for two more times to take best of the three readings. You have to maintain the values in a book or paper. Your doctor will interpret and tell you the findings of PEF. Asthma diary Maintaining an asthma diary helps you to keep track of your asthma control and medicines that you are taking. You can download an asthma diary from internet, take printout and maintain it. Symptoms and PEFR chart: For your doctor’s use Visit Date of Visit Symptoms PEFR value PEFR zone* 1 • Cough • Green zone 2 • Wheezing • Yellow zone • Breathlessness • Red zone 3 • Pain or pressure on chest • Difficulty in sleeping • Green zone 4 • Difficulty in physical activity • Yellow zone • Red zone • Cough • Wheezing • Green zone • Breathlessness • Yellow zone • Pain or pressure on chest • Red zone • Difficulty in sleeping • Difficulty in physical activity • Green zone • Yellow zone • Cough • Red zone • Wheezing • Breathlessness • Pain or pressure on chest • Difficulty in sleeping • Difficulty in physical activity • Cough • Wheezing • Breathlessness • Pain or pressure on chest • Difficulty in sleeping • Difficulty in physical activity * Green zone: PEF reading is in the range of 80–100% of the patient’s personal best compared with predicted value Yellow zone: PEF reading is in the range of 50–79% of the patient’s personal best compared with predicted value Red zone: PEF reading is in the range of <50% of the patient’s personal best compared with predicted value 10

Myths and Facts about Asthma Unfortunately in our country, many consider asthma as a taboo and the patients get stigmatised and guilty about the condition. There are several myths about asthma, which you should not believe. Here are some myths and facts. MYTHS FACTS Asthma is a temporary disease Asthma is a chronic disease that affects people for Inhalers are inferior to oral drugs the life; continuous treatment is essential Inhalers may be difficult to carry or use but they are more effective and safe compared to oral drugs Regular use of inhaler develops habit and No, inhaler is not addictive, and it does not effectiveness comes down become a habit; the effectiveness also does not Regular use of the inhaler makes children dull and it change slows their growth No, inhaler has no impact on growth or liveliness Inhaler medicine has a lot of side-effects of a child With use of inhaler I have to alter my food habits No, if the inhaler is properly used with proper drug and dose, most people do not develop any Asthma is curse of God side-effects Asthma is infectious and spreads from one person to No, use of inhaler has no effect on your food habit. other However, taking healthy diet will help to control Alternate medicine can cure asthma asthma Allergy testing can cure asthma No, it is a disease of abnormal immune response Asthma can’t kill a person to allergen Asthma is not infectious and it does not spread Only children can get asthma from one person to another Milk and diary products are bad as they increase No, there is no cure for asthma; it can only be mucus controlled You can’t exercise Allergy testing can identify things that you areallergic to, it can’t cure asthma An asthma attack can be very fatal and in rare cases it can kill. So one must visit the doctor ASAP in case of an attack No, asthma can happen at any age Milk or diary products do not increase mucus; like any other food, moderation is important If you have severe symptoms or asthma attack, you can’t exercise; otherwise, you can 11

Conclusion • Asthma is a condition which can be well controlled with medication and you can lead a normal life like any other person. • However, you have to take medicines as suggested by doctor, visit the doctor regularly, do yoga, do exercise, follow healthy lifestyle, follow healthy diet and keep a watch on your asthma and its symptoms. • If you do all these, there is very high possibility that you would lead a normal, active and productive life as anyone else. Disclaimer Content of this booklet is for the purpose of information only. It can’t be treated as replacement to an expert advise. Please consult a doctor/an expert before implementing any suggestions related to medicines, use of medication, diagnostic techniques, monitoring techniques, yoga, diet, or any other suggestion. The content is developed by expert writers, however, the publisher or the authors are not responsible for any errors, omissions or outcomes of any suggestions mentioned in this booklet. 12