Asthma Related To Sensitising Or Irritant Exposure In The Workplace
Occupational asthma has become the most common type of adult-onset asthma in many industrialised countries, having been implicated in 915% of adult-onset asthma . Two types of occupational asthma have been defined: sensitiser induced and irritant induced .
Sensitiser-induced asthma is a subtype of occupational asthma typically presenting with a latent period of exposure, followed by the onset of clinical disease. After sensitisation, airway reactions develop from levels of exposure to the sensitising agents that were tolerated before sensitisation. Although the mechanism causing occupational asthma from some sensitisers has been demonstrated to have an immunological basis , the mechanisms for some suspected sensitisers are yet to be defined. There are more than 250 agents that have been adequately documented to cause sensitiser-induced asthma . Some sensitising agents have differential effects on asthma onset depending on the dose. For example, in farmers, exposure to low-dose endotoxins and fungal spores appears to have a protective effect on the development of atopic asthma but may induce non-atopic adult-onset asthma at higher doses .
Asthma Triggers In Adults
People with asthma have airways that are more sensitive to some things that may not impact people without asthma. The things that set off or start symptoms are called triggers.
Adults with asthma are sensitive to the same kinds of triggers as younger people. However, every person with asthma has a different experience, and everyone may have a different trigger. You may have more than one trigger which flares up your asthma symptoms.
Triggers may include:
- in certain circumstances, thunderstorms.
Remember, for most people with asthma, triggers are only a problem when asthma is not well-controlled with preventer medicine.
How Is Asthma Classified
Asthma is classified into four categories based upon frequency of symptoms and objective measures, such as peak flow measurements and/or spirometry results. These categories are: mild intermittent mild persistent moderate persistent and severe persistent. Your physician will determine the severity and control of your asthma based on how frequently you have symptoms and on lung function tests. It is important to note that a person’s asthma symptoms can change from one category to another.
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How Many People Die From Asthma
- On average, ten Americans die from asthma each day. In 2019, 3,524 people died from asthma. Many of these deaths are avoidable with proper treatment and care.7
- Adults are five times more likely to die from asthma than children.7
- Women are more likely to die from asthma than men, and boys are more likely than girls.7
- Black Americans are nearly three times more likely to die from asthma than white Americans.7
At What Ages Are People Most Likely To Have Asthma
Recent figures show that young adults are the group most likely to have been diagnosed with asthma at some point in their lifetime. Between 2004-12, lifetime prevalence of asthma has declined in children and increased in adults.
Number of people per 100,000 ever diagnosed with asthma, by age group, 200412
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Is There An App For That
There are variety of mobile apps available for people with asthma. These can be a useful way to learn about and take control of your asthma, eg, they can help you keep track of your symptoms, triggers, peak flow readings and medication. You can also create an asthma action plan together with your doctor or nurse. The Health Navigator app library team has reviewed some asthma apps that you may like to consider. Read more about asthma apps.
What Do The Two Types Have In Common
Exact causes of asthma can be difficult to pinpoint. Allergies and triggers in the environment can cause asthma symptoms and an asthma flare-up, and genetics can also play a role. But the exact reasons why people develop asthma remain unclear.
Childhood asthma and adult-onset asthma share many of the same triggers. For all people with asthma, exposure to one of the following triggers may cause an asthma attack, though different people have different triggers:
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Asthma In Children And Adultswhat Are The Differences And What Can They Tell Us About Asthma
- 1Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- 2Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- 3Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
- 4Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
Key Points About Asthma In Adults
Asthma is thought to be caused by a combination of genetic and environmental factors.
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Childhood Asthma And Lung Function
Studies that have investigated the impact of childhood asthma on lung function from childhood to adolescence have found that different asthma phenotypes differentially impact long-term lung function outcomes. This is particularly relevant to longitudinal asthma phenotypes, which earlier studies attempted to identify by manually classifying the change of symptoms, but more recent studies have identified distinct longitudinal phenotypes using advanced statistical techniques such as Latent Class Analysis as mentioned above. Overall, the use of LCA has led to the identification of more asthma phenotypes and therefore has helped to better disentangle the long-term effects of childhood asthma. The majority of studies have shown that persistent wheeze is related to reduced lung function development throughout adolescence , while some suggest the effects of persistent wheeze and relapsed wheeze on lung function are established from mid-childhood, without further decline in tracking of FEV1 over time . It has also been reported that childhood asthma associated with allergic comorbidities, such as eczema and allergic rhinitis, has persistent lung function impairment from birth to adolescence as compared to asthma without such comorbidities . These findings have led to the hypothesis that asthma with atopic dermatitis and allergic rhinitis may represent a specific phenotype originating in utero .
Parental And Personal Smoking
In utero maternal smoking and parental smoking in early life has been shown to be temporally associated with increased asthma in young children . Recent evidence from multi-generational studies suggest that grandmaternal smoking while the mother is in utero and paternal smoking during his adolescence can independently increase the risk of subsequent offspring childhood asthma. These findings suggest that tobacco smoking may cause heritable modifications of the epigenome, which increase the risk of asthma in future generations .
Smoking also seems to interact with sex. Female smokers had a higher prevalence of asthma than female non-smokers, but this difference was less frequent for males, suggesting that females may be more susceptible. Many studies have found that personal smoking predisposes an individual to increased risk of incident or new-onset asthma, although smoking-onset in adolescence, or adulthood typically occurs after early-onset asthma . As non-atopic asthma becomes increasingly common compared with atopic asthma in adults, this is most likely because this phenotype frequently coincides with a substantial history of cigarette smoking and its potential to predispose to chronic airflow limitation . Smokers with asthma form a distinct group that are more likely to have suboptimal asthma control and develop asthma-COPD overlap syndrome in later life, characterized by incompletely reversed airflow obstruction following an inhaled bronchodilator .
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Management Of Acute Asthma
Asthma is a common cause of emergency department visits and hospital admissions. Hospitalizations for asthma in adults remained relatively stable from 2000 to 2010 at approximately 119 per 100,000. Interestingly, pediatric admissions from asthma declined during the same period from 165 per 100,000 to 130 per 100,000.268 The treatment of acute asthma is based on the cornerstones of chronic asthma therapy but typically requires greater attention to patient monitoring and an escalation in the aggressiveness of asthma care.
Patients with asthma exacerbations require prompt evaluation and treatment in order to limit morbidity and mortality. Goals include relief of airflow obstruction and amelioration of respiratory symptoms. Patients with milder symptoms may be evaluated in an outpatient setting but should be referred to an acute care facility if they fail to respond promptly to aggressive treatment with bronchodilators and systemic glucocorticoids.118 Conversely, certain patients are at high risk of asthma-related death and should be evaluated in the emergency department as soon as possible when their symptoms worsen. This includes patients with a history of recent exacerbation or previous near-fatal asthma, overutilization of SABAs or underutilization of ICSs, recent oral glucocorticoid use, poor compliance with asthma action plans, or concomitant psychiatric disease.270
Theresa W. Guilbert, … Robert F. LemanskeJr, in, 2010
Causes And Triggers Of Asthma
Asthma is caused by swelling of the breathing tubes that carry air in and out of the lungs. This makes the tubes highly sensitive, so they temporarily narrow.
It may happen randomly or after exposure to a trigger.
Common asthma triggers include:
- smoke, pollution and cold air
- infections like colds or flu
Identifying and avoiding your asthma triggers can help you keep your symptoms under control.
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Symptoms Like Coughing Wheezing And Feeling Breathless Could Mean You Have Asthma See Your Gp To Confirm A Diagnosis Of Asthma And Start Treatment
Find out why its important to get a diagnosis so you can start treatment for asthma, how asthma is diagnosed, and how you can take positive steps to stay symptom free after a diagnosis.
- tightness in the chest
- feeling short of breath.
Not everyone with asthma will get all of these. For example, not everyone wheezes. But if youre experiencing one or more of these symptoms, make an appointment with your GP.
Most people with well-managed asthma only have symptoms now and then. But some people have symptoms a lot of the time, particularly the small percentage of people with severe asthma.
A key thing with asthma is that symptoms come and go – you may not have them all the time.
Why its important to see your GP to confirm a diagnosis
If youve noticed asthma-like symptoms, dont ignore them. Make an appointment with your GP or an asthma nurse as soon as you can.
The quicker you get diagnosed, the quicker you can get the right medicines to help you deal with your symptoms.
After Your Asthma Diagnosis
The good news is there are lots of effective medicines available to help manage your symptoms. With the right treatment plan and good support from your GP you could stay symptom free.
Here are some things you can do straight away to get off to a good start:
Use an asthma action plan
An asthma action plan is a simple tool to help you manage your asthma well. You fill it in with your GP or asthma nurse.
It tells you exactly how to manage your asthma every day and what to do if symptoms get worse. Evidence suggests that using one means youre less likely to end up in hospital with an asthma attack.
Once you’ve got your own, personalised, asthma action plan, take it along to all your appointments to make sure its always up to date.
Know how to use your inhaler
Using an asthma inhaler can be tricky to get right even if youve been using one for some time. Make sure you start using yours in the best way from the beginning. Some inhalers are best used with a spacer.
Your GP should show you how to use your inhaler and spacer in the right way, but you can also ask the pharmacist to show you when you pick up your prescription.
We have some inhaler videos too which you can watch at home.
Go to all your asthma check-ups
When youre first diagnosed, you may need to see your GP or asthma nurse a few times to check how well your treatment is working. You can also talk about how youre coping with your asthma.
If you smoke, get support to quit
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Create An Asthma Action Plan
Both adults and children need to create an asthma action plan to outline what type of medicine they should take and when. It will also provide details for what to do when a persons asthma is dangerously out of control. These instructions will help you, your child, friends and relatives know when its time to change treatments or seek emergency care.
To make this plan, discuss your treatment options with your doctor. Plan what you should do in the event of an asthma flare-up. Define at what point you need to increase treatment measures to prevent or reduce an attack.
List what triggers can be avoided and the best ways to avoid them. Share this plan with friends, relatives, and any caregivers your children may have. Together, you will be able to successfully treat your or your childs asthma and avoid future complications.
There Are Many Different Types Of Asthma Brought On By Many Different Triggers
If youre struggling with asthma symptoms trouble breathing, a persistent cough or tightness in the chest an allergist can help you take control by providing a diagnosis and identifying the underlying causes.
Learn about the triggers and treatment for allergic asthma and how an allergist can help you manage allergy and asthma symptoms.
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Asthma Facts And Figures
Asthma causes swelling of the airways. This results in narrowing of the airways that carry air from the nose and mouth to the lungs. Allergens or irritating things entering the lungs trigger asthma symptoms. Symptoms include trouble breathing, wheezing, coughing and tightness in the chest. Asthma can be deadly.
- There is no cure for asthma, but it can be managed with proper prevention of asthma attacks and treatment.
- More Americans than ever before have asthma. It is one of this countrys most common and costly diseases.
Lab And Imaging Tests
If the symptoms are severe and abnormal breathing sounds are detected, your doctor may order blood tests to investigate whether viral pneumonia, RSV, or influenza is involved.
If a bacterial infection is suspected, a throat swab or sputum culture may be performed.
In emergency situations, pulse oximetry or an arterial blood gas test will be used to see if blood oxygen levels are low. Other pulmonary function tests may be performed to evaluate how well your lungs are functioning during and after an acute attack.
Allergen testing may be useful in diagnosing allergic asthma, but it does not necessarily exclude viral-induced asthma as a cause.
Even if a respiratory virus cannot be identified, the co-occurrence of a respiratory infection with a reduced forced expiratory volume of 20% or more is strongly suggestive of viral-induced asthma, particularly in people with well-controlled disease.
Given that viral-induced asthma is as common as it is, findings like these will often warrant treatment even if the viral culprit is not identified.
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Objective Measurements To Confirm Variable Expiratory Airflow Limitation
In a patient with typical respiratory symptoms, obtaining objective evidence of excessive variability in expiratory airflow limitation is essential to confirming the diagnosis of asthma . The greater the variations in lung function, or the more times excess variation is seen, the more likely the diagnosis is to be asthma. Spirometry is the preferred objective measure to assess for airflow limitation and excessive variability in lung function. It is recommended for all patients over 6 years of age who are able to undergo lung function testing .
Spirometry measures airflow parameters such as the forced vital capacity and the forced expiratory volume in 1 s . Lung volumes are not measured with spirometry, and instead require full pulmonary function testing. The ratio of FEV1 to FVC provides a measure of airflow obstruction. In the general population, the FEV1/FVC ratio is usually greater than 0.750.80 in adults, and 0.90 in children. Any values less than these suggest airflow limitation and support a diagnosis of asthma . Because of the variability of asthma symptoms, patients will not exhibit reversible airway obstruction at every visit and a negative spirometry result does not rule out a diagnosis of asthma. This is particularly true for children who experience symptoms predominantly with viral infections, or who are well controlled on asthma medications. Therefore, to increase sensitivity, spirometry should be repeated, particularly when patients are symptomatic .