Chronic Asthma Symptoms , Postnasal Drip , Sinus Congestion And its association of Asthma flare up

In this blog, we will see the relation of postnasal drip and associated chronic symptoms of asthma and how asthma may improve with improvement in postnasal drip.

Chronic cough is one of the important symptoms in the patient with chronic asthma in association with wheezing and shortness of breath.  More than one-third of patients with chronic asthma have associated postnasal drip and/or sinus congestion, which is present most of the days in a week.  There may be a variation in seasonal pattern where it may exacerbate more in the spring and the fall, and may be less in the summer.  Any associated infection, exposure to chemicals, dust, or perfumes may exacerbate the nasal symptoms and may further increase the need of rescue inhaler for a patient with chronic asthma.

The treatment of postnasal drip may vary from use of inhaled steroids to simple measures like Neti Pot, sinus rinse, or saline spray.  Many patients have allergies to cats, rugs, birds, pollen, etc., and avoiding the allergens may further help decrease the sinus symptoms.

Many patients have associated constipation or irregular bowel movement or may have GERD-like symptoms.  With improvement in regular bowel movement, the gastrocolic reflex decreases and thereby many chronic asthmatic patients may experience some improvement in the sinus symptoms.

The association of postnasal drip and GERD has a relation with control of asthma symptoms.  In the previous blog, the relationship of GERD symptoms and asthma has been discussed.  If one is experiencing either of these symptoms or its combination, the control of one of these symptoms may further help to control asthma. There is a significant relation between persistent postnasal drip and difficulty controlling asthma symptoms with increase need of a rescue inhaler.

Some simple breathing techniques like alternated nostril breathing, slow deep breathing exercises, and healing breath exercises may help to improve nasal symptoms and thereby improve the airflow through both nostrils, which improves the sense of well being in many asthmatic patients because of improvement of breathing.  This will further help in decreasing the chest symptoms, nighttime wheezing and cough.

In a patient with chronic asthma, if they get a sinus infection, this
needs to be treated on an urgent basis and many may require 2 to 3 weeks of
antibiotics.  Regular use of Neti Pot or sinus rinse in many patients with chronic sinus congestion may help keep the nasal passages open and thereby decrease asthma flareup.  Many factors exacerbate asthma, and nasal sinus congestion or postnasal drip is among them so by improving the symptoms it may help in controlling asthma.

Pulmonary Function Test -Understanding Its Basics

In this blog we will briefly see what the pulmonary function test is, how it can help patients with asthma and other underlying lung conditions without going into very technical details and numbers.

 The pulmonary function test is a very unique test to assess the functionality of the lung.  If the chest x-ray of the person is the anatomy of the lung then the pulmonary function test is the physiology function of the lung.  It is like an electrocardiogram (ECG) of the lung to some extent, but not fully.

 The pulmonary function test is a test where one can assess the mechanics of the lung, the lung volumes, the diffusion capacity and airway resistance.  Whether the test is normal or abnormal needs to be looked into upon comparison with the person’s age, sex, race and height.  Weight generally does not have any relation in this calculation.  The numbers that come out in the test are compared with the reference numbers based on the protocol that is used.

 The pulmonary function test has components like spirometry, which is a common part of the test, generally done in a doctor’s office to quickly assess underlying obstructive or restrictive lung disease.  Obstruction lung disease is where there is obstruction of the lung either from asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis or a combination of the disease, etc.  The restrictive lung disease is where there is restriction of the lung, meaning it has become shorter or smaller in size.  Many times it may truly not be decreased but could be from body habitus and weight gain in most patients, but in conditions like pulmonary fibrosis, the lungs may shrink and may give restrictive lung disease.  The lung volumes are generally used for assessment.  Diffusion capacity is also one of the components to see how much of the diffusion of carbon monoxide occurs.

 Generally, in the spirometry component there is forced expiratory volume in first second (FEV1), forced vital capacity (FVC) and the ratio of FEV1/FVC are the common numbers that are used.  Generally, numbers ranging between 80 and 120 predicted for FEV1 and FVC is considered normal.  This gives an idea about if someone has underlying obstruction or restriction and based on the ratio of FEV1 upon FVC. If the FEV1 and FVC are decreased and the ratio of FEV1 and FVC is normal then it has restrictive changes. It will be obstructive changes if the ratio of the FEV1 and FVC is decreased.  In lung volumes, the TLC or total lung capacity is used and generally it is also between 80 and 120% of the predicted.  When numbers are falling out of this range, generally the pulmonary function test will be read as abnormal.

 The pulmonary function test helps to assess the severity of asthma or COPD or any other underlying condition like pulmonary function test, interstitial lung disease, etc.  A smoker should consider having a pulmonary function test if not done to assess and obtain a baseline of his or her lung capacity.  When a good bronchodilator response is seen on the pulmonary function test, it generally has a relation with underlying bronchial asthma.  A pleuritic assessment of lung disease can be performed either with complete pulmonary function test or with just a spirometry component of the pulmonary function test to monitor underlying lung disease.  The person with bronchial asthma or COPD, emphysema, and is on inhalers or nebulizer if they do not have a pulmonary function test performed then they may consider having the test to assess and obtain a baseline and periodically may be performed as clinically indicated to assess the progression or stability of the disease.

 The technique of the pulmonary function test is very important and a good cooperation with a respiratory therapist is key, otherwise the pulmonary function test may be a suboptimal test as it is an effort dependent test.

For patients with asthmatic bronchitis or bronchial asthma symptoms, who are on bronchial asthma treatment and been clinically  monitored, Pulmonary function test may help the monitoring of bronchial  asthma . In patient with chronic asthma as their asthma improves  its asthma  treatment  can be monitored  periodically with the pulmonary function test. Similarly patient with Emphysema on treatment can be monitored.

 To summarize this article, a pulmonary function test is a key lung test for patients with asthma, COPD and other lung disorders to help establish a baseline and assess the progression and/or stability of the disease if done periodically.  It is an effort dependent test so it needs to be done with correct technique otherwise may give rise to false results.  A good bronchodilator response seen on the pulmonary function test may be associated with patients with bronchial asthma.  Smokers may consider having a baseline pulmonary function test if not done.

Bronchial Asthma And Its Diurnal and Seasonal Variability from Ayurveda Perspective

In this blog will look into the seasonal change and variability of the diurnal changes and  its  symptoms and exacerbation of the bronchial asthma. It is a  reversible  airway obstructive disease . Will discuss integrative pulmonary medical perspective with use of Ayurveda to understand the disease at new angle.

Bronchial asthma is the bronchoconstrive disease lung disorder  with generally  good a bronchodilator response. It is one the common disorder with about 5% of population been affected at varying degree. An improvement of 12% and more than 200ml in Force vital capacity and or First Expiratory volume in first second on Pulmonary function test suggest underlying bronchial asthma. Also if the mechacholine challenge test is done and is positive at a lower concentration in a clinically adequate picture suggest underlying bronchial asthma. This are the general diagnostic criteria for diagnosis or asthma or exclusion of the bronchial asthma.

Bronchial asthma patient have a varying degree of the symptoms based on the degree of the severity of the disorder one has, specially if they have  more than 3-5 years of the symptoms. Bronchial asthma could be related to the intrinsic asthma factors or the extrinsic  cause or combination of both with allergic symptoms affecting the  nasal and sinus passages. The common asthma symptoms are cough, wheezing, post nasal drip and the reflux symptoms.

Patient with moderate to severe persistent bronchial  asthma symptoms may see a diurnal variation in their daily symptoms and also see the variability of   the symptoms as the weather changes. With the change in the  fall to winter, winter to spring or spring to summer they have different variability of the symptoms and it s exacerbation.

Now lets look into the asthma at different angle. Looking at the angle of Ayurveda and its relation with the daily symptoms. It helps to understand the reason for the change as diurnal variable or seasonal variability.

Ayurveda or traditional  Indian medicine has documented the day divided into 3 sets of 4 hours and similarly for the night also. This change happens with the movement of the sun and so is the change in the barometric pressure in the daytime and the  night time . This will has some effect on the airway in patients with bronchial asthma and change in the wheezing, cough, shortness of breath symptoms.

Ayurveda has describe the day in the Kapha, Pitta, and Vata periods. Kapha is earth and water. Pitta is fire and water. Vata is air and space combinations.  Ayurveda describes five basic elements of the universe from which the body and mind is formed. They are the five great elements namely Space, earth, water, fire, and earth. Body is formed with this permutation and combination of this elements based on one’s on genetics. So this five elements when combined in 3 different combination sets will give rise to 3 basic change or called the Dosha in Ayurveda. So there are Kapha dosha, Pitta dosha and the Vatta dosha. This individual  dosha  again will  give rise to the 3 phases of time during the day and similarly during the night. Day time divided equally with the night time so 12 hours of day and night. As there are 3 dosha will  again divide the day and night in 3 sets again

The Kapha period ( earth + water component which increased at that time in the body  ) is 6am-10am or 6am-10pm where there is increase in flame formation and the mucus secretion. Patients generally have some respiratory symptoms at that time. The Pitta period  ( Fire+ water component increased at this time in the body) is 10am-2pm or 10pm -2am and generally  have the  increase in the acid secretion, GERD symptoms. Genrally there is  decrease in the bronchospasm at that time. Respiratory symptoms do get better generally around lunch time or around midnight  but may get worse latter.  The Vata  period ( air+ space increased at this time in the body) is 2pm-6pm or 2am-6am when the gas is more formed and passed, bronchospasm or cough may come back, person with heart problem may get chest tightness symptoms. Also the night time symptoms of use of inhalers in the middle of the night comes back.

As there is weather pattern in the nature  and it give rise to the   climate.  As discussed  above period  of Kapha, Pitta and Vatta  will give rise to the Kapha period of weather in winter time, Vata period in the spring and the fall time and Pitta period in the summer time. So the patient depending on the genetics  or the Prakruti of the person will have some phase more worse then the other. Some may have worse time in the spring but summer may not be as bad or symptoms may almost goes away. In some it comes in the fall  but winter may be ok. And in some the winter and fall is bad but spring and summer may not be as bad.

By understanding  one owns asthma symptoms if one keeps a log of the symptoms and keep a small diary and the peakflow  one can understand the pattern of the asthma. This may help as a useful guide to prevent future attacks or at least understand the sequence of events happening and more preventive measure may be taken accordingly. If one shows its pattern to their doctor may further guide accordingly.

10 Helpful Tips For Bronchial Asthma Patients This Winter Season

In this blog we will see bronchial asthma and its management aspect of the disease with asthma prevention tips. Winter months for many bronchial asthma patients is the rough time of the year, as well as for some asthma patients the spring and or fall is a tough time.  A few helpful tips may help understand the asthma disease process, understanding your asthma symptoms; plan the asthma care to prevent exacerbation of asthma symptoms.

1. Update Doctor Visit: Have a Doctor visit if not done recently this fall, especially if you have moderate to severe bronchial asthma. Get checked by your physician if not done recently to adjust your inhalers, nebulizers and medications, flu vaccination and follow the recommendations of your physician. Make sure you have enough refills on your medication.

2. Emergency Prescription: Have a prescription of antibiotic and steroid handy if you have severe persistent bronchial asthma.  Based on the severity of underlying asthma, it may be good to have a prescription of an antibiotic and prednisone handy especially if you have an exacerbation of symptoms on the holiday or weekend and doctor may not be available right away.  In mild cases discuss such plan with your doctor for medication to be called in to the pharmacy.

3. Know your medication: Understand your medications, read about the inhalers you are taking.  Know the normal dose, frequency and maximum dose allowed in 24 hours.  Know the precautions which need to be taken, like with inhaled steroids, the need to rinse the mouth after use.  Understand the side effects of the medication. This is a key of asthma management.  Report side effects if you get to your health care provider. Know your treatments of asthma that you are getting from your health care provider. Similarly the treatments for asthma that you have received before. With this understanding will help you understand your disease process. Example once you needed the tapering steroids when you were sick was given for your asthma exacerbation. If you are taking long acting bronchodilator with the inhaled steroids and it is the ongoing treatment for your asthma to control asthma symptoms.

4. Peak flow meter: Get a pick flow meter if you don’t have and do peak flow meter reading and keep a log of your peek flow.  If there is a change in your peek flows inform your health care provider. Many peak flow meters will have green, yellow and red zone and keep track of it. With the change in the zone or change in peak flow by more than 100 inform your physician.

5. Simple Precautions to take: Wash your hands frequently; this will prevent germs from passing from one person to another person. Stay away from sick people.  If you know someone is sick avoid contact with them as much as possible, as this will prevent exposure and exacerbation of the symptoms.  Cover your face when coughing.  This prevents germs being spread through the air and other people being exposed if you are sick.

6. Urgent treatment for bronchial asthma: Get urgently treated with the onset of cold symptom, bronchitis, early pneumonia symptoms. Know your asthma symptoms and especially if someone in the family feels that it has changed don’t ignore it. It needs to be controlled.    If you get cold or respiratory symptoms contact your doctor to see if an antibiotic is needed or whether a change of inhalers may be needed would be adequate or if there is a need for steroids. See plan #2 and discuss with your doctor before you get sick.

7. Bronchial Asthma education.  Learn about the disease, exacerbation factors, and prevention and how to control.  Get familiar with asthma symptoms. Night time cough is a very common symptom of asthma not under control or its onset is a good of worsening asthma clue which most people don’t think. They think of wheezing which comes later and cough is a common symptom of asthma. Need for night time use of the inhaler means that the asthma symptoms are not under control. Post nasal drip and the GERD are two other exacerbation factors of asthma that one needs to look into if it starts suddenly. Smoking cessation if one is smoking is a key for asthma control. There are no specific cures for asthma but good education and understanding the disease and how to adjust medication, drugs, exercise, few foods to avoid, good life style, good sleep and relaxation, Yoga and Pranayama may work for many to control the asthma and allergy symptoms under control.

8. Bronchial asthma and food:    Learn about the food that causes the bronchospasm, increase mucus production, increase post nasal drip or sinus congestion or sinus headaches etc. Few foods to avoid is  cold water or ice water or  cold drinks or ice drinks or anything that is cold and not at room temperature as it produces slow bronchospasm and increase mucus formation and slows the digestion. Unfortunately chocolate which tastes so good is not good for asthma it increases bronchospasm. Foods like banana, milk products, tomatoes, potatoes, eggplant etc. increase mucus formation. Avoid them if possible.

9. Plan the emergency care: Think what you or your family will do if your asthma flares up? Make a plan now. What if the flare up is mild will you call your doctor and be seen? If it is moderate then will you go to the Emergency room to get treated right away? What if you cannot breath will you call 911? Who will call 911? Who will inform EMS or emergency medical service personal about the medical condition and the medication that you are taking. Plan the care and take care of asthma. By this there is no last minute panic in the family.

10. Learn Ayurveda and or other alternative medical prevention options:  Prevention is better than the cure is the old say in English. Many asthma patients are looking for a prevention aspect and cannot find that works. Ayurveda is the science of healthy living and is the traditional Indian medical science. Ayurveda is oldest medical science which has documented the asthma and its causes and prevention and treatment.  Bronchial asthma is a long term disease for many people.  If one is interested by slowly learning natural ways to control it may decrease long term use of medication and side effects of the drugs and improve quality of life. Use the medicines and inhalers under guidance of the doctor but as asthma improves the dose could be decreased or minimized or discontinued gradually. Or only need for the rescue inhaler is needed. One should know that if more than 2 albuterol inhaler canisters use in one calendar year means that asthma is not under control.  Make a short term and long term plan for asthma improvement.  By understanding your own body your mind and emotion is a key to improve health and Ayurveda helps to provide this insight.  Learn your body type, imbalance of the energy in the body, toxin built up, body type food, all this are referenced in Ayurveda. What we eat is what we are is the old say and it is true. As food has effect on our health and so is the effect on asthma symptoms. Ayurveda has a great insight for prevention of asthma. If one is interested in learning more than one may learn  appropriate Ayurveda diet based on the one’s Prakruti ( genetics) and Vikruti ( imbalance or toxins in the body). Good book to start is Ayurvedic Cooking for Self-Healing by Usha Lad, Vasant Lad.

Coordinate care with your physician and do regular follow up. No asthma care improves without multimodalities management like medication, inhalers, diet, exercise, sleep, relaxation, social support, and off course good guidance and monitoring of health care professional. Good luck and best wishes…