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.

ASTHMA ACTION PLAN

In this blog we will briefly review the asthma action plan or different techniques one may use to control and manage asthma, better understand one’s own health with goal of prevention of asthma attack thereby helping control of asthma, decreasing need for medications, and decreasing exacerbation of asthma.  This blog gives a general guideline and one may want to talk to their physician to better understand and coordinate the plan.

Also, different asthma action plans can be found on line for further developing your own plan and coordinate with the family member in case of an emergency on how it needs to be tackled.

  1. Understanding ones own asthma. Have a clear picture from a physician whether the asthma is mild, moderate or severe. Understand the use of medications an correct inhaler technique. Know the difference between a maintenance inhaler and rescue inhaler or nebulizer. How frequently it can be used and what is the maximum dose in 24 hours. Are there other associated conditions with asthma that have been triggered such as postnasal drip, heartburn, etc.
  1. Understand which inhalers your physician has recommended, and what is the regular dose. Is it twice a day? Is it once a day? Or, does it need to be used every 4 hours as needed? For example, Advair Diskus, Symbicort inhaler, Dulera inhaler are twice a day inhalers, but Albuterol inhaler as a rescue can be used every 4 to 6 hours if needed. Singular may be a once a day medication. Rinsing the mouth afte  the use of inhalers may help in preventing oral thrush.
  1. Family plan. Have a documented family plan with the family members if the asthma
    gets worse, and how it should be tackled. In mild situations, the primary care can be contacted.  How will moderate to severe asthma  situations be tackled? Through primary care or the Emergency Room?  Have this be clear with the primary care and family members, and what are the steps that can be taken to prevent an  Emergency Room visit.
  1. Prevention of exacerbation of asthma. Find out different triggers that have been exacerbating the symptoms like allergies, increasing the dripping and asthma symptoms, wheezing, smoking, smoke exposure directly or indirectly.  If one is smoking then he/she needs to quit and at the same time prevent second hand smoke exposure, perfumes, cologne, etc., one needs to avoid this contact.  If someone is working with dust or chemicals use a mask to prevent or to avoid symptoms altogether to avoid this kind of work exposure.
  1. Peak flow meter. One may want to have a peak flow meter, which may have a green, yellow and red zone.  Monitoring the peak flow may help to understand the severity of asthma and once there is  change in the color may contact primary care.  Example: A person with a peak flow in the green zone and if changes to
    yellow zone may be a sign to contact a primary care.
  1. Asthma education. Obtain asthma education through the primary care, other sources like the internet, and educational books and material that provide a basic
    education for asthma.  Also, there  are foods that may trigger bronchospasm like yogurt, dairy products, cold water,  cold drinks, cola, chocholate  etc., which may be avoided. Fruits like bananas may trigger asthma or nasal congestion symptoms  in many that may want to be avoided. Speak to your doctor about a change in diet before making any  dietary changes.
  1. Log of symptoms, inhalers. Keep a regular log of symptoms like wheezing, coughing, postnasal drip, gastroesophageal reflux disease, sleep symptoms one has and how frequent they are. Also, get input from the family members as many times the one coughing is not aware about the coughing, but the family member is aware. Also, keep a regular log of use of rescue inhaler and review with the primary care or  your lung doctor if you have one.
  1. Sleep symptoms. Are asthma symptoms waking you up at night? How frequent is
    it? Is there nighttime use of inhalers? Are you coughing and wheezing? As asthma improves, the symptoms should  resolve and one should be able to sleep regularly.
  1. Exercise. Regular exercise further helps to control asthma. If someone has exercise-induced asthma, may use a rescue inhaler prior to that. Before you start an  exercise program, check with your primary care.
  1. Pranayama / yoga. Many breathing exercises such as slow deep breathing, alternated nostril breathing if done correctly over a period or time may further
    decrease bronchospasm. If one is interested, he/she may learn many of the simple yoga exercises and by doing it may further help control asthma symptoms along with good sleep, regular exercise, avoiding the triggers of asthma, and remaining vigilant  about the symptoms and its prevention.

11.    Acute infection: In the event of an acute respiratory tract infection, see your primary           care on an urgent basis or if there is an increase in severe symptoms call 9-1-1 or go          to the nearest Emergency Room.

This is a general action plan or something similar one may develop. There are many different states which provide an asthma action plan or one may visit the Center of Disease Control Intervention website for different asthma plan and do ones own research.  This is a general guideline that we have seen that has helped our patients and have found
useful. Please contact your primary care or your pulmonologist and review the asthma plan with your healthcare provider and make appropriate changes as they recommend.
I hope some of these simple measures as stated above help your asthma or someone you may share this information.

Best wishes!

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.