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.

Chronic Asthma Management and Use of Peak Flow Meter

In this blog we will look into the peak flow meter, and its use and management of bronchial asthma.

A peak flow meter is a very good simple device that a patient with bronchial asthma may use for management of bronchial asthma to check the variability of airway responsiveness.

There is a predicted peak flow based on age, height, sex, and race which one may need to know. Obtain the predicted peak flow calculation through your healthcare provider or you can search on line for the formula.  It is a general number for a guideline and may have some variations but it will be a good gauge to understand a person’s peak flow.

Generally, the variation is less than 20%.  In patients with mild, intermittent asthma the peak flow is generally more than 80% of the predicted and the variation should be less than 20%.

The patient with asthma symptoms or experiencing acute on chronic asthmatic bronchitis may experience an increase in peak flow variation during the acute phase and should stabilize to the baseline.  Generally, with mild intermittent asthma, the peak flow variation is less than 20%.

With mild persistent asthma, patients will have an increase in severity of asthma where they tend to have symptoms more than two times at night in a month and about twice a week.  Although the predicted peak flow is greater than 80%, they may experience a peak flow variability of 20-30%.

For example, if a 35-year-old gentleman with a height of 5 feet 6 inches has a peak flow of 512 liters per minute, the 20% variation would be a peak flow range between 400 to 600 liters per minute.  If it goes less than 400 liters per minute, it should be considered increased variability.

Also, there are some peak flows which are color coded with a green zone, a yellow zone and a red zone.  This makes it a little simpler for people to follow.  As long as they stay within the green zone, they should be okay; but once they change to the yellow zone, this may suggest increase bronchospasm, increase mucus formation or start of early infection, etc.  One needs to contact the healthcare provider as it could be an early sign of asthma flare up.

The peak flow can help in asthma exacerbation prevention by monitoring very closely before it becomes worse.  Patients with chronic asthma will find it helpful.

If the patient has bronchial asthma but also has associated chronic pulmonary disease, the variation in the peak flow may not be as much especially if one is a smoker.

In patients with moderate persistent asthma, the peak flow variability may be more than 30%.

This would be someone who has daily symptoms and uses a rescue inhaler at least twice a week or more and has a one-time nighttime symptom in a month.  Also, patients with severe persistent asthma may have daily symptoms and frequent nighttime symptoms.  The peak flow generally varies less than 60% of the predicted, and has increase variability to more than 30% in a day from a baseline.

As asthma improves with treatment, the variability may change and should become less than 20% with decrease in the need of rescue inhaler.  Monitoring acute infections, avoiding drugs that produce bronchospasm,  eliminating foods that increase mucus formation, and avoiding external factors that increase bronchospasm in conjunction with the standard treatment with inhalers and medication may further help chronic bronchial asthma treatment and management with monitoring of one’s own peak flow and keeping a log on a regular basis.  This log may also help provide a chance for the healthcare professional to review the change and make adjustments in medications as needed and the person to better understand their own underlying asthma and its variability.  A simple peak flow meter can give a lot of insight into one’s own bronchospasm and its management.

For more information on peakflow you can visit the following website.

http://www.lung.org/lung-disease/asthma/living-with-asthma/take-control-of-your-asthma/measuring-your-peak-flow-rate.html

If anyone interested in joining the asthma program please free to contact us  at info@asthma-copd-care.com or call at 717-338-9797
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.