The Profound Impact of Asthma: Understanding Triggers and The Importance of Physiotherapy in Asthma Management
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on JANUARY 19, 2024
The profound impact of asthma, a condition affecting over 2.7 million Australians, more than 11% of the population, has raised pressing public health concerns (Australian Bureau of Statistics, 2018). Contemporary research underscores the vital role of early diagnosis and appropriate treatment in managing this chronic respiratory condition, leading to improved patient outcomes and quality of life (Global Initiative for Asthma, 2022).
Additionally, an emerging body of research emphasises the importance of physiotherapy in asthma management. As demonstrated by Cordova-Rivera et al. (2018), physiotherapy interventions can assist with symptom control, promote lung function, and enhance exercise capacity. This growing body of evidence demands more than just our attention; it calls for us to transcend traditional medical treatments for asthma and wholeheartedly embrace a multidisciplinary approach.
Keilor Road Physiotherapy believes that physiotherapy, with its proven efficacy in controlling symptoms and enhancing lung function, can occupy a more central role in asthma management strategies. The promise of a higher quality of life for those affected by asthma lies in this broader, more inclusive approach. As healthcare professionals, we're tasked with making this promise a reality, leveraging contemporary research, integrating emerging practices, and shaping a future where asthma's impacts are effectively mitigated. Because, at the end of the day, it isn't just about managing a condition—it's about enabling those affected by it to breathe easier and live fuller, healthier lives.
What Is Asthma?
Asthma is a chronic inflammatory disease of the respiratory system, characterised by episodic, reversible bronchial obstruction (Global Initiative for Asthma, 2022). It is a complex condition that involves various cells and cellular components, resulting in symptoms such as wheezing, shortness of breath, chest tightness, and coughing.
The respiratory system is meticulously designed for gas exchange. Key structures include the bronchi and bronchioles, airway tubes that facilitate the passage of air into and out of the lungs. In people with asthma, these airways' lining becomes inflamed and swollen. This inflammation leads to an increased sensitivity to various triggers, such as allergens, cold air, exercise, or emotional stress, causing a bronchospasm - a constriction of the muscles surrounding the airways (British Thoracic Society, 2019).
Over time, chronic inflammation can induce permanent changes in the airway, known as "airway remodelling". This process can exacerbate the severity and chronic nature of asthma (Holgate, 2011). Understanding the intricate pathophysiology of asthma is essential, as it forms the foundation of our strategies to manage and control this condition. As we expand our knowledge, we equip ourselves to effectively combat this widespread disease, thereby enhancing patient outcomes and improving quality of life.
Causes and Triggers of Asthma attacks
Asthma triggers vary widely among individuals and understanding them is paramount to effective disease management.
Common triggers includes:
allergens
environmental factors
respiratory infections
physical exertion
certain medications
Allergens such as pollen, dust mites, and pet dander can prompt an immune response leading to airway inflammation and subsequently trigger an asthma episode (Dharmage et al., 2019). Environmental pollutants, such as tobacco smoke and air pollution, can similarly cause inflammatory responses, aggravating asthma symptoms (Kim et al., 2021).
Respiratory infections, particularly those viral in nature, can cause an acute increase in airway inflammation and exacerbate asthma symptoms (Busse et al., 2010). Physical exertion, known as exercise-induced bronchoconstriction, can lead to transient narrowing of the airways, triggering an asthma attack (Weiler et al., 2016). Additionally, certain medications, including aspirin and non-steroidal anti-inflammatory drugs, can induce asthma symptoms in some individuals (Kowalski et al., 2017).
Individual triggers and their impacts can be minimised through strategic measures, informed by the latest scientific research. For example, allergens such as pollen, dust mites, and pet dander, can be managed through various environmental control strategies. These include the use of air purifiers and hypoallergenic bedding, which have been shown to reduce allergen concentrations and associated asthma symptoms (Sublett, 2011). Additionally, regular cleaning, particularly in the bedroom, can reduce exposure to dust mites (Matsui et al., 2017).
For exercise-induced bronchoconstriction, tailored exercise regimes, combined with pre-exercise medication such as short-acting beta-agonists, have proven effective (Parsons et al., 2013).
Lastly, asthma patients with sensitivity to aspirin and non-steroidal anti-inflammatory drugs can opt for alternative pain relievers like paracetamol, under medical guidance (Kowalski et al., 2019).
Adopting individualised strategies based on the identification of triggers can substantially reduce asthma symptoms and enhance overall asthma control, thereby improving the quality of life for those affected.
Symptoms of Asthma attacks
The clinical manifestations of asthma can range from mild to severe and vary between individuals. The typical symptoms include wheezing, coughing—particularly at night or during exercise, shortness of breath, and chest tightness (Global Initiative for Asthma, 2022).
An asthma attack, or an exacerbation, is a period of heightened symptoms, often triggered by exposure to allergens or irritants, infections, or significant physical activity. During an attack, inflammation and constriction of the airways intensify, leading to increased difficulty breathing, persistent coughing, severe wheezing, and an escalating feeling of tightness in the chest (Barnes, 2019).
Recognising the signs of an impending asthma attack is crucial, as immediate intervention can prevent a severe exacerbation and reduce the need for emergency medical care. Quick-relief medications, such as short-acting beta-agonists, can help relax the muscles around the airways, offering immediate but temporary relief (National Asthma Council Australia, 2020).
Understanding these symptoms and the nature of asthma attacks underscores the importance of maintaining an updated and personalised asthma action plan, allowing for prompt and effective management of this chronic condition. Modern research continues to guide our approach, with the goal of empowering those with asthma to live with minimal disruption and maximum wellbeing.
Diagnostics and Treatment Options for Asthma
The journey to an asthma diagnosis is comprehensive, beginning with a detailed medical history, progressing to physical examinations, and often incorporating diagnostic tests. A patient's medical history provides essential context, detailing the frequency and pattern of symptoms, any family history of asthma or allergies, and how the individual has previously responded to asthma medication. The physical examination may reveal signs of asthma or rule out other conditions. In many cases, lung function tests such as spirometry are employed to quantitatively assess the degree of airway obstruction (Pellegrino et al., 2005). Spirometry measures the volume and speed of air that a patient can exhale, offering crucial insights into their respiratory health. In addition, allergy tests may be conducted to identify specific triggers that may be exacerbating the asthma symptoms. This multi-faceted approach ensures a thorough and accurate diagnosis, paving the way for an effective treatment plan, including the use of medications.
Asthma medications are generally divided into two categories: relievers and preventers.
Relievers, such as short-acting bronchodilators, provide immediate relief of acute symptoms by relaxing the muscles around the airways (O'Byrne et al., 2017).
Preventers, including inhaled corticosteroids, work over time to reduce inflammation, thus preventing the onset of symptoms and reducing the frequency of exacerbations (Normansell et al., 2017).
Given the variable nature of asthma, an individualised treatment plan, tailored to the patient's specific needs and severity of asthma, is essential. This often includes a combination of medication, avoidance of triggers, and self-monitoring of symptoms.
New advances and insights into the pathophysiology of asthma continue to shape the diagnostic process and the evolution of therapeutic strategies, aiding healthcare providers in delivering personalised and effective management plans for people with asthma.
The Role of Physiotherapy in Asthma Management
Physiotherapy plays a pivotal role in asthma management, with specialised clinics like Keilor Road Physiotherapy providing targeted interventions for patients. These interventions often include guided exercise regimes and breathing techniques tailored to the individual's abilities and needs.
Exercise has numerous benefits for people with asthma. A personalised exercise plan, tailored to the individual's fitness level, severity of asthma, and personal preferences can improve lung function, reduce the frequency and severity of symptoms, and boost overall fitness levels (Carson et al., 2013). Moreover, controlled exercise can reduce the hyperreactivity of airways, making them less likely to constrict in response to triggers (Eichenberger et al., 2013). The goal is to incorporate a variety of aerobic activities that enhance cardiovascular fitness without triggering asthma symptoms. These activities can range from low-impact exercises such as walking and yoga, to more vigorous activities like swimming, provided they are well-tolerated by the individual (Carson et al., 2013).
Keilor Road Physiotherapy’s role is crucial in monitoring the patient's response to exercise, adjusting the plan as needed, and teaching the individual how to manage their asthma symptoms during physical activity. By incorporating strategies like warming up before exercise and cooling down afterwards, along with the judicious use of pre-exercise medication, we can help individuals with asthma to safely engage in and enjoy physical activity.
Breathing exercises like the Buteyko technique can also help manage asthma symptoms, reducing reliance on medication (Burgess et al., 2011). The Buteyko technique is a breathing method developed by Ukrainian physiologist Konstantin Buteyko. This technique emphasises nasal breathing and encourages shallow breathing or reduced breathing, which can help manage symptoms of asthma. By training individuals to voluntarily reduce their breath volume, this approach can potentially reduce hyperventilation, leading to less bronchoconstriction and decreased asthma symptoms (Burgess et al., 2011).
By engaging with established physiotherapy practices like Keilor Road Physiotherapy, patients are afforded expert guidance, offering the best chance to optimise their asthma management through carefully curated, evidence-based exercise regimes and breathing techniques.
Breathing Techniques for Asthma Control
Breathing techniques have long been recognised as a potent tool in managing asthma, with evidence indicating that techniques like the Buteyko technique, diaphragmatic breathing, pursed lip breathing, and controlled breathing exercises can significantly reduce asthma symptoms and foster relaxation (Thomas et al., 2018).
Breathing exercises like the Buteyko technique help manage asthma symptoms, reducing reliance on medication (Burgess et al., 2011). The Buteyko technique is a breathing method developed by Ukrainian physiologist Konstantin Buteyko. This technique emphasises nasal breathing and encourages shallow breathing or reduced breathing, which can help manage symptoms of asthma. By training individuals to voluntarily reduce their breath volume, this approach can potentially reduce hyperventilation, leading to less bronchoconstriction and decreased asthma symptoms (Burgess et al., 2011).
Diaphragmatic breathing is another technique which encourages deeper breaths by engaging the diaphragm, potentially leading to enhanced lung ventilation and better oxygen exchange. Pursed lip breathing involves inhaling through the nose and exhaling slowly through pursed lips, which can reduce breathlessness by slowing the breathing rate and aiding in the release of trapped air in the lungs. Controlled breathing exercises promote slower and more relaxed breathing, which can help manage symptoms during an asthma attack and improve overall respiratory muscle control (Holland et al., 2012).
Practising these techniques involves a few key steps.
For diaphragmatic breathing,
One can lie down or sit comfortably,
Place a hand on the abdomen,
Inhale slowly through the nose, and
Observe the abdomen rise.
Exhale slowly, noticing the abdomen fall.
For pursed lip breathing,
Inhale slowly through the nose,
Then exhale slowly through pursed lips, taking twice as long to exhale as to inhale.
Controlled breathing exercises often involve slowing the breath, focusing on exhaling completely, and using breath-holding techniques.
Keilor Road Physiotherapy offers expert guidance in learning and mastering these techniques. Regular practice, ideally under the supervision of a trained physiotherapist, can significantly improve one's ability to manage asthma symptoms, improve overall breathing patterns, and enhance quality of life.
Prevention and Lifestyle Tips
Managing asthma requires a comprehensive approach, encompassing a range of preventative measures and lifestyle adjustments. Ensuring good indoor air quality can help reduce exposure to common triggers like dust mites, pet dander, and mould (Nurmatov et al., 2015). Measures like using air purifiers, vacuuming regularly, and maintaining a clean home can all contribute to healthier indoor air.
Avoiding smoke exposure, including passive smoking and exposure to wood-burning stoves or open fires, is crucial as smoke can exacerbate asthma symptoms (Stølevik et al., 2012). Managing allergies, particularly for those with allergic asthma, is essential. This can involve avoiding known allergens, using appropriate medications, or undergoing immunotherapy.
Adherence to an asthma action plan, a written plan developed with a healthcare provider, can be instrumental in preventing exacerbations and managing symptoms when they occur. This plan often includes information about when to use certain medications or when to seek medical help.
Regular asthma check-ups are vital for monitoring the condition's progression, ensuring medication effectiveness, and reinforcing proper inhaler technique. Adherence to prescribed medication, even when symptoms are absent, is key to controlling inflammation and preventing severe attacks (McDonald et al., 2018).
A healthy lifestyle plays a significant role in asthma management. A balanced diet, rich in fruits and vegetables, can provide the necessary nutrients for immune function and lung health. Regular exercise, guided by physiotherapy practices like Keilor Road Physiotherapy, can improve lung function and general health. Adequate rest, stress management techniques, and regular practice of relaxation exercises can also improve the overall control of asthma.
Conclusion
Asthma is a complex and multifaceted condition, impacting millions of Australians. This article has underscored the importance of understanding the nature of asthma, its triggers, symptoms, diagnostic processes, and treatment options. Knowledge empowers individuals to actively participate in their own care, resulting in improved disease management.
The management of asthma is incredibly diverse. Regular check-ups, adherence to medication, and the significance of a personalised asthma action plan cannot be understated. Additionally, we have highlighted how crucial lifestyle changes and preventative measures, such as maintaining good indoor air quality, managing allergies, and following a healthy lifestyle, can significantly reduce asthma symptoms and exacerbations.
The valuable role of physiotherapy has also been highlighted. Keilor Road Physiotherapy use a combination of tailored exercise regimes, breathing techniques like the Buteyko method, diaphragmatic breathing, and controlled breathing exercises which has been proven to vastly improve lung function, reduce symptoms, and enhance overall quality of life.
While asthma is a chronic condition, it need not hamper the quality of one's life. With the right knowledge, proactive management, and the integration of physiotherapy techniques, individuals with asthma can control their condition effectively. Leading an active, fulfilling life, unrestricted by respiratory health, is a fully achievable aspiration for asthma sufferers. Through understanding and managing asthma proficiently, we can transform this chronic condition into a manageable aspect of life.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.