Asthma: Symptoms, Diagnosis and Treatment

What is asthma?

Asthma is a long-term condition in which the airways become inflamed, swollen and over-sensitive. When an irritant or allergen is inhaled, the muscle around the airway tightens and the lining produces extra mucus, so the passage narrows and breathing becomes difficult. This narrowing is largely reversible, which separates asthma from most other chronic lung diseases: with the right treatment, lung function returns to normal or near normal between episodes.

Asthma is common across all age groups in Hyderabad. Urban air pollution, seasonal pollen, indoor humidity that favours house dust mite, and construction dust in corridors such as the Financial District and Gachibowli all add to the burden. Many adults who assume they have recurrent bronchitis in fact have undiagnosed asthma that has never been formally tested.

The most important message for patients is that asthma is controllable. A person with well-controlled asthma should sleep through the night, exercise, work and travel without limitation, and should rarely need a reliever inhaler. Poor control is a signal that the diagnosis, the inhaler technique, the dose or the trigger exposure needs review.

Symptoms of asthma

Asthma symptoms typically come and go, vary in intensity, and are often worse at night or in the early hours of the morning. The four classic symptoms are:

• Wheezing: a whistling or musical sound on breathing out, sometimes noticed by family members before the patient notices it.
• Shortness of breath: particularly on exertion, on climbing stairs, or during a viral cold.
• Chest tightness: a band-like or heavy sensation across the chest that patients frequently mistake for a cardiac problem.
• Cough: usually dry and persistent. In cough-variant asthma, cough is the only symptom and there is no audible wheeze at all, which is a common reason for delayed diagnosis.

Patterns that point towards asthma

Symptoms that worsen at night, after laughing or exercising, or after exposure to cold air, dust, smoke or paint fumes suggest asthma, as do symptoms that flare in a particular season. Rapid improvement after a salbutamol inhaler is another clue. Childhood eczema, allergic rhinitis or a family history of allergy raise the likelihood further.

Signs that asthma is not controlled

Needing a reliever inhaler more than twice a week, waking at night because of breathlessness or cough, limiting exercise or household activity, or having needed oral steroids or a hospital visit in the past year all indicate poorly controlled asthma that needs a treatment review.

Common triggers and risk factors

Identifying and reducing personal triggers matters as much as the medication itself. Common triggers in this region include house dust mite in bedding and upholstery, mould in damp walls, grass and tree pollen, smoke from cigarettes, incense sticks, mosquito coils and kitchen fires, traffic pollution, cold air, strong scents and cleaning chemicals, and pet dander.

Non-allergic triggers matter too. Viral respiratory infections are the commonest cause of asthma attacks in children and adults alike. Exercise, emotional stress, reflux, obesity, untreated allergic rhinitis or sinusitis, and drugs such as aspirin, other non-steroidal anti-inflammatory drugs and beta-blockers can all worsen asthma. Occupational exposure to flour, isocyanates, wood dust or solvents can cause work-related asthma that improves during holidays.

How asthma is diagnosed

Asthma should not be diagnosed on symptoms alone. A structured assessment confirms the diagnosis, excludes conditions that mimic it, and establishes a baseline against which treatment can be measured.

Clinical assessment

The consultation begins with a detailed symptom history: pattern, timing, triggers, response to previous inhalers, allergy history, home and workplace environment, and family history. Examination assesses the chest, the upper airway and the nose, since rhinitis and asthma very often coexist.

Spirometry with reversibility testing

Spirometry is the cornerstone test. The patient breathes forcefully into a machine that measures how much air can be exhaled and how quickly. An obstructive pattern with significant improvement in FEV1 after an inhaled bronchodilator confirms reversible airflow limitation, the hallmark of asthma. It is painless and is repeated at follow-up to track control objectively.

Additional tests where needed

Conditions that imitate asthma and must be considered include COPD, vocal cord dysfunction, post-nasal drip, reflux, bronchiectasis, heart failure and airway damage after tuberculosis.

Asthma treatment

Modern asthma treatment is built on inhaled anti-inflammatory therapy rather than on reliever inhalers. Current guidance recommends that every adult and adolescent with asthma receives inhaled corticosteroid-containing treatment, and that salbutamol-only treatment is no longer acceptable, because it relieves the spasm without treating the inflammation beneath it.

Controller therapy

An inhaled corticosteroid, alone or with a long-acting bronchodilator, is taken daily to suppress airway inflammation. Combination inhalers containing budesonide with formoterol can serve as both maintenance and reliever in one device, which simplifies treatment and reduces severe attacks. Doses are stepped up until control is achieved, then stepped down to the lowest effective dose.

Add-on treatments

A long-acting antimuscarinic inhaler, a leukotriene receptor antagonist, or treatment of coexisting allergic rhinitis and reflux may be added when control remains incomplete. Allergen immunotherapy is considered in selected patients with clear, single-allergen sensitisation.

Inhaler technique and adherence

A large proportion of difficult asthma is in fact incorrect inhaler use. Technique is checked and re-taught at every visit, a spacer is prescribed where appropriate, and the device is matched to what the patient can use reliably. Adherence is discussed openly, since many patients stop preventer inhalers as soon as they feel well.

Written asthma action plan

Every patient should leave the clinic with a written plan stating the daily medication, how to recognise worsening, what to increase and when, and when to seek emergency care. Vaccination against influenza and pneumococcal disease, weight management, smoking cessation and graded exercise complete the plan.

Severe and difficult-to-treat asthma

A small proportion of patients remain symptomatic despite high-dose inhaled therapy taken correctly. They need assessment for alternative diagnoses, ongoing trigger exposure and inflammatory phenotyping. Where eosinophilic or allergic inflammation persists, biologic therapies directed against IgE, interleukin-5 or the interleukin-4 receptor substantially reduce attacks and the need for oral steroids. Long-term oral corticosteroids risk diabetes, osteoporosis, cataract and adrenal suppression, and should be a last resort.

When to seek urgent care

Seek emergency medical attention immediately if there is breathlessness at rest or difficulty completing a sentence, a reliever inhaler that gives little or no relief or is needed every one to two hours, blue lips or fingertips, drowsiness or confusion, or a peak flow reading below half the personal best. Asthma deaths are almost always preventable, and most follow a period of worsening symptoms that was not acted upon.

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