Asthma is the predominant respiratory illness in Canada. The number of asthmatics increases each year. The causes (environmental or other) of this increase are still not clearly defined.
Today, close to 2.5 million Canadians suffer from asthma. In Quebec, it is estimated that more than 600,000 people have asthma, including over 350,000 children and adolescents.
Every year in this country, the direct and indirect costs of asthma treatment exceed the billion dollar mark. Furthermore, this disease is responsible for approximately 70,000 ER visits, 4,000 hospitalizations and, unfortunately, between 150 and 300 deaths.
Asthma is a chronic respiratory disease characterized by inflammation and (partial and reversible) obstruction of the bronchi. Because of its hypersensitivity, the respiratory tract reacts by contracting and congesting when irritated, which renders breathing difficult.
Obstruction is caused by three mechanisms:
- inflammation of the inner bronchial wall;
- contraction of the muscle fibers surrounding the bronchi (bronchoconstriction);
- overproduction of mucus (thick secretions) clogging the bronchial tubes.
This bronchial obstruction can lead to the following symptoms:
- shortness of breath;
- chest tightness;
- mucus production.
When a person experiences one or more of these symptoms, he/she is said to be having an "asthma attack". A severe asthma attack can be a terrifying experience accompanied by sensations of suffocation, shortness of breath and loss of control. As a result, poorly-treated or underestimated asthma can put a person's life in danger.
The precise causes of asthma have not been completely determined, but the disease appears to be the result of a complex interaction between several genetic (hereditary predisposition) and environmental factors.
Asthma triggers may vary from one person to the next. It is therefore important for any sufferer to identify the elements likely to lead to the appearance of symptoms.
Factors triggering asthma symptoms
- sudden temperature changes (cold air and humidity)
- tobacco smoke (also an inflammatory factor)
- strong odours (cleaning products, perfume)
- the quality of indoor and outdoor air
- workplace irritants (occupational asthma)
- colds and viral respiratory infections
Irritants cause a contraction of the respiratory tract (bronchoconstriction). Because of the irritation, the tiny muscle fibres surrounding the bronchi are stimulated, squeeze the respiratory tract and prevent air from circulating properly.
The symptoms of bronchoconstriction produced by irritants are usually immediate, short lasting and reversible thanks to the use of rescue medicine (bronchodilators).
The symptoms produced by inflammatory factors may appear more gradually. They can trigger or increase asthma symptoms over a period of several weeks, or even months, and are not as easily reversible.
Other potential triggers
- gastroesophageal reflux (stomach acid reflux)
- food and drug intolerance
- hormonal changes (during menstrual cycle, pregnancy)
- allergic rhinitis
- emotional disturbances (stress, anxiety)
- physical exercise
The consensus among specialists is that the best way to manage asthma is to actively involve patients in their treatment. While the drugs used to treat asthma are very effective, the treatment's success depends heavily on a proper understanding of the disease and a reduction of the principal triggers.
The following are the main steps leading to its optimal management:
- Quickly obtain a precise diagnosis, based on your personal history as well as on objective measurements of your respiratory function (spirometry);
- Learn to recognize and properly understand the symptoms of asthma;
- Control your environment and avoid triggering factors;
- Make sure you correctly understand how your rescue medication works, and use it as prescribed;
- Make sure you correctly understand how your daily maintenance medication works, and use it as prescribed;
- Develop a personalized action plan with your doctor;
- Regularly reassess your asthma's management by means of the required respiratory tests (spirometry, peak flow measurement, etc.).
The following are the main criteria indicating well-managed asthma:
- You experience daytime symptoms fewer than 4 times a week;
- You experience nocturnal symptoms (night-time) fewer than once a week;
- Your level of physical activity is normal;
- You are not absent from work or school because of your asthma;
- You use your rescue bronchodilator fewer than four times a week;
- Your peak flow readings are within the normal values recommended by your doctor.
How useful are respiratory tests?
The respiratory tests frequently used to diagnose and monitor asthma are spirometry and peak flow measurement. These are simple tests that measure, among other things, the maximum amount of air that you can breathe out and the rate at which you can do so.
A spirometry is performed in a doctor's office, clinic or hospital by a healthcare professional. It provides data and several measurements that can help establish a diagnosis or monitor the progression of the disease.
You can measure your own peak flow (PF) with an inexpensive and easy-to-use device. By keeping a regular record of your PF measurements, you can monitor the management of your asthma and validate the effectiveness of your medication.
People with asthma should be able to lead a normal life. To do so, there are several drugs that help manage and prevent the symptoms of asthma. The following distinguishes between drugs used in the event of an asthma attack (rescue medication) and drugs used on an everyday basis (maintenance medication).
This medication is used to relieve the immediate or acute symptoms of asthma. It is therefore taken in the event of an attack. Most rescue drugs are short-action bronchodilators. They are fast-acting (a few minutes) and serve to relax the muscle fibers surrounding the bronchi. The effects of the medication are felt for 4 to 6 hours.
This medication is taken on a regular basis. It includes long-acting bronchodilators and inhaled corticosteroids, which are used in the daily treatment of asthmatics. These two drug categories are often combined in a single device, but they can also be prescribed separately.
Long-acting bronchodilators are designed to relax the muscle fibers surrounding the bronchi. Their action lasts 12 to 24 hours. Inhaled corticosteroids on the other hand are designed to appease inflammation of the inner bronchial wall. Maintenance drugs are usually taken each day as a means of constant prevention.
Combination of inhaled corticosteroids and long-acting bronchodilators:
Over 50% of asthmatics manage their illness inadequately, although many believe they are in control. The result is observed in the form of daily symptoms, more frequent administration of rescue medication, ER consultations accompanied by frequent hospitalizations, as well as absenteeism from work or school.
Asthmatic children can exhibit a variety of symptoms, such as a persistent cough following a cold, or difficulty breathing while engaging in physical activity, running in cold temperature conditions, following exposure to an allergen. Others will develop a cough and daily shortness of breath. These symptoms can vary over the course of a day, and from one day to the next.
It is essential that you identify and eliminate the factors triggering or aggravating your child's asthma, and make his/her environment healthier. By doing so, you will improve your child's quality of life, reduce the frequency and intensity of his/her symptoms, avoid absenteeism from school and hospitalizations, while decreasing the need for medication.
Some of the factors triggering your child's asthma can be avoided, while others can be minimized by taking adequate precautions. The following are a few practical tips. Bear in mind that triggers vary from one child to the next.
- Avoid exposing your child to second-hand smoke, by not smoking. Avoid using a wood stove that produces smoke;
- Avoid exposure to irritants such as the fumes from paint, cleaners and perfumes;
- Remove carpets, dust the furniture and clean the floors with a damp cloth (to avoid raising dust);
- Avoid vacuuming or cleaning the house while the child is present;
- Eliminate mould on plants or in rooms plagued by excessive humidity or water infiltration;
- Maintain the ambient relative humidity rate between 40 and 50%. Avoid sudden humidity variances;
- Avoid feather pillows and bed covers; preferably, select bedding that is hypoallergenic and washable. Clean the bedding once a week. Cover the mattress with a waterproof fabric or a special casing;
- Avoid stuffed or woolen animals. Wash fabric toys regularly. Choose toys that are hypoallergenic or stuffed with foam rubber.
- If your child is allergic to animals, it would be wise not to have pets or birds in the house, and to avoid all contact with these. Remember that there is no such thing as a non-allergenic pet.
Physical activity and sports:
- Most asthmatic children can practice their favourite sport without restriction, as long as their asthma is properly managed. They simply have to progress at their own pace and respect their limits. If need be, children can use their bronchodilator (rescue medication) 15 minutes before their exercise, to prevent shortness of breath.
- Asthma is not caused by psychological factors, but, in certain cases, strong emotions can trigger an asthma attack. When children are angry, get them to calm down; encourage them to talk and verbalize their emotions. It is essential that children learn to manage their stress and emotions.
- Make sure your child understands his/her illness, symptoms and treatment;
- Discuss the matter with the teacher or educator: provide them with information regarding your child's illness, what triggers the latter, and the steps to take in case of an attack;
- Make sure your child always has his/her rescue medication close at hand.
The Quebec Lung Association offers toll-free telephone assistance, provided by healthcare professionals, to help people with lung diseases and their cargivers, and to answer their questions. This service is available Monday to Thursday, from 8:00 a.m. to 4:30 p.m., and Fridays, from 8:00 a.m. till noon.
The Quebec Lung Association also gives you access to extensive literature in English an French including guides and folders. Contact us for more information:
- Spirometry: a simple breathing test
- Guide Info-Asthme (disponible en français seulement)
- L’enfant asthmatique (disponible en français seulement)
- Le carnet de suivi DEP (disponible en français seulement)
- Plan d’action pour l’asthme (disponible en français seulement)
- L’asthme professionnel (disponible en français seulement)
Your generous contributions to our funding campaigns support the maintenance of these services. Bequests, commemorative donations and planned donations are also practical ways of supporting the Lung Association.
The 2015 asthma campaign was made possible thanks to the participation of AstraZeneca