Clinical FeaturesRespiratory

Can Asthma be Prevented?

Written by Written by Tatiana Larmak – http://orcid. org/0000-0001-5371-2958.
Lecturer of the Department of Advanced Training of Junior Medical Specialists at the Municipal Health Care Institution ‘Kharkiv Regional Medical Vocational College’, Kharkiv, Ukraine. An independent trainer, consultant to medical facilities and non-medical facilities to instruct medical staff on how to safely provide services to patients/clients. Corresponding Author details:

“Prevention is so much better than healing because it saves the labor of being sick.” Tom Adams

The pulmonary system has been studied since antiquity. For the first time, bronchial asthma was mentioned in Homer’s “Iliad”, in which one of the characters, the doctor Machaon, periodically suffered from asthma attacks. Herodotus believed that there is a relationship between asthma attacks and the seasons of the year. Hippocrates in his work “Corpus Hippocraticum” described a disease of the respiratory tract with chronic attacks of suffocation and viscous sputum and called it “asthma”. Also, Hippocrates introduced the term orthopnea (orthopnoea; Greek orthos straight, vertical + pnoē breathing) – the forced position of a person sitting or standing to facilitate breathing in a difficult prone position. Hippocrates called cold and dampness to be the cause of orthopnea. Areteus of Cappadocia, an ancient physician and philosopher, in his essay “The Causes and Symptoms of Acute and Chronic Diseases”, described orthopnea as a disease which occurs when inhaling moist cold air and attributed it to the lung diseases. Galen, Avicenna, the ancient Indian doctors also majorly contributed to the study of asthma. The English physician John Floyer, in his “Treatise of the Asthma” (1698), noted: “I have assign’ d the immediate Cause of the Asthma, to the Straitness, Compression, or Constriction of the Bronchia…” Floyer himself suffered from asthma. His research is still relevant and is of interest in the study of bronchial asthma. In the middle of the 18th century, German scientists Kurshman and Leiden singled out asthma as a separate disease. In 1860, Henry Hyde Salter, a physician at the Charing Cross Hospital in London, in his Treatise On Asthma: Its Pathology and Treatment, described “a peculiar paroxysmal character of dyspnea with intervals of healthy breathing between attacks” and suggested that asthma is allergic in nature and can give hyperreactivity to the cold air.

Scientists from all over the world have been studying bronchial asthma. In recent decades, bronchial asthma (BA) has been one of the most common chronic diseases, especially among children. It ranks 5th after the diseases of the cardiovascular system, oncology and diabetes. The reasons for the rapid increase in the incidence of bronchial asthma, scientists believe are the deterioration of the environment across the globe, especially in large cities. Asthma affects more than 300 million (about 6-7% of children and 3-4% of adults) people in the world, and by 2025 the number may increase up to 400 million or more. The number of patients suffering from asthma increases by 1.5 times every 10 years. Asthma can lead to disability which significantly reduces the quality of life and also causes great economic and social damage to countries. More than 180,000 people die from asthma every year in the world; and there is a negative trend in mortality, especially in countries with low living standards, where detection and treatment are insufficiently provided. People can get sick with asthma, regardless of age, profession, country, nationality or race (WHO data).

Such international programs as International Study Asthma and Allergies in Childhood (ISAAC) and the European Community Respiratory Health Survey (ECRHS) have been studying asthma. The ECRHS, conducted in 56 countries among children and in 22 countries among adults, found that the prevalence of asthma depends on climate and geography: higher in Englishspeaking countries – the UK, Ireland, USA and lower in the Mediterranean and Eastern European countries; the frequency of manifestations varies which is associated with environmental factors. In addition, the prevalence of asthma in highly developed countries is higher among urban residents than among the rural residents. Studies by American scientists at George Washington University have shown that the atmospheric air of megacities is heavily polluted with car exhaust gases which annually provokes the incidence of bronchial asthma in the world. In recent years, there has been a tendency to increase and spread the incidence of bronchial asthma.

Bronchial asthma is a noninfectious chronic inflammatory disease, allergic in nature and genetically (hereditary) predisposed, which affects therespiratory system, in particular the bronchi, characterized by the periodic attacks in a form of a severe cough, dyspnea, shortness of breath and alternating periods of remission and exacerbation. Every tenth inhabitant in the world will suffer from allergies by 2030 (WHO forecast). The factors which cause attacks and exacerbation of asthma are divided into external and internal. External include a large number of allergens: flowering plants, tobacco smoke, pet hair, especially cats, household chemicals, cold air, food products, bad ecology and much more which can cause inflammation of the bronchial mucosa, their hypersensitivity. Internal factors include hereditary (genetic) predisposition, in other words, the likelihood of getting sick is higher if there are patients with bronchial asthma in the family. Various concomitant diseases of the respiratory system also exacerbate the process. The professional activity of a person, associated with harmful factors plays an important role: grain, wood, metal dust; wool, animal biological substrates; adhesives, resins, latex, etc. Strong emotions and stress can also provoke an attack.

The season plays a key role for people with asthma. Winter is the most provocative season. In winter, the likelihood of exacerbations of bronchial asthma increases. Cold frosty air, fluctuations in temperature and humidity, icy wind and possible frequent respiratory infections exacerbate the condition of asthmatics, most of whom react to the change of seasons but feel worse, namely, in cold winter weather. A sharp change in temperature can lead to a narrowing of the airways – cold bronchospasm, for example, when leaving a warm room in the cold which leads to an asthma attack. If you cover your nose and mouth with a scarf or a glove for a short time when going outside, the cold air will warm up and the irritation of the respiratory tract will not occur. However, breathing into a scarf or other warm clothes for a long time is not recommended, since the warm air which appears from breathing moistens the fabric in which the pathogens of various respiratory infections easily multiply and the resulting condensate mixed with cold air outside causes irritation of the bronchi and may provoke an asthma attack. Modern thermal masks with a special mesh which protects against temperature changes allow people with asthma to be safe in the frosty air. The increased sensitivity of the bronchi to respiratory infections is also manifested by bronchospasm and leads to an attack, so it is advisable to avoid crowded places during the seasonal rise in respiratory diseases. It is necessary to prescribe antipyretic, analgesic drugs, antibiotics for respiratory infections with a great care as they can cause an asthma attack in a patient with asthma and even lead to death. The air, especially in megacities, is polluted with various harmful substances (smog – exhaust gases, waste, etc.). When inhaling not just cold, but polluted cold air, the sensitivity of the mucous membrane of the upper respiratory tract increases which causes an asthmatic attack, so it is recommended that asthma patients always have an inhaler with them.

The nose plays a fundamental role in protecting the respiratory organs from various harmful effects. A huge number of functions that the nose performs – respiratory, protective, speech, information, calorific, olfactory, excretory, suction, aesthetic are so closely interconnected that a violation of the process of one affects all the others. The respiratory function is the main function of the nose. Violation of the respiratory function worsens the functioning of the lungs, the cardiovascular system and increases intracranial pressure. Each person has two lungs: the right and the left and two nasal passages: right and left (nostrils). The right nasal passage is responsible for the work of the right lung, the left – for the left. Therefore, the closedness or congestion of one nostril leads to oxygen starvation of the corresponding lung and the breathing process is carried out by only one functioning nostril. The main protective barrier against environmental factors is the nasal mucosa. The flow of the inhaled air, passing through the nasal cavity is moistened and heated from + 25 ° C to + 35 ° C, so the cold air does not enter the lower respiratory tract. Also, there are cilia (hair) in the nose which do not let various harmful air components into the respiratory tract: dust, dirt and other small particles. Violation of the nasal breathing is one of the main causes of rhinitis. In the cold, it is difficult to breathe through the nose as the lumen of the nasal passages narrows due to the swelling of the vessels of the nasal mucosa, the blood flow worsens and the air does not have time to heat up. Various allergens, for instance, dust, plants, tobacco smoke, chemicals, polluted air, especially cold air and others, entering the nasal cavity, cause sensitization of the body, i.e. the body becomes sensitive to foreign agents (antigens-AG), for which the immune system produces protective antibodies – immunoglobulins E (Ig E). With repeated exposure of AG to the nasal mucosa, the amount of Ig E in the blood increases which causes an allergic reactionhypersensitivity of the immediate Asthma type – allergic rhinitis. A direct link between allergic rhinitis and bronchial asthma is maintained by inflammation of the mucous membrane of the nasal cavity and bronchi. With bronchial asthma, a person is often forced to breathe through the mouth which aggravates one’s condition. When walking, especially fast, running, exercising in the fresh air at low temperatures of -10 ° C and below, asthma attacks may occur as breathing becomes faster during exercise and a large amount of cold air enters the respiratory tract. However, physical activity is necessary to strengthen the immune system and maintain a human health. For an asthmatic, as for all the people, movement is life. Children and adults who are overweight or obese are at risk for developing asthma. Short-term (15 – 20 min.) physical activity of moderate intensity in frosty weather (-5 ° C) improves blood circulation, oxygen supply to all organs and tissues of the human body which contributes to the good functioning of the cardiovascular, respiratory and other systems and is the prevention of many diseases, particularly, asthma.

The problem of non-communicable diseases (NCDs), leading to disability and death, has remained relevant for all countries of the world over the past three decades. Bronchial asthma is included in the list of non-communicable diseases (NCDs) of the WHO Global Action Plan for the Prevention and Control of NCDs until 2030. One of the main points of the plan is “Prevention must be a central component of the response to NCDs.” According to the UN Sustainable Development Agenda, the goal is to achieve the NCD prevention and control the targets which will improve the air quality of the cities, especially in megacities, for the safety of people’s lives. “By adopting the 2030 Agenda for Sustainable Development, all governments – not just ministries of health – have committed to support the national responses to NCDs.” Founded in 2009, the Global Alliance for Chronic Respiratory Diseases (GARD), a community of more than 2,000 nongovernmental organizations (NGOs) in 170 countries, works with WHO on NCD prevention and advocates for people at risk of developing NCDs or suffering from NCDs. In 1993, The Global Initiative for Asthma (GINA) was launched in collaboration with the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization. Since 1998, at the initiative of GINA, the World Asthma Day has been celebrated every first Tuesday of May in order to inform the population of all countries of the world about the incidence of asthma and its prevention. In 2006, WHO defined A European Strategy for the Prevention and Control Noncommunicable Diseases aiming at strengthening the health system for better prevention and control of NCDs and set out on a course to recovery.

To date, the treatment of bronchial asthma has not given a complete recovery to patients, but can maintain a long-term remission. The scientists from the USA, Canada, Ireland, Germany have discovered a substance – itaconate which is produced by the immune cells of the human body – macrophages. With the help of itaconate, the immune response can be regulated. Itaconate has an anti-inflammatory effect which will allow the treatment of various diseases with severe inflammatory processes, such as bronchial asthma. Research by Professor in the Department of Biochemistry, Trinity College School of Biochemistry and Immunology, Trinity Institute of Biomedical Sciences, Dublin, Ireland, Luke A. J. O’Neill, showed the effectiveness of itaconate in laboratory models of bronchial asthma. A drug made on the basis of itaconate can change the quality of life of people suffering from bronchial asthma.

Prevention is necessary for any process that negatively affects human health and is aimed at preventing the onset of the disease. It is much easier to prevent any process than to deal with it. Prevention of bronchial asthma is multicomponent. It includes the prevention of: a) allergies – a complete exclusion or minimization of contact with allergens, for example, dust, animals, tobacco, cigarette smoke, drugs, especially aspirin and others; b) chronic respiratory diseases such as bronchitis, pneumonia, bronchiectasis, etc.; c) respiratory infections: influenza, adenovirus, rhinovirus, respiratory syncytial, etc. Airing, wet cleaning of premises, personal hygiene rules, walks in the fresh air, a balanced fortified diet – more vitamins, vegetables and fruits; hardening, regular breathing and physical exercises, strengthen the immune system, protect the human body from the onset and illness of bronchial asthma and allergies. In addition, the results of a study by the scientists of the Johns Hopkins University School of Medicine in Baltimore, USA showed that the intake of foods containing vitamin D, for example, fish oil, seafood, egg yolk and others, reduces the risk of developing allergies and asthma, especially in obese children living in air polluted areas. Children with a genetic predisposition to the disease should be breastfed for up to 12 months to strengthen the immune system and maintain normal intestinal microflora. It is advisable to introduce additional nutrition for breastfeeding no earlier than 6 months of the first year of life without the content of allergenic products: citrus fruits, red apples, carrots, etc.; also prevent the occurrence of respiratory diseases – rhinitis, sinusitis, laryngitis, tracheitis, bronchitis; adenoid formation. Adults with a genetic predisposition are recommended to take a course of prophylactic treatment with antihistamines – anti-allergy drugs. To prevent exacerbations and alleviate the condition of patients suffering from allergies or asthma, an elimination regime is created – a complete exclusion or reduction of contact with an allergen which causes allergy or an asthma attack.


Bronchial asthma is a big problem for all countries of the world. Timely early diagnosis and a wellorganized prophylaxis in bronchial asthma prevents its occurrence and the identification of the risk factors will allow targeted preventive measures. Prevention is often much more effective than cure. High-quality preventive measures will significantly reduce the incidence and the prevalence of bronchial asthma among adults and, especially, children. It is much easier to prevent morbidity than to deal with it.

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