Asthma

Asthma is a relatively common condition that is characterised by at least partially reversible inflammation of the airways and reversible airway obstruction due to airway hyperactivity. It can be acute, sub-acute or chronic and/or exercise induced.

What happens in Asthma?
Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.
Airway obstruction occurs due to the combination of:
• Inflammatory cell infiltration.
• Mucus hyper secretion with mucus plug formation.
• Smooth muscle contraction.
These irreversible changes may become irreversible over time due to
• Basement membrane thickening,
• Collagen deposition, and
• Epithelial desquamation.
Airway remodeling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.
Role of physiotherapy
The majority of patients suffering from asthma will seek physiotherapy for dyspnoea and hyperventilation. Our physiotherapists treat asthma in a variety of ways with the aim to improve breathing technique. Physiotherapy techniques for asthma are in addition to medication and should never be used as a replacement for prescribed medication, however may reduce the dosage required.
1. Breathing Retraining Techniques - to normalise breathing patterns by stabilising respiratory rate and increasing expiratory airflow. Instructions are given from the physiotherapist on how to complete this technique, with the following components:
• Decreasing Breaths Taken (Reducing Respiratory Rate)
• Taking Smaller Breaths (Reducing Tidal Volume)
Diaphragmatic breathing through use of abdominal muscles and lower thoracic chest movement)
Relaxation – Relaxed and controlled breathing
Pursed lip breathing
These retraining techniques help control breathing and reduce airflow turbulence, hyperinflation, variable breathing pattern and anxiety.
2. Physical Training : Physical training should be prescribed by physiotherapists for asthmatics to –
• Increase fitness and cardiorespiratory performance,
• Reduce symptoms such as breathlessness and improve quality of life. 3. Respiratory Muscle Training - Hyperinflation in asthma causes increased lung volume, leading to altered inspiratory muscle mechanics. Inspiratory muscles are shortened resulting in a sub-optimal length-tension relationship for contraction. There is a decreased capacity for tension generation when breathing, resulting in accessory muscles of inspiration being utilized.
Breathing exercises are carried out using an external device to make breathing more difficult. This helps to strengthen the inspiratory muscles, making it easier to breathe in everyday life. A breathing device is used which sets up a load to breathe against. During inspiration air is only released if enough effort is used to force open the valves of the device. Respiratory muscles are forced to work harder, increasing their strength, leading to diaphragmatic breathing becoming easier, reducing hyperinflation.
4. Removal of secretions
• Percussions
• Shaking
• Vibrations,
• Postural drainage and
• Effective coughing
5. Range of motion exercises
6. Education about condition - use of a bronchodilator and any other medication, how to prevent chest infection from occurring, Correct posture in standing and sitting which assists in the management of asthma attacks by allowing the chest to expand appropriately and the lungs to function optimally.