Asthma is a chronic inflammatory disease of the airways, i.e. the tubes that bring air in and out of the lungs. It is manifested by repeated episodes of cough, wheezing, breathlessness, and a feeling of tightness in the chest. There are several known trigger substances and factors for asthma, which initiate symptoms in susceptible people, by producing an allergic reaction. Common asthma-producing substances are dust, smoke, exhaust fumes, pollens, fungal spores, droppings of insects, animal furs, stress, some food substances, etc. Hereditary factors are also very important as asthma tends to occur in families. The prevalence of asthma is more in women beginning from the age of 15, the world over. Compared to men, they suffer from more severe symptoms and use the ‘rescue inhalers’ more frequently. Women are known to visit hospitals more frequently due to asthma attacks and suffer more from disturbed sleep and anxiety due to asthma. What causes a higher prevalence of asthma in women is not known precisely. But there are several theories. Episodes of asthma are known to occur during the menstrual cycle, attacks are aggravated during pregnancy. This leads to a suspected role of hormones, particularly oestrogen in causing non-allergic asthma in women. Women suffering from asthma are exposed more to smoke, especially in poor families, where wood is burnt for cooking. If a husband or any other male member of the family smokes and a woman is exposed to cigarette smoke passively, this can trigger an asthma attack. While doing domestic chores such as cleaning, there is exposure to dust, insect droppings, etc., and other substances likely to precipitate asthma. While getting dressed, a woman is likely to use body lotion, face cream, lipstick, perfume, etc., and other cosmetics which contain chemicals. One or more of these chemicals can initiate and aggravate asthma. Being more emotional, by nature, women can be more stressed by trivial issues, thus precipitation and aggravation of asthma can occur. The airways of a woman are anatomically smaller in size and lung capacity is less compared to men. This could be a reason why women suffer from more severe breathlessness, due to asthma, compared to men. The social aspect of this problem is also important. Many women tend to neglect their health and report a health issue only when the problem becomes severe. Hence, minor symptoms of asthma may be neglected. In some cases, women who are financially and physically dependent on their families are neglected by their spouses, thus early asthma symptoms may not receive attention unless they become severe. Diagnosis of asthma is based on symptoms, physical examination, and a simple blood test showing higher levels of white blood cells indicating allergy and lung function tests. If lung function tests reveal obstruction of the airways, which is reversed after inhalation of bronchodilator (a drug used to widen the airways), it confirms the diagnosis of asthma. Identifying the precise allergy-causing substances is possible through allergy tests. This involves the use of injections of possible allergy-producing substances beneath the skin and seeing the reaction after 24 to 48 hours. These tests are not easily available and are expensive. However, one can be vigilant and identify some asthma-causing substances by self-observation. A woman can stop the use of chemical-containing toilette products and cosmetics. Regarding diet, a food substance can be removed from the daily diet for two to three days and then reintroduced. If the removal of that substance causes relief in asthma symptoms and reintroduction precipitates the problem, that substance can be considered to be contributing to the precipitating asthma episodes. This can be tried over all substances used in the daily diet, one by one. Women need to be made more aware of asthma and need to avoid trigger factors. They should learn to use inhaler drugs properly so that they can manage their symptoms at home. They also should be aware of when to visit a hospital. Dr Rachna Pande is a specialist in internal medicine.
