Volume 3, Issue 1, 2024, Page 652-660

International Journal of Pharma Research and Technology

A Brief Review on Chronic Asthma

Patil MP1*, Patil DR2, Jain AS3, Shaikh AZ4, Shaikh SR5, Pawar SP6
P. S. G. V. P. M's College of Pharmacy, Shahada, Nandurbar
[email protected]

Abstract
Asthma is a chronic condition that mostly affects the lungs. There are 300 million asthma
sufferers in the world. This chronic illness claims the lives of 255,000 people annually
throughout the world. The symptoms of asthma include wheezing, chest tightness, coughing, and
shortness of breath when the lung’s airways enlarge and narrow. Inflammation (swelling) in the
airways is what causes asthma. The muscles surrounding the airways tighten and the lining of the
airways expands during an asthma episode. The amount of air that can enter the airway is
lowered as a result. Breathing allergens or triggers can cause asthma symptoms in people with
sensitive airways. This review mostly discusses the primary causes, signs, a diagnosis, and the
necessary precautions to prevent future progression, and the causes and treatments for persistent
asthma. Asthma is treated with a variety of herbal remedies, including ginseng, ginko biloba,
licorice, and cinnamon. In the future, we can use machine learning and artificial intelligence (AI)
programs to cure asthma.
Keywords: Asthma, Chronic, Inflammation, Ginko Biloba, Licorice, Cinnamon.

Introduction

Breathing might be challenging due to the team, serve to enhance the pharmacologic
chronic airway illness known as “Asthma”. management of asthma[1].According to recent
The airways that deliver oxygen to the lungs estimates, there are 300 million asthma
temporarily narrow due to inflammation of sufferers globally and more than 22 million in
the airways that occurs with asthma. As a the United States. Although the illness affects
result, people have asthma symptoms as people of all ages, it most often first appears
coughing, wheezing, shortness of breath, and in children, affecting 6 million kids in the US
tightness in the chest. Asthma is also referred at the moment. Over 255,000 people
to as “bronchial asthma.”The nights and early worldwide pass away from asthma each year.
mornings are typically when asthmatics Asthma is one of the most common chronic
experience these symptoms the most diseases, and it has a major socioeconomic
frequently. By educating patients about their impact on both patients and caregivers.
drugs, how to take them, and the significance Asthma affects people of all ages, including
of following the directions on the label, children, and has a negative effect on both
pharmacists, as members of the healthcare academic and professional performance [2].

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 Volume 3, Issue 1, 2024, Page 652-660

What is an Asthma attack? The airways may get obstructed during some
asthma attacks, preventing oxygen from
Coughing, chest tightness, wheezing, and reaching the lungs. Additionally, oxygen
breathing difficulties can all be symptoms of cannot enter the bloodstream and reach the
an asthma attack. The attack takes place in the body’s important organs as a result of this.
airways of your body, which are the channels These types of asthma episodes can be fatal,
through which air travels to your lungs. The and the patient may require urgent
airways in your lungs narrow as air passes hospitalization. At the same time carbon
through them, just as the branches of a tree dioxide deposition in the lungs leads to
are narrower than the trunk. Your lungs
carbon dioxide poisoning [4].
airways enlarge on the sides and constrict
during an asthma attack. Less air enters and Causes of Asthma attack
exits your lungs, and the mucus your body
produces further obstructs the airways. By May experience an asthma attack if you are
being aware of the symptoms of an asthma exposed to “asthma triggers”. The asthma
attack, avoiding triggers, and adhering to your triggers that apply to you might not apply to
doctor’s recommendations, you can manage someone else. Learn how to avoid your
your condition. When your asthma is under triggers by being aware of them. Whenever
you can’t avoid the triggers, be on the lookout
control:
for an attack. Most common triggers include:
 You won’t experience symptoms like
Environmental Factors
coughing or wheezing;
 You’ll sleep better; Asthma symptoms and allergic reactions are
 You won’t be absent from work or frequently brought on by strong fumes from
school; household cleaners and paints or indoor air
 You can engage in all physical pollution from mold. Nitrogen oxide from gas
activities [3]. stoves is another indoor environmental
element linked to asthma. In actuality, those
During asthma attack following changes
who use gas to cook are more likely to
takes place
experience symptoms like hay fever, asthma
 The airway narrows as a result of attacks, and wheezing and to be breathless.
tightened muscles surrounding it. Several factors, including smog, sulfate-
 The airway may move less air through dioxide, nitrogen oxide, ozone, chilly
it. temperatures, and excessive humidity, have
 The airways become even more been demonstrated to make certain people get
constricted as a result of increased asthma [5].
airway inflammation.
Allergies
 The production of mucus in the
airways increases, further obstructing Animal proteins (primarily cat and dog
airflow. allergens), dust mites, cockroaches, and fungi
are common sources of indoor allergens. The
aim for energy-efficient housing may have
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increased exposure to these asthma triggers. Types of Asthma

The airway inflammation linked to asthma is
frequently caused by allergic reactions Child onset asthma
sparked by blood antibodies. Most people Childhood asthma is referred to as child-onset
who have asthma also have allergies. In asthma. This type of asthma develops when a
actuality, nearly 25% of individuals with youngster, most likely for hereditary reasons,
allergic rhinitis (hay fever) also develop becomes sensitive to common environmental
asthma [6]. allergens. The child has atopic dermatitis,
which is a genetically predisposed condition
Tobacco smoke
of extreme sensitivity to environmental
Tobacco smoke has been associated to an allergens. Any compounds that the body will
increased risk of developing asthma, as well mistake for a foreign object and react to with
as an increased risk of dying from respiratory an immune reaction are considered allergens.
infections, wheezing and asthma. These differ greatly between people and
Additionally, there is a higher chance of frequently consist of animal proteins, fungus,
asthma prevalence in children whose moms pollen, house-dust mites, and some type of
smoke as well as in other persons who are dust. Asthma Symptoms in Young Children
exposed to secondhand smoke. Smoking (0–6 Years) Nearly 80% of instances of
among teenagers has also been linked to asthma start in the first 6 years of life,
higher asthma risk. Smoking tobacco is bad according to studies on the disease’s natural
for everyone, but it’s especially bad for history. This age group’s pediatric asthma
asthmatics. If you smoke and have asthma, symptoms are diverse and not always
give up the habit [7]. associated with asthma, making a diagnosis
difficult [9].
Pregnancy
Adult-onset asthma
Your vulnerability to asthma seems to depend
on how you enter the world. Compared to When a person develops asthma after
kids born vaginally, babies born by Caesarean becoming 20 years old, this phrase is used.
sections have a 20% higher prevalence of Adult-onset asthma is less common than
asthma. This discrepancy may be brought on child-onset asthma and affects women more
by immune system-modifying infections than males. An allergy or another allergic
brought on by bacterial exposure during item may also cause it. According to
cesarean sections. Children who have mothers estimates, up to Allergies may be the cause of
who smoke throughout pregnancy have less 50% or more of adult-onset asthma cases.
developed lungs. This could increase the risks However, a sizeable Exposure to a significant
for asthma. According to epidemiological majority of adult-onset asthma does not
studies, bronchial asthma is one of the most appear to be caused by this type of adult-onset
prevalent conditions that can complicate asthma is known as non-allergic asthma. This
pregnancy (1–7%) [8]. grownup is not allergic. Intrinsic asthma is
another name for onset asthma. Exposure to
an object or substance Adult-onset asthma can

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 Volume 3, Issue 1, 2024, Page 652-660

also be brought on by specific polymers, as another catalyst. Occupational asthma

metals, drugs, or wood dust. Asthma [10]. typically develops soon after a patient starts a
new job and goes away quickly once that
Exercise-induced asthma employment is left [12].
You may have exercise-induced asthma if you Nocturnal Asthma
cough, wheeze, or feel short of breath during
or after activity. Naturally, your degree of Night time asthma strikes between midnight
fitness also plays a role; if you run quickly for and 08:00. It is brought on by sinus disorders
ten minutes when unfit, you’ll get out of or set off by indoor irritants like dust and pet
breath. If, however, you’re coughing, dander. It is possible for nocturnal or
wheezing, or panting is uncharacteristic, it midnight asthma to develop without the
may be a sign of exercise-induced asthma. patient noticing any symptoms during the day.
Exercise-induced asthma causes the bronchial When lying down, the patient may experience
tubes (airways) to inflame and produce more wheezing or shortness of breath, but they
mucus, which makes it harder for the sufferer might not be aware of these symptoms until
to breathe in and out of the lungs [11]. they awaken the patient in the middle of the
night, generally between 2 and 4 AM [13].
Cough induced asthma
Steroid-Resistant Asthma (Severe
One of the most challenging asthmas to Asthma): Some patients are steroid resistant,
identify is asthma brought on by coughing. even though the majority of patients benefit
Other options need to be ruled out, such as from routine inhaled glucocorticoid (steroid)
chronic bronchitis, hay fever-related postnasal medication. Inflammation of the airways and
drip, or sinusitis. In this situation, coughing immunological activation are significant
may happen all by itself without the presence factors in persistent asthma. As a result,
of any other asthma-like symptoms. Any time
current recommendations for treating asthma
of day or night can bring on a coughing fit. have prioritized the use of anti-inflammatory
Occupational asthma medications, particularly inhaled
glucocorticoid (GCs). Glucocorticoids are a
Something at the patient’s place of type of medication used to treat asthma
employment causes this particular sort of because they lower immune activation and
asthma. Asthma can be brought on by airway inflammation. However, compared to
substances like chemicals, vapors, gases, people with steroid sensitive (SS) asthma,
smoke, dust, fumes, or other particles. It a people with steroid resistant asthma have
virus (the flu), molds, animal products, higher levels of immunological activation in
pollen, humidity, and temperature are their airways [14].
additional potential causes. Stress may serve

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 Volume 3, Issue 1, 2024, Page 652-660

Receptors Working in Asthma

Figure No.1: Overview of DP2 (prostaglandin 2) receptor mediated immune cells in the
inflammatory pathway [15-18]

Test and Diagnosis asthma symptoms are present but objective

tests of lung function are normal.
Diagnosis
Medical history
A complete medical history, physical
examination, and objective evaluations of Patients with recurrent coughing, wheezing,
lung function (spirometry is recommended) chest tightness, and shortness of breath should
are all required for the diagnosis of asthma. It have asthma suspected. Strongly suggestive
may also be helpful to screen for indicators of of asthma are symptoms that are
airway inflammation during a unpredictable, intensify at night, happen after
bronchoprovocation challenge in order to exposure to allergens or irritants, and react to
diagnose the condition especially when effective asthma therapy. The following
conditions should be ruled out as potential

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 Volume 3, Issue 1, 2024, Page 652-660

causes of suspected asthma symptoms: heart function tests are normal but symptoms imply
disease, chronic obstructive pulmonary asthma. Challenge testing needs to be done at
disease (COPD), bronchitis, chronic sinusitis, a facility that is set up to handle acute
gastro esophageal reflux disease, and bronchospasms and according to tight
recurrent respiratory infections. Identification guidelines. Increased doses or concentrations
of patients with asthma can also be aided by a of a stimulus are inhaled by the test subject
positive family history of asthma or other until a predetermined degree of broncho
atopic diseases, as well as a personal history constriction is reached, often a 20% decline in
of atopic disorders, especially allergic rhinitis. FEV1. To remove the obstruction, a rapid-
It’s crucial to look for potential asthma acting bronchodilator is then administered via
triggers during the history, such as dust mites, inhalation.
cockroaches, and animal dander, moulds,
pollens, exercise, and exposure to tobacco Allergy skin testing
smoke or cold air. Additionally advised is allergy skin testing to
establish the patient’s allergic status and to
Physical examination
discover potential asthma triggers. The
The physical examination of people with allergens specific to the patient’s location are
suspected asthma is frequently unremarkable often used in testing. As an alternative to skin
since asthma symptoms might vary. Usually, tests, allergen-specific IgE tests that detect a
a patient’s symptoms are required for physical patient’s specific IgE levels against particular
findings to become apparent. As a result, an allergens in vitro have been proposed;
asthma diagnosis cannot be ruled out in the however, these tests are less sensitive and
absence of physical signs. Auscultation- more expensive than skin tests [20].
confirmed wheeze indicates the presence of
an airflow restriction and is the most typical Treatment
aberrant physical result. Atopic disorders such In order to prevent exacerbations, which are
allergic rhinitis or dermatitis should be sudden and/or progressive worsenings of
checked for concurrently by doctors by asthma symptoms that frequently call for
checking the skin and upper respiratory immediate medical attention and/or the use of
system [19]. oral steroid therapy, and lower the risk of
morbidity and mortality, it is important to
Tests
achieve and maintain control of the disease.
Challenge testing Utilizing the criteria in Table 2, the amount of
asthma control should be evaluated at each
Measurements of airway responsiveness visit, and treatment should be customized to
utilizing direct airway challenges to inhaled achieve control. Most asthma patients can be
bronchoconstrictor stimuli (such as controlled with a combination of avoidance
methacholine or histamine) or indirect strategies and pharmaceutical treatments. The
challenges with mannitol or exercise may pharmacologic treatments frequently used to
help confirm a diagnosis of asthma when lung
treat asthma can be divided into two groups:
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 Volume 3, Issue 1, 2024, Page 652-660

controllers (medications used regularly for a descriptions of various machine learning

long period of time that primarily achieve techniques as well as details on how the
control through anti-inflammatory actions) presented results were assessed. According to
and relievers (medications used on a short- the “sample size” column, only a few research
term basis to reduce symptoms).An as-needed have enrolled bigger patient cohorts (only
basis for prompt symptom and four studies have involved >1000 patients)
[22]
bronchoconstriction alleviation). ICSs, .
leukotriene receptor antagonists (LTRAs),
long-acting beta2-agonists (LABAs) 2) Patient Classification
combined with an ICS, and anti-IgE treatment Examined in a pediatric population the
are examples of controller drugs. connection between asthma control and
exhaled biomarkers. The ability of fractional
 Medication for relief [e.g.-
nitric oxide (FeNO), volatile organic
SALMETEROL, SALBUTAMOL]
compounds (VOCs), and cytokines/
 Anti-IgE Therapy [e.g.-
chemokines to distinguish between children
OMALIZUMAB]
with persistently managed and uncontrolled
 Inhaled Corticosteroids [e.g.-
asthma was specifically examined by the
FLUTICASONE, THEOPHYLLINE]
authors. Different feature sets were provided
 Allergen specific immunotherapy
as input to a random forest in order to
[e.g.-MONTELUKAST,
differentiate between the two patient groups
ZAFIRLUKAST] [21].
during a year-long follow-up of 96 asthmatic
Future perspectives for treating of asthma: children. An AUC of 0.86 was obtained while
only using a certain collection of VOCs;
Artificial intelligence and machine learning however, adding the other two inputs did not
program improve the classification’s accuracy [23].
1) Asthma screening and diagnosis 3) Asthma Management and monitoring
As expected, mostly clinical data have been With 40 papers that predominantly address
used for the diagnosis and screening of asthma exacerbations and asthma flare-ups,
asthma; these data specifically include this area is also very populated. A summary
information from the medical history, pattern of these investigations is presented. Twelve
of symptoms, pulmonary function tests, lung researches used decision trees, random
sounds from auscultation, etc. 37 research use forests, or variants of these methods in their
clinical data, 12 of which focus on features machine learning analyses. Eleven studies
related to lung or breath sounds. We note that used artificial neural networks (ANNs), four
only a few machine learning algorithms, such used support vector machines, three used
as ANNs, support vector machines, random Bayes networks or naïve Bayes techniques,
forests, and decision trees, are used in the and three used logistic regression. Used
papers under the heading “Asthma screening expert knowledge in an ensemble classifier to
and diagnosis.” It should be noted that the detect the asthma control level, which
following additional material contains
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 Volume 3, Issue 1, 2024, Page 652-660

produced an overall accuracy of 91.66%. The Conclusion

algorithm was created using information
gathered from 96 asthmatic patients who were A variety of illnesses together referred to as
tracked for 9 months. The suggested model is asthma cause recurrent, reversible bronchial
intended to function as a real-time preventive blockage. Despite the fact that the disease can
system for asthma control, according to the develop at any age, the majority of the time
the first symptoms appear in children. There
scientists [24].
are many genome-wide genes that somewhat
4) Asthma treatment raise the risk of asthma as well as a major
hereditary component to the condition. In this
Studies using machine learning algorithms for
review, the pathogenesis, causes, symptoms,
all aspects of asthma treatment can be found
and therapy of persistent asthma were
in the last category. It is noteworthy that only
thoroughly discussed. The most prevalent
one article by, which was also listed in earlier
respiratory condition, asthma, significantly
categories, is included in this category. By
increases morbidity and mortality. Patients
analyzing how different asthma phenotypes
with recurrent cough, wheezing, chest
responded to treatment, the scientists hoped to
tightness, and dyspnea should have asthma
better target the care given to their patients.
suspected, and the diagnosis should be
We purposefully included this sparsely filled
validated with objective tests of lung function
category to draw attention to the literature’s
(spirometry is preferable).Testing for allergies
lack of machine learning algorithms utilized
is also advised to find potential causes of
for treating asthma. Of the study’s
asthma symptoms. Most people can control
participants, 56% had asthma; the remaining
their asthma with the use of preventative
44% did not. The total accuracy was
measures and the proper pharmaceutical
increased by the application of machine
interventions. For the vast majority of asthma
learning techniques. The accuracy, sensitivity,
patients, ICSs are the norm in terms of
AUC, and specificity of the XG Boost
treatment. If patients are unable to regulate
prediction model for the diagnosis of asthma
their symptoms with low-to-moderate ICS
were 87.1%, 82.5%, 93.0%, and 97.9%,
doses, and future perspectives for treating of
respectively [25].
asthma like Artificial Intelligence (AI)

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