What is Asthma?
The presentation of asthma can range from very mild symptoms to life-threatening ones. It can be present nearly all the time in the mild form or can present in the form of acute attacks. These acute attacks are often triggered by a wide variety of factors, including exercise, exposure to dust, or allergies.
There are two broad categories of asthma: allergic and non-allergic. Allergic asthma is known as an atopic condition, which is usually associated with other allergic health conditions, such as allergic dermatitis and food allergies. Atopic people become hyperresponsive to a wide variety of environmental allergens and foods. It is reported to affect one out of every 5 individuals.
There is currently no cure for asthma itself. Medical treatment aims at lowering both the intensity and the frequency of asthma attacks. Meanwhile, preventive therapy is directed at avoiding exposure to various known allergens.
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What are Asthma Attacks and How Often They Occur?
Asthma attacks are acute exacerbations of the underlying condition, with the hallmark of airway inflammation and difficulty breathing. These attacks are transient, and the duration of the attack varies from one patient to another. In the majority of cases, these attacks are triggered by exposure to allergens, dust, smoke, or certain foods.
During the attacks, the lung airways become inflamed, and the amount of air that can pass through these inflamed pathways is markedly reduced. This requires extra effort by the body to deliver the oxygen from the air to the lungs. The attacks can last from few seconds to few days based on many factors, including the duration of exposure to allergens, the amount of inhaled/digested allergens, and the time of initiation of medical therapy.
What are the Symptoms and Signs of Asthma?
The symptoms of asthma can range from mild breathlessness to severe forms, including:
The following signs are characteristic of asthma attacks:
- The sudden and rapid occurrence of symptoms
- The inability to speak
- Heavy breathing
- Severe shortness of breath
- The lips color turns blue
- Limited chest expansion
There is a long list of triggers that can provoke an asthma attack. Avoiding these triggers may help in reducing the number of attacks that patients encounter. They include:
The Severity of Asthma Attacks
The severity of an asthma attack can be measured based on the various clinical symptoms and the duration of the attack. The severity can be categorized into four scales.
Stage One: Intermittent Asthma Attacks
In this category, the asthma attacks occur <2 days every week, and they don’t interfere with the activities of daily living. This type of asthma occurs for a minimal period of time with short periods of acute attacks, which rarely involves nighttime symptoms.
Stage Two: Mild Asthma Attacks
In this category, the asthma attacks occur >2 days every week. However, there are minimal interferences with the activities of daily living. This type is not often associated with acute nighttime attacks; however, they can occur in some cases.
Stage three: Moderate Asthma Attacks
In this category, asthma attacks can occur more than 4 days per week, with significant interference with activities of daily living. This usually involves acute flareups during nighttime. This stage requires various drugs to control and alleviate asthma symptoms.
Stage Four: Severe Asthma Attacks
In this category, the attacks are the worst; they can happen throughout the day. There is a marked degree of interference with activities of daily living. Patients with severe asthma usually have acute flareups during nighttime.
Noteworthy, if the asthma attack lasted for more than 24 hours, then the person becomes at risk of severe complications, including death. This emergency condition is called status epilepticus, and it requires immediate medical care.
How can Asthma be Treated?
The treatment of asthma aims at reducing the number of acute attacks as well as their intensity. There are multiple treatment options for asthma, which include corticosteroids, adrenergic receptor agonists, anti-cholinergic drugs, epinephrine, leukotriene receptor antagonist, and mast cell stabilizer.
Cannabis, Cannabinoids, and Asthma
The cannabis plant contains more than 500 compounds with at least 104 phytocannabinoids. Two cannabinoids are produced in greater amounts than others: tetrahydrocannabinol (THC) and cannabidiol (CBD).
There are two main cannabinoid receptors in the human body: CB1 and CB2. They interact with the endogenous cannabinoids, or endocannabinoids, in a system called the Endocannabinoid system (ECS). This system regulated many physiological processes by activating or inhibiting these cannabinoid receptors.
CB1 receptors are mainly found in the brain and the central nervous systems, while CB2 receptors are distributed throughout the body and the immune system. CB1 receptors are involved with sleep and other motor and behavioral processes, while CB2 receptors are involved with the modulation of pain and inflammation.
In the lungs, CB1 receptors are distributed throughout the smooth muscle fibers that line the airways, and thus, it is perceived that CB1 receptors help regulate the bronchial muscle tone. Meanwhile, CB2 receptors are found on the various immune cells (macrophages and T and B lymphocytes), which are responsible for modulating inflammation.
What are the Beneficial Effects of Cannabinoids on Asthma?
The exact effects and mechanisms of various cannabinoids on the lungs are not yet fully understood. Most of the cannabinoids, including CBD, have not been sufficiently-researched to establish their efficacy and safety. However, there are many preclinical studies that demonstrate the beneficial effects of medical cannabis in asthma.
- Bronchodilation: Many studies have shown that using cannabis, whether by inhalation or by ingestion, can markedly increase lung volumes by around 100 ml. This effect usually starts within five minutes after inhalation can last for 2 hours. However, ingestion of cannabis can lead to similar, but less marked, effects with delayed onset. The mechanism through which these effects are exhibited is through the activation of CB1 receptors in the smooth muscle fibers of the airways, leading to their relaxation and bronchodilation.
- Anti-inflammation: Allergic asthma is characterized by airway hypersensitivity, the elevation of serum immunoglobulin-E, airway eosinophilia, and an increased secretion of mucus. THC and cannabinol (CBN) have been shown to reduce mucus production in murine models, which allow for more air to get into the lungs. Also, some cannabinoids have been shown to reduce allergic asthma triggered primarily by the cytokines that are secreted from Th2 cells.
- Anxiolysis: The prevalence of anxiety and associated psychological problems are highly prevalent in people with asthma. Both anxiety and emotional stress are known triggers for asthma attacks. Cannabinoids, including CBD, are shown to have both anxiolytic and anxiogenic effects. However, it is not yet clarified how the reduction of asthma-related anxiety can result in the reduction of acute asthma exacerbations
- Smoking cessation: Smoking is known as a major trigger of acute asthma attacks. Several studies, including two double-blinded, placebo-controlled clinical trials, have shown a beneficial effect of CBD use on smoking cessation. A recent study demonstrated that the short-term use of CBD through inhalation could markedly reduce the number of cigarettes smoked by up to 40%.
It is important to know that the effectiveness of using CBD as a therapeutic option for asthma has not been studied in randomized controlled trials yet. Therefore, it is advised not to use CBD for asthma without consulting a physician first.
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