Symptoms over time

In some diseases, the symptoms people have change over time as the disease begins to do different things to the body. In asthma, the disease stays in the airways. In a previous post, I have already discussed how an asthma attack progresses, but as a refresher, when some allergen irritates your airways, they overreact by getting smaller and making more mucous. This ultimately makes it harder for air to move in and out and makes breathing difficult. In any asthmatic, this is what happens. Most people will experience the classic symptoms of asthma: Wheezing, difficulty breathing, coughing, and a feeling of tightness in the chest might also occur. A person with asthma can expect this to happen throughout their life when they have an attack, but it can be reduced significantly if controlled well with medication.

What happens to a person with asthma's lungs over time is thought to be dependent on how well they control it. As I have said before, even when someone might not feel like they are having an asthma attack, there still might be a little bit of airway flare-up happening. Over a long period of time, if this mild flare-up is not controlled, the airways can do what is called "re-modeling." This remodeling is what can cause even more problems down the road. Remember, inflammation is a natural process that is made to help heal the body after it experiences injury, but in asthma, this inflammation is not wanted because it serves no good purpose: it makes us unable to breathe and it works when we don't even notice it to slowly damage our airways over time if it is not controlled with medication. The idea is that over time, after being under even small amounts of inflammation, the cells in our airways change because they are adapting to the inflammation. They are "remodeling." In this process, the little smooth muscles that line our airways (and cause them to either constrict or open up) become thicker. The walls of the airways themselves also thicken. This makes the airway even smaller and is irreversible. The cells also begin to lose their cilia, which are like little fingers that push mucous and other things that shouldn't be in our airways up and out. These impairments will cause persistent airflow limitation and obstruction.

(In this picture, don't worry about the tricky words. You can see the changes that can happen to airways overtime in a person with asthma. The bottom left picture shows an airway that is more fibrous, meaning it has become stiffer. This makes it less easy to open and close the airways how we would like them to. The little smooth muscle layer that lines our smaller airways gets really thick, which means there is less room for what we want, which is air! Also, the cells that make mucous in our airways increase and we have more of it. This is what we want to prevent!)

If a person has asthma that is not well-controlled by medication (I am not talking about fast-acting inhalers here, but am instead talking about medications that are made to provide asthma control for long periods of time), this remodeling will happen, and the extent to which it happens varies depending on the person. As you can see, we don't want this and should take our controlling medications to prevent it, because it is not reversible.

Source:

National Heart, Lung and Blood Institute (2014). What Are the Signs and Symptoms of Asthma? Retrieved February 7, 2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/signs

Shifren, A., Witt, C., Christie, C., & Castro, M. (2012). Mechanisms of Remodeling in Asthmatic Airways. Hindwai Journal of Allergy, 12-12. Retrieved on 2/7/15 from http://www.hindawi.com/journals/ja/2012/316049/.