World Asthma Day (May 06)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Asthma continues to be a disease for which presently there is no cure. It remains an important human disease that is responsible for substantial worldwide morbidity and mortality(1,2). The causes of asthma are multifactorial and include a complex combination of host genetic, immunological and environmental factors(2,7). Epidemiological studies show strong associations between asthma and infection with respiratory pathogens(5,6). Apart from specified lung function tests(2), routinely performed IVD clinical laboratory tests could diagnose and monitor asthma severity by confirming respiratory pathogen, and assess lung function, identify inflammation status, and detect allergic triggers, which aid in the personalized treatment plans and better control of asthma(3,4). Prompt treatment on asthmatic attacks can prevent serious complications such as, difficulty in breathing, airway damage, respiratory failure and death (if not treated in time)(1). Asthma patients can live active and fulfilling lives with good understanding of life-style changes, effective treatment modes and proper ongoing management(1). Regular screening of asthma status by fifth generation IVD laboratory tests could impact patient outcomes and overall healthcare costs(3,4).
Q1. What is the description of asthma and asthma attacks?
ANS: Asthma is characterized by chronic inflammation and narrowing of the respiratory airways, excessive mucous secretion, bronchial hyperreactivity, and reversible airflow obstruction that leads to asthma attacks such as recurrent episodes of cough, wheezing, and dyspnea (shortness of breath).
Note
Asthma attacks cause great distress, which may result in hospital admission and, in severe cases, death (if prompt treatment is not available). Inhaled corticosteroid-containing specific medications could prevent asthma attacks by treating the underlying inflammation that causes asthma symptoms.
Q2. What is the prevalence of asthma?
ANS: Asthma is one of the most common chronic non-communicable diseases. It affects over 260 million people worldwide and is responsible for over 450,000 deaths each year. Most of these deaths are preventable(7). In India, about 35 million people suffer from asthma, which represent a significant portion of the global burden.The main issues of concern are underdiagnosis and inadequate treatment(8).
Note
(A) Asthma is the most common chronic medical condition in the pediatric population, that affects about 10% of children and adolescents(8).
(B) Lack of availability or high cost of inhaled medicines, are the major contributors to 96% of global asthma deaths. Many patients with asthma have limited access to essential inhaled medicines, which results in poorly controlled asthma and preventable asthma deaths.
Q3. What is the theme of ‘World Asthma Day’?
ANS: The theme of world asthma is “Make inhaled treatments accessible for all”. This is to ensure that patients with asthma can access inhaled medications that are essential both for controlling the underlying disease and treating attacks.
Q4. Which respiratory pathogens are responsible to aggravate asthma?
ANS: Common respiratory viruses such coronaviruses, adenoviruses, rhinoviruses, human respiratory syncytial virus, influenza viruses, etc., bacteria, such as Streptococcus pneumonia, Corynebacterium diphtheria, Mycoplasma pneumonia, Hemophilus pneumonia, etc. and fungi such as Aspergillus sp, Pneumocystis jirovecii, Cryptococcus neoformans, Candida sp, etc.(3).
Q5. What type of common air pollutants are responsible for the severity of asthma?
ANS: The common air pollutants that lead to severity of asthma include: Particulate matter, carbon monoxide, ozone, nitrogen dioxide, sulfur dioxide, volatile organic compounds (VOCs), etc.(4).
Note
(A) Numerous factors influence personal exposure to household air pollutants, including household characteristics, such as indoor allergens, molds, strong odors, combustion of solid fuels, cooking practices (involving steam and gas), allergens from the household pests and poor ventilation(4).
(B) Particulate matter 2.5 (PM2.5) can aggravate asthma. PM2.5 refers to fine, inhalable particles with a diameter of 2.5 micrometers or smaller, posing a significant health risk as they can penetrate deep inside the lungs through blood circulation. Sources of PM2.5 are: Inhaled smoke from smoking, wildfires, vehicle exhausts, industrial emissions, combustion from stoves and power plants(9).
Q6. Why asthma is not curable? How asthma is controlled?
ANS: Asthma is a disease for which presently there is no cure, due to genetic and (or) immunological maladaptation of patient’s respiratory airway passage epithelium to specific allergens in atmosphere and foods. Asthma can be very well controlled by modifying behavior patterns of the patient and using the appropriate therapies. These factors take into account the patient’s specific reactions to atmospheric and dietary components, related increased levels of IgE antibodies and abnormaly increased cytokines (messenger proteins of immune cells); such as IL3, IL4 and IL5 and maintenance of respiratory airway epithelium(1).
Q7. What life-style changes are necessary to prevent attacks of asthma?
ANS: The following lifestyle changes are necessary to prevent attacks of asthma: Recognizing and avoiding asthma-triggers, such as allergens, irritants, living in atmosphere having acceptable Air Quality Index (AQI< 200) and practicing good respiratory hygiene(2).
Q8. What are the criteria for asthma remission?
ANS: The following are the important criteria for asthma remission(2):
(A) Long-term continued absence of asthma symptoms and asthma exacerbations
(B) Stable lung functions
(C) No need for use of systemic corticosteroids for the treatment of asthma
Note
Asthma can cause permanent changes to the airways, making it difficult to reverse the condition completely. While there is no cure, asthma can be controlled well, and many people can live active and fulfilling lives with proper management and treatment. If asthma symptoms get worse, it is necessary to contact a physician immediately(1).
Q9. How pigeons are responsible to aggravate asthma?
ANS: Pigeon droppings can spread fungal diseases like histoplasmosis and cryptococcosis, which are responsible to aggravate asthma(11).
Q10. What are the specified ‘Lung function tests’?
ANS: The following are routinely performed ‘Lung function tests’(2):
Tests to measure lung function:
(A) Spirometry: This test is useful to measure the degree of narrowing of bronchial tubes.
Additional tests:
(B) Methacholine challenge test: Methacholine is responsible to trigger asthma.
(C) A chest X-ray: To identify any structural abnormalities or diseases (such as infection) that may be a cause to aggravate breathing problems.
(D) Allergy test: This test can be performed by a skin test or blood test.
(E) Nitric oxide test: This test measures the quantity of the nitric oxide gas in the breath. When airways are inflamed in asthma, nitric oxide levels may be high.
Q11. What are the routinely performed IVD laboratory tests that could prevent severity of Ashma?
ANS:
(A) Complete hemogram
(B) SGPT, SGOT and LDH
(C) Serum procalcitonin
(D) C-reactive protein
(E) Serum ferritin (3,4).
Refer to Case study.
Q12. What are the recent innovations in IVD that have significantly impacted the management and monitoring of asthma?
ANS: Advancements in the fifth generation point of care test (POCT) methods for blood can determine hematology parameters, using automated hematology analyzers in 2-3 minutes. Rapid immunochromatographic tests (Based on ELISA tests) and RT-PCR techniques can diagnose microbial infections with accuracy and precision(3). Refer to ‘Case study’. Moreover, increased cytokine levels also can be determined by ELISA and flowcytometry tests(3,4).
CASE STUDY 1
A 21-year-old college student, a known asthma case, suffered from high fever, pain in the chest, recurrent episodes of cough, wheezing, and shortness of breath. With reference to COVID 19 pandemic, he was advised nasopharyngeal screening test. His laboratory test report was as follows:
SARS-CoV-2 RT PCR test: Positive
Blood oxygen level (By oximeter) : 85% (Normal: 95-100%)
Upon admission to a hospital ward, the following tests were advised:
COMPLETE HEMOGRAM:
| PARAMETER | VALUE | NORMAL RANGE |
| Hemoglobin | 13.8 g/dl | 13–18 g/dl |
| Total erythrocyte count | 4.6 X 1012/l | 5.0 ± 0.5 X 1012 /l |
| Total leukocyte count | 3,600/cmm | 4000-10,000/cmm |
| Differential leukocyte count | ||
| Neutrophils | 80% | 40–75% |
| Lymphocytes | 10% | 20–45 % |
| Monocytes | 10% | 2–10% |
| PCV | 44% | 36–48% |
| MCV | 88.5 fL | 82–92 fL |
| MCH | 28.5 pg | 27–32 pg |
| MCHC | 33 % | 32–36 % |
| RDW- CV | 12.8 | 12–14 |
| MPV | 13.8 fL | 7.5-12.0 fL |
| PWD | 19.3% | 15-17 % |
| Platelet count | 85,000/cmm | 1.5-4.5 m/cmm |
| Absolute neutrophil count | 2270 | 2,500-7,000 |
| Absolute lymphocyte count | 380 | 1,000-4,000 |
| Neutrophils/Lymphocytes ratio (NLR) | 8.0 | 0.78-3.53 |
| Platelets/Lymphocytes ratio (PLR) | 223 | 97-194 |
Evaluation of The CBC Report
RT PCR test indicated corona virus infection.
- Low blood oxygen level was due to poor exchange of oxygen at the alveoli due to exacerbation of asthma by corona virus infection (as indicated by increased wheezing and shortness of breath).
- These test reports were confirmed by the following CBC values: (C,D,E,F):
- Decreased total leucocyte (WBC) count, with decreased neutrophils, lymphocytes and platelets indicate bone marrow viral infection.
- Bone marrow viral infection is confirmed by the increase in number of large size platelets (Increased MPV, PWD).
- Increased Neutrophil/Lymphocytes (NLR) indicate subclinical inflammation.
- Incresed platelet/lymphocyte ration (PLR) indicate increased inflammation.
Additional Laboratory Tests
| PARAMETER | VALUE | NORMAL RANGE |
| C-Reactive protein (CRP) | 38 mg/L | < 5.0 mg/L |
| Serum procalcitonin | 3.3 ng/ml | 0.10-0.49 ng/ml |
| Serum ferritin | 348 µg/L | 15-300 µg/L |
LUNG FUNCTION ENZYME TESTS
| PARAMETER | VALUE | NORMAL RANGE |
| SGOT | 210 IU | 8-40 IU |
| Serum Lactate Dehydrogenase (LDH) | 310 IU | 70-240 IU |
COAGULATION TESTS
| PARAMETER | VALUE | NORMAL RANGE |
| Prothrombin time | 16 seconds | 12-16 seconds |
| D-dimer | 0.4 mg/L | <0.5 mg |
Evaluation of the Additional laboratory reports
(A) Increase in R-reactive protein (CRP) indicate increase in the inflammation. Increased CRP also confirms the following histogram values: MPV, PWD, NLR and PLR.
(B) Increase in serum procalcitonin indicate presence of secondary bacterial infection.
(C) Increase in serum ferritin confirms the viral infection
(D) Increased SGOT and LDH indicate moderate damage of lung tissue.
Q13. How routine and advanced IVD laboratory tests were useful to control asthma and microbial infections?
ANS:
(A) Bacterial infection could be treated by appropriate antibiotics.
(B) Corona infection could be controlled by appropriate supportive therapy, that includes drugs to decrease fever, cough, increased cytokines, and multivitamins and consideration of canulated oxygen, if needed.
(C) Effective use of post-analytical quality control (QC) measures as described in the evaluation of CBC and additional test reports.
Q14. How regular IVD laboratory test reports could impact asthma patient outcomes and overall health care costs?
ANS: The mean annual direct cost for asthma treatment in India was ₹18,737, with medications, doctor’s visits, investigations, and hospitalization costing ₹7,427, ₹2089, ₹1103, and ₹62,500 respectively. Indirect costs include lost working days for patients care and caregivers, which were also significant( ). Regular IVD laboratory tests can decrease severity of asthma and will be helpful to meet the asthma improvement criteria suggested in the answer of Q.8, thus impacting the overall health cost of the patient(12).
References
(1) Giovanni Rolla. Why Current Therapy Does Not Cure Asthma. Is It Time to Move Towards a One Health Approach? J Asthma Allergy (2023) Sep 4;16:933–936. doi: 10.2147/JAA.S429646.
(2) Mayo clinic health care bulletin on asthma (2025).
(3) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(4) Godkar PB, Godkar DP. Medical Biochemistry, Theory and Practicals (1st edition, 2024), CBS Publishers, New Delhi,India.
(5) Irene Mikhail,MD; MitchellH. Grayson,MD. Asthma and viral infections an intricate relationship. Ann Allergy Asthma Immunol, 123(2019)352e358.
(6) Michael R. Edwards, Nathan W. Bartlett, Tracy Hussell, Peter Openshaw & Sebastian L. Johnston. The microbiology of asthma. Nature Reviews Microbiology volume 10, pages 459–471 (2012).
(7) GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990‑2015: A systematic analysis for the global burden of disease study 2015. Lancet 2016;388:1545‑602.
(8) S Agrawal, N Pearce, S Ebrahim. Prevalence and risk factors for self-reported asthma in an adult Indian population: a cross-sectional survey. Int J Tuberc Lung Dis. 2013 Feb;17(2):275–282. doi: 10.5588/ijtld.12.0438.
(9) Sarath Raju, Trishul Siddharthan, Meredith C McCormack. Indoor Air Pollution and Respiratory Health Clin Chest Med. Clin Chest Med. 2020 Dec;41(4):825–843. doi: 10.1016/j.ccm.2020.08.014.
(10) Baldacci S, Maio S, Cerrai S, et al. Allergy and asthma: Effects of the exposure to particulate matter and biological allergens. Respir Med. 2015;109(9):1089–1104. 10.1016/j.rmed.2015.05.017
(11) Luke Curtis, Bob Lee, Center for Environmental and Occupational Medicine, University of Illinois Chicag. Pigeon allergens in indoor environments: A preliminary study, Wiley. Allergy, August 200257(7):627-31.DOI:10.1034/j.1398-9995.2002.03405.
(12) GBD 2015 Mortality and Causes of Death Collaborators. Global, regional,and national life expectancy, all‑cause mortality, and cause‑specific mortality for 249 causes of death, 1980‑2015: A systematic analysis for the global burden of disease study 2015. Lancet 2016;388:1459‑544.
