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1.

Introduction

Bronchial asthma is a disease caused by increased


responsiveness of the tracheobronchial tree to various
stimuli. The result is paroxysmal constriction of the bronchial
airways. Bronchial asthma is the more correct name for the
common form of asthma. The term 'bronchial' is used to
differentiate it from 'cardiac' asthma, which is a separate
condition that is caused
by heart failure. Although the two types of asthma have
similar symptoms, including wheezing (a whistling sound in
the chest) and shortness of breath, they have quite different
causes.

Bronchial asthma is a disease of the lungs in which an


obstructive ventilation disturbance of the respiratory
passages evokes a feeling of shortness of breath. The cause
is a sharply elevated resistance to airflow in the airways.
Despite its most strenuous efforts, the respiratory
musculature is unable to provide sufficient gas exchange.
The result is a characteristic asthma attack, with spasms of
the bronchial musculature, edematous swelling of the
bronchial wall and increased mucus secretion. In the initial
stage, the patient can be totally symptom-free for long
periods of time in the intervals between the attacks. As the
disease progresses, increased mucus is secreted between
attacks as well, which in part builds up in the airways and
can then lead to secondary bacterial infections. Bronchial
asthma is usually intrinsic (no cause can be demonstrated),
but is occasionally caused by a specific allergy (such as
allergy to mold, dander, dust). Although most individuals
with asthma will have some positive allergy tests, the allergy
is not necessarily the cause of the asthma symptoms.

Symptoms can occur spontaneously or can be triggered by


respiratory infections, exercise, cold air, tobacco smoke or
other pollutants, stress or anxiety, or by food allergies or
drug allergies. The muscles of the bronchial tree become
tight and the lining of the air passages become swollen,
reducing airflow and producing the wheezing sound. Mucus
production is increased.

Typically, the individual usually breathes relatively normally,


and will have periodic attacks of wheezing. Asthma attacks
can last minutes to days, and can become dangerous if the
airflow becomes severely restricted. Asthma affects 1 in 20
of the overall population, but the incidence is 1 in 10 in
children. Asthma can develop at any age, but some children
seem to outgrow the illness. Risk factors include self or
family history of eczema, allergies or family history of
asthma. Bronchial asthma causes cough, shortness of
breath, and wheezing. Bronchial asthma is an allergic
condition, in which the airways (bronchi) are hyper-reactive
and constrict abnormally when exposed to allergens, cold or
exercise.

Treatment is aimed at avoiding known allergens and


controlling symptoms through medication. A variety of
medications for treatment of asthma are available. People
with mild asthma (infrequent attacks) may use inhalers on
an as-needed basis. Persons with significant asthma
(symptoms occur at least every week) should be treated
with anti-inflammatory medications, preferably inhaled
corticosteroids, and then with bronchodilators such as
inhaled Alupent or Vanceril. Acute severe asthma may
require hospitalization, oxygen, and intravenous
medications.

Decrease or control exposure to known allergens by staying


away from cigarette smoke, removing animals from
bedrooms or entire houses, and avoiding foods that cause
symptoms. Allergy desensitization is rarely successful in
reducing symptoms.

Aspiration pneumonia is bronchopneumonia that develops


due to the entrance of foreign materials that enter the
bronchial tree, usually oral or gastric contents (including
food, saliva, or nasal secretions). Depending on the acidity of
the aspirate, a chemical pneumonitis can develop, and
bacterial pathogens (particularly anaerobic bacteria) may
add to the inflammation.
3. What are the signs and symptoms of aspiration
pneumonia?

Sometimes it may take a few days for symptoms of


aspiration pneumonia to begin. The signs and symptoms of
aspiration pneumonia can get worse very quickly. The signs
and symptoms that you have may depend on what you
inhaled into your lungs, and how much was inhaled. Common
signs and symptoms may include one or more of the
following:

Frequent coughing. Your cough may may bring up bad-


smelling mucus from your lungs. This phlegm (flem) may
have pus or streaks of blood in it. You may also cough up
frothy (bubbly) fluid from your lungs.

Shortness of breath or noisy breathing. Your heartbeat or


breathing (while resting) may seem much faster than
normal.

Fever or chills. You may sweat a lot.

Chest pain when you cough or take a deep breath.

Trouble swallowing, or you feel like something is stuck in


your throat.

Feeling dizzy, faint, or having new trouble thinking


(confusion). You may feel upset or anxious.

Feeling like you cannot get enough air. Your skin, lips, or
fingernails may turn dusky or blue.
How is aspiration pneumonia diagnosed?

Your caregiver will examine you and listen to your heart and
lungs through a stethoscope (STETH-oh-skohp). You may
need tests such as blood tests or a chest x-ray. You may
need different tests to find out more about how well you
swallow. These tests may include swallowing studies, or
special tests of your throat or esophagus. Special x-ray
pictures, such as a barium swallow, may be needed to see
what happens when you swallow. You may need an
endoscopy (en-DOS-koh-pee) to find or treat a swallowing
problem. During an endoscopy, your caregiver uses a small
tube with a light on the end (called a scope). The scope lets
your caregiver see your throat, esophagus, and stomach.

How is aspiration pneumonia treated?

You may need to stay in the hospital to get better from


aspiration pneumonia. You may need oxygen and special
medicines to help your lungs. You may need medicine to help
reduce the acid in your stomach or to help food move
through your stomach faster. You may need antibiotics (an-
ti-bi-AH-tiks) to prevent or treat an infection caused by
bacteria (bak-TEE-ree-ah). You may need a machine to help
you breathe. If you inhaled something solid, you may need a
bronchoscopy (brong-KOS-ke-pee) to remove it. This
procedure uses a small, flexible scope that is passed through
your mouth and into your lungs. You may need special
caregivers to help decrease your chance of inhaling
something into your lungs again. A speech and language
pathologist (pah-THOL-oh-jist) or an occupational (ok-u-
PAY-shun-al) therapist may help find and treat swallowing
problems. A dietitian (deye-e-TISH-an) can help you plan
easy-to-swallow meals to decrease your risk of choking.

Risks:

Aspiration pneumonia can be serious, even life threatening.


You may get a lung infection that may spread to the
bloodstream or other areas of your body. You may get other
life threatening problems such as respiratory failure (when
you cannot breathe without the help of a machine).
Pneumonia is even more dangerous for people over the age
of 50, and people with immune system or other health
problems. It may take a long time to get better after having
aspiration pneumonia. The sooner your pneumonia is
treated, the less chance you have of problems.

What causes asthma? - Asthma is caused by inhaling an


allergen that sets off the chain of biochemical and tissue
changes leading to airway inflammation,
bronchoconstriction, and wheezing