Overview

Asthma is a common chronic disease worldwide and affects approximately

24 million persons in the United States. It is the most common chronic
disease in childhood, affecting an estimated 7 million children. The
pathophysiology of asthma is complex and involves airway inflammation,
intermittent airflow obstruction, and bronchial hyperresponsiveness,
resulting in bronchoconstriction.

Asthma symptoms, which include coughing, wheezing, and chest
tightness, are common in an asthma attack. Sometimes asthma is
called bronchial asthma or reactive airway disease. Asthma can be
controlled with proper treatment.

Etiology

Factors that can contribute to asthma or airway hyperreactivity may include
any of the following:
Environmental allergens (eg, house dust mites; animal allergens,
especially cat and dog; cockroach allergens; and fungi)
Viral respiratory tract infections
Exercise, hyperventilation
Gastroesophageal reflux disease
Chronic sinusitis or rhinitis
Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity,
sulfite sensitivity
Use of beta-adrenergic receptor blockers (including ophthalmic
preparations)
Obesity
Environmental pollutants, tobacco smoke
Occupational exposure
Irritants (eg, household sprays, paint fumes)
Various high- and low-molecular-weight compounds (eg, insects, plants,
latex, gums, diisocyanates, anhydrides, wood dust, and fluxes;
associated with occupational asthma)
Emotional factors or stress
Perinatal factors (prematurity and increased maternal age; maternal
smoking and prenatal exposure to tobacco smoke; breastfeeding has not
been definitely shown to be protective)


Extrinsic
Type I hypersensitivity reaction
Intrinsic
unknown mechanism
Allergic (atopic) Respiratory infections (usually viral)
Most common type Stress
Allergens: Pollen, dust, food, molds,
animal dander etc
Exercise
Occupational exposure: fumes,
gases, and chemicals
Cold temperatures
Drug induced (aspirin)

Sputum cytology:
Curschmann spirals: twisted mucous plugs admixed with sloughed
epithelium.
Eosinophils
Charcot-Leyden crystals: composed of eosinophil membrane protein
Microbiology
Mucous plugs
Hypertrophy of mucous glands with goblet cell hyperplasia
Inflammation (especially eosinophils)
Edema
Hypertrophy and hyperplasia of bronchial wall smooth muscle
Thickened basement membranes




Pathophysiology
The pathophysiology of asthma is complex and involves the following
components:
Airway inflammation
Intermittent airflow obstruction
Bronchial hyperresponsiveness

Signs and Symptoms

People with asthma experience symptoms when the airways tighten,
inflame, or fill with mucus. Common asthma symptoms include:
Coughing, especially at night
Wheezing
Shortness of breath
Chest tightness, pain, or pressure

Early warning signs of asthma include:
Frequent cough, especially at night
Losing your breath easily or shortness of breath
Feeling very tired or weak when exercising
Wheezing or coughing after exercise
Feeling tired, easily upset, grouchy, or moody
Decreases or changes in lung function as measured on a peak flow
meter
Signs of a cold or allergies (sneezing, runny nose, cough, nasal
congestion, sore throat, and headache)
Trouble sleeping








Asthma signs and symptoms include:
Shortness of breath
Chest tightness or pain
Trouble sleeping caused by shortness of breath, coughing or wheezing
A whistling or wheezing sound when exhaling (wheezing is a common
sign of asthma in children)
Coughing or wheezing attacks that are worsened by a respiratory virus,
such as a cold or the flu
Signs that your asthma is probably worsening include:
Asthma signs and symptoms that are more frequent and bothersome
Increasing difficulty breathing (measurable with a peak flow meter, a
device used to check how well your lungs are working)
The need to use a quick-relief inhaler more often

Test and diagnosis

Lung (pulmonary) function tests to determine how much air moves in
and out as you breathe. These tests may include:

Spirometry. This test estimates the narrowing of your bronchial tubes by
checking how much air you can exhale after a deep breath and how fast
you can breathe out.
Peak flow. A peak flow meter is a simple device that measures how hard
you can breathe out. Lower than usual peak flow readings are a sign your
lungs may not be working as well and that your asthma may be getting
worse.

Methacholine challenge. Methacholine is a known asthma trigger that,
when inhaled, will cause mild constriction of your airways. If you react to
the methacholine, you likely have asthma. This test may be used even if
your initial lung function test is normal.

Imaging tests. A chest X-ray and high-resolution computerized
tomography (CT) scan of your lungs and nose cavities (sinuses) can
identify any structural abnormalities or diseases (such as infection) that

can cause or aggravate breathing problems.

Sputum eosinophils. This test looks for certain white blood cells
(eosinophils) in the mixture of saliva and mucus (sputum) you discharge
during coughing. Eosinophils are present when symptoms develop and
become visible when stained with a rose-colored dye (eosin).


Treatment

P2-Agnnist (albuterol) inhalers help bronchodilate and reduce airflow
obstruclion. Corticosteroids: Used to reduce inflammation. Inhaled form given to
reduce systemie side effects. Oral or parenteral steroids are used in acule,
severe allacks.
Xanthines (iheophylline): 'These drugs increase cAMP, leading to airway dilation.
'They may also have an anti-inflammalory effect. Cromolyn: Inhibils the release
of inflanimatory medialors irom mast cells.
Leukotriene blockers: Zileuton inhibils 5-lipoxv'geiiase, which reduces the
prodiietion of leukotrienes. Montelukast and zafirlukast are leukot- riene D^-

receplor antagonisls.
Omaliziimab: Monoclonal anlibody that binds circulating IgF. reducing airway
inllammalion.