ASTHMA

Introduction:

Asthma is a chronic inflammatory disease of the airways that causes airway

hyperresponsiveness, mucosal edema, and mucus production. This inflammation
ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness,
wheezing, and dyspnea.

Asthma differs from other obstructive lung diseases in that it is largely reversible,
either spontaneously or with treatment. Patients with asthma may experience symptom-
free periods alternating with acute exacerbations, which last from minutes to hours or
days. Asthma can occur at any age and is the most common chronic disease of childhood.
Despite increased knowledge regarding the pathology of asthma and the development of
better medications and management plans, the death rate from asthma continues to
increase. For most patients it is a disruptive disease, affecting school and work
attendance, occupational choices, physical activity and general quality of life.

Allergy is the strongest predisposing factor for asthma. Chronic exposure to

airway irritants or allergens also increases the risk for developing asthma. Common
allergens can be seasonal (grass, tree and weed pollens) or perennial (mold, dust, roaches
or animal dander). Common triggers for asthma symptoms and exacerbations in patients
with asthma include air irritants (air pollutants, cold, heat, weather changes, strong odors
or perfumes, smoke), exercise, stress or emotional upsets, sinusitis with postnasal drip,
medications, viral respiratory tract infections, and gastroesophageal reflux. Most people
who have asthma are sensitive to a variety of triggers. A patient’s asthma condition will
change depending upon the environment, activities, management practices and other
factors.
CLASSIFICATION:

1. Extrinsic Asthma – called Atopic/allergic asthma. An “allergen” or an “antigen” is a

foreign particle which enters the body. Our immune system over-reacts to these often
harmless items, forming “antibodies” which are normally used to attack viruses or
bacteria. Mast cells release these antibodies as well as other chemicals to defend the
body.

Common irritants:

• Cockroach particles
• Cat hair and saliva
• Dog hair and saliva
• House dust mites
• Mold or yeast spores
• Metabisulfite, used as a preservative in many beverages and some foods
• Pollen

2. Intrinsic asthma – called non-allergic asthma, is not allergy-related, in fact it is

caused by anything except an allergy. It may be caused by inhalation of chemicals
such as cigarette smoke or cleaning agents, taking aspirin, a chest infection, stress,
laughter, exercise, cold air, food preservatives or a myriad of other factors.

• Smoke
• Exercise
• Gas, wood, coal, and kerosene heating units
• Natural gas, propane, or kerosene used as cooking fuel
• Fumes
• Smog
• Viral respiratory infections
• Wood smoke
• Weather changes
Pathophysiology:

Casual Factors: Contributing factors:

Predisposing factors: • Exposure to indoor • Respiratory
• Atopy or outdoor allergens infections
• Female gender • Occupational • Air pollution
sensitizers • Active/ passive
smoking

Inflammation

Hyperresposiveness of
airway Airflow limitation.

Symptoms:
Risk Factors for exacerbations:
Wheezing
Allergens
Cough
Respiratory infections
Dyspnea
Exercise and hyperventilation
Chest tightness
Weather changes
Exposure to sulfur dioxide
Exposure to foods, additives and
medications.
Treatment:

The Global Initiative for Asthma 6-point plan

• Educate patients to develop a partnership in asthma management.

• Assess and monitor asthma severity with symptom reports and measures of lung
function as much as possible.
• Avoid exposure to risk factors.
• Establish medication plans for chronic management in children and adults.
• Establish individual lans for managing exacerbations.
• Provide regular follow-up care.

Pharmacotherapy:

Two general classes of asthma medications are long-acting medications to achieve

and maintain control of persistent asthma and quick relief medications for immediate
treatment of asthma symptoms and exacerbations. Because the underlying pathology of
asthma is inflammation, control of persistent asthma is accomplished primarily with
regular use of anti-inflammatory medications. These medications have systemic side
effects when used long term. Corticosteroids are the most potent and effective anti-
inflammatory medications currently available.