Asthma- Symptoms, Causes and treatment

Asthma is a condition of paroxysmal, reversible airways obstruction. It is a syndrome characterized by increased responsiveness of trachea and bronchi to various stimuli. Asthma is manifested by acute, recurrent or chronic attacks of widespread bronchial-bronchiolar narrowing.

Types 

A. Extrinsic
(Atopic); In children

BIntrinsic
(Non-Atopic); In Adults

Asthma- Signs and Symptoms

asthma

AGeneral  —

  1. Cough with or without sputum production
  2. Intercostal retractions
  3. Shortness of breath that gets worse with exercise or activity
  4. Wheezing
    a. Comes in episodes
    b. May go away on its own
    c. Improves with bronchodilators
    d. Usually begins suddenly

5. Abnormal breathing pattern –Breathing out takes more than twice as long as breathing in
6. Breathing temporarily stops
7. Chest pain
8. Nasal flaring
9.Tightness in the chest

B. Life-Threatening

  1. Bluish color to the lips and face
  2. Decreased level of alertness ( severe drowsiness or confusion)
  3. Extreme difficulty in  breathing
  4. Rapid pulse
  5. Severe anxiety due to shortness of breath
  6. Sweating

Asthma Causes

  1. Triggers–
  • Weather(sudden changes in temperature, fog, wind, thunderstorm)
  • Exercises(running)
  • Stress
  • Coughing
  • Repeated laughing
  • Drugs (NSAID’s, Beta/Alpha-blockers)

    2. Inducers
  • Infections (Pertussis, Mycoplasma, Viral URTI, Respiratory syncytial virus bronchiolitis)
  • Cigarrete smoking

3. Allergens

(house dust, mite, tree pollen, feathers, paint, smoke, animal, dander, molds, milk, eggs, nuts, chocolates, fish, shell-fish, strawberries)

Investigations

  1. Allergen specific IgE
  2. Arterial blood gas analysis
  3. Chest x-ray
  4. Lung function tests
  5. PBF
  6. PEFR
  7. Skin tests
  8. Sputum test
  9. Total Serum IgE
  10. Spirometry

 Asthma Treatment

 A. In Chronic cases-

  1.  Medications
  2.  Self-Management — Educating about the nature of treatment and how to use it, recognition of acute exacerbations, self-assessment.
  3. PEFR monitoring
  4. Non-Pharmacological, like- Stopping smoking, Reducing weight, Avoiding allergens, Family therapy for–(Depression, Anxiety, Denial of disease)

B. In Acute severe cases—

  1. Oxygen—Through nasal prongs or masks
  2. Corticosteroids
  3. Beta-agonists—Adrenaline, Nebulized salbutamol/terbutaline, Parenteral beta-agonists, Anticholinergic, Aminophylline
  4. Antibiotics
  5. Ventilators

Asthma Complications

  1. Respiratory—
    • Atelectasis lobular
    • Bronchiectasis
    • Subcutaneous emphysema
    • Mediastinal emphysema
    • Spontaneous pneumothorax
    • Cystic degeneration of lungs
    • Spontaneous rib fracture
    • Recurrent bronchitis
    • Pneumonia
    • Respiratory failure
    • Cor pulmonale
  2. Cardiac
    • Dysrhythmias
    • Myocardial infarction
  3. Hypokalemia
  4. Acute myopathy
  5. Nausea and vomiting(dose related)

Asthma Prevention

  • Identify and avoid the allergen/triggers
  • Hypo sensitization—Raising immunity to the offending allergen
  • Psychotherapy
  • Chest exercise

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