Asthma is a condition of paroxysmal, reversible airway obstruction. It is a syndrome characterized by increased responsiveness of the 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
B. Intrinsic
(Non-Atopic); In Adults
Signs and Symptoms of Asthma
A. General
- Cough with or without sputum production
- Intercostal retractions
- Shortness of breath that gets worse with exercise or activity
- Wheezing
a. Comes in episodes
b. May go away on its own
c. Improves with bronchodilators
d. Usually begins suddenly
- Abnormal breathing pattern –Breathing out takes more than twice as long as breathing in
- Breathing temporarily stops
- Chest pain
- Nasal flaring
- Tightness in the chest
B. Life-Threatening
- Bluish colour to the lips and face
- Decreased level of alertness ( severe drowsiness or confusion)
- Extreme difficulty in breathing
- Rapid pulse
- Severe anxiety due to shortness of breath
- Sweating
Causes
- Triggers–
- Weather (sudden changes in temperature, fog, wind, thunderstorm)
- Exercises (running)
- Stress
- Coughing
- Repeated laughing
- Drugs (NSAIDs, Beta/Alpha-blockers)
2. Inducers
- Infections (Pertussis, Mycoplasma, Viral URTI, Respiratory syncytial virus bronchiolitis)
- Cigarette smoking
3. Allergens
( house dust, mite, tree pollen, feathers, paint, smoke, animal, dander, milk, eggs, nuts, chocolates, fish, shellfish, strawberries and many more..)
Investigations
- Allergen specific IgE
- Arterial blood gas analysis
- Chest x-ray
- Lung function tests
- PBF
- PEFR
- Skin tests
- Sputum test
- Total Serum IgE
- Spirometry
Treatment
A. In Chronic cases
- Medications
- Self-Management — Educating about the nature of treatment and how to use it, recognition of acute exacerbations, self-assessment.
- PEFR monitoring
- Non-Pharmacological, like- Stopping smoking, Reducing weight, Avoiding allergens, Family therapy for–(Depression, Anxiety, Denial of disease)
B. In Acute severe cases
- Oxygen—Through nasal prongs or masks
- Corticosteroids
- Beta-agonists—Adrenaline, Nebulized salbutamol/terbutaline, Parenteral beta-agonists, Anticholinergic, Aminophylline
- Antibiotics
- Ventilators
Complications
Respiratory—
- Atelectasis lobular
- Bronchiectasis
- Subcutaneous emphysema
- Mediastinal emphysema
- Spontaneous pneumothorax
- Cystic degeneration of the lungs
- Spontaneous rib fracture
- Recurrent bronchitis
- Pneumonia
- Respiratory failure
- Cor pulmonale
Cardiac
- Dysrhythmias
- Myocardial infarction
Hypokalemia
Acute myopathy
Nausea and vomiting (dose-related)
Prevention
- Identify and avoid the allergen/triggers
- Hypo sensitization—Raising immunity to the offending allergen
- Psychotherapy
- Chest exercise
- Breathing exercises like pranayama including anulom-vilom and kapaal bhaati improve the lungs function significantly and help in the prevention of Asthma.