Bronchial Asthma is a disease of chronic airway inflammation characterized by chronic airway inflammation, bronchial hyperactivity and reversible airway obstruction.
There are two types of Asthma based on the sensitivity.
Atopic or Extrinsic Asthma: Hypersensitive to allergen e.g. pollen, dust mites.
Non-Atopic Intrinsic Asthma: Airway reactivity to non-immune triggers e.g. aspirin, NSAIDs, beta-blockers, sulfites, irritant dust, pollutants, cold, exercise, infection, stress.
- 5-10% populations are affected
- Half of the cases have onset before age 10 but can develop at any age.
- Male are prone to this than Female
- Family History of asthma or atopic diseases.
Signs and Symptoms:
- A cough
- Shortness of breath
- Chest tightness
- Expiratory wheeze
- Prolonged expiration
- Productive sputum
- Overinflation with air, mucus, and debris
- Nocturnal awakening
- Sleep disturbances
- Severe Acute Exacerbations:
- Accessory muscle use
- Unable to speak full sentence
- Decreased air movement
- Hyperinflation (increased AP diameter of thorax)
- Altered mental status
- Pulsus paradoxes
- Increased eosinophils
- Patient History, Family History
- Physical examination
- Pulmonary Function Test (PFT):
- Decreased FEV1 (Forced Expiratory Volume)
- Increased TLC (total Leukocyte Count)
- Increased RV (Right Ventricle)
- Demonstration of reversible airway dysfunction
- Increase FEV1 after beta antagonist inhaler
- Bronchoconstriction in response to methacholine or cold air challenge.
- Chest X-ray: hyperinflation, atelectasis.
- Arterial blood gas (ABG) test to measures the amount of oxygen and carbon dioxide in the blood.
- Respiratory alkalosis.
- Metabolic Acidosis.
- Sputum culture
- Avoid risk factors
- Supplemental oxygen therapy
- Beta-agonists for bronchodilation
- Short-acting (albuterol) – for acute rescue
- Long-acting (salmeterol) – for nocturnal use, exercise and persistent asthma.
- Inhaled corticosteroids for chronic therapy
- Anticholinergics (ipratropium)
- Mast cell stabilizers in children
- Leukotriene inhibitors (montelukast)
- Systemic steroids (prednisolone), nebulized beta-agonists, and occasionally theophylline for acute and severe exacerbations.
- Status Asthmaticus: The prolonged severe attack that doesn’t respond to initial therapy may lead to respiratory failure and death.