Bronchial asthma has become very common these days. What are its sign, symptoms, and treatment?

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.

Epidemiology:

• 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
• Tachycardia
• Tachypnoea
• Severe Acute Exacerbations:  
• Accessory muscle use
• Unable to speak full sentence
• Decreased air movement
• Hyperinflation (increased AP diameter of thorax)
• Altered mental status
• Hypoxia
• Pulsus paradoxes
• Increased eosinophils

Investigations:

• 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.
• Hypoxemia.
• Metabolic Acidosis.
• Sputum culture

Treatment:

• 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.