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

1 Answer
Minal

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.

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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

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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

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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.

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