Image Source: Asthma inhaler
Definition:- Definition of the “Asthma is a chronic inflaming condition of the airways”. It involves complex interactions between many cells and inflammatory mediators that result in inflammation, obstruction increased airway responsiveness and discontinuous asthma symptoms. Neutrophils may play an important role in some asthma exacerbations.
According to the Centers for Disease Control and Prevention (CDC), 1 in 13 people have asthma.
According to WHO estimates, 235 million people struggle from asthma.
Asthma is the most common chronic disease amongst children. Asthma is more public in adult women than men.
Just not a public health problem for high income countries: it happens in all countries irrespective of level of growth. Over 80% of asthma deaths happen in low and lower-middle income countries.
Below diagnosed and under treated, creating a considerable problem to persons and families and possibly limiting individuals’ actions for a lifetime.
The primary chronic disease asthma in children. Asthma is more communal in children than adults. Asthma is more mutual in boys than girls.
Signs & Symptoms:-
Breathlessness while walking, speaks in sentences, moderate wheezing.
Dyspnea while at rest, in phrases, loud wheezing throughout expiration
Breathlessness while at rest, speaks in words loud wheezing, coughing difficulty speaking, accessory chest muscle use, and chest hyperinflation
Severe respiratory distress, failure confusion lethargy, cyanosis disappearance of breath sounds, and pulsus paradoxus≥ 12 mm Hg
»Allergens (e.g., pollen, house dust mite, animal dander, mold, cockroaches, food)
»Concurrent predisposition to allergy is highly prevalent in patients with asthma, especially children.
»For example, allergic rhinitis is reported in 45% of patients with asthma compared to 20% of the general population.
»Occupational experiences (e.g., chemical irritants, flour, wood, textile dusts)
»Viral respiratory tract infections
»Emotions (e.g., anxiety, stress, hard laughter, crying)
»Asthma and Chronic Obstructive Pulmonary Disease.
»Exposure to irritations (e.g., strong odors, chemicals, fumes)
»Environmental exposures (e.g., weather changes, cold air, sulfur dioxide, cigarette smoke)
»Reactions to drugs may occur as a result of hypersensitivity or as an extension of the pharmacological effect.
Problematic drugs include:-
»aspirin and other non-steroidal anti-inflammatory drugs such as ibuprofen (note: cyclooxygenase
»inhibitors are not recommended for use in aspirin-sensitive asthma patients)
»antiadrenergic and cholinergic drugs (e.g.β-adrenergic blockers, bethanechol)
»medications (or foods) that contain tartrazine, sulfites, benzalkonium chloride, and other preservatives
»Excipients in inhaled drugs that are derivatives of legumes in peanut allergic patients.
Allergens:- Pollens, molds, house dust mite, animals (dander, saliva and urine).
Industrial chemicals:- Isocyanate-containing paints, epoxy resins, aluminum, hair sprays, penicillin’s and cimetidine.
Drugs:-Aspirin, ibuprofen and other prostaglandin synthetase inhibitors, β-adrenoceptor blockers.
Foods:- foods are cause but examples includes nuts, seafood, fish, dairy products, food coloring, especially tartarzine, benzoic acid and sodium metabisulfite.
Environmental pollutants:- Traffic fumes. Cigarette smoke, sulphurdioxide
Other industrial triggers:-Wood or grain dust, colophony in solder,cotton, dust, grain weevils and mites
Miscellaneous:- exercise, Cold air, hyperventilation, viral respiratory tract infections, emotion
The asthma guidelines highlight that disease severity is used to initiate therapy and asthma control should be used to monitor therapy.
The guidelines have also been modified to incorporate domains of both disease risk and impairment to determine disease severity .
The guidelines define impairment as the frequency and intensity of symptoms and functional limits the patient is presently experiencing or has recently expert.
Risk is defined as the likelihood of asthma exacerbations, progressive decline in lung function or adverse effects from medicines.
A patient’s severity classification plays an important Role in determining the most appropriate pharmacotherapeutic approach and is determined by
»Symptoms (short-acting β-agonist use, nocturnal symptoms),
»Interference with normal daily activity,
»Frequency of exacerbations.
»Lung function (spirometry to determine FEV1 and FVC).
On postmortem examination of patients with asthma, the following characteristics have been identified:
»Hypertrophy of smooth muscle
»Airways covering plugs containing of inflammatory cells and their debris, proteins, and mucus.
»Inflammatory cellular infiltrate with vasodilation, denuded airway epithelium, and micro vascular leakage
»the Vasodilation of the vasculature
»Denuded airway epithelium
»Micro vascular leakage
»Collagen deposition in basement membranes.
Major contributing processes:-
The Airway obstruction:-this is responsible for many of the clinical appearances of asthma.
Airway cross section:-
Image source: Normal airway cross section
»Airway barrier reduces ventilation to some lung areas, which causes a perfusion imbalance that leads to hypoxemia. This is reflected by a reduction in the partial pressure of arterial oxygen (Pao2) observed in moderate-to-severe exacerbations.
The Demagogic cells:- (i.e., mast cells, eosinophil’s, activated T cells, macrophages, and epithelial cells) secrete peacekeepers and influence the airways unswervingly or via neural devices.
Hyper responsiveness:- an exaggerated response to certain stimuli, is an important feature of asthma and appears to correlate with clinical severity and medication requirements.
Enlarged levels of demagogic mediators and infiltration by provocative cells are thought to be the primary mechanisms in charge for airway hyper receptiveness.
The Airway inflammation:- is critical to development of asthma and underwrites to airway hyper
Image source: Damaged Airway cross section
responsiveness, Airflow obstruction, Demagogic cells and their intermediaries are answerable for altered mucociliary purpose, epithelial trouble fluctuating from minor ciliary loss to severely denuded epithelium, increased airway permeability , and complete clearance of inflammatory mediators.
»Acute inflammation is related with early enrollment of cells to the airway.
»Chronic inflammation is associated with persistent cell damage and ongoing repair, resultant in airway irregularities that may become perpetual.
»Modification in autonomic neural regulator also contributes to barrier.
Airway remodeling:- can result from persistent inflammation to chronic asthma symptoms. The resulting damage can yield permanent airway abnormalities because of subbasement membrane collagen deposition and fibrosis.
Hypertrophy of the airway smooth muscle is additional form of tissue transformation in asthma. These events may occur even in the face.
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