Asthma

General Illness Information

Common Name: ASTHMA

Medical Term: None Specified

Description:

Asthma is a chronic disorder with recurrent attacks of wheezing, shortness of breath and cough.

Asthma is defined as an inflammatory disorder of the airways characterized by intermittent or persistent symptoms such as shortness of breath, chest tightness, wheezing, sputum production and cough, associated with variable airflow limitation and a variable degree of airway hyperresponsiveness to endogenous or exogenous stimuli

It affects all ages but 50% of the cases are in children under age 10 (more common in males). In adult onset asthma, females are more often affected than males.

Causes:

Hypersensitivity reactions in air passages result in over-activity and spasm followed by swelling of the passages and thickening of lung secretions (sputum). This decreases or closes off air to the lungs.

These reactions are result of: Allergens, such as pollen, dust animal dander, molds and some foods; Lung infections such as bronchitis; Air irritants, such as smoke and odors; Exposure to occupational chemicals or other materials; Exercise- in exercise-induced asthma; Aspirin – in aspirin intolerant asthma

Prevention:

Avoid known allergens and air pollutants. Take prescribed preventive medicines regularly; don’t omit them when you feel well. Avoid aspirin. Investigate and avoid triggering factors.

Signs & Symptoms

Asthma attacks vary in frequency and severity. Some patients are free of symptoms most of the time and will have brief occasional episodes of wheezing and shortness of breath. However, other patients will have cough and wheezing all the time and get worse when they get a viral infection or are exposed to allergens or irritants. An asthmatic attack may begin suddenly and present with the following:

  • Chest tightness and shortness of breath.
  • Wheezing upon breathing out.
  • Neck muscles tighten.
  • Coughing, especially at night, with little sputum. Also cough on exertion or exposure to cold air.
  • Severe symptoms of acute attack include:
  • Indrawing of the chest wall muscles.
  • Bluish skin.
  • Exhaustion.
  • Grunting respiration.
  • Inability to speak.
  • Mental changes, including restlessness or confusion.

Risk Factors

  • Other allergic conditions, such as eczema or hay fever.
  • Family history of asthma or allergies.
  • Exposure to air pollutants.
  • Smoking.
  • Use of drugs such as aspirin.
  • Stresses (viral infection, exercise, emotional upset, noxious odors, tobacco smoke).

Diagnosis & Treatment

Goals of asthma treatment:

  • Achieve and maintain control of symptoms.
  • Prevent asthma exacerbations.
  • Maintain optimal pulmonary function.
  • Maintain normal activity levels( +exercise).
  • Avoid adverse effect from asthma medications.
  • Prevent the development of irreversible airflow limitation.
  • Prevent asthma mortality.

General Measures:

  • Diagnostic test may include laboratory blood studies, chest x-ray, pulmonary-function tests and allergy testing, usually with skin tests.
  • Emergency-room care and hospitalization for severe attacks.
  • Counseling, if asthma is stress-related.
  • Environmental measures and education
  • Eliminate allergens and irritants at home and a work, if possible.
  • Treatment for desensitizing to specific allergens.
  • Keep regular medications with you at all times.
  • Sit upright during attacks.
  • Maintain acceptable asthma control and determine minimal medication required to achieve asthma control.
  • Provide and explain an action plan- for management of exacerbations.
  • Ensure regular follow up with your physician to review asthma control and compliance to treatment and environmental control issues.
  • Stay indoors as much as possible during high allergen times.
  • Additional information available from the Asthma and Allergy Foundation of America, 1717 Massachusetts Ave., Suite 305, Washington, DC 20036, Or The Canadian Lung Association www.lung.ca.

Medications:

Categories of asthma medications:

1. Bronchodilators:

Bronchodilators, such as salbutamol open air passages. These are for quick relief of symptoms but does not treat the inflammation in the airway lininig. The effect of these medications lasts 4 to 6 hours. These bronchodilators can be taken orally, injected or inhaled. Inhalation is the preferred method of administering the medication because it deposits the drug directly in the airways and therefore acts very quickly except in severely obstructed airways. The side effects of these drugs are rapid heartbeat, restlessness, headache and tremors.

Ipratropium bromide is sometimes used to provide quick relief of symptoms.

Theophylline, another drug that produces bronchodilatation. It is usually taken orally- theophylline is available in many forms, from short-acting tablets and syrups to longer-acting sustained release tablets and capsules. In severe attack it can be used intravenously.

Newer longer acting bronchodilators e.g. salmeterol are also available. These cannot be used as quick relief or rescue medication because the onset of action is much slower. These are useful in preventing an asthma attack and are used in maintenance therapy.

2. Anti-inflammatory medications:

Corticosteroid inhalers and oral – used in the treatment and prevention of asthma. Inhaled steroids are recommended as the mainstay in the treatment and management of an asthmatic patient. With the newer steroid inhalers the risk of side effects is minimized further because of reduced systemic absorption, which is claimed to be less than 1%. Intravenous cortisone drugs (emergencies only) to decrease the body’s allergic response

Leukotriene receptor antagonists (zafirlucast, montelukast and pranlukast) are used as preventive treatment in mild to moderate asthma. The advantage of this medication is that it is taken orally. Leukotriene receptor antagonists are especially effective in aspirin-intolerant asthma and exercise- induced asthma.

Antiallergic agents – cromolyn sodium or nedocromil by nebulizer.

Activity:

  • Stay active, but avoid sudden bursts of exercise. If an attack follows heavy exercise, sit and rest. Sip warm water.
  • Treatment with bronchodilators often prevents exercise-caused asthma.
  • Swimming is perhaps the best exercise for asthma patients.

Diet:

  • No special diets but avoid foods to which you are sensitive.
  • Drink at least 3 quarts of liquid daily to keep secretions loose.

Possible Complications:

  • Respiratory failure.
  • Pneumothorax.
  • Lung infection and chronic lung problems from recurrent attacks.

Prognosis

Symptoms can be controlled with treatment and strict adherence to prevention measures. Half the children will outgrow asthma. Without treatment, severe attacks can be fatal.

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