Question 1 of 10

    Asthma (Asthmas)

    Two Peak Flow Meters[1]

    Asthma is a chronic inflammatory disease of the airways characterized by airway hyperresponsiveness and reversible airflow obstruction. It is caused by a combination of incompletely understood environmental and genetic interactions. Common symptoms include wheezing, coughing and dyspnea, which may vary from mild and almost undetectable to severe and unremitting. Symptoms can be prevented by avoiding triggers.

    The disease is promted by the following process: auto-immune.

    Presentation

    Most of the symptoms of asthma involve the respiratory system and symptoms depend mainly on the severity of the condition. Some of the symptoms of asthma are:

    Cough: The cough from asthma is so distressing that one find it difficult to sleep. It usually worsens late at night and early in the morning.

    Wheezing: Wheezing manifests itself as squeaky or a whistling sound while breathing.

    Chest tightness: The patient feels as if something is sitting on the chest and squeezing.

    Shortness of breath: Most people find it very difficult to breathe. They feel as if they cannot breathe out.

    Symptoms may vary depending on the severity of the condition and if left untreated can even turn fatal. Treatment given at the first onset of symptoms can leave the patient symptomless during the day and night.

    Complications

    Though not life threatening, asthmatic attacks can affect the regular activities in school and at work and may require frequent hospitalizations. Moreover, it can result in permanent narrowing of the airway. Using long term medications have their own side effects too [10]. Normal asthmatic attacks if not taken proper care can turn out to be life threatening condition called the status asthmaticus that may require hospitalization.

    Jaw & Teeth
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  • Entire body system
    Agitation
    • Symptoms of Asthma The prominent symptoms of asthma attacks are: Decrease in the functioning of the lungs Chronic cough Interrupted talking Shortness of breath Flaring of nostrils Agitation Hyperinflation A feeling of tightness in the chest Diagnosis[organicfacts.net]
    • Side effects are common, including increased energy, insomnia, hunger, agitation, and mood alteration, but they generally can be tolerated for a short period during which restoration of normal breathing is the priority.[uptodate.com]
    • A person may also experience insomnia, agitation, vomiting, and seizures.[merckmanuals.com]
    Congestive Heart Failure
    • Then, there are other medical conditions such as chronic obstructive pulmonary disease, congestive heart failure and heart disease that can coexist with asthma and complicate diagnosis and treatment.[khn.org]
    • In adults, COPD, congestive heart failure, airway masses, as well as drug-induced coughing due to ACE inhibitors should be considered.[en.wikipedia.org]
    • heart failure; COPD, chronic obstructive pulmonary disease; DPI, dry powder inhaler; IgE, immunoglobulin E; LFTs, liver function tests; max, maximum; MDI, pressurized metered-dose inhaler; N/A, not available; NS, normal saline; sol'n, solution; tab,[clevelandclinicmeded.com]
    Hypoxemia
    Nocturnal Awakening
    • This patient is more likely to require hospitalization or emergency department management, miss school or work days, and experience nocturnal awakening or limitation in routine activities because of asthma.[clevelandclinicmeded.com]
    Recurrent Bronchitis
    • Most children with chronic or recurrent bronchitis have asthma.[emedicine.medscape.com]
    • Signs and symptoms Signs and symptoms of asthma include the following: Wheezing Coughing Shortness of breath Chest tightness/pain Other nonspecific symptoms in infants or young children may be a history of recurrent bronchitis, bronchiolitis, or pneumonia[emedicine.medscape.com]
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  • neurologic
    Dizziness
    • Keep an eye out for side effects of medications or other signs of allergies, which might make asthma symptoms worse, including a very dry mouth, stuffy nose, dizziness, pains and a swollen tongue.[draxe.com]
    Grunting
    • […] child exhales • Shortness of breath or rapid breathing, which may be associated with exercise • Chest tightness (a young child may say that his chest “hurts” or “feels funny”) • Fatigue (your child may slow down or stop playing) • Problems feeding or grunting[aaaai.org]
    Insomnia
    • A person may also experience insomnia, agitation, vomiting, and seizures.[merckmanuals.com]
    • Side effects are common, including increased energy, insomnia, hunger, agitation, and mood alteration, but they generally can be tolerated for a short period during which restoration of normal breathing is the priority.[uptodate.com]
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  • respiratoric
    Abnormal Breathing
    • […] below, it is best to visit a doctor immediately: Bluish colour of the lips and face Decreased level of alertness, such as severe drowsiness or confusion Rapid pulse Severe anxiety due to shortness of breath Sweating Other symptoms that may occur are abnormal[thehealthsite.com]
    Common Cold
    • The individual episodes are frequently triggered by viral respiratory infections (causes of the common cold).[uichildrens.org]
    • Respiratory infections: Viral or bacterial respiratory infections that trigger asthma attack are common cold, flu, bronchitis and sinus infections.[thehealthsite.com]
    • Symptoms may be aggravated by changes in air quality, the common cold, exercise, exposure to allergens, or changes in the weather.[uptodate.com]
    Cough
    • Usually, the cough is nonproductive and nonparoxysmal.[emedicine.medscape.com]
    • CVA is characterized by a persistent, dry cough.[healthline.com]
    • If you can't hear any coughing or wheezing, then don't wake your child.[rch.org.au]
    • Historical Examples Perhaps then my (coughing) —my—my asthma will invent some opportunity to carry me off.[dictionary.com]
    • In some children chronic cough may be the only symptom.[aaaai.org]
    Dry Cough
    • CVA is characterized by a persistent, dry cough.[healthline.com]
    • Regardless of age, asthma symptoms can include: • Dry cough, especially at night or in response to specific “triggers” • Tightness or pressure in the chest • Wheezing — a whistling sound — when exhaling • Shortness of breath after exercise or physical[asthmaandallergies.org]
    • A dry cough at night or while exercising may be the only symptom.[merckmanuals.com]
    Dyspnea
    Persistent Cough
    • Other nonspecific symptoms in infants or young children may be a history of recurrent bronchitis, bronchiolitis, or pneumonia; a persistent cough with colds; and/or recurrent croup or chest rattling.[emedicine.medscape.com]
    • Asthma can usually be diagnosed by the symptoms alone, for example, a persistent cough or wheezing which is brought on after exercise.[homehealth-uk.com]
    • cough with colds; and/or recurrent croup or chest rattling.[emedicine.medscape.com]
    Pneumonia
    • Asthma is also the most common underlying diagnosis in children with recurrent pneumonia; older children may have a history of chest tightness and/or recurrent chest congestion.[emedicine.medscape.com]
    • Complications There are several conditions that can complicate asthma; they include 1,6,16 : atelectasis pneumonia mucoid impaction of the airways pneumothorax pneumomediastinum and related subcutaneous emphysema eosinophilic lung disease allergic bronchopulmonary[radiopaedia.org]
    • […] such as: persistent tiredness underperformance or absence from work or school psychological problems – including stress, anxiety and depression disruption of your work and leisure because of unexpected visits to your GP or hospital lung infections (pneumonia[nhs.uk]
    • People with asthma are at risk of developing complications from respiratory infections such as influenza and pneumonia.[aaaai.org]
    Prolonged Expiration
    Rales
    • See also status asthmaticus. asthma, cardiac , n a condition characterized by shortness of breath (paroxysmal dyspnea), sonorous rales, and expiratory wheezes that resemble bronchial asthma; related to cardiac failure. asthma a condition marked by recurrent[medical-dictionary.thefreedictionary.com]
    Respiratory Distress
    Sputum Production
    • Anticholinergic agents (ipratropium [ Atrovent , Atrovent HFA], tiotropium [Spiriva], umeclidinium [Incruse Ellipta]) can help decrease sputum production.[medicinenet.com]
    Tachypnea
    • […] epithelium and obstruction of peripheral airways with mucus Exacerbating factors Rapid changes in temperature or humidity, allergies, URIs, exercise, stress or cigarette smoke Mortality 18.8/million blacks; 3.7/million whites–US, age 15-24 Clinical Wheezing, tachypnea[medical-dictionary.thefreedictionary.com]
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  • cardiovascular
    Chest Pain
    • Typical symptoms include cough, wheezing, shortness of breath, and chest pain or tightness.[emedicine.medscape.com]
    • It is important that you describe your child's symptoms -- cough , wheezing, shortness of breath, chest pain , or tightness -- in detail, including when and how often these symptoms have been occurring.[webmd.com]
    • pain Diagnosis Asthma is diagnosed based on the patient’s medical history, physical examination and laboratory test results.[thehealthsite.com]
    • Chest pain or tightness can accompany an asthma attack.[medicinenet.com]
    • In children, chest pain is often present.[en.wikipedia.org]
    Cyanosis
    • Seek medical help immediately for: Fast breathing with chest retractions (skin sucks in between or around the chest plate and/or rib bones when inhaling) Cyanosis (very pale or blue coloring in the face, lips, fingernails) Rapid movement of nostrils Ribs[aafa.org]
    • Confusion, lethargy, and a blue skin color (cyanosis) are signs that the person’s oxygen supply is severely limited, and emergency treatment is needed.[merckmanuals.com]
    • The skin is usually pale and moist with perspiration, but in a severe attack there may be cyanosis of the lips and nailbeds.[medical-dictionary.thefreedictionary.com]
    Heart Disease
    • ‘Members suffer from illnesses such as cancer, heart disease, diabetes and asthma.’[en.oxforddictionaries.com]
    • These are two keys to good asthma control and can also reduce your risk of heart disease.[verywell.com]
    • Then, there are other medical conditions such as chronic obstructive pulmonary disease, congestive heart failure and heart disease that can coexist with asthma and complicate diagnosis and treatment.[khn.org]
    • Called also atopic asthma. atopic asthma see allergic asthma (above). cardiac asthma a term applied to breathing difficulties due to pulmonary edema in heart disease, such as left ventricular failure.[medical-dictionary.thefreedictionary.com]
    Tachycardia
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  • urogenital
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  • psychiatrical
    Anxiety Disorder
    • Psychological disorders are also more common, with anxiety disorders occurring in between 16–52% and mood disorders in 14–41%.[en.wikipedia.org]
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  • Workup

    The diagnosis of asthma is usually done by assessing the patient’s condition, by doing a complete physical examination, undertaking a thorough medical history and by doing lung function tests.

    Obstruction of the airflow is assessed and proper examination is done, if the obstruction is at least partially reversible [1].

    Wheezing is assessed using a stethoscope and the obstruction is considered reversible if the wheeze disappears with treatment or if the triggering factor is resolved. Various physiological tests are done to assess lung function. Some of them are:

    • Spirometry
    • Peak flow meter
    • Bronchial provocation

    Apart, from these various other tests are done to exclude other possible diseases. Some of such tests are, X-ray of the chest and sinuses, testing for allergies and evaluation for gastroesophageal reflux diseases [3]. These can act as triggering factors and can worsen the asthmatic condition and hence assessment of possibilities for such worsening conditions is absolutely crucial.

    Test Results

    Pulmonary Function Test
    Reversible Airway Obstruction
    • Asthma is a relatively common condition that is characterised by at least partially reversible inflammation of the airways and reversible airway obstruction due to airway hyper-reactivity.[radiopaedia.org]
    • Asthma is a complex clinical syndrome of chronic airway inflammation characterized by recurrent, reversible, airway obstruction.[medicinenet.com]
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  • Other Test Results
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  • Laboratory

    Serum
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  • Microbiology
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  • ECG

    QRS Wave
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  • Axis
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  • Rhythm
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  • Imaging

    X-ray
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  • Treatment

    Treatment involves keeping the symptoms under control by using proper medications. The breathing pattern should be tracked often to assess the efficacy of the medication. In case of occasional flare-ups, inhalers such as albuterol are used for symptomatic relief. The choice of various medications used in the treatment of asthma are based on the patient’s age, symptoms, triggers and effectiveness [6]. Medications for asthma are of three categories.

    Preventive, Long term medications

    They reduce the inflammation of the airways leading to symptoms. Some of such medications are:

    • Inhaled corticosteroids- E.g. Fluticasone, budesonide
    • Leukotriene modifiers – e.g. Motelukast, zafirlukast
    • Long acting beta agonist – e.g. Salmeterol, Formoterol
    • Combination inhalers- e.g. Fluticasone- salmeterol, budesonide-Formoterol
    • Theophylline

    Quick relief inhalers 

    They open up the swollen airway and hence ease breathing. Some of such medications are:

    • Short acting beta agonists
    • Ipratropium
    • Oral and intravenous corticosteroids

    Allergy medications such as antihistamines and decongestants if necessary [9].

    Prognosis

    Asthma is a chronic disease and prognosis usually depends on the severity of the disease. In some cases the disease can go into longer periods of remission. Generally in mild to moderate cases, the symptoms can improve over time and in some adults, they can even be disease free. Even when it comes to some severe cases, adults may find good improvement depending on the timeliness, the effectiveness of the treatment and the degree of lung obstruction.

    Only in about 10% of the cases the condition is very severe and persistent and not responsive to treatment [7]. There is an irreversible decline in lung function in such patients and there are also changes in the walls of the airways which are progressive.

    Smoking exacerbates the condition and declination in lung function is much faster in people with asthma than normal individuals. Death as a result of asthmatic attacks is relatively rare and can be prevented by proper medications. Though this disease condition is not that debilitating, it can turn out to be a hindrance to day-to-day activities and work if not properly controlled.

    Complications

    Acute Respiratory Failure
    Alkalosis
    • In the early stages of an acute episode, respiratory alkalosis results from hyperventilation.[emedicine.medscape.com]
    • Mild-to-moderate asthma is typically associated with respiratory alkalosis and mild hypoxemia on the basis of ventilation-perfusion mismatching.[clevelandclinicmeded.com]
    Allergic Rhinitis
    • Treating concurrent conditions such as allergic rhinitis and gastroesophageal reflux disease ( GERD ) may also improve asthma control.[medicinenet.com]
    • You're also more likely to have asthma if you have atopic syndrome, or atopy — that is, if you have a predisposition toward certain allergic hypersensitivity reactions, such as atopic eczema and hay fever (allergic rhinitis).[everydayhealth.com]
    • A triad of atopic eczema, allergic rhinitis and asthma is called atopy.[en.wikipedia.org]
    • (See "Patient education: Trigger avoidance in asthma (Beyond the Basics)" and "Allergen avoidance in the treatment of asthma and allergic rhinitis" .)[uptodate.com]
    • It is observed primarily in persons who have asthma (exercise-induced bronchoconstriction in asthmatic persons) but can also be found in patients with normal resting spirometry findings with atopy, allergic rhinitis , or cystic fibrosis and even in healthy[emedicine.medscape.com]
    Aspergillosis
    • […] be present in 48% of cases with asthma 1 ) pulmonary oedema (rare): pulmonary oedema due to asthma (usually occurs with acute asthma) CT CT is usually used to detect the presence of complicated associated conditions such as allergic bronchopulmonary aspergillosis[radiopaedia.org]
    Asthma
    • Cough may be the only symptom of asthma, especially in cases of exercise-induced or nocturnal asthma.[emedicine.medscape.com]
    • Managing asthma can help keep asthma symptoms under control.[health.howstuffworks.com]
    • Work closely with your child's asthma care team to learn all you can about asthma, how to avoid asthma triggers , what asthma drugs do, and how to correctly give asthma treatments.[webmd.com]
    Atelectasis
    • Complications There are several conditions that can complicate asthma; they include 1,6,16 : atelectasis pneumonia mucoid impaction of the airways pneumothorax pneumomediastinum and related subcutaneous emphysema eosinophilic lung disease allergic bronchopulmonary[radiopaedia.org]
    • This causes portions of the lung to appear more dense and cast more of a shadow on a chest x-ray (this is called atelectasis).[uichildrens.org]
    Bronchiectasis
    • […] as individual features, they include 2 : bronchial wall thickening 2-3 expiratory air trapping inspiratory decreased lung attenuation small centrilobular opacities 6,8 bronchial luminal narrowing: reduced bronchoarterial-diameter ratio 7 subsegmental bronchiectasis[radiopaedia.org]
    • Although asthma is a chronic obstructive condition, it is not considered as a part of chronic obstructive pulmonary disease, as this term refers specifically to combinations of disease that are irreversible such as bronchiectasis, chronic bronchitis,[en.wikipedia.org]
    Churg-Strauss Syndrome
    • Asthma has been associated with eosinophilic granulomatosis with polyangiitis (formerly known as ChurgStrauss syndrome), an autoimmune disease and vasculitis.[en.wikipedia.org]
    • Cataracts Skin thinning and easy bruising Insomnia Used for acute attacks and for asthma that cannot be controlled with inhaled therapy Leukotriene modifiers Montelukast Zafirlukast Zileuton Eosinophilic granulomatosis with polyangiitis (formerly called Churg-Strauss[merckmanuals.com]
    • Jamaleddine G, Diab K, Tabbarah Z. et al: Leukotriene antagonists and the Churg-Strauss syndrome.[clevelandclinicmeded.com]
    Conjunctivitis
    • The most commonly used asthma medications include the following: Short-acting bronchodilators (albuterol [Proventil, Ventolin, ProAir, ProAir RespiClick, Maxair, Xopenex ]) provide quick relief and can be used in conjunction for exercise-induced symptoms[medicinenet.com]
    • Leukotriene receptor antagonists (such as montelukast and zafirlukast) may be used in addition to inhaled corticosteroids, typically also in conjunction with a LABA.[en.wikipedia.org]
    Eosinophilia
    • Lab Eosinophilia; increased hematocrit if dehydrated.[medical-dictionary.thefreedictionary.com]
    • […] for 16 weeks and sputum eosinophilia for 4 weeks, there was no significant effect on the late asthmatic response or airway hyperresponsiveness to allergen challenge.[clevelandclinicmeded.com]
    • Other factors that impact mortality include age older than 40 years, cigarette smoking more than 20 pack-years, blood eosinophilia, forced expiratory volume in one second (FEV 1 ) of 40-69% predicted, and greater reversibility. [35] The estimate of lost[emedicine.medscape.com]
    Food Allergy
    • Hidden food allergies are often triggers for asthma attacks. [draxe.com]
    • Testing for food allergies is not indicated in the diagnosis of asthma.[medicinenet.com]
    • Common allergens, which could trigger asthma are mould spores, pollen , pets and sometimes food allergies .[homehealth-uk.com]
    • Epinephrine auto-injectors are the recommended first-line treatments for food allergies).[theatlantic.com]
    • Although food allergies induce asthma only rarely, certain foods (such as shellfish and peanuts) can induce severe attacks in people who are sensitive to these foods.[merckmanuals.com]
    Hay Fever
    • ‘In both generations the prevalence of asthma was higher in participants with hay fever.’[en.oxforddictionaries.com]
    • Conditions like hay-fever, eczema, or hives, which are usually the result of allergy, may occur along with asthma.[asthma.ie]
    • Often people with asthma get hay fever or eczema as well, and have a family history of these conditions. [asthmafoundation.org.nz]
    • Pollens and moulds - asthma is often worse in the hay fever season.[patient.info]
    • You're also more likely to have asthma if you have atopic syndrome, or atopy — that is, if you have a predisposition toward certain allergic hypersensitivity reactions, such as atopic eczema and hay fever (allergic rhinitis).[everydayhealth.com]
    Hypercapnia
    Hyperventilation
    • […] triggers can also cause asthma attacks, including: Airborne irritants, such as smoke (from cigarettes or burning wood or grass), industrial emissions, vehicle exhaust, ozone, smog, or sulfur dioxide Some foods and food additives Respiratory infections Hyperventilation[everydayhealth.com]
    • Hyperventilation triggered by the hypoxic drive also causes a decrease in PaCO 2 .[emedicine.medscape.com]
    • Hyperventilation, excessively rapid and deep breathing, can worsen asthma.[uichildrens.org]
    • The Buteyko breathing technique for controlling hyperventilation may result in a reduction in medication use; however, the technique does not have any effect on lung function.[en.wikipedia.org]
    • Exercise, cold air, and isocapnic hyperventilation—other approaches that require complex equipment—have a lower sensitivity.[clevelandclinicmeded.com]
    Hypoxia
    • Vasoconstriction due to alveolar hypoxia also contributes to this mismatch.[emedicine.medscape.com]
    • Workup • ABGs—hypoxia, respiratory acidosis. • Plain chest film—hyperinflation. • PFTs—decreased vital capacity, increased functional residual capacity, increased residual volume. • Spirometry—decreased FEV1.[medical-dictionary.thefreedictionary.com]
    • For emergency management other options include: Oxygen to alleviate hypoxia if saturations fall below 92%.[en.wikipedia.org]
    Inspiration
    • In a more severe asthmatic episode, wheezing is also present during inspiration.[emedicine.medscape.com]
    • The upper airway is designed to keep inspired air at 100% humidity and body temperature at 37 C (98.6 F).[emedicine.medscape.com]
    • . & n. asth·mat′i·cal·ly adv. asthma [az′mə] Etymology: Gk, panting a respiratory disorder characterized by recurring episodes of paroxysmal dyspnea, wheezing on expiration and/or inspiration caused by constriction of the bronchi, coughing, and viscous[medical-dictionary.thefreedictionary.com]
    Nasal Polyp
    Pneumothorax
    • Complications There are several conditions that can complicate asthma; they include 1,6,16 : atelectasis pneumonia mucoid impaction of the airways pneumothorax pneumomediastinum and related subcutaneous emphysema eosinophilic lung disease allergic bronchopulmonary[radiopaedia.org]
    • A chest radiograph should not be obtained unless complications of pneumonia, pneumothorax, or an endobronchial lesion are suspected.[clevelandclinicmeded.com]
    Recurrent Pneumonia
    • Asthma is also the most common underlying diagnosis in children with recurrent pneumonia; older children may have a history of chest tightness and/or recurrent chest congestion.[emedicine.medscape.com]
    Respiratory Acidosis
    • Workup • ABGs—hypoxia, respiratory acidosis. • Plain chest film—hyperinflation. • PFTs—decreased vital capacity, increased functional residual capacity, increased residual volume. • Spirometry—decreased FEV1.[medical-dictionary.thefreedictionary.com]
    • Respiratory failure leads to respiratory acidosis due to retention of carbon dioxide as alveolar ventilation decreases.[emedicine.medscape.com]
    Subcutaneous Emphysema
    • Complications There are several conditions that can complicate asthma; they include 1,6,16 : atelectasis pneumonia mucoid impaction of the airways pneumothorax pneumomediastinum and related subcutaneous emphysema eosinophilic lung disease allergic bronchopulmonary[radiopaedia.org]
    Tracheomalacia
    • Patients with excessive dynamic airway collapse (EDAC), bronchomalacia, or tracheomalacia also have an expiratory monophonic wheeze heard over the large airways.[emedicine.medscape.com]
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  • Etiology

    The etiology for the occurrence of asthma has not yet been completely established. The link between the genetic and the environmental factors in the occurrence of asthma is still a subject of debate and studies are being carried on to establish the relationship of allergy to asthma. Exposure to infections and endotoxins in infancy or early childhood may act as risk factors depending on the timing of exposure.

    Prenatal exposure to maternal smoking has been strongly associated with the incidence of asthma. Moreover, stress, diet, nutrition, mode of delivery and use of antibiotics are also associated with the occurrence of asthma. In later stages of life, exposure to allergens, gender, sex, family size and structure, occupational exposure to allergens are all considered to be predisposing factors to asthma.

    Epidemiology

    Most of the cross-sectional studies that are population based are dependent mostly on recognizing the symptoms. There is a wide variation on documentation of prevalence of asthma.

    Documented evidence suggests low prevalence rate of asthma in Asian countries like China and India. There is only a 2-4% of prevalence in these countries when compared to developed countries such as the United Kingdom, Canada, Australia and New Zealand, the prevalence of this disease is documented to be 15-20%.

    Sex distribution
    Age distribution

    Pathophysiology

    The pathophysiology of asthma is a complex phenomena and the attack may be spontaneous or it may be triggered. Either way, the attack progresses as follows.

    • Initially there is an activation of the inflammatory cells resulting in the release of inflammatory mediators from the epithelial cells, macrophages and the bronchial mast cells.
    • There is an increased responsiveness in the airway smooth muscles as a result of alterations in the neural control of the muscle tone and disturbance in the epithelial integrity.
    • This results in clinical manifestations such as dyspnea and wheezing.

    The various factors that contribute for the clinical manifestations are, bronchospasms, edema and inflammation of the mucosa, thick mucus that contributes to airway obstruction, hyperinflation, impaired gas exchange and increased work on breathing [4]. If the initial attack is not taken good care the condition may exacerbate into a more acute and severe form called the status asthmaticus which may require hospitalization.

    Prevention

    Asthmatic attacks can be prevented by reducing the exposure to the triggers. For this the first step is to identify the triggers. Some of such triggers include air pollution, allergies, sinusitis, cold air, flu virus, smoke and fragrances. Maintaining a diary of conditions that can trigger an asthmatic attack can be helpful in managing the symptoms.

    An IgE testing can also be done to identify substances that can sensitize and induce an asthmatic attack. For some people exercise may induce an asthmatic attack and such people should consult their physician before undergoing an exercise regimen [2].

    Smoking can worsen the asthmatic attack and hence smoking in any form such as smoking tobacco, fireworks, incense and candles should be avoided.

    If cold and flu can induce an asthmatic attack, avoiding situations that can cause a cold or flu such as a crowded place or exposure to cold air must be avoided to reduce the incidence of asthmatic attacks [5].

    Summary

    Asthma is a chronic inflammatory disease found worldwide. This disease affects the airways and is characterized by a reversible bronchospasm and airflow obstruction. It has been estimated that 24 million people are affected by this disease and being a common childhood disease, more than 7 million children are found to be victims of this disease.

    The occurrence of asthma has increased over the recent years especially after the 1970s. Asthma has also been found to be a cause for around 250,000 deaths. The etiology for the occurrence of asthma is a bit complex and involves a combination of genetic and environmental factors.

    Patient Information

    Asthma is a chronic illness that can be managed successfully with proper medications. Though an asthmatic attack turning to become fatal is rare, it can be debilitating at times affecting day-to-day life. Hence it is necessary to keep note on the triggering factors by maintaining a diary and avoiding them [8]. Usage of proper medications prescribed by the physician are mandatory to avoid future asthmatic attacks and avoiding flare ups.

    Self-assessment

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    References

    1. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. J Allergy Clin Immunol. Nov 2007;120(5 Suppl):S94-138.

    2. National Heart, Lung, and Blood Institute. Global Strategy for Asthma Management and Prevention. NIH Publication; 2008.

    3. Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med. Jul 2000;162(1):34-9.

    4. Randolph C. Exercise-induced asthma: update on pathophysiology, clinical diagnosis, and treatment. Curr Probl Pediatr. Feb 1997;27(2):53-77

    5. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. Jan 2008;31(1):143-78.

    6. Management of Asthma Working Group. VA/DoD clinical practice guideline for management of asthma in children and adults. Washington (DC): Department of Veteran Affairs, Department of Defense; 2009

    7. Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma--United States, 1980-2004. MMWR Surveill Summ. Oct 19 2007;56(8):1-54.

    8. Kotses H, Bernstein IL, Bernstein DI, Reynolds RV, Korbee L, Wigal JK, et al. A self-management program for adult asthma. Part I: Development and evaluation. J Allergy Clin Immunol. Feb 1995;95(2):529-40.

    9. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2010. Available at http://www.ginasthma.org.

    10. Sears MR. Consequences of long-term inflammation. The natural history of asthma. Clin Chest Med. Jun 2000;21(2):315-29.

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