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.

urogenital
  • more...
  • psychiatrical
    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]
    Anxiety Disorder
    • […] conditions A number of other health conditions occur more frequently in those with asthma, including gastro-esophageal reflux disease (GERD), rhinosinusitis , and obstructive sleep apnea . [27] Psychological disorders are also more common, [28] with anxiety[en.wikipedia.org]
  • more...
  • cardiovascular
    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]
    • disease that exacerbate—and are exacerbated by—asthma.[theatlantic.com]
    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]
    • pain is often present. [98] Signs occurring during an asthma attack include the use of accessory muscles of respiration ( sternocleidomastoid and scalene muscles of the neck), there may be a paradoxical pulse (a pulse that is weaker during inhalation[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]
    • 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]
    • High PaCO 2 , or requiring mechanical ventilation, or both Life-threatening (any one of) Clinical signs Measurements Altered level of consciousness Peak flow 33% Exhaustion Oxygen saturation 92% Arrhythmia PaO 2 8 kPa Low blood pressure "Normal" PaCO 2 Cyanosis[en.wikipedia.org]
    Tachycardia
  • more...
  • gastrointestinal
  • more...
  • respiratoric
    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]
    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]
    • […] 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]
    • 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]
    • Suggested Articles Feline Asthma: What You Need To Know Lung Ailments: A Widespread Source of Feline Woe Dyspnea Pneumonia Nasopharyngeal Polyps Feline Asthma: A Risky Business for Many Cats For some cats, this common respiratory affliction can have perilous[vet.cornell.edu]
    Dyspnea
    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]
    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]
    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]
    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]
    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]
    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]
    Sputum Production
    • Anticholinergic agents (ipratropium [ Atrovent , Atrovent HFA], tiotropium [Spiriva], umeclidinium [Incruse Ellipta]) can help decrease sputum production.[medicinenet.com]
    Exertional Dyspnea
    Prolonged Expiration
    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]
    Respiratory Distress
  • more...
  • neurologic
    Insomnia
    • Glidewell, PsyD, is an insomnia specialist and clinical psychologist at National Jewish Health.[nationaljewish.org]
    • 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]
    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]
    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]
  • more...
  • Entire body system
    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]
    • 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]
    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]
    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]
    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]
  • more...
  • Jaw & Teeth
  • more...
  • 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.

    Laboratory

    Serum
    Hypercapnia
  • more...
  • Microbiology
  • more...
  • Imaging

    X-ray
    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]
    • 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]
    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]
  • more...
  • ECG

    Rhythm
  • more...
  • Axis
  • more...
  • QRS Wave
  • more...
  • Test Results

    Other Test Results
  • more...
  • 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 hyperreactivity.[radiopaedia.org]
    • Asthma is a complex clinical syndrome of chronic airway inflammation characterized by recurrent, reversible, airway obstruction.[medicinenet.com]
  • more...
  • 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

    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]
    • 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]
    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]
    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]
    • Asthma Can Be Deadly Asthma can kill.[onhealth.com]
    Inspiration
    • In a more severe asthmatic episode, wheezing is also present during inspiration.[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]
    • The upper airway is designed to keep inspired air at 100% humidity and body temperature at 37 C (98.6 F).[emedicine.medscape.com]
    Acute Respiratory Failure
    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]
    • Exercise, cold air, and isocapnic hyperventilation—other approaches that require complex equipment—have a lower sensitivity.[clevelandclinicmeded.com]
    • […] generators. [189] Manual therapies, including osteopathic , chiropractic , physiotherapeutic and respiratory therapeutic maneuvers, have insufficient evidence to support their use in treating asthma. [190] The Buteyko breathing technique for controlling hyperventilation[en.wikipedia.org]
    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]
    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]
    • Children who require LABA as part of their asthma treatment may need to go to the hospital more frequently. [152] Leukotriene receptor antagonists (such as montelukast and zafirlukast ) may be used in addition to inhaled corticosteroids, typically also in conjunction[en.wikipedia.org]
    Hypoxia
    • 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]
    • Vasoconstriction due to alveolar hypoxia also contributes to this mismatch.[emedicine.medscape.com]
    • For emergency management other options include: Oxygen to alleviate hypoxia if saturations fall below 92%. [168] Corticosteroid by mouth are recommended with five days of prednisone being the same 2 days of dexamethasone . [169] One review recommended[en.wikipedia.org]
    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]
    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]
    • […] critical goal of asthma research. [91] 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[en.wikipedia.org]
    Nasal Polyp
    • Nasal polyps or increased amounts of nasal secretions often are noted in asthmatic individuals.[medical-dictionary.thefreedictionary.com]
    • polyps affects 5-10% of patients with asthma.[emedicine.medscape.com]
    • polyps . [113] In people who are affected, low doses paracetamol or COX-2 inhibitors are generally safe. [114] Alcohol-induced asthma Alcohol may worsen asthmatic symptoms in up to a third of people. [115] This may be even more common in some ethnic[en.wikipedia.org]
    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]
    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]
    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]
    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]
    • (See "Patient education: Trigger avoidance in asthma (Beyond the Basics)" and "Allergen avoidance in the treatment of asthma and allergic rhinitis" .)[uptodate.com]
    • House dust mite avoidance measures for perennial allergic rhinitis.[emedicine.medscape.com]
    • Risk for asthma, then, is determined by both a person's genetics and the level of endotoxin exposure. [66] Medical conditions A triad of atopic eczema , allergic rhinitis and asthma is called atopy. [70] The strongest risk factor for developing asthma[en.wikipedia.org]
    Churg-Strauss Syndrome
    • Jamaleddine G, Diab K, Tabbarah Z. et al: Leukotriene antagonists and the Churg-Strauss syndrome.[clevelandclinicmeded.com]
    • […] developing asthma is a history of atopic disease ; [57] with asthma occurring at a much greater rate in those who have either eczema or hay fever . [71] Asthma has been associated with eosinophilic granulomatosis with polyangiitis (formerly known as ChurgStrauss[en.wikipedia.org]
    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]
    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]
    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]
    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]
    Eosinophilia

    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.

    Causes

    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]
    • 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]
    Hypoxia
    • 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]
    • Vasoconstriction due to alveolar hypoxia also contributes to this mismatch.[emedicine.medscape.com]
    • For emergency management other options include: Oxygen to alleviate hypoxia if saturations fall below 92%. [168] Corticosteroid by mouth are recommended with five days of prednisone being the same 2 days of dexamethasone . [169] One review recommended[en.wikipedia.org]
    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]
    Air Pollution
    • It is certainly not a matter of air pollution.[biology-pages.info]
    • We had mentioned some in the lesson, but to recap and expand, they include—outdoor air pollution from factories and car exhaust, pet dander and fur, mold, pollen, dust mites and dust, tobacco smoke, cockroaches, fragrances, exercise, temperature changes[ed.ted.com]
    Aspirin
    • […] rs28730619 rs1800925 rs17334242 rs1042714 rs1805018 rs1051931 rs4986790 influences a wide variety of both infectious and non-infectious diseases rs4986791 rs1801105 rs2280089 rs2280090 rs612709 rs574174 rs44707 rs2787094 rs569108 rs324981 rs1154404 rs4794067 Aspirin[snpedia.com]
    • Aspirin desensitization treatment for the management of aspirin-exacerbated respiratory disease.[emedicine.medscape.com]
    • […] emissions, vehicle exhaust, ozone, smog, or sulfur dioxide Some foods and food additives Respiratory infections Hyperventilation (heavy, fast breathing) Strong emotional states, such as stress, anxiety , depression , or fear Certain medications , including aspirin[everydayhealth.com]
    • Some drugs like aspirin and other NSAIDs are also known to cause asthma attacks.[thehealthsite.com]
    • In specialized treatment centers, persons who are sensitive to aspirin and related medications can be desensitized to aspirin.[uptodate.com]
    Bronchitis
    • Most children with chronic or recurrent bronchitis have asthma.[emedicine.medscape.com]
    • Chronic obstructive pulmonary disease (COPD) encompasses two groups of lung disease, chronic bronchitis and emphysema.[toxipedia.org]
    • Included in this group of diseases are refractory (severe) asthma, emphysema and chronic bronchitis.[acaai.org]
    • ‘This means it is very bad for people with respiratory problems such as bronchitis and asthma.’[en.oxforddictionaries.com]
    • If you smoke and have asthma you are more likely to suffer from other lung diseases such as bronchitis .[homehealth-uk.com]
    Psychological Stress
    • These conditions include runny nose, sinus infections, reflux disease, psychological stress, and sleep apnea .[nhlbi.nih.gov]
    • "Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-analysis".[en.wikipedia.org]

    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.

    Other symptoms


    Self-assessment

    Ask Question


    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.

    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.

    • Accuracy of clinical assessment in the diagnosis of pulmonary embolism - M Miniati, R Prediletto, B Formichi - American journal of , 1999 - Am Thoracic Soc
    • A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure - MW Rich, V Beckham, C Wittenberg - England Journal of , 1995 - Mass Medical Soc
    • Conn's Current Therapy 2008: Text with Online Reference - RE Rakel, ET Bope - 2007 - lavoisier.fr
    • Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases - N Horie, R Kawano, J Inaba, T Numa, T Kato - Journal of oral , 2008 - J-STAGE
    • A model of airway narrowing in asthma and in chronic obstructive pulmonary disease - BR Wiggs, C Bosken, PD Pare, A James - American Journal of , 1992 - Am Thoracic Soc
    • Brugada syndrome with ventricular tachycardia and fibrillation related to hypokalemia. - T Araki, T Konno, H Itoh, H Ino, M Shimizu - Circulation journal: official , 2003 - ukpmc.ac.uk
    • Alterations of red-cell glycolytic intermediates and oxygen transport as a consequence of hypophosphatemia in patients receiving intravenous hyperalimentation - SF Travis, HJ Sugerman, RL Ruberg - England Journal of , 1971 - Mass Medical Soc
    • A novel hypothesis to explain the bronchconstrictor effect of deep inspiration in asthma - GP Burns, GJ Gibson - Thorax, 2002 - thorax.bmj.com
    • A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients with acute respiratory failure - M Antonelli, G Conti, M Rocco, M Bufi - England Journal of , 1998 - Mass Medical Soc
    • Asthma deaths in Cardiff 1963-74: 53 deaths in hospital. - JB MacDonald, ET MacDonald, A Seaton - British medical , 1976 - bmj.com
    • Acid-base disturbances in acute asthma. - RD Mountain, JE Heffner - CHEST , 1990 - journal.publications.chestnet.org
    • A combined respiratory and cutaneous hypersensitivity syndrome induced by work exposure to quaternary amines - JA Bernstein, T Stauder, DI Bernstein - Journal of Allergy and , 1994 - Elsevier
    • A randomised, double-blind, placebo-controlled study to evaluate the role of formoterol in the management of acute asthma - K Najafizadeh, HS Pour, M Ghadyanee - Emergency Medicine , 2007 - emj.bmj.com
    • Cardiac effects of isoproterenol, hypoxia, hypercapnia and fluorocarbon propellants and their use in asthma inhalers. - DG Clark, DJ Tinston - Annals of allergy, 1972 - ncbi.nlm.nih.gov
    • Acid-base disturbances in acute asthma. - RD Mountain, JE Heffner - CHEST , 1990 - journal.publications.chestnet.org
    • A nonstationarity test for the spectral analysis of physiological time series with an application to respiratory sinus arrhythmia - EJM Weber, P Molenaar, MW Molen - Psychophysiology, 2007 - Wiley Online Library
    • Acute respiratory distress in adults - DG Ashbaugh, D Boyd Bigelow, TL Petty, BE Levine - The Lancet, 1967 - Elsevier
    • Picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia. - MT Kauppinen, P Saikku, P Kujala, E Herva, H Syrjälä - Thorax, 1996 - thorax.bmj.com
    • Gene mutations-including three novel nucleotide substitutions-and haplotype background in patients with asthma, disseminated bronchiectasis and chronic obstructive - M Tzetis, A Efthymiadou, S Strofalis, P Psychou - Human genetics, 2001 - Springer
    • Air pollution and bronchitic symptoms in Southern California children with asthma. - R McConnell, K Berhane, F Gilliland - Environmental health , 1999 - ncbi.nlm.nih.gov
    • Cardiopulmonary function in bronchial asthma. A comparison with chronic pulmonary emphysema. - MH Williams Jr, LR Zohman - The American review of respiratory , 1960 - ncbi.nlm.nih.gov
    • A computerized reminder strategy is effective for annual influenza immunization of children with asthma or reactive airway disease - M Gaglani, M Riggs, C Kamenicky - infectious disease , 2001 - journals.lww.com
    • Bronchial asthma, nasal polyps, and aspirin sensitivity: Samter's syndrome. - HJ Zeitz - Clinics in chest medicine, 1988 - ukpmc.ac.uk
    • Asthma mortality associated with pneumothorax and intermittent positive-pressure breathing - MS Karetzky - The Lancet, 1975 - Elsevier
    • Superoxide dismutase, but not CuZn superoxide dismutase, is highly expressed in the granulomas of pulmonary sarcoidosis and extrinsic allergic alveolitis - E Lakari, P Pääkkö, VL Kinnula - American journal of respiratory , 1998 - Am Thoracic Soc
    • A Pseudo-Tuberculous Condition Associated with Eosinophilia. - C Frimodt-Möller, RM Barton - Indian Medical Gazette, 1940 - cabdirect.org
    • Clinical features of medical pneumomediastinum - H Miura, O Taira, S Hiraguri, K Ohtani, H Kato - Annals of thoracic and , 2003 - atcs.jp
    • Atmospheric pressure changes and outdoor temperature changes in relation to spontaneous pneumothorax - HJM Smit, WL Devillé - CHEST , 1999 - journal.publications.chestnet.org
    • Cardiac tamponade as a result of infusion - MM McHenry, DM Hopkins - JAMA: The Journal of the American , 1968 - Am Med Assoc
    • Allergic Aspergillus sinusitis: a newly recognized form of sinusitis - ALA Katzenstein, SR Sale, PA Greenberger - Journal of Allergy and Clinical , 1983 - Elsevier
    • Respiratory and allergic disorders in elite athletes: epidemiology, mechanisms and diagnosis: Part I of the report from the Joint Task Force of the European Respiratory - KH Carlsen, SD Anderson, L Bjermer, S Bonini - Allergy, 2008 - Wiley Online Library
    • Aspirin-induced asthma - I Power - British journal of anaesthesia, 1993 - British Jrnl Anaesthesia
    • An appropriate negative bronchoscopy rate in suspected foreign body aspiration - PC Mantor, DW Tuggle, WP Tunell - The American journal of surgery, 1989 - Elsevier
    • Changes of airway smooth muscle in experimental asthma - JF Souhrada - Respiration physiology, 1978 - Elsevier
    • Major allergen from the house dust mite Dermatophagoides pteronyssinus, Antigen P1: comparison of patients with asthma, atopic dermatitis, and perennial rhinitis - FC Rawle, EB Mitchell - The Journal of , 1984 - Am Assoc Immnol
    • An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. - MA Fischl, A Pitchenik, LB Gardner - The New England journal of , 1981 - ukpmc.ac.uk
    • Allergic granulomatosis and angiitis (Churg-Strauss syndrome). Report and analysis of 30 cases. - LC Chumbley, EG Harrison Jr - Mayo Clinic proceedings. , 1977 - ukpmc.ac.uk
    • Adrenergic agonist, prostaglandins, and cortisol on lymphocyte levels of cyclic adenosine monophosphate and glycogen: abnormal lymphocytic metabolism in asthma - TP Lee, WW Busse, CE Reed - Journal of Allergy and Clinical Immunology, 1977 - Elsevier
    • And mast cell histamine but blocks cyclooxygenase and lipoxygenase metabolism of arachidonic acid inhibits immunoglobulin E-mediated asthma in rhesus monkeys - R Patterson, JJ Pruzansky, KE Harris - Journal of Allergy and Clinical , 1981 - Elsevier
    • And prevalence of asthma among adult Finnish men and women of the Finnish Twin Cohort from 1975 to 1990, and their relation to hay fever and chronic bronchitis - E Huovinen, J Kaprio, LA Laitinen - CHEST , 1999 - journal.publications.chestnet.org
    • Asthma and bacterial sinusitis in children - R Friedman, M Ackerman, E Wald - Journal of Allergy and , 1984 - Elsevier
    • [Acute asthma in children--anaphylaxis] - KH Carlsen - Tidsskrift for den Norske laegeforening: tidsskrift for , 1993 - ukpmc.ac.uk
    • Allergic factors associated with the development of asthma and the influence of cetirizine in a double‐blind, randomised, placebo‐controlled trial: First results of ETA® - P Wahn - Pediatric Allergy and Immunology, 2007 - Wiley Online Library
    • Angina pectoris (or status anginosus) and cardiac asthma induced by paroxysmal auricular fibrillation and paroxysmal tachycardia - L WOLFF - New England Journal of Medicine, 1933 - Mass Medical Soc
    • An Unusual Presentation of Laryngeal Asthma as Negative Pressure Pulmonary Edema - P Tadi, A Mahalingashetty - CHEST , 2012 - journal.publications.chestnet.org
    • )-acrylic acid 2, 2-dimethyl-8-oxo-3, 4-dihydro-2H, 8H-pyrano [3, 2-g] chromen-3-yl-ester, inhibits ovalbumin-induced lung inflammation in a mouse model of asthma - EJ Yang, GY Song, JS Lee, CY Yun, IS Kim - and Pharmaceutical Bulletin, 2009 - J-STAGE
    • A critical approach to noncardiac chest pain: pathophysiology, diagnosis, and treatment - J Fang, D Bjorkman - The American journal of gastroenterology, 2001 - nature.com
    • Chronic cough in childhood: approach to diagnosis and treatment - DP Parks, RC Ahrens, CT Humphries - The Journal of , 1989 - Elsevier
    • Association of Chlamydia pneumoniae(strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma. - DL Hahn, RW Dodge - Journal of the American , 1991 - researchgate.net
    • Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects. - B Forsberg, J Pekkanen, J Clench-Aas - International journal of , 1997 - IEA
    • Chest pain in children - SM Selbst - Pediatrics, 1985 - Am Acad Pediatrics
    • Asthma severity is associated with body mass index and early menarche in women - R Varraso, V Siroux, J Maccario, I Pin - American journal of , 2005 - Am Thoracic Soc
    • Allergic bronchopulmonary aspergillosis in three patients with normal chest x-ray films. - M Rosenberg, R Mintzer - CHEST , 1977 - journal.publications.chestnet.org
    • The American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina - E Braunwald, EM Antman, JW Beasley, RM Califf - Circulation, 2000 - Am Heart Assoc
    • Airways inflammation in nocturnal asthma - RJ Martin, LC Cicutto, HR Smith - American Journal of , 1991 - Am Thoracic Soc
    • ABC of allergies: venom allergy - PW Ewan - BMJ: British Medical Journal, 1998 - ncbi.nlm.nih.gov
    • A community-based study of the epidemiology of asthma: incidence rates, 1964–1983 - JW Yunginger, CE Reed, EJ O'Connell - American Journal of , 1992 - Am Thoracic Soc
    • Propionate, 1 mg daily, versus fluticasone propionate, 2 mg daily, or budesonide, 1.6 mg daily, in patients with chronic severe asthma. International Study Group - JG Ayres, ED Bateman, B Lundback - European Respiratory , 1995 - ersj.org.uk
    • Airway inflammation in childhood asthma - A Barbato, G Turato, S Baraldo, E Bazzan - American journal of , 2003 - Am Thoracic Soc
    • Asthma in the elderly - HY Lee, TB Stretton - British medical journal, 1972 - bmj.com
    • Airway DehydrationA Therapeutic Target in Asthma? - E Moloney, S O'Sullivan, T Hogan - CHEST , 2002 - journal.publications.chestnet.org
    • Aerobic conditioning in mild asthma decreases the hyperpnea of exercise and improves exercise and ventilatory capacity - TS Hallstrand, PW Bates - CHEST , 2000 - journal.publications.chestnet.org
    • Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid - AP Greening, PW Ind, M Northfield, G Shaw - The Lancet, 1994 - Elsevier
    • Anxiety sensitivity and disabling chronic health conditions - GJG Asmundson, KD Wright - Journal of Behaviour , 2000 - Taylor & Francis
    • Acute coronary insufficiency due to pulmonary embolism - S Dack, AM Master, H Horn, A Grishman - The American Journal of , 1949 - Elsevier
    • Cellular characteristics of sputum from patients with asthma and chronic bronchitis. - PG Gibson, A Girgis-Gabardo, MM Morris, S Mattoli - Thorax, 1989 - thorax.bmj.com
    • Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease - M Take, M Sekiguchi, M Hiroe, K Hirosawa - Heart and Vessels, 1985 - Springer
    • Chest pain in otherwise healthy children and adolescents is frequently caused by exercise-induced asthma - L Wiens, J Portnoy, R Sabath, L Ewing - Pediatrics, 1992 - Am Acad Pediatrics
    • Allergic vs nonallergic asthma: what makes the difference? - S Romanet‐Manent, D Charpin, A Magnan - Allergy, 2003 - Wiley Online Library
    • 2 A critical appraisal of the cardiovascular history and physical examination - A Panju, B Hemmelgarn, J Nishikawa - Evidence-Based , 2008 - books.google.com
    • A clinical index to define risk of asthma in young children with recurrent wheezing - JA Castro-Rodriguez, CJ Holberg - American Journal of , 2000 - Am Thoracic Soc
    • Airway sensory nerves: a burning issue in asthma? - D Spina - Thorax, 1996 - thorax.bmj.com
    • Allergic rhinobronchitis: the asthma–allergic rhinitis link - F Simons - Journal of allergy and clinical immunology, 1999 - Elsevier
    • Cockroach asthma - HS Bernton, TF McMahon, H Brown - British journal of diseases of the chest, 1972 - Elsevier
    • A Specific LTD4/LTE4receptor Antagonist Improves Pulmonary Function in Patients with Mild, Chronic Asthma - ML Cloud, GC Enas, J Kemp, T Platts-Mills - American Journal of , 1989 - Am Thoracic Soc
    • A 10 year follow up of 180 adults with bronchial asthma: factors important for the decline in lung function. - CS Ulrik, V Backer, A Dirksen - Thorax, 1992 - thorax.bmj.com
    • Stenosis and tricuspid regurgitation without septal defects), peripheral vasomotor symptoms, broncho-constriction, and an unusual type of cyanosis: A clinical and - Å Thorson, G Biörck, G Björkman, J Waldenström - American heart journal, 1954 - Elsevier
    • Manifestations of heat and effort sensitiveness and cold sensitiveness (relationship to heat prostration, effort syndrome, asthma, urticaria, dermatoses, noninfectious - WW Duke - Journal of Allergy, 1932 - Elsevier
    • Bronchocentric granulomatosis as a manifestation of allergic bronchopulmonary aspergillosis without bronchial asthma]. - W Wöckel, N Wernert, N Graf - medizinische Wochenschrift (1946), 1987 - ncbi.nlm.nih.gov
    • Assessment of respiratory function in the asthmatic child. - RS Jones - British medical journal, 1966 - bmj.com
    • All That Wheezes Is Not Asthma - JH Hartmann - ems-expo.info
    • A clinical scoring system for the diagnosis of respiratory failure: preliminary report on childhood status asthmaticus - DW Wood, JJ Downes, HI Leeks - Archives of Pediatrics & , 1972 - Am Med Assoc
    • Acute pericarditis simulating myocardial infarction - L Wolff - New England Journal of Medicine, 1944 - Mass Medical Soc
    • Behavioral Interventions in Asthma Breathing Training - T Ritz, WT Roth - Behavior modification, 2003 - bmo.sagepub.com
    • An asthma model developed in the guinea pig by intranasal application of 2, 4-toluene diisocyanate - Y Sugawara, Y Okamoto, T Sawahata - archives of allergy , 1993 - content.karger.com
    • A paper strip test for screening of pheochromocytoma - T Sato, K YOSHINAGA - Japanese circulation journal, 1967 - ci.nii.ac.jp
    • A CASE OF TRANSIENT SUCCESSIVE PULMONARY INFILTRATION (LOEFFLER'S SYNDROME) ASSOCIATED WITH TRICHINIASIS* - JF Slowey - Annals of Internal Medicine, 1944 - Am Coll Physicians
    • A Manual of clinical diagnosis - JC Todd - 1908 - books.google.com
    • CT mosaic pattern of lung attenuation: distinguishing different causes. - EJ Stern, SJ Swensen, TE Hartman - American Journal of , 1995 - Am Roentgen Ray Soc
    • Asthma caused by the complex salts of platinum - D Hunter, R Milton, KMA Perry - British journal of industrial , 1945 - ncbi.nlm.nih.gov
    • An unusual complication of dengue infection - J Chien, A Ong, SY Low - Singapore Med J, 2008 - smj.sma.org.sg
    • Accuracy of clinical assessment in the diagnosis of pulmonary embolism - M Miniati, R Prediletto, B Formichi - American journal of , 1999 - Am Thoracic Soc
    • A case of isocyanate-induced asthma possibly complicated by food allergy after peanut consumption: a case report - EÇ Mingomataj, E Gjata, F Xhixha - Journal of Occupational , 2008 - biomedcentral.com
    • A family study of the genetic basis of asthma and wheezy bronchitis. - B Sibbald, ME Horn, I Gregg - Archives of disease in childhood, 1980 - adc.bmj.com
    • A community-based study of the epidemiology of asthma: incidence rates, 1964–1983 - JW Yunginger, CE Reed, EJ O'Connell - American Journal of , 1992 - Am Thoracic Soc
    • Clinical Value of a Tracing of Forced Expiration (Expirogram) - W Franklin, AL Michelson, FC Lowell - New England Journal , 1955 - Mass Medical Soc
    • Airway hyperresponsiveness in asthma: a problem of limited smooth muscle relaxation with inspiration. - G Skloot, S Permutt, A Togias - Journal of Clinical investigation, 1995 - ncbi.nlm.nih.gov
    • Association of poor clinical status and heavy exposure to tobacco smoke in patients with cystic fibrosis who are homozygous for the F508 deletion - PW Campbell, RA Parker, BT Roberts - The Journal of , 1992 - Elsevier
    • Changes in total lung capacity during acute spontaneous asthma - SP Blackie, S Al-Majed, CA Staples - American Journal of , 1990 - Am Thoracic Soc
    • Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study. - J Blanquer, R Blanquer, R Borras, D Nauffal, P Morales - Thorax, 1991 - thorax.bmj.com
    • Abnormal lung sounds in patients with asthma during episodes with normal lung function - HJW Schreur, J Vanderschoot, AH Zwinderman - , 1994 - chestjournal.chestpubs.org
    • Asthma in schoolchildren. Demographic associations and peak expiratory flow rates compared in children with bronchitis. - RF Hamman, T Halil, WW Holland - British journal of preventive & , 1975 - jech.bmj.com
    • Central and peripheral airway sites of nitric oxide gas exchange in COPD - , A Krishnan, C Fraser, CM Shinar - CHEST , 2010 - journal.publications.chestnet.org
    • Reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV1 in primary care patients presenting with a persistent cough? - HA Thiadens, GH De Bock, JC Van Houwelingen - Thorax, 1999 - thorax.bmj.com
    • Airway remodeling in asthma - JA Elias, Z Zhu, G Chupp - Journal of Clinical , 1999 - Am Soc Clin Investig
    • Early-life psychological stress exacerbates adult mouse asthma via the hypothalamus–pituitary–adrenal axis - Y Chida, N Sudo, J Sonoda, T Hiramoto - American journal of , 2007 - Am Thoracic Soc
    • A Clinical Classification on Asthma Based Upon A Review of Six Hundred and Forty-Eight Cases - FM RACKEMANN - The American Journal of the Medical , 1921 - journals.lww.com
    • A Clinical Study Of Pulmonary Tuberculosis And Its Homoeopathic Management - VC Pavadashettar - 2007 - 119.82.96.198
    • " Tokyo-Yokohama asthma". The rapid development of respiratory distress presumably due to air pollution. - HW Phelps, S Koike - The American review of respiratory disease, 1962 - ncbi.nlm.nih.gov

    Media References

    1. Two Peak Flow Meters, Public Domain

    Languages

    Self-assessment
    Symptoma
      • Hi, this is Symptoma.