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ASTHMA, AIRWAY OBSTRUCTION, AIRWAY HYPERRESPONSIVENESS

Asthma
is a syndrome characterized by airflow obstruction that varies markedly, both spontaneously and with treatment.
Asthmatics have a special type of inflammation in the airways that makes them more responsive to those who are
nonasthmatics to a wide range of triggers, leading to excessive narrowing with consequent reduced airflow and
symptomatic wheezing and dyspnea.
Narrowing of airways is usually reversible, but in some patients with chronic asthma, there may be an element of
irreversible airflow obstruction
Airway Obstruction
is a blockage in the airway. It may partially or totally prevent air from getting into lungs.
Types:
Upper airway obstructions: area from nose and lips to larynx
Lower airway obstructions: larynx narrow passageways of lungs
Partial airway obstructions: allow some air to pass, still can breathe but difficult
Complete airway obstructions: dont allow any air to pass, cant breath
Acute airway obstructions: occur quickly. Ex. Choking on a foreign object
Chronic airway obstructions can occur in one of two ways, these can be blockages that take a long time to
develop or that last for a long time. Ex. Emphysema
Cause:
- inhaling or swallowing foreign object
- small object becoming lodged in the nose or mouth
- allergic reactions
- trauma to airway from an accident
- vocal cord problems
- infections
Airway Hyperresponsiveness
AHR is the characteristic physiologic abnormality of asthma and describes the excessive bronchoconstrictor
response to multiple inhaled triggers that would have no effect on normal airways. Increased bronchoconstrictor
responsiveness is seen with direct bronchoconstrictors such as histamine and methacholine, which contact
airway smooth muscle, but is characteristically also seen with many indirect stimuli, which release
bronchoconstrictors from mast cells or activate sensory nerves
Mechanism:
- Excessive contraction of the airway smooth muscle may result from increased volume and or contractility of
airway smooth muscle cells
- Uncoupling of airway contraction as a result of inflammatory changes in the airway contraction as a result of
inflammatory changes in the airway wall may lead to excessive narrowing of the airways and a loss of the
maximum plateu of contraction found in normal airways when bronchoconstrictor substances are inhaled
- Thickening of the airway wall by edema and structural changes amplifies airway narrowing due to contraction of
the airway smooth muscle for geometric reasons
-Sensory nerve may be sensitized by inflammation, leading to exaggerated bronchoconstriction in response to
sensory simuli.

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