Asthma

Definition: Asthma is an inflammation that affects the airways of the lungs. Asthma
is also more common in people who have allergies or who are exposed to tobacco smoke.
However, anyone can develop asthma at any time.
How does it happen: normally the air moves freely because the muscles that
surround the airways are relaxed. In asthma the bands of muscle that surround the airways
tighten, so the air cannot move freely. Also the glands in the epithelium produces more
mucus, thicker than normal resulting in a lack of space to air move freely.

The result of this three signs (Bronchospasm, inflammation and mucus production)
take the patient to have dyspnea, wheezing and coughing.

Pathogenesis: The limitation of the airway flow is due to the bronchoconstriction

and also by other factors like edema of the bronchial wall, vascular congestion and
obstruction of the airway because of the secretion. All these factors result in the reduction
of the forced expiratory volume in 1s, FEV1. The proportion between FEV1/ forced vital
capacity (FVC) and the peak expiratory flow also increases the resistance of the respiratory
airway. The early closing of the airway produces hyperinflation pulmonary or trapped air
and increase in the residual volume. PCO2 is usually low because of the hyperventilation.
The airway hyperreactivity is characteristic in asthmatics and it describes the
excessive bronchoconstriction respond due to multiple elements that are inhaled, this
reaction may not have any effect in a normal airway. This reaction may happen because of
direct broncoconstrictors such as histamine and metacoline that constrict the smooth muscle
of the respiratory system. Some of the indirect elements produce the liberation of
broncocosntritors substances from the mastocytes that activate sensitive nervous reflexes.
Other indirect elements are the allergens, exercise, hyperventilation, fog, dust and sulfur
dioxide.

How does the patient feel: symptoms may vary from ne people to other, also in one
person the episodes can be different. The most common symptoms include:

Cough, especially at night

Dyspnea or shortness of breath
Wheezing
Chest tightness or pressure

Asthma is caused by:

Infections
Exercise
Weather (especially cold air)
Tobacco smoke

Allergens (strong odors, air

pollution.)
Emotions
Medications


The most important thing is that the airway is sensitive in these
patients to these triggers, so the goal is to determine which of these is the
responsible for the symptoms and when found, avoid it.

Treatment:

Long-term asthma control medications, the recommended dose is daily, because

these medications are for control on a dayt-day basis, to prevent the patient from having an
asthma attack.. Types of long-term control medications include:

Inhaled corticosteroids. These drugs are anti-inflammatory, and include for the
treatment of asthma, fluticasone, budesonide, flunisolide, ciclesonide, beclomethasone
and mometasone.

Its important that the patient use these medications for days to weeks, to reaches the
maximum benefit. Due to the fact that these corticosteroid are different from the oral
corticosteroid, have a very low side effects and are safer for a long-term use.

Leukotriene modifiers. These includes Montelukast, zafirlukast and zileuton, and

are oral medications, they help relieve asthma symptoms for up to 24 hours. They
includes side effects such as psiychological reactions, as aggression, hallucinations,
depression, afitation and suicidal thinking

Long-acting beta agonists. These inhaled medications open the airways by

relaxing the smooth muscle. These include salmeterol and formoterol. Some research
shows that they may increase the risk of a severe asthma attack, so take them only in
combination with an inhaled corticosteroid. And because these drugs can mask asthma
deterioration, don't use them for an acute asthma attack.

Combination inhalers. These medications contain a long-acting beta agonist along

with a corticosteroid. Because these combination inhalers contain long-acting beta
agonists, they may increase your risk of having a severe asthma attack.
o fluticasone-salmeterol
o budesonide-formoterol
o mometasone-formoterol

Theophylline. Theophylline is a daily pill that helps keep the airways open
(bronchodilator) by relaxing the muscles around the airways. It's not used as often now as
in past years.

Quick-relief (rescue) medications are used as needed for rapid, short-term

symptom relief during an asthma attack or before exercise if your doctor
recommends it. Types of quick-relief medications include:

Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within

minutes to rapidly ease symptoms during an asthma attack. They include albuterol,
levalbuterol and pirbuterol. Short-acting beta agonists can be taken using a portable,
hand-held inhaler or a nebulizer a machine that converts asthma medications to a fine
mist so that they can be inhaled through a face mask or a mouthpiece.

Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to

immediately relax your airways, making it easier to breathe. Ipratropium is mostly used
for emphysema and chronic bronchitis, but it's sometimes used to treat asthma attacks.

Oral and intravenous corticosteroids. These medications which include

prednisone and methylprednisolone relieve airway inflammation caused by severe
asthma. They can cause serious side effects when used long term, so they're used only on
a short-term basis to treat severe asthma symptoms.

One thing to archive is that asthma cannot be cured, but controlled.

How is asthma diagnosed: To diagnose asthma, your doctor will first review
your medical history, family history, and symptoms. Your doctor will want to know any
past history of breathing problems you may have had, as well as a family history of asthma,
allergies, eczema (a bumpy, itchy skin rash caused by allergies), or other lung disease. It is
important that you describe your symptoms in detail (cough, wheeze, shortness of breath,
chest tightness), including when and how often they occur.

The doctor will perform a physical examination and listen to your heart and
lungs. He or she may also order breathing tests, allergy tests, blood tests, and chest and
sinus X-rays. The tests will find out if you do have asthma and if there are any other
conditions that are contributing factors.

References:
Asthma Overview. Celeveland Clinic. [reviewed on: 7/10/2014] available:
http://my.clevelandclinic.org/health/diseases_conditions/hic_Asthma_An_Overv
iew
Asthma Treatments and drugs. Mayo Foundation for Medical Education and
Research.
[Internet]
[Reviewed
on
Feb.
13/14]
available:
http://www.mayoclinic.org/diseases-conditions/asthma/basics/treatment/con20026992