Bronchial Asthma

Reversible constriction of bronchiole characterized by wheezing,

breathlessness, chest tightness, & cough (WBC)
Chronic inflammatory disorder of the airways that causes recurrent episodes
of wheezing, breathlessness, chest tightness, and cough, particularly at night
and/or in the early morning
Symptoms (WBC) are usually associated with:
i) widespread but variable bronchoconstriction
ii) airflow limitation that is at least partly reversible, either spontaneously or
with treatment

The hallmarks of the disease are:

increased airway responsiveness to a variety of stimuli, resulting in episodic
bronchoconstriction; (stimuli that trigger attacks in patients would have little
or no effect in subjects with normal airways)
inflammation of the bronchial walls; (Many cells play a role in the
inflammatory response, in particular lymphocytes, eosinophils, mast cells,
macrophages, neutrophils, epithelial cells) and
increased mucus secretion
(AIM)

Asthmatic individuals experience attacks of varying severity of dyspnea,

coughing, and wheezing due to sudden episodes of bronchospasm
Status asthmaticus: Rare but fatal state of unremitting attacks,
in patients who have had a long history of asthma
asthma
Patients may be virtually asymptomatic between the attacks
Increasing incidence of asthma in the Western world in the past four decades

Classification
1) Based on absence or presence of allergen sensitization
atopic (evidence of allergen sensitization, often in a patient with a history of
allergic rhinitis, eczema) and
non-atopic (without evidence of allergen sensitization)

2) Based on pattern of airway inflammation (subgroups differing in their etiology,

immunopathology, and response to treatment)
eosinophilic,
neutrophilic,
mixed inflammatory, and
pauci-granulocytic asthma

3) Based on the agents or events that trigger bronchoconstriction

seasonal,
exercise-induced,
drug-induced (e.g., aspirin),
 occupational asthma, and
asthmatic bronchitis in smokers.

Atopic Asthma
most common type of asthma
classic example of type I IgE-mediated hypersensitivity reaction
disease usually begins in childhood
is triggered by environmental allergens, such as dusts, pollens, roach or animal
dander, and foods
a positive family history of asthma is common, and
a skin test with the offending antigen in these patients results in an immediate
wheal-and-flare reaction
Atopic asthma may also be diagnosed based on evidence of allergen
sensitization by serum radioallergosorbent tests (called RAST), which identify
the presence of IgE specific for a panel of allergens

Non-Atopic Asthma
individuals with no evidence of allergen sensitization,
skin test results are usually negative
a positive family history of asthma is less common in these patients
Respiratory infections due to viruses (e.g., rhinovirus, parainfluenza virus) are
common triggers in non-atopic asthma
In these patients hyperirritability of the bronchial tree probably underlies their
asthma
It is thought that virus-induced inflammation of the respiratory mucosa lowers
the threshold of the subepithelial vagal receptors to irritants
Inhaled air pollutants, such as sulfur dioxide, ozone, and nitrogen dioxide, may
also contribute to the chronic airway inflammation and hyperreactivity that are
present in some cases.

Drug-Induced Asthma
Several pharmacologic agents provoke asthma.
Aspirin-sensitive asthma is an uncommon yet fascinating type, occurring in
individuals with recurrent rhinitis and nasal polyps
These individuals are exquisitely sensitive to small doses of aspirin as well as
other nonsteroidal antiinflammatory medications, and they experience not only
asthmatic attacks but also urticaria
It is probable that aspirin triggers asthma in these patients by inhibiting the
cyclooxygenase pathway of arachidonic acid metabolism without affecting
the lipoxygenase route, thus tipping the balance toward elaboration of the
bronchoconstrictor leukotrienes

Occupational Asthma
This form of asthma is stimulated by fumes (epoxy resins, plastics), organic and
chemical dusts (wood, cotton, platinum), gases (toluene), and other chemicals
(formaldehyde, penicillin products)
 Minute quantities of chemicals are required to induce the attack, which usually
occurs after repeated exposure
The underlying mechanisms vary according to stimulus and include type I
reactions, direct liberation of bronchoconstrictor substances, and hypersensitivity
responses of unknown origin