ASTHMA

BY SUJALA V 11408043

INTRODUCTION
Asthma is a disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing. ASTHMA (In greek means PANTING)is the common chronic inflammatory disease of the airways. Characterized by airflow obstruction and Bronchospasm. Asthma is an inflammatory disease and not simply a result of excessive smooth muscle contraction. Increased airway inflammation follows exposure to inducers such as allergens or viruses, exercise, or inhalation of nonspecific irritants.

HISTORY BEHIND ASTHMA

Recognized and named by Hippocrates in 1930 -50 it was considered as one of holy seven psychosomatic illness It was initially wheezing was suppressed as cry of a child for his mother.

RESPIRATORY SYSTEM

LUNGS
Lungs The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

WHAT HAPPENS IN ASTHMA

Causes, incidence, and risk factors

Common asthma triggers include: Animals (pet hair or dander) Dust Changes in weather (most often cold weather) Chemicals in the air or in food Exercise,mold,pollen Respiratory infections, such as the common cold Stress Tobacco smoke Asprin and non steroidal anti inflammatory drugs(NSAIDs) provoke asthma

CONTD

OTHER CAUSES
Genetic factors: Environmental factors: Dietary changes: Occupational exposure:

Allergy
Degranulation process Antigen attacks the body Antigen presenting cell activates the immune system and produce TH2 lymphocytes that produces IL 4. TH2 interacts with B lymphocytes and produce IgE that causes inflammatory response

SYMPTOMS
Wheezing Dyspnea( shortness of breath) Chest tightening Coughing Clear sputum Paradoxical pulse Over inflation of chest Tachycardia(rapid heart rate) Rhonchus lung sound ( can be heard through stethoscope)

PREVALANCE
The prevalence of respiratory allergy as 15-30 per cent and 3.5-20 per cent of the population in any country is suffering from asthma Worldwide, asthma cases are increasing at a rate of 50 per cent every decade asthma is the highest in developed countries such as the United States, the United Kingdom, Australia, New Zealand and Northwest Europe

CONTD
It affects 7% of the population of the US, 5% of British people. Asthma causes 4,000 deaths per year in the US and 2,50,000 deaths per year worldwide. Asthma was diagnosed in india. 2.28%, 1.69%, 2.05 and 3.47% respondents respectively at Chandigarh, Delhi, Kanpur and Bangalore

TYPES OF ASTHMA
Asthma is clinically classified according to, forced expiratory volume in 1 second (FEV1) By SPIROMETRY. Other than this there are four different kinds of asthma a. Occupational asthma b. Exercise induced asthma c. Cough variant asthma d. Medication induced asthma e. Nocturnal asthma

GENETIC BASIS OF ASTHMA

Over 100 genes are associated By 2005 end , 25 genes has been associated to asthma in 6 or more population -GSTM1 -IL10 -CTLA4 -SPINK5 -LTC4S -LTA -GPRA -NOD1 -CC16 -GSTP1 - STAT6 -NOS1 - CCL5 -TBXA 2R -TGFB1 - IL4 -IL13 -CD14 -ADRB2 -HLA DRB1 -HLA DQB1 -TNF -FCER 1B -IL4R -ADAM 33

M any of these genes are responsible for immune response or inflammatory response, although these genes are not related to asthma always.

ROLE OF GENES
A Disintegrin and Metalloprotease33 (ADAM 33):-located on chromosome 20p13 . susceptibility gene for asthma.it is a highly polymorphic gene with 14119 bps, 22 exons and 21 introns. causes bronchial hyper responsive Interleukin-4 (IL-4): chromosome 5 at position q31 with 32675 bps, 10 exons and 9 introns. IL-4 is a cytokine secreted by helper T cell type 2 (TH2 cells) that stimulates the production of IgE and induces eosinophilmediated attacks against allergens. It was found that polymorphism in the promoter of the IL-4 is associated with asthma . ORMLD gene:- was found in the blood of children. Chromosome 17.causes childhood asthma

CONTD
G-protein-coupled receptor for asthma (GPRA): This is localized on chromosome 7p with 7 SNPs. this gene is involved in asthma and may have application in other inflammatory diseases. Transforming growth factor beta 1(TGF 1): The genes encoding for TGF 1 is localized on the chromosome 6q11.TGF 1 is an important protein with both pro-inflammatory and anti-inflammatory properties. Interleukin -21 (IL-21): The gene for IL-21 is located on chromosome 4q26q27 and encodes for a multifunctional cytokine which is produced by activated CD4+ T cells and affects growth and survival of numerous immune cells. It is important in asthma as it also regulates IgE production and has been implicated in asthma

CONTD.
Signal transducer and activator of transcription 6 (STAT6): The gene for STAT6 is located on chromosome 12q13. It is a member of the STAT family of transcription factors which plays a central role in IL-4 mediated biological responses. Mast cell chymase (CMA1): The gene for mast cell chymase is located on chromosome 14q11.2 and encodes for a serine protease expressed in mast cells and is important for inflammation and airway remodeling. An association has been observed with asthma and increased total IgE. Eotaxin(SCYA11): The gene for eotaxin is located on chromosome 17q21.1-q21.2 and encodes for the chemokine that is a specific attractant for eosinophils and has been implicated in asthma.

DIAGNOSIS
Few tests are carried out. Peak flow Spirometry Complete Pulmonary Function Testing Diffusion Capacity Chest X-Ray Bronchoprovocation Challenge Testing Pulse Oximetry Arterial Blood Gas (ABG) Allergy Testing

Other diseases.
Some diseases are misdiagnosed as Asthma in infants and children's Allergic rhinitis and sinusitis Vocal cord disfunctioning Enlarged tumors in the air passages. Cystic fibrosis Pulmonary embolism Gastro esophageal reflux

CONTD
In adults Chronic bronchitis Mechanical obstruction of airways by benign or malignant tumors Congestive heart failure Chronic obstructive pulmonary disease(COPD) Pneumonia Emphysema

PREVENTION
Reduce exposure to allergens to which the person is sensitive Avoid exposure to environmental tobacco smoke, from burning wood or even chemicals Avoid exertion outdoors when levels of air pollution are high Avoid use of allergic drugs Avoid sulphite-containing and other foods to which they are sensitive

TREATMENT
corticosteroids( in inhalers) Fluticasone taken as regular dosage Leukotrienes antagonistics (montelukas) immunomodulators( eg omalizumab( anti IgE)) allergy desensitization mast cell stabilizers (cromolyn & nedocromil) Preventive inhalers (formetol)

Treatment during attacks

Salbutamol/Ventolin: Taken during attacks only.

Nebulizer:use oxygen, compressed air to break up medical solutions/suspensions into small aerosol droplets that can be directly inhaled from the device Steroids are given by oral or intravenous means.ex Prednisone.

OTHER METHODS
Intravenous salbutamol Anticholinergics like glycopyrrolate Methylxanthines (theophylline, aminophylline) Inhalation anesthetics that have a bronchodilatory effect (isoflurane, halothane etc.) used in addition to other treatment in severe acute asthma attacks Mechanical ventilation for patients reaching respiratory arrest. Heliox :- mixture of helium and oxygen(breathing gas).

Eminent people with Asthma

Steve Allen - comedian, actor Elizabeth Taylor - actress Bill Clinton - 42nd President of the U.S. Che Guevara - South American revolutionary leader John F. Kennedy - 35th President of the U.S.

References
www.asthma.net www.asthma.org www.allergy.co.in Pubmed Wikipedia NCBI