Asthma is a chronic inflammatory disorder of the airways. This underlying condition can be exacerbated by environmental triggers to which asthma patients are hyperresponsive. Exposure to environmental "triggers" leads to greater inflammation and worsening of respiratory symptoms. The most common symptoms are wheezing, coughing, difficulty breathing, and a feeling of chest tightness. These symptoms are associated with variable airflow and obstruction that is often reversible. In terms of biology, mast cells, eosinophils, T-lymphocytes, neutrophils, macrophages and epithelial cells are involved in the asthmatic response. The treatment of asthma involves the avoidance of known triggers, the use of bronchodilators to reverse the airflow obstruction, and the use of drugs to reduce inflammation and prevent block inflammatory responses. If necessary, extreme treatment can involve complete ventilatory support.
Symptoms include episodic wheezing, chest tightness, shortness of breath, or cough. These symptoms worsen in the presence of triggers such as allergens, irritants, or exercise. Often these symptoms are worse at night. Asthma is often found in patients with atopy, allergic rhinitis or dermatitis. Often, their relatives have asthma, allergy sinusitis, or rhinitis. It is important to note that cough may be the only symptom.
Many pre-school aged children are mis-labeled as having bronchiolitis, bronchitis, or pneumonia. However, recurrent asmtha-like symptoms in the presence of viral URI points to the likelihood that the patient has asthma. Even if it is the first episode, wheezing associated with a viral URI can be treated as asthma. In some cases, these symptoms will remit as the child gets older; however, it may persist into adulthood as asthma. Persistence is associated with continued allergies, family history of asthma, and perinatal exposure to aeroallergens and passive smoke.
Diagnosis is based on a history or presence of episodic symptoms of airflow obstruction, demonstration that the airflow obstruction is at least partially reversible, and an exclusion of alternative diagnoses. The severity of asthma is divided into four steps according to clinical features prior to treatment. For each step, specific therapeutic protocols exist, one for adults and children over 5 years of age, and one for children 5 years of age and younger. Management of asthma requires periodic reassessment, and patients may change steps.
Pharmacotherapy consists of two type of agents: those which give quick relief by reversing symptoms, and those that contribute to long-term control of asthma. Specific recommendations exist for management of asthma at home, as well as in the ER, ward and PICU.
Patient education occupies an important position in asthma management,
as patients must be taught how to avoid triggering
asthmatic exacerbations, how to use their medications and equipment (such
as inhalers, nebulizers, peak
flow meters), and what to do if their symptoms worsen.
| Pulmonology |
| NetScut |
