Bronchial Asthma and its treatment

Hello students and friends, today we are going to learn about what is chronic asthma, its triggers, cause, symptoms, medications as well as first-aid for an asthmatic attack.

Lets clear one thing that there is no difference between asthma and bronchial asthma, bronchial asthma is another name for asthma.

• Inflammatory disease of small airways of the lungs characterized by episodic reversible bronchial obstruction due to hyperresponsiveness of the tracheobronchial tree.

• Asthma is associated with mast cells, eosinophils & T-lymphocytes.

MAST CELLS- they release histamine which is released when there is an allergic reaction in the body.

EOSINOPHILS- a type of WBC(white blood cell).

T-LYMPHOCYTES- a type of lymphocyte, plays a central role in immune responses and associated with allergy & inflammation.

Asthma can increase the risk of developing bronchitis.

Bronchial Asthma Triggers/Main cause of asthma

1. Smoking/second-hand smoking
2. Excercise
3. Air pollution or inhalation of toxins
4. Anxiety
5. Emotional stress
6. Perfumes & fragrance
7. Wheather(cold weather mainly)
8. Acid reflux
9. Allergens(dust mites, pollen)
10. Certain drugs(NSAIDs, aspirin, &beta-blockers)

Foods that should be avoided-

1. Cow milk
2. Peanut
3. Wheat
4. Fish
5. Eggs

Signs and symptoms

1. Shortness of breath
2. Excessive coughing or a cough that stays, which leads to sleep disturbances
3. Chest tightness
4. Wheezing sound during breathing.

Factors affecting asthma

1. Respiratory infections
2. Tobacco smoking
3. Dust pollutants
4. Cold weather
5. Emotional stress.

Types of asthma

• 2 types:

1. Extrinsic asthma
2. Intrinsic asthma

Extrinsic Asthma

• Begins usually in childhood.
• Family history of preceding allergies is involved
• Hypersensitivity to allergens.
• IgE level in the serum increases.
• Increase in eosinophils.
• Atopic.
• Most episodic.
• Positive skin sensitivity test.

Intrinsic Asthma

• Develops later in adulthood.
• Family history is not involved.
• Normal IgE level.
• Symptoms develop after any trigger factors(respiratory infections, exercise, emotional stress, etc.)
• Non-atopic.
• Negative skin sensitivity test.

Pathophysiology

• Chronic inflammation of respiratory tubes, tightening of respiratory smooth muscles, and episodes of bronchoconstriction.
• When an asthmatic episode occurs, an inflamed airway responds to environmental triggers(smoke, dust, etc.).
• Narrowing of airways in asthma occurs due to inflammation and bronchoconstriction of the airways.
• When airways get narrow, a wheezing sound is produced.
• There are various ways of inflammation- macrophages, mast cells, lymphocytes, eosinophils, neutrophils.
• Breathing gets difficult due to the narrowing of airways, thus airways get narrow, excess production of mucus occurs.
• The immune system of the body gives a response in the bronchial airways, results in asthma.
• The airways exhibit hypersensitivity to particular triggers(stimuli). It is usually categorized as a Type I hypersensitivity reaction.
• When the bronchi expose to these triggers, they contract and go into a spasm(asthmatic attack).
• Inflammation occurs which leads to further narrowing of airways, thus mucus production increases which leads to coughing and other breathing difficulties.
• Then vascular leakage increases which leads to edema and an increase in mucus secretion.
• When mucus secretion increases, airways obstruct and remodeling of airways occurs leads to smooth muscle hypertrophy/hyperplasia.
• Hyperplasia- increase in the number of cells.
• Hypertrophy- increase in the size of cells.

Diagnosis

1. Pulmonary function test
2. Spirometry
3. Peak expiratory flow
4. Chest X-Ray
5. The wheezing sound produced; difficulty in breathing.

Treatment

1. Bronchodilator- beta-adrenergic blockers; helps to open the lung airways.
2. Self-care- it is an important factor, if we want to cure this condition then we have to care for ourselves.
3. Anti-inflammatory drugs- corticosteroids; prevent joint swelling and inflammation of the tissues.
4. Inhalers(dry powder inhalers)
5. Breathing exercises

In the case of mild asthma-

• Asthalin inhalers are given; sorbitol.

If severity increases-

• Corticosteroids: we can give corticosteroids in 2 ways- either by inhalers or by nebulizer
• Inhalers: salbutamol, declasone
• Nebulizer: they are rest fumes; in this mixing of salbutamol & declasone is done.
• We can give some drugs through IV- Aminophylline and theophylline.
• Aminophylene(250mg) is given over 20 minutes.
• Theophylline is given in a slow manner, as it has a narrow therapeutic range; if it goes beyond the 20 micrograms per liter serum level then the patient will collapse.
• The normal level of theophylline- 10-20 micrograms per milliliter.

Acute severe asthma- systemic steroid

If uncontrolled- apetroprium bromide

70-80% Helium

• Decrease airway resistance; improve the effect of aerosolized bronchodilators.

First Aid

• First Aid is given in the case when there is no medication available at that moment:
• Loose clothing of the patient
• Airway assist
• Maintain the position of the patient.

During an asthma attack:

• Respiratory rate>25 breaths per minute
• Heart rate>110 beats per minute
• Oxygen saturation<92%
• Cyanosis occurs
• The partial pressure of oxygen< 8 KPa
• Peak Expiratory flow<50%; If PEF<33%, then this will lead to a life-threatening condition.
• Silent chest
• Effect on the central nervous system- drowsiness, confusion.

If life-threatening symptoms are seen in asthma-like cyanosis of lips or nails of fingers,then immediate medical care is required.

If someone questions that his asthma can go away, then the answer is `yes' it can go away. It mainly goes away in that condition when it occurs in childhood as compared to adults.

Hope you all find this helpful for you, if you have any query related to this topic or any other topic then you all are free to contact me via contact us or you can also ask your doubts on the comment box. Thank you! 

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