Asthma
It is a chronic inflammatory disorder of the  breathing in allergy-causing substances
airways characterized by recurrent episode of wheezing,
breathlessness, chest tightness, and coughing.
Inflammation causes increased responsiveness of the
airways to multiple stimuli. The widespread airflow
obstruction that occurs during the acute episodes usually
reverses either spontaneously or with treatment.
CAUSES
The exact cause of asthma is not known.
 What all people with asthma have in common is
chronic airway inflammation and excessive
airway sensitivity to various triggers.
 Research has focused on why some people
develop asthma while others do not.
 Some people are born with the tendency to have
asthma, while others are not. Scientists are trying to
find the genes that cause this tendency.
 The environment you live in and the way you
live partly determine whether you have asthma
attacks.
An asthma attack is a reaction to a trigger. It is
similar in many ways to an allergic reaction.
 An allergic reaction is a response by the
body's immune system to an "invader."
 When the cells of the immune system sense an
invader, they set off a series of reactions that help
fight off the invader.
 It is this series of reactions that causes the
production of mucus and bronchospasms. These
responses cause the symptoms of an asthma attack.
 In asthma, the "invaders" are the triggers listed
below. Triggers vary among individuals.
 Because asthma is a type of allergic reaction, it
is sometimes called reactive airway disease.
Each person with asthma has his or her own unique
set of triggers. Most triggers cause attacks in some
people with asthma and not in others. Common
triggers of asthma attacks are the following:
 exposure to tobacco or wood smoke,
 breathing polluted air,
 inhaling other respiratory irritants such as
perfumes or cleaning products,
 exposure to airway irritants at the workplace,
(allergens) such as molds, dust, or animal dander,
 an upper respiratory infection, ,
 exposure to cold, dry weather,
 emotional excitement or stress
 physical exertion or exercise,
 reflux of stomach acid known
as gastroesophageal reflux disease, or GERD,
 sulfites, an additive to some foods and wine,
and
Risk factors for developing asthma:
 hay fever (allergic rhinitis) and other allergies
-- this is the single biggest risk factor;
 eczema: another type of allergy affecting the
skin; and
 genetic predisposition: a parent, brother, or
sister also has asthma.
SIGNS AND SYMPTOMS
When the breathing passages become irritated or
infected, an attack is triggered. The attack may come on
suddenly or develop slowly over several days or hours.
The main symptoms that signal an attack are as follows:
 wheezing,
 breathlessness,
 chest tightness,
 coughing, and
 difficulty speaking.
Symptoms may occur during the day or at night. If they
happen at night, they may disturb your sleep.
Wheezing is the most common symptom of an asthma
attack.
 Wheezing is a musical, whistling, or hissing
sound with breathing.
 Wheezes are most often heard during
exhalation, but they can occur during breathing in
(inhaling).
 Not all asthmatics wheeze, and not all people
who wheeze are asthmatics.
Current guidelines for the care of people with asthma
include classifying the severity of asthma symptoms, as
follows:
 Asthma
 Mild intermittent: This includes attacks no
more than twice a week and nighttime attacks no
more than twice a month. Attacks last no more than a
few hours to days. Severity of attacks varies, but
there are no symptoms between attacks.
 Mild persistent: This includes attacks more
than twice a week, but not every day, and nighttime
symptoms more than twice a month. Attacks are
sometimes severe enough to interrupt regular
activities.
 Moderate persistent: This includes daily
attacks and nighttime symptoms more than once a
week. More severe attacks occur at least twice a week
and may last for days. Attacks require daily use of
quick-relief (rescue) medication and changes in daily
activities.
 Severe persistent: This includes frequent severe
attacks, continual daytime symptoms, and frequent
nighttime symptoms. Symptoms require limits on
daily activities.
DIAGNOSTIC EXAMS
1. Pulmonary function test
2. ABG’s
3. Pulse oximetry
4. Skin testing
TREATMENT
Since asthma is a chronic disease, treatment goes on for
a very long time. Some people have to stay on treatment
for the rest of their lives. The best way to improve your
condition and live your life on your terms is to learn all
you can about your asthma and what you can do to make
it better.
 Become a partner with your health-care
provider and his or her support staff. Use the
resources they can offer -- information, education,
and expertise -- to help yourself.
 Become aware of your asthma triggers and do
what you can to avoid them.
 Follow the treatment recommendations of your
health-care provider. Understand your treatment.
Know what each drug does and how it is used.
 See your health-care provider as scheduled.
 Report any changes or worsening of your
symptoms promptly.
 Report any side effects you are having with
your medications.
Treatment Goals
 prevent ongoing and bothersome symptoms;
 prevent asthma attacks;
 prevent attacks severe enough to require a visit
to your provider or an emergency department or
hospitalization;
 carry on with normal activities;
 maintain normal or near-normal lung function;
and
 have as few side effects of medication as
possible.
MEDICATIONS
Controller medicines help minimize the inflammation
that causes an acute asthma attack.
 Long-acting beta-agonists: This class of drugs
is chemically related to adrenaline,
ahormone produced by the adrenal glands. Inhaled
long-acting beta-agonists work to keep breathing
passages open for 12 hours or longer. They relax the
muscles of the breathing passages, dilating the
passages and decreasing the resistance to exhaled
airflow, making it easier to breathe. They may also
help to reduce inflammation, but they have no effect
on the underlying cause of the asthma attack. Side
effects include rapid heartbeat and
shakiness. Salmeterol(Serevent)
and formoterol (Foradil) are long-acting beta-
agonists.
 Inhaled corticosteroids are the main class of
medications in this group. The inhaled steroids act
locally by concentrating their effects directly within
the breathing passages, with very few side effects
outside of the lungs. Beclomethasone (Vancenase,
Beclovent) and triamcinolone(Nasacort, Atolone) are
examples of inhaled corticosteroids.
 Leukotriene inhibitors are another group of
controller medications. Leukotrienes are powerful
chemical substances that promote the inflammatory
response seen during an acute asthma attack. By
blocking these chemicals, leukotriene inhibitors
reduce inflammation. The leukotriene inhibitors are
considered a second line of defense against asthma
and usually are used for asthma that is not severe
enough to require oral corticosteroids.
 Asthma
o Zileuton (Zyflo), zafirlukast (Accolate),
and montelukast (Singulair) are
examples of leukotriene inhibitors.
 Methylxanthines are another group of
controller medications useful in the treatment of
asthma. This group of medications is chemically
related tocaffeine. Methylxanthines work as long-
acting bronchodilators. At one time, methylxanthines
were commonly used to treat asthma. Today, because
of significant caffeine-like side effects, they are being
used less frequently in the routine management of
asthma. Theophylline and aminophylline are
examples of methylxanthine medications.
 Cromolyn sodium is another medication that
can prevent the release of chemicals that cause
asthma-related inflammation. This drug is especially
useful for people who develop asthma attacks in
response to certain types of allergic exposures. When
taken regularly prior to an exposure, cromolyn
sodium can prevent the development of an asthma
attack. However, this medicine is of no use once an
asthma attack has begun.
 Omalizumab belongs to a newer class of
agents that works with the body's immune system. In
people with asthma who have an elevated level of
Immunoglobulin E (Ig E), an allergy antibody, this
drug given by injection may be helpful with
symptoms that are more difficult to control. This
agent inhibits IgE binding to cells that release
chemicals that worsen asthma symptoms. This
binding prevents release of these mediators, thereby
helping in controlling the disease.
Rescue medications are taken after an asthma attack
has already begun. These do not take the place of
controller drugs. Do not stop taking your controller
drug(s) during an asthma attack.
 Short-acting beta-agonists are the most
commonly used rescue medications. Inhaled short-
acting beta-agonists work rapidly, within minutes, to
open the breathing passages, and the effects usually
last four hours. Albuterol(Proventil, Ventolin) is the
most frequently used short-acting beta-agonist
medication.
 Anticholinergics are another class of drugs
useful as rescue medications during asthma attacks.
Inhaled anticholinergic drugs open the breathing
passages, similar to the action of the beta-agonists.
Inhaled anticholinergics take slightly longer than
beta-agonists to achieve their effect, but they last
longer than the beta-agonists. An anticholinergic drug
is often used together with a beta-agonist drug to
produce a greater effect than either drug can achieve
by itself. Ipratropium bromide (Atrovent) is the
inhaled anticholinergic drug currently used as a
rescue asthma medication.
HOME CARE
 Know your triggers and do what you can to
avoid them.
 If you smoke, quit.
 Do not take cough medicine. These medicines
do not help asthma and may cause unwanted side
effects.
 Aspirin and nonsteroidal antiinflammatory
drugs, such as ibuprofen, can cause asthma to worsen
in certain individuals. These medications should not
be taken without the advice of your health-care
provider.
 Do not use nonprescription inhalers. These
contain very short-acting drugs that may not last long
enough to relieve an asthma attack and may cause
unwanted side effects.
 Take only the medications your health-care
provider has prescribed for your asthma. Take them
as directed.
 Do not take any nonprescription preparations,
herbs, or dietary supplements, even if they are
completely "natural," without talking to your health-
care provider first. Some of these may have unwanted
side effects or interfere with your medications.
 If the medication is not working, do not take
more than you have been directed to take. Overusing
asthma medications can be dangerous.
 Be prepared to go on to the next step of your
action plan if necessary.
If you think your medication is not working, let your
health-care provider know right away.
PREVENTION
You need to know how to prevent or minimize future
asthma attacks.
 Asthma
 If your asthma attacks are triggered by an
allergic reaction, avoid your triggers as much as
possible.
 Keep taking your asthma medications after you
are discharged. This is extremely important. Although
the symptoms of an acute asthma attack go away after
appropriate treatment, asthma itself never goes away.