The specific cause of asthma is unknown, it’s thought to be caused by combination

of modifiable and non modifiable factors. The asthma trigger by exposure to the trigger
factor. In asthma there often an excessive reaction from type 2 helper cell or TH2 cell
against specific allergen. Th2 cell are immune cell subtype which are known to be involved
in asthma. The atopic triad also known as the atopic dermatitis and allergic rhinitis.
Allergens from the environmental factors triggers and picked up by the dendritic cell which
present in the TH2 cell which produces cytokines like IL4 and IL5 leading to number of
features of asthma. IL4 produces IgE antibodies which coat mast cell and stimulate them
release histamine, leukotrienes and prostaglandins. IL5 activates eosinophils which
promotes response by releasing cytokines and leukotrienes. Results to type 1
hypersensitivity reaction. This leads to smooth muscle spasm muscle spasm and increase
secretion also it narrow the airway making difficult to breathe. There also increased of
vascular premeability and recruitment of other cell in the blood this immune cell specially
eosinophils released chemical mediator that can damage the endothelium of the lungs. Then
after that the airway obstruction will happen that causes the asthma attack.
 An asthma attack may occur spontaneously or in response to a trigger. Although it isn't
clear why some people get asthma and others don't, studies show that asthma occurs due to the
combination of environmental and inherited (genetic) factors. Below are the detailed explanations
of these factors.

For non-modifiable factors, we have

 Gender: As adults, women have an increased asthma prevalence compared to men. Further,
women are more likely to have severe asthma and a later onset of asthma compared to men

 Family History: three-fifths of all asthma cases are hereditary. According to a CDC report,
if a person has a parent with asthma, they are three to six times more likely to develop
asthma than someone who does not have a parent with asthma.

For modifiable factors, we have

 Environmental allergens: Indoor air pollution such as cigarette smoke, mold, and noxious
fumes from household cleaners and paints can cause allergic reactions and asthma.
Environmental factors such as pollution, sulfur dioxide, nitrogen oxide, ozone, cold
temperatures, and high humidity are all known to trigger asthma in susceptible individuals.

 Emotional factors/stress: Research has shown that the body's response to stress triggers
the immune system and causes the release of certain hormones. This can lead to
inflammation within the airways of the lungs, triggering an asthma attack.

 GERD (GastroEsophageal Reflux Disease): The refluxed gastric acid irritates the nerve
endings in the esophagus generating signals to the brain. Subsequently, the brain responds
with impulses to the lungs that stimulate the muscle and mucus production in the airways.
The small airways of the lungs then constrict, resulting in asthma symptoms.

Either way, these factors trigger airway inflammation making the lining of your airways to
be inflamed (swollen). From here on, there is an initial release of inflammatory mediators from
bronchial mast cells, eosinophils, histamine, macrophages, followed by the activation of other
inflammatory cells. These chemicals perpetuate inflammatory response leading to acute
bronchoconstriction and increased goblet cells (mucus-secreting epithelial cell). For the acute
bronchoconstriction, the smooth muscles of the bronchi (airways) tighten and narrow, producing
wheezing sounds and making it difficult for us to breathe. As the body's capacity to take in oxygen
reduces, a person may have lower blood oxygen levels leading to different conditions such as chest
tightness. As per the goblet cells, over-production of mucus leads to frequent coughing. Moreover,
production of thick mucus may also result in increased work of breathing leading to the same path
as the aforementioned one.
 We are focusing on atopic asthma. So here we have columnar epithelial cells with
goblet cells which secrete mucus in top and here we have the lumen. Below the columnar
epithelium, we have lamina propria where we have mastcell and dendritic cells
macrophages. So asthmatic inhales an allergen and this allergen will trigger a reaction, so
few things can happen. One thing is that the allergen will being gulp by dendritic cells and
activate the dentritic cells. Also the columnar epithelial cells will recognize this and secrete
a substance called thymic stromal lymphocyte. Thymic stromal lymphocyte will condition
activated DC to produce chemocons to attract specifically T-helper2 cells. The active DC
itself will activate T-helper cells to differentiate into two and also will secrete chemocons to
attract the t-helper 2 to the area to the bronchioles or the lungs. So the activated T-helper 2
cell does two simple things. First thing the T-helper 2 cells role is to promote humoral
immunity so it will stimulate plasma cells through interleukin 13 and interleukin 4 and this
will promote IgE production by the plasma cells. IgE will obviously a help by muscles to
create IgE muscle complex. T-helper 2 itself through interleukin 9 will stimulate or promote
mast cells activity. Another important function T-helper 2 cells do is that it will stimulate
eosinophil production from the bone marrows through interleukin 5. So interleukin 5 will
stimulate eosinophil production so you get more eosinophil and more eosinophil’s there’s
are chemotactic basically a thing occurring which will attract the eosinophil’s to the area to
the lungs and so we have increasing eosinophil amounts in the lungs. So the inhaled
allergen will bind onto IgE mast cell complex and this will cause the mast cell to release a
few things namely histamine, prostaglandins and leukotrienes. All this specifically
histamine will stimulate smooth muscles in the airway to caused constrictions, so we get
bronchoconstriction also during this process the endothelial cell will release stem cell
factors that was essentially maintain the mast cell to the area. So you can imagine that if
there’s a IgE being produced this essentially this memory being produced whenever the
same top of allergen is inhaled it will trigger the process of histamine released and
bronchoconstriction and you get more eosinophil so you get the whole process still
occurring.
 Non-Modifiable Factors Modifiable Factors
- Age and Gender - Environmental Allergens
- Family History - Emotional Factors/Stress
- GERD

Triggers airway inflammation

Dendritic Cell

TH2 Cell
IL 5 IL 13 and 4

Eosinophils IgE Antibodies

Mast Cell
Cytokines & Leukotrines
Histamines, Leukotrienes & Prostaglandins

Type 1 Hypersensitivity

Acute Bronchoconstriction ↑ Goblet Cells (Mucus production)

Narrowing of the airway passages Wheezing Cough

Difficulty of Breathing

↓ Oxygenation

Chest tightness ASTHMA

 An asthma attack may occur spontaneously or in response to a trigger. Although it isn't
clear why some people get asthma and others don't, studies show that asthma occurs due to the
combination of environmental and inherited (genetic) factors. Below are the detailed explanations
of these factors.

For non-modifiable factors, we have

 Age and Gender: Childhood asthma occurs more frequently in boys than in girls. Around
age 20, the ratio of asthma between men and women is the same. At age 40, more females
than males have adult asthma.

 Family History: three-fifths of all asthma cases are hereditary. According to a CDC report,
if a person has a parent with asthma, they are three to six times more likely to develop
asthma than someone who does not have a parent with asthma.

For modifiable factors, we have

 Environmental allergens: Indoor air pollution such as cigarette smoke, mold, and noxious
fumes from household cleaners and paints can cause allergic reactions and asthma.
Environmental factors such as pollution, sulfur dioxide, nitrogen oxide, ozone, cold
temperatures, and high humidity are all known to trigger asthma in susceptible individuals.

 Emotional factors/stress: Research has shown that the body's response to stress triggers
the immune system and causes the release of certain hormones. This can lead to
inflammation within the airways of the lungs, triggering an asthma attack.

 GERD (GastroEsophageal Reflux Disease): The refluxed gastric acid irritates the nerve
endings in the esophagus generating signals to the brain. Subsequently, the brain responds
with impulses to the lungs that stimulate the muscle and mucus production in the airways.
The small airways of the lungs then constrict, resulting in asthma symptoms.

Either way, these factors trigger airway inflammation making the lining of your airways to
be inflamed (swollen). From here on, activated Dendritic Cell produces chemocons to attract
specifically T-helper2 cells. Through IL 13 and 4, it produces IgE antibodies which bind to the
mast cell and stimulate them releasing histamine, leukotrienes and prostaglandins. Through
IL 5, it activates eosinophils which promote response by releasing cytokines and
leukotrienes. Both resulting to type 1 hypersensitivity reaction. These chemicals perpetuate
inflammatory response leading to acute bronchoconstriction and increased goblet cells (mucus-
secreting epithelial cell). For the acute bronchoconstriction, the smooth muscles of the bronchi
(airways) tighten and narrow, producing wheezing sounds and making it difficult for us to breathe.
As the body's capacity to take in oxygen reduces, a person may have lower blood oxygen levels
leading to different conditions such as chest tightness which will eventually bring forth to asthma.
As per the goblet cells, over-production of mucus leads to frequent coughing leading to the same
path as the aforementioned one.
9/22/2021