ASTHMA

Asthma is a chronic disease of the air passages characterized by inflammation and narrowing of the
airways. Symptoms of asthma include shortness of breath, cough, and wheezing. It commonly presents in childhood
and is usually associated with conditions such as eczema and hay fever. This activity outlines the evaluation and
treatment of asthma and explains the role of the interprofessional team in managing patients with this condition.

Asthma is a very common childhood illness leading to multiple hospital admissions and increased
healthcare costs. The key feature is airway hyper-responsiveness, which can be triggered by many factors. If not
treated promptly, asthma has a high mortality. Asthma comprises a range of diseases and has a variety of
heterogeneous phenotypes. The recognized factors that are associated with asthma are a genetic predisposition,
specifically a personal or family history of atopy (propensity to allergy, usually seen as eczema, hay fever, and
asthma)

Asthma also is associated with exposure to tobacco smoke and other inflammatory gases or particulate matter.

The overall etiology is complex and still not fully understood, especially when it comes to being able to say
which children with pediatric asthma will carry on to have asthma as adults (up to 40% of children have a wheeze,
only 1% of adults have asthma), but it is agreed that it is a multifactorial pathology, influenced by both genetics and
environmental exposure.

Triggers for asthma include:

 Chronic sinusitis

 Environmental allergens

 Tobacco smoke

 Obesity

Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an
environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen
(e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus
production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.

Airway obstruction occurs due to the combination of:

 Inflammatory cell infiltration.

 Mucus hyper secretion with mucus plug formation.

 Smooth muscle contraction.

These irreversible changes may become irreversible over time due to

 Basement membrane thickening, collagen deposition, and epithelial desquamation.

 Airway remodelling occurs in chronic disease with smooth muscle hypertrophy and hyperplasia.
Reference: Hashmi, M. et al. (2023). Asthma. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430901/
HYPERTENSION

Systemic arterial hypertension is the most important modifiable risk factor for all-cause morbidity and
mortality worldwide and is associated with increased risk of cardiovascular disease (CVD). Fewer than half of those
with hypertension are aware of their condition, and many others are aware but not treated or inadequately treated,
although successful treatment of hypertension reduces the global burden of disease and mortality. The aetiology of
hypertension involves the complex interplay of environmental and pathophysiological factors that affect multiple
systems, as well as genetic predisposition.

Evaluation of patients with hypertension includes accurate standardized blood pressure (BP) measurement,
assessing patients’ predicted risk of atherosclerotic CVD, evidence of target organ damage, detection of secondary
causes of hypertension and presence of comorbidities, including CVD and kidney disease. Lifestyle changes,
including dietary modifications and increased physical activity, are effective in lowering BP and preventing
hypertension and its CVD sequelae. Pharmacological therapy is very effective in lowering BP and preventing CVD
outcomes in most patients; first line antihypertensive medications include angiotensin-converting enzyme (ACE)
inhibitors, angiotensin II receptor blockers, dihydropyridine calcium channel blockers and thiazide diuretics.

The pathophysiological mechanisms responsible for hypertension are complex and act on a genetic
background. Primary hypertension involves multiple types of genes; some allelic variants of several genes are
associated with an increased risk of developing primary hypertension and are linked in almost all cases to a positive
family history. This genetic predisposition, along with a host of environmental factors, such as high Na + intake, poor
sleep quality or sleep apnoea, excess alcohol intake and high mental stress, contribute to the development of
hypertension.

The probability of developing hypertension increases with aging, owing to progressive stiffening of the
arterial vasculature caused by, among other factors, slowly developing changes in vascular collagen and increases in
atherosclerosis. Immunological factors can also play a major part, especially on the background of infectious or
rheumatological diseases such as rheumatoid arthritis. The mosaic theory of hypertension describes its multifaceted
pathophysiology.

Reference:
Acelajado, S. et. al (2018). Hypertension Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477925/