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GENALDO, MD, RN
DEFINITION is a disease of the respiratory system in which the airways constrict, become inflamed, and are lined with excessive amounts of mucus, often in response to one or more "triggers," such as exposure to an environmental stimulant (or allergen ), cold air, exercise, or emotional stress.
CHARACTERISTICS The disorder is a chronic or recurring inflammatory condition in which the airways develop increased responsiveness to various stimuli, characterized by bronchial hyper-responsiveness, inflammation, increased mucus production, and intermittent airway obstruction
Etiology It is not clear exactly what makes the airways of people with asthma inflamed. New research suggests that being exposed to things like tobacco smoke, infections, and some allergens early in your life may increase your chances of developing asthma.
There are things in the environment that bring on your asthma symptoms and lead to asthma attacks. Some of the more common things include exercise, allergens, irritants, and viral infections. Some people have asthma only when they exercise or have a viral infection.
There are seven categories of stimuli:
allergens, typically inhaled, which include waste from common household insects, such as the house dust mite and cockroach, grass pollen, mould spores and pet epithelial cells; medications, including aspirin and β-adrenergic antagonists (beta blockers);
air pollution, such as ozone, nitrogen dioxide, and sulfur dioxide, which is thought to be one of the major reasons for the high prevalence of asthma in urban areas; various industrial compounds and other chemicals, notably sulfites; chlorinated swimming pools generate chloramines— monochloramine (NH2Cl), dichloramine (NHCl2) and trichloramine (NCl3)—in the air around them, which are known to induce asthma.
early childhood infections, especially viral respiratory infections. However, persons of any age can have asthma triggered by colds and other respiratory infections even though their normal stimuli might be from another category (e.g. pollen) and absent at the time of infection. exercise, the effects of which differ somewhat from those of the other triggers emotional stress, which is poorly understood as a trigger
The mechanisms behind allergic asthma— i.e., asthma resulting from an immune response to inhaled allergens—are the best understood of the causal factors. In both asthmatics and non-asthmatics, inhaled allergens that find their way to the inner airways are ingested by a type of cell known as antigen presenting cells, or APCs.
APCs then "present" pieces of the allergen to other immune system cells. In most people, these other immune cells ( TH0 cells) "check" and usually ignore the allergen molecules. In asthmatics, however, these cells transform into a different type of cell (TH2), for reasons that are not well understood. The resultant TH2 cells activate an important arm of the immune system, known as the humoral immune system. The humoral immune system produces antibodies against the inhaled allergen.
Later, when an asthmatic inhales the same allergen, these antibodies "recognize" it and activate a humoral response. Inflammation results: chemicals are produced that cause the airways to constrict and release more mucus, and the cell-mediated arm of the immune system is activated. The inflammatory response is responsible for the clinical manifestations of an asthma attack.
In essence, asthma is the result of an abnormal immune response in the bronchial airways. The airways of asthmatics are " hypersensitive" to certain triggers, also known as stimuli. In response to exposure to these triggers, the bronchi (large airways) contract into spasm (an "asthma attack").
Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads 08/03/09
Signs and Symptoms
Coughing. Coughing from asthma is often worse at night or early in the morning, making it hard to sleep. Wheezing. Wheezing is a whistling or squeaky sound when you breathe. Chest tightness. This can feel like something is squeezing or sitting on your chest.
Shortness of breath. Some people say they can't catch their breath, or they feel breathless or out of breath. You may feel like you can't get enough air in or out of your lungs. Faster breathing or noisy breathing.
Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators. These are typically provided in pocket-sized, metered-dose inhalers (MDIs).
Nebulizer—which provides a larger, continuous dose—can also be used. Nebulizers work by vaporizing a dose of medication in a saline solution into a steady stream of foggy vapour, which the 16 08/03/09
Short-acting, selective beta2-adrenoceptor agonists, such as salbutamol (albuterol USAN), levalbuterol, terbutaline and bitolterol - inhaled delivery, which allows the drug to target the lungs specifically;caution against using these medicines too frequently, efficacy may decline, producing desensitization resulting in an exacerbation of symptoms which may lead to refractory asthma and death.
Older, less selective adrenergic agonists, such as inhaled epinephrine and ephedrine tablets - inhaled epinephrine has been shown to be an effective agent to terminate an acute asthmatic exacerbation Anticholinergic medications, such as ipratropium bromide - can be used in patients with heart disease; however, they take up to an hour to achieve their full effect and are not as powerful as the β2adrenoreceptor agonists
The most effective treatment for asthma is identifying triggers, such as pets or aspirin, and limiting or eliminating exposure to them. Desensitization to allergens has been shown to be a treatment option for certain patients.
Smoking cessation and avoidance of secondhand smoke is strongly encouraged in asthmatics. 08/03/09 19
For those in whom exercise can trigger an asthma attack (exercise-induced asthma), higher levels of ventilation and cold, dry air tend to exacerbate attacks. For this reason, activities in which a patient breathes large amounts of cold air, such as skiing and running, tend to be worse for asthmatics, whereas swimming in an indoor, heated pool, with warm, humid air, is less likely to provoke a response
Monitoring your asthma so that you can recognize when your symptoms are getting worse and respond quickly to prevent or stop an asthma attack. Avoiding things that bring on your asthma symptoms or make your symptoms worse. Doing so can reduce the amount of medicine you need to control your asthma. Advise to carry quick-relief inhaler with you at all times in case of an asthma attack.