NIKHIL KUMAR

SOMVIR
 Definition
Asthma is a chronic inflammatory disease of the airways
which develops under the allergens influence, associates
with bronchial hyper responsiveness and reversible
obstruction and manifests with attacks of dyspnea,
breathlessness, cough, wheezing, chest tightness and sibilant
rales more expressed at breathing-out.
Epidemiology
According to epidemiological studies asthma affects 1-18% of

population of different countries.

Only in 2006 more than 300 million patients suffered from

asthma all over the world, 250 thousands of patients die of
asthma. The incidence of asthma is higher in countries with
increased air pollution.
Epidemiology
causes
 Allergic reactions to plants, foreign bodies
in the air way.
Etiology

The allergens are divided into

•Communal
•Industrial
•Occupational
•Natural
•Pharmacological
Communal : allergens are contained in the air of apartment
houses. They are:

◦ House-dust mites which live in carpets mattresses and

furniture;

◦ Vital products of domestic insects

◦ Ttobacco smoke during active or passive smoking;

◦ Various communal aerosols and synthetic detergents.

 Among the industrial allergens nitric, carbonic, sulphuric
oxides, formaldehyde, ozone and emissions of biotechnological
industry - main components of industrial and photochemical.

The most important occupational allergens are dust of

stock buildings, mills weaving-mills, book depositories etc.

Natural : Allergens are represented by plant pollen

(especially ambrosia wormwood and goose-foot pollen) and different
respiratory, particularly viral, infections.
 Some allergens which may cause asthma

Spittle, excrements,
House-dust mites which live in
carpets, mattresses and
hair and fur
upholstered furniture of domestic
animals

Plant pollen

Dust of Food
Pharmacological
book components
agents (enzymes,
depo- (stabilizers,
antibiotics,
sitories genetically modified
vaccines, serums)
products)
Asthma Triggers

©2010
 Trigger-factors, which provoke bronchospasm, are: a
simultaneous penetration of a large quantity of allergen,
viral respiratory infection, hyperventilation, physical
exertion, emotional stress, becoming too cold, adverse
weather conditions, administration of some medicines
(aspirin, b-blockers).
 Pathophysiology
Asthma pathophysiology is quite difficult and
insufficiently studied. Undoubtedly, in most cases the
disease is based on 1 type hypersensitivity reaction. The
genesis of any allergic reaction may be divided into
immune, pathochemical and pathophysio-logic phases.
Classifications of Asthma
 1. Spasmodic: sporadic in nature with varying intervals
of free and difficulty due to precipitating factors often
readily defined.

 2. Continuous: some shortness of breath on occasion,

transit wheezing on strenuous exercise and wheezy rales
hard deep inspiration.
Classifications of Asthma cont…

 3. Intractable: persistent wheezing requiring

regular daily medication for either control of
symptoms or ability to function.

 4. Status Asthmaticus: sever attach in which

patient deteriorates in spite of adequate
treatment.
Clinical manifestations
Attacks of expiratory dyspnea
◦ Shortness of breath

◦ Cough.

◦ Chest tightness

◦ Wheezing (high-pitched whistling sounds when

breathing out)
 In typical cases in development of asthma
exacerbation there are 3 periods – prodromal period, the
height period and the period of reverse changes.
At the prodromal period:
 vasomotor nasal reaction with profuse watery discharge,
 sneezing, dryness in nasopharynx,
 paroxysmal cough with viscous sputum,
 emotional labiality,
 excessive sweating,
 skin itch and other symptoms may occur.
 At the peack of exacerbation there are:
◦ expiratory dyspnea

◦ forced position with supporting on arms

◦ poorly productive cough

◦ cyanotic skin and mucous tunics

◦ hyperexpansion of thorax with use of all accessory muscles during

breathing

◦ at lung percussion: tympanitis, shifted downward lung borders

◦ at auscultation: diminished breath sounds, sibilant rales, prolonged breathing-

out, tachycardia.

◦ in severe exacerbations: the signs of right-sided heart failure (swollen neck

veins, hepatomegalia), overload of right heart chambers on ECG.
 At the period of the reverse changes,
 Which comes spontaneously or under
pharmacologic therapy.

 Dyspnea and breathlessness relieve or disappear.

 Sputum becomes not so viscous.

 Cough turns to be productive.

 Patient breathes easier.

Diagnosis
Typical clinical
manifestations and
lung function
assessment are
sufficient for
diagnosis of
asthma.
Radiographic image
Posteroanterior chest radiograph

pneumomediastinum in bronchial asthma

CT scan

expiration demonstrates a mosaic pattern of lung attenuation

CT scan

mild bronchial thickening and dilatation

High-resolution CT scan

during expiration and after a methacholine challenge

Coronal hyperpolarized helium (He-
3) MRI

before treatment with an inhaled bronchodilator (ie, albuterol)

Multiple dark areas of wedge-shaped ventilation defects
second image MRI

40 minutes after treatment

 Management
1. Avoiding the contact with allergen. If it is impossible, the specific
hyposensitization with standard allergens should be performed. It
is rather effective in case of monoallergy, in intermittent and mild
persistent asthma, in remission phase.

2. Elimination of trigger factors (rational job placement, changing

the residence, psychological and physical adaptation, careful drug
using) is the second condition for successful asthma treatment.

3. Optimally selected medical care is the base of asthma

management.
Combined inhaled drugs (corticosteroids with b2-
agonists) (nebulasers, turbuhalers, spasers, spinhalers,
sinchroners) enhance the effectiveness of asthma
therapy.
Management
◦ Oxygen

◦ Systemic corticosteroids

◦ Inhalations of short-acting b2-agonists – Salbutamol or Fenoterol through

nebuliser – 3 times at 1st hour, then once an hour till distinct improvement of
patient’s condition is achieved; then 3-4 times a day.

◦ Inhaled ant cholinergic drugs or Aminophylline IV.

◦ If ineffective - artificial lung ventilation.

Prognosis
 In case of early detection and adequate
treatment the prognosis for the disease is
favourable.

 It becomes serious in severe persistent and

poorly controlled (insensitive for corticosteroids)
asthma.
The examination of working capacity

◦ The patients with unfavorable for the disease

conditions of work need the job replacement.

◦ Physical labours with severe asthma are disable to

work.
Prophylaxis
Preservation of the environment, healthy life-
style (smoking cessation, physical training) – are the
basis of primary asthma prophylaxis. These measures in
combination with adequate drug therapy are effective
for secondary prophylaxis.
References
 https://www.nhlbi.nih.gov/health-
topics/asthma
 https://www.aaaai.org/conditions-and-
treatments/asthma
 https://asthma.ca/get-help/asthma-
3/diagnosis-3/how-to-tell-you-have-
asthma/
 https://acaai.org/asthma/types-asthma