Bronchial Asthma: Def ,Types, Symptoms & Rx

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Bronchial Asthma: Def ,Types, Symptoms & Treatment

Bronchial Asthma is an Episodic Disease manifested Clinically by Paroxysms ( Sudden Attack) of :Dyspnoea, Cough and Wheezing

Definition of Bronchial Asthma:

Asthma  ( Bronchial  Astma) is a disease of Airways that is characterized by increase Responsivness of the Trachio- Bronchial Tree to a Variety of Stimuli Resulting Narrowing of the Air Passages which may be Relieved by Spontaneously or by Medication.

ASTHMA is an Reversible Airways Disease of lungs.

 

Bronchial Asthma Types & Treatment- allinfopedia

Bronchial Asthma Types & Treatment- Lung Anatomy of Bronchial Asthma

Epediomology:

Bronchial Asthma is Common and Prevalent world-wide ; in United States about 4% of Population is Reported to suffer from this Disease. It occurs at all ages but nearly 50% of cases develop it before the age of 10 – 12 years.In Adults, Both Genders are Affected equally but in Children there is 2:1 (Male: Female) ratio.

classification of Asthma

Mild Intermittent Asthma

  • Symptoms of a cough, wheeze, chest tightness or difficulty breathing less than twice a week
  • Flare-ups are brief, but intensity may vary
  • Nighttime symptoms less than twice a month
  • No symptoms between flare-ups
  • Lung function test FEV1 equal to or above 80 percent of normal values
  • Peak flow less than 20 percent variability AM-to-AM or AM-to-PM, day-to-day.

Mild Persistent Asthma

  • Symptoms of a cough, wheeze, chest tightness or difficulty breathing three to six times a week
  • Flare-ups may affect activity level
  • Nighttime symptoms three to four times a month
  • Lung function test FEV1 equal to or above 80 percent of normal values
  • Peak flow less than 20 to 30 percent variability.

Moderate Persistent Asthma

  • Symptoms of a cough, wheeze, chest tightness or difficulty breathing daily
  • Flare-ups may affect activity level
  • Nighttime symptoms 5 or more times a month
  • Lung function test FEV1 above 60 percent but below 80 percent of normal values
  • Peak flow more than 30 percent variability.

Severe Persistent Asthma

  • Symptoms of a cough, wheeze, chest tightness or difficulty breathing continuously
  • Nighttime symptoms frequently
  • Lung function test FEV1 less than or equal to 60 percent of normal values
  • Peak flow more than 30 percent variability.

 Bronchial Asthma Types And Etiopathogenesis:

Based on the Stimuli ( Trigger Factors) initiating Bronchial Asthma , Two Broad Etiologic Types are Described Below:

1 Extrinsic Asthma ( Allergic , Atopic)

2 Intrinsic Asthma ( Idiosyncratic , Non- Atopic)

A Type is MIXED TYPE in which Features overlap into either of two main Types.

1#Extrinsic ( Atopic or Allergic) Asthma :

1 This is the most common type of Asthma . It usually begins in Childhood or in Early Adult Life.
2 Most Patients of this Type of Asthma have Personal or Family History of Proceding Allergic disease such as Rhinitis , Urticaria or Infantile Eczema.
3 Hypersensitivity to Various Allergens is usually present in this Cases.
4 Most of these Allergens cause ill-effects by inhalation e.g. House Dust , Pollens , Animal Danders or Faecus ,Moulds etc.
5 Occupational Asthma is Stimulated by Fumes, Gases, Organic and Chemical Dusts etc.

Etiopathogenesis of Extrinsic Asthma:

There are increased levels of IgE in the Serum and Postive Skin Test with the specific inhaled antigen representing an IgE- mediated type Ist Hypersensitivity Reaction which include an “ Acute Immediate Response ” and a ” Late Phase Reaction”.

  • Acute Immediate Response :
  • The Acute Immediate Response is initiated by IgE- Sensitised mast cells ( counterparts of circulating Basophils ) on the mucosal Surface . Mast cells on degranulation release mediators like Histamines, Leukotrienes , Prostaglandins, Platelet activating factors and Chemotactic factors for eosinophils and neutrophils.

The net effects of these above mediators are Broncho-constriction , Oedema , Mucus Hypersecretion and Accumulation of eosinophils and neutrophils.

  • Late Phase Reaction:
  • The late Phase Reaction follows the acute immediate Response and is responsible for the prolonged manifestations of Asthma. It is caused by excessive mobilisation of Blood Leucocytes that include basophils besides eosinophils and neutrophils. In addition, Inflammatory injury is Caused by neutrophils and by major basic Protein ( MBP) of eosinophils

2# Intrinsic ( Idiosyncratic or Non- Atopic)

  1.  This type of Asthma Develops later in Adult Life .
  2. This Type of Asthma have Negative Personal or Family History of Allergy , Negative Skin Test and Normal Serum Level of IgE.
  3. Most of these patients develops typical symptoms-complex after an Upper Respiratory Tract infection by Viruses.
  4. Nasal Polyps and Chronic Bronchitis are Commonly Present.
  5. There are no recognisable allergens but 10% of Patients become hypersensitive to Drugs , mostly from Small doses of Aspirin i.e. Aspirin – Sensitive Asthma).

3# Mixed Type Asthma

Many Patients do no clearly identified into either of two above types and having mixed features of above types.

Those patients who develops asthma in early life have strong Allergic component, while those who develop the disease late having non-allergic component.

Either type of asthma can be precipitated by Cold, Exercise and Emotional Stress.

Symptoms of Bronchial Asthma;

Main Symptoms Which Usually associated with Asthma are:

  • Dyspnoea ( Difficulty in Breathing or Breathlessness or Chest Tightness) ,
  • Cough with Sputum Production and
  • Wheezing;
  1. it is the High-pitched, whistling sound
  2. Created by unstable/turbulent airflow through obstructed airtubes or airways/passage.
  3. The Sound Usually heard during expiration

These Above main Symptoms Varies Person to Person or According to the type of Asthmatic Attack or may be due to Viral Infection like Cold .

  • Signs of a Common cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache)

Early Symptoms of  Bronchial Asthma:

  1. Frequently Coughing especially during Sleep
  2. Frequently Difficulty in Breath
  3. Tachypnea or Rapid Breathing
  4. Feels very tired or weak after / during exercise
  5. Alter Breathing or Heart Rate
  6. Difficulty in Swallowing too
  7. Decreased Lungs Capacity and altered inspired or Expired air lung Capacity
  8. Disturbed Sleep due to breathlessness
  9. Difficulty in performing Activities of Daily living
  10. Bluish discoloration of the Lips And Nails
  11. Difficulty in Speaking
  12. Tightness in the Neck and Chest Muscles
  13. Feeling of Mild Anxiety or Panic

Sign of Asthma Check out by the Physician

  • Increased Pulse Rate
  • Increased Heart Rate
  • Use of Accessory muscles For the Respiration

Asthma Trigger Factors:

Bronchial Asthma Types &Treatment- allinfopedia

Asthma Trigger Factors

  • Exercise
  • GERD-  Gastro Esophagal Reflux Disease
  • PND – Post Nasal Drip
  • Pollen
  • Feathers
  • Bugs in the Home
  • Chemical Fumes
  • Cold Air
  • Fungus Spores
  • Dust
  • Smoke
  • Strong Odors
  • Air Pollution/ Pollutants
  • Anger
  • Stress
  • Pets
  • Genetic Predisposition
  • Environmental Factors

Preventive Measures For BRONCHIAL ASTHMA;

  1. Avoid the Exposure to All Trigger factors For Example :Exercise, Pollen, Bugs in the Home, Chemical Fumes ,Cold Air ,Fungus Spores ,Dust, Smoke, Strong Odors ,Pollution ,Anger, Stress, Pets etc.
  2. Asthmatic person Should Avoid working in the fumes ,Coal ,Gases , Organic or Chemical Dust industries.
  3. Remove All Allergic Causes

Clinical Features of  Bronchial Asthma;

Asthmatic Patients suffer from Episodes of Acute exacerbations ( an increase in the severity of a disease ) interspersed with symptoms- free periords.

Characteristics Clinical Features: are Paroxysms or Sudden Dyspnoea , Cough and Wheezing.

Diagnosis Of Bronchial Asthma;

  • History
  • Physical Examination

1. Chest auscultation by Stethoscope

  1. Heard Expiratory wheezing sound
  2. Low/Decreased breathing  sounds
  3. Cough/Coughing Frequent

2. Asthmatic Patient mostly used Accessory Muscles of Respiration.

Accessory muscles of respiration

  • The Accessory Inspiratory Muscles are the Sternomastoid, the Scalenus anterior, medius and posterior, the Pectoralis major and minor, the inferior fibres of serratus anterior and latissimus dorsi.
  • The Accessory Expiratory Muscles are the abdominal muscles: Rectus abdominis, External oblique, Internal oblique and Transversus abdominis.

3. Presence of allergic Reactions 

  1. Eczema- Skin Reactions (Rednesss , Ichting & lessions )
  2. Nasal polyps– are non cancerous growths within the nose or Nasal sinuses. Symptoms -breathlessness , loss of smell, decreased taste, post nasal drip, and a runny nose
  3. Inflamed turbinates ( nasal concha)
  4. Eyelid edema ( Accumulation of an excessive amount of watery/ Tranparent fluid in cells)
  • PFT – Pulmonary (Lung) Function Test

Pulmonary Function Test provide a Quantitative and Objective assessment of the Physiological derangement associated with Pulmonary disease. PFT specially done to measure Heart Rate and the functioning of the Lung.

Alternative Name  of PFTs ; Spirometry; Spirogram; Lung function tests .

Pulmonary function tests are done to Diagnose :

  • It is the Main Test For the Diagnosis  of lung disease, such as Asthma, bronchitis, and emphysema.
  • Assessment of  the cause of Dyspnoea ( Breathlessness or shortness of breath).
  • Diagnosis of Severity of Dysfunction .
  • Assessment of Reversivility of airway /airtubes /air passage obstruction.
  • Measure whether exposure to chemicals at work affects lung function.
  • Assess lung functions before surgery.
  • Identification & Screening of unsuspected disease.
  • Assessment of the effect of the certain Drugs or medication .
  • Identification of Cause of Respiratory Symptoms.
  • Evaluation of effectiveness of Short-Term and Long -Term Rx (Treatment ).
  • Evaluation  of Lungs disease Rx ( Treatment).

Treatment Of Bronchial Asthma:

 

 

Classification of Asthma – Source -http://www.familyallergy.com/asthma/asthma-classification.html

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