Asthma

Davidson + osmosis + step up medicine

 General characteristics:
 Defined by following triad
 Airway inflammation
 Airway hyperresponsiveness
 Reversible airflow obstruction
 Asthma can begin at any age
 chronic, reversible airway inflammation characterized by periodic attacks of wheezing, SOB, chest
tightness, and coughing
 peak flow meters are useful in the office and at home for monitoring
 Extrinsic vs intrinsic asthma
 Extrinsic asthma (most cases)
 Patients are atopic i.e., produce immunoglobulin E (IgE) to environmental
antigens. May be associated with eczema and hay fever.
 Patients become asthmatic at a young age
 Intrinsic asthma – not related to atopy or environmental triggers
 Triggers include pollens, house dust, molds, cockroaches, cats, dogs, cold air, viral
infections, tobacco smoke, medication (b-blockers, aspirin), and exercise.
 Chronic inflammatory disorder of airways, smooth muscle spasm(reversible) + increased
mucous secretion narrow airway. Is a type of obstructive lung disease. Over years 
edema scarring and fibrosis  thickened wall basement.
 Symptoms include dyspnea + chest tightness + cough + wheezing + symptoms free
period.
 Sputum  has curschmann spirals  mucous plugs  casts from small bronchi.
 Asthma is classified according to 1. Amount of obstruction: a. FEV1. b. PEFR (peak
expiratory flow rate., 2. Frequency if symptoms: a. night time b. Early morning
 Types: 1. Intermittent. 2. Mild persistent. 3. Moderate persistent. 4. Severe persistent.
 Affects 300 million people.
 Pathophysiology: common example of allergens includes dust mites, pets, pests, fungi.
Followed by Broncho constrictor response. In case of Aspirin-sensitive asthma 
ingestion of salicylates or NSAID  inhibit cyclooxygenase  shunting metabolism of
arachidonic acid through lipoxygenase pathway  asthmogenic cysteinyl leukotrienes.
In exercise induced asthma  hyperventilation + heat loss from mucosa of lung 
water loss from peri cellular lining fluid of respiratory mucosa  triggers mediator
release.
 Clinical picture:
 Typical symptoms include recurrent episodes of wheezing, chest tightness,
breathlessness, cough.
 Classical precipitants include exercise, particularly In cold weather, exposure to
airborne allergens or pollutants, viral URTI.
 Little to find on examination.
 Inspection for nasal polyp and eczema should be performed. Patients with mild
intermittent asthma are usually asymptomatic between exacerbations. Asthma
characteristically displays a diurnal pattern with symptoms, lung function being
 worse in early morning, particularly when poorly controlled. Symptoms such as
cough wheeze disturb sleep and have led to term nocturnal asthma. Particular
enquiry should be made about potential allergens. Can be triggered by medication 1.
Aspirin 2. Oral contraceptive pills 3. Cholinergic agents 4. Beta-blockers. Severe form
of asthma is more common in women.
 Symptoms are typically worse at night
 Investigation:
 Peak flow meter
 CXR if diagnosis in doubt to rule out pneumonia, pneumothorax.
 Diagnosis:
 based on history.
 By using spirometer, to measure FEV1, VC. Patients should be instructed to record
peak flow reading after rising in morning and before bed. > 20% diurnal variation of >
3 days in a week for 2 weeks on PEF diary. FEV1 > 15% decrease after 6 min of
exercise. FEV1 > 15% increase following administration of bronchodilator/trial of
corticosteroids.