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Asthma

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Introduction

Asthma is a chronic inflammatory disease of air passages that is characterized by narrowing

of airways, reversible airway obstruction and increased mucous secretion on the airways. The
cardinal symptoms include high-pitched expiratory wheezing, shortness of breath, chest tightness
and cough. Asthma is a common disease that ranges from mild manifestation to occasional wheezing
to severe life-threatening airway obstruction (Hashmi,2021). The airway hyperresponsiveness may
be triggered by several factors such as viral infections, cold air, exercise, stress, and irritants like
smoke. There two types of asthma: atopic and nonatopic. Atopic (allergic) asthma is triggered by
allergens such as pollen, domestic animals, and dust mites (Hashmi,2021). There is evidence of
allergen sensitization, and the patient has a history of allergic rhinitis or eczema, and it mostly
develops during childhood. Nonatopic (nonallergic) asthma develops in patients above forty years
and is triggered by various factors like viral infections, medications like aspirin and exercise. 5-10% of
the U.S. population has asthma and it is more common in blacks and in whites (Jiam,2021). The
prevalence has been increasing annually for the last 20 years (Jiam,2021).

Etiology

Risk factors for asthma include a family history of asthma, any history of allergies, a low
socioeconomic status and atopic dermatitis. The cardinal risk factor is atopy (type 1 hypersensitivity)
(Jiam,2021). Nonallergic asthma can be triggered by viral respiratory infections, stress, exercise,
rhinitis, and irritants such as tobacco. Pathology begins with exposure to allergen or triggering
factors which causes bronchial hypersensitivity causing bronchial smooth muscles to contract
leading to obstruction and hypersecretion of mucus (Jiam,2021). Eosinophils are the key mediator
inflammatory cells for Type 1 hypersensitivity. Eosinophils release proinflammatory cytokines that
amplify the inflammation process (Jiam,2021).

Obstructive diagnostics

Asthma is a reversible obstructive pulmonary disease which can be assessed using the
Pulmonary Function Tests (PFTs). Characteristics findings of PFTs is an obstructive airflow pattern
which is reversible with an excessive variability of lung function (Jiam,2021). Chronic obstructive
pulmonary disease is not reversible therefore can be distinguished from asthma. The peak expiratory
flow rate is greatly reduced during asthma exacerbations (Johnson,2018). The FEV1/FVC ratio
(spirometry) is reduced as well (Johnson,2021). In suspected allergy asthma, an allergy workup
shows eosinophilia and increased total IgE. The clinical presentation of asthma is episodic made up
of asymptomatic phase with episodes of acute exacerbations.

Treatment

Pharmacological treatment of asthma is classified into reliever drugs and controller drugs.
Reliever drugs treat acute exacerbations and cause bronchodilation while controllers prevent acute
exacerbations which are anti-inflammatory as well (Hashmi,2021). Acute exacerbations are relieved
using short and long-acting beta 2 adrenergic agonists such as salbutamol and salmeterol
respectively (Hashmi,2021). Other reliever drugs include methylxanthines like theophylline and
antimuscarinics like ipratropium bromide. For long-term control of chronic asthma to avoid having
acute exacerbations, corticosteroids are given. An inhaled corticosteroid plus a short acting beta 2
agonist can be administered (Hashmi,2021). Examples of inhaled corticosteroids include budesonide
and fluticasone. Other controller drugs that can be co-administered include mast cell stabilizers like
nedocromil, leukotriene antagonists like montelukast and zafirlukast (Hashmi,2021). An IgE
antagonist like omalizumab can be used to prevent acute exacerbations as well (Hashmi,2021).
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Other non-pharmacological long-term management interventions include lifestyle

recommendations like advising the patient to quit smoking if they have been smoking. The patient
should also self-monitor themselves to avoid acute attacks (CDC, 2021). Other necessary changes
include weight loss and occupational change. Reducing exposure to triggers or allergens like
medications, dust and pollen is essential (CDC, 2021). Other comorbidities such as rhinosinusitis,
anxiety and depression should be managed as well. In patients who do not respond to therapy a
chest CT scan can be done to identify any other potential risks such as foreign bodies or infections in
the lung (Hashmi,2021). Asthma in pregnancy if not well managed can lead to increased risk of
pregnancy complications like pre-eclampsia and premature birth. Frequently monitoring and
administering of inhalational treatments is therefore recommended.
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References

CDC. "Asthma - Management And Treatment | CDC". Cdc.Gov, 2021,

https://www.cdc.gov/asthma/management.html.

Hashmi, Muhammad et al. "Asthma". Ncbi.Nlm.Nih.Gov, 2021,

https://www.ncbi.nlm.nih.gov/books/NBK430901/.

Jiam, Nicole. "Asthma - Knowledge @ AMBOSS". Amboss.Com, 2021,

https://www.amboss.com/us/knowledge/Asthma/.

Johnson, Jeremy, and Wesley Theurer. "A Stepwise Approach To The Interpretation Of Pulmonary
Function Tests". Aafp.Org, 2018, https://www.aafp.org/afp/2014/0301/p359.html.