Types of asthma

1. Transient early wheezing Mostly in preschool children less than 3 years old It is virus associated wheeze Production of wheeze due to narrowing of small airways resulr of inflammtion and immune response to viral infection Common in male and usually resolve by 5years

2. Persistent and recurrent wheezing Commonly above 3years old Triggered by allergens such as dusts, pets, pollens and etc Also called atopic asthma

Pathophysiology
Environmental triggers Upper respiratory tract infections Allergens (e.g. house dust mite, grass pollens, pets) Smoking {active or passive) Cold air Exercise Emotional upset or anxiety Chemical irritants (e.g. paint, aerosols) Atopy Genetic predisposition

Bronchial inflammation Oedema Excessive mucus production lnfiltration with cells (eosinophils, mast cells, neutrophils, lymphocYtes)

Bronchial hyper responsiveness

Airway narrowing

Clinical feature
Wheeze Cough Dyspnea Chest tightness The symptoms worse at night and in the early morning

 Cortisol production increases in the day time and drops during night time Cortisol act as bronchodilator. Thus increase in cortisol production during day time do not show any significant in the airway obstruction Decrease in cortisol level cause severe airway obstruction.

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