What is Asthma?

Asthma is a chronic, inflammatory lung disease in which the airways become blocked or narrowed. These effects are usually temporary, but they cause shortness of breath, breathing trouble, and other symptoms. If an asthma episode is severe, a person may need emergency treatment to restore normal breathing. Asthma is characterized by acute episodes in which breathing becomes more difficult. Typical symptoms of asthma include wheezing, shortness of breath, chest tightness, and coughing. People with asthma typically have extra sensitive or hyperresponsive airways in their lungs. An acute asthma episode results when trigger substances irritate tissues in the airways, causing them to become red, swollen, and narrow. The resulting bronchoconstriction (muscles that encircle the airways tighten or go into spasm) makes it difficult for the asthma sufferer to take air in and out of the lungs.

 The prevalence of asthma has been increasing since the early 1980s across all age, sex and racial groups. However, the prevalence of asthma is higher among children than adults, and higher among blacks than whites.

Asthma

Lung

Classification
Asthma severity Clinical features Nighttime symptoms Lung function Treatment Mild intermittent Symptoms no more than twice per week No interference with normal activity No more than twice per month FEV1>80% FEV1/FVC normal Inhaled short-acting 2 agonist as needed

Mild persistent

Symptoms more than twice per week but less than once per day Minor limitation with normal activity Daily symptoms Daily use of inhaled 2 agonist Exacerbations at least twice per week, may last days Continual symptoms Extremely limited with normal activity Frequent exacerbations

Three of four times per month

FEV1 >80% FEV1/FVC normal

Anti-inflammatory therapy Alternative: sustainedrelease theophylline, leukotriene modifier or cromoglycate Inhaled short acting 2 Low-dose inhaled corticosteroid plus long-acting 2 agonist or; Medium-dose inhaled corticosteroid Medium or high-dose inhaled corticosteroid plus long-acting 2 agonist Consider short course of oral corticosteroid

Moderate persistent

More than once per week but not nightly

FEV1>60% but <80% FEV1/FVC reduced 5%

Severe persistent

Often nightly

FEV1<60% FEV1/FVC reduced > 5%

Smoking and asthma

An asthma attack occurs when your airways become irritated and inflamed. Cigarette smoke is one item on a long list of potential asthma triggers. These airborne irritants appear to stimulate irritant receptors located primarily in the wall of the larynx, trachea and large bronchi. Stimulation of the receptors initiates a reflex arc that travels to the central nervous system and back to the bronchi via the vagus nerve. This efferent vagal stimulation of the bronchi completes the reflex arc and induces bronchoconstriction.

Pathomechanism
Inhaled allergen (cigarette smoke )
Response to extrinsic antigen (allergen) Increase IgE production by plasma cell (B cell) & lymphoid tissues IgE binds to mast cell (on bronchial wall)

Decrease CAMP

React at specific receptor sites on membrane of smooth muscle

Secretion of mediators in mast cell (histamine, leukotrienes, prostaglandin)

Degranulation of mast cell after binding antigen on IgE

Bronchoconstriction of smooth muscle

Decrease airways caliber (narrowing airway)

Wheezing Breathlessness Cough

Pathology findings
Edema and cellular infiltrates within the bronchial wall (eosinophils and lymphocytes) Epithelial damage, with a fragile appearance of the epithelium and detachment of the surface epithelial cells from the basal cells Hypertrophy and hyperplasia of the smooth muscle membrane Thickening of the epithelial basement membrane Enlargement of the mucus-secreting apparatus, with hypertrophy of mucous glands and an increased number of goblet cells

Long-Term Medication
Inhaled Corticosteroids
The most effective medications for asthma. They reduce inflammation in your airways and prevent blood vessels from leaking fluid into your airway tissues. Help decrease the frequency of attacks and reduce the need for other medications. Because inhaled corticosteroids control most forms of asthma by delivering medication directly to your airways, they have a lower risk of side effects than are associated with oral corticosteroids. Inhaled corticosteroids include Floven), Pulmicort, Azmacort, Aerobid, Qvar. Side effects associated with inhaled corticosteroids can include hoarseness or loss of voice, oral yeast infections (thrush), and cough. Long-term use of inhaled corticosteroids may slightly increase the risk of skin thinning, bruising, osteoporosis, eye pressure and cataracts. In children, inhaled corticosteroids may slow growth.

Long-acting beta-2 agonists. A group of medications called bronchodilators, which open

up constricted airways.

Leukotriene modifiers. Reduce the production or block the action of leukotrienes

substances released by cells in your lungs during an asthma attack. Leukotrienes cause the lining of your airways to become inflamed, which in turn leads to wheezing, shortness of breath and mucus production. Leukotriene modifiers include Singulair and Accolate.

Cromolyn (Intal). Preventative inhaler.