Asthma

Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in
and out of your lungs. If you have asthma, the inside walls of your airways become sore and
swollen. That makes them very sensitive, and they may react strongly to things that you are
allergic to or find irritating. When your airways react, they get narrower and your lungs get less
air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in
the morning or at night.

When your asthma symptoms become worse than usual, it's called an asthma attack. In a severe
asthma attack, the airways can close so much that your vital organs do not get enough oxygen.
People can die from severe asthma attacks.

Asthma is treated with two kinds of medicines: quick-relief medicines to stop asthma symptoms
and long-term control medicines to prevent symptoms.

Signs and symptoms

Because of the spectrum of severity among asthma patients, some people with asthma only rarely
experience symptoms, usually in response to triggers, where as other more severe cases may
have marked airflow obstruction at all times. Common symptoms of asthma include wheezing,
shortness of breath, chest tightness and coughing. Symptoms are often worse at night or in the
early morning, or in response to exercise or cold air.

Asthma Attack

An acute exacerbation of asthma is commonly referred to as an asthma attack. The cardinal

symptoms of an attack are shortness of breath (dyspnea), wheezing, and chest tightness.
Although the former is often regarded as the primary symptom of asthma, some people present
primarily with coughing, and in the late stages of an attack, air motion may be so impaired that
no wheezing is heard. When present the cough may sometimes produce clear sputum. The onset
may be sudden, with a sense of constriction in the chest, as breathing becomes difficult and
wheezing occurs (primarily upon expiration, but sometimes in both respiratory phases). It is
important to note inspiratory stridor without expiratory wheeze however, as an upper airway
obstruction may manifest with symptoms similar to an acute exacerbation of asthma, with stridor
instead of wheezing, and will remain unresponsive to bronchodilators. Signs of an asthmatic
episode include wheezing, prolonged expiration, a rapid heart rate (tachycardia), and rhonchous
lung sounds (audible through a stethoscope). The affected patient may also appear pale. During a
serious asthma attack, the accessory muscles of respiration (sternocleidomastoid and scalene
muscles of the neck) may be used, shown as in-drawing of tissues between the ribs and above the
sternum and clavicles, and there may be the presence of a paradoxical pulse (a pulse that is
weaker during inhalation and stronger during exhalation), and over-inflation of the chest.
During very severe attacks, an asthma sufferer's face and fingernails can turn blue from lack of
oxygen, and can experience chest pain or even loss of consciousness. A patient's fingernails may
also turn purple due to a lack, or low amount of oxygen circulating through the bloodstream. Just
before loss of consciousness, there is a chance that the patient will feel numbness in the limbs
and palms may start to sweat. The person's feet may become cold. Severe asthma attacks which
are not responsive to standard treatments, called status asthmaticus, are life-threatening and
may lead to respiratory arrest and death.

Though symptoms may be very severe during an acute exacerbation, between attacks a patient
may show few or even no signs of the disease.

Cause

Asthma is caused by environmental and genetic factors, which can influence how severe asthma
is and how well it responds to medication. Some environmental and genetic factors have been
confirmed by further research, while others have not. Underlying both environmental and genetic
factors is the role of the upper airway in recognizing the perceived dangers and protecting the
more vulnerable lungs by shutting down the airway. Margie Profet has argued that allergens look
to our immune systems like significant threats. Asthma, in this view, is seen as an evolutionary
defense. This view also suggests that removing or reducing airborne pollutants should be
successful at reducing the problem.

Environmental

Many environmental risk factors have been associated with asthma development and morbidity
in children.

Environmental tobacco smoke, especially maternal cigarette smoking, is associated with high
risk of asthma prevalence and asthma morbidity, wheeze, and respiratory infections. Low air
quality, from traffic pollution or high ozone levels, has been repeatedly associated with increased
asthma morbidity and has a suggested association with asthma development that needs further
research.

Recent studies show a relationship between exposure to air pollutants (e.g. from traffic) and
childhood asthma. This research finds that both the occurrence of the disease and exacerbation of
childhood asthma are affected by outdoor air pollutants.

Viral respiratory infections are not only one of the leading triggers of an exacerbation but may
increase one's risk of developing asthma.

Psychological stress has long been suspected of being an asthma trigger, but only in recent
decades has convincing scientific evidence substantiated this hypothesis. Rather than stress
directly causing the asthma symptoms, it is thought that stress modulates the immune system to
increase the magnitude of the airway inflammatory response to allergens and irritants.
Antibiotic use early in life has been linked to development of asthma in several examples; it is
thought that antibiotics make one susceptible to development of asthma because they modify gut
flora, and thus the immune system

Risk factors

Studying the prevalence of asthma and related diseases such as eczema and hay fever have
yielded important clues about some key risk factors. The strongest risk factor for developing
asthma is a history of atopic disease; this increases one's risk of hay fever by up to 5x and the
risk of asthma by 3-4x. In children between the ages of 3-14, a positive skin test for allergies and
an increase in immunoglobulin E increases the chance of having asthma. In adults, the more
allergens one reacts positively to in a skin test, the higher the odds of having asthma.

Because much allergic asthma is associated with sensitivity to indoor allergens and because
Western styles of housing favor greater exposure to indoor allergens, much attention has focused
on increased exposure to these allergens in infancy and early childhood as a primary cause of the
rise in asthma. Primary prevention studies aimed at the aggressive reduction of airborne allergens
in a home with infants have shown mixed findings.

Treatment of Asthma Treatment

Asthma cannot be cured, but it can be controlled with proper asthma management.

The first step in asthma management is environmental control. Asthmatics cannot escape the
environment, but through some changes, they can control its impact on their health.

Listed below are some ways to change the environment in order to lessen the chance of an
asthma attack:

 Clean the house at least once a week and wear a mask while doing it
 Avoid pets with fur or feathers
 Wash the bedding (sheets, pillow cases, mattress pads) weekly in hot water
 Encase the mattress, pillows and box springs in dust-proof covers
 Replace bedding made of down, kapok or foam rubber with synthetic materials
 Consider replacing upholstered furniture with leather or vinyl
 Consider replacing carpeting with hardwood floors or tile
 Use the air conditioner
 Keep the humidity in the house low

The second step is to monitor lung function. Asthmatics use a peak flow meter to gauge their
lung function. Lung function decreases before symptoms of an asthma attack - usually about two
to three days prior. If the meter indicates the peak flow is down by 20 percent or more from your
usual best effort, an asthma attack is on its way.
The third step in managing asthma involves the use of medications. There are two major groups
of medications used in controlling asthma - anti-inflammatories (corticosteroids) and
bronchodilators.

Anti-inflammatories reduce the number of inflammatory cells in the airways and prevent blood
vessels from leaking fluid into the airway tissues. By reducing inflammation, they reduce the
spontaneous spasm of the airway muscle. Anti-inflammatories are used as a preventive measure
to lessen the risk of acute asthma attacks.

Three drugs, zafirlukast (Accolate), montelukast (Singulair) and zileuton (Zyflo), are part of a
newer class of anti-inflammatories called leukotriene modifiers. Taken orally, these drugs work
by inhibiting leukotrienes (fatty acids that mediate inflammation) from binding to smooth muscle
cells lining the airways. They also reduce the recruitment of inflammatory cells to the airways.
These drugs both prevent and reduce symptoms, and are intended for long-term use.

Other inhaled anti-inflammatory drugs include cromolyn sodium (Intal) and nedrocromil
(Tilade).

Bronchodilators work by increasing the diameter of the air passages and easing the flow of gases
to and from the lungs. They come in two basic forms - short-acting and long-acting. The short-
acting bronchodilators are metaproterenol (Alupent, Metaprel), ephedrine, terbutaline (Brethaire)
and albuterol (Proventil, Ventolin). These drugs are inhaled and are used to relieve symptoms
during acute asthma attacks. The long-acting bronchodilators are salmeterol (Serevent),
metaproterenol (Alupent), and theophylline (Aerolate, Bronkodyl, Slo-phyllin, and Theo-Dur to
name a few). Serevent and Alupent are inhaled and theophylline is taken orally. These drugs are
sometimes used to control symptoms in special circumstances, such as during sleep or when
intensive exposure to a particular irritant can be predicted (i.e. pollen season). Atrophine sulfate
(Atrovent) is another highly effective bronchodilator. This drug opens the airways by blocking
reflexes through nerves that control the bronchial muscles.

Some people cannot control the symptoms by avoiding the triggers or using medication. For
these people, immunotherapy (allergy shots) may help. Immunotherapy involves the injection of
allergen extracts to "desensitize" the person. The treatment begins with injections of a solution of
allergen given one to five times a week, with the strength gradually increasing.

Prevention of Asthma Treatment

Periodic assessments and ongoing monitoring of asthma are essential to determine if
therapy is adequate.

Patients need to understand how to use a peak flow meter and understand the symptoms and
signs of an asthma exacerbation.

Regular follow-up visits (at least every six months) are important to maintain asthma control and
to reassess medication requirements.

Patients with persistent asthma should be given an annual influenza vaccine.

ASTHMA

Submitted by:
Cerveza, Julie-Ann D
Elefante, Sheilla C.

Submitted to:
Ma’am Racquel D. Realin
Shift: MTW 3pm-11pm