Group- 11

 Asthma is a chronic disease involving the

airways in the lungs. These airways, or
bronchial tubes, allow air to come in and out
of the lungs.
 it is a predisposition to chronic inflammation
of the lungs in which the airways(bronchi) are
reversibly narrowed.
 Term Asthma Comes From Greek Aazein
 Hippocrates (~400 BC) was the first to use
the term “Asthma” (Greek for “wind” or “to
blow”) for panting and respiratory distress.
 He is considered to be the physician who
identified the relationship between the
environment and respiratory disease
correlating climate and location with
illness.
Asthma medicines of the 1940’s and 1950’s
consisted of epinephrine injections (adrenaline)
and aminophylline tablets or suppositories. In
the 1960’s oral combinations were the staples of
chronic therapy. Inhalation of epinephrine
(Primatene) and isoproterenol (Isuprel) were used
as rescue agents. Oral prednisone was and
continues to be prescribed for severe disease.
 The number of people with asthma continues
to grow. One in 12 people (about 25 million,
or 8% of the U.S. population) have asthma.
 In children-About 1 in 10 (10%) have asthma
 In adults- 1 in 12 adults (8%) have asthma.
 Women were more likely than men and boys
more likely than girls to have asthma.2
 Asthma is characterized by inflammation of
the bronchial tubes with increased production
of sticky secretions inside the tubes. People
with asthma experience symptoms when the
airways tighten, inflame, or fill with mucus.
Common asthma symptoms include:
 Coughing, especially at night
 Wheezing
 Shortness of breath
 Chest tightness, pain, or pressure
 not every person with asthma has the same
symptoms in the same way. You may not have all
of these symptoms, or you may have different
symptoms at different times. It may vary from
mild to severe.
 some might have asthma symptoms every day. In
addition, some people may only have asthma
during exercise, or asthma with viral
infections like colds.
 Mild asthma attacks are generally more common.
Usually, the airways open up within a few
minutes to a few hours. Severe attacks are less
common but last longer and require immediate
medical help. It is important to recognize and
treat even mild asthma symptoms to help you
prevent severe episodes and keep asthma under
better control
 Although the cause of asthma is unknown, a
number of things that can increase chances
of developing the condition have been
identified. These include:
 a family history of asthma or other related
allergic conditions (known as atopic
conditions) such as eczema, food
allergy or hay fever
 respiratory tract infections – particularly
infections affecting the upper airways, such
as colds and the flu
 allergens – including pollen, dust mites,
animal fur or feathers
 airborne irritants – including cigarette smoke,
chemical fumes and atmospheric pollution
 medicines – particularly the class of
painkillers called non-steroidal anti-
inflammatory drugs (NSAIDs), which
includes aspirin and ibuprofen, and beta-
blockers sometimes given for high blood
pressure or some types of heart disease
 emotions – including stress or laughing
 indoor conditions – including mould or damp,
house dust mites and chemicals in carpets
and flooring materials
 exercise
 food allergies – including allergies to nuts or
other food items
 foods containing sulphites – naturally occurring
substances found in some food and drinks, such
as concentrated fruit juice, jam, prawns and
many processed or pre-cooked meals
 weather conditions – including a sudden change
in temperature, cold air, windy days,
thunderstorms, poor air quality and hot, humid
days
 During normal
breathing, the airways
to the lungs are fully
open, allowing air to
move in and out freely.
But people with
asthma have inflamed,
super-sensitive
airways.
 During an asthma
episode,
inflamed airways react
to environmental
triggers such as
smoke, dust, or
pollen.
 In response to exposure
to these triggers,
the smooth muscles to
contract. (bronchospasm)
 The lining of the airways
swell and become more
inflamed, leading to a
further narrowing of the
airways and
excessive mucus producti
on, which leads to
coughing and other
breathing difficulties.
 Reduction in airway diameter.
 Increase in airway resistance.
 Hyperinflation of the lungs and the thorax.
 Increased work of breathing
◦ i.e. Forced vital capacity ≤ 50% of the normal.
◦ Forced expiratory volume(FEV1) averages to 30% or
less.
◦ In acutely ill patients residual volume(RV) = 400% of
normal.
 1. Child-Onset Asthma
 Asthma that begins during childhood is called
child-onset asthma. This type of asthma
happens because a child becomes sensitized
to common allergens in the environment -
most likely due to genetic reasons. The child
is atopic - a genetically determined state of
hypersensitivity to environmental allergens.
 The airway cells are sensitive to particular
materials making an asthmatic response
more likely if the child is exposed to a certain
amount of an allergen.
2. Adult-Onset Asthma
 This term is used when a person develops
asthma after reaching 20 years of age. Adult-
onset asthma affects women more than men,
and it is also much less common than child-
onset asthma.
 It can also be triggered by some allergic
material or an allergy. It is estimated that up
to perhaps 50% of adult-onset asthmas are
linked to allergies.
 Non allergic adult onset asthma
 A substantial proportion of adult-onset
asthma does not seem to be triggered by
exposure to allergen(s); this is called non-
allergic adult-onset asthma.
 This non-allergic type of adult onset asthma
is also known as intrinsic asthma. Exposure
to a particle or chemical in certain plastics,
metals, medications, or wood dust can also
be a cause of adult-onset asthma.
3. Exercise-Induced Asthma
 Shortness of breath and coughing occurring after an
exhausting exercise is termed exercise-induced
asthma.
 Exercise-induced asthma involves symptoms that
usually occur about 5-20 minutes after beginning an
exercise that involves breathing through the mouth.
 Sport activities that require continuous strenuous
activity or that are played in cold weather are very
dangerous and the most likely to trigger an asthma
attack.

Precautions include using a bronchodilator inhaler

just prior to the sports activity and deep nasal
breathing until the body feels warmed up.
5. Occupational Asthma
 Occupational asthma occurs due to a trigger
in the place of work.
 Common triggers include
◦ pollutants in the air, such as smoke, chemicals,
fumes, dust, or other particles;
◦ respiratory diseases, such as colds and flu;
◦ allergens in the air, such as molds, animal hair, bird
feathers, and pollen;
◦ extremes of temperature or humidity.
Most of the trigger substances are very commonly
found, and are not normally hazardous.
4. Cough variant asthma –
Coughing can occur alone, without the other
symptoms of asthma that are usually
present. Cough variant asthma causes great
difficulty for the doctor to accurately
diagnose the true underlying cause of
asthma because it can be easily confused
with other conditions, such as bronchitis or
hay fever or sinusitis. Coughing can occur
anytime - day or night.
6. Nocturnal Asthma
 Nocturnal asthma occurs between midnight.
 It is triggered by allergens in the home such as
dust and pet dander or is caused by sinus
conditions.
 The patient may have wheezing or short breath
when lying down and may not notice these
symptoms until awoken by them in the middle of
the night - usually between 2 and 4 AM.
 A useful treatment in this case is to take a
steroid inhaler before going to bed. This reduces
the tendency of the airways to narrow.
7. Medication induced asthma
 Aspirin and other non-steroidal anti-
inflammatory drugs (also known as NSAIDs)
can worsen asthma or even be fatal.
 With this type of sensitivity you need to stay
away from drugs like ibuprofen, naproxen
and diclofenac as they may trigger asthma
attacks if you have asthma.
8. Glucocorticoids Resistant Asthma
 While the glucocorticoids are one of the most
potent anti-inflammatory drugs available and
are normally very effective in the treatment of
asthma, a small group of patients do not
respond to these medications and are often
labeled as 'steroid resistant.'
 The most certain way to diagnose asthma is a
medical and family history, physical exam and
test results.
 The best initial test : peak expiratory flow rate
(PEFR).
 Chest X ray is most often normal in asthma, but
may show hyperinflation.
 Chest X ray can be used to:
 exclude pneumonia
 exclude other diseases such as pneumothorax or
chronic hypersensitivity pneumonitis (CHP) in
cases that are not clear.
▶Most accurate: pulmonary function testing (PFTs).
 Peak expiratory flow rate (PEFR) is the maximum
flow rate generated during a forceful exhalation,
starting from full lung inflation.
 Peak flow rate primarily reflects large airway flow
and depends on the voluntary effort and
muscular strength of the patient.
 A small hand-held device known as a peak flow
meter is used.
 The degree of airway obstruction can aid in the
diagnosis of asthma.
 Low test values may be caused by a less than
maximal effort rather than by airway obstruction.
 Is a pulmonary function test; one of the most
accurate in the diagnosis of asthma.

 Assesses the integrated mechanical function of

the lung, chest wall, and respiratory muscles by
measuring the total volume of air exhaled from a
full lung (total lung capacity [TLC]) to maximal
expiration (residual volume).

 Involves taking a deep breath and exhaling as

fast as possible through a mouthpiece attached
to a machine called a spirometer.
 The spirometer takes two measurements:

1. the volume of air you can breathe out in

the first second of exhalation (the forced
expiratory volume in one second, or FEV1) and,

2. the total amount of air you breathe out (the

forced vital capacity or FVC).

 Reduction in the amount of air exhaled

forcefully in the first second of the forced
exhalation (FEV1) may reflect reduction in the
maximum inflation of the lungs (TLC),
obstruction of the airways, or respiratory
muscle weakness.
 The readings are then compared with average
measurements for people your age, sex and
height, which can show if your airways are
obstructed.

 Response of FEV1 to inhaled bronchodilators is

used to assess the reversibility of airway
obstruction.

 This is known as reversibility testing, and it can

be useful in distinguishing asthma from other
lung conditions such as chronic obstructive
pulmonary disease (COPD).
 This test is sometimes used to diagnose asthma
when the diagnosis is not clear from the more
simple tests discussed above.

 Patient will be asked to breathe in a medication

that deliberately irritates or constricts the airways
slightly.

 If the patient has asthma, a small decrease in FEV1

measured using spirometry is observed along with
mild asthma symptoms.

 Airways will not respond to this stimulus if the

patient does not have asthma.
 It may also be useful in some cases to carry out
tests to check for inflammation in the airways.

 Done in two main ways:

• Mucus sample: sample of mucus (phlegm) is

tested for signs of inflammation in the airways

• Nitric oxide concentration – as the patient

breathes out, the level of nitric oxide in the
breath is measured using a special machine; a
high level of nitric oxide can be a sign of airway
inflammation
 Done to find out which allergens affect the
patient.

 Skin testing or a blood test can be used to

confirm whether your asthma is associated with
specific allergies, such as dust mites, pollen or
foods.

 Tests can also be carried out to see if you are

allergic or sensitive to certain substances known
to cause occupational asthma.
 Most children who have asthma develop their
first symptoms before 5 years of age.

 Asthma in young children (aged 0 to 5 years) can

be hard to diagnose.

 Symptoms of asthma also occur with other

childhood conditions.

 A young child who has frequent wheezing with

colds or respiratory infections is more likely to
have asthma if:
• One or both parents have asthma
• Child has signs of allergies
• Child has allergic reactions to pollens or other
airborne allergens
• Child wheezes even when he or she doesn't have
a cold or other infection

 It's hard to do lung function tests in children

younger than 5 years.

 Doctors must rely on children's medical

histories, signs and symptoms, and physical
exams to make a diagnosis.
 Medications
 The right medications depend on a number
of things, including age, symptoms, asthma
triggers and what seems to work best to keep
asthma under control.
 Preventive, long-term control medications
reduce the inflammation in airways that leads
to symptoms. Quick-relief inhalers
(bronchodilators) quickly open swollen
airways that are limiting breathing. In some
cases, allergy medications are necessary.
Long-term asthma control
medications, generally taken daily, are the
cornerstone of asthma treatment. These
medications keep asthma under control on a
day-to-day basis and make it less likely you'll
have an asthma attack. Types of long-term
control medications include:
1. Inhaled corticosteroids. These anti-
inflammatory drugs include fluticasone
(Flovent HFA), budesonide (Pulmicort
Flexhaler), flunisolide (Aerobid), ciclesonide
(Alvesco), beclomethasone (Qvar) and
mometasone (Asmanex).
2. Leukotriene modifiers. These oral medications —
including montelukast (Singulair), zafirlukast (Accolate)
and zileuton (Zyflo) — help relieve asthma symptoms for
up to 24 hours. In rare cases, these medications have been
linked to psychological reactions, such as agitation,
aggression, hallucinations, depression and suicidal
thinking. Seek medical advice right away for any unusual
reaction.

3. Long-acting beta agonists. These inhaled medications,

which include salmeterol (Serevent) and formoterol
(Foradil, Perforomist), open the airways. Some research
shows that they may increase the risk of a severe asthma
attack, so take them only in combination with an inhaled
corticosteroid. And because these drugs can mask asthma
deterioration, don't use them for an acute asthma attack.
4. Combination inhalers. These medications —
such as fluticasone-salmeterol (Advair
Diskus), budesonide-formoterol (Symbicort)
and mometasone-formoterol (Dulera) —
contain a long-acting beta agonist along with
a corticosteroid. Because these combination
inhalers contain long-acting beta agonists,
they may increase your risk of having a
severe asthma attack.
5. Theophylline. Theophylline (Theo-24,
Elixophyllin, others) is a daily pill that helps
keep the airways open (bronchodilator) by
relaxing the muscles around the airways. It's
not used as often now as in past years.
 Quick-relief (rescue) medications are used as
needed for rapid, short-term symptom relief
during an asthma attack — or before exercise if
your doctor recommends it. Types of quick-relief
medications include:
1. Short-acting beta agonists. These inhaled,
quick-relief bronchodilators act within minutes
to rapidly ease symptoms during an asthma
attack. They include albuterol (ProAir HFA,
Ventolin HFA, others), levalbuterol (Xopenex) and
pirbuterol (Maxair). Short-acting beta agonists
can be taken using a portable, hand-held inhaler
or a nebulizer — a machine that converts asthma
medications to a fine mist — so that they can be
inhaled through a face mask or a mouthpiece.
2. Ipratropium (Atrovent). Like other
bronchodilators, ipratropium acts quickly to
immediately relax your airways, making it easier
to breathe. Ipratropium is mostly used for
emphysema and chronic bronchitis, but it's
sometimes used to treat asthma attacks.
3. Oral and intravenous corticosteroids. These
medications — which include prednisone and
methylprednisolone — relieve airway
inflammation caused by severe asthma. They can
cause serious side effects when used long term,
so they're used only on a short-term basis to
treat severe asthma
 Allergy medications may help if your asthma is
triggered or worsened by allergies. These include:
1. Allergy shots (immunotherapy). Over time, allergy
shots gradually reduce immune system reaction to
specific allergens. People generally receive shots
once a week for a few months, then once a month
for a period of three to five years.
2. Omalizumab (Xolair). This medication, given as an
injection every two to four weeks, is specifically for
people who have allergies and severe asthma. It
acts by altering the immune system.
3. Allergy medications. These include oral and nasal
spray antihistamines and decongestants as well as
corticosteroid and cromolyn nasal sprays.
There is no exact prevention for your asthma
however you can work with you doctor to
keep your asthma under control and to
avoid asthma attack

 Follow your asthma action plan. With your

doctor and health care team a detailed plan
for taking medications and managing an
asthma attack should be made and followed
 Get vaccinated for influenza and
pneumonia. Staying current with
vaccinations can prevent flu and pneumonia
from triggering asthma flare-ups.
 Identify and avoid asthma triggers.
 Monitor your breathing. You may
learn to recognize warning signs of
an impending attack, such as slight
coughing, wheezing or shortness of
breath. Do breathing exercise.
 Identify and treat attacks early. If you
act quickly, you're less likely to have
a severe attack.
 Take your medication as
prescribed. Just because your asthma
seems to be improving, don't change
anything without first talking to your
doctor.
 http://www.nhs.uk/Conditions/Asthma/Page
s/Causes.aspx
 http://www.medicalnewstoday.com/info/asth
ma/
 http://www.mayoclinic.org/diseases-
conditions/asthma/basics/prevention/con-
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