Asthma

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1- Introduction

2- Physiological  Overview

3- Symptoms

4- Treatment

Introduction

Asthma is defined as “a chronic disorder of the airways that involves a complex interaction of airway obstruction, bronchial hyperresponsiveness and an underlying inflammation. Many cells and cellular elements contribute to the inflammatory response including mast cells, eosinophils, neutrophils, T lymphocytes, macrophages, and damaged epithelial cells (especially in sudden onset, fatal exacerbations, occupational asthma, and individuals who smoke). In susceptible individuals, this inflammation causes recurrent episodes of coughing (particularly at night or early in the morning), wheezing, breathlessness, and chest tightness. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.
© image from radiopaedia.org

Physiological Overview

  • Airway Inflammation:

    • Immune Response: Asthma involves an immune response where the airways react to certain triggers, such as allergens (like pollen or dust mites), irritants (like smoke or strong odors), or infections.
    • Inflammatory Cells: The immune system triggers the release of inflammatory cells like eosinophils, mast cells, and T lymphocytes into the airway tissues.
    • Chemical Mediators: These cells release chemical mediators such as histamine, leukotrienes, and cytokines, which cause inflammation and airway constriction.

    Airway Hyperresponsiveness:

    • Smooth Muscle Constriction: The muscles surrounding the airways (smooth muscles) contract excessively in response to triggers, causing the airways to narrow (bronchoconstriction).
    • Mucus Production: Inflammation also stimulates the production of thick mucus in the airways, further obstructing airflow.

    Remodeling of Airways:

    • Structural Changes: Chronic inflammation can lead to structural changes in the airways over time, known as airway remodeling. This includes thickening of the airway walls, increased smooth muscle mass, and changes in blood vessels.

    Triggers and Symptoms:

    • Triggers: Asthma symptoms can be triggered by a variety of factors, including allergens, respiratory infections, exercise, cold air, stress, and irritants like smoke or strong odors.
    • Symptoms: Common symptoms include wheezing (a whistling sound when breathing), coughing (especially at night or early morning), shortness of breath, and chest tightness or pain.

    Diagnosis and Management:

    • Diagnosis: Asthma is typically diagnosed based on symptoms, medical history, lung function tests (spirometry), and sometimes allergy testing.
    • Management: Treatment usually involves medications to control inflammation and bronchoconstriction, such as inhaled corticosteroids, bronchodilators (like beta-agonists), leukotriene modifiers, and sometimes allergy medications. Lifestyle changes and avoiding triggers are also important.

    Importance of Asthma Control:

    • Long-term Management: Effective management aims to achieve and maintain asthma control, which means minimizing symptoms, preventing exacerbations (asthma attacks), maintaining normal activity levels, and reducing the need for quick-relief medications (like rescue inhalers).
© image from www.southeasternlungcare.com

Symptoms

Asthma symptoms can vary in severity and frequency from person to person. They typically include:

  1. Wheezing: A whistling sound when breathing, especially during exhaling.
  2. Coughing: Often worse at night or early in the morning, and can be persistent.
  3. Shortness of Breath: Difficulty breathing, which may feel like you can’t catch your breath.
  4. Chest Tightness: A feeling of pressure or tightness in the chest.
  5. Difficulty Speaking: Rapid breathing and inability to speak in full sentences due to breathlessness.
  6. Increased Respiratory Rate: Breathing faster than usual.
  7. Anxiety: Feeling anxious or panicked due to difficulty breathing.

Treatment

The treatment of asthma typically involves a combination of medications, lifestyle modifications, and management of triggers. The goals of asthma treatment are to achieve and maintain asthma control, prevent exacerbations (asthma attacks), and minimize symptoms. Here’s an overview of the main components of asthma treatment:

1. Medications

a. Controller Medications

  • Inhaled Corticosteroids (ICS): These are the most effective medications for long-term control of asthma. They reduce inflammation in the airways and prevent asthma symptoms.
  • Long-Acting Beta-Agonists (LABA): Often combined with ICS, LABAs help relax the smooth muscles of the airways, making breathing easier.
  • Leukotriene Modifiers: These medications block the action of leukotrienes, which are chemicals that contribute to inflammation in asthma.
  • Mast Cell Stabilizers: Help prevent the release of substances that cause inflammation in the airways.
  • Biologics: Target specific molecules involved in the immune response in severe asthma cases.

b. Reliever or Rescue Medications

  • Short-Acting Beta-Agonists (SABA): These are quick-relief medications that provide immediate relief during asthma symptoms or exacerbations by relaxing the airway muscles.

2. Lifestyle and Behavioral Adjustments

  • Identifying and Avoiding Triggers: Such as allergens (like pollen, dust mites), irritants (like smoke, strong odors), respiratory infections, and exercise-induced asthma triggers.
  • Developing an Asthma Action Plan: A personalized plan developed with a healthcare provider that outlines steps to take based on asthma symptoms and peak flow readings.

3. Monitoring and Management

  • Regular Monitoring: This includes tracking symptoms, peak flow measurements (to monitor lung function), and adjusting treatment as needed.
  • Education: Understanding asthma triggers, medications, and the importance of adherence to the treatment plan.

4. Emergency Treatment

  • Bronchodilators: Short-acting beta-agonists (SABA) are used as first-line treatment during acute asthma attacks to quickly relieve bronchospasm and improve airflow.

5. Severe Asthma Management

  • Biologic Therapies: Targeted therapies for severe asthma that doesn’t respond well to traditional medications.
  • Bronchial Thermoplasty: A procedure for severe asthma that involves applying controlled heat to the airways to reduce smooth muscle mass.

6. Supportive Therapies

  • Allergy Management: Immunotherapy (allergy shots) for allergic asthma.
  • Physical Activity: Encouraging regular physical activity while managing asthma triggers.
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