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Asthma

more about Asthma

  • Asthma is an allergic disease of the lungs.  Patients with asthma typically have minimal daily problems, but exposure to certain "triggers" can increase the effort required to breathe.  These episodes of increased breathing problems are called "exacerbations."
  • The lungs are made up of progressively smaller airway branches.  Bronchi (airway passages) branch into smaller-diameter passages, called bronchioles.  These in turn branch into even smaller bronchioles.  Oxygen from the air is transported to the blood through the small, thin terminal sacs (alveoli) at the end of the smallest final branches of the airways.
  • Waste products (carbon dioxide) from the blood are also transported outside the body via the alveoli. 
  • Asthma is the result of narrowing, inflammation or mucus plugging of the bronchioles and bronchi.
  • Small muscle bundles, surrounding the bronchioles, can constrict, further narrowing the bronchioles.  When deprived of circulating air, the alveoli can collapse (atelectasis), but this is secondary to the plugging of the bronchioles.
  • If enough airway passges are narrowed or plugged, the asthmatic feels short of breath and cannot move air in and out fast enough to meet the needs of the body. 
  • Many agents (see below) may trigger asthma.  The mechanism of how this specifically occurs is still not clearly understood.  Multiple factors are known to contribute.
  • Agents that treat/improve asthma usually affect a single factor that is interfering with the patency of the bronchioles.  For example:
    1. Beta agonists affect beta receptors on the bronchi and bronchioles, causing the air passages to open.
    2. Corticosteroids decrease inflammation around the air passages.
    3. Anti-leukotrienes prevent local hormones from causing inflammation.

  • Shortness of breath
  • Wheezing
  • Cough
  • Chest tightness
  • Heart racing
  • Rapid breathing
  • Sweating
  • Bluish skin color (cyanosis)
  • Retractions ("pulling in" of the tissues between the ribs with each breath)
  • Nasal flaring (extra-wide opening of the nose with inspiration)
  • Abdominal breathing (excessive movement of the abdomen with breathing)

  • Allergy induced (pollens, dust, mites, molds, cigarette smoke, etc.)
  • Exercise-induced
  • Bronchitis
  • Gastroesophageal reflux
  • Congestive heart failure (fluid backs up into lungs)
  • Stress
  • Cold air
  • Odors
  • Post-nasal drip
  • Sinus infections
  • Weather changes
  • Beta-blocker medications (e.g., Propranolol)
  • Aspirin
  • Nasal polyps & aspirin together
  • Nonsteroidal anti-inflammatories (e.g., Ibuprofen)
  • Aerolized Pentamadine
  • Other medications
  • Sulfites (additive to food and wine)
  • Children who develop Bronchiolitis are predisposed to later onset of asthma.

  • Examination may show:
    1. Wheezing in lungs
    2. Prolonged time to exhale air
    3. Poor air movement in lungs
    4. Flow meter shows decreased peak airway flow
  • Pulmonary function testing:
    1. Limited airflow especially on exhaling
    2. Worse airflow when given Methacholine
    3. Improved airflow with medications to open up alveoli
  • Laboratory findings (possible occurrences)
    1. Increased eosinophil count
    2. Abnormal arterial blood gas
  • Chest X-ray usually normal
  • Diagnosis of asthma is usually made when a child has at least two episodes with the above symptoms, which stop after treatment with Albuterol.
  • Specialized breathing studies can be done to confirm the diagnosis, but most children are unable to cooperate with the testing procedures.

  • There is no "cure" for asthma, although most children either outgrow the disease or find that the symptoms decrease as they get older.
  • Treatment takes several routes: avoidance of "triggers" that cause the disease to worsen from time to time, use of "rescue" medications when a child has acute respiratory problems, and use of "preventative" medications to control the disease and prevent exacerbations.
  • Although specialized ("HEPA") filters are popular, there is no evidence that their use improves symptoms in children with asthma.
  • Acute attack:
    1. Short-acting beta agonist inhalers, e.g., Albuterol (Proventil, Ventolin)
    2. Corticosteroids, e.g., Prednisone
    3. Anticholinergics, e.g., Atrovent
    4. Aminophylline
    5. Oxygen if necessary
    6. Terbutaline
    7. Epinephrine
    8. Isoproterenol (now rarely used)
  • Chronic (preventive) treatment:
    1. Corticosteroid inhalers (e.g., Flovent)
    2. Cromolyn sodium inhaler
    3. Nedocromil sodium (Tilade) inhaler
    4. Antileukotrienes, e.g., singular
    5. Serevent
    6. Theophylline

  • Prevention of exposure to triggers is key to the long-term control of asthma; the medications above are all helpful, but the best way to control asthma is to prevent the exacerbations in the first place.
  • All children have different triggers, but some common ones include
    1. Aspirin
    2. Dust mites, cockroaches, and other household pests
    3. Pet dander
    4. Viral infections
    5. Stuffed animals
    6. Down bedding products
  • Treatment of underlying causes such as infections, GE reflux, congestive heart failure, etc.
  • Sinus infections, allergies, and GE reflux commonly interfere with the treatment of asthma. Treat these in order to treat the asthma properly.

  • Chronic (preventive) asthma medications usually do not help during an asthma attack.  Do not use them for this!  Contact your physician or get immediate emergency medical care.
  • Asthma can lead to death.  Seek emergency medical help/advise quickly.

  • Pneumonia
  • Bronchiolititis
  • Chlamydia infection
  • Laryngotracheo bronchitis
  • Foreign body aspiration
  • Bronchiolitis obliterans
  • Gastoesophageal reflux




more about Asthma


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