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
- 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:
- Beta agonists affect beta receptors on the bronchi and
bronchioles, causing the air passages to open.
- Corticosteroids decrease inflammation around the air
- Anti-leukotrienes prevent local hormones from causing
- Shortness of breath
- Chest tightness
- Heart racing
- Rapid breathing
- 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.)
- Gastroesophageal reflux
- Congestive heart failure (fluid backs up into lungs)
- Cold air
- Post-nasal drip
- Sinus infections
- Weather changes
- Beta-blocker medications (e.g., Propranolol)
- 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.
- Wheezing in lungs
- Prolonged time to exhale air
- Poor air movement in lungs
- Flow meter shows decreased peak airway flow
- Pulmonary function testing:
- Limited airflow especially on exhaling
- Worse airflow when given Methacholine
- Improved airflow with medications to open up alveoli
- Laboratory findings (possible occurrences)
- Increased eosinophil count
- 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:
- Short-acting beta agonist inhalers, e.g., Albuterol (Proventil, Ventolin)
- Corticosteroids, e.g., Prednisone
- Anticholinergics, e.g., Atrovent
- Oxygen if necessary
- Isoproterenol (now rarely used)
- Chronic (preventive) treatment:
- Corticosteroid inhalers (e.g., Flovent)
- Cromolyn sodium inhaler
- Nedocromil sodium (Tilade) inhaler
- Antileukotrienes, e.g., singular
- 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
- Dust mites, cockroaches, and other household pests
- Pet dander
- Viral infections
- Stuffed animals
- 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
- Asthma can lead to death. Seek emergency medical
- Chlamydia infection
- Laryngotracheo bronchitis
- Foreign body aspiration
- Bronchiolitis obliterans
- Gastoesophageal reflux
under which this service is provided to you. Read our
Copyright © 2002 - 2003 eCureMe, Inc All right reserved.