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Asthma

 
  By : , NJ, USA       22.3.2010         Phone:-          Fax:-          Mail Now
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Asthma is one of the most scary medical conditions which can affect both adults and children. Symptoms of asthma vary widely from person to person and are sometimes even different within the same person.



Asthma is a disease of the airways- bronchi and bronchioles. It is characterized of constriction of the smooth muscles of the airways, by inflammation and excessive secretion of mucus. This causes narrowing of the air passages, increasing the effort of breathing and reducing the amount of oxygen available. 

Causes

There is a genetic component to asthma where children of asthmatics are more prone to develop asthma. It can be triggered by :
- viral infection of respiratory tract
- inhaled irritants like tobacco, smoke, pollutants, and fumes
- vigorous exercise or stress
- allergies to pollen, mold, and pets
- exposure to cold air
Asthma attacks can be very severe which can lead to decreased oxygen in the blood requiring external ventilation. Death caused by asthma is not uncommon.

Symptoms

Symptoms vary from person to person. They include dry cough, shortness of breath, chest tightness, and audible wheezing. In severe cases, there can be increased heart rate, sweating, extreme anxiety and inability to speak without gasping for air. 

Emergency symptoms include bluish color of the face and lips, extremely labored respiration, mental confusion, and exhaustion. These symptoms require immediate medical attention. 

Diagnosis

History: 

Questions include: 
-what activities cause onset of symptoms, 
-if there are any exposure to irritants, cold air, exercise
-any recent illnesses or exposure to any sick contacts
-what, if any, home medications have been used thus far

Examination:
-Physical exam by medical personnel

Diagnostic tests include:
-Chest x-ray
-Pulmonary function tests
-incentive spirometry
-skin test for allergens

 

Classification of Asthma

 

Daytime Symptoms

Nighttime Symptoms

PFTs

Intermittent < 2x/ week < 2x/ month > 80%
Mild persistent > 2x/ week > 2x/ month > 80%
Moderate persistent Daily  > 5x/ month 60- 80 %
Severe persistent Continuous Frequent < 60 %

Treatment:

Bronchodilators are medications that relax the smooth muscles of the bronchi, helping air move in and out. They can be short acting, lasting 4-6 hrs, and long-acting, which last up to 12 hrs. They can be given as inhalers, such as salmeterol, albuterol, and ipratropium. 

Mast cell stabilizers: Mast cells can release histamine which can cause bronchoconstriction. This can be prevented by mast cell stabilizers. 

Corticosteroids: This group of drugs decrease inflammation and mucus production. They can be inhaled, oral or intravenously. Inhaled steroids may need to be used daily, depending on the severity of symptoms. Side effects include oral thrush, sore throat, and hoarseness. Oral steroids may be given in severe attacks. High dose side effects include weight gain, osteoporosis, cataracts, and glaucoma. 

Leukotriene modifiers: Leukotrienes are substances released by the body in response to an allergic response. Leukotriene modiferes block this reaction. They are prescribed in asthma and in nasal allergy. 

Exercise Induced asthma- Ways to prevent these attacks include using bronchodilators half an hour prior to exercise and having a person do warm up and cool down activies for 15 minutes prior to vigorous exercise and avoid exercising in cold weather. 

Prevention:

- avoid cigarette smoke, wood burning stoves and fire places
- decrease dust in your living space by eliminating carpets, rugs, and pets
- do not use strong toxic chemicals for cleaning. 
- Replace feather pillows with hypoallergenic pillows
- Prevent cockroach infestations
- Limit the time spent outside when pollen counts are high
- Avoid cold weather exposure
- Remember to get your flu shot!

When to see a doctor:

If the frequency of the attacks increase significantly, or maintenance medication is being used more than 6x/day, you should contact your health care provider.








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