ASTHMA

ASTHMA or HYPERACTIVE AIRWAY DISEASE
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells. In susceptible individuals, this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. The inflammation also causes an associated increase in the existing bronchial responsiveness to a variety of stimuli.
Factors predisposing asthmatic symptoms-
Allergic-pollens, animals, feathers, molds, food, household dust.
Non allergic-Inhaled irritants, dust, cigarette smoke, pollution, chemical.
Ambient environment-High humidity, cold air
Respiratory Infections-common cold, bacterial bronchitis
Drugs-aspirin
Emotions-stress, excitement
Exercise
During an asthma attack, the lumen of the airways is narrowed or occluded by a combination of bronchial smooth muscle spasm, inflammation of the mucosa and overproduction of viscous, tenacious mucus.
Clinical Features-
Patient has a rapid rate of breathing and uses the accessory muscles.
Expiratory phase of breathing is prolonged with audible wheezing.
Frequent unproductive cough
Feeling of tightness in the chest.
Lung volume and flow rates are reduced.
X-ray findings-Lungs may appear hyperinflated or show small atelectatic areas.
Arterial Blood Gas analysis-Partial pressure of oxygen decreases, partial pressure of carbon dioxide increases and pH,7.3 (if attack progresses)
Treatment –
Acute cases-Bronchodilators, Corticosteroids
-supplemental oxygen
-breathing control
-avoid bronchial irritants
-controlled unforced coughing manuovers in optimal body positions.
Reduce the overall oxygen demand including that associated with an increased work of breathing.
Reduce activity
Body positioning improving breathing efficiency
judicious sleep and rest periods
Restricted diet
adequate hydration
Maintainance of a thermal environment
Rest
Reduced arousal and environmental stimulation.
Sensitive indicators of ensuing compromise in oxygen transport-Bedside spirometry and Peak Expiratory Flow Rate (PEFR)
DURING EXERCISE-Focus on low intensity warm up and prolonged cool down.