Pulmonary Asthma, Symptoms and treatments: Patients with respiratory diseases generally come with abnormal symptoms or with any abnormal finding in their chest x-ray.
To get a clinical diagnosis of the disease or to reach its possible diagnosis, one should know all information and tests related to it, like physical examination, pulmonary function test, any additional imaging studies and bronchoscopic examination.
Today asthma is a very common disease. It is said that almost 2.5-5.0% of the people are affected by pulmonary Asthma in India.
It occurs in all ages but predominantly in early life. About one-half of cases develop before the age of 10, and another third occurs before the age of 40.
In childhood, there is a 2:1 male/female ratio which gets equalize by the age of 30.
What is asthma?
Asthma is the condition of Airway hyperreactivity (AHR). In this condition, the patient has the tendency for airways to contract very easily and respond it very quickly to the trigger factors that have little or almost no effects to the normal individual.
This trigger factor produces airways inflammation and narrowing under the influence of the neurogenic mechanism.
What can cause asthma?
Pulmonary Asthma is called to be a Heterogeneous disease. The major cause of pulmonary Asthma is allergens exposure.
Inhalation of this allergen exposure causes airways obstruction by producing inflammation and swelling of the air passage.
Allergen which produces airways obstructions are:-
- House dust mite, dust
- Animal Hairs
- Features or cotton of pillow and mattress
- Grass pollens
- Tree pollens
- Weed pollens
With this there are other factors which are responsible are as follows
- Infections– Viral infections like rhinitis
- Exercise– Violent exercise in few individuals may produce the asthmatic condition
- Drugs– Drugs like aspirin, beta-blockers, histamine, NSAID’s
- Various food and drinks
- Climates– Sudden change in the climate aggravates the asthmatic condition in an individual.
- Pollution and dusty environment
- Emotions (psychological asthma)– Emotional disturbances and upset became the trigger factor for asthma. This include-
- Fear of being alone
- Fear of appearing in the examination
- Unsuccessful or one-sided love
- Separation fear from their loved ones
- Fear of restriction
- Fear of financial loss
- Worries of family or business
- Obstruction in the nasal passage
- Dietary deficiency
Besides the above-mentioned condition hereditary factor plays an important role in pulmonary Asthma
Why airways constriction occurs?
This occurs when airways reactivity is high, symptoms are more severe and persistent and the amount of therapy required to control the patient’s complaints is greater.
Airways reactivity rises after the exposure to viral infection or any allergens which cause breathlessness in the patient which is a result of subacute inflammation of airways.
The airways become edematous and infiltrated with eosinophils, neutrophils, and lymphocytes, with or without an increase in the collagen content of the epithelial basement membrane.
It is believed that the physiologic and clinical features of pulmonary Asthma are derived from an interaction between the resident and infiltrating inflammatory cells in the airways surface epithelium, inflammatory mediators and cytokines.
The mediators released are histamine; bradykinin; the leukotrienes C, D, and E; platelet-activating factor; and prostaglandins (PGs)—produces an intense, immediate inflammatory reaction which involves bronchoconstriction, vascular congestion, and oedema formation.
This produces prolonged contraction of airways smooth muscle and mucosal oedema which is the pathophysiological features of pulmonary Asthma.
Signs and symptoms of asthma
For diagnosing pulmonary Asthma, the symptoms consist of a triad which is-
- Dyspnea (difficulty in breathing)
- A cough
In most of the typical form of asthma, all three symptoms co-exist.
- At the onset of asthma the patient complaints of constriction in the chest, often with a nonproductive cough.
- Respiration of the patient becomes audible harsh.
- Wheezing is present in both phase of respiration (inspiration and expiration) and is prominent.
- Expiration becomes more prolonged.
- Tachypnea, tachycardia, and mild systolic hypertension present in the patient.
- Patient lungs become overinflated, and the anteroposterior diameter of the chest increases.
- Breathing becomes shallow.
These are the physiological alterations which are present in the asthmatic patients, there may be other signs and symptoms of asthma may be present in other patients during the asthmatic attack.
Can Asthma responsible for death?
If the obstruction of the airways is very severe, in this extreme situation, wheezing may lessen markedly or even disappear, the cough may become extremely ineffective, and the patient may begin a gasping type of respiration.
This is produced due to extensive mucus plugging which results in impending suffocation.
For these patients ventilator assistance by the mechanical method is required otherwise patient death may occur.
How to diagnose asthma?
For diagnosing asthma various methods has been adopted which are as follows
- Blood examination:- These patients have increased eosinophil counts, which is more than 400. IgE levels are also elevated.
- Sputum examination:- Sputum examination reveals the severity of airways obstruction. In sputum examination, the eosinophil counts will show an increase in number.
- Airway hyperresponsiveness (AHR):- Increased AHR is a characteristic of bronchial asthma. It can be measured by a histamine challenge test.
- CT scan of the chest:- Usually it is not required until there is any other associated disease of the lungs is suspected.
- Trigger factor identification:- To know the trigger factor, a brief history with his/her occupation is to be taken.
- Skin prick test:- This can be done by injecting a small number of allergens in the skin. Wheal or flare will appear at the place of injected allergen. This test shows a positive result in asthmatic patients.
Along with these, there are other tests which are also used to diagnose asthma are
Management of Asthma
- By educating the patient to treat himself under the guidance of a doctor. To take medicines regularly and consult the doctor on time.
- Identify and reduce the exposure to the risk or trigger factors
- Manage exacerbation by providing bronchodilator to relieve bronchospasm and hypoxia.
- Special situations like allergic rhinitis, pregnancy and others require special attention.
- Asthma drugs are mostly given as an injection, tablet, syrup, or in aerosol form (in inhaler device).
- Nebulisers are advised to the patients to relieve bronchoconstriction.
- Bronchodilators like- beta-2-agonists, anticholinergics, theophyllines are used.
Asthmatic patients are very difficult to control with available conventional therapies in a few patients.
It is advised to get a proper medication once you are diagnosed with asthma, otherwise, the condition will get worsen which may lead to death.