• Heterogeneous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyper-responsiveness
  • Affects about 18.8 million Americans
  • Women are 62% more likely to have asthma than men
  • Older adults may be undiagnosed

Risk factors and triggers

  • Related to patient (e.g., genetic factors)
  • Related to environment (e.g., pollen)
  • Male gender is a risk factor in children (but not adults)
  • Obesity is also a risk factor
  • Genetics-inherited component is complex
  • Immune response–hygiene hypothesis
  • Allergens: May be seasonal or year-round depending on exposure to allergen
    • Cockroaches, Furry animals, Fungi, Pollen, Molds

Trigger of Asthma attacks

  • Exercise
    • Exercise-induced asthma (EIA) or exercise-induced bronchospasm (EIB) is induced or exacerbated during physical exertion
      • Occurs after vigorous exercise
      • Pronounced with exposure to cold air
  • Air pollutants
    • Can trigger asthma attacks
      • Cigarette or wood smoke
      • Vehicle exhaust
      • Concentrated pollution
        • Aerosol sprays
        • Oxidants
        • Perfumes
        • Sulfur dioxides
  • Respiratory infections
    • Major precipitating factor of an acute asthma attack
      • Increase Inflammation and hyper-responsiveness of tracheobronchial system
        • Sinusitis, allergic rhinitis
        • Viral upper respiratory tract infection
  • Allergic rhinitis and nasal polyps
    • Large polyps need to be removed
    • Sinus problems are usually related to inflammation of the mucous membranes
        • Animal dander (e.g., cats, mice, guinea pigs)
        • Cockroaches
        • House dust mite
        • Molds
        • Pollens
  • Drugs and Food additives
    • Asthma triad: Nasal polyps, asthma, and sensitivity to aspirin and NSAIDs
      • Wheezing develops in about 2 hours.
      • Sensitivity to salicylates
        • Found in many foods, beverages, and flavorings
    • β-Adrenergic blockers
    • ACE inhibitors
    • Food allergies may cause asthma symptoms
      • Rare in adults
      • Oral food challenges
        • Beer, wine, dried fruit, shrimp,
        • processed potatoes
        • Monosodium glutamate
        • Sulfites (bisulfites and metabisulfites)
        • Tartrazine
  • Gastroesophageal reflux disease
    • GERD more common in persons with asthma
      • Reflux may trigger bronchoconstriction as well as cause aspiration
      • Asthma medications may worsen GERD symptoms
  • Emotional stress
    • Psychologic factors can worsen the disease process
      • Extreme emotional expressions
      • Attacks can trigger panic and anxiety


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