Asthma

Asthma

• 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