Asthma is an inflammatory condition characterized by reversible or at least partially chronic narrowing of the bronchi of the lungs. The bronchi are muscular tubes that carry air into the lungs. The bronchi take air from the smaller airways, the bronchioles , and carry it back to them. With asthma , the walls of the bronchi are inflamed and swollen. In this case, the airway narrows and makes breathing difficult, causing wheezing, shortness of breath or coughing. AcuteAsthma attacks or attacks worsen this condition by constricting the bronchial muscles and secreting excessive amounts of mucus. The diameter of the bronchi may become narrow enough to allow only a small amount of air to move in or out. This causes the affected person to cough and wheeze, feel a pressure in their chest, and struggle to breathe. Although the cause is not clear, asthma attacks can occur at any time, but they are especially frequent at night and in the morning. Severe asthma attacks can be life-threatening and often require emergency medical care.
Asthma is one of the most common chronic diseases in children. Before puberty, asthma affects more boys than girls. After adolescence, it mostly affects girls. Asthma is more common in urban areas than rural areas. Currently, although asthma is not a preventable or fully curable disease, it is a manageable disease and most asthmatics can lead active and fairly normal lives.
According to the severity and frequency of disease symptoms, asthma is divided into four categories. These categories are mildly intermittent, mildly persistent (persistent), moderately persistent, and severely persistent. Those with intermittent mild asthma only show occasional asthma symptoms. Other times they have no complaints. Severe persistent asthmatics may need to take medication many times a day to control their condition.
Although the exact cause of asthma is not known, different factors interact in a complex way. The triggering factors for asthma attacks will be different for everyone. Many, if not all, people with asthma are allergic to certain substances. In these people, asthma attacks can be triggered by allergens to which they are sensitive. The bronchi are overreacting to airborne pollen, dust mites, pet dander, particulates and fumes, and allergens such as cockroaches in the home, workplace and environment. Stress, strong emotional responses (laughing, crying, and getting angry), exercise, and exposure to cold weather can also cause asthma attacks. some beta-blockersand drugs such as aspirin, sulfites in wine and nuts, and infections can cause seizures in some people.
Other lung diseases and conditions may have symptoms similar to those of asthma, accompany and/or exacerbate asthma. Stomach-oesophageal reflux disease, also called acid reflux, can trigger or worsen asthma attacks in some people.
NHLBI (National Heart, Lung, and Blood Institute) NAEPP (National Asthma Education and Prevention Program) program was launched in August 2007, “3. Expert Panel Report: published the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. These updated guidelines are intended to help guide the diagnosis and follow-up of asthma patients. These guidelines focus on the assessment and follow-up of asthma, education of patients and encouraging their participation in the treatment of their disease, control of environmental factors that can trigger or aggravate asthma attacks, and the use of medications. The patient’s discomfort, the risks of exposure to the side effects of drugs,
The goals of initial testing are to diagnose asthma and assess its severity. Tests can be used to distinguish asthma from other diseases with similar symptoms and to identify the presence of allergens that have the potential to trigger or aggravate asthma attacks. The goals of ongoing testing consist of monitoring lung function and control of asthma, assessing and relieving asthma attacks, and addressing complications and emerging side effects.
Lung Function Tests and Imaging Studies
are the main tests used to diagnose, evaluate and monitor asthma.
Diagnosis of asthma Recommendations of the NAEPP guidelines for diagnosing asthma:
● A detailed medical history and physical examination focused on the chest and respiratory tract
- Application of spirometry to patients 5 years of age and older to demonstrate reversible or partially reversible airway obstruction by inhalation of short-acting bronchodilator bronchodilators . This test measures the flow rate and amount of exhaled air into a pipe. It is applied to evaluate narrowed or obstructed airways.
- Additional testing is done as needed to help rule out other diagnoses. These tests may include exercise, cold air, use of substances such as methacholine or histamine that stimulate bronchial constriction, other lung function tests, and/or a lung x-ray.
Asthma assessment and follow-up
- Spirometry – requested to assess lung function.
- Determination of the maximal exhaled airflow rate (PEF) – Measures the ability and speed of exhaling air from the lungs. This test uses a small device called a Peak Flow Ratemeter and can be administered by the patient for home monitoring of lung function.
- Pulse oximetry- A non-invasive test used for continuous monitoring of O2 saturation. It can be used in an emergency room or hospital to assess oxygenation status.
- chest x-ray
- Nitric oxide test in exhaled air – The FDA has approved a breath test that measures nitric oxide in exhaled air. Although very small amounts of nitric oxide are normally present in exhaled air, its levels are elevated when the airways are inflamed, as in asthmatic patients. Levels may rise or fall depending on the effectiveness of anti-inflammatory treatment. Although this test can be useful in guiding the management of asthma patients, it is neither recommended nor widely used by NAEPP guidelines.
Laboratory Tests Laboratory tests
are used to help exclude other clinical conditions that cause asthma-like symptoms, to identify the patient’s allergies, to detect and evaluate emerging complications. During severe asthma attacks, tests may be ordered to evaluate and monitor organ function, oxygen levels, and the body’s acid-base balance .
- Blood allergy testing: – specific blood tests for allergens suspected to cause symptoms, such as dust mites, mold, pet dander and pollen. It may be ordered to help identify asthma triggering factors.
- Blood gases – a blood sample is taken from an artery to assess blood pH, oxygen, and carbon dioxide. Blood gases may be requested while the patient is having an asthma attack.
- Complete blood count – evaluates blood cells
- KMP (Comprehensive Metabolic Panel) – assesses organ function
- Theophylline – monitoring of treatment medication (if patient is taking medication)
Other tests that may be ordered occasionally:
- Cystic fibrosis tests – ordered to rule out cystic fibrosis
- Sputum culture – requested to diagnose lung infections caused by bacteria .
- ARB smear preparation and culture – used to detect tuberculosis and non-tuberculous mycobacteria (NTM) .
- Lung biopsy – ordered to evaluate lung tissue for lung damage and cancer.
- Sputum cytology – occasionally requested to evaluate cells detected in the lungs. In some asthma patients, two types of white blood cells, eosinophils and neutrophils , may increase in inflammatory conditions.
Goals of asthma treatment:
- Preventing or minimizing the number of asthma attacks
- Relieve asthma attacks, reduce the number of emergency room admissions and hospitalizations
- Maintaining good asthma control
- Minimizing lung damage and slowing the progression of lung damage
- Whenever possible, identify, treat, and manage asthma exacerbations, asthma-related complications, or medication side effects.
- Educating patients and ensuring their participation in their treatment.
- Promoting a normal and active life
Preventing asthma attacks involves a combination of avoiding the substances that trigger the attacks, maintaining good asthma control, and recognizing and passing the early signs of an upcoming attack.
Since asthma treatment is tailored to the patient, the treatment depends on the severity of the asthma in the patient. Both long-term and short-term controls should be considered. Those who experience mild, intermittent asthma attacks may also experience occasional severe Acute asthma attacks.
Patients should be educated, in collaboration with their doctors, about their child’s illness and follow-up, and the medications that will best treat their asthma over time. A treatment plan should be developed that keeps their asthma under control day by day, guides their behavior when an asthma attack occurs, and helps them know when to seek medical help. Doctors will determine the best course of treatment, taking into account all the drugs that patients are taking, along with the entire clinical picture.
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