Asthma - Is A Recurrent, Reversible Condition of The Lungs in Which There Is Airway

Asthma is a recurrent, reversible condition of the lungs in which there is airway
obstruction due to spam of the bronchial smooth muscle, edema of the mucosa, and increase
mucus secretions in the bronchi and bronchioles that has been brought on by various stimuli
Bronchial Asthma is a condition which manifest itself clinically by intermittent episodes
of wheezing and dyspnoea: it is generally associated with a hyper-responsive state of the
bronchi which may be antigen mediated (allergic).
Pathophysiology:
1. Automatic nerves are stimulated by irritants; thus trigger mucous secretion and
capillary dilatation.
a. There appears to defect in the sympathetic nerves (beta advantage end plates) in the
bronchi.
b. When exposed to stimulants to which they are particularly hypertensive, these
nerves fall to induce smooth muscle relaxation but instead cause contraction; they
fall to decrease mucous secretion and produce edema of bronchial mucosa.
2. Antigen antibody reaction
a. Susceptible individuals form abnormally large amounts of IgE when exposed to
certain allergens.
b. This immunoglobulin (IgE) fixes itself to the mast cells of the bronchial mucosa
c. When the individual is exposed to certain allergens the resulting antigen combines
with the cell bound IgE molecules, causing the mast cell to degranulate and release
chemical mediators.
d. These chemical mediators, primarily histamines and slow reacting substance of
anaphylaxis (SRSA) are known to produce bronchospasm.
3. Other factors can precipitate an asthmatic attack.
.aRespiratory tract infection.
.b Intolerance to certain drugs such as aspirin and indomethacin
.cCold and sudden barometric changes
.d Exercise
.eEmotional upset
.f Air pollutants industrial chemicals
Classifications
A. Extrinsic Bronchial asthma
1. Cause
a. Hypersensitivity reaction to inhalant allergen
b. Mediated by IgT
2. Diagnostic evaluation
a. Correlation with expose to aeroallergens
b. Positive skin test
3. Major inhalant allergens
a. Haze dust, mold spores, pollen, feathers, animal, danders
4. Diagnosis
Favourable, with avoidance of often drug allergens; good response to
bronchia dilators and specific therapy.
B. Intrinsic Bronchial Asthma

1. Causes
a. Worthily definite
b. Infection open present
c. Skin test of common inhalant antigens and foods are usually negative(non
IgE mediated)
C. Mixed asthma immediate type appears to complain allergenic reaction and infection
D. Aspirin induced asthma
(A type of intrinsic asthma induced by ingestion of aspirin and related compounds)
1. Clinical manifestations spread over a period of time have been described as a
triad
a. Bronchial asthma
b. Nasal polyposis
c. Severe reactions to aspirins.
2. Consent of symptoms after aspirins ingestion (20 minutes to two hours)
a. Watery rhinorrhea, followed by marked flushing op upper part of body
b. Nausea and vomiting
c. Wheezing, dyspnoea and cyanosis
Altered Physiology
1. The turbinate warm and moisten all air which passes into the lungs.
2. Inspired air contains particulate matter which is removed by the blanket of
mucous present in the trachiobronchial tree. This mucous is kept moisten by
inspired moist air.
3. The blanket of mucous is moved constantly upward by the propelling action of
the cilia and if mucous becomes thickened or implicated it cannot be moved.
4. An increased local deposition and concentration of allergens occurs.
5. This produces intrabronchial accumulation and stagnation of mucous which is the
primary cause of the respiratory embarrassment.
6. Chemical mediators is asthma
a. Primary involved are histamine and SRSA. SRSA appears after histamine
release and persist for a longer period. It is not inhibited by the action of the
antihistamines.
b. These materials are primarily responsible for changes in the blood vessels and
mucous membrane in the bronchi and bronchioles, as well as for the initiation
of brochospasm.
7. During as asthma attack, abnormal constriction of muscle surrounding the
bronchioles (Spasms) results in narrowed bronchiolar lungs and decreased oxygen
supply in alveoli.
a. In addition, edema, inflammation, and increased mucous production further
compromise respirations.
b. Hyper resonance and decreased breath sounds may be observed.
Drugs
1.
2.
3.
4.
5.
Ammophylline bronchodilator
a. Toxin reaction may occur, both is more likely to happen with prolonged over
dose or when given in conjunction with epinephrine or ephiphrine without
reducing aminophylline dosage.
a1. Serum drug level should be done
a2. Toxic reactions includes: fever, restlessness, nausea, and vomiting,
hypertension, abdominal distension
b. Side effects irritability, excitability, contemned dehydration, vomiting,
hematemesis, protein urea, stupor, convulsions coma, death. Hypotension
occurs with IV use. Avoid ingestion of stimulants
c. Occasionally cyanosis and syncope may appear after only a small amount of
the prescribed dose. This is considered an idiosyncrasy and the drug should be
discontinued
a.
Epinephrine relaxes bronchial smooth muscle and constricts bronchial mucosal
vessels, thereby reducing congestions and edema; act as broncho dilator.
a. The smallest dose offering relief should be used
b. Side effect insomnia, headache, nervousness, palpitations pericardial pain,
hypertension, hypoxemia, tachycardia, nausea, sweating, urinary retention. (it
may potentate aminophylline toxicity)
Ephedrine relaxes bronchial smooth muscle and constricts bronchial mucosal
vessels, thereby reducing congestion and edema. Acts as a bronchodilator.
a. Has the advantage of prolonged action and oral administration
b. Side effects same as for epinephrine
c. Do not allow child to drink coke, tea, or coffee. As they may increase
nervousness
Pseudo ephedrine
a. Has prolonged action and can be administered orally
b. Side effects Veletively free
Isoproterenol bronchia dilator
a. Toxin reaction headache, flushing, dizziness, tumours, nausea and vomiting
b. Side effects nervousness, palpitations, pink saliva or sputum if orally
administered
c. Do not use concurrently with epinephrine
Expectorants given as an adjunct to hydration; thins secretions and helps the

child to cough productively (saturated solution of potassium iodine, robitussin)
7. Aerosolized bronchodilators (bronleasol)
8. Copticosteriods anti inflammatory agents; diminish the inflammatory
components of asthma thus reducing airway obstruction.
a. Produced beneficial effect only after severe hours
b. Used what other drugs fail to bring beneficial relief from on asthmatic attack.
c. Side effects use for mild attack may lead to suppression of ademal cavity.
Prolonged use may lead to growth retardation and steroid dependency
6.
Cromolyn sodium prophylaxis adjunct to existing treatment, especially for

steroids dependent child. It inhibits the release of histamine and the SRSA. It
has prophylactic nation; it should not be used in acute attack.
10. During transition from IV to oral bronchodilators, respirations should be
monitored carefully and frequently.
9.

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Asthma is a recurrent, reversible condition of the lungs in which there is airway

B. Intrinsic Bronchial Asthma

Expectorants given as an adjunct to hydration; thins secretions and helps the

Cromolyn sodium prophylaxis adjunct to existing treatment, especially for

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