ASTHMA: signs, types, trigger, diagnosis, therapy

Have you ever been running around with a friend, or eating, or probably in a scented environment, and suddenly your friend starts to gasp for breath, starts wheezing, eyes become red and may even lose consciousness??, Yeah your friend may most likely have asthma?

Well, Asthma is a pulmonary (lung-related) disorder. In this disorder, the airway is obstructed, but this airway obstruction is reversible. This obstruction is due to;

1. Inflammation of the walls of the airway
2. Increase in mucus production from the walls of the airway.
3. Hyper-responsiveness of the walls of the airway to a lot of stimuli such as exercise, cold, pets, pests.

SIGNS OF AN ASTHMATIC EPISODE

1. Rapid breathing: The patient’s breathing rate increases to get more air into the system, but this doesn’t work as the airway is blocked due to fluid accumulation and inflammation of the walls of the airway.
2. Prolonged expiration: It takes a very long time before the patient is able to breathe out, it also takes a longer time for the patient to breathe in.
3. Increased heart rate: There is hypoxia during an asthmatic episode. To get more oxygen to circulate the system, the force and rate of contractions increase so that more blood can circulate the system to transport more oxygen. This doesn’t work, because oxygen isn’t entering the system.
4. Breathlessness: Due to blockage of the airway, every attempt to breathe is hindered
5. Chest tightness: Muscles of the chest works with the lungs, so it contracts with the lungs to pump more air out. This leads to chest tightness and chest pain.
6. Unconsciousness: Due to hypoxia and general weakness, the patient may collapse.

Usually, before the asthmatic episode starts, there’s usually exposure to a trigger. The trigger also known as stimuli cause a Cascade of events. First, when this trigger lands on the surface of the lungs, the body senses it as an intruder, the white blood cells which are like the army of the body, sends some of its differentials to attack the intruder: in this case, the trigger. White blood cell differentials such as lymphocytes and monocytes move to where the trigger has landed, these white blood cells differentials then causes an increase in fluid (mucus) production with the aim of flushing out the trigger. This mucus then blocks the airway reducing the amount of air being released. To alter this to chest muscles becomes tighter (which is very painful) and the lungs begin to pump more air out, but the airway has already been blocked due to the inflamed muscles of the airway and the mucus.

TYPES OF TRIGGERS

1. Cold air, hot air
2. Exercise
3. Emotional trauma, stress.
4. Pets, pests,(cockroaches).
5. Medical conditions such as pregnancy, brain trauma, lung disorders, respiratory tract infections
6. Drugs such as Non Steroidal anti-inflammatory drugs e.g Aspirin,beta-blockers eg propanolol etc.

DIAGNOSIS

1. Usually, medication history and family history should be taken. For medication history, some drugs such as Beta-blockers can cause bronchoconstrictions which is similar to that seen in Asthma. The presence of Asthma in the family up to the grandchildren or grandparents should be taken note of, cause it means that the family has a gene that precipitates asthma attack.
2. Usually, asthma is suspected if the patient suffers from eczema or other allergic conditions.
3. For adults, a peak flow meter is used. The peak flow meter measures lung function and breathing rates.

DIFFERENTIAL DIAGNOSIS

1. COPD: COPD Means chronic pulmonary obstructive disorder, has almost the same signs and symptoms as asthma, but it isn’t. COPD is usually seen in chronic smokers, older people, and isn’t reversible ( it progresses with time).
2. The patient should be assessed on the drugs he/she is taking eg Some anti-inflammatory drugs or beta-blockers. These drugs induced bronchoconstrictions similar to Asthma. In this case, the drugs should be stopped.

DRUG THERAPY IN ASTHMA

The following drugs are useful for asthma therapy;

1. Short-acting beta-agonists eg Salbutamol, terbutaline
2. Inhaled corticosteroids (ICS)
3. Systemic, oral or intravenous steroids e.g Prednisone, prednisolone, methylprednisolone.
4. OXYGEN to alleviate hypoxia.
5. Anticholinergics such as glycopyrrolate, atropine.
6. Methylxanthines eg theophylline, aminophylline.
7. Inhalation anaesthetics eg Isoflurane, enflurane, ketamine.
8. Magnesium sulphates etc.

GOALS OF THERAPY

1. Regulating of lung function to near best lung function.
2. Good exercise performance without asthmatic interruption.
3. Reduced need for anti-asthmatics.
4. Reduced/no emergency visits to the hospital.
5. Provision of pharmacotherapy without/minimal side effects.
6. Preventing loss of consciousness/death.
7. Treating the patient to meet the expectation of the patient, parents, caregivers.

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