BRONCHIAL

ASTHMA

MADE BY:
SONAKSHI CHAUHAN
ROLLNO. 81
BATCH: 2015-2016
 ACKNOWLEDGEMENT
I SONAKSHI CHAUHAN is thankful to my teachers
CERTIFICATE
 INTRODUCTION
Bronchial asthma, commonly referred to as asthma, is a chronic
respiratory disease characterised by the inflammation of the airways
of the lungs.It is characterised by hyper responsiveness of
tracheobronchial smooth muscles to a variety of stimuli, resulting in
narrowing of air tubes, often accompanied by increased secretion,
mucosal edema and mucus plugging. This makes it hard for the
person to breathe which eventually leads to an asthma attack. A
person suffering from asthma generally exhibits symptoms such as
breathlessness, coughing, chest tightness and wheezing.
According to the World Health Organization, there are around 15-20
million bronchial asthma patients in India. As of 2011, 235–330
million people worldwide are affected by asthma,and approximately
250,000–345,000 people die per year from the disease.Rates vary
between countries with prevalences between 1 and 18%. It is more
common in developed than developing countries. One thus sees
lower rates in Asia, Eastern Europe and Africa. Within developed
countries it is more common in those who are economically
disadvantaged while in contrast in developing countries it is more
common in the affluent. The reason for these differences is not well
known.Low and middle income countries make up more than 80% of
the mortality.
While asthma is twice as common in boys as girls, severe asthma
occurs at equal rates. In contrast adult women have a higher rate of
asthma than men and it is more common in the young than the old.
 CAUSES OF BRONCHIAL
ASTHMA
The exact cause of asthma is not fully understood. It is believe to be
caused by a combination of genetic (inherited) and environmental
factors. It may be related to modern living, including environmental
changes, diet or exposure to some infections.
It is known that most people with asthma constantly have some
degree of inflammation in their airways. Their airways are also
sensitive to certain irritants, known as triggers. Triggers can cause
tightening or constriction of the already inflamed airways, thus
provoking an asthma attack. Each individual tends to have different
asthma triggers. Common asthma triggers include:
 Pollens or moulds
 House dust mites
 Animals
 Air pollution
 Certain foods or food additives
 Strong perfumes
 Exercise
 Cigarette smoke
 Some medicines eg: aspirin, non-steroidal anti-inflammatory
drugs, beta blockers
 Respiratory infections such as colds and influenza
 Changes in temperature and humidity
 Psychological influences eg: extremes of emotion
 Workplace irritants eg: paint and varnish fumes, flour, wood
dust.
 SIGNS AND SYMPTOMS
With asthma the airways in the lungs are sensitive to certain
irritants. When exposed to these irritants the small airways in the
lungs (the bronchioles) become irritated and swollen and the
muscles surrounding the bronchiole walls constrict
(bronchoconstriction). Excess mucous is produced inside the airways
and it becomes difficult for air to travel to and from the lungs,
making breathing difficult and producing the cough, wheeze and
shortness of breath that are characteristic of asthma.
Asthma attacks are characterised by difficulty breathing – especially
exhaling. The severity of asthma symptoms varies between
individuals. Some experience only mild symptoms while others have
very severe symptoms. Attacks can happen suddenly and can occur
after periods of being relatively symptom free. A severe asthma
attack can be life threatening if treatment is not sought immediately.
Common signs and symptoms of asthma include:
 Coughing – which may worsen at night
 Wheezing
 Chest tightness
 Shortness of breath
 Difficulty speaking (in more severe attacks)
 Blueness around the mouth (in more severe attacks).
TYPES OF BRONCHIAL
ASTHMA
1. Occupational asthma
Known as work-related asthma, occupational asthma can be
characterised by airway obstruction and inflammation that stems
from exposure to irritants in the workplace. Common occupational
asthma causes or triggers include fumes, adhesives, grains, dust, gases
and so on.
A person may experience general symptoms such as coughing,
shortness of breath and chest tightness when exposed to such
irritants. Also, the symptoms usually tend to disappear outside the
workplace.
Occupations that are at a high risk of developing occupational asthma
are drug manufacturers, cigarette makers, bakers, cement workers
and so on. Treatment and management of occupational asthma
necessitates reduced exposure to irritants that trigger your
symptoms. Prevention of an occupational asthma attack requires
steps such as giving up smoking, avoiding chemical fumes and staying
away from allergens.

2. Allergic asthma
This is the most common type of asthma. Patients suffering from
allergic asthma exhibit typical symptoms when exposed to allergens
such as pet fur, dust, pollen, fragrances and so on. In case of allergic
asthma, the airways are highly sensitive and contract when exposed
to allergens. This leads to inflammation of airways which then get
clogged with mucus. Allergic asthma symptoms may include
wheezing, coughing and chest tightness amongst other asthmatic
symptoms.
Allergic asthma treatment is similar to the treatment for bronchial
asthma and includes using bronchodilators which can make breathing
easier. Also, your doctor can prescribe a medicine for allergic asthma
such as anti-inflammatory drugs to reduce swelling of the airways.
Further, the doctor may also recommend wearing a face mask while
going out, keeping your bedding and kitchen clean and getting rid of
mould.

3. Exercise induced asthma

Exercise induced asthma causes coughing, wheezing, fatigue and
shortness of breath amongst others. This is because, while performing
an exercise, a person usually inhales cool and dry air through his/her
mouth. The airways are highly sensitive to changes in temperature
and hence react by contracting. This can trigger typical symptoms like
the ones mentioned above.
It is important to observe the frequency and severity of symptoms in
order to establish an accurate diagnosis of exercise induced asthma.
Your doctor will enquire about your medical history, the
environmental conditions and specific details about the exercise.
Treatments include using bronchodilators prior to exercise to prevent
a flare up of symptoms. Your doctor may also recommend the best
inhaler for exercise induced asthma to inhale the prescribed
medication. Additionally, warming up before an exercise and relaxing
after can also help prevent symptoms.
 4. Cough variant asthma
It is usually characterised by coughing as the only symptom that
can last for more than 8 weeks. The cough is dry and non-
productive and people may or may not show any other asthma
symptoms such as shortness of breath and chest pain amongst
others. Coughing can be induced by exposure to triggers such
as dust and perfumes and may worsen with exercise. Diagnosis
becomes difficult since cough is the only symptom. The doctor
may ask you about your medical history and perform tests such
a Spirometry and chest x-rays. Once diagnosed, cough variant
asthma treatment in adults and children is treated in the same
way as bronchial asthma.

5. Nocturnal asthma
People suffering from nocturnal asthma or night-time asthma often
experience a worsening of symptoms during the night. Typical asthma
symptoms such as difficulty in breathing, cough and chest tightness
occur at night and make sleeping difficult. Nocturnal asthma causes
include contraction of airways during sleep, exposure to allergens,
sinus infection, Gastroesophageal reflux disease (GERD) and air
conditioning amongst others. A peak flow meter for diagnosis is
usedto measure the peak flows while or before sleeping and
awakening; a significant difference being indicative of nocturnal
asthma. Treatment is similar to treatment of bronchial asthma and
includes avoiding triggers to prevent the flare up of symptoms.
 DIAGNOSIS
If asthma is suspected, the following may be undertaken by a doctor
to assist with diagnosis:
 A full medical history including any family history of asthma
 Discussion of current symptoms
 Physical assessment
 A chest x-ray may be ordered
 Measurement of how quickly air can be exhaled using a peak
flow meter.
Asthma symptoms and signs vary through the day and through the
week. Peak flow meter tests twice daily for a week or before and
after using a reliever inhaler will show this variation. The peak flow
rate may vary by more than 20% in asthma sufferers.
Sometimes specialised challenge tests may be useful. These tests
use a chemical to try to provoke a brief episode of asthma which can
be measured. This can confirm a diagnosis and indicate severity.
Collection of phlegm or measurement of nitric oxide may be used to
follow the progress of more complex asthma.
Specialist referral should be considered if there is uncertainty about
the diagnosis, when the response to initial treatment is not what was
expected, or when an occupational cause of asthma is possible.
 TREATMENT
The right medications for you depend on a number of things — your
age, symptoms, asthma triggers and what works best to keep your
asthma under control.
Preventive, long-term control medications reduce the inflammation
in your airways that leads to symptoms. Quick-relief inhalers
(bronchodilators) quickly open swollen airways that are limiting
breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications, generally

taken daily, are the cornerstone of asthma treatment. These
medications keep asthma under control on a day-to-day basis and
make it less likely you'll have an asthma attack. Types of long-term
control medications include:

 Inhaled corticosteroids
These anti-inflammatory drugs include fluticasone (Flonase, Flovent
HFA), budesonide (Pulmicort Flexhaler, Rhinocort), flunisolide
(Aerospan HFA), ciclesonide (Alvesco, Omnaris, Zetonna),
beclomethasone (Qnasl, Qvar), mometasone (Asmanex) and
fluticasone furoate (Arnuity Ellipta).
You may need to use these medications for several days to weeks
before they reach their maximum benefit. Unlike oral
corticosteroids, these corticosteroid medications have a relatively
low risk of side effects and are generally safe for long-term use.

 Leukotriene modifiers
These oral medications — including montelukast (Singulair),
zafirlukast (Accolate) and zileuton (Zyflo) —
help relieve asthma symptoms for up to 24 hours.
In rare cases, these medications have been linked to psychological
reactions, such as agitation, aggression, hallucinations, depression
and suicidal thinking. Seek medical advice right away for any unusual
reaction.
 Long-acting beta agonists. These inhaled medications,
which include salmeterol (Serevent) and formoterol (Foradil,
Perforomist), open the airways.
Some research shows that they may increase the risk of a severe
asthma attack, so take them only in combination with an inhaled
corticosteroid. And because these drugs can mask asthma
deterioration, don't use them for an acute asthma attack.

 Combination inhalers
These medications — such as fluticasone-salmeterol (Advair Diskus),
budesonide-formoterol (Symbicort) and formoterol-mometasone
(Dulera) — contain a long-acting beta agonist along with a
corticosteroid. Because these combination inhalers contain long-
acting beta agonists, they may increase your risk of having a severe
asthma attack.
 Theophylline. Theophylline (Theo-24, Elixophyllin, others) is
a daily pill that helps keep the airways open (bronchodilator) by
relaxing the muscles around the airways. It's not used as often
now as in past years.

Quick-relief (rescue) medications are used as needed for

rapid, short-term symptom relief during an asthma attack — or
before exercise if your doctor recommends it. Types of quick-relief
medications include:
 Short-acting beta agonists. These inhaled, quick-relief
bronchodilators act within minutes to rapidly ease symptoms
during an asthma attack. They include albuterol (ProAir HFA,
Ventolin HFA, others) and levalbuterol (Xopenex).
Short-acting beta agonists can be taken using a portable, hand-held
inhaler or a nebulizer — a machine that converts asthma
medications to a fine mist — so that they can be inhaled through a
face mask or a mouthpiece.
 Ipratropium (Atrovent). Like other bronchodilators,
ipratropium acts quickly to immediately relax your airways,
making it easier to breathe. Ipratropium is mostly used for
emphysema and chronic bronchitis, but it's sometimes used to
treat asthma attacks.
 Oral and intravenous corticosteroids. These
medications — which include prednisone and
methylprednisolone — relieve airway inflammation caused by
severe asthma. They can cause serious side effects when used
long term, so they're used only on a short-term basis to treat
severe asthma symptoms.
If you have an asthma flare-up, a quick-relief inhaler can ease your
symptoms right away. But if your long-term control medications are
working properly, you shouldn't need to use your quick-relief inhaler
very often.

Keep a record of how many puffs you use each week. If you need to
use your quick-relief inhaler more often than your doctor
recommends, see your doctor. You probably need to adjust your
long-term control medication.
Allergy medications may help if your asthma is triggered or
worsened by allergies. These include:
 Allergy shots (immunotherapy). Over time, allergy shots
gradually reduce your immune system reaction to specific
allergens. You generally receive shots once a week for a few
months, then once a month for a period of three to five years.
 Omalizumab (Xolair). This medication, given as an
injection every two to four weeks, is specifically for people who
have allergies and severe asthma. It acts by altering the
immune system.

Bronchial thermoplasty
This treatment — which isn't widely available nor right for everyone
— is used for severe asthma that doesn't improve with inhaled
corticosteroids or other long-term asthma medications.
Generally, over the span of three outpatient visits, bronchial
thermoplasty heats the insides of the airways in the lungs with an
electrode, reducing the smooth muscle inside the airways. This limits
the ability of the airways to tighten, making breathing easier and
possibly reducing asthma attacks.