Bronchial Asthma 

Asthma is a chronic inflammatory disease of the airways that causes airway hyper-responsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea 

Causes :

Possible causes are: 

• dust - dust mites   -  roaches -  pets 

• certain types of cloth  -  horses - detergents, and soaps 

• Certain foods - molds and pollens. 

• pollens can be strongly suspected (If the attacks are seasonal) 

• Genetic predisposition - Smoking and Environmental Tobacco 

• Exercise and hyperventilation - Cold air 

The most common symptoms of asthma are: 

• Cough, with or without mucus production. 

• Mucus is so tightly wedged in the narrowed airway that the patient cannot cough it up. 

• Generalized wheezing (the sound of airflow through narrowed airways), 

• Generalized chest tightness and dyspnea occur. 

• Prolonged expiration with effort. 

• Diaphoresis 

• Tachycardia, and a widened pulse pressure 

• Hypoxemia and central cyanosis (a late sign of poor oxygenation). 

• Allergic reactions (eczema, rashes, and temporary edema). 

• Patient becomes more fatigued, the PaCO2 may rise. 

Complications: 

Complications of asthma may include: 

• status asthmaticus 

• respiratory failure 

• pneumonia and atelectasis 

• Airway obstruction, particularly during acute asthmatic episodes  

 Treatment

NB :

    Immediate intervention is necessary because the continuing and progressive dyspnea leads to  increased anxiety, aggravating the situation

*Goals of Asthma Treatment 

• Prevent chronic and troublesome symptoms 

• Maintain near-normal pulmonary function 

• Maintain normal activity levels 

• Prevent recurrent exacerbations of asthma 

• Provide optimal pharmacotherapy with minimal or no adverse effects 

Pharmacological therapy :

                     1/   Long-Acting Control Medications

1/ Corticosteroids (most potent and effective anti-inflammatory) 

• They are broadly effective in alleviating symptoms, improving airway function. 
• Initially, the inhaled form is used (using A spacer) 
• The patient should rinse the mouth after administration to prevent thrush, a common complication of inhaled corticosteroid use. 

2/ Long-acting beta2-adrenergic agonists 

• Used with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night. 
• Effective for preventing exercise-induced asthma. 
• Not indicated for immediate relief of symptoms

3/ Methylxanthines (theophylline) 

• Mild to moderate bronchodilators usually used in addition to inhaled corticosteroids Mainly for relief of nighttime asthma symptoms. 
• Theophylline may have a mild anti-inflammatory effect 

4/ Leukotriene modifiers (inhibitors) or anti-leukotrienes 

• Potent broncho-constrictors (dilate blood vessels and alter permeability). 
• provide an alternative to inhaled corticosteroids may be added to a regimen of inhaled corticosteroids in more severe asthma 

                         2/    Quick-Relief Medications

1/ Short-acting beta-adrenergic agonists 

• Relieving acute symptoms 
• Preventing exercise-induced asthma. 
• Have a rapid onset of action. 

2/ Anticholinergics 

• bring added benefit in severe exacerbations 
• Used more frequently in COPD patients.