Definition:
Classification
Extrinsic (atopic)
Allergens (common inhaled allergens, e.g. dust mite, pollen and fungi)
identified by skin-prick reactions.
In adults sensitisation to chemicals or biological products may be the
cause.
Intrinsic
Usually starts in middle age; no definite external cause identifiable.
Many patients show degree of atopy and gives history consistent with
childhood asthma.
Aetiology:
1. Atopy
Develop IgE antibodies against common environmental antigens.
Serum IgE affected by environmental and genetic factors.
Growing up in relatively clean environment may predispose towards IgE
response to allergens.
2. Hyperresponsiveness of the airways
to stimuli such as inhaled histamine and methacholine (bronchial
provocation tests used to diagnose bronchial hyperreactivity).
Pathophysiology:
Primary abnormality airway narrowing:
Bronchial muscle contraction airway hyperresponsiveness to variety
of stimuli.
Mucosal swelling/inflammation mast cells and basophil degranulation
resulting in the release of inflammatory mediators.
Increased mucus production within airway lumen.
Inflammation
Increased mast cells, eosinophils, T lymphocytes and dendritic cells in
bronchial walls, mucous membranes and secretions.
Medication
Most drugs directly into lungs lower doses used and reduced
systemic side-effects compared to oral treatment.
Managed with stepwise approach depends on repeated PEFR
measurements.
o Starts with most appropriate to initial severity. When controlled,
treatment gradually reduced to previous step over period of 1 3
months.
B agonists
o relax smooth muscle; bronchodilation.
Antimuscarinic
o bronchodilation and may be additive to adrenoceptor stimulants.
Corticosteroids
o Inhaled used as maintenance in all but very mild patients. If not
controlled, oral.
Prognosis:
Mild-to-moderate can improve over time, many adults become
symptom free.
Severe may experience improvement depending on degree of
obstruction in the lungs and effectiveness of treatment.
10% of severe persistent cases changes in airway wall structure,
leading to progressive and irreversible problems in lung function.