Definition

a chronic inflammatory disease of airways that is

characterized by increased responsiveness of the
tracheobronchial tree to a multiplicity of stimuli.
Typically, most attacks are short-lived, lasting minutes
to hours, and clinically the patient seems to recover
completely after an attack
Etiology
Asthma is a very common disease with immense social
impact.
asthma that has its onset in early life tends to have a
strong allergic component, whereas asthma that
develops late tends to be nonallergic or to have a
mixed etiology.
Risk factor
Airway hyper responsiveness
Familial history of asthma
Pathophysiology
A reduction in airway diameter brought about by contraction of
smooth muscle, vascular congestion, edema of the bronchial
wall, and thick, tenacious secretions.
The net result is
An increase in airway resistance
A decrease in forced expiratory volumes and flow rates
Hyperinflation of the lungs and thorax
Increased work of breathing
Alterations in respiratory muscle function
Changes in elastic recoil
Abnormal distribution of both ventilation and pulmonary
blood flow with mismatched ratios
Altered arterial blood gas concentrations.
Clinical Manifestation
Episodic wheezing, cough and dyspnea
Onset:
Patient experience a sense of constriction in the
chest
Non productive cough
Harsh, audible respiration (wheezing)
Prolonged expiration
Tachypnea, tachycardia and systolic hypertension
Barrel chest (increase AP diameter)
 Prolonged:
Loss of adventitious breath sound
High-pitch wheezing
Accessory muscle becomes visibly active
Paradoxical pulse develops
 End of episodes:
Cough w/ thick, stingy mucus charcot-leyden
crystal
Wheezing is less extreme
Gasping type of respiration impending
suffocation
Timing acute/sudden episodes; may occur during
the night (nocturnal asthma)
Diagnosis
Reversible airway obstruction.
Reversibility is traditionally defined as a 15% increase
in FEV1 after two puffs of a -adrenergic agonist.
Sputum and blood eosinophilia and measurement of
serum IgE levels
Difference of asthma from other diseases with dyspnea
and wheezing
Physical findings and symptoms
History of periodic attacks
Personal and family history of allergic diseases
Nocturnal awakening with dyspnea and/or wheezing
Most common and so prevalent that absence of which
produces doubt about diagnosis
 Timing:
Acute episodes, separated by symptom free periods. Nocturnal
episodes common
Aggravating factors:
Variable, including allergens, irritants, respiratory infections,
exercise and emotions
Relieving factors:
Separation from aggravating factors
Symptoms:
Wheezing, cough, tightness in chest
Setting:
Environmental and emotional conditions