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Asthma is a disease affecting the lungs. Because of asthma the lung tissues become inflamed and narrowed, and this influences the breathing process of the patient. They feel chest tightness, shortness of breath, wheezing and coughing at night or at early morning. Usually the symptoms of chronic asthma are being observed from childhood, but the disease can affect all age groups and reveal itself in adulthood as well. Asthma is a long-term disease.
In most of the cases the inflamed airways react to a specific allergen coming from the environment such as pollen, dust or smoke. In order to protect the breathing functions the lungs start to overproduce the mucus which makes breathing difficult. In this way, the body manifests an immune response to the environmental irritant (de Boer, 2012). Figure 1 shows the main symptoms, ways of diagnostics, epidemiology, and treatment for asthma.
Asthma is determined by various renewable symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezing, coughing, compression in the chest and shortness of breath. It is believed that the cause of asthma is a combination of two factors - genetic and environment (Custovich, 2012). Diagnosing the disease usually is based on clinical presentation, response to treatment over time, and spirometry. Clinically, the disease is determined by the frequency of recurrence of symptoms by about ' in volume per second forced expiratory volume (FEV1) and at peak expiratory flow rate. In addition, asthma is still atopic (external) and nonatopic (internal), which speaks of atopic predisposition to developing hypersensitivity reactions.
In the treatment of acute symptoms usually use inhaled quick action beta agonist (such as salbutamol) and oral corticosteroids. In severe cases may require corticosteroids, intravenous magnesium sulfate and hospitalization. The symptoms can be prevented avoidance of allergens and irritants and inhalation corticosteroids. Beta-agonists long-acting (TDBA) or the antagonists of leukotrienes can be used in addition to inhaled corticosteroids if asthma symptoms can not take control.
It is possible to consider the hyperreactivity of the bronchi when asthma is associated with the state of the airways when they constrict too easily and / or too much in response to the triggering factors, which are clinically the most characteristic physiological abnormalities in this disease. The mechanisms responsible for the increased reactivity or "hyperresponsiveness" may be related to altered behavior of airway unstriated muscle. In addition, inflammatory changes in the wall, particularly in peribronchial areas can significantly increase while reducing the constriction of unstriated muscle.
In patients with asthma not only the amount of secretion in the bronchi is increased; secret generated also differs in viscosity, elasticity and the rheological properties. Abnormal increase in viscosity and the "rigidity" of the secret is not simply due to increased mucus production, but also due to accumulation of epithelial cells, albumin, basic proteins, isolated from eosinophils, and inflammatory cell DNA. In the sputum of these changes are manifested in the form of mucous clots.
Because Asthma is accompanied by chronic inflammation and irritation of the bronchial tree receptors airways become sensitive to different kinds of provoking factors. During an asthma attack the muscles surrounding the bronchi, are reduced, leading to a marked narrowing of the airway.
With the progression of asthma, inflammation in the airways is increasing and leading to swelling of bronchial walls, and further narrowing of the bronchial tree. In addition, the gland located in the walls of the bronchi secretes mucus, which is accumulated in the narrowed airways, disrupting the air permeability. These events lead to a disruption of breathing, especially on exhalation, which often becomes a "whistling". This is what asthma exacerbation refers to (Lichtenstein, 2013). Figure 2 shows the main causes, symptoms and treatments of asthma exacerbation.
Figure 1. Main peculiarities of asthma.
The duration of the attack may vary depending on provoking factors. Light episodes may occur only several minutes, in more severe the attack time can be from several hours to several days. Mild attacks of the disease resolve spontaneously or may require the drug therapy. The duration of severe attacks can be shortened through the use of bronchodilators and anti-inflammatory drugs.
Figure 2. Main peculiarities of asthma exacerbation.
The diagnosis of asthma is revealed through specific pulmonary function tests (spirometry): the patient needs to breathe out air into a special instrument. A mandatory study is also the measurement of peak expiratory flow rate. This is necessary for gaining the objective control over asthma and determining the required dosage of medication.
With the help of X-ray and computed tomography lungs can reveal the presence of infections and other respiratory tract lesions, chronic circulatory failure or getting a foreign body in the respiratory tract.
The patient should also undergo a research by the allergist using skin tests with a variety of allergens. This study is necessary to determine what may cause an attack.
References
Custovic, A.; Simpson, A. (2012). "The role of inhalant allergens in allergic airways disease". Journal of investigational allergology & clinical immunology: official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunologia 22 (6): 393–401.
de Boer, J.D., Majoor, C.J., van 't Veer, C., Bel, E.H., and T. van der Poll (2012). "Asthma and coagulation". Blood 119 (14): 3236–44.
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
Lichtenstein, R. (2013). Pediatric emergencies. Philadelphia, Pa.: Elsevier. p. 1022.
Sbihi, H.. Tamburic, L., Koehoorn, M., Brauer, M. (2016). "Perinatal air pollution exposure and development of asthma from birth to age 10 years". European Respiratory Journal.
