Asthma Overview and Triggers

Asthma

• Asthma is a condition where the tracheo-bronchial smooth muscles are hyper-responsive to various stimuli, leading to airway narrowing.
• The narrowing often comes with increased secretions and edema in the tracheo-bronchial tree.
• Asthma symptoms like dyspnea and wheezing are prevalent.
• There are two types of childhood asthma: recurrent wheezing mostly triggered by respiratory tract infections and chronic asthma linked to allergies, persisting into adulthood.
• Risk factors for persistent asthma include family history, allergy, atopic dermatitis, allergic rhinitis, and food allergy.
• Exposure to severe lower respiratory tract infections like pneumonia and environmental tobacco smoke can also be risk factors.

Asthma Triggers

• Common triggers include viral respiratory tract infections, aeroallergens like animal dander, dust mites, cockroaches, pollens, and air pollutants.
• Environmental tobacco smoke, sulfur dioxide, particulate matter, dust, and wood or coal burning smoke also contribute to asthma trigger.
• Exercise, crying, laughter, and hyperventilation are additional triggers.

Co-morbid Conditions

• Rhinitis, sinusitis, and gastroesophageal reflux are co-morbid conditions that can exist with asthma.

Clinical Features

• Intermittent dry coughing and expiratory wheezing are common features.
• Older children and adults may experience shortness of breath and chest tightness.
• Younger children might experience intermittent "chest pain."
• Night and early morning exacerbations of respiratory symptoms are frequent.
• Daytime symptoms often link with physical activities or play.

Diagnosis

• Peak expiratory flow monitoring devices are used to measure airflow.
• Chest radiographs often appear normal, but subtle hyperinflation (flattening of the diaphragms) and peribronchial thickening may be observed.

Four Components of Optimal Asthma Management

• Regular Assessment and Monitoring: Asthma checkups are crucial, every 2-4 weeks until control is achieved and 2-4 times per year to maintain good control. Lung function monitoring is essential.
• Control Factors Contributing to Asthma Severity: Problematic environmental exposures should be eliminated or reduced. Co-morbid conditions like rhinitis, sinusitis, and gastroesophageal reflux must be treated.
• Asthma Pharmacotherapy: Long-term control medications and quick-relief medications are used. Beta agonists, Ipratropium, and Inhaled Corticosteroids play a significant role. Step-up, step-down approaches are used to manage asthma.
• Patient Education: A two-part care plan is provided. Daily management strategies and action plans for asthma exacerbations are essential for patients.

Eliminating or Reducing Problematic Environmental Exposures

• Eliminating or reducing environmental tobacco smoke exposure is critical.
• Eliminating pets like cats, dogs, rodents, and birds can also be beneficial.
• Minimizing dust mites and dust is essential.

Treating Co-morbid Conditions

• Rhinitis, sinusitis, and gastroesophageal reflux require treatment.

Annual Influenza Vaccination

• Annual influenza vaccination is recommended for asthma patients.

Classification of Asthma Severity

• Asthma severity is classified based on the frequency of daytime and nighttime symptoms.
• Severe Persistent Asthma: Symptoms occur daily, with frequent nighttime symptoms, and FEV1 or PEF percentages fall below 60.
• Moderate Persistent Asthma: Symptoms occur daily, with nighttime symptoms more than once a week but less than twice a month. FEV1 or PEF percentages range from 60-80.