Bronchial Asthma - S6 Medical Course

Study Notes

Bronchial asthma is a chronic inflammatory lung disease with significant respiratory symptoms, activity limitations, and potential for life-threatening flare-ups.
Characterized by three primary airway issues: obstruction, inflammation, and hyperresponsiveness.

Asthma implies difficulty in breathing; main symptoms include dyspnea, cough, and wheezing.
Risk factors include:
- Activity: Exercise-induced asthma.
- Diet: Allergens in eggs, fish, and milk.
- Drugs: Reactions to aspirin and penicillin.
- Family history: Correlation with urticaria and hay fever.
- Inhalants: Tobacco smoke, dust, pollen, and molds.
- Infections: Sources like tonsillitis and bronchitis.
- Hormonal influences: Variations during pregnancy, menstruation, and menopause.

Genetic predisposition; the risk increases significantly if one or both parents have asthma.
Atopic conditions are essential in asthma development, with environmental allergens provoking IgE antibody overproduction.
Obesity and stress also contribute to the exacerbation of asthma symptoms.

Atopic Asthma: Most common variant, linked to allergies and high levels of IgE.
Allergic Bronchopulmonary Mycosis (ABPM): Hypersensitivity to molds, especially Aspergillus fumigatus.
Aspirin-sensitive Asthma (ASA): Onset typically in adulthood; severe reactions after NSAID use.

Triggers lead to inflammatory cell activation (mast cells, eosinophils, etc.) releasing mediators like histamine, causing bronchoconstriction and airway hyperresponsiveness.
Clinical signs include:
- General signs: Tachypnea, tachycardia, prolonged expiration.
- Local signs: Hyperinflation, use of accessory muscles, wheezing, diminished breath sounds.

Chest X-ray, sputum analysis, blood tests, allergy tests, ECG, pulmonary function tests (PFT), bronchial provocation tests, and exercise testing.

Severe complications can include status asthmaticus, COPD development, respiratory failure, cor pulmonale, pneumothorax, and allergic aspergillosis.

A progressive, severe asthma attack persisting for more than 6 hours, requiring immediate intervention.
Symptoms include tachypnea, cyanosis, and potential vascular collapse.

Therapeutic: Inhaled bronchodilators (short and long-acting), anti-inflammatory drugs (corticosteroids, leukotriene inhibitors), and antihistamines.
Long-term management: Avoidance of triggers and adherence to inhaler therapy.

Indications for ICU transfer include PaCO2 > 40 mmHg or PEF < 25% of baseline.
ICU treatment involves frequent nebulization of B2 agonists, intravenous hydration, and potential intubation if necessary.