Asthma can be divided into four types:
A. Mild intermittent: Symptoms less than or equal to two per week; asymptomatic with usual peak expiratory flow rate (PEFR) between attacks; nighttime symptoms less than or equal to two per month; PEFR greater than 80% expected with less than 20% variability
B. Step 2—Mild Persistent: More than two symptoms a week but less than one per day; exacerbations may interfere with activity; nighttime symptoms more than twice a month; PEFR of greater than or equal to 80% is expected, with a 20% to 30% range of variability.
Step 3: Be Moderately Persistent: Daily symptoms necessitate the use of a beta 2 agonist; attacks impair activity; exacerbations more than or equal to two per week; nighttime symptoms more than one a week; PEFRs between 60% and 80% with greater than 30% variability
D. Step 4—Severe Persistent: Continuous symptoms with little physical activity; recurrent exacerbations; frequent nighttime symptoms; PEFR less than or equal to 60% with greater than 30% variability is expected.
Incidence.
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| Asthma Causes,Signs,Symptoms,Diagnosis How to Treat Asthma |
The rate of occurrence
A. Asthma affects 25 million Americans and 300 million people worldwide.
B. Asthma is the most common respiratory condition in children, affecting 15% of those under the age of 18.
C. Up to 95% of asthma patients also have chronic rhinitis.
D. Other co-morbid disorders, such as gastroesophageal reflux disease (GERD) and obesity, are often associated with asthma.
E. While asthma can strike at any age, it is most commonly diagnosed before the age of five.
Parthenogenesis
Asthma is caused by a complex series of processes that begin with airway inflammation caused by physical, chemical, and pharmacological agents (such as allergens, furry animals, cockroaches, dust mites, pollen and mould, cold air, viral respiratory infections, and exercise).Airway hyper responsiveness, broncho constriction, airway wall edoema, chronic mucus plug formation, and chronic airway remodelling are all symptoms of this condition.
Predisposing Factors
A. In children
1. Allergy or family history of allergy
2. Atopy
3. Ethnicity (Puerto Rican descent, non-Hispanic Black)
4. Gender: Male during childhood
B. In adults
1. Family history
2. Coexisting sinusitis, nasal polyps, and sensitivity to aspirin or other
nonsteroidal anti-inflammatory drugs (NSAIDs)
3. Exposure in workplace to wood dust, metals, and animal products
4. Premenstrual asthma (PMA)
5. Gender: Female in adulthood
6. Ethnicity: Non-Hispanic Black for persistent asthma
7. Occupational exposures
8. Comorbidities in older adults
C. In all ages
1. Inhalation of irritants such as tobacco smoke
2. Viral respiratory infections
3. Gastroesophageal reflux
4. Obesity
5. Lower socioeconomic level
D. Triggers
1. Allergen exposure
2. Viral infections of the upper airways
3. Medication (potential risk with beta-blockers, angiotensin-converting
enzyme [ACE] inhibitors, aspirin, cyclooxygenase [COX] inhibitors)
4. Exercise
5. Situational factors: Cold air, laughter, strong odors, air pollution,
smoke exposure, pregnancy
6. Foods
7. Hormones
8. Gastrointestinal (GI) reflux
9. Stress
Typical Complaints
A. Consistent cough (worse at night and early morning)
C. Recurrent shortness of breath B. Recurrent wheezing (SOB)
Dyspnea (Dyspnea) (less likely to be reported in the elderly)
E. Chest tightness that occurs on a regular basis (may worsen with moderate activity)
Some Symptoms and Signs
A. Symptoms that wake you up at night B. Symptoms that change with the seasons or environment C. Chest discomfort and tightness with moderate activity
Diagnostic Procedures
The gold norm is spirometry. Spirometry is not a replacement for peak flow metre measurements. Before and after the patient inhales a short-acting bronchodilator, measure the forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1).
B. Examine a chest X-ray (CXR) and a full blood count (CBC) to rule out other diagnoses and infections.
C. For children with chronic asthma, allergy testing is recommended.
D. Measure the PEFR after inhaling SABA. If the PEFR increases by 15% after 15 to 20 minutes, the diagnosis is confirmed.
2. In patients taking bronchodilators, PEFR varies by more than 20% between waking and 12 hours later (or 10 percent without bronchodilators).
3. After 6 minutes of exercise, the PEFR drops by more than 15%.
jogging or working out
E. For nondiagnostic spirometry, consider a bronchial provocation examination with histamine or methacholine.
Differential Diagnoses
A. In infants and children
1. Asthma
2. Pulmonary infections:
a. Pneumonia
b. Respiratory syncytial virus (RSV)
c. Viral bronchiolitis
d. Tuberculosis (TB)
3. Allergic rhinitis and sinusitis
4. Foreign body in the nose, trachea, or bronchus
5. GERD
6. Cystic fibrosis (CF)
7. Bronchopulmonary dysplasia
8. Vocal cord dysfunction
9. Enlarged lymph nodes or tumors
B. In adults
1. Asthma
2. Chronic obstructive pulmonary disease (COPD)
3. GERD
4. Congestive heart failure (CHF)
5. Cough secondary to medications such as ACE inhibitors or betablockers
6. Pneumonia, including aspiration pneumonia in elderly or postcerebrovascular accident (CVA)
7. Pulmonary embolism
8. Laryngeal dysfunction
9. Benign and malignant tumors
10. Vocal cord dysfunction
Treatment
As directed by the doctor
