Asthma

Medicine > Respiratory

Background knowledge 🧠

Definition

Asthma is a chronic inflammatory disorder of the airways resulting in recurrent and reversible bronchoconstriction.
Characterised by airway hyperresponsiveness and chronic airway inflammation.

Aetiology

Allergens: Pollen, dust mites, pet dander.
Occupational: Chemicals, dust, fumes.
Respiratory infections.
Exercise.
Drugs: NSAIDs, beta-blockers.
Gastroesophageal reflux disease (GERD).

Clinical Features 🌡️

Clinical Features

Episodic breathlessness.
Wheezing.
Cough, often nocturnal.
Chest tightness.

Investigations 🧪

Tests

Spirometry: Reduced FEV1/FVC ratio, reversibility with bronchodilator.
Peak expiratory flow rate (PEFR) monitoring.
Allergy testing.
Blood tests: eosinophil count, IgE levels.

Management 🥼

Management

Relievers: Short-acting beta-agonists (SABA) e.g., salbutamol.
Preventers:
- Inhaled corticosteroids (ICS) e.g., beclomethasone.
- Long-acting beta-agonists (LABA) e.g., formoterol.
- Leukotriene receptor antagonists e.g., montelukast.
Acute severe asthma (Asthma attack):
- Oxygen.
- Nebulised SABA.
- Systemic corticosteroids.
Education and self-management: asthma action plan.
Eliminate aggravating factors (e.g., avoid allergens, smoking cessation).

Complications

Status asthmaticus (severe asthma not responding to treatment).
Chronic obstructive pulmonary disease (COPD).
Respiratory failure.

Prognosis

Variable.
Most have good control with treatment, but some may progress to chronic respiratory impairment.

Key Points

Asthma is characterised by airway hyperresponsiveness and chronic airway inflammation with variable airflow obstruction.
It is defined by the history of one of more respiratory symptoms such as a wheeze, episodic breathlessness, chest tightness and cough that vary overtime and in intensity.
Variable airflow obstruction is observed through reversibility with bronchodilator in spirometry.
Stepwise management with inhaled therapy is required (relievers and preventers).
Patient education and adherence is crucial to prevent progression and asthma attacks.

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