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Asthma

Background knowledge ๐Ÿง 

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 ๐ŸŒก๏ธ

Clinical Features

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

Investigations ๐Ÿงช

Tests

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

Management ๐Ÿฅผ

Management

  • Relievers: Short-acting beta-agonists (SABA)ย 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 asthmaticusย (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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