Asthma is a disease of chronic inflammatory airways, which results in reducing or even blocking the flow of air. Its pathophysiology is related to interaction between genetic and environmental factors that manifest as attacks of breathlessness due to swelling of the lining bronchial, the overproduction of mucus in the airways and smooth muscle contraction of the airways, with consequent reduction of its diameter (bronchospasm).
Crises are characterized by various symptoms such as dyspnea, cough and wheezing, especially at night. The narrowing of the airways is usually reversible but in patients with chronic asthma, the inflammation can determine airflow obstruction to airflow. Pathologic features include the presence of inflammatory cells in the airways plasma exudation, edema, muscle hypertrophy, mucus plugs and desquamation of the epithelium. The diagnosis is mainly clinical and treatment consists of educational measures, drugs that improve the airflow in asthma and anti-inflammatory, mainly based on steroids.
Signs and symptoms
Characteristically the disease, symptoms appear cyclically with periods of worsening. Among the main symptoms are: a cough that may or may not be accompanied by some sputum (phlegm), shortness of breath with pain or burning in the chest and a wheezing (wheezing). In most cases there is no sputum or have the type “egg”.
Symptoms can occur at any time of day, but tend to predominate in the morning or evening. Asthma is the leading cause of chronic cough in children and is among the leading causes of chronic cough in adults.
According to the standards of the crises and tests, asthma can be classified in: Intermittent asthma, mild persistent asthma, moderate persistent asthma, severe persistent asthma.
Intermittent Asthma: symptoms less than once a week; bouts of short duration (light); sporadic nocturnal symptoms (no more than twice a month); pulmonary function tests normal in the period between attacks.
Mild persistent asthma: symptoms at least once a week, but less than once a day; presence of nocturnal symptoms more than twice a month, but less than once a week; pulmonary function tests normal in the period between attacks.
Moderate Persistent Asthma: daily symptoms; crises can affect daily activities and sleep; presence of nocturnal symptoms at least once a week; pulmonary function tests: peak expiratory flow (PEF) or forced expiratory volume in one second (FEV ¹)> 60% and 60% of expected
The diagnosis is made based on signs and symptoms that occur repetitively and are referred to by the patient. On physical examination, the doctor may find wheezing in the lungs, especially in exacerbation of the disease. However, not all wheezing is due to asthma, may also be caused by other diseases. However, in individuals who are out of crisis, the physical examination may be completely normal.
There are additional tests that may help physicians, among them are: chest X-rays, blood tests and skin (to see if the patient is allergic) and spirometry to identify and quantify the obstruction to airflow. Bronchial provocation test with pro-inflammatory substances, eg histamine, methacholine.
Asthma patients can also take home a device that measures the peak flow of air is important to monitor the course of the disease. Exacerbations of asthma, peak flow is reduced.
Treatment Note: If you need help, consult a health professional. The information contained herein does not have the character of advice.
To treat asthma, a person must have some care for the environment, especially in his home and at work, in addition to using the medication and keep regular appointments. Drugs can be divided into two classes: relief and maintenance.
Mainly used as medications for relief cut an asthma attack. An inhaler typical bronchodilator.
The bronchodilator is a medicine, as its name says, it dilates the bronchi (airways) when asthma is out of breath, wheezing or coughing. There bronchodilators called beta2-agonists – have a short effect and other effects prolonged (lasting up to 12h). The effect of short often used as needed. If the person is well, without symptoms, do not need to use them. Now those of prolonged effects tend to be used continuously, every 12 hours, and are indicated for specific cases of asthma. In addition to beta2-agonists, other bronchodilators such as anticholinergics theophyllines and may be used.
Used mainly to avoid and prevent crises (maintenance).
The inhaled corticosteroids are currently the best approach to combat inflammation and are used in almost all asthmatics. Are not only used by patients with mild intermittent asthma (which have sporadic symptoms). Such drugs are used in order to prevent exacerbations of the disease or at least minimize them and increase disease-free survival between one crisis and another. Anti-inflammatory drugs should be used continuously (every day), since that fight chronic inflammation of the bronchial mucosa, which is the substrate for subsequent events.
There are other treatment options, such as cromolyn sodium (commonly used in small children), the nedocromil, ketotifen and leukotrienes. The latter is relatively new and can be used in specific cases of asthma or associated with steroids.
Both bronchodilators and anti-inflammatory drugs can be used in several ways: by nebulization dose inhaler ( “spray” or “puffer”) dry powder inhalers (via Turbuhaler, Rotahaler, Diskhaler or capsules for inhalation) -> are different (and practical) devices for inhalation; compressed; syrup.
Physicians prefer the use of medications for nebulization, metered dose inhaler or dry powder of being more effective and cause fewer side effects.