Asthma: Overview and Treatment

Asthma: Overview and Treatment

Asthma is a heterogeneous chronic disease characterized by chronic airway inflammation. People with asthma often have a history of respiratory symptoms such as coughing, which varies in frequency and severity, and reversible airflow limitation.

# Causes of Asthma

Factors that can trigger an asthma attack include:

• Upper respiratory tract infections: Such as Rhinovirus.

• Inhaled allergens: Including pollen, dust, pet dander.

• Exercise-induced asthma: Occurs after exercising.

• Cigarette smoke: Both direct and secondhand smoke can trigger asthma.

• Environmental pollution: Vehicle exhaust, dust.

• Weather changes: Sudden changes in temperature.

• Psychological factors: Stress, anxiety.

# Basic features of asthma

Asthma is characterized by:

• Inflammation: Chronic airway inflammation.

• Obstruction: Airflow limitation due to airway edema and smooth muscle contraction.

• Hypersensitivity: The airway is easily irritated by allergens.

# Asthma attack

An asthma attack can occur even if the patient is receiving preventive medication. They commonly occur at midnight, early morning or after exertion.

Characteristics of an asthma attack:

• Resolution: Asthma attacks usually resolve gradually due to:

• Spontaneous resolution: Body’s self-recovery.

• Sudden resolution: After using bronchodilator medication.

• Due to using bronchodilator and corticosteroid: Best treatment outcome.

# Clinical Manifestations

Shortness of breath:

• Characteristic: Difficulty breathing out, prolonged exhalation.

Lung examination:

• During an asthma attack: Lung percussion is louder than normal, wheezing, rales, rhonchi, prolonged forceful exhalation.

• Outside an asthma attack: Lungs are near normal.

Asthma in children:

• Children under 2 years old: Rapid breathing, wheezing.

Severe asthma:

• Characteristics: Lasts for more than 3 days, unresponsive to treatment, severe shortness of breath.

# Tests

• Chest X-ray:

• Early stage: Normal.

• Later stage: Emphysema, widened chest cavity, air trapping.

• Complete blood count: Increased eosinophils, elevated IgE.

# Diagnosis

• Children over 5 years old:

• History of respiratory symptoms: Coughing, wheezing, shortness of breath, chest tightness.

• Evidence of reversible airflow limitation (FEV1 < 80%).

• Positive salbutamol test: FEV1 increases by 12% after using a bronchodilator.

# Differential diagnosis

• Children under 24 months: Asthma can be confused with bronchiolitis.

# Treatment

Dosage:

• Salbutamol test dosage for bronchodilator recovery: 200 mcg.

• Salbutamol nebulizer dosage for relieving asthma attack: 0.15 mg/kg/day.

• Oral prednisolone dosage for moderate asthma attack: 1-2 mg/kg/day.

• Methylprednisolone intravenous dosage for severe asthma attack: 2 mg/kg/day.

Medication:

• Relieving asthma attack:

• Beta 2 adrenergic bronchodilator: Most commonly used medication.

• Intravenous aminophylline.

• Subcutaneous adrenaline.

• Oral or intravenous corticosteroid.

• Prevention:

• ICS (inhaled corticosteroids): Most commonly used medication.

• Leukotriene inhibitors.

# Asthma attack severity classification

Asthma attack severity is determined based on:

• Peak expiratory flow rate (PEFR):

• Moderate asthma attack: 60-80%.

• Blood gas + spirometry: Most accurate diagnosis.

• Clinical:

• Grade 1 (mild, intermittent): Symptoms < 1 time/week during the day, <= 2 times/month at night, FEV1 > 80%, PEP variation < 20%.

• Grade 2 (mild persistent): Symptoms > 1 time/week < 1 time/day during the day, > 2 times/month at night, FEV1 > 80%, PEP variation 20-30%.

• Grade 3 (moderate, persistent): Symptoms: daily during the day, > 1 time/week at night, FEV1 60-80%, PEP variation > 30%.

• Grade 4 (severe asthma): Symptoms: often, continuously during the day, often at night, FEV1 < 60%, PEP > 30%.

# Notes

• Asthma patients need to be monitored and treated according to the doctor’s instructions.

• Avoid contact with asthma triggers.

• Use medication at the correct dosage and duration.

• Be aware of any unusual symptoms and go to the hospital immediately when necessary.