– IgE mediated
– Triggered by allergens
– Presents in childhood
– Positive family history
– Diagnosed by RAST (radioallergosorbent tests)
Abbreviations: IgE, immunoglobulin E; NSAIDs, nonsteroidal anti-inflammatory drugs.
Asthma results from an interplay between genetic factors, environmental factors, and immune response. Airway inflammation forms the core pathophysiologic mechanism. The pathogenesis of asthma is depicted in Figure 1 . Atopic asthma is characterized by a TH2 and immunoglobulin E (IgE) response to allergens in genetically predisposed individuals. The asthma related genetic polymorphisms possibly influence immune process. Some of the genetic associations are described below 2 :
Pathogenesis of asthma.
Gross appearance.
In patients with severe asthma, the lungs appear overinflated showing atelectatic areas. The most prominent gross finding includes airways (bronchi and bronchioles) occluded by thick, tenacious mucus plugs. 2
A characteristic microscopic finding is Curschmann Spiral ( Figure 2 ) seen in sputum or bronchoalveolar lavage samples of asthma patients. It is the result of mucus plugs extruding from subepithelial mucous gland or bronchioles. Numerous eosinophils with Charcot-Leyden crystals ( composed of an eosinophil protein called galectin-10) are also present. 2 There are other typical microscopic findings of asthma, collectively known as “airway remodeling” that result in airway obstruction, which include ( Figures 3 – 5 ) 2 :
Curschmann spiral (1000×).
Sub-basement membrane fibrosis and submucosal eosinophilic infiltration (×200 magnification).
Squamous metaplasia, sub-basement membrane fibrosis and intraepithelial and submucosal eosinophilic infiltration (×400 magnification).
Goblet cell hyperplasia and smooth muscle hypertrophy (×100 magnification).
Airflow obstruction is a result of the following changes in asthma 4 :
Airway obstruction leads to increased airflow resistance and expiratory flow rate reduction. These changes result in reduced air expulsion and may lead to hyperinflation of the lung. This overdistention helps preserve airway patency, thus improving expiratory flow. However, it also increases the work of breathing by altering pulmonary mechanics.
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
BACKGROUND Severe life threatening asthma (SLTA) is important in its own right and as a proxy for asthma death. In order to target hospital based intervention strategies to those most likely to benefit, risk factors for SLTA among those admitted to hospital need to be identified. A case-control study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have different sociodemographic and clinical characteristics, evidence of inadequate ongoing medical care, barriers to health care, or deficiencies in management of the acute attack.
METHODS Seventy seven patients with SLTA were admitted to an intensive care unit (pH 7.17 (0.15), Pa co 2 10.7 (5.0) kPa) and 239 matched controls (by date of index attack) with acute asthma were admitted to general medical wards. A questionnaire was administered 24–48 hours after admission.
RESULTS The risk of SLTA in comparison with other patients admitted with acute asthma increased with age (odds ratio (OR) 1.04/year, 95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20 to 0.68). These variables were controlled for in all subsequent analyses. There were no differences in other sociodemographic features. Cases were more likely to have experienced a previous SLTA (OR 2.04, 95% CI 1.20 to 3.45) and to have had a hospital admission in the last year (OR 1.86, 95% CI 1.09 to 3.18). There were no differences between cases and controls in terms of indicators of quality of ongoing asthma specific medical care, nor was there evidence of disproportionate barriers to health care. During the index attack cases had more severe asthma at the time of presentation, were less likely to have presented to general practitioners, and were more likely to have called an ambulance or presented to an emergency department. In terms of pharmacological management, those with SLTA were more likely to have been using oral theophylline (OR 2.14, 95% CI 1.35 to 3.68) and less likely to have been using inhaled corticosteroids in the two weeks before the index attack (OR 0.69, 95% CI 0.47 to 0.99). While there was no difference in self-management knowledge or behaviour scores, those with SLTA were more likely to have inappropriately used oral corticosteroids during the acute attack (OR 2.09, 95% CI 1.02 to 4.47).
CONCLUSIONS In comparison with those admitted to hospital with acute severe asthma, patients with SLTA were indistinguishable on sociodemographic criteria (apart from male predominance), were more likely to have had a previous SLTA or hospital admission in the previous year, had similar quality ongoing asthma care, had no evidence of increased physical, economic or other barriers to health care, but had demonstrable deficiencies in the management of the acute index attack. Educational interventions, while not losing sight of the need for good quality ongoing care, should focus on providing individual patients with better advice on self-management of acute exacerbations.
https://doi.org/10.1136/thorax.55.12.1007
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No one really knows what causes asthma . What we do know is that asthma is a chronic inflammatory disease of the airways. The causes can vary from person to person. Still, one thing is consistent: When airways come into contact with a trigger, they become inflamed, narrow, and fill with mucus.
When you have an asthma attack, your airways narrow and it gets hard to breathe. This can result from spasms of the muscles around the airways, inflammation and swelling of the mucosal membrane that lines them, or high amounts of mucus inside them. You might have shortness of breath, wheeze or cough as your body tries to get rid of mucus.
Why do you have asthma and your friend doesn't? No one knows for sure. Allergies play a role for many people, as do genetics.
If you or a loved one has asthma, it's important to understand what your triggers are. Once you figure that out, you can take steps to avoid them. As a result, you’ll have fewer and less severe asthma attacks .
Some known triggers of asthma attacks include:
Allergies with asthma is a common problem. Eighty percent of people with asthma have allergies to things in the air, like tree, grass, and weed pollens; mold; animal dander; dust mites ; and cockroach droppings. In one study, children with high levels of cockroach droppings in their homes were four times more likely to have childhood asthma than children with low levels. An allergy to dust mites is another common asthma trigger.
If you have asthma that’s hard to control, see an allergist to find out if you have allergies. Treating your allergies with medication and avoiding your triggers can help lower the odds of a severe asthma attack.
Food allergies can cause mild to severe life-threatening reactions. They rarely cause asthma without other symptoms. If you have food allergies , asthma can be part of a severe, life-threatening reaction called anaphylaxis . The most common foods associated with allergic symptoms are:
Food preservatives can trigger isolated asthma, especially sulfite additives, like sodium bisulfite, potassium bisulfite, sodium metabisulfite, potassium metabisulfite, and sodium sulfite, which are commonly used in food processing or preparation.
For about 80% of people with asthma, a heavy workout can cause airways to narrow. Exercise is often the main asthma trigger. If you have exercise-induced asthma, you will feel chest tightness, cough , and have trouble breathing within the first 5 to 15 minutes of an aerobic workout. For most people, these symptoms go away in the next 30 to 60 minutes of exercise. But up to 50% of people with exercise-induced asthma may have another attack 6 to 10 hours later. A slow warm-up may help prevent this.
If you have severe asthma and you’re not active now, talk to your doctor first about how to track your breathing and choose the right activities. When it’s winter, avoid exercising outdoors in very cold weather because the exposure could trigger asthma.
Severe heartburn and asthma often go hand-in-hand. Up to 89% of people with asthma also have severe heartburn (you might hear your doctor call it gastroesophageal reflux disease, or GERD ). It usually happens at night when you're lying down. Normally, a valve prevents stomach acids from backing up into your esophagus (the tube food goes down when you eat). When you have GERD, this valve doesn't work like it should. Your stomach acids reflux, or back up, into the esophagus. If the acids reach your throat or airways, the irritation and inflammation they cause could trigger an asthma attack.
Clues that suggest reflux as the cause of asthma include the start of asthma in adulthood, no family history of asthma, no history of allergies or bronchitis , difficult-to-control asthma, or coughing while lying down.
If your doctor suspects this problem, they may recommend specific tests to look for it, change your foods, or offer medications .
People who smoke cigarettes are more likely to get asthma. If you smoke with asthma, it may make symptoms like coughing and wheezing worse. Women who smoke during pregnancy raise the risk of wheezing in their babies. Babies whose mothers smoked during pregnancy also have worse lung function. If you have asthma and you're a smoker, quitting is the most important step you can take to protect your lungs .
Much like asthma causes inflammation in the lining of your airways, sinusitis causes inflammation in the mucus membranes that line your sinuses . This makes the membranes put out more mucus. If you have asthma and your sinuses get inflamed, your airways may too. Prompt treatment of a sinus infection can relieve asthma symptoms.
Cold, flu, bronchitis , and sinus can cause an asthma attack. These respiratory infections that trigger asthma can be viral or bacterial. They're a common cause of asthma, especially in children under age 10. You may be more likely to have an attack for up to 2 months after an upper respiratory infection. Anywhere from 20% to 70% of adults with asthma also have sinus disease. Also, 15% to 56% of people with allergic rhinitis ( hay fever ) or sinusitis also have signs of asthma.
Many people with asthma are sensitive to certain medications that can trigger an asthma attack . If you have asthma , you need to be aware of what other medications may be triggers. You don’t need to avoid these medications unless you know that they’re triggers. But if they have never triggered your asthma , it is still best to take them with caution because a reaction can happen at any time.
Below is a list of the most common medications known to trigger asthma or related symptoms. However, if you are prescribed any medication that you think may be causing your asthma to get worse, discuss it with your doctor.
If you have severe asthma, talk to your doctor about any medication you’re considering taking, even if it’s an over-the-counter medication. If you know that you're sensitive to particular drugs, make sure your doctor notes the problem on your chart. Always talk to your pharmacist about this reaction before you start a new medication.
Irritants. Tobacco smoke, smoke from wood-burning appliances or fireplaces, strong odors from perfumes, cleaning agents, etc., can all trigger asthma. So can air pollution, workplace dust, or fumes from chemicals.
Weather. Cold air, changes in temperature, and humidity can cause an attack.
Strong emotions. Stress and asthma are often seen together. Anxiety, crying, yelling, stress, anger, or laughing hard can bring on an asthma attack.
When you have asthma, your airways are always inflamed and sensitive. They react to a variety of external triggers. Contact with these triggers is what causes asthma symptoms. Your airways tighten and get more inflamed, mucus blocks them, and your symptoms get worse. An asthma attack can start right after exposure to a trigger or several days or even weeks later.
Reactions to asthma triggers are different for each person and vary from time to time. Something may bother you but not others with asthma. You might have many triggers while they have none. And while avoiding triggers is a good way to control asthma, the best way is to take medications and follow treatments exactly as prescribed by your doctor in your asthma action plan.
Figuring out what was going on around you when you had an attack is the first step to identifying your triggers.
Your doctor may also do blood testing or ask you to use a device called a peak flow meter. It measures how much air you exhale and how quickly it comes out. It can alert you to changes in your breathing and the onset of asthma symptoms.
Ask your asthma doctor if using a peak flow meter would help you narrow down the causes of your asthma.
It can be tough to identify them all, and they can change. For example, you might not have been bothered by tree pollen when you were a child, only to have a problem with it as an adult.
Even when you know your triggers, you might have a hard time avoiding them in certain situations. For example, you may notice that your workplace is cleaned with a cleaning product that bothers your lungs.
That’s why it’s so important to work closely with the doctor who treats your asthma. They can help you think of strategies to avoid triggers, or at least cut down on the amount of time you spend near them. They can also make sure you have the right medication when an asthma attack does strike.
Warning signs of a potential asthma attack include:
Use your asthma rescue inhaler medication as soon as you start to feel an attack come on. If it doesn’t seem to work and you feel like you still can’t breathe, call 911 so you can get to an emergency room right away.
If you have a steroid medicine at home (such as prednisone), you can take it on your way to the ER.
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Acute asthma attack is one of the most common causes of visits to hospital emergency departments in all age groups of the population and accounts for the greater part of healthcare burden from the disease. Despite, Acute asthma attack is an important public health problem that affects not only the patients, but also to the family, health professionals, health care institutions and development ...
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In the present case, PaCO 2 was as high as 90 mmHg at the time of arrival to ED, which was halved and normalized approximately two hours later, consistent with the time course in this study. In this case, we diagnosed asthma as the cause of the cardiac arrest through the background of self-discontinuation of asthma medication, hearing of a very ...
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Current studies show that Sevoflurane has significant bronchodilator properties and is an effective treatment option for severe acute asthma before rescue therapies [9]. The beneficial effect of Sevoflurane in our case is supported by alveolar unit and distal airway dilation, which reduce distortion of the surrounding parenchyma and amount of ...
A case-control study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have different sociodemographic and clinical characteristics, evidence of inadequate ongoing medical care, barriers to health care, or deficiencies in management of the acute attack.
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Cold, flu, bronchitis, and sinus can cause an asthma attack. These respiratory infections that trigger asthma can be viral or bacterial. They're a common cause of asthma, especially in children ...
1 INTRODUCTION. Acute severe asthma is a life-threatening emergency characterized by severe tachypnea, tachycardia, and type 1 respiratory failure. 1 According to the international standard guidelines, it is managed with bronchodilators, systemic steroids, and magnesium sulfate in emergency cases. 2 Here, we describe a case of a 38 years old male who presented with a severe asthmatic attack ...
Asthma is a condition caused by chronic inflammation of the small airways in the lungs. This leads to swelling and increased mucus production within conducting zone pas-sageways. Due to the chronic inflammation, an asthmatic's airways are already more narrow than the airways of an individual without this disease (Figure 1).