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Asthma
Asthma is a condition of the airways that are narrowed because hyperactivity to certain stimuli, which cause inflammation; constriction is temporary.
Cause
In patients with asthma, airway constriction in response to stimuli that in normal lung will not affect the respiratory tract. This narrowing can be triggered by various stimuli, such as pollen, dust, animal dander, smoke, cold air and exercise.
In an asthma attack, smooth muscle spasm of the bronchi and the tissues lining the airways have swollen because of the inflammation (inflammation) and the release of mucus into the airways. This will reduce the diameter of the airways (called bronchoconstriction) and this causes narrowing of the patient must exert every effort in order to breathe.
Certain cells in the airways, especially mastosit allegedly responsible for the beginning of this constriction. Mastosit throughout the bronchi release material such as histamine and leukotrienes that lead to: - smooth muscle contraction - increased mucus formation - transfer of certain white blood cells into the bronchi. Mastosit such materials issued in response to something they recognize as foreign bodies (allergens), such as pollen, fine dust contained in the house or animal fur.
But asthma can also occur in some people without a specific allergy. The same reaction occurs if the person is doing sports or being in cold weather. Stress and anxiety can also trigger the release of histamine and leukotrienes.
Other cells that eosinophils are found in asthmatic airways release other materials (as well as leukotrienes), which also causes constriction of the airways.
Asthma can also be caused by the high ratio of plasma bilirubin as a result of oxidative stress induced by oxidants.
Symptom
The frequency and severity of asthma attacks varies. Some patients more often free of symptoms and only suffered a brief attack of shortness of breath and light, which occurs at any time. Other patients almost always have a cough and wheezing (asthma) and have a great attack after suffering a viral infection, exercise or after exposure to allergens and irritants. Crying or laughing hard can also cause symptoms and often prolonged cough, especially at night time or cold weather.
An asthma attack can occur suddenly marked by wheezing (wheezing, asthma), cough and shortness of breath. Wheezing sounds especially when the patient exhaled breath. At other times, an asthma attack occurs slowly with symptoms gradually worsened. In the second situation, which was first felt by a person with asthma is shortness of breath, cough or tightness in the chest. The attack could take place within a few minutes or may last up to several hours, even for a few days.
Initial symptoms in children can include itching in the chest or neck. Dry cough at night or during exercise could also be the only symptom.
During asthma attacks, shortness of breath may become more severe, causing anxiety. As a reaction to anxiety, patients will also be spending a lot of sweat.
In a very severe attack, the patient became difficult to talk because of crowded very great. Confusion, lethargy (decreased state of consciousness, where the patient such as deep sleep, but can be aroused briefly and then immediately fell asleep again) and cyanosis (bluish skin looks) is a sign that the patient oxygen supply is very limited and need immediate treatment. Although he has suffered a severe attack, the patient will usually recover completely, Sometimes some of the alveoli (air pockets in the lungs) can rupture and cause air to accumulate in the pleural cavity or cause air collects around the organs of the chest. This will exacerbate the difficulty felt by the patient.
Diagnosis
Diagnosis based on typical symptoms.
To confirm the diagnosis can be repeated spirometry examination. Spirometry is also used to assess the severity of airway obstruction and to monitor treatment.
Determining the factors triggering asthma is often not easy. Allergy skin tests can help determine the allergens that trigger asthma symptoms. If the diagnosis is doubtful or if it is felt very important to know the factors triggering the occurrence of asthma, the bronchial challenge test can be done.
Treatment
Drugs can make people with asthma live a normal life. Immediate treatment to control asthma attacks is different from routine treatment to prevent attacks.
Beta-adrenergic receptor agonists is the best medicine to reduce asthma attacks that occur suddenly and to prevent attacks that may be triggered by exercise. Bronchodilators stimulated by widening the airway beta-adrenergic receptors.
Bronchodilators are working on all of beta-adrenergic receptors (eg adrenaline), causing side effects such as rapid heartbeat, restlessness, headache and tremors (shaking) muscles. Bronchodilators are only working on beta2-adrenergic receptors (which are mainly found in cells in the lungs), has few side effects on other organs. Bronchodilators (eg, albuterol), causes fewer side effects compared with bronchodilators that work on all of beta-adrenergic receptors.
Most of bronchodilators work in a few minutes, but the effect only lasts for 4-6 hours. Newer bronchodilators have a longer effect, but because it works more slowly, then the drug is more widely used to prevent attacks.
Bronchodilators are available in the form of tablets, injections or inhalers (inhaled drugs) and very effective. Inhalation of bronchodilator drugs will precipitate directly in the airways, so that at first it works fast, but can not reach the airway becomes blocked by weight. Bronchodilator by mouth (swallowed) and injections can reach the area, but has side effects and early works tend to be slower.
Another type of bronchodilator is theophylline. Theophylline is usually given by mouth (swallowed); available in various forms, ranging from tablets and syrup until the capsule short-acting and long-acting tablet. In a severe asthma attack, can be given intravenously (through a vein).
Number of theophylline in the blood can be measured in the laboratory and should be monitored closely, because the amount is too small will not provide the effect, while the amount is too much can cause abnormal heart rhythms or seizures. The first time taking theophylline, the patient may feel a little nauseous or agitated. Both of these side effects usually disappear when the body can adjust to the medication. In larger doses, the patient may feel a rapid heartbeat or palpitations (heart pounding). Can also occur insomnia (difficulty sleeping), agitation (anxiety, phobia), vomiting, and seizures.
Corticosteroids inhibit inflammatory response and is highly effective in reducing symptoms of asthma. If used long term, gradually corticosteroids will cause a reduction in the likelihood of asthma attacks by reducing airway sensitivity to some stimuli.
But the use of corticosteroid tablets or injections can lead to long term:
• impaired wound healing process
• inhibition of growth of children
• loss of calcium from bone
• bleeding gastric
• premature cataracts
• an increase in blood sugar levels
• weight gain
• starvation
• mental disorders
Tablets or corticosteroid injections can be used for 1-2 weeks to reduce severe asthma attacks. For long term use of corticosteroid inhalers are usually given because the inhalers, a drug that reached the lungs 50 times more than the drugs to other body parts. Corticosteroids by mouth (swallowed) is given for long term only if other treatments can not control asthma symptoms.
Cromolin and nedocromil block the release of materials suspected of inflammation from mast cells and cause a reduction in the possibility of shrinkage of the airways. This medicine is used to prevent attacks, not to treat an attack. The drug is particularly effective for children and for asthma because of sports. This drug is very safe, but relatively expensive and must be taken regularly even though the patient free of symptoms.
Anticholinergic drugs (eg atropine and ipratropium bromide) works by blocking the formation of smooth muscle contraction and excessive mucus in the bronchi by acetylcholine. Furthermore, this drug will cause a widening of the airways in patients who had previously been taking beta2-adrenergic receptor agonist.
Leukotriene modifiers (eg montelucas, zafirlucas and zileuton) is a new drug to help control asthma. This drug inhibits the action or formation of leukotrienes (chemicals made by the body that cause asthma symptoms).
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