Asthma: What is Asthma, Causes and Treatment of Asthma, Asthma Information, Consultation and Analyses, Signs of Asthma

What is Asthma?

Asthma is a disease caused by pulmonary lung discomfort expiration. This discomfort is also reversible, either spontaneously or under treatment.

Three main mechanisms here can explain:

* Inflammation of the bronchi;
* Bronchial hyper-responsiveness;
* Reduced size (diameter) of the latter = bronchoconstriction.

The subject with asthma is often a subject with allergic land. This presents an excessive immune response (very large influx of immunoglobulin E) in relation to an external agent: the agent responsible is known allergen.

The inhalation of the allergen causes a decrease in the diameter of the bronchi (bronchial hyperreactivity) and a release of chemical mediators.

Some of these mediators, in association with other cells of inflammation (the eosinophils) are longer term and lead to alterations of the bronchial mucosa. A state of chronic inflammation of the bronchi is created and will be the target of the basic treatment of asthma.

The extent of deterioration and the bronchial inflammation is correlated with the severity of asthma.

[?] Causes and risk factors of Asthma

It is fundamental to the future of asthma to determine the cause of his asthma.

When the allergen is identified, it is called allergic asthma, atopic or to specific bronchial hyperreactivity. The allergenic substance may be inhaled in the form (in air) or by ingestion (food or drugs).

In air, the most frequent causes are house dust, pollens, molds, or elements present in the environment of the patient: flour bread for example.

In some cases, the element responsible for asthma can not be identified. There is talk of nonspecific bronchial hyperreactivity.

In both cases, it should search for factors of asthma such as smoking (active or passive), physical exercise, stress, ect ...

Also sought: a gastroesophageal reflux or vasculitis.

The concept of land or personal allergic family can be found at diagnosis of asthma.

[?] The signs of the disease

The frequency and degree of symptoms vary widely from one patient to another and from time to time with the same subject.

It distinguishes paroxysmal asthma attack, asthma continues to dyspnoea and severe acute asthma.

The paroxysmal asthma attack:

Asthma has three phases:

* The first consists of signs of the crisis (sometimes absent): a cough, contact with the allergen;
* The second is the crisis itself with acute breathing difficulties. It often occurs at night, the patient is wheezing, especially at the end, which can be heard by those around her, and prefers sitting on the edge of the bed. It feels a tightness in the chest, his breath is accompanied by distention of the thorax;
* In a third step, these signs are declining, even faster than was early treatment. The patient cough and sputum (spit).

Asthma continues to dyspnea usually affects older people and is characterized by persistent respiratory symptoms even between crises.

The acute severe asthma may occur immediately or on a ground unstable asthma. Asthma is unstable recognizes an increase in seizure frequency (several acute attacks within a single day: asthma attack), a degradation of peak expiratory flow (PEF or peak flow) or by a greater consumption medicines dealing with crises.

In acute severe asthma, the patient can not impose sentences without pauses for breath. His breathing is ineffective, it gets tired, agitated, anxious is becoming cyanotic. It can become confused about this in his reflecting a progressive respiratory failure.

[?] Consultation

During an asthma attack paroxysmal, clinical examination reveals a distended chest, locked in forced inspiration, wheezing. The lung auscultation revealed expiratory wheezing.

Asthma described severe acute cyanosis, decreased wheezing or silence auscultation. The cardiac and respiratory frequencies are increased. It appears a progressive respiratory exhaustion with use of accessory respiratory muscles. These signs require hospitalization in an emergency by the emergency.

[?] Reviews and analyzes

In order to highlight the cause of allergic asthma, it is first necessary to conduct a very thorough examination on the arrangements for crisis occurred (to identify the allergen in question).

On practice tests in search of markers indicating an allergy: increased white blood eosinophils and total immunoglobulin E and / or specific in the blood. It also performs skin tests allergists.

The measurement of peak expiratory flow (PEF or peak flow) is very useful. X-ray chest, blood gases to quantify the oxygenation of the blood, the count of the blood and respiratory tests can also be made.

[?] Evolution of the disease

Asthma paroxysmal takes the form of crises interspersed with periods of calm, unpredictable as to their duration.

The asthma attack paroxysmal sells mostly under treatment. It may recur. It can also be complicated by atelectasis (retraction of all or part of a lung), a pneumothorax, air in the tissues (thoracic and subcutaneous), heart failure.

This form of asthma may change the mode of asthma continues to dyspnea.

The acute severe asthma may recur and be fatal.

[?] Do not confuse with ...

In adults, it is necessary to distinguish asthma:

* Heart failure;
* In a chronic obstructive pulmonary disease;
* In a benign tumor of the trachea or bronchus;
* From a tracheal or bronchial cancer.

[?] Treatment

It depends on the severity of asthma.

The first steps based on the elimination of contact with the allergen and the removal of factors crises. Respiratory physiotherapy can be very useful in patients with bronchial secretions.

Classifying asthma into four stages of severity according to symptoms, crises, the existence or not of a nocturnal asthma, the clinical status between attacks, frequency of use of inhaled medications and peak flow ( DEP). Each of the four stages, will be assigned a different treatment. The severity of asthma believes Stage 1 to Stage 4.

The crisis of severe acute asthma or status asthmaticus routinely treatable in hospital, his salary will not be discussed here.

We distinguish the handling of the crisis and treatment.

[?] Treatment

Treatment of inflammation

It is essential to avoid crises and it is too often neglected by patients.

The treatment relies mainly on the daily use of inhaled corticosteroids or inhaled cromones. Their goal is to reduce the local inflammation and bronchial hyperreactivity. These products do not deal with the crisis.

Another type of anti-inflammatory drugs is also available: the antileucotriènes. They work by blocking the action of leukotrienes, substances that increase bronchoconstrictrices inflammation and mucus secretion in the bronchi.

Treatment of bronchoconstriction

Inhaled anticholinergics are sometimes prescribed daily for treatment. They are bronchodilators by a local anticholinergic effect in the muscles of the bronchi.

Bronchodilators or inhaled beta2 stimulants orally are sometimes associated with anti-inflammatory but never given alone. These compounds are substances long-acting.

Theophylline is a bronchodilator the oldest. It is less used because it has side effects (gastrointestinal, cardiac and neurological) and a low therapeutic margin. In short, it is difficult to adjust the dosage for effective treatment without the risk of toxicity.


Handling of the crisis = treatment of bronchoconstriction

The benchmark treatment of asthma attack is taking bronchodilators beta2 stimulants. These products, administered by inhalation, enable an immediate relaxation of bronchial muscle resulting in bronchodilation and relief.

The use of inhalation devices is not always easy, especially in children who may have difficulty coordinating inspiration and of the device. In this case, there is room for inhalation to overcome this difficulty.

In case of serious crisis, corticosteroids orally or subcutaneously may also be prescribed.

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