chronic asthma

Chronic AsthmaDiagnosisWheezing, Cough, Shortness of Breath and Chest Tightness.Familiar HistoryComprehensive AssessmentIt is essential to assess the severity of the symptoms byestablishing how often they occur.Whether signs and symptoms are cause nocturnal waking orexercise limitation. HypoxemiaRespiratory alkalosisObstructive defects in pulmonary function testsReduced total lung capacityResidual volume increasedHypersensitive reactions (over 20% above or below) in response to a irritant. Consider chest X-rayTest Exhaled Nitric OxidePulse Oxygen Level testAsthma Control Test - allows a clinician to monitor how well current treatments are working. Chronic asthma cases tends to have persistent and prolonged effects that is not responsive to medications.Clinical ManifestationWheezingCoughShortness of BreathChest TightnessTachypnea or tachycaridia (less frequent in chronic asthma)HypoxemiaLow Spirometry - measures lung volumes andairflow.Low Peak Flow - measures Expiratory Flow Rates.Epidemiology26 million Americans.7 million Children in America. Genetics or familiar history can play a significant role in diagnosis.Australia and New Zealand have the highest prevalence rates. United States has a 4-8% prevalence rate with more boys affected than girls.PathophysiologyAround 100 different identified genes have been show to play a role in the susceptibility and pathogenesis of asthma. These genes show expression in asthma patients can often be based off age and irritant exposure. These genes influence the production of interleukin-4, interleukin-5, immunoglobulin E, eosinophils, B-adrenergic receptors, and mast cells. Frequent factors that can increase a genes expression of asthma that include exposures to air pollution, smoke or tobacco products, recurrence of upper respiratory infections, gastroesophageal reflux disease, and obesity. The epithelium becomes damaged and starts to shed creating a hyper-sensitive airway exposing of sensory nerves, allowing the penetration of allergens, and breaking down inflammatory mediators. Bronchospasms create a quick and sharp contraction of the bronchial smooth muscle adding to the overall narrowing of the airway.As asthma progresses and is left untreated or not properly managed, the structure of the airway can be remodeled leading to permanent fibrotic damage changing the structural cells and tissues in the lower respiratory tract.The chronic remodeling of the airway is what characterizes chronic asthma.TreatmentAvoidance of irritants Dust mitesPollen and SporesDietaryAnti-inflammatory medicationsInhaled corticosteroidsShort- acting, beta-agonistUse albuterol/levalbuterol puffs, 15 minutes as directed with activity.
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