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- The lungs are made up of
progressively smaller airway branches. Bronchi (airway
passages) branch into smaller-diameter passages, called
bronchioles. These in turn branch into even
smaller bronchioles. Oxygen from the
air is transported to the blood through
the small, thin terminal sacs (alveoli) at the end of
the smallest final branches of the airways.
- Waste products (carbon dioxide) from
the blood are also transported outside the body via the
alveoli.
- Asthma is the result of narrowing, inflammation or
mucus plugging of the bronchioles and bronchi.
- Small muscle bundles, surrounding the bronchioles, can
constrict, further narrowing the bronchioles. When
deprived of circulating air, the alveoli can collapse
(atelectasis), but this is secondary to the plugging of the
bronchioles.
- If enough airway passges are narrowed
or plugged, the asthmatic feels short of breath and cannot move
air in and out fast enough to
meet the needs of the body.
- Many agents (see below) may trigger
asthma. The mechanism of how this specifically occurs
is still not clearly understood. Multiple factors are
known to contribute.
- Agents that treat/improve asthma usually affect a
single factor that is interfering with the patency of
the bronchioles. For example:
- Beta agonists affect beta receptors
on the bronchi and bronchioles, causing the air passages to open.
- Corticosteroids decrease inflammation
around the air passages.
- Anti-leukotrienes prevent local hormones from causing
inflammation.
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- Shortness of breath
- Wheezing
- Cough
- Chest tightness
- Heart racing
- Rapid breathing
- Sweating
- Bluish skin color
(cyanosis)
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- Allergy induced (pollens, dust,
mites, molds, cigarette smoke, etc.)
- Exercise induced
- Bronchitis
- Gastroesophageal Reflux
- Congestive Heart Failure (fluid backs up into lungs)
- Stress
- Cold air
- Odors
- Post-nasal drip
- Sinus infections
- Weather changes
- Beta-blocker medications (e.g.,
propranolol)
- Aspirin
- Nasal polyps &
aspirin together
- Nonsteroidal anti-inflammatories
(e.g., ibuprofen)
- Aerolized pentamadine
- Other medications
- Sulfites (additive to food and
wine)
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- Wheezing in lungs
- Prolonged time to exhale air
- Poor air movement in lungs
- Flow meter shows decreased peak airway flow
- Pulmonary function testing:
- Limited airflow especially on
exhaling
- Worse airflow when given
methacholine
- Improved airflow with medications to open up bronchi and
bronchioles.
- Laboratory findings (possible occurrences)
- Increased eosinophil count
- Abnormal arterial blood gas
- Chest X-Ray usually
normal
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- Short-acting beta agonist
inhalers, e.g., albuterol (Proventil, Ventolin)
- Corticosteroids, e.g., prednisone
- Anticholinergics, e.g., Atrovent
- Aminophylline
- Oxygen if necessary
- Terbutaline
- Epinephrine
- Isoproterenol (now rarely used)
- Chronic (preventive) treatment:
- Corticosteroid inhalers (e.g., Flovent)
- Cromolyn Sodium inhaler
- Nedocromil Sodium (Tilade)
inhaler
- Chronic (preventive) asthma
medications usually do not help during an asthma
attack. Do not use them for this! Contact your
physician or get immediate emergency medical care.
- Asthma can lead to death. Seek emergency medical
help/advise
quickly.
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- Avoid known triggers at work or
home.
- Treatment of underlying causes such as infections, GE Reflux, Congestive Heart Failure, etc.
- Sinus infections, allergies, and GE Reflux commonly interfere
with the treatment of asthma. Treat these in order to treat
the asthma properly.
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