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Asthma is a chronic respiratory disease associated with reversible airflow obstruction, bronchial hyperresponsiveness (BHR), and airway inflammation triggered by various stimuli, including viral upper respiratory infection, environmental allergens, and occupational exposures. It can lead to recurrent episodes of wheezing, cough, and dyspnea (Holguin, 2017).
Presentation (Holguin, 2017)
Categories of Asthma Severity (Fanta & Barrett, 2022)
The early phase of asthma (1st hour) is triggered by IgE antibodies that are sensitized and released by plasma cells (Sinyor & Perez, 2022). Based on Sinyor & Perez (2022), these antibodies respond to environmental triggers. IgE antibodies then bind to high-affinity mast cells and basophils. When a pollutant or risk factor gets inhaled, the mast cells release cytokines and eventually de-granulate. Released from mast cells are histamine, prostaglandins, and leukotrienes. These cells, in turn, contract the smooth muscle and cause airway tightening. In the late phase (4-6 hrs), eosinophils, basophils, neutrophils, and helper and memory T-cells all localize to the lungs, which causes bronchoconstriction and inflammation. As a result of inflammation and bronchoconstriction, there is an intermittent airflow obstruction, resulting in increased work of breathing.
Labs/Diagnostics (Holguin, 2017)
Pulmonary Function Test
Methacholine (a cholinergic agent utilized to stimulate bronchial constriction excludes asthma).
Other studies (Bray, 2018)
Differential Diagnosis (Holguin, 2017):
Congestive heart failure
Other differential diagnoses (Bray, 2018)
Treatment (Holguin, 2017)
Patient Education and Prevention (Bray, 2018):
Referrals (Fanta & Barrett, 2022)
Bray, S.L. (2018). Asthma. In Hollier, A. (Ed). Clinical Guidelines In Primary Care (2nd Ed, pp. 662-669). Advanced Practice Education Associates, Inc.
La Fayette, LA.
Fanta, C.H. & Barrett, N.A. (June 06, 2022). An overview of asthma management. UpToDate. https://www.uptodate.com/contents/an-overview-of-asthma-management?source=history_widget#H31
Holguin, F. (2017). Asthma. In McKean, S.C., Ross, J.J. Dressler, D.D. & Scheurer, D.B. (Eds.). Principles and Practice of Hospital Medicine (2nd ed., Chap. 231, pp. 4507-4509). McGraw-Hill Education.
Sinyor, B. & Perez, L.C. (May 08, 2022) Pathophysiology of asthma. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK551579/
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