Asthma, Adult

Basics

Description

  • Atopic triad: Asthma, eczema, allergic rhinitis
    • Genetic predisposition for developing IgE against environmental allergens
  • Obstructive process—increased expiratory resistance:
    • Airway inflammation
    • Bronchospasm
    • Mucosal edema
    • Mucous plugging
    • Smooth muscle hypertrophy
  • Consequences:
    • Air trapping
    • Airway remodeling
    • Increased dead space
    • Hyperinflation
  • Status asthmaticus refers to disease that does not respond to therapy within 30–60 min
  • Risk factors for life-threatening disease:
    • Prior intubation or ICU admission
    • ≥3 ED visits for asthma in past year
    • ≥2 hospitalizations for asthma in past year
    • ED visit or hospitalization in past month
    • ≥3 Short acting beta-agonist (SABA) cannisters used per month
    • Delay in seeking care
    • Social determinants of health: low socioeconomic status, little social support, location of residence (exposure to allergens more frequent in urban areas), discrimination due to race or other social factors
    • Comorbidities, especially cardiovascular disease, other chronic lung disease, psychiatric disease, substance use disorder

Etiology

  • Inflammatory process of the airways evidenced by episodic and reversible airflow obstruction and hyperresponsiveness with many cells and cellular elements contributing to the disease:
    • Neutrophils
    • Mast cells
    • Eosinophils
    • Macrophages
    • T-lymphocytes
    • Epithelial cells
    • Cytokines
    • IgE
  • Triggers:
    • Pollen
    • Dust mites
    • Molds
    • Animal dander
    • Other environmental allergens
    • Viral upper respiratory infections
    • Occupational chemicals
    • Tobacco smoke
    • Environmental change
    • Cold air
    • Exercise induced
    • Emotional factors
    • Menstrual associated
    • Drugs:
      • Aspirin
      • NSAIDs
      • β-Blockers

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