16.01.2016
Asthma is a chronic disease of the respiratory system in which the airway occasionally constricts, becomes inflamed, and is lined with excessive amounts of mucus, often in response to one or more triggers. The symptoms of asthma, which can range from mild to life threatening, can usually be controlled with a combination of drugs and environmental changes.
The use of bronchodilators started in 1901, but it was not until the 1960s that the inflammatory component of asthma was recognized, and anti-inflammatory medications were added to the regimen. In most cases, a physician can diagnose asthma on the basis of typical findings in a patient's clinical history and examination.
Testing peak flow at rest (or baseline) and after exercise can be helpful, especially in young asthmatics who may experience only exercise-induced asthma. Chronic obstructive pulmonary disease, which closely resembles asthma, is correlated with exposure to cigarette smoke, an older patient, less symptom reversibility after bronchodilator administration (as measured by spirometry, or measuring of breath), and decreased likelihood of family history of atopy.
Pulmonary aspiration (the entry of secretions or foreign material into the trachea and lungs), whether direct due to dysphagia (swallowing disorder) or indirect (due to acid reflux), can show similar symptoms to asthma. Asthma is categorized by the United States National Heart, Lung and Blood Institute as mild persistent, moderate persistent, and severe persistent.
Although asthma is more common in affluent countries, it is by no means a problem restricted to such nations; WHO estimates that there are between 15 and 20 million asthmatics in India.
There appears to be a relatively high incidence of asthma in sports such as cycling, mountain biking, and long-distance running, and a relatively lower incidence in weightlifting and diving. The quality of asthma treatment varies along racial lines, likely because many low-income people cannot afford health insurance and because there is still a correlation between class and race.
If gastro-esophageal reflux disease (GERD) is present, the patient may have repetitive episodes of acid aspiration, which results in airway inflammation and "irritant-induced" asthma. Later, when an asthmatic inhales the same allergen, these antibodies "recognize" it and activate a humoral response. The Beta-Adrenergic Theory has been cited in the scholarship of such noted investigators as Richard Lockey (former President of The American Academy of Allergy, Asthma, and Immunology), Charles Reed (Chief of Allergy at Mayo Medical School), and Craig Venter (Human Genome Project). Signs of an asthmatic episode or asthma attack are shortness of breath (dyspnea), either stridor (a high-pitched breathing noise caused by obstruction of the airway) or wheezing, rapid breathing (tachypnea), prolonged expiration, a rapid heart rate (tachycardia), rhonchous lung sounds (audible through a stethoscope), and over-inflation of the chest.
Although stridor is "often regarded as the sine qua non of asthma,"[29] some victims primarily exhibit coughing, and in the late stages of an attack, air motion may be so impaired that no wheezing may be heard. During very severe attacks, an asthma sufferer can turn blue from lack of oxygen, and can experience chest pain or even loss of consciousness. The most effective treatment for asthma is identifying triggers, such as pets or aspirin, and limiting or eliminating exposure to them. As is common with respiratory disease, smoking adversely affects asthmatics in several ways, including an increased severity of symptoms, a more rapid decline of lung function, and decreased response to preventive medications.[30] Asthmatics who smoke typically require additional medications to help control their disease.
The specific medical treatment recommended to patients with asthma depends on the severity of their illness and the frequency of their symptoms. For those in whom exercise can trigger an asthma attack (exercise-induced asthma), higher levels of ventilation and cold, dry air tend to exacerbate attacks.
A novel therapeutic target currently under investigation is the A2B receptor, a cell surface G-protein coupled receptor expressed in the lungs and in inflammatory cells expressed in asthma.
Given that some research has identified a negative association between helminth infection (hookworm) and asthma and hay fever, some have suggested that hookworm infestation, although not medically sanctioned, would cure asthma.
Long-acting bronchodilators (LABD) are similar in structure to short-acting selective beta2-adrenoceptor agonists, but have much longer sidechains resulting in a 12-hour effect, and are used to give a smoothed symptomatic relief (used morning and night). Currently available long-acting beta2-adrenoceptor agonists include salmeterol, formoterol, bambuterol, and sustained-release oral albuterol.
Current treatment protocols recommend prevention medications such as an inhaled corticosteroid, which helps to suppress inflammation and reduces the swelling of the lining of the airways, in anyone who has frequent (greater than twice a week) need of relievers or who has severe symptoms.


Asthmatics sometimes stop taking their preventive medication when they feel fine and have no problems breathing. Inhaled glucocorticoids are the most widely used of the prevention medications and normally come as brown inhaler devices (ciclesonide, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, and triamcinolone). Long-term use of corticosteroids can have many side effects including a redistribution of fat, increased appetite, blood glucose problems and weight gain. Methylxanthines (theophylline and aminophylline), which are sometimes considered if sufficient control cannot be achieved with inhaled glucocorticoids and long-acting ?-agonists alone. If chronic acid indigestion (Gastroesophageal reflux disease, GERD) contributes to a patient's asthma, it should also be treated, because it may prolong the respiratory problem. Symptomatic control of episodes of wheezing and shortness of breath is generally achieved with fast-acting bronchodilators.
Short-acting, selective beta2-adrenoceptor agonists, such as salbutamol (albuterol United States Adopted Name (USAN)), levalbuterol, terbutaline, and bitolterol, which normally come as blue inhaler devices.
Tremors, the major side effect, have been greatly reduced by inhaled delivery, which allows the drug to target the lungs specifically; oral and injected medications are delivered throughout the body. Older, less selective adrenergic agonists, such as inhaled epinephrine and ephedrine tablets, are available over the counter in the US. New World Encyclopedia writers and editors rewrote and completed the Wikipedia article in accordance with New World Encyclopedia standards. This airway narrowing causes symptoms such as wheezing, shortness of breath, chest tightness, and coughing, which respond to bronchodilators.
Hippocrates thought that the spasms associated with asthma were more likely to occur in tailors, anglers, and metalworkers. Moses Maimonides, an influential medieval rabbi, philosopher, and physician, wrote a treatise on asthma, describing its prevention, diagnosis, and treatment.[4] In the seventeenth century, Bernardino Ramazzini noted a connection between asthma and organic dust. The majority of these triggers can often be identified from the history; for instance, asthmatics with hay fever or pollen allergy will have seasonal symptoms, those with allergies to pets may experience an abatement of symptoms when away from home, and those with occupational asthma may improve during leave from work. The diagnosis of "severe persistent asthma" occurs when symptoms are continual with frequent exacerbations and frequent nighttime symptoms and results in limited physical activity, and when lung function as measured by PEV or FEV1 tests is less than 60 percent predicted with PEF variability greater than 30 percent.
According to the Centers for Disease Control and Prevention's (CDC) National Health Interview Surveys, some 9 percent of US children below 18 years of age had asthma in 2001, compared with just 3.6 percent in 1980 (see figure). One survey of participants in the 1996 Summer Olympic Games showed that 15 percent had been diagnosed with asthma, and that 10 percent were taking asthma medication.[8] These statistics have been questioned on at least two bases. In the Western world these are disproportionately minority, and more likely to live near industrial areas.
For example, black Americans are less likely to receive outpatient treatment for asthma despite having a higher prevalence of the disease, they are more likely to have emergency room visits or hospitalization for asthma, and they are three times as likely to die from an asthma attack compared to white Americans. In both asthmatics and non-asthmatics, inhaled allergens that find their way to the inner airways are ingested by a type of cell known as antigen presenting cells, or APCs.
Inflammation results and chemicals are produced that cause the airways to constrict and release more mucus, and the cell-mediated arm of the immune system is activated. Epidemiological findings give clues as to the pathogenesis (or its origin): the incidence of asthma seems to be increasing worldwide, and asthma is now much more common in affluent countries. In nature, babies are exposed to bacteria and other antigens soon after birth, "switching on" the TH1 lymphocyte cells of the immune system that deal with bacterial infection.
In others, it is an intermittent illness marked by episodic symptoms that may result from a number of triggering events, including upper respiratory infection, airborne allergens, and exercise. During a serious asthma attack, the accessory muscles of respiration (sternocleidomastoid and scalene muscles of the neck) may be used, shown as in-drawing of tissues between the ribs and above the sternum and clavicles, and the presence of a paradoxical pulse (a pulse that is weaker during inhalation and stronger during exhalation). Specific treatments for asthma are broadly classified as relievers, preventers, and emergency treatment.


While patients report improved symptom control, these drugs do not replace the need for routine preventers, and their slow onset means the short-acting dilators may still be required. The spacer is a plastic cylinder that mixes the medication with air in a simple tube, making it easier for patients to receive a full dose of the drug and allows for the active agent to be dispersed into smaller, more fully inhaled bits.
They have no cardiac side effects and thus can be used in patients with heart disease; however, they take up to an hour to achieve their full effect and are not as powerful as the ?2-adrenoreceptor agonists. This article abides by terms of the Creative Commons CC-by-sa 3.0 License (CC-by-sa), which may be used and disseminated with proper attribution. A bronchodilator is a medication intended to improve bronchial airflow by acting on ?2 receptors in bronchial smooth muscle and bronchial mucus membranes.
Direct aspiration (dysphagia) can be diagnosed by performing a Modified Barium Swallow Test (a test involving X-rays, in which the swallowing mechanism of the patient can be viewed on a video screen) and can be treated with feeding therapy by a qualified speech therapist. Occasionally, allergy tests are warranted and, if positive, may help in identifying avoidable symptom triggers.
For one, persons with mild asthma may be more likely to be diagnosed with the condition than others because even subtle symptoms may interfere with their performance and lead to pursuit of a diagnosis. Inflammation soon follows, leading to a further narrowing of the airways and excessive mucus production, which leads to coughing and other breathing difficulties.
If this stimulus is insufficient—as it may be in modern, clean environments—then TH2 cells predominate, and asthma and other allergic diseases may develop. Despite the severity of symptoms during an asthmatic episode, between attacks an asthmatic may show few signs of the disease. Patients must be cautioned against using these medicines too frequently, as with such use their efficacy may decline, producing desensitization resulting in an exacerbation of symptoms which may lead to refractory asthma and death. Breathing disorders during sleep are common among asthmatics, may help predict severe asthma. Serevent Diskus, Advair Diskus, and Foradil Information (Long Acting Beta Agonists): Drug information. Common asthma inhalers cause up to 80 percent of asthma-related deaths, Cornell and Stanford researchers assert.
Credit is due under the terms of this license that can reference both the New World Encyclopedia contributors and the selfless volunteer contributors of the Wikimedia Foundation. But human creativity has been applied to develop a myriad of ways to prevent attacks and relieve symptoms, such as tightness of the chest and trouble breathing. Diagnosis in children is based on a careful compilation and analysis of the patient's medical history and subsequent improvement with an inhaled bronchodilator medication.
In most people, these other immune cells (TH0 cells, or T helper cells) "check" and usually ignore the allergen molecules.
National Asthma Education and Prevention Program, and the British Guideline on the Management of Asthma[33] are broadly used and supported by many doctors. In adults, diagnosis can be made with a peak flow meter (which tests airway restriction), looking at both the diurnal variation and any reversibility following inhaled bronchodilator medication. The TH2 lymphocytes and eosinophil cells (both types of white blood cells involved in immune response) that protect us against parasites and other infectious agents are the same cells responsible for the allergic reaction.
In the developed world, these parasites are now rarely encountered, but the immune response remains and is wrongly triggered in some individuals by certain allergens.
Pathogenic bacteria and viruses in induced sputum or pharyngeal secretions of adults with stable asthma.



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