Asthma is a chronic inflammatory disease of the airways involving a range of cells, including mast cells and eosinophils. This inflammation causes in susceptible persons symptoms which are usually associated with intense but variable obstruction of airways, often spontaneously reversible or under treatment and causing bronchial hyperreactivity, occurring due to allergic or non-allergenic stimuli.
From the pathophysiological point of view, the recurrent and episodic bronchial obstruction is caused by inflammation, bronchial spasm and bronchial hypersecretion.
“Genetic factor has been shown to predispose to asthma occurrence, as evidenced by children of allergic (atopic) parents, which often have allergic reactions marked by high levels of IgE (e.n. – immunoglobulin E, also called Reagin)”, says Dr. Anca Mihalcescu , specialist of Internal Medicine, Lung specialist at Romgermed.
What causes the disease
Causative factors are: household allergens (room dust contains mite powder, animal allergens contained in saliva, appendages, urine or feces of pets and fungi – mold spores; environmental allergens (pollens of trees in spring and summer, fungi, occupational, such as physical effort or professional allergens).
“Main causes are smoking, air pollution (asthma frequently occurs in industrialized cities), home pollution from heating sources, respiratory viral infections with sincytial virus, rhinovirus, influenza and parainfluenza viruses, frequently occurred in childhood”, warns Dr. Anca Mihalcescu.
The factors that trigger asthma attack are causal factors, or physical effort, cold air, fog, food additives, drugs (asthmatics shall not take aspirin or other NSAIDs, with caution Paracetamol).
Asthma can be manifested by attacks of breathlessness, accompanied by wheezing (whistling) and pronounced nocturnal cough that awakes the patient. Between these bouts, a normal state of the patient could be noticed, in which no symptom is present. Atypical onset is manifested only by episodic irritating cough with or without nasal coryza.
“Diagnosis is easily determined if the patient is seen in the crisis, otherwise the medical history is very important. Exploration of ventilatory function is realized through spirometry and PEF or FEV variability and their reversibility under treatment confirms the suspicion of asthma. FEV values <75% for adult and FEV <85% in children prove bronchial obstruction and in bronchodilator tests (with beta 2 agonists) FEV must increase by 15-20% (~ 200 ml), which shows a positive test with reversibility of obstruction”, explains Dr. Mihalcescu.
Extrinsic asthma is triggered by an allergen, begins in childhood, with increased level of IgE and positive skin tests.
Intrinsic asthma is caused by infectious factors, with ambiguous skin tests and normal IgE titers.
Nocturnal asthma is frequently caused by house dust or a gastro-esophageal reflux must be excluded.
Asthmaticus status is the most dramatic picture of asthma characterized by dyspnea crisis with polipnea, accompanied by psychical agitation or by confusion. The patient experiences accentuated wheezing, tachycardia, can not articulate words, have hypotension and PaO2 is greater than 60 mm Hg, and pulmonary listener: respiratory silence or “pigeon noise”.
Asthma with pulmonary infiltrates, including allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome, Periarteritis nodosa.
Stages of evolution:
- Mild intermittent asthma
- Mild persistent asthma
- Moderate persistent asthma
- Severe persistent asthma
Differential diagnosis must be carefully realized in order to avoid another lung or heart disease. Thus, ECG has an important role and especially a cardiologic examination.
To properly treat asthma, several steps must be taken: identification of triggers and assessment of severity; therapeutic education of patient is the key to success; determination of medication adequate to severity. Anti-inflammatory medication includes corticosteroids, sodium nedocromil, theophylline, beta2agonistii with long-term action, sodium cromoglycate. Bronchodilator medication is represented by beta2agonisti, anticholinergics and theophylline.
Romgermed Medical Group offers customized solutions for the diagnosis, treatment and follow-up of patients suffering from asthma (and other diseases) through its clinics and laboratories in Bucharest.
Medical services (examinations, laboratory tests, ultrasound and other therapeutic maneuvers) are offered both as CASMB settlement and on additional charges – you can find further information at the reception of Romgermed Clinics or on site: www.clinicaromgermed.ro.