1. What is Asthma ?
1.1. Familial Disorder
1.2. 100 genes identified
1.3. Hyper responsive airways
2. What increases risk of developing asthma?
2.1. Genetics
2.2. Age at onset
2.3. High levels of allergen exposure
2.4. Exposure to air pollution
2.5. Recurrent respiratory tract infections
2.6. Gastroesophageal re-flux disease (GERD)
2.7. Obesity
3. Early asthmatic response caused by allergen or irritant exposure
3.1. Immune activation
3.1.1. Interleukin-4 productions
3.1.2. IgE Production
3.2. Mast Cell Degranulation
3.2.1. Chemotactic Mediators
3.2.1.1. Cellular infiltration
3.2.1.1.1. Neutrophils
3.2.1.1.2. Lymphocytes
3.2.1.1.3. Eosinophils
3.2.2. Vasoactive Mediators
3.2.2.1. Vasodilation
3.2.2.1.1. Bronchospasm
3.2.2.1.2. Vascular congestion
3.2.2.1.3. Impaired Mucocilliary function
3.2.2.1.4. Thickening of airway walls
3.2.2.1.5. Increased contractile function of bronchial smooth muscle
3.2.2.1.6. Mucous secretion
4. Clinical Presentation
4.1. Reversible decreases in FEV1
4.2. Severe Broncho spasm
4.3. Hypoxemia
4.4. Acidosis (caused by a rise in PaCO2)
4.5. Lethal warning signs
4.5.1. PaCO2 > 70 mmHg
4.5.2. Absent breath sounds (silent chest)
4.5.3. Emergent treatment necessary
5. Hygiene Hyposthesis
6. Evaluation
6.1. History of Allergies
6.2. Recurrent episodes of wheezing
6.3. Excerise intolerance
6.4. Dyspnea and cough
7. Treatment
7.1. Rapid assessment of arterial blood gases
7.2. Search for underlying triggers
7.3. Mechanical ventilation if indicated
7.4. Management of Chronic symptoms
7.4.1. short acting beta agonists
7.4.2. inhaled corticosteroids
7.4.3. leukotriene antagonists for those not controlled on corticoseteroids
7.4.4. Avoidance of allergens and irritants
7.4.5. Develop Action plan for worsening symptoms