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Asthma

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Asthma
Classification and external resources
An asthma attack causes the airways to constrict, and too much mucous to be made which makes breathing difficult.
ICD-10J45.
ICD-9493
OMIM600807
DiseasesDB1006
MedlinePlus000141
eMedicinearticle/806890
MeSHD001249

Asthma (or Asthma bronchiale) is a disease that causes affects the airways - called bronchi and bronchioles - that are inside the lungs. It causes the tissue inside the airways to swell, and the bands of muscle around the airways to constrict making them too narrow for enough air to pass through and breath normally. Asthma also causes the goblet cells inside the airways to make more mucous than normal, this clogs the airways which are already too narrow during an asthma attack, making it even more difficult to breath.

A person having an asthma attack often makes wheezing sounds when trying to breath, this is the sound of air trying to pass through the too narrow airway. They also have shortness of breath, which means they cannot take a full deep breath; chest tightness which feels like their chest is being squeezed and they may also cough a lot.

Asthma attacks can be a medical emergenciy because they can be fatal (cause a person to die).

Types of Asthma[edit | edit source]

This is a cross-section of the primary bronchi (one is bronchus, two are bronchi) which shows the inside of the airways.[1] It is a posterior view which means looking from behind.[2]

Atopic asthma[edit | edit source]

Atopic asthma is the most common form of asthma. Atopy is when there are changes in some of the genes a person is born with (genetic predisposition) that makes them much more sensitive (hypersensitive) to environmental antigens - such as chemicals, smoke, dust etc. This hypersensitivity causes their body to react in certain ways, usually a person who is atopic develops allergic rhinitis but they may also get atopic dermatitis, food allergy and asthma. If a person has one parent who is atopic they have a 50% chance of being atopic too. If they have two parents who are atopic they have a 75% chance of being atopic.[3]

Cough-variant asthma[edit | edit source]

Cough-variant asthma is a type of asthma in which a cough is the main, and sometimes only sign. Cough-variant asthma usually does not cause wheezing or breathlessness and causes a dry, scratchy, mostly nonproductive cough (this means little or no phlegm is coughed up). About 30% of people who have cough-variant asthma will develop typical asthma.[4]

Work-related asthma[edit | edit source]

These workers are checking the furnace at a steel factory. The furnace gives off smoke, fumes and small particles. These are irritants and they can cause or trigger work-related asthma.

Work related asthma are types of asthma that are caused or made worse by irritants in the environment at a person's place of work. The kind of jobs that may cause work related asthma are usually those in which there is a lot of smoke or chemicals are used. There are different types of work-related asthma (WRA):[5]


1. Occupational asthma with latency: this asthma type is when the signs and symptoms of asthma occur after a period of time (latency) after being exposed to the environmental irritants. e.g.: John starts working at a factory where chemicals are used the first week of January. At the end of March he starts developing the signs and symptoms of asthma. The period of time from when he started the job in January to when the signs and symptoms of asthma started in March is the latency period.[6]


2. Irritant-Induced Asthma (IIA) is occupational asthma without latency: this is an asthma type is when the signs and symptoms of asthma can occur immediately (without latency) after being exposed to the environmental irritants. [[Frank starts a new job working as a janitor where he uses ammonia to clean. After opening the bottle of ammonia and breathing the fumes Frank starts finds it difficult to breath, his chest tightens up and he develops other signs and symptoms of asthma.[7]

3. Reactive Airways Dysfunction Syndrome (RADS):

4. Work-aggravated asthma: this is when a person already has asthma and environmental triggers at their place of work makes it worse.

Exercise induced asthma[edit | edit source]

Exercise induced asthma (EIA) - also called exercise induced bronchospasm - is the term used to describe asthma cases in which exercise is the main, and many times the only trigger for an asthma attack. If a person already has a form of asthma or they are atopic there is more of a chance of getting EIA.

Nocturnal asthma[edit | edit source]

Nocturnal asthma: is the term used to describe asthma cases that get worse at night (nocturnal).

Status asthmaticus[edit | edit source]

Status asthmaticus is a severe form of asthma in which an asthma attack gets worse as it goes along and the medicines that are usually used to treat asthma do not work. Status asthmaticus can be fatal.[8]

Triggers[edit | edit source]

Animation of the airway (bronchiole) getting narrower (constriction) because of inflammation caused by an asthma attack. The small objects entering the bronchiole are irritants - irritants can be of many different types, such as pollen, dust, tobacco or wood smoke, etc. - which can trigger an asthma attack. In healthy lungs when irritants are breathed in and enter the airways they are trapped by a thin layer of mucous. During an asthma attack as shown here, too much mucous is made, which then blocks the already constricted airway further. This makes it difficult to breathe because air cannot get through.

A trigger factor or trigger for short, is something that causes the signs and symptoms of a medical condition to begin in a person who already has that medical condition. Common triggers for asthma are:

  • Cigarette smoke
  • Pets (Cats and dogs)
  • Bugs
  • Mold
  • The outdoors
  • Exercise

The way to avoid triggers is to get rid of them if possible.

Asthma attack.PNG

Treatment[edit | edit source]

A woman using an inhaler which has medicine to treat an asthma attack inside. When the inhaler is placed in the mouth and pressed the medicine is sprayed into the throat and then enters the lungs.[9]

Asthma can be controlled most often by avoiding contact with triggers and by using certain drugs. Most asthma sufferers carry special medicines around with them. These are called inhalers. The medicine inside the inhaler opens the tubes that go to the lungs. The inhaler is usually used to prevent an asthma attack, or to stop an attack that is already happening.

Rescue medicine — A rescue medicine is an inhaler ("puffer") that is used if a person thinks they are having an asthma attack.

Controller medicine — A controller medicine is a medicine in either a pill or an inhaler taken every day to prevent asthma attacks.

Common treatment in a hospital[edit | edit source]

Hospitals have other options they can use in an emergency when the regular treatments don't work:

  • Oxygen
  • Certain drugs that act like an asthma spray, but are much stronger
  • Certain drugs that can be given through an IV (intravenously).
  • Steroids
  • Breathing aids (including tubes, and valves in very severe cases)

Certain types of drugs can make an asthma attack worse[edit | edit source]

There are certain types of drugs that can make an asthma attack worse. These drugs include Aspirin, Paracetamol and Non-steroidal anti-inflammatory drugs. Using Beta blockers is dangerous: On of the effects they have is to tighten the airways.

Epidemiology[edit | edit source]

Asthma rates by age, sex and race in the United States in 2011. (CDC)
This map shows how many asthma cases there were in each country in 2003.[10]
Percentage of population
     >10.1      7.6-10.0      5.1—7.5      2.5-5.0      0-2.5      no data: for these areas there was not enough information.

In medicine epidemiology is the study of what causes diseases and medical conditions, how often they happen, where they happen and who they happen to.[11]

Asthma is more common in younger people and is twice as common in boys as girls, however cases of severe asthma happen at about the same rate in both sexes.[12] In adults women have a higher rate of asthma than men.

In developed countries like the United States, Canada, Germany etc. it is more common in poor people but in developing countries it is more common in people who are not poor. More than 80% of the people who die from asthma are from low and middle income countries .[13]

As of 2011, 235–300 million people worldwide are affected by asthma,[14] and approximately 250,000 people die per year from the disease. Rates vary between countries with prevalences between 1 and 18%.It is more common in developed than developing countries.

The amount of asthma cases reported each year has gotten much higher between the 1960s and 2008[15][16][17] Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world.[18] Asthma affects approximately 7% of the population of the United States and 5% of people in the United Kingdom.[19] Canada, Australia and New Zealand have rates of about 14–15%.[20]

References[edit | edit source]

  1. Lois White, Gena Duncan: Medical Surgical Nursing: An Integrated Approach. Delmar Cengage Learning; 2 edition (2001); p.385 ISBN 0766825663
  2. posterior view: Merriam-Webster: Visual Dictionary Online
  3. William M. Thurlbeck, Andrew M. Churg: Pathology of the Lung Thieme Medical Publishers; 2 Sub edition (1995) p. 144 ISBN 0865775346
  4. Juzar Ali, Warren Summer, Michael Levitzky: Pulmonary Pathophysiology, A Clinical Approach: McGraw-Hill Medical; 3 edition, 2009 p.25 ISBN 0071611541
  5. Jeffrey Brent, Kevin Wallace, Keith Burkhart: Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient, Mosby; 1 edition (2004); p.1000 ISBN 0815143877
  6. Severe Asthma: Pathogenesis and Clinical Management (Lung Biology in Health and Disease): editors: Stanley J Szefler, Donald Y. M. Leung. CRC Press; 2 edition (2001); p.382 ISBN 082470552
  7. John B. Sullivan, Jr., Gary R. Kriege: Clinical Environmental Health and Toxic Exposures : Lippincott Williams & Wilkins; Second edition (2001) p.230 ISBN 068308027X
  8. David Dolinak, Evan Matshes, Emma O. Lew: Forensic Pathology: Principles and Practice. Academic Press; 1 edition, 2005. p.356 ISBN 0122199510
  9. Donna Falvo: Medical And Psychosocial Aspects Of Chronic Illness And Disability. Jones & Bartlett Learning, 4th edition (2010) p.338; ISBN 0763731668
  10. Global Initiative for Asthma
  11. epidemiology: Free Merriam Webster Dictionary 2013, retrieved January 11, 2013
  12. Bush A, Menzies-Gow A (December 2009). "Phenotypic differences between pediatric and adult asthma". Proc Am Thorac Soc 6 (8): 712–9. doi:10.1513/pats.200906-046DP. PMID 20008882.
  13. World Health Organization. "WHO: Asthma". Archived from the original on 15 December 2007. http://www.who.int/mediacentre/factsheets/fs307/en/. Retrieved 2007-12-29.
  14. "World Health Organization Fact Sheet Fact sheet No 307: Asthma". 2011. http://web.archive.org/web/20110629035454/http://www.who.int/mediacentre/factsheets/fs307/en/. Retrieved February 20 17th,2013.
  15. Grant EN, Wagner R, Weiss KB (August 1999). "Observations on emerging patterns of asthma in our society". J Allergy Clin Immunol 104 (2 Pt 2): S1–S9. doi:10.1016/S0091-6749(99)70268-X. PMID 10452783.
  16. Anandan C, Nurmatov U, van Schayck OC, Sheikh A (February 2010). "Is the prevalence of asthma declining? Systematic review of epidemiological studies". Allergy 65 (2): 152–67. doi:10.1111/j.1398-9995.2009.02244.x. PMID 19912154.
  17. Murray and Nadel's textbook of respiratory medicine. (5th ed. ed.). Philadelphia, PA: Saunders/Elsevier. 2010. pp. Chapter 38. ISBN 1-4160-4710-7.
  18. Bousquet, J; Bousquet, PJ; Godard, P; Daures, JP (2005 Jul). "The public health implications of asthma.". Bulletin of the World Health Organization 83 (7): 548–54. PMID 16175830.
  19. Anderson, HR; Gupta R, Strachan DP, Limb ES (January 2007). "50 years of asthma: UK trends from 1955 to 2004". Thorax 62 (1): 85–90. doi:10.1136/thx.2006.066407. PMC 2111282. PMID 17189533.
  20. Masoli, Matthew (2004). Global Burden of Asthma. p. 9. http://www.ginasthma.org/pdf/GINABurdenReport.pdf.