Asthma

• Respiratory symptoms


  • Wheezing
  • Shortness of breath
  • Chest tightness
  • Cough
  • Expiratory airflow limitation
• Classifications

  • Frequency of Symptoms
  • Frequency of Medication
  • FEV1
  • PEFR
• Pathophysiology

  1. Initial allergen exposure

  2. Dendritic cell uptake

  3. Activation of Th2 cells

  4. Release of cytokines (IL-13/4 and IL-5)

  5. IL-13/4 leads to IgE release, IL-5 leads to Eosinophils release

  6. Mast cell-IgE complex leads to degranulation of mast cells, IL-5 leads to Eosinophils release

  7. Release of more cytokines and LT

  8. Hyperreactive responses
• Fatal Asthma: Status asthmaticus - bluish coloration on the lips, inability to speak in full sentences, hunched shoulders, orthopnea
• Levels of Asthma

  • Intermittent
  • Mild Persistent
  • Moderate Persistent
  • Severe Persistent
• Background of the disease

  • Chronic inflammatory disease of the airways
  • Defined by respiratory symptoms
  • Heterogeneous
  • Immunohistopathologic features
• Risk factors


  • Environmental exposure
  • Genetic predisposition
  • Obesity
  • Race
  • Sex
• Main causes

  • Airway inflammation
  • Bronchial hyperresponsiveness
  • Intermittent airflow obstruction
• Asthma phenotypic classification (GINA)

  • Allergic Asthma: childhood, associated with a family history of atopy
  • Non-allergic Asthma
  • Adult-onset Asthma: often non-allergic, rule out occupational asthma
  • Asthma with persistent airflow limitation
  • Asthma with obesity
• Diagnosis

  1. Physical Examination

  2. Medical and Famil
• Clinical manifestation

  • Coughing
  • Chest tightness
  • Dyspnea
  • Wheezing
• Status asthmaticus


  • bluish coloration on the lips
  • inability to speak in full sentences
  • hunched shoulders
  • orthopnea
• Diagnosis: Spirometry with bronchodilator

  • Measures: how much and how fast air moves in and out both before and after breathing in a bronchodilator
• Challenge Agents for Bronchoprovocation Test

  • Inhaled methacholine
  • Inhaled mannitol
  • Histamine
  • Exercise
• Diagnosis: Sputum Test

  • Curschmann spirals in the sputum - Coiled, basophilic mucinous elongated casts sometimes found in the sputum and tracheal/bronchial washings
• Reliever

  • Rescue medication
  • Acute attacks
  • Quick relief of symptoms
  • Action lasts up to 4 to 6 hours
• Long-term treatment goals

  • Symptom control: To attain good control of symptoms and maintain normal activity levels
  • Risk reduction: To minimize future risk of exacerbations, fixed airflow limitation, and medication side effects
• Diagnosis: Fractional Exhaled Nitric Oxide


  • Measures: the amount of nitric oxide that is exhaled
• Controller

  • Control/treat chronic inflammation
  • Prevent future attacks
  • Long-term control
  • Prevent airway remodeling
• SHORT-ACTING
• Diagnosis: Bronchoprovocation Test


  • Measures: how airways react when the patient breathe in specific substances in the air
• Fatal Asthma
• Diagnosis: Peak Expiratory Flow Test

  • Measures: how fast the patient can exhale, the degree of obstruction in the airway
• Diagnosis

  1. Physical Examination

  2. Medical and Family History

  3. Allergy Tests

  4. Blood Tests and Sputum Test

  5. Spirometry with/without a bronchodilator

  6. Bronchoprovocation

  7. Peak Expiratory Flow Test

  8. Fractional Exhaled Nitric Oxide
• Reliever
• Diagnosis: Spirometry

  • Measures: how much air one can breathe in and out, how easily and fast they can blow the air out
• Long-term treatment goals
• Controller
• Treatment: Beta-2 Agonist
• Methylxanthines Treatment


  Promotes smooth muscle relaxation
• Monoclonal Antibody Treatment

  Omalizumab – humanized, monoclonal anti-IgE antibody
• Leukotriene Receptor Antagonist (LTRA) Treatment


  Inhibits cysteinyl leukotriene receptor for prevention of LT-induced symptoms
• Methylxanthines

  • Theophylline
  • Doxofylline: better safety profile
• Non-Pharmacologic Treatments


  • Breathing exercise
  • Knowing the triggers
  • Weight loss
• Anticholinergics

  • Ipratropium: short-acting, 4 to 8 hours
  • Tiotropium: long-acting, 24 hours
• Controller

  • Control/treat chronic inflammation
  • Prevent future attacks
  • Long-term control
  • Prevent airway remodeling
• Anticholinergics Treatment

  Provide relief of bronchospasm
• Treatment

  1. Reliever

  2. Controller
• Reliever

  • Rescue medication
  • Acute attacks
  • Quick relief of symptoms
  • Action lasts up to 4 to 6 hours
• Inhalational therapy is preferred over oral therapy due to direct delivery, smaller dose, fewer side effects, and safety for long-term use