Bronchial Asthma

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BRONCHIAL ASTHMA

Definition: It is an allergic condition characterized by paroxysmal attacks of dyspnoea accompanied by wheezing, chiefly expiratory in nature, associated with bronchial spasm.

Types: (a) Extrinsic—Starts in childhood becomes alright in adult life (b) Intrinsic—Starts in adult, continue rest of life.

Aetiology: Predisposing factors—(a) Heredity, (b) Sex— Both. (c) Age—usually start in childhood or early adult life.

Exciting factors: (a) Psychic upset-emotional anxiety, worry etc. (b) Bronchial stimulation—by cold air or fog, dust, fumes etc. (c) Bronchial infection by various pathogenic organisms. (d) Allergy to various—i) inhalants, e.g. pollens, room dust, book dust, orris-root powder, animal and flower emanations, drugs, gum acacia etc. (ii) ingestants e.g. eggs, milk, fish, cheese, crabs, drugs etc.

Pathology: During the attacks, lungs are voluminous and emphysematous, filling the entire pleural cavities. Area of emphysema alternate with the areas of Atelectasis or collapse.

In an uncomplicated case, however, there may be no emphysema. If (asthma) associated with bronchitis, emphysema ensues.

Clinical Features: Symptoms—I. During an attack—(i) paroxysmal attack (sudden appearance & sudden relief) (2) Expiratory dyspnoea (3) Period of freedom (4) Description of attack :— (a) patient Sits upright, (b) holds something, (c) leans forwards, (d) tries with all efforts to expel air from lungs, (e) becomes pale and cyanotic.

II. In between attack—No troubles.

Signs: During an attack—(l) Cyanosis, pale, tachycardia, accessory muscles of respiration becomes prominent. (2) Inspection—chest is hold in the position of full inspiration, neck veins prominent. (3) Palpation—Vocal fremitus slightly diminished. (4) Percussion—hyper-resonant lungs; cardiac and liver dullness diminished, (5) Auscultation—Wheezing rhonchi sound present, a few crepitations may be present.

(6) Other systems—ft long standing cases-right heart failure.

Investigations: (1) Blood shows slight eosinophilia. (2) Lung function test—abnormal. (3) X-ray of chest—increased bronchial marking or may show emphysematous changes in late stages. (4) Sputum shows presence of eosinophils, Charcot-Leyden crystals, Cruschmann‘s spirals and Laennec’s pearls.

Differential Diagnosis: (1) Cardiac Asthma — there is usually a lesion in the heart with or without congestive heart failure. The breathing tends to be less labored, but more rapid. (2) Renal Asthma — There is usually a history of chronic nephritis; the urine contains albumin. Relief is obtained by giving alkalies to overcome acidosis. (3) Bronchopneumonia — High temperature, toxemia, dyspnoea etc. are the main symptoms. (4) Pulmonary embolism sudden severe breathlessness with chest pain and rusty sputum. (5) Tropical Eosinophilia — usually young age, dominant cough and the characteristic blood picture are the main features. 6) Chronic bronchitis —  cough with sputum. Middle aged smokers or during childhood.

Complications: (I) Status Ashmaticus. (2) Bronchitis or Tuberculosis. (3) Emphysema of lungs (4) Bronchiectasis. (5) Infection with all sequels. (6) Right heart failure

At stages called chronic Cor Pulmonale.

Status Asthmaticus: It is a state of series of asthmatic attacks without any remission which makes the patient exhausted and out of sort. In severe cases the characteristic features are — (1) Severe breathlessness and anxiety. ) Inability to speak with one breath (3) Cyanosis (4) Pulse rate is increased; pulsus paradoxus. (5) Copious bronchial secretion. (6) Severe hyperinflation of the chest. Breath sound markedly diminished. Chronic (Bronchial) Asthma The paroxysmal character of symptoms is lost, the chief clinical features being continuous braze and breathlessness on exertion. Cough and mucoid with recurrent episodes of frank respiratory infection, a common and may be due to associated chronic bronchitis.

Prognosis The individual attack is good, except in severe asthmaticus where there is occasionally a fatal outcome.

Treatment: (I) Prevention of cold, dust, infection; Food avoid allergens. (2) Rest in bed in propped up position

If you want to experience a different approach to control your asthma, watch the video below. It contains a yoga lesson dedicated to this condition.

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