Asthma

Introduction and Facts

Asthma is a heterogeneous disease. Asthma is defined as a disease with a history of respiratory disorders in the form of coughing whose intensity varies from time to time, shortness of breath, chest compressions, accompanied by variable expiratory airflow obstruction. According to WHO, in 2011, it was estimated that there were 235 million asthmatics in the world.

Pathophysiology

The pathogenesis of asthma involves three main processes: airway inflammation, hyperresponsive bronchioles, and intermittent airflow obstruction. The inflammatory process involves T helper 2 and interleukin 4, which will stimulate IgE formation against allergens. IgE will attach to mast cells in the airways. When in contact with an allergen, mast cells that IgE has sensitized will release histamine mediators, prostaglandins which cause a hyperresponsive reaction in the bronchioles. The hyperresponsive bronchiolus reaction in edema and bronchoconstriction then results in airflow obstruction that varies in intensity.

In asthma, there are slow reactions and fast reactions in the airways:

1. Rapid reaction, arising from a few minutes to 2 hours maximum in the form of releasing mediators of allergic reactions from mast cells. Rapid response mainly causes bronchospasm.

2. Slow reaction, occurs after 3-5 hours later. In this slow reaction, bronchial spasm is also accompanied by mucosal edema and airway inflammation, reaching a maximum after 4-8 hours and disappearing after 8-12 hours or longer. This slow reaction is an inflammatory reaction of airway inflammation due to infiltration of inflammatory cells, especially eosinophil cells, airway hyperreactivity, and bronchospasm. Increased airway hyperreactivity occurs 8 hours after stimulation with allergens or other stimuli and persists or increases in severity for several days, even weeks.

Clinical Symptoms and Complications

The most common symptom of asthma is a wheezing sound when breathing. Other symptoms include shortness of breath, chest pain, chronic cough, and difficulty sleeping due to coughing or wheezing. Also called asthma flare-ups or asthma attacks, asthma symptoms are often caused by allergies and exposure to pet dander, dust mites, pollen, or mold. Non-allergic triggers include smoke, pollution or cold air, or changes in the weather.

Children with asthma may exhibit the same symptoms as adults, such as coughing, wheezing, and shortness of breath. In some children, a chronic cough may be the only symptom.

Diagnosis

On history, patients usually complain of intermittent breathing problems with four main symptoms, namely coughing, shortness of breath, chest compressions, and wheezing. These symptoms are generally more frequent or severe at night, in cold air, or triggered by specific allergens such as dust mites or animal dander. A respiratory infection or physical activity may also trigger symptoms.

On auscultation of patients who are experiencing symptoms, wheezing can be heard during expiration.

On spirometry examination, several parameters of the patient's respiratory function can be measured. When experiencing asthma symptoms, the forced expiratory volume of 1 second FEV1 will usually be measurably lower. FEV1 is the total volume of air the patient exhales when exhaling as hard as possible. Patients with low FEV1 were given bronchodilator drugs; If after administration of bronchodilator drugs there is an improvement of more than 12% and 200 mL, it is called positive bronchodilator reversibility and becomes a strong basis for the diagnosis of asthma.

Medication and Treatment

There is no cure for asthma, but symptoms can be controlled with effective asthma medication and management. This involves taking medication as directed and learning to avoid the triggers that cause asthma symptoms. Patients when experiencing severe shortness of breath can come to the emergency department. Treatment to relieve symptoms of asthma attacks using reliever drugs is adjusted to the severity of the asthma attack.

Patients with mild to moderate attacks can speak in sentences or a few words, sit or lie down, and have an oxygen saturation of 90-95% air. In mild attacks, do not have to use ipratropium.

Severe attack patients speak a few words, usually, stoop, and their oxygen saturation is less than 90%. If the attack is so intense that signs of respiratory failure such as impaired consciousness are found, endotracheal intubation and ICU treatment should be performed. In severe attacks, use short-acting beta2 agonist SABA, ipratropium, administration of oxygen with a target oxygen saturation of 93-95%, oral or intravenous corticosteroids, and intravenous magnesium may be considered.

Many people with asthma also have allergies, so doctors can also do allergy testing. Treating the allergy triggers that underlie asthma will greatly help sufferers avoid asthma symptoms.

Reference:

1. Prihartanto D. Treatment options in asthma attacks. CDK. 2016;437:541-3.

2. American Academy of Allergy Asthma & Immunology. Asthma [Internet]. 2019. Available from: https://www.aaaai.org/conditions-and-treatments/asthma