Chronic Asthma

Chronic Asthma

Pathology:                   Chronic,reversible airway inflammation causing obstruction to airflow due to increasedsensitivity to a variety of stimuli


·       Early reaction (minutes):bronchospasm

·       Late reaction (3-5 hours): oedemaand mucus


Aetiology:                    Genetic: Polygenic inheritance, atopy

Environmental: house dust mites, pet-derivedallergens, smoke, pollen and

                                 workplace agents, NSAIDs, beta-blockers, cold weather


Symptoms:                   Wheeze,shortness of breath, cough, chest tightness.


Signs:                              Polyphonicwheeze on auscultation, tachypnoea, diurnal variation


Investigations:          Spirometry: >15% improvement after B2agonist/steroid trial

Peak Expiratory Flow (PEF): >20% diurnal variation for>3days

Hypersensitivity Testing: e.g. skin prick tests, RAST, totalIgE level

Chest X-Ray: To exclude pneumothorax orinfection


Treatment:                 Treatment is based on Figure 2.6 andtreatment regimes should be stepped down  

after a period of well-controlled asthma forat least 3 months


















Figure 2.5 ChronicAsthma Treatment Protocol



Complications:          Persistent symptoms, infections,pneumothorax, long-term steroids, bronchiectasis


Prognosis:                    Generallyvery good


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