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Home > Blog > Pulmonology > Bronchial Asthma
Pulmonology

Bronchial Asthma

by Narayana Health May 20, 2020
written by Narayana Health May 20, 2020
Bronchial Asthma | Narayana Health

Asthma is a heterogeneous disease, characterized by chronic airway inflammation. It is defined by h/o respiratory symptoms such as dry cough, SOB, chest tightness, a wheeze that vary over time & intensity, together with variable expiratory airway limitation, which may later become persistent.

In common language, asthma is associated with airway hyper-responsiveness and airway inflammation in response to an external allergen; which leads to airway narrowing & subsequently difficulty in breathing.

Epidemiology:

  • As of 2004, it was estimated that as many as 300 million people of all ages suffer from asthma, by 2025, it is expected that this number will rise to 400 million worldwide (GINA).
  • The Indian study on the epidemiology of asthma.
  • Respiratory symptoms and chronic bronchitis (INSEARCH) in every adult, estimated the prevalence rate of asthma at 2.05% between 2007 and 2009, with an estimated burden of about 17.23 million in 2011.
  • Agarwal etal. estimated the prevalence rate of self-reported asthma at around 2%.

Asthma phenotypes: Recognizable cluster of demographic, clinical, and/or pathophysiological characteristics are k/an asthma phenotype.

  • Allergic asthma
  • Non-allergic asthma
  • Adult-onset (late-onset) asthma
  • Asthma with persistent airflow limitation
  • Asthma with obesity

Triggering factors:

  • Respiratory infection (viral)
  • Allergen or irritant exposure
  • Cold weather
  • Exercise
  • Smoke/dust/fumes
  • Medication such as B-blocker (beta-blocker) and aspirin
  • Pollen
  • Mites
  • Mould & fungus
  • Air pollutants (NO2, SO2, O3)
  • Emotional stress

Diagnosis of Bronchial Asthma:

  • History of variable respiratory symptoms:
  • Wheeze
  • SOB (shortness of breath)
  • Chest tightness
  • Cough

Pulmonary function test with bronchodilator reversibility:

  • Document variable expiratory airflow limitation.
  • At a time when fevi is reduced, confirm that fevi/fvc is also reduced.
  • Positive BDR: increase in FEV, >12% and >200 ml from baseline.

Management:

1. Non-pharmacological:

  • Cersation of smoking & ETS (Environmental Tobacco smoke exposure)
  • Encourage regular physical activity for general health benefits
  • Avoid medication (NSAIDs; beta-blocker)
  • Weight reduction/healthy diet
  • Encourage breathing exercises
  • Avoid outdoor allergen (like pollen/dust)
  • Deal with emotional stress (anxiety/depression)
  • Psychological counseling.

2. Pharmacological:

  • Inhaled coticosteroid
  • Inhaled long-acting beta-agonist
  • Leukotriene modifiers

Add on therapy:

  1. Tiotropium
  2. Low dose Macrolide
  3. Low dose oral corticosteroid
  4. Anti IgE
  5. Anti IL4 R
  6. Anti IL5/5R
  7. Bronchial Thermoplasty

Other Therapies:

  1. Allergen Immunotherapy
  2. Vaccination – Influenza & Pneumococcal Vaccine
  3. Vitamin D Supplementation

Dr. Jagdish Lohia, Consultant – Pulmonology, Brahmananda Narayana Multispeciality Hospital, Jamshedpur

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