Hen phế quản – Chronic Asthma
23
October

By Adem Lewis / in , , , , , , , , , , /


asthma is one of the most common
diseases in the world it currently affects around 300 million adults and
children experts predict that by 2025 this figure may rise to 400 million this
mirrors an increase in other atopic conditions such as eczema hay fever and
rhinitis in Europe the rate is highest in the UK where over 15% of the
population is asthmatic albania greece Switzerland and Denmark have the lowest
prevalence you asthma is a disease of the respiratory
system this system is responsible for supplying oxygen to the body and
removing carbon dioxide it is made up of the nose throat or thanks windpipe
or trachea and the two lungs situated on either side of the chest each lung
consists of two branches called bronchi which divide into smaller and smaller
branches called bronchioles and end as air sacs called alveoli when we breathe in air passes into the
lungs ultimately reaching the alveoli here the blood absorbs oxygen from the
inhaled air and releases carbon dioxide back into the alveoli to be breathed out
if inhaled foreign particles reach the lungs the body sends immune cells to
attack them and produces mucus in the local area to protect the walls of the
airways you the Airways of asthmatic individuals are
chronically inflamed which means they are typically irritated and swollen they
are also extra sensitive or hyper responsive so they react more easily and
strongly to inhaled foreign particles during an asthma attack the Airways
become very narrow the muscles around the Airways tighten and too much mucus
is produced obstructing air movement because it is harder for air to pass
through the narrow Airways symptoms of shortness of breath wheezing koffing
and tightness in the chest develop itching on the chest or neck may be an
early symptom especially in children an attack may be over in minutes or it
may last for hours or days most sufferers are symptom free in the
periods between attacks however in some people the Airways may be constantly
impaired and they make off and wheeze most of the time there are several forms
of asthma and the features vary greatly from patient to patient
the allergic or extrinsic type accounts for 90% of cases and typically develops
in childhood most sufferers will also have allergies or atopic conditions such
as eczema hay fever or rhinitis all members of their family will have
allergic asthma is triggered by inhaled allergens such as pet dander and dust
mites pollen and moles as well as foods including seafood
and peanuts non-allergic or intrinsic asthma is less common and normally
starts in those aged over 40 years it is not triggered by allergens but may
develop after a respiratory viral infection such as cold bronchitis and
sinusitis as a result of reflux disease or may be triggered by exercise stress
or certain medications irritants in the general environment such as cigarette
smoke and air pollution or the person’s workplace can worsen asthma symptoms the
disease is only considered occupational if it develops specifically due to
long-term exposure to irritants at the workplace culprits may include chemicals
metals wood dusts and plant products some people suffer asthma attacks only
when they exercise this form can affect any age of patient frequent coughing may
be the only symptom aspirin and other non-steroidal anti-inflammatory drugs
are known to worsen symptoms of asthmatics especially women the severity
of asthma symptoms can also be influenced by pregnancy and obesity
triggers of non-allergic asthma can also worsen symptoms of the allergic type
asthma can start at any age but is most common in children children often grow
out of asthma by adulthood and tend to suffer from the allergic form they are
prone to attacks following rival infections in the respiratory system asthma is classified depending on how
severe and frequent the attacks are and by the results of Peakflow tests the
categories are mild intermittent mild persistent and moderate or severe
persistent diagnosis is usually made by assessing the symptoms cough shortness
of breath chest tightness and the characteristic feature wheeze symptoms
are typically worse at night intermittent variable and provoked by
triggers peak flow testing is invaluable for diagnosis it can also be used to
assess disease severity identify exercise and occupational related forms
and measure response to treatment peak flow assesses airway obstruction by
measuring how fast you can breathe air out of your lungs the flow rate will be
lower than expected if you have asthma and will vary day-to-day there will also
be a marked dip in airflow in the morning’s histamine challenge tests can
also be used diagnostically to identify bronchial hyper responsiveness further
tests of lung function can help rule out other diseases and skin prick tests may
be useful to identify triggering allergens in young children lung test
may be difficult to perform so diagnosis may be based upon symptoms risk factor
assessment and response to treatment you management of asthma follows a stepped
approach and uses two types of treatment those that relieve symptoms during an
attack and those that control asthma over the long term patients are
allocated a step according to their disease severity in the first step
inhaled short-acting inhaled beta-2 agonists are used to relieve symptoms
examples include salbutamol and to boot align the patient takes medication only
when the attack occurs the drugs quickly expand or dilate the Airways the effect
is short lasting wearing off after an attack symptom relief may be the only
intervention required in mild intermittent asthma if symptom relief
alone is not sufficient disease controlling drugs may also be prescribed
these drugs correct the underlying airway problems in asthma and therefore
help to prevent attacks the first controller drug to be used is usually an
inhaled steroid such as fluticasone or budesonide
steroids reduce the inflammation in the Airways decreasing swelling and mucus
secretion and therefore improve breathing the next step if required is
to add an inhaled long-acting beta 2 agonist such as a femoral or summer
Tirol these drugs keep the airways dilated over a long period other
preventative options that can be added to the mix are leukotriene modifying
agents which reduce inflammation and dilate the Airways the dilating agent
theophylline or beta-2 agonist tablets alternatively a higher dose of inhaled
steroid dose may be tried the last step is to begin continuous or frequent
courses of oral steroids to target the inflammation as well as stepping up to
increase asthma control treatment is stepped down as symptoms improve a
completely different to therapy targets antibodies that are
produced by the immune system following exposure to the antigen monoclonal
antibodies such as our meliza mob blocked the action of antibodies and
thereby reduce the severity of the asthma attack this treatment may be most
suitable for patients with severe persistent allergic asthma you several different inhaler devices are
available to deliver asthma medication to the lungs the type of device may
depend on the prescribed medication a metered dose inhaler or MDI delivers a
measured amount of medicine directly into the lungs in the form of a spray a
spacer may be attached to a Dinn halation to administer the medication
shake the inhaler remove the cap from the mouthpiece and attach the spacer
device if required holding your head erect exhale normally close your mouth
around the open end of the spacer or hold the mouthpiece a couple of inches
in front of your mouth if a spacer is not used breathe slowly and press the
inhaler once continue to inhale for several seconds hold your breath to a
count of ten or for as long as possible remove the device from your mouth exhale
slowly rinse your mouth with water to reduce the likelihood of unwanted
effects an auto hailer is a breath activated MDI it is used by pressing a
switch and then breathing through the mouthpiece it is not recommended for
young children a dry powder inhaler is similar to a MDI but is breath activated
the dry powder medication comes as a capsule or disc or may be stored in
compartment in the inhaler different types of dry powder inhaler Zoar DPI’s
are available depending on the medication prescribed examples include a
Kouhei la area Liza rota hailer and turbulence contains several doses of the
medication in powder form to use this device push the thumb grip away until
the click sound is heard slide the lever away until it clicks seal the mouthpiece
with the lips breathe in steadily and deeply remove
the ocular and hold your breath as long as possible
exhales slowly push the thumb grip towards you and close the device an area
Lizer uses medication in capsule form to use pull the cap twist the mouthpiece to
expose the capsule chamber take one blistered capsule and place it in the
chamber in the base now close the mouthpiece by twisting holding the area
Lizer erect press the two buttons on the base once a click indicates that the
capsule is pierced release the buttons and close the mouthpiece with your lips
ensuring that the two buttons are on the sides inhale deeply the capsule spins in
the chamber and disperses the medicine a rota hailer uses a capsule called rotor
cap hold the rotor hailer erect and insert the rotor cap into the opening
with the transparent end first the top of the capsule should be leveled with
the opening twist the base of the rotor hailer to split the capsule inhale
deeply and breathe out slowly a rattling sound is heard as the capsule moves open
the inhaler to remove the used capsule the rotor hailer is generally used to
deliver cebu tamal a turbulent multi dose inhaler it has an indicator which
shows the number of doses left in sumter be hailers a red indicator appears when
there are 20 doses left holding the tur be hailer upright remove the cap and
twist the coloured grip as far as possible
and then bring it back a click is heard when it is ready inhale deeply remove
the inhaler and then exhale replace the cap after use nebulizers I used to administer high
doses of medication directly into the lungs since regular inhalers may be
insufficient the nebulizer converts the asthma drug from a solution into a fine
spray from the mouthpiece or facemask to be inhaled the medication can be inhaled
by regular breathing over five to ten minutes you it is important to learn about your
disease and its treatment including how to use and look after your inhaler visit
your doctor regularly to review your care plan you should also learn how to
recognize lack of asthma control from symptoms or peak flow measurements and
to know when to seek emergency care identifying and avoiding the factors
that trigger your attacks is key for example exposure to house dust mites can
be minimized by using protective mattress covers removing or heavily
vacuuming carpets and applying anti mite chemicals to soft furnishings
particularly where you sleep similarly preventing further exposure to the
synthesising substance is critical in occupational asthma smoking and passive
smoking should be avoided by all patients parents of asthmatic children
should stop smoking if you are obese it helps if you can lose some weight
although you cannot cure asthma you can control it by following these simple
measures as well as taking your prescribed medications


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