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Asthma

An allergic inflammatory disease of the airways, involving mast cells, eosinophils, macrophages, fibroblasts, and neutrophils. Such inflammatory changes are associated with widespread airflow obstruction, which is variable and improves (reverses) spontaneously or with appropriate therapy. Inflammation progresses to increased airway irritability (hyperresponsiveness) induced by the inhalation of allergens, cold air, and occupational factors. Although bronchospasm can be induced immediately after exposure to a specific allergen in an appropriately sensitized recipient, it is the late allergic response that most resembles the inflammatory reaction occurring in asthma. Central to this reaction is the release from mast cells, eosinophils, and lymphocytes of chemical mediators such as histamine, leukotrienes (potent bronchoconstricting agents), and various cytokines which perpetuate the response. Potent neurohumoral agents derived from neural pathways contribute further to the bronchospasm.

Wheezing, nocturnal breathlessness, coughing, and chest tightness often relieved by expectoration are highly suggestive of asthma. Episodes of breathlessness which result from exposure to an irritant (such as cold air) or an allergen (such as dust mites) following exercise or a viral infection and which are reversed spontaneously or with therapy are diagnostic of asthma. Eczema and edema in the folds of the nasal chambers are suggestive of a hereditary allergy, the major predictor of asthma. Objective measures of airflow obstruction which improved spontaneously or with therapy are also central to establishing an asthma diagnosis. Atopy, the genetic predisposition for developing an immunoglobulin-E (IgE) mediated (allergic) response to inhaled environmental allergens, is the strongest predisposing factor for developing asthma. Asthma may be classified, therefore, according to severity, etiology, or pattern of airflow obstruction. It is helpful to differentiate those factors that induce inflammation from those that incite acute bronchospasm in susceptible individuals. The association of an elevated serum IgE and the occurrence of asthma in all age groups, including those who are not atopic, makes antigenic stimulation causal in all instances of asthma. The severity of asthma can best be defined in terms of peak-flow monitoring (monitoring the severity of the allergy). Such evaluations as mild, moderate, and severe are useful in applying therapy in a stepwise manner contingent on severity.

Successful management of asthma requires education of the sick individual coupled with the development of a partnership with an asthma management health-care team; assessing and monitoring the severity of asthma, with utilization of objective parameters of assessment (for example, the peak-flow meter, a device that measures the amount of air that enters and leaves the lungs); environmental management to avoid asthma triggers; and establishment of a drug regimen that controls asthma (medications include bronchodilators, which act as relievers, and bronchodilators, which act as preventers), as well as a written plan to prevent the condition from becoming worse. Adequate management of asthma should control the symptoms, prevent asthma attacks, return and maintain pulmonary function as close to normal as possible, maintain normal activity levels including exercise, avoid adverse side effects from the drugs, reduce and prevent irreversible airway changes, and prevent mortality.Allergy

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From McGraw-Hill Concise Encyclopedia of Environmental Science. The Content is a copyrighted work of McGraw-Hill and McGraw-Hill reserves all rights in and to the Content. The Work is © 2008 by The McGraw-Hill Companies, Inc.
 
 
 
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