Bronchial Asthma: Etiology, Pathophysiology, Diagnosis and Management

Abstract

Bronchial asthma is a disorder of the airways causing swelling and narrowing; which leads to wheezing, shortness of breath, chest tightness, and coughing. The impact of asthma in children depends on complex interaction between disease severity, reaction of children towards disease, treatment efficiency, social roles, and social environment. Most common asthma triggers of bronchial asthma are dust, animal dander, weather changes, pollution, mold, pollen, respiratory infections, stress, and tobacco smoke. The main pathophysiological characteristics of asthma are inflammation and airway remodeling, which include goblet cell hyperplasia, subepithelial fibrosis, collagen deposition, mucosal gland, hyperplasia, smooth muscle hypertrophy, and changes in the extracellular matrix. Spirometry (test lung function when diagnosing asthma), pulse oximetry (monitors oxygen saturation which used to measure amount of arterial hemoglobin that is combined with oxygen) used for diagnosis bronchial asthma. The goal of asthma treatment is to achieve normal respiratory function, with an absence of symptoms, exacerbations, or adverse effects. The beta 2 agonists are sympathomimetic drugs that produce “selective” activation of beta 2 adrenergic receptors, promote bronchodilation, and thereby relieve bronchospasm. The use of short actin beta 2 agonists as a reliever five or more times daily indicates controller agents need to be increased. Prednisone and prednisolone are preferred glucocorticoids for oral therapy of asthma. Methylxanthines are widely used in the treatment of asthma due its ability to inhibit phosphodiesterase causing bronchodilatation. The adverse effects of theophylline include gastrointestinal symptoms such as nausea and vomiting at initial oral administration. In addition, toxic symptoms may progress to tachycardia and arrhythmia.