The asthma [ASM] Greek άσθμα, Asthma , via the Latin asthma meaning “breathing”, is a disease of the respiratory system affecting the lower airways and in particular the two bronchi , defined as difficulty breathing at the end. The disease is explained by three mechanisms characteristics:
inflammation with edema of the epithelium, bronchial;
a bronchoconstriction by bronchospasm;
bronchial hyper-activity (chronic or otherwise) as manifested by increased secretion of mucus , especially due to a remodeling of the upper airway 1 .
1 History 
3 Types of asthma and clinical manifestations
3.1 Chronic asthma
3.2 Allergic asthma
3.3 The exercise-induced asthma
4 Expansion of recent asthma
6.1 Chronic asthma
6.2 The asthma attack
6.3 The acute attack
6.4 The therapeutic management
7 Differential Diagnosis
8 The fight against asthma: directions for research
8.1 The pollution and allergens
9 Assessing the severity of an asthma attack
10 Psychological effect
11 Asthma and Flu
12 Notes and references
13 See also
13.2 External Links
History 2 [ edit ]
Asthma is a disease known since antiquity. Aretaeus , around the first century, mentions it in one of his works. Moses Maimonides in the XII th century also refers to this disease.
The Treatise of the Asthma of John Floyer (1649-1734), published in 1698 and is based in part on his own experience, is the first medical textbook addressing fully asthma.
The French writer Marcel Proust suffered from asthma since childhood, the disease affecting up to his work.
Epidemiology [ edit ]
This article or section adopts a regional perspective or cultural and should be internationalized .
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In France, a national survey conducted by the National Health Insurance Fund (CNAM) in the year 2007 on all patients 5 to 44 years treated for asthma, found that 900,000 people were receiving regular treatment with three or more prescriptions for asthma credit card offers medications. Of these 900 000 patients, 27%, mostly in the age group 20-29 years, had an asthma inadequately controlled, requiring at least four times a year to use a drug intended to treat only the crisis 3 . In France, there are approximately 15,000 hospitalizations per year for an asthma attack, and 1,000 deaths 3 .
Types of asthma and clinical manifestations [ edit ]
The bronchi have a specific role in protecting the lungs of foreign agents or external aggression, including the restriction of the bronchial diameter. Asthma is characterized by an overreaction of the bronchial tubes from the middle. The airways of an asthmatic are inflammatory and have their reduced diameter. The mucus produced in response to inflammation further reduces the diameter of the bronchi, making expiration difficult, there is talk of expiratory airflow obstruction. The causes of inflammation and especially its conditions allow events to establish three main types of asthma.
Although each patient longer meets one or more of the profiles of asthmatics, it is only a general manifestation of the disease, it is not uncommon for a chronic asthmatic crises to know allergic asthma or exercise-induced asthma and vice versa.
In all types of asthma found the following symptoms:
Difficulty breathing or shortness of breath .
Chest tightness (feeling of heaviness in the chest).
A tachypnea or conversely a bradypnea , that is to say an increase or a decrease in respiratory rate.
A whistle at the end (known as respiration sibilant ).
A decrease in the saturation of the hemoglobin oxygen mainly for severe attacks.
A tachycardia .
A draw in case of severe crisis.
A cough may be chronic or dominate the night.
Crises that may occur after exercise (known as exercise-induced Denver Divorce Attorney asthma or specifically bronchospasm post-exercise).
Only the intensity, duration and causes of these symptoms vary from one type to another.
Chronic asthma [ edit ]
This is a chronic bronchial hyperactivity little subject to external agents. The chronic inflammation is often slow and progressive installation.
Usually present from childhood, it can manifest in the early years of childhood by repeated attacks of asthma or chronic wheezy bronchitis. In this case, there is a worsening of the asthmatic syndrome, which is a chronic (when there was this aggravation until a trigger).
Due to the slow onset and progressive inflammation, it may go unnoticed, especially because the patient has time to get used to the respiratory difficulties and gradually loses the notion of “normality” breathing, until that the discomfort becomes too invasive in the patient’s life.
Unprocessed form of asthma that typically progresses to respiratory failure.
Although the actual causes remain to this day debatable, one prevailing hypothesis is that this form of asthma is caused by an autoimmune reaction. That is to say that the patient’s immune system would attack its own lungs, thus maintaining the inflammation in time.
Allergic asthma [ edit ]
Generally characterized by the occurrence of one or more crises caused by an overreaction of the bronchial tubes of the patient to an outside agent (usually allergic). This is the form of the asthma worse in the short term, the degree of bronchial reaction may be particularly important and sometimes fatal.
The asthma allergy is manifested by a sudden blockage and rapid progression of the bronchial airways, the patient in crisis choking suffocation (inability to breathe properly preventing new inspiration) and lack of oxygen in the blood (the impossibility to expire preventing the supply of oxygen due to the inspiration, and saturating the body in carbon dioxide).
This form of asthma may develop into chronic asthma, particularly if exposure to allergen is constant and long lasting.
The asthma attack is always a medical emergency life-threatening and requires specific treatment.
The exercise-induced asthma [ edit ]
This is manifested by an asthma attack occurring during physical exertion. The cause is defined as an effort traumatic for the bronchi. That is to say a special effort seeking the bronchi and / or carried out under conditions that make work more difficult bronchi.
The effort is typically a cardio (requesting the cardiac system in particular so breathing).
Environmental factors such as aggravating asthma, are the cold, wind and poorly ventilated environments.
The cold and wind, by promoting airway inflammation, also promotes the crisis.
This type of asthma is sometimes isolated or sometimes associated with chronic asthma or allergic, becoming a type of complication induced asthma.
Asthma attacks could be facilitated by intense stress 4 . Indeed, stress has the effect of increasing the heart rate and develop a hyperventilation syndrome, facilitating or aggravating asthma.
Asthma by the crisis are also classified as follows:
The intermittent asthma which is arbitrarily defined as the occurrence, at most, two brief seizures per week and / or two nightly episodes per month, and PEF greater than 80%.
The persistent asthma that is defined when more than two episodes per week and / or more than two nocturnal episodes per month, with repercussions on the current activities. It can be mild, moderate or severe.
The severe acute asthma that involves life-threatening. It requires urgent treatment in hospital (for example, in France about 2000 people a year die from asthma, or 3.2 cases per 100 000) 5 . Clinically, there is at least one of the following signs:
unusual feeling of crisis;
difficulty speaking (speak a word at a time);
increased heart rate ( tachycardia CF> 120 per minute)
disturbance of consciousness ( confusion , coma );
“Auscultatory silence” (absence of breath sounds on auscultation);
a decrease in PEF ( peak expiratory flow or Peak Flow ) halved compared to the best score of the patient, or from its theoretical value, the DEP is the only objective means of evaluating the intensity of the asthma attack ;
resistance to treatment of the crisis ( bronchodilator fast action);
a respiratory rate above 25 per minute in adults, 30 per minute in children over 5 years, 50 per minute in children 2 to 5 years, even with low breathing pauses in breathing;
a low blood pressure .
It is advisable to separate the asthma of the infant , which is defined by the appearance of at least three episodes of wheezing before the age of three. Asthma in infants usually disappear by the age of five years.
Recent expansion of asthma [ edit ]
There has been a rapid expansion of the disease for 40 years in developed countries 6 , 7 . It occurs mainly in countries with a high degree of industrialization, or industrialization rapidly developing, for example it is little known in sub-Saharan Africa. In 1999 researchers at the International Study of Asthma and Allergies in Childhood few have quantified data on asthma, by measuring the percentage of asthma and allergies among 13-14 year olds in different countries:
Sweden and auto insurance quotes Finland: between 10% and 20%;
Albania, Romania, Russia, Georgia and Uzbekistan: <6%;
UK:> 30% (asthma is the second leading cause of death [ref. needed] ).
Monitoring trends in incidence in France is conducted by the sentinel network of INSERM .
Note that recent studies correlate the increase in asthma with Bisphenol A 8 , 9 , banned in France in the manufacture of bottles since 2010.
Diagnosis [ edit ]
Pulmonary function tests or PFT;
Test reactivity to a bronchodilator (expiratory flow before and after salbutamol);
Bronchial challenge test ;
Measurement of exhaled NO (diagnostic aid but also evaluating the effectiveness of treatment).
Treatment [ edit ]
The Ventolin is the drug most commonly used to treat asthma, in France. Indeed over 65% of people with asthma use this bronchodilator.
Chronic asthma [ edit ]
Corticosteroids are used to treat chronic inflammation, while bronchodilator relieves the patient daily.
The first paintball equipment line of treatment is a beta-2 mimetic short-acting (eg Ventolin which is of salbutamol ).
Second comes the treatment by inhaled corticosteroids (eg Flixotide is propionate fluticasone ) + beta-2 mimetic short-acting, in a crisis.
Third, if the consumption of beta-2 mimetic short-acting (Ventolin) inhaler more than a year (or two uses per week), should be treated with an inhaled corticosteroid + beta-2 agonist long duration of action (eg Seretide is propionate fluticasone + of salmeterol ).
It is also recommended to monitor and possibly treat allergies by antihistamine . People with allergic asthma should avoid contact with the most common allergens (cat dander, dust, pollen, etc.).
In recent years emerged receptor antagonists of leukotrienes (eg montelukast , zafirlukast ).
The asthma attack [ edit ]
Measuring therapeutic administration of a bronchodilator on salbutamol or terbutaline , causing a “relaxation” of the bronchial muscles and the reopening of the bronchi ( bronchodilation ).
The administration is primarily by inhalation: MDIs or powders. The technique for using metered dose inhalers should always be known by the patient for maximum effectiveness.
The use of specific devices ” spacer “greatly facilitates the administration of metered dose inhalers, especially in children but also adults. Any crisis that does not stop quickly to the medication should be treated as a medical emergency.
The acute attack [ edit ]
Medicalized transfer and immediate hospitalization is needed. The first line of treatment is based on a high flow oxygen (6-8 liters / min), associated with the use of beta 2-stimulating short-acting inhaled at high doses, and administration of oral corticosteroids or intravenous 10 . Indeed, the main risk here is asphyxia.
Moreover, as in several cases of difficult ventilation, the permissive hypercapnia is an approach advocated by several authors.
The therapeutic management [ edit ]
Adapted in asthma crisis, it is based on the following prior to prevent the occurrence but also the intensity of crises:
rehabilitation training ( adapted physical activities ) to push the threshold of exercise intensity causing the onset of bronchospasm after exercise; minimize ventilatory adaptation necessary for a given intensity (less shortness of breath with exercise) ; fight against the deconditioning of a population that minimizes physical activities for fear of the crisis;
act on the cause of asthma if it is allergic, either by carrying out the eviction (= separation) of the allergen , or by attempting a desensitization to denver car accident lawyer the allergen. The results are good with car insurance comparison mites , and pollen – not so good with animals;
order to prevent crises, asthmatics can use a device ( peak-flow ) to measure their peak expiratory flow, control of bronchial obstruction and thus adapt their treatment outcome Bankruptcy (taking acting bronchodilator quick example or change in treatment of substance in collaboration with the physician);
In 1950 Professor J. Turiaff prescribed a self-immunization which gave results of permanent cure in some patients. ! [ref. required]
The method of thoracic manipulation called “Method Gesret” 11 [ref. TBC] practiced in several countries since 1995. [unpublished work?]
Differential diagnosis [ edit ]
See the equivalent asthma, associated pathology speaking by bronchial hyperresponsiveness, causing spasmodic cough and night, without causing clinically detectable decrease in the volume of air exhaled.
The fight against asthma: research directions [ edit ]
The allergens and pollution [ edit ]
In the early 1960s, has challenged the allergens , mites and others. Hunting allergens resulting (using various products, possibly for most allergens) has helped some patients.
The evolution of the correlation between asthma and allergy is not always symmetrical: this correlation has been demonstrated in Britain, but neither in Germany nor in Italy, where the incidence of allergies has increased but not that of asthma seven . Which tends to prove that asthma could be intrinsic causes an autoimmune reaction or a genetic predisposition, although there is to date no studies proving it formally.
However, some studies tend to show that asthma is also strongly developed in areas subject to air pollution.
In the early 1990s, it was shown that particles of diesel into the air damaging the heart and lungs. Manufacturers have therefore changed the compression ratio of diesel engines and reducing the size of airborne particles that damage the lungs now.
A Dutch study clarifies the relationship between exposure to air pollutants and increased risk of asthma in children 12 .
Scientific studies show that air pollution is a cause of asthma 13 , including VOC (Volatile Organic Compounds) and NOx ( oxides of nitrogen : carbon monoxide and nitrogen dioxide) present in both the air in certain industrial cleaning or repair 13 .
To protect domestic pollution, asthma and allergies, doctors recommend regularly ventilate her apartment, or use a e-cigarette device to purify the air of volatile microparticles 14 or residues of cleaning products or pollutants renovation, such as the air purifier . Using an air exchange system also helps reduce respiratory illnesses in children 15 .
Furthermore, the UFC has recently raised the issue of indoor air pollution and pollution impacts in interior spaces. In addition to NOx, dust and VOCs in the air, polluting industrial products used in the renovation of carpet glued pollutant whose impact on health is denounced by consumer groups as well as paints industrial adhesives and cleaning products as directly responsible for asthma in children and the frail.
Tobacco [ edit ]
Stephen Holgate considers that the smoke of tobacco is by far the leading identified cause of asthma. He and his team have shown that tobacco smoke modifies the genes of mouse lung cells, and may cause genetic changes in the lungs of the fetus , making them vulnerable to asthma . The same could be true for unhealthy diets even for paracetamol (a powerful antioxidant that has recently been linked to asthma).
Smoking both active and passive 16 may be involved.
Hygiene [ edit ]
Since the 1990s, we began to emphasize the lack of coexistence between humans and bacteria in the countries most affected by the disease. And are called into question the “surhygiène” with its antibacterial cleaning products, as well as the widespread use of broad spectrum antibiotics and routine vaccinations [ref. required] – all leading to a lack of self-immunization with no exposure to surrounding bacteria. One wonders why, for example, found in an Indian hospital a group of children from poor neighborhoods and afflicted with pneumonia and other infections, while the group of children from wealthy neighborhoods is suffering from asthma. This “hygiene hypothesis” is supported by evidence such as any occurrence of allergies in children living on farms or contact with animals, those who eat unpasteurized milk, or in 3 e or 4 th or 5 th child of a family – who are exposed at an early age to all pathogens and other microorganisms than their elders can bring to school. Researchers are exploring the possibilities of causing the same response in the immune system of a child as that caused by infection with bilharzia parasites. On the other hand, the “hygiene hypothesis” justifies the rise of allergies more than asthma, which do not necessarily go together (you can have one without the other, under one or more forms).
Genetics [ edit ]
In recent years researchers have shown that the airways of patients with chronic asthma are permanently altered by disease or – possibly – develops differently in the womb. Stephen Holgate, one of the researchers on asthma in Britain, published in the journal Nature the results Plastic Bins of a five-year research involving the gene ADAM33 . This is the first gene discovered for asthma, and monitor how the muscle develops in the airways. Holgate also believe that environmental factors could influence things much earlier than previously thought in the development of the disease: they could influence gene expression in fetal development, thereby contributing to genetic modification favoring disease . Holgate and his team have already demonstrated the modification of the gene ADAM33 by tobacco smoke in cultures of mouse lung tissue. In October 2005 they published a report showing that when the tissues of the airways of asthmatics are inflamed, they produce a molecule called TNF alpha, or tumor necrosis factor alpha . But the gene ADAM33 , involved in asthma, behaves very similar to the gene ADAM17 responsible for the production of TNF alpha. We also find that molecule TNF alpha in inflamed tissue of patients with other chronic inflammatory diseases such as rheumatoid arthritis or Crohn’s disease . After six years of struggle with the pharmaceutical industry to perform these tests, Holgate was able to convince them to take on an experience that goes against denver martial arts a general tendency to take for asthma disease allergenic. In October 2004, he and his team injected 15 volunteers with the etanercept , a soluble receptor for TNF-alpha, which intercepts the molecule and prevents it from binding to cells and tissues to irritate the bronchial tubes. The results are very satisfactory for the moment, with persistent and marked improvements in each of 15 volunteers. To this date November 2005, three of these patients did not use any steroid from CrossFit Denver 12 weeks of weekly injections, a little over twelve months ago.
Other genes are correlated with asthma. A mutation in the gene encoding YKL-40 (a chitinase ) and significantly increases the risk of developing asthma 17 .
Assessing the severity of an asthma attack [ edit ]
An acute asthma attack is characterized by an acute exacerbation of dyspnea , coughing and wheezing, and is accompanied by a decrease (transient) pulmonary function. Assessing the severity of an asthma attack can be done by the evaluation of lung function (peak expiratory flow or PEF, forced expiratory volume per second, or FEV). Clinical evaluation of the severity of the crisis is even more important that the evaluation of pulmonary function, partly because the results of measurements of lung function during an acute asthma attack are not always reliable. Depending on the severity of the crisis, it must decide whether the patient can be treated as first-line home (hospitalization with no improvement) or should be hospitalized immediately.
Criteria based on which a severe asthma attack should be suspected and immediate hospitalization considered are:
Dyspnea at rest does not allow to pronounce a sentence at once.
Heart rate> 110/minute in adults,> 120/minute in children over 5 years,> 130/minute in children 2 to 5 years. (Caution: in case of asthma and life-threatening, a bradycardia can occur!)
Respiratory rate> 25/minute in adults,> 30/minute in children over 5 years old,> 50/minute in children 2 to 5 years. (Caution: in case of asthma and life-threatening, respiratory failure can occur with decreased respiratory rate!)
Use of accessory respiratory muscles.
PEF <50% of predictive value or personal best.
Oxygen saturation <92%.
The warning signs suggestive of exhaustion and the need for immediate admission to an emergency department.
Onset of sedation or confusion.
Decrease in pulse rate.
Decrease in respiratory rate.
Decreased or absent breath sounds, inspiratory.
Disappearance of the whistle.
Following patients who are at high risk of death due to asthma, attention is needed, faster and hospitalization is required:
Patients with a history of near fatal asthma.
Patients who were hospitalized in the previous year for asthma.
Patients taking corticosteroids by mouth or who have recently arrested.
Patients who frequently use beta-2-agonists to short-acting inhaled.
Patients who do not follow their treatment properly anti-asthmatic chronic.
Patients with a history of psychiatric or psychosocial problems (including the use of sedatives ).
Psychological effect [ edit ]
Contrary to popular belief, the disease is not triggered by somatic or psychological causes. However, stress and the panic that usually accompanies an asthma attack worsens respiratory discomfort felt by the patient, including the hyperventilation syndrome.
Calm an asthmatic crisis can improve his breathing, but only a specific medical care (mainly immediate-acting bronchodilator) is likely to pass the crisis.
Influenza and asthma [ edit ]
Most asthmatics, like other vulnerable individuals may experience complications and exacerbated serious flu cases.
The vaccine against seasonal flu, they are recommended (from 6 months, paid at 100% for asthmatics ) in France by the Superior Council of Public Health of France , and by equivalent bodies in most other industrialized countries ( EU , USA ). Vaccination reduces the risk in patients with asthma hospitalization and increased need for government help medication.
But the three million French asthma sufferers (especially children and teenagers), only 32% have been vaccinated in winter 2006 – 2007, and less than a quarter of under 65 were vaccinated (and only 14% under 15), against 77% among those 65 and older. The allergy to eggs (rare and detectable by skin testing) is the only cons-indication, if the subject is free of active infection, fever and / or unstable asthma. Asthmatics vaccinated have no significant side effects or particularly within fifteen days (no change in respiratory rate or increased need for bronchodilators or increased medical consultations or use of steroids)