Patofisiologi dari asthma attack

1. Anasthma attackmay occur spontaneously or in response to a trigger. Either way, the attack progresses in the following manner: There is an initial release of inflammatory mediators from bronchial mast cells, epithelial cells, and macrophages, followed by activation of other inflammatory cells Alteration of autonomic neural control of airway tone and epithelial integrity occur and the increased responsiveness in airways smooth muscle results in clinical manifestations (e.g. wheezing and dyspnea)2. Three events contribute to clinical manifestations Bronchial spasm Inflammation and edema of the mucosa Production of thick mucus, which results in increased airway resistance, premature closure of airways, hyperinflation, increased work of breathing, and impaired gas exchange3. If not treated promptly,status asthmaticus an acute, severe, prolongedasthma attackthat is unresponsive to the usual treatment may occur, requiring hospitalization.

What's the Difference Between Asthma and Colds?Asthma is associated with inflammation of the lower airways inside your lungs called the bronchial tubes. Colds result from infection with a virus. Cold viruses mainly affect your nose and throat. These are the upper airways.You normally take air into your body through your nose and windpipe into your bronchial tubes, which go on to branch into smaller tubes. At the end of these tubes there are tiny air sacs called alveoli that deliver oxygen and remove carbon dioxide from the blood as we breathe.During normal breathing, the bands of muscle that surround the airways are relaxed. Air moves freely. During an asthma attack, three main changes occur that stop air from moving easily through the airways:1. The bands of muscle that surround the airways tighten. This makes the airways narrow. This tightening is called bronchospasm.2. The lining of the airways becomes swollen or inflamed.3. The cells that line the airways produce more mucus, which is thicker than normal.All of these factors -- bronchospasm, inflammation, and mucus production -- cause asthma symptoms such as difficulty breathing, wheezing, coughing, breathlessness, and difficulty performing activities.Colds are respiratory infections caused by viruses. Several hundred different viruses may cause your cold symptoms. These viruses can also affect your airways, sinuses, throat, voice box, and bronchial tubes.

Asthma, viruses and the fluThe common cold is caused by a virus that infects the respiratory tract (nose, throat and lungs). It causes up to 80% of reported asthma attacks and is commonly spread through the air or on hard surfaces when the infected person coughs or sneezes.Influenza (flu) is caused by one particular virus. There are several forms of the flu virus, and each can change over time. Flu causes only a small percentage of asthma attacks. However, people with asthma are at a higher risk of developing complications with the flu such as pneumonia, bronchitis, or ear infections. This can mean you have to stay at home and miss work or school, or even have to go to hospital (especially children under 2 years old and the elderly).Medications Some medications may trigger asthma, and others can have an impact on your asthma control. You should always check with your doctor or pharmacist before taking any new medication, and make sure you have your reliever with you when you start new medications in case you develop symptoms. The most common issues occur with the following medications: Beta blocker drugs these medications are used for conditions such as high blood-pressure, angina, migraine, heart failure, and as eye drops to treat glaucoma. They can aggravate asthma symptoms Non-steroidal anti-inflammatory (NSAIDs) drugs these include some common pain relievers such as aspirin and medications taken for arthritis or joint pain which may be prescribed or bought over the counter. In some people, these can actually cause an asthma attack within a short time of taking them. This can happen even if you have taken these medications before. For more details, seeAspirin-sensitive asthmabelow Cholinergic drugs- these are used to treat glaucoma, e.g. carbachol, pilocarpine Cholinesterase inhibitors used to treat dementia, e.g. Aricept (donepezil), or uncommon conditions such as myasthenia gravis, e.g. Mestinon (pyridostigmine) Somecomplementary medicationssuch as Echinacea or Royal Jelly can cause life-threateninganaphylaxisin some peopleConsult your doctor or pharmacist to make sure that yourasthma medicationswill not interact with your other prescribed or non-prescribed medications. If you have been taking other prescribed medications it is important that you DO NOT stop taking them abruptly without first discussing this with your doctor.Aspirin-sensitive asthmaMost people with asthma can take pain relievers without any problems. However, up to 11% of adults and 2% of children may develop asthma symptoms after taking aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), and should avoid using these medications. Examples of NSAIDs are Voltaren, Diclofenac, Indocid, Brufen and Ibuprofen, among others. They are also found in some over-the-counter preparations such as Alka-Seltzer tablets.Aspirin/NSAID-intolerant asthma (also known as aspirin-sensitive asthma) is a distinct type of asthma where symptoms can occur within a few minutes or up to 3 hours after taking this type of medication. Symptoms include some or all of the following: shortness of breath severely watery eyes or nose puffiness around the eyes, and/or skin rednessThose at highest risk of having a reaction are: People who first developed asthma as an adult, and dont have allergies People who have recurring nasal polyps People who tend to have sudden, severe asthma attacks People with severe asthma who have a long-term blocked nose or severe watery noseHow do I know if Im sensitive to aspirin or NSAIDS?If you are, you typically begin to experience symptoms at around age 30, even if you have taken this type of medication when you were younger with no problems. The first symptoms are severe runny and/or blocked nose and sneezing. Further reactions can lead to a loss of sense of smell, nasal polyps and chronic sinusitis. Asthma typically develops over the next few years.What should I do if I have a reaction?If youve had a runny nose or wheezing within 3 hours of taking aspirin or an NSAID, you should let your doctor and pharmacist know. You should then avoid taking any medications of this type ever again. You should check the contents label of all over-the-counter preparations. Alternative pain relievers are available so talk to your doctor or pharmacist. For something like a simple headache, a normal dose of paracetamol is recommended. Many people take low-dose aspirin for heart problems and this tends to be safe, but check with your doctor if you are concerned. People who have aspirin-sensitive asthma should be taking a regularpreventer medication, and should be referred to a specialist respiratory physician if possible.If you do develop asthma symptoms at any time, use yourreliever medicationas advised by your doctor. You should carry yourreliever medicationwith you at all times, and you should also have an up to dateAsthma Action Planso you know what to do when your asthma gets worse.

Asthma and menstruationMany women with asthma find their symptoms are worse just before or during menstruation. Medications used for period pain such as Nurofen, Ponstan and othernon-steroidal anti-inflammatory tabletscan actually aggravate asthma in some women. Therefore, paracetamol is recommended as a safer alternative.Note: Keeping a peak flow and/or symptom diary will help clarify whether this is an issue for you. Talk to your doctor about yourAsthma Action Planand whether extra preventer treatment during the week before your period would be helpful.

What Causes a Severe Asthma Attack?Whereas the causes of an acute, severeasthma attack are unknown, those people who have them may have a history of infrequent health care, which may result in poor treatment of asthma.Some research shows that people who are at risk for a severe asthma attackhave poor control of allergens or asthma triggers in the home and/or workplace. These people may also infrequently use their peak flow meter and inhaled corticosteroids. Inhaled steroids are potent anti-inflammatory drugs that are highly effective in reducing inflammation associated with asthma.To prevent a severe asthma attack, it is important to monitor your lung function using a peak flow meter regularly and take your asthma medication as recommended by your health care provider.How Is a Severe Asthma Attack Diagnosed?To diagnose a severe asthma attack as actual status asthmaticus, your doctor will notice physical findings such as your consciousness, fatigue, and the use of accessory muscles of breathing. Your doctor will notice your respiration rate, wheezing during both inhalation and exhalation, and your pulse rate. Some other tests may include peak expiratory flow and oxygen saturation, among others. Other physical symptoms will be noticed with the chest, mouth, pharynx, and upper airway.How Is a Severe Asthma Attack Treated?A severe asthma attackmay not respond quickly to routine treatment with asthma inhalers. Continuous use of an asthma nebulizer and injections of drugs such as epinephrine and corticosteroids for asthma are often necessary to stop the asthma attack. Other therapies may include terbutaline injections, magnesium sulfate (induces smooth muscle relaxation of the airways), and leukotriene inhibitors, which are anti-inflammatory drugs.During a severe asthma attackthat does not respond to asthma drugs, a mechanical ventilator may be needed to assist the lungs and respiratory muscles. A facemask is applied or a breathing tube is inserted in the nose or mouth for this asthma treatment. These breathing aids are temporary and are removed once the attack has subsided and the lungs have recovered sufficiently to resume the work of breathing on their own. A short hospital stay in an intensive care unit may be necessary with a severe asthma attack.To avoid hospitalization with a severe asthma attack, it is imperative to begin immediate early treatment at the first sign of symptoms either at home or in your doctor's office. If you have asthma, it's also important to see your doctor frequently to monitor your lung function and to assess your asthma medications. Also, using your peak flow meter several times daily can help you monitor your breathing, so you can start treatment immediately if you notice a lower reading, even if you feel fine.