Bronchial Asthma

Bronchial Asthma

A chronic inflammatory disease characterized by hyper responsiveness and reversible obstruction of the airway.

It is an allergic reaction of type 1 hypersensitivity

Pathophysiology-

Triggering agents

  • Drug
  • Infection
  • Allergens ( dust, occupational, cold, smoke, pollution)
  • Exercise induced

Types

  1. Extrinsic / Atopic- atopic individuals who show positive skin-prick reactions to common inhalant allergens such as dust mite, animal danders, pollens and fungi. They have definite external causes.
  2. Intrinsic- Although it starts in middle age so called as late onset asthma, patients still show features compatible to childhood asthma and positive skin allergen test.
  3. Mixed- They have features of both extrinsic and intrinsic types. Extrinsic- develop asthma by extrinsic causes such as intolerance to NSAIDS given for hypertension or angina that block the protective effect of endogenous adrenergic agonists. Intrinsic- occur at middle age.
  4. Others-
  • Status asthmaticus
  • Drug induced asthma

Clinical features-

  • Wheezing
  • Dry cough
  • Acute onset of reversible breathlessness
  • Chest tightness
  • Trouble sleeping because of breathing problem

Investigation-

  • Chest X-ray shows- hyperinflation of lungs, flattened ribs and diaphragm and decreased intercostal space.
  • CBC
  • ESR increases
  • Sensitivity test for common allergen
  • Pulmonary function test
  • CT scan

Treatment

Medical treatment-

  1. Bronchodilators-
  • β agonists- Salbutamol
  • Anticholinergics- Atropine
  • Methylxanthines- Theophylline
  1. Anti inflammatory-
  • Steroids- Cortisone, Prednisolone
  • NSAIDs- except aspirin as it can induce asthma
  • Antihistamines- Cetirizine
  • Mast cell stabilizer- Rupatadine
  1. Leukotriene antagonist- Montelukast
  2. Anti IgE- Omalizumab

Physiotherapy management-

Medical conditionFrequencyIntensityTimeTypeResistance
Asthma3-5 days/weekModerate- 40-59% HRR.When tolerated progress to 60-70% after 1 monthProgressivelyincrease to atleast 30–40min.Aerobicactivitiesusing largemuscle groups, suchas walking,cycling,swimming, orpool exercise2-3 days/week at 60-70% 1 RM
  • All exercises need to be combined with regulation of respiration to produce exhalation on effort or stretch.
  • Ventilatory muscle training.
  • Breathing Exercises :

Breathing is natural and effortless when your lungs are healthy. 

Your diaphragm does roughly 80% of the work when you breathe in and out, filling your lungs with a mixture of oxygen and other gases and then expelling the waste gas. 

Mark Courtney, a respiratory therapist with Lung HelpLine, compares the process to a self-closing screen door with a spring. 

“Like a door, our lungs are springy. 

With asthma and, especially, COPD, our lungs lose their springiness over time. 

They don’t return to where they were when you first started breathing, and air becomes caught in our lungs “Courtney clarifies.

  1. Pursed lip breathing:

This practice helps you take fewer breaths and keep your airways open for longer. 

You can be more physically active since more air can move in and out of your lungs. 

Simply breathe in through your nose and out through your mouth for at least twice as long with pursed lips to practise.

  1. Diaphragmatic Breathing:

Begin by breathing in via your nose, just as you would with pursed-lip breathing. Keep an eye on how your stomach fills up with air. To be conscious of your tummy rising and falling, place your hands lightly on your stomach or place a tissue box on it. Exhale for at least two to three times as long as you inhale through your mouth. Relax your neck and shoulders as you retrain your diaphragm to assist in the filling and emptying of your lungs.

  • Thoracic Expansion Exercises:

Reference-

  • Jennifer A. Pryor and Barbara A. Webber ( Physiotherapy for respiratory and cardiac problems)
  • Praveen Kumar and Michael Clark ( Clinical medicine)
  • Nicki R. Colledge, Brian R. Walker and Stuart H. Ralston ( Davidson’s principles and practice of medicine )
  •  J. Larry jamson, Anthony S. Fauci, Dennis L. Casper, Stephen L. Hauser, Dan L. Longo and Joseph Loscalzo (Harrison’s manual of medicine)