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Asthma


What is it
Asthma is an increasingly common disease among children and young people. It is estimated that it suffers from 5 percent of the adult population and 10 percent of children and adolescents in industrialized countries, and in many cases, the disease appears in response to certain stimuli that produce allergy: pollen, dust mites, particles of cat and dog skin, smoke, cold air, certain foods or

Asthma
food additives.


It is characterized by the occurrence of episodes of respiratory distress (seizures or attacks), usually associated with other symptoms such as coughing, wheezing and choking. Symptoms vary by age.

In this way, cough predominates in children, especially at night, while in adults the three main symptoms are chest stiffness, wheezing, and fatigue at night.

In recent years there has been a higher prevalence and a progressive increase in cases in children and adolescents, which highlights the need to take preventive measures. The cure for asthma can only be achieved in some cases of allergic asthma or related to the patient's workplace, provided that the causative agent can be avoided.


Causes

Pollens: Although pollination occurs during spring, there are variations according to climates and types of plants. Pollen allergy symptoms are usually detected with concentrations greater than 50 grains of pollen per cubic meter of air. The small size of the pollen favors that it is suspended in the air for a long time and travels great distances until it enters the respiratory passages.

Asthma

Dust mites: They are microscopic parasites that live in house dust and feed on dermal scales and other waste. They need precise conditions to develop: 25ยบ C temperature and 85 percent humidity.

Fungi: Some fungi produce allergens that are deposited in their spores, and the release of these depends on the humidity, temperature and the existence of organic matter in their environment, such as garbage or shower curtains. The most favorable times for its development are spring and autumn, and among the most common are the Alternaria, Cladosporium, Penicillium, aspergillus, and mucor.


symptom
The symptoms, frequency, and severity of asthma vary from person to person and usually get worse with physical activity or at night. People with asthma may present:
Asthma

Wheezing produced during the exit of the air through the narrowed bronchi. It is what we commonly call chest pitos.


  • Trouble breathing, also known as breathlessness.
  •  
  • Chest tightness.
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  • Episodes of dry cough, which occur especially at night or early in the morning.
  •  
  • A lower level of activity.
  •  
  • Inability to sleep


Tiredness during the day.
During asthmatic crises, the bronchial mucosa lining the respiratory ducts becomes inflamed and thick mucus is produced that clogs the ducts of the airways. As a consequence, the muscles surrounding these ducts contract and narrow by decreasing their diameter, impede the passage of air and complicate breathing. The basic characteristics of the disease are the following:

Inflammation: Increases bronchial sensitivity and obstruction. Sometimes its origin is allergic. It produces an increase in secretions and contraction of the bronchial musculature.

Increased bronchial sensitivity: After exposure to various stimuli (fumes, gases, odors, cold air or exercise), asthmatic bronchial tubes contract causing narrowing of the airway.



Types
There are different classifications of asthma. As for its origin, it can be divided into intrinsic asthma and extrinsic or allergic asthma. The origin of intrinsic asthma is unknown and is most often detected in adulthood. It has a worse prognosis than that of an allergic nature and tends to become chronic. Extrinsic asthma, meanwhile, consists of an antigen-antibody reaction that triggers the process. It mainly affects children and young adults, is characterized by reversible and brief attacks of bronchospasms with wheezing and respiratory distress, and is controlled with adequate treatment.

Allergy is an alteration of the body's defense mechanism that consists of an exaggerated reaction, by means of a special antibody (immunoglobulin E), against substances that, in principle, are not harmful (pollens, mites, epithelia, food or medicine). When these antibodies, which are fixed in certain cells, bind to the allergens, the release of certain substances that, directly or through other cells, causes inflammation of the organ where they settle (bronchi, nose, eyes or skin) ). There is an inherited predisposition for allergy, but exposure to allergens is necessary to develop the disease.

Asthma can also be classified as mild, moderate or severe, depending on the frequency and intensity of symptoms, the way in which it affects the daily activity and the degree of bronchial obstruction. Mild asthma can be controlled by pharmacological treatment and does not usually alter the daily life of patients and moderate asthma requires more severe treatments and interferes with the daily activities of patients

In the case of severe asthma:

Severe uncontrolled asthma is a debilitating and life-threatening form of the disease in which patients experience frequent exacerbations, also known as seizures or outbreaks, and more modernly as an attack and a considerable limitation of lung function and quality of life...


There are different phenotypes of severe asthma, including eosinophilic, paucigranulocytic and neutrophilic. In approximately 50 percent of patients with severe asthma, eosinophils are the biological effector cells that cause hypersensitivity of the respiratory tract, intensifying asthma symptoms, affecting lung function and increasing the frequency of exacerbations.

In patients with severe uncontrolled asthma, the number of eosinophils or biological effector cells is high and requires chronic treatment with oral treatments, which cause serious side effects.

Diagnosis
In the first place, the clinical diagnosis must be made, based on the clinical history where the symptoms described above are revealed. In addition, it is necessary to investigate the characteristics of the crises, presentation form, the interval between crises, triggers, seasonal period, the evolution of the disease and general pediatric history in order to be able to make a differential diagnosis of other respiratory pathologies that may occur with the same symptoms as asthma. In order to objectify the airflow obstruction, the functional diagnosis is made, which consists of a respiratory function test (spirometry). It has a disadvantage that requires the collaboration of the child and therefore is done in children over 6 years.

In all children in whom bronchial asthma is suspected, basal and bronchodilator spirometry should be performed (give the child to inhale a drug) in order to demonstrate that the airway obstruction is reversible (characteristic of asthma). Finally, an etiological diagnosis, aimed at finding the cause that triggers the symptoms; Identifying the cause is the most important step to control the disease.

Treatments
The treatment of asthma should cover several fronts: inflammation of the bronchial mucosa, bronchospasm and allergies:
Asthma
1. Inflammation of the bronchial mucosa:
In recent years it has been shown that the treatment of inflammation is the most important part of asthma treatment. Until now, too much emphasis was placed on bronchodilation, but if inflammation is not treated, the effects of bronchodilators are ephemeral. There are various medications that have an anti-inflammatory effect on the bronchial mucosa, but the most potent and effective are inhaled corticosteroids. By inhalation, the doses of corticosteroids used are very low and produce a topical effect without the side effects of oral, intravenous or intramuscular administration. Inhaled corticosteroids have become the most important medication in the treatment of asthma. They begin to be prescribed in patients with persistent asthma, that is, those in which symptoms occur several days a week, and in those in which nocturnal symptoms occur. For those whose symptoms occur sporadically, for example once or twice every 15 days, it is not necessary to start with corticosteroids and bronchodilators may suffice.

2. Bronchospasm:
Inhaled corticosteroids do not act immediately, although when they take effect after a few days of treatment, the bronchospasm remits. But for the immediate treatment of the same bronchodilators are used that are normally administered by inhalation. There are two fundamental types depending on the duration of their action: long-acting bronchodilators are taken in the morning and at night every day, whether or not they have symptoms, while short-acting ones are usually reserved for taking if necessary. (choking sensation, cough, etc). The primary objective is for patients to resort to short-acting bronchodilators very rarely. Obviously, there are patients with severe asthma who, despite receiving maximum anti-inflammatory treatment, often require bronchodilators.

3. Allergies:
In patients in whom an allergic component is demonstrated, treatment with antihistamines may be beneficial. On the other hand, with certain allergies, there are effective immunological treatments (vaccines) that can help notably in the control of asthma. However, the most effective treatment of allergies is to avoid or reduce exposure to allergens as much as possible. For example, in the case of allergy to dust mites, simple household hygiene measures can significantly reduce their presence.

Diseases associated with asthma:
Gastroesophageal reflux and chronic sinusitis can aggravate or cause asthma, so it is important to rule them out in cases of asthma that do not respond to the usual treatment.


Other data
This disease is a public health problem that affects 10 percent of children and young people, and 5 percent of the adult population in industrialized countries.




"The alexithymia could also be one of the causes of the low compliance of the treatment that is registered among asthmatic patients," said Vicente Plaza, of the Pulmonology Service of the San Pablo Hospital, in Barcelona. Asthma is the most frequent cause of pediatric emergency visits and the fifth cause of consultation in primary care. About 60 percent of the emergencies treated in the pulmonology services are asthma exacerbations caused, most of the time, due to lack of compliance with the prescribed treatment.

This confirms that the disease is not well controlled, since more than half of the asthmatics diagnosed, despite being under treatment, have to use rescue medication to relieve the exacerbation of their symptoms.

The lack of compliance could be resolved with more comfortable drugs, better communication between doctor and patient and education of the patient. "The patient should be informed about everything related to his illness and trained for the correct use of the medication, creating an active and continuous relationship between the physician, the patient, and their environment.

Thus, through the acceptance and understanding of the disease the patient is responsible for their treatment, and does not need to lie to the doctor or feel guilty for not following the treatment, "says Santiago Nevot, head of the Pediatric Service of the General Hospital of Manresa So far it has been proven that compliance is better with oral drugs than inhaled, and increases if it is a single daily dose.

Asthma is associated with a significant physical and socioeconomic burden. In 2014, it caused more than 345,000 deaths and each year is responsible for the loss of 22 million years of disability-adjusted life worldwide. Adults and children with severe uncontrolled asthma lose twice working days and schooling in front of patients who control the disease.

The economic burden of asthma is high and the estimate of annual direct costs in the US. UU. It is approximately 50 billion dollars, mostly related to hospitalizations. In Europe, the cost of asthma has been estimated at 18 billion pounds each year and the loss of productivity represents almost 10 billion pounds of such costs.

Uncontrolled asthma is the subtype of the disease that represents the greatest economic burden. Patients with uncontrolled asthma are 39 percent more likely to go to the emergency room and 22 percent more likely to be hospitalized than those in whom the disease is less severe. Consequently, although severe asthma accounts for 10 percent of patients, severe uncontrolled asthma accounts for 50 percent of the economic burden.
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