Bronchial Asthma

is a disease of the lungs where an obstruction or disturbance in the ventilation of the respiratory passages evokes a feeling of shortness of breath. This leads to paroxysms which constrict the bronchial air passages.

Asthma is associated with mast cells, eosinophils, and T lymphocytes. Mast cells are the allergy-causing cells that release chemicals like histamine. Histamine is the substance that causes nasal stuffiness and dripping in a cold or hay fever, constriction of airways in asthma, and itchy areas in a skin allergy. Eosinophils are a type of white blood cell associated with allergic disease. T lymphocytes are also white blood cells associated with allergy and inflammation. These cells, along with other inflammatory cells, are involved in the development of airway inflammation in asthma that contributes to the airway hyperresponsiveness, airflow limitation, respiratory symptoms, and chronic disease. In certain individuals, the inflammation results in the feelings of chest tightness and breathlessness that's felt often at night (nocturnal asthma) or in the early morning hours. Others only feel symptoms when they exercise (called exercise-induced asthma). Because of the inflammation, the airway hyperresponsiveness occurs as a result of specific triggers. Allergies are strongly linked to bronchial asthma and to other respiratory diseases such as chronic sinusitis, middle ear infections, and nasal polyps. Most interestingly, a recent analysis of people with asthma showed that those who had both allergies and asthma were much more likely to have nighttime awakening due to asthma, miss work because of asthma, and require more powerful medications to control their symptoms.

a. 

Causes of Bronchial Asthma There can be several causes of Bronchial Asthma. The main cause is a raised level of resistance to the airflow in the bronchial passages. Although the muscles of these passages work harder, they are unable to support the activity of breathing and gas exchange. The result is an attack of bronchial asthma where there are spasms of the bronchial muscles, a swelling of the bronchial wall and an increase in the secretion of mucous.

Other causes of bronchial asthma are: respiratory infections, cold air, exercise, smoke, pollutants, stress, anxiety, and allergies from food or drugs.

Sometimes, Bronchial Asthma is also triggered by pollen, dust, fungi or mold.

b.

Symptoms of Bronchial Asthma



wheezing breath which includes a whistling sound in the chest, and shortness of breath

increased secretion of mucous occurs during the asthma attack. This can also happen in the periods between two asthma attacks.

  c.

difficult to breathe and feel a lot of pain in the chest area

Treatment for Bronchial Asthma



control the environment. Living in an environment which is free from dust, smoke, pets, pollutants and allergens will ensure that the asthma attacks remain in control.

The patient must also wear a mask covering his nose and mouth every time he cleans the home or dusts the furniture.

People suffering from asthma should ensure that their clothes, bedding, furniture etc do not collect dust and dirt. They can also consider using an air conditioner to regulate the atmosphere and the humidity in their surroundings.

Addison's disease Adrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency Addison's disease is a disorder that occurs when the adrenal glands do not produce enough of their hormones. Causes, incidence, and risk factors The adrenal glands are small hormone-secreting organs located on top of each kidney. They consist of the outer portion (called the cortex) and the inner portion (called the medulla). The cortex produces three types of hormones:
y The glucocorticoid hormones (such as cortisol) maintain sugar (glucose)

control, decrease (suppress) immune response, and help the body respond to stress. y The mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance. y The sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive. Addison's disease results from damage to the adrenal cortex. The damage causes the cortex to produce less of its hormones. This damage may be caused by the following:
y The immune system mistakenly attacking the gland (autoimmune disease) y Infections such as tuberculosis, HIV, or fungal infections y Hemorrhage, blood loss y Tumors y Use of blood-thinning drugs (anticoagulants)

Risk factors for the autoimmune type of Addison's disease include other autoimmune diseases:
y Chronic thyroiditis y Dermatis herpetiformis y Graves' disease

y Hypoparathyroidism y Hypopituitarism y Myasthenia gravis y Pernicious anemia y Testicular dysfunction y Type I diabetes y Vitiligo

Certain genetic defects may cause these condition. Addison s disease is also called adrenal insufficiency. There are 2 types of adrenal insufficiency: Primary adrenal insufficiency Primary adrenal insufficiency occurs when the outer layer of the adrenal gland (the part that produces corticosteroids) is damaged and doesn t produce enough hormones. This damage is usually caused by an autoimmune disease. Normally, your immune system produces antibodies to help protect the body against viruses, bacteria and other foreign substances. An autoimmune disease is when your immune system produces antibodies that attack your body's adrenal glands, or other tissues and/or organs.

Other causes of adrenal gland failure include:

y y y y

Tuberculosis Other infections of the adrenal glands Cancer of the adrenal glands Bleeding into the adrenal glands

Secondary adrenal insufficiency Secondary adrenal insufficiency occurs when you have another condition that causes the adrenal gland to fail to produce enough hormones. For example, secondary insufficiency can be caused by a diseased pituitary gland. The pituitary gland is a gland in your brain that makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal glands to produce their hormones. If the pituitary gland is unable to produce enough ACTH, the adrenal glands will not produce enough of their hormones either.

You can also develop temporary secondary adrenal insufficiency if you suddenly stop taking a corticosteroid medicine (such as prednisone). Corticosteroids are prescribed for treatment of conditions such as asthma and arthritis. Symptoms
y Changes in blood pressure or heart rate y Chronic diarrhea y Darkening of the skin - patchy skin color y Unnaturally dark color in some places y Paleness y Extreme weakness y Fatigue y Loss of appetite y Mouth lesions on the inside of a cheek (buccal mucosa) y Nausea and vomiting y Salt craving y Slow, sluggish movement y Unintentional weight loss

Hyperpigmentation, or darkening of the skin, can occur in Addison s disease but not in secondary adrenal insufficiency. This darkening is most visible on scars; skin folds; pressure points such as the elbows, knees, knuckles, and toes; lips; and mucous membranes such as the lining of the cheek. Because the symptoms progress slowly, they are often ignored until a stressful event like an illness or accident causes them to worsen. Sudden, severe worsening of symptoms is called an Addisonian crisis, or acute adrenal insufficiency. In most cases, symptoms of adrenal insufficiency become serious enough that people seek medical treatment before a crisis occurs. However, sometimes symptoms first appear during an Addisonian crisis. Sometimes, the symptoms of Addison s disease appear suddenly. This is called acute adrenal failure or an Addisonian crisis. It can be fatal if it isn't treated. The symptoms may include:
y y y y

Pain in the abdomen, lower back or legs Severe vomiting and diarrhea Dehydration Low blood pressure

y y

Loss of consciousness Difficulty breathing

Signs and tests Tests may show:

y Increased potassium y Low blood pressure y Low cortisol level y Low serum sodium y Normal sex hormone levels

Other tests may include:

y Abdominal x-ray y Abdominal CT scan

How will my doctor know I have Addison s disease? Your doctor will ask you about your medical history and your symptoms. He or she may also perform laboratory tests to determine whether you have Addison s disease:
y

Blood tests: Tests that measure the levels of sodium, potassium, cortisol and ACTH in your blood can help your doctor know whether an adrenal insufficiency is causing your symptoms. Your doctor can also use a blood test to see if an autoimmune disease is the possible cause of your Addison s disease. ACTH stimulation test: Your doctor may test your body s ability to secrete cortisol in response to an injection of synthetic ACTH. This will check to see if your adrenal glands are damaged. In a healthy person, cortisol levels rise after the ACTH injection. Insulin-induced hypoglycemia test: If your doctor suspects pituitary gland disease, he or she may test your blood sugar and cortisol levels at various points after an injection of insulin. Normally, glucose levels fall and cortisol levels rise after an insulin injection.

Imaging tests: Your doctor may want to do a computerized tomography (CT) scan to check the size of your adrenal glands or pituitary gland and look for problems that could help identify the cause of your adrenal insufficiency.

Treatment Treatment with replacement corticosteroids will control the symptoms of this disease. However, you will usually need to take these drugs for life. People often receive a combination of glucocorticoids (cortisone or hydrocortisone) and mineralocorticoids (fludrocortisone). Never skip doses of your medication for this condition, because life-threatening reactions may occur. The health care provider may increase the medication dose in times of:
y Infection y Injury y Stress

During an extreme form of adrenal insufficiency, adrenal crisis, you must inject hydrocortisone immediately. Supportive treatment for low blood pressure is usually needed as well. Some people with Addison's disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. It is important for you to always carry a medical identification card that states the type of medication and the proper dose needed in case of an emergency. Additionally, your health care provider may advise you to always wear a Medic-Alert tag (such as a bracelet) alerting health care professionals that you have this condition in case of emergency. Prognosis With hormone replacement therapy, most people with Addison's disease are able to lead normal lives.