characterized by increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli. Typically, most attacks are short-lived, lasting minutes to hours, and clinically the patient seems to recover completely after an attack Etiology Asthma is a very common disease with immense social impact. asthma that has its onset in early life tends to have a strong allergic component, whereas asthma that develops late tends to be nonallergic or to have a mixed etiology. Risk factor Airway hyper responsiveness Familial history of asthma Pathophysiology A reduction in airway diameter brought about by contraction of smooth muscle, vascular congestion, edema of the bronchial wall, and thick, tenacious secretions. The net result is An increase in airway resistance A decrease in forced expiratory volumes and flow rates Hyperinflation of the lungs and thorax Increased work of breathing Alterations in respiratory muscle function Changes in elastic recoil Abnormal distribution of both ventilation and pulmonary blood flow with mismatched ratios Altered arterial blood gas concentrations. Clinical Manifestation Episodic wheezing, cough and dyspnea Onset: Patient experience a sense of constriction in the chest Non productive cough Harsh, audible respiration (wheezing) Prolonged expiration Tachypnea, tachycardia and systolic hypertension Barrel chest (increase AP diameter) Prolonged: Loss of adventitious breath sound High-pitch wheezing Accessory muscle becomes visibly active Paradoxical pulse develops End of episodes: Cough w/ thick, stingy mucus charcot-leyden crystal Wheezing is less extreme Gasping type of respiration impending suffocation Timing acute/sudden episodes; may occur during the night (nocturnal asthma) Diagnosis Reversible airway obstruction. Reversibility is traditionally defined as a 15% increase in FEV1 after two puffs of a -adrenergic agonist. Sputum and blood eosinophilia and measurement of serum IgE levels Difference of asthma from other diseases with dyspnea and wheezing Physical findings and symptoms History of periodic attacks Personal and family history of allergic diseases Nocturnal awakening with dyspnea and/or wheezing Most common and so prevalent that absence of which produces doubt about diagnosis Timing: Acute episodes, separated by symptom free periods. Nocturnal episodes common Aggravating factors: Variable, including allergens, irritants, respiratory infections, exercise and emotions Relieving factors: Separation from aggravating factors Symptoms: Wheezing, cough, tightness in chest Setting: Environmental and emotional conditions