ASTHMA AND BRONCHITIS

Pulmonary Disorders: Asthma & Bronchitis
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Pulmonary Disorder: Asthma
Asthma is a clinical condition that is marked by an obstruction of air flow in the lungs. During asthma there are no problems with inspiration, but the expiration of air becomes difficult. It is an inflammatory disease and is marked by triad aetiology. These are airway inflammation, airway constriction and airway hyper-responsiveness. Asthma is triggered by certain substances that are called allergens. These allergens interact with immunoglobulin E receptors on the mast cells. The mast cells of an asthmatic individual are sensitised and produce hyper-response towards such allergens. They respond by liberation of histamine that acts on the smooth muscles of the bronchioles to cause airway constriction. Further, histamine may cause neutrophils and leukotrienes to invade the bronchioles, which leads to inflammation. All such actions cause the narrowing of bronchioles and trap the air inside the alveoli. Increased efforts are required to expel the air, out of the lungs. This causes hyperventilation symptoms of asthma (Gibson, McDonald & Marks, 2010).
Stages of Asthma
Asthma is classified according to the severity of symptoms and obstruction (Hargreave, & Parameswaran, 2006).
Severity Symptom frequency Night time symptoms %FEV1 predicted
Intermittent < 2 /weeks < 2 /month >80
Mild persistent >2/week 3-4/month >80
Moderate persistent Daily >1/week 60-80
Severe persistent Continuously >7/week <60
Clinical Manifestations According to Age:
Age Group manifestations
Infant(0-1 years) Wheezing, shortness of breath, running nose, trouble feeling asleep
Child (2-12 years) Wheezing, shortness of breath, non-productive cough, running nose
Adolescents (13-18) Hyperventilation, chest tightness, fatigue, trouble feeling asleep, productive cough
Young Adult( 19-39) Hyperventilation, Increased work of breathing, cough or without a productive cough, FEV1 70-80%
Adult (40-64) Hyperventilation, wheezing, productive or a non-productive cough, FEV1< 60
Mature Adult (65+) Hyperventilation, Increased work of breathing, non-productive cough
Pulmonary Disorder: Bronchitis
Bronchitis is an infection of the respiratory tract.

It can affect both the upper and lower respiratory tract of an individuals. The infections may be caused by virus or bacteria. Due to infection, various immune cells like macrophages and neutrophils accumulate around these pathogens and leads to inflammation. There is a persistent presence of non-productive and dry hacking cough. Later on, as the disease progresses to the lower respiratory tract it is accompanied by a productive cough. The colour of a cough depends upon the severity of infection. When infection is less the sputum is usually colourless and thin. As the severity of infection increases the sputum becomes thick and a pus-filled discharge is emitted in the sputum. The colour of the pus filled sputum is yellow or green. As the disease progresses there can be chances of haemoptysis (Tackett & Atkins, 2012).
Bronchitis may be classified with the nature of onset:
Acute Bronchitis Chronic Bronchitis
Quick onset, usually with exposure to cold Late onset, may be allergen-driven
Persistent dry hacking cough Persistent productive cough
Shortness of breath Shortness of breath
Wheezing Wheezing
Fever Might or might not occur with fever
Malaise
Chest pain
haemoptysis
Clinical Manifestations According to Age:
Age Group manifestations
Infant(0-1 years) Wheezing, running nose, trouble feeling asleep, low-grade fever
Child (2-12 years) Wheezing, non-productive cough, running nose, fever low grade to high grade.
Adolescents (13-18) Wheezing, chest tightness, fatigue, trouble feeling asleep, non-productive or a productive cough, fever high grade to low grade
Young Adult( 19-39) Wheezing, Increased work of breathing, cough or without a productive cough, severe fatigue
Adult (40-64) wheezing, productive cough and persistence cough, haemoptysis, increased work of breathing
Mature Adult (65+) Chest tightness, Increased work of breathing, non-productive cough, malaise
References
Gibson PG, McDonald VM, & Marks GB (2010). “Asthma in older adults”.  Lancet 376 (9743), 803–13
Hargreave, FE & Parameswaran, K (2006). “Asthma, COPD and bronchitis are just components of airway disease”. European Respiratory Journal 28 (2): 264–7
Tackett, KL; & Atkins, A (2012). “Evidence-based acute bronchitis therapy.”. Journal of pharmacy practice 25(6), 586–90