Health and Psychology

Asthma is a common medical condition in whichthe airways become inflammed.  This is caused by a variety of triggering stimuli that result in partially or completely reversible constriction of the bronchi and smaller airways.  Asthma depends on both genetic and environmental factors.  Genetic factors include genes responsible for parts of the immune system (T-helper cells and cytokines and the ADAM33 gene).  Environmental components include dust mites, cockroaches, pet dander, pollen, and other allergens,including medication, physical exertion, air temperature, gastroesophageal reflux, and infection, as well as other irritants.  Air polution may contribute to exacerbations, but has not been difinitively linked to asthma.  Asthma has increased in the general population since the 1970's.

The diagnosis of asthma is made based on pulmonary function tests that both confirm the diagnosis and classify the severity.  In a sirometry (a type of pulmonary function test) a person breathes into a tube as forcefully as possible for as long as possible.  Flow rate, lung volume, gas exchange, and respiratory muscle function are measured.  Spirometry can be done using gas dilution techniques or body box plethysmography to determine functional residual capacity of the lungs.  Total lung capacity of less than 80% of the predicted value is considered impaired.

Asthma is classified into four categories:  Mild intermittent, mild persistent, moderate persistent, and severe persistent. Mild intermittent asthmaor mild persistent asthma patients usually are asymptomatic between exacerbations.  People with exacerbations or people with more severe symptoms will have a sense of difficulty breathing, chest tightness, wheezing, and coughing.  In some people accessory muscles in the chest and neck are needed to help them breathe.  Asthma is usually brought on by exposure to a trigger.

Treatment for asthma include controlling triggers, taking medication for emergency or to prevent attacks, and to control baseline lung function.  Medications for asthma include bronchodialors to open the airway, and relax smooth muscle, medications to stabilize mast cells, methylxanthines, leukotriene modifiers, corticosteroids, Beta agonists, anticolinergics, and combinations of those.  Immunotherapy may also be used.

Peak flow monitoring is a useful way to keep track of asthma symptoms and to develop a plan for treatment.  A tube is used to measure forceful expiration and to document response to treatment.  Generally a person can monitor their asthma once a day in the morning.  If the peak flow is below 80% of baseline, then twice a day monitoriing may be needed.  Emergency medications are used to manage an exacerbation of symptoms.  Metered dose inhalers are used with a spacer to ensure the medication gets into the lungs.  People will often feel better after 2-4 puffs and their peak flow will get back to 80% or higher of baseline.  This step may be repeated.  For people that are not responding emergency treatment is required.  A secondary medication may be needed, or an emergency room or doctor visit may be needed.

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