Asthma, a disease of the airways, has become increasingly common in industrialized nations. According to "Harrison's Principles of Internal Medicine," it affects about 15 percent of children and 10 percent of adults in affluent countries. Symptoms can be acute or chronic, and can range from mild to severe. Most patients with asthma are well managed with outpatient treatment.
Symptoms of Asthma
Symptoms are caused by inflammation and constriction of the airways, which prevent exhalation of air. Symptoms of asthma typically include a triad of coughing, wheezing and shortness of breath. Chest tightness may also occur. The wheezing sound accompanies exhalation. According to the Mayoclinic.com, asthma can occur without wheezing. Symptoms may be triggered by exercise or other triggers and often worsen at night, causing the patient to wake from sleep. Some asthma attacks are triggered by cold; others by heat and stress often causes worsening of symptoms.
Description of a Severe Asthma Attack
An acute severe asthma attack consists of worsening shortness of breath and wheezing, with no relief from inhalers. The patient is unable to complete a sentence, his ribs retract in an effort to breath and his heart rate increases. Blood oxygen level falls and the patient becomes cyanotic, which means that his lips and skin become blue. Severe asthma is a medical emergency that can lead to death. It requires treatment in the emergency room. Occasionally patients require intubation and hospitalization in the intensive care unit.
Refractory Asthma
Refractory asthma refers to asthma that isn't well controlled by treatment. According to "Harrison's Principles of Internal Medicine," about five percent of asthmatics suffer from refractory asthma. Some have continuous symptoms and their lung functions are poor. Others have normal lung functions in between attacks, but suffer from severe exacerbations. Unlike other asthmatics, who can lead a normal life between attacks, patients with refractory asthma may become disabled by the continuous symptoms and frequent hospitalizations. Due to their poor response to the usual treatment methods, they need a thorough evaluation to discover any potential triggers for their asthma or any other underlying disease of the lungs and airways that may have been overlooked. Some have severe allergies underlying the asthma and need to carry with them at all times injectable epinephrine, known as an epi-pen.
References
- "Harrison's Principles of Internal Medicine, 17th edition"; Anthony Fauci et al.; 2008
- Mayoclinic.com: Asthma-Symptoms
- Mayoclinic.com: Asthma without wheezing - Is this possible?
