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Saturday, October 31, 2020

Asthma Types: Allergic Asthma, Adult-Onset Asthma, Asthma-COPD Overlap (ACO).....

 


Asthma Types: Allergic Asthma, Adult-Onset Asthma, Asthma-COPD Overlap (ACO).....



Exacerbations of asthma are the leading cause of morbidity and mortality from asthma. The initial pathology of asthma has been described by patients who died of severe asthma. A more recent description of patients who died suddenly of a serious episode describes the presence of neutrophilic inflammation in the respiratory tract, with little evidence of intraluminal obstruction. Respiratory virus infections cause acute exacerbations of asthma in all age groups

Asthma management should be tailored to the needs of the patient and the severity of asthma. Guidelines should be followed whenever possible. Asthmatics of any severity should have immediate access to short-acting inhaled beta-agonists. In addition, there must be a plan to monitor asthma control and exacerbation treatment


Asthma Types


Given the varied presentation and course of the disease, it is not surprising that asthma has been clinically classified in several ways, for example by triggering factors, severity, pattern of asthma attacks and even in response to available treatments. However, there is no real classification based on molecular mechanisms, as these mechanisms are not currently well understood. A central question is whether there are different types of asthma or if there is only one central mechanism with varying severity and interaction with other exogenous factors to create a varied presentation and course


Allergic Asthma


Allergic asthma usually precipitates after exposure to all the triggers that are pollen, dust...., but there may be a subset of people in whom there will be no allergic history, but will still have asthma, so these are the non-allergic type of asthma 


Nonallergic Asthma


Non-allergic asthma, or non-atopic asthma, is a type of asthma that is not related to an allergy trigger such as pollen or dust, there may be a subset of people where there will be no allergic history but will still have asthma, so this is the non-allergic type of asthma


Adult-Onset Asthma


Asthma can start at any age, even in elderly patients. The principles of treatment are the same as for other asthmatics, but side effects of therapy can be a problem, such as muscle tremor with β2 agonists and more systemic side effects with ICS. Comorbidities are more common in this age group and interactions with drugs such as β2 blockers, COX inhibitors, and agents that can affect theophylline metabolism should be considered. COPD is more likely in elderly patients and can coexist with asthma. An OCS test can be very helpful in documenting your steroid reactivity for asthma


Childhood Asthma


In childhood, a child may develop asthma once he is exposed to certain triggers, such as inhaling pollen or catching a cold or other respiratory infection, causing inflammation in the lung and airways, but sometimes, with age it may improve or disappear completely and this is  known as childhood asthma


Seasonal Asthma


Some people only experience asthma symptoms at certain times of the year, in case the weather is cold or there are pollen in the air. This is known as seasonal asthma


Asthma-COPD Overlap (ACO)


Although asthma and COPD are distinct syndromes with different clinical presentations and underlying inflammatory mechanisms, some patients with asthma have features of COPD (e.g., asthmatics who smoke and severe asthmatics with irreversible airflow limitation) and some patients with COPD have features of asthma with increased reversibility and increased eosinophils in the airways and blood. This may represent the coincidence of two common diseases or these may be different phenotypes. Patients with ACO tend to have more symptoms and exacerbations. They can benefit from triple therapy with ICS, LABA and LAMA.


Exercise-Induced Bronchoconstriction (EIB)


Exercise-induced bronchoconstriction, or EIB, is the preferred term for what has been known for years as exercise-induced asthma. Exercise-induced bronchospasm is thought to be a reflection of the increased BHR of asthmatics. There is a correlation, although not perfect, between EIB and reactivity to histamine and methacholine


Occupational Asthma


Each patient interviewed about allergy or asthma history should be asked to provide a detailed professional history. Much occupational asthma escapes diagnosis because doctors get an inadequate occupational history. A huge variety of possible industrial circumstances can lead to exposure and subsequent disease


Cough-Variant Asthma


A severe cough is the predominant symptom. There may be other causes of cough, such as:

Cough due to sinusitis with asthma is common


Nighttime (Nocturnal) Asthma


The worsening of asthma during sleep is known as nocturnal asthma. Patients with nocturnal asthma have a significant decline in lung function between bedtime and awakening; Although the pathogenesis of this phenomenon is unknown, it has been associated with diurnal patterns of circulating endogenous secretion of cortisol and epinephrine. Direct evidence of an inflammatory component of nocturnal asthma includes an increase in circulating histamine and excretion of activated eosinophils and leukotrienes during the night, associated with increased hyper-reactivity to methacholine


Health Conditions That May Mimic Asthma / Difficult-to-control asthma


Several diseases, such as cardiac asthma can cause some of the same symptoms as asthma, which is a form of heart failure in which symptoms mimic some of the signs of regular asthma

There is what is known as aspirin induced asthma as I told earlier many of the drugs can cause asthma many of the drugs can precipitate asthma one of the most common drug is aspirin so if you are taking aspirin for some pain like headache or from joint pains


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