Thursday, April 24, 2014

Chronic Asthmatic Bronchitis

Definition

Chronic asthmatic bronchitis refers to an underlying asthmatic problem in patients in whom the asthma has become so persistent that clinically significant chronic airflow obstruction is present despite anti-asthmatic therapy. The symptoms of chronic bronchitis are generally also present.

Description

Asthma, chronic bronchitis and emphysema all diffusively affect the bronchial tree and may give rise to the syndrome of wheezing, cough, and shortness of breath. It is clinically difficult to distinguish among these disorders, and for this reason estimates of their prevalence are not entirely accurate. However, they are common.

It is unclear why there are wide differences in susceptibility to small airways abnormalities in response to inhalation of bronchial irritants. Early childhood infections, unidentified immunologic mechanisms, and bronchial hyperactivity have all been suggested as determinants of susceptibility. Small airways abnormalities may develop in persons with persistent asthma, and asthmatics do appear to be unusually susceptible to the effects of smoking.

Under diagnosis of asthma is a problem. It must be recognized that 50 percent of children with asthma develop their initial symptoms before their first birthday. There is a mislabeling of young children with asthma who wheeze with respiratory infections such as wheezy bronchitis, asthmatic bronchitis, or bronchitis despite ample evidence that there is a variable airflow limitation and the proper diagnosis is asthma.

Another cause of under diagnosis is the failure to recognize that asthma may accompany other chronic respiratory disease, such as bronchopulmonary dysplasia, cystic fibrosis, or recurrent croup, which can dominate the clinical picture.

Causes

It is not well known why some people with asthma go on to develop chronic asthmatic bronchitis. Smoking and exposure to environmental toxins appear to play a role.

Symptoms

Wheezing, shortness of breath, recurrent infections and cough all appear as symptoms of this problem. While these also occur in those with simple asthma, those with chronic asthmatic bronchitis tend to have increased severity and frequency of these complaints.

Treatment

In addition to treatment of the asthmatic condition itself, a number of complications may arise that require hospitalization. These include serious infectious complications such as acute bronchitis, pneumonia, or sinusitis. Hospitalization may also be indicated for the treatment of iatrogenic complications of the primary disorder including the following: medication overdose or severe adverse reaction to medication, complications of standard treatment (severe side effects from steroid therapy) acute complications (hyperglycemia or fluid retention) and chronic complications (opportunistic infections - ocular and skeletal).

In the case of patients with status asthmaticus requiring treatment with mechanical ventilation, there may be complications of the mechanical ventilation, including disorders of the trachea or persistent bronchopleural fistula, which may require prolonged hospitalization or readmission.

Questions

What is the nature or primary cause of the airways obstruction?

What is the relationship between asthma and bronchitis?

Is emphysema also present?

Is the diagnosis clear-cut or do further tests need to be performed?

What triggers an attack?

Can susceptibility be minimized? How?

What medications can be prescribed?

What are the complications that can occur?

How can these complications be avoided or minimized?

Is hospitalization required?