Asthma

Asthma Revision

Asthma is a chronic disease that affects the airways of your lungs, this causes them to constrict in response to certain allergens or triggers, severe contractions are known as an asthma attacks and can restrict oxygen to vital organs, this requires medical intervention such as the use of various inhalers.

Symptoms of asthma may be coughing wheezing, heavy and interrupted breathing, and in severe cases cyanosis can occur (skin/extremities turn blue due to lack of oxygen)

-in our case involving the child infected with asthma and cystic fibrosis, the severity tightening of the airways is going to increase due to the build-up of mucus characteristic of CF

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Those with asthma are predisposed towards chest infections due to the build-up of mucus in the lungs which traps bacteria isn’t being shifted as efficiently as it should be

There are two primary types of chest infection, acute/chronic bronchitis and pneumonia. Acute bronchitis is self-limiting and usually clears up within a few weeks, though if the condition is quite severe it can cause permanent damage to the lungs. Bronchitis is a condition were by the bronchi produces too much mucus and they become swollen, the coughing is the bodies attempt to remove the mucus. Complications can arise when the patient is already infected with asthma, which can cause the airways to become swollen more regularly. The chronic variant occurs when bronchitis occurs for 3-4 months

Pneumonia is a condition whereby the alveoli in the body become inflamed and as such cannot efficiently diffuse oxygen into the blood stream; it is caused by a virus bacteria or fungus. Again this condition is worsened by bronchiole inflammation which further cuts down the bodies supply of oxygen1

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Seasons of asthma and chest infection

-Cold air thickens the mucus in the lungs and nose making it harder to remove allergens or triggers
- Histamine is also produced by the lungs in response to cold air which causes wheezing
-poor air quality (histamine causes nearby vessels to become permeable causes blood fluids to enter the site and cause swelling)5
-prevalence of flu, and cold viruses
-Even the psycho-social aspect of depression can lead to poor asthma management and more attacks 4

Interestingly vitamin D deficiency has also been proposed to causes asthma by recent studies, this makes sense as asthma cases increase in seasons that lack sunlight (a major source of vitamin C)2+3






Inhalers6

Relievers – use to relieve an occurring asthma attack, contains drugs such as salbutamol or terbutaline. These drugs cause the bronchioles to dilate and allow air into the lung compartments. They are blue in colour.

Preventers – taken every day, or at a prescribed timetable after consultation with your GP, these inhalers contain steroids such as Beclometasone, reducing the inflammation of the airways. Their purpose is to prevent asthma attacks throughout the day. Though it may take many weeks for them to become fully effective.

Long acting – Often taken in combination with the preventer if fails to control the symptoms. They work similarly to relievers, but over a 12 hour period and contain the drug salmeterol, these are often green in colour.

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Spacers
Pressurized reservoir ensures than none of the drug is lost, ensures the patient receives full medication without needing good coordination.

Nebulisers
Used In hospital in emergency cases allows a high quantity of drug to be administered at once.

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Triggers
Triggers are essentially anything that can cause an asthma attack; this can be pollen, smoke, dust mites, Household pet and even negative emotions stress causing higher blood pressure and increased heart rate which can leads to heavy breathing. This can trigger the airways to contract. In addition to this allergens of all kinds can trigger an asthmatic attack.

(IgE which is bound to mast cells binds to a complementary antigen, if the antigen binds to the IgE then histamine is released which can cause an asthmatic attack)5

In our case the dog household pet could be a potential trigger- it can’t be factored out

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Green sputum and the 3 day delay…

Green mucus is clearly indicative of infection (white blood cells mixed with bacteria) which gives it the colour, this is also characteristic of respiratory infections7. Though this may not be a direct response form the HPV vaccine there may be other indirect causes… HPV symptoms at their most severe can be vomiting fever muscle pain and vomiting, nothing particularly linked to the respiratory system. However like all vaccines there is the chance for an allergic reaction or a compromised immune system, this could explain the same day coughing (Though further tests may need to be performed to establish if there really is a causal linkage)8