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Resources » Articles/Knowledge Sharing » Health »
Classification Of Asthma - Etiological classification, Diagnosis Of Asthma
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Classification Of Asthma
Introduction
Throughout the past years have tried to develop appropriate classifications of asthma based on factors unique triggers (allergens, drugs, occupational chemicals, etc ...), in the degree of bronchial reactivity in the pathophysiology, the therapeutic response or other elements, but none has found general acceptance. For practical purposes, have been assumed that conventional classifications are useful in the clinical categorization of patients according to the most important etiological factors, the disease course and severity of symptoms.
Etiological classification
Bronchial asthma is characterized not only by the wide variations in the expression of the disease, but also by how often you are in the same patient, multiple factors involved. In fact, it is unlikely that a single causal factor is responsible for all the alterations that accompany asthma, although, of course, a particular agent may be responsible for symptoms in a time of evolution.
Rackemann introduced since 1918 in terms of extrinsic asthma and intrinsic asthma, they have been used in a traditional way, despite all the limitations of this classification.
Extrinsic asthma includes those patients who can demonstrate an antigen-antibody reaction as a trigger of the process. In general, this antigen-antibody reaction is mediated by IgE (atopic extrinsic asthma), while in other cases of occupational origin usually not demonstrated a hypersensitivity reaction type I Gell and Coombs (no extrinsic atopic asthma).
Intrinsic Asthma is a broader term and covers a heterogeneous group of patients with the common feature that is not possible to detect a specific antigen as a precipitating cause. Intrinsic asthma has a number of characteristics that differentiate it from extrinsic: they usually start in adulthood, in many cases is associated with nasal polyps, maxillary sinusitis, and / or idiosyncrasy to aspirin and other nonsteroidal anti-inflammatory or ASA triad Vidal, and has a chronic course with frequent need for oral steroids to control it.
Moreover, within an etiological classification of asthma is necessary to make special mention of specific forms of asthma.
Exercise-induced asthma is a phenomenon that can occur in isolation or in association with any type of asthma. Many patients experience airway obstruction, 5 to 20 minutes after completing the exercise or in the course of it, by a mechanism that seems to include the cooling, the relative dryness of the airway secondary to increased ventilation and loss heat the air.
Occupational asthma is produced by the inhalation of industrial fumes, dust and fumes that are in the workplace. Have described four patterns of response in asthma: immediate exclusive, late-exclusive, dual, and recurrent night for several days. These patients, although varying depending on the type of response that will, tend to improve outside of the workplace during holidays, weekends and periods of low. Several recent reviews describe the potential pathogenic mechanisms for occupational asthma, ranging from simple irritant reaction in patients with bronchial hyperreactivity (eg, SO2 or NO2) to the antigen-antibody reactions mediated by IgE or not (eg, epithelial cells of animals , seeds and some low molecular weight compounds such as isocyanates or epoxy resins).
Classification In Relation To Age
• Asthma in infants: The vast majority are of viral origin, for the same viruses that cause bronchiolitis. In this type of asthma cannot be demonstrated eosinophilic infiltration of the mucosa, so that if one is not bronchial asthma by definition.
• Asthma school age: It mainly affects boys (2:1 to 4:1, depending on age groups), and is associated with allergy neumoalergenos in most cases.
• Asthma in adolescence: It is characterized by denial of symptoms and treatment regimens, and is the age range with higher mortality.
• Adult asthma
Diagnosis Of Asthma
A. Diagnosis of asthma (itself) and the severity-evolution.
1. Measurement peak (PEAK-FLOW) through measuring device for self-control.
2. Respiratory function tests: Forced spirometry using a spirometer. It can see the obstruction of the airway by the decrease in VEMS and FMME.
3. TEST bronchodilation: The positivity criterion for the diagnosis of asthma is the improvement of FEV1 greater than 15% after inhaling a bronchodilator.
4. TEST metacholine or evidence of obstruction after inhalation of metacholine positivity criterion for asthma is an inhaled low dose produced a greater decrease in FEV1 of 20%.
B. Causes of the Diagnosis:
1. Allergy skin tests: We conducted a house dust mites and storage, pollens from grasses, weeds and trees, fungi, animals and skin products and meal and other miscellaneous occupational allergens depending on the clinical history and in every possible causal relationship case.
2. Markers of inflammation
Total and specific IgE in serum are characteristic of allergy, no asthma diagnosis
Inflammatory activity suggests of eosinophilic cationic protein (ECP) in serum
Levels of nitric oxide in exhaled air; it also suggests the inflammatory activity.
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