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Asthma

Definition
Asthma is a chronic (long-lasting) inflammatory disease of the airways. In those susceptible to asthma,
this inflammation causes the airways to narrow periodically. This, in turn, produces wheezing and
breathlessness, sometimes to the point where the patient gasps for air. Obstruction to air flow either stops
spontaneously or responds to a wide range of treatments, but continuing inflammation makes the

A comparison of normal bronchioles and those of an asthma sufferer.


(Illustration by Hans & Cassady.)
airways hyper-responsive to stimuli such as cold air, exercise, dust mites, pollutants in the air, and
even stress and anxiety.

Description
Between 17 million and 26 million Americans have asthma, and the number seems to be increasing. In
about 1992, the number with asthma was about 10 million, and had risen 42% from 1982, just 10 years
prior. Not only is asthma becoming more frequent, but it also is a more severe disease than before,
despite modern drug treatments. Asthma accounts for almost 500,000 hospitalizations, two million
emergency department visits, and 5,000 deaths in the United States each year.
The changes that take place in the lungs of asthmatic persons makes the airways (the "breathing tubes,"
or bronchi and the smaller bronchioles) hyperreactive to many different types of stimuli that don't affect
healthy lungs. In an asthma attack, the muscle tissue in the walls of bronchi go into spasm, and the cells
lining the airways swell and secrete mucus into the air spaces. Both these actions cause the bronchi to
become narrowed (bronchoconstriction). As a result, an asthmatic person has to make a much greater
effort to breathe in air and to expel it.
Cells in the bronchial walls, called mast cells, release certain substances that cause the bronchial muscle
to contract and stimulate mucus formation. These substances, which include histamine and a group of
chemicals called leukotrienes, also bring white blood cells into the area, which is a key part of the
inflammatory response. Many patients with asthma are prone to react to such "foreign" substances as
pollen, house dust mites, or animal dander; these are called allergens. On the other hand, asthma affects
many patients who are not allergic in this way.
Asthma usually begins in childhood or adolescence, but it also may first appear during adult years. While
the symptoms may be similar, certain important aspects of asthma are different in children and adults.

Child-onset asthma
Nearly one-third on the 17 to 26 million Americans with asthma are children. When asthma begins in
childhood, it often does so in a child who is likely, for genetic reasons, to become sensitized to common
allergens in the environment (atopic person). When these children are exposed to house-dust mites,
animal proteins, fungi, or other potential allergens, they produce a type of antibody that is intended to
engulf and destroy the foreign materials. This has the effect of making the airway cells sensitive to
particular materials. Further exposure can lead rapidly to an asthmatic response. This condition of atopy
is present in at least one-third and as many as one-half of the general population. When an infant or
young child wheezes during viral infections, the presence of allergy (in the child or a close relative) is a
clue that asthma may well continue throughout childhood.

Adult-onset asthma
Allergenic materials may also play a role when adults become asthmatic. Asthma can actually start at any
age and in a wide variety of situations. Many adults who are not allergic have conditions such
as sinusitis or nasal polyps, or they may be sensitive to aspirin and related drugs. Another major source of
adult asthma is exposure at work to animal products, certain forms of plastic, wood dust, or metals.

Causes and symptoms


In most cases, asthma is caused by inhaling an allergen that sets off the chain of biochemical and tissue
changes leading to airway inflammation, bronchoconstriction, and wheezing. Because avoiding (or at
least minimizing) exposure is the most effective way of treating asthma, it is vital to identify which allergen
or irritant is causing symptoms in a particular patient. Once asthma is present, symptoms can be set off or
made worse if the patient also has rhinitis (inflammation of the lining of the nose) or sinusitis. When, for
some reason, stomach acid passes back up the esophagus (acid reflux), this can also make asthma
worse. A viral infection of the respiratory tract can also inflame an asthmatic reaction. Aspirin and a type of
drug called beta-blockers, often used to treat high blood pressure, can also worsen the symptoms of
asthma.
The most important inhaled allergens giving rise to attacks of asthma are:

animal dander

mites in house dust

fungi (molds) that grow indoors

cockroach allergens

pollen

occupational exposure to chemicals, fumes, or particles of industrial materials in the air

Key terms
Allergen A foreign substance, such as mites in house dust or animal dander which, when inhaled,
causes the airways to narrow and produces symptoms of asthma.
Atopy A state that makes persons more likely to develop allergic reactions of any type, including the
inflammation and airway narrowing typical of asthma.
Hypersensitivity The state where even a tiny amount of allergen can cause the airways to constrict
and bring on an asthmatic attack.
Spirometry A test using an instrument called a spirometer that shows how difficult it is for an asthmatic
patient to breathe. Used to determine the severity of asthma and to see how well it is responding to
treatment.
Inhaling tobacco smoke, either by smoking or being near people who are smoking, can irritate the airways
and trigger an asthmatic attack. Air pollutants can have a similar effect. In addition, there are three
important factors that regularly produce attacks in certain asthmatic patients, and they may sometimes be
the sole cause of symptoms. They are:

inhaling cold air (cold-induced asthma)

exercise-induced asthma (in certain children, asthma is caused simply by exercising)

stress or a high level of anxiety

Wheezing is often obvious, but mild asthmatic attacks may be confirmed when the physician listens to the
patient's chest with a stethoscope. Besides wheezing and being short of breath, the patient
may cough and may report a feeling of "tightness" in the chest. Children may have itching on their back or
neck at the start of an attack. Wheezing is often loudest when the patient breathes out, in an attempt to
expel used air through the narrowed airways. Some asthmatics are free of symptoms most of the time but
may occasionally be short of breath for a brief time. Others spend much of their days (and nights)
coughing and wheezing, until properly treated. Crying or even laughing may bring on an attack. Severe
episodes are often seen when the patient gets a viral respiratory tract infection or is exposed to a heavy
load of an allergen or irritant. Asthmatic attacks may last only a few minutes or can go on for hours or
even days (a condition called status asthmaticus).
Being short of breath may cause a patient to become very anxious, sit upright, lean forward, and use the
muscles of the neck and chest wall to help breathe. The patient may be able to say only a few words at a
time before stopping to take a breath. Confusion and a bluish tint to the skin are clues that the oxygen
supply is much too low, and that emergency treatment is needed. In a severe attack that lasts for some
time, some of the air sacs in the lung may rupture so that air collects within the chest. This makes it even
harder to breathe in enough air.

Diagnosis
Apart from listening to the patient's chest, the examiner should look for maximum chest expansion while
taking in air. Hunched shoulders and contracting neck muscles are other signs of narrowed
airways. Nasal polyps or increased amounts of nasal secretions are often noted in asthmatic patients.
Skin changes, like atopic dermatitis or eczema, are a tipoff that the patient has allergic problems.
Inquiring about a family history of asthma or allergies can be a valuable indicator of asthma. The
diagnosis may be strongly suggested when typical symptoms and signs are present. A test called
spirometry measures how rapidly air is exhaled and how much is retained in the lungs. Repeating the test
after the patient inhales a drug that widens the air passages (a bronchodilator) will show whether the
airway narrowing is reversible, which is a very typical finding in asthma. Often patients use a related
instrument, called a peak flow meter, to keep track of asthma severity when at home.
Often, it is difficult to determine what is triggering asthma attacks. Allergy skin testing may be used,
although an allergic skin response does not always mean that the allergen being tested is causing the
asthma. Also, the body's immune system produces antibody to fight off the allergen, and the amount of
antibody can be measured by a blood test. This will show how sensitive the patient is to a particular
allergen. If the diagnosis is still in doubt, the patient can inhale a suspect allergen while using a
spirometer to detect airway narrowing. Spirometry can also be repeated after a bout of exercise if
exercise-induced asthma is a possibility. A chest x ray will help rule out other disorders.

Treatment
Patients should be periodically examined and have their lung function measured by spirometry to make
sure that treatment goals are being met. These goals are to prevent troublesome symptoms, to maintain
lung function as close to normal as possible, and to allow patients to pursue their normal activities
including those requiring exertion. The best drug therapy is that which controls asthmatic symptoms while
causing few or no side-effects.

Drugs
METHYLXANTHINES. The chief methylxanthine drug is theophylline. It may exert some anti-inflammatory
effect, and is especially helpful in controlling nighttime symptoms of asthma. When, for some reason, a
patient cannot use an inhaler to maintain long-term control, sustained-release theophylline is a good
alternative. The blood levels of the drug must be measured periodically, as too high a dose can cause an
abnormal heart rhythm or convulsions.
BETA-RECEPTOR AGONISTS. These drugs, which are bronchodilators, are the best choice for relieving
sudden attacks of asthma and for preventing attacks from being triggered by exercise. Some agonists,
such as albuterol, act mainly in lung cells and have little effect on other organs, such as the heart. These
drugs generally start acting within minutes, but their effects last only four to six hours. Longer-acting
brochodilators have been developed. They may last up to 12 hours. Bronchodilators may be taken in pill
or liquid form, but normally are used as inhalers, which go directly to the lungs and result in fewer side
effects.
STEROIDS. These drugs, which resemble natural body hormones, block inflammation and are extremely
effective in relieving symptoms of asthma. When steroids are taken by inhalation for a long period,
asthma attacks become less frequent as the airways become less sensitive to allergens. This is the
strongest medicine for asthma, and can control even severe cases over the long term and maintain good
lung function. Steroids can cause numerous side-effects, however, including bleeding from the stomach,
loss of calcium from bones, cataracts in the eye, and a diabetes-like state. Patients using steroids for
lengthy periods may also have problems with wound healing, may gain weight, and may suffer mental
problems. In children, growth may be slowed. Besides being inhaled, steroids may be taken by mouth or
injected, to rapidly control severe asthma.
LEUKOTRIENE MODIFIERS. Leukotriene modifiers (montelukast and zafirlukast) are a new type of drug
that can be used in place of steroids, for older children or adults who have a mild degree of asthma that
persists. They work by counteracting leukotrienes, which are substances released by white blood cells in
the lung that cause the air passages to constrict and promote mucus secretion. Leukotriene modifiers
also fight off some forms of rhinitis, an added bonus for people with asthma. However, they are not
proven effective in fighting seasonal allergies.
OTHER DRUGS. Cromolyn and nedocromil are anti-inflammatory drugs that are often used as initial
treatment to prevent asthmatic attacks over the long term in children. They can also prevent attacks when
given before exercise or when exposure to an allergen cannot be avoided. These are safe drugs but are
expensive, and must be taken regularly even if there are no symptoms. Anti-cholinergic drugs, such as
atropine, are useful in controlling severe attacks when added to an inhaled beta-receptor agonist. They
help widen the airways and suppress mucus production.
If a patient's asthma is caused by an allergen that cannot be avoided and it has been difficult to control
symptoms by drugs, immunotherapy may be worth trying. Typically, increasing amounts of the allergen
are injected over a period of three to five years, so that the body can build up an effective immune
response. There is a risk that this treatment may itself cause the airways to become narrowed and bring
on an asthmatic attack. Not all experts are enthusiastic about immunotherapy, although some studies
have shown that it reduces asthmatic symptoms caused by exposure to house-dust mites, ragweed
pollen, and cat dander.

Managing asthmatic attacks


A severe asthma attack should be treated as quickly as possible. It is most important for a patient
suffering an acute attack to be given extra oxygen. Rarely, it may be necessary to use a mechanical
ventilator to help the patient breathe. A beta-receptor agonist is inhaled repeatedly or continuously. If the
patient does not respond promptly and completely, a steroid is given. A course of steroid therapy, given
after the attack is over, will make a recurrence less likely.
Maintaining control
Long-term asthma treatment is based on inhaling a beta-receptor agonist using a special inhaler that
meters the dose. Patients must be instructed in proper use of an inhaler to be sure that it will deliver the
right amount of drug. Once asthma has been controlled for several weeks or months, it is worth trying to
cut down on drug treatment, but this must be done gradually. The last drug added should be the first to be
reduced. Patients should be seen every one to six months, depending on the frequency of attacks.
Starting treatment at home, rather than in a hospital, makes for minimal delay and helps the patient to
gain a sense of control over the disease. All patients should be taught how to monitor their symptoms so
that they will know when an attack is starting, and those with moderate or severe asthma should know
how to use a flow meter. They should also have a written "action plan" to follow if symptoms suddenly
become worse, including how to adjust their medication and when to seek medical help. A 2004 report
said that a review of medical studies revealed that patients with self-management written action plans had
fewer hospitalizations, fewer emergency department visits, and improved lung function. They also had a
70% lower mortality rate. If more intense treatment is necessary, it should be continued for several days.
Over-the-counter "remedies" should be avoided. When deciding whether a patient should be hospitalized,
the past history of acute attacks, severity of symptoms, current medication, and whether good support is
available at home all must be taken into account.
Referral to an asthma specialist should be considered if:

there has been a life-threatening asthma attack or severe, persistent asthma

treatment for three to six months has not met its goals

some other condition, such as nasal polyps or chronic lung disease, is complicating asthma

special tests, such as allergy skin testing or an allergen challenge, are needed

intensive steroid therapy has been necessary

Special populations
INFANTS AND YOUNG CHILDREN. It is especially important to closely watch the course of asthma in
young patients. Treatment is cut down when possible and if there is no clear improvement, some other
treatment should be tried. If a viral infection leads to severe asthmatic symptoms, steroids may help. The
health care provider should write out an asthma treatment plan for the child's school. Asthmatic children
often need medication at school to control acute symptoms or to prevent exercise-induced attacks. Proper
management will usually allow a child to take part in play activities. Only as a last resort should activities
be limited.
THE ELDERLY. Older persons often have other types of obstructive lung disease, such as chronic
bronchitis or emphysema. This makes it important to know to what extent the symptoms are caused by
asthma. Giving steroids for two to three weeks can help determine this. Side-effects from beta-receptor
agonist drugs (including a speeding heart and tremor) may be more common in older patients. These
patients may benefit from receiving an anti-cholinergic drug, along with the beta-receptor agonist. If
theophylline is given, the dose should be limited, as older patients are less able to clear this drug from
their blood. Steroids should be avoided, as they often make elderly patients confused and agitated.
Steroids may also further weaken the bones.

Prognosis
Most patients with asthma respond well when the best drug or combination of drugs is found, and they
are able to lead relatively normal lives. More than one-half of affected children stop having attacks by the
time they reach 21 years of age. Many others have less frequent and less severe attacks as they grow
older. Urgent measures to control asthma attacks and ongoing treatment to prevent attacks are equally
important. A small minority of patients will have progressively more trouble breathing and run a risk of
going into respiratory failure, for which they must receive intensive treatment.
Prevention

Minimizing exposure to allergens


There are a number of ways to cut down exposure to the common allergens and irritants that provoke
asthmatic attacks, or to avoid them altogether:

If the patient is sensitive to a family pet, removing the animal or at least keeping it out of the
bedroom (with the bedroom door closed), as well as keeping the pet away from carpets and
upholstered furniture and Removing hair and feathers.

To reduce exposure to house dust mites, removing wall-to-wall carpeting, keeping humidity
down, and using special pillows and mattress covers. Cutting down on stuffed toys, and
washing them each week in hot water.

If cockroach allergen is causing asthma attacks, killing the roaches (using poison, traps, or
boric acid rather than chemicals). Taking care not to leave food or garbage exposed.

Keeping indoor air clean by vacuuming carpets once or twice a week (with the patient absent),
avoiding using humidifiers. Using air conditioning during warm weather (so that the windows
can be closed).

Avoiding exposure to tobacco smoke.

Not exercising outside when air pollution levels are high.

When asthma is related to exposure at work, taking all precautions, including wearing a mask
and, if necessary, arranging to work in a safer area.

More than 80% of people with asthma have rhinitis and recent research emphasizes that treating rhinitis
helps benefit ashtma. Prescription nasal steroids and other methods to control rhinitis (in addition to
avoiding known allergens) can help prevent asthma attacks. It is also important for patients to keep open
communication with physicians to ensure that the correcnt amount of medication is being taken.

Resources

Periodicals
"Many People With Asthma Arent Taking the Right Amount of Medication." Obesity, Fitness & Wellness
Week (September 25, 2004): 87.
Mintz, Matthew. "Asthma Update: Part 1. Diagnosis, Monitoring, and Prevention of Disease
Progression." American Family Physician September 1, 2004: 893.
Solomon, Gina, Elizabeth H. Humphreys, and Mark D. Miller. "Asthma and the Environment: Connecting
the Dots: What Role do Environmental Exposures Play in the Rising Prevalence and Severity of
Asthma?" Contemporary Peditatrics August 2004: 73-81.
"Whats New in: Asthma and Allergic Rhinitis." Pulse September 20, 2004: 50.

Organizations
Asthma and Allergy Foundation of America. 1233 20th Street, NW, Suite 402, Washington, DC 20036.
(800) 727-8462. http://www.aafa.org.
Mothers of Asthmatics, Inc. 3554 Chain Bridge Road, Suite 200, Fairfax, VA 22030. (800) 878-4403.
National Asthma Education Program. 4733 Bethesda Ave., Suite 350, Bethesda, MD 20814. (301) 495-
4484.
National Jewish Medical and Research Center. 1400 Jackson St., Denver, CO 80206. (800) 222-LUNG.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

asthma /asthma/ (azmah) recurrent attacks of paroxysmal dyspnea, with wheezing due to spasmodic
contraction of the bronchi. It is usually either an allergic manifestation (allergic or extrinsic a.) or
secondary to a chronic or recurrent condition (intrinsic a.). asthmatic

bronchial asthma asthma.

Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

asthma ( z m , s -)
n.
Bronchial asthma.

asthma
asthmat ic (-m t k) adj. & n. Top: normal bronchiole
Bottom: asthmatic bronchiole
The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company.
All rights reserved.

asthma

[azm]

Etymology: Gk, panting

a respiratory disorder characterized by recurring episodes of paroxysmal dyspnea, wheezing on


expiration and/or inspiration caused by constriction of the bronchi, coughing, and viscous mucoid
bronchial secretions. The episodes may be precipitated by inhalation of allergens or pollutants, infection,
cold air, vigorous exercise, or emotional stress. Treatment may include elimination of the causative agent,
hyposensitization, aerosol or oral bronchodilators, beta-adrenergic drugs, methylxanthines, cromolyn,
leukotriene inhibitors, and short- or long-term use of corticosteroids. Sedatives and cough suppressants
may be contraindicated. Also called bronchial asthma. See also allergic asthma, asthma in
children, exercise-induced asthma, intrinsic asthma, organic dust, status asthmaticus.

Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.


asthma,

n respiratory illness in which constricted bronchi and sticky bronchoid secretions cause wheezing and
paroxysmal dyspnea.

Asthma.

Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.

asthma (azm ),

n a condition characterized by paroxysmal wheezing and difficulty in breathing resulting from


bronchospasms. Frequently has an allergic basis and occasionally an emotional origin. See also status
asthmaticus.

asthma, cardiac,

n a condition characterized by shortness of breath (paroxysmal dyspnea), sonorous rales, and expiratory
wheezes that resemble bronchial asthma; related to cardiac failure.

Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All rights reserved.
asthma

a condition marked by recurrent attacks of dyspnea, with wheezing due to spasmodic constriction of the
bronchi.

It is also known as bronchial asthma. Attacks vary greatly from occasional periods of wheezing and slight
dyspnea to severe attacks that almost cause suffocation.

acute equine asthma


sudden attacks of respiratory distress in horses at pasture; the dyspnea responds dramatically to
treatment with corticosteroids combined with antihistamines.
allergic asthma
extrinsic asthma; bronchial asthma due to allergy. Called also atopic asthma.
atopic asthma
see allergic asthma (above).
bronchial asthma
asthma.
cardiac asthma
a term applied to breathing difficulties due to pulmonary edema in heart disease, such as left ventricular
failure.
feline asthma
see feline bronchial asthma.
Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007 Elsevier, Inc. All rights reserved

asthma

Internal medicine per the American Thoracic Society, 1987Asthma is a [chronic] clinical syndrome
characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli. The major
symptoms of asthma are paroxysms of dyspnea [particularly exhaling air, accompanied by chest
tightness], wheezing, and cough, which may vary from mild and almost undetectable to severe and
unremitting (status asthmaticus). The primary physiological characteristic of this hyperresponsiveness is
variable airways obstruction. This can take the form of spontaneous fluctuations in the severity of
obstruction, substantial improvements in the severity of obstruction following bronchodilators or
corticosteroids, or increased obstruction caused by drugs or other stimuli. Histologically, patients with
fatal asthma have evidence of mucosal edema of the bronchi, infiltration of the bronchial mucosa or
submucosa with inflammatory cells, especially eosinophils, and shedding of epithelium and obstruction of
peripheral airways with mucus Exacerbating factors Rapid changes in temperature or humidity, allergies,
URIs, exercise, stress or cigarette smoke Mortality 18.8/million blacks; 3.7/million whitesUS, age 15-24
Clinical Wheezing, tachypnea, tachycardia, bronchiolitis, prolonged expiration, inter- & subcostal
retraction, nasal flaring DiffDx Aspiration, bronchitis, bronchopulmonary dysplasia, cystic fibrosis, GERD,
vascular rings, pneumonia Workup ABGshypoxia, respiratory acidosis; CXRhyperinflation; PFTs
vital capacity, functional residual capacity, residual volume Spirometry FEV 1 Lab Eosinophilia, Hct
if dehydrated Pathology Bronchial and bronchiolar occlusion by plugs of thick, tenacious mucus,
accompanied by Curschman spirals, Charcot-Leyden crystals, thickening of bronchial epithelium, edema
and inflammation with abundant eosinophils, size of submucosal glands, hypertrophy of bronchial wall
muscle Management Bronchodilatorsin particular 2-adrenoreceptor agonists, corticosteroids; anti-T-cell
agents, phosphodiesterase inhibitor, K+-channel activators, thromboxane antagonists See Allergic
asthma, Cardiac asthma, Exercise-induced asthma, Occupational asthma, Status
asthmaticus, Yokohama asthma. Cf COPD .

McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc.

Patient discussion about Astma.

Q. How long does asthma stay with someone? My son has had asthma since he was three years old.
The doctors keep telling us that he will grow out of it, he is now twelve. And it even got a little bit worse
then ever.

A. some people grow out of it and some don"t,it might depend on how severe the asthma is,

Q. How do I tell my friend his smoking is affecting my asthma? I recently was diagnosed with
asthma. Today I almost pass out from second hand smoke @ work. My co-worker smokes but also let his
clothes smoke with him - After his smoke break I literally have to leave - he knows I have asthma - how
can I tell him without consequences from manager and other co-workers or making him feel bad?

A. I would just tell him about your condition and that it bothers you. I would ask him to not smoke around
you. If he does not respond to your niceness then I would go to Human Resources or a manager and deal
with it that way. Besides, his smoke breaks take up a lot of time from the company and is consider time-
theft.

Q. What causes asthma? My 5 year old son has trouble breathing sometimes after he runs around too
much. My friend suggested he might have asthma. What causes this disease?

A. Asthma is a common disease which children are frequently diagnosed with.


The physiological mechanism that causes trouble breathing is in fact known: the immune system is hyper
stimulated at its basis, therefore many environmental factors, such as dust, animal hair, cigarette smoke
or physical activity can arouse it more easily.
This causes a series of chemical secretions that lead to constriction of the smooth muscle in the bronchi
(the large breathing tubes), and the feeling of not being able to breath regularly.
The disease is known to be genetically associated, and it is very common that children diagnosed with
asthma have first degree family relatives with the disease or relatives that often suffer from allergies.
Read more or ask a question about Astma
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Asthma, Guidelines for Treatment/management


SymptomsSx FEV1/PEFR Management Strategy
variability
Mild intermittent asthma
Symptoms 2 X/wk Nocturnal > 80%/< 20% Inhaled 2agonists PRN
Sx < 2 X/month
Mild persistent asthma
Symptoms > 2 X/wk; < 1 X/day > 80%/2030% Inhaled corticosteroids (200800 g/day) or cromolyn or
Nocturnal Sx > 2 X/month nedocromil; zafikulast or zileuton if Pt > age 12; long-acting
2agonist, sustained release theophylline, especially for nocturnal
Sx Inhaled 2agonists PRN
Moderate persistent asthma
Symptoms daily Nocturnal Sx > 1 6080%/>30% Inhaled corticosteroids (8002000 g/day) Long-acting 2agonist
X/wk Daily 2 agonists required or sustained release theophylline, especially for nocturnal Sx
Inhaled 2agonists PRN
Severe persistent asthma
Continuous Sx Frequent nocturnal <60%/>30% Inhaled corticosteroids (8002000 g/day) Long-acting
Sx Frequent exacerbations 2 agonist or sustained release theophylline, especially for
Limitation of physical activity nocturnal Sx Inhaled 2agonists PRN, oral corticosteroids

Asma

Takrif
Asma ialah satu kronik (tahan lama) penyakit berkaitan radang laluan udara. Dalam
itu rentan untuk asma, keradangan ini menyebabkan laluan udara untukmenyempitkan secara berkala.
Ini, bergilir-gilir, menghasilkan berdehit dan sesak nafas, kadang-kadang tepat di
mana pesakit tercungap-cungap udara. Halanganuntuk aliran udara sama ada menghentikan dengan
spontan atau memberikan respons kepada satu pelbagai rawatan-rawatan,
tetapi keradangan berlanjutan membuat

Satu perbandingan bronkiol normal dan yang satu penghidap asma.

(Contoh Oleh Hans & Cassady.)

laluan udara hiper responsif untuk rangsangan seperti udara sejuk, latihan,mengibas hama, bahan
pencemar dalam udara, malah tekanan dankebimbangan.

Huraian
Antara 17 juta dan 26 juta rakyat Amerika mempunyai asma, dan nomborkelihatan akan bertambah.
Dalam kira-kira 1992, nombor dengan asma ialah kira-kira 10 juta, dan telah naik 42% dari 1982, hanya
10 tahun sebelumnya. Bukan sahaja asma menjadi lebih kerap, tetapi ia juga ialah satu lebih penyakit
teruk daripada sebelum, walaupun rawatan
perubatan moden. Asmamenjelaskan hampir 500,000 kemasukan ke hospital, dua juta jabatan
kecemasan melawat, dan 5,000 kematian dalam Amerika Syarikat setiap tahun.

Perubahan yang berlaku dalam paru-paru orang-orang lelah membuat laluan udara ("bernafas tiub-tiub ,"
atau bronchi dan lebih kecil bronkiol) hyperreactive untuk banyak jenis-jenis berbeza rangsangan don&
itu#x0027;t menjejaskanparu-paru yang sihat. Dalam satu serangan asma, tisu otot dalam dinding-
dinding bronchi memasuki kekejangan, dan lapisan sel-sel laluan udara kembangdan rembes mukus ke
dalam ruang-ruang udara. Kedua-dua tindakan-
tindakanini menyebabkan bronchi menjadi menyempitkan (bronchoconstriction).Hasilnya,
seseorang lelah perlu membuat satu usaha lebih hebat lagi untukmenyedut udara dan
untuk mengeluarkan ia.

Sel-sel dalam dinding-dinding bronkus, memanggil sel-sel masta, membebaskanbahan-bahan


tertentu yang menyebabkan otot bronkus menguncup danmerangsang pembentukan mukus. Bahan-
bahan tersebut, yang termasukhistamina dan satu kumpulan bahan-bahan
kimia memanggil leukotrienes, juga membawa sel-sel darah putih ke kawasan itu, yang
ialah satu penyelesaiansebahagian daripada gerak balas radang.
Banyak pesakit dengan asmacenderung untuk menanggapi sedemikian "foreign" bahan-
bahan sebagai debunga, debu rumah hama, atau kemarahan kebinatangan; ini telah dipanggil alergen.
Sebaliknya, asma melibatkan banyak pesakit yang tidak alah dalam cara ini.

Asma biasanya bermula dalam zaman kanak-kanak atau keremajaan, tetapi ia juga
boleh pertama muncul semasa tahun-tahun dewasa. Manakala gejala-gejala boleh jadi serupa, aspek
penting tertentu asma jadi berbeza dalam anak-anak dan orang-orang dewasa.

Asma permulaan Child


Hampir satu pertiga pada 17 untuk 26 juta rakyat Amerika dengan asma ialah kanak-kanak.
Bila asma bermula dalam masa kanak-kanak, ia dilakukan acap jadi dalam seorang kanak-kanak yang
adalah mungkin, untuk sebab-
sebab genetik, menjadi memeka kepada alergen biasa dalam persekitaran (orang atopi). Bila anak-
anak ini terdedah untuk debu rumah hama, protin-protin haiwan, kulat, atau alergen berpotensi lain,
mereka menghasilkan sejenis antibodi yang dimaksudkan untukmelingkungi dan memusnahkan bahan-
bahan luar negeri. Ini mempunyai akibat dari membuat sel-sel laluan udara peka kepada bahan-bahan
tertentu. Pendedahanlebih lanjut boleh memimpin cepat untuk satu reaksi lelah. Keadaan ini atopi sedia
ada dalam sekurang-kurangnya satu pertiga dan sebanyak separuh penduduk awam.
Bila satu bayi atau budak kecil termengah-mengah semasa jangkitan
virus, kehadiran alahan (dalam budak itu atau satu keluarga dekat) adakah satu petunjukasma itu
mungkin meneruskan sepanjang zaman kanak-kanak.

Asma dewasa awal


Bahan-bahan alergenik mungkin juga main satu peranan apabila orang-orang
dewasa menjadi asma. Asma boleh sebenarnya memulakan di mana-mana umur dan
dalam satu pelbagai situasi luas. Kebanyakan orang dewasa yang tidak alah mempunyai syarat-
syarat seperti sinusitis atau polips nasum, atau mereka boleh jadi
sensitif untuk aspirin dan dadah berkaitan. Satu lagi sumber utama asma dewasa ialah pendedahan di
tempat kerja untuk hasilan haiwan, bentuk-bentuk tertentuplastik, habuk kayu, atau logam-logam.

Menyebabkan dan gejala-gejala


Dalam kebanyakan kes, asma disebabkan oleh menarik
nafas satu alergen yang bertolak rantai tisu dan biokimia perubahan membawa kepada keradangan salur
pernafasan, bronchoconstriction, dan berdehit. Kerana mengelakkan (atau sekurang-
kurangnya mengurangkan) pendedahan ialah jalan paling berkesan merawat asma, ia amat
penting untuk pengenalpastian yang alergen atau miang menyebabkan gejala-gejala dalam satu pesakit
tertentu. Sebaik sahaja asma sedia ada, gejala-gejalaboleh ditetapkan dari atau bertambah
buruk jika pesakit itu juga mempunyai rinitis (keradangan lapisan hidung) atau sinusitis. Bila, untuk
beberapa sebab, pas-pasasid perut menyokong kerongkong (refluks berasid), ini boleh juga
membuat asma lebih buruk. Satu jangkitan virus saluran pernafasan boleh juga
membakar satureaksi lelah. Aspirin dan sejenis dadah memanggil pengepung beta, sering biasa
merawat tekanan darah tinggi, boleh juga memburukkan tanda-tanda lelah.
Paling penting menyedut alergen menjadikan untuk serangan-serangan asma ialah:

kemarahan kebinatangan

hama dalam debu rumah

kulat (acuan) itu berkembang dalam rumah

alergen lipas

debunga

pendedahan pekerjaan kepada bahan kimia, wasap, atau zarah-zarah bahan-


bahan perindustrian dalam udara

Syarat-syarat utama
Alergen Satu benda asing, seperti hama dalam debu rumah atau kemarahan kebinatangan yang,
apabila menyedut, menyebabkan laluan udara untukmenyempitkan dan menghasilkan tanda-tanda lelah.

atopi Sebuah negara yang membuat orang-orang lebih mungkin pada membangunkan reaksi
alergi mana-mana jenis, termasuk keradangan dan laluan udaramenyempitkan biasa asma.

kehiperpekaan Negeri di mana walaupun satu jumlah yang sangat kecil alergen boleh
menyebabkan laluan udara untuk menjerut dan menyebabkan satu serangan asma.

spirometri Satu ujian menggunakan


satu alat memanggil satu spirometer yang menunjukkan betapa sukarnya ia
untuk seorang pesakit lelah untuk bernafas.Digunakan menentukan keterukan asma dan
untuk melihat betapa baik ia memberikan respons kepada rawatan.

Menarik nafas asap tembakau, sama ada dengan merokok atau menjadi berhampiran rakyat yang
adalah merokok, dapat mengganggu laluan udara dan picu satuserangan asma. Bahan pencemar-
bahan pencemar udara boleh mempunyai satu kesan serupa. Sebagai tambahan,
terdapat tiga faktor penting yang sering hasilmenyerang dalam pesakit-pesakit lelah tertentu, dan mereka
boleh kadang-kadang jadi sebab tanda-tanda tunggal. Mereka Ialah:

menarik nafas udara sejuk (asma teraruh sejuk)

asma disebabkan senaman (dalam anak-anak tertentu, asma adalah disebabkan hanya
dengan bersenam)

tekanan atau satu tahap kebimbangan tinggi

berdehit sering jelas, tetapi serangan-serangan lelah sederhana boleh


dipastikan apabila doktor mendengar patient'dada s dengan satu stetoskop. Selain berdehit
danmenjadi semput, pesakit boleh batuk dan boleh melaporkan satu perasaan "tightness"
dalam dada. Anak-anak Mungkin Telah gatal pada belakang atau leher mereka
pada permulaan satu serangan. berdehit sering paling kuat apabila pesakit itu melepaskan nafas,
dalam satu percubaan untuk mengeluarkan udara terpakai melaluimenyempitkan laluan udara.
Beberapa asma bebas gejala-gejala kebanyakan daripada masa tetapi boleh sekali-sekala
jadi semput untuk satu jam pendek. Lainnyamembelanjakan kebanyakan daripada hari-hari mereka
(dan malam-malam) batuk dan berdehit, sehingga dengan betul diperlakukan. Menangis atau
malahan riangboleh menyebabkan satu serangan. Adegan-adegan teruk kerap
kelihatan apabila pesakit itu mendapat jangkitan
saluran pernafasan virus atau didedahkan untuk satubeban berat satu alergen atau miang. Serangan-
serangan lelah mungkin tahan hanya beberapa minit atau boleh meneruskan
perjalanan berjam atau hari-hari teratur(suatu syarat memanggil status asmatikus).
Menjadi semput boleh menyebabkan seorang pesakit menjadi sangat risau, duduk
tegak, cenderung ke hadapan, dan menggunakan otot-otot leher dan dinding
dadauntuk membantu bernafas. Pesakit mungkin boleh mengatakan hanya sedikit kata pada masa
sebelum menghentikan untuk tarik nafas. Kekeliruan dan satu sedikit warna kebiru-
biruan untuk kulit ialah tanda-tanda yang bekalan oksigen ialah banyak terlalu rendah, dan rawatan
kecemasan itu diperlukan. Dalam satu kecaman kerasyang tahan untuk seketika, beberapa kantung-
kantung udara dalam peparu boleh pecah supaya udara mengutip dalam dada. Ini membuat ia malah
lebih kuat untukmenyedut udara cukup.

diagnosis
Selain mendengar patient'dada s, pemeriksa seharusnya
mencari pengembangan dada maksimum ketika membawa masuk udara. Bahu bongkok dan otot-otot
leherkontrak ialah tanda-tanda lain menyempitkan laluan udara. polips
nasum atau amaun yang meningkat rembesan-rembesan hidung sering menyatakan dalam pesakit-
pesakit lelah. Perubahan-perubahan kulit, seperti dermatitis atopi atau ekzema, ialah
sedikit amaran yang pesakit mempunyai masalah-masalah alah.

Bertanya tentang sejarah penyakit lelah keluarga atau alahan-alahan boleh


jadi satu penunjuk berharga asma. diagnosis boleh dengan kuat disarankan apabilasimptom-
simptom biasa dan tanda-tanda hadir. Satu ujian memanggil spirometri mengukur bagaimana cepat udar
a dihembuskan dan berapa ditahan dalam paru-
paru.Mengulang ujian selepas pesakit menghisap sejenis ubat yang meluaskan laluan-laluan udara (satu
bronkodilator) adakah menunjukkan sama ada salur udara yangmenyempit boleh diterbalikkan, yang
ialah penemuan yang sangat biasa dalam asma. Sering pesakit-pesakit menggunakan satu alat
berkaitan, memanggil satu meteraliran puncak, untuk mengawasi ketenatan asma apabila di rumah.

Selalunya, ia sukar untuk untuk menentukan apa mencetuskan serangan-


serangan asma. Ujian kulit alahan boleh digunakan, walaupun sambutan alahan kulit tidak
selalu bererti yang alergen diuji menyebabkan asma. Juga, body'sistem
imun s menghasilkan antibodi berlawan dari alergen, dan banyaknya antibodi boleh diukur olehsatu ujian
darah. Ini akan menunjukkan betapa sensitif pesakit ialah untuk satu alergen tertentu. Jika diagnosis
tetap ada dalam keraguan, pesakit boleh menyedutalergen suspek semasa menggunakan
satu spirometer untuk mengesan salur udara yang menyempit. spirometri boleh
jadi diulang selepas satu perlawanan latihanjika asma disebabkan senaman ialah satu kemungkinan. Sat
u x-ray dada akan membantu mengenepikan kekacauan lain.

Rawatan
Pesakit-pesakit seharusnya secara berkala diperiksa dan mempunyai fungsi paru-
paru mereka diukur oleh spirometri untuk pastikan matlamat-matlamat rawatan itu
adalah ditemui. Matlamat-matlamat ini adalah akan menghalang gejala-gejala menyusahkan,
untuk penyenggaraan fungsi paru-paru sebagai hampir normal yang mungkin, dan
untuk membenarkan pesakit-pesakit untuk meneruskan aktiviti-aktiviti
biasa mereka termasuk yang memerlukan kesungguhan. Terapi ubat paling baikialah apa
yang mengawal tanda-tanda asma ketika menyebabkan beberapa atau tiada kesan sampingan.

Dadah
METHYLXANTHINES. Dadah metilxantina utama ialah teofilina. Ia boleh
menggunakan beberapa kesan anti-mudah terbakar, dan terutama berguna dalam mengawaltanda-tanda
lelah waktu malam. Bila, untuk beberapa sebab, seorang pesakit tidak boleh
menggunakan satu alat sedut untuk penyenggaraan kawalan jangka panjang,
teofilina pelepasan bertahan ialah satu pilihan yang bijak. Tahap dadah darah mesti diukur secara
berkala, sebagai terlalu tinggi satu dos boleh menyebabkan saturentak jantung yang tidak normal atau
terkejang-kejang.

AGONIS RESEPTOR BETA. Dadah ini, yang ialah bronkodilator,


ialah pilihan terbaik untuk melegakan serangan-serangan tiba-tiba asma dan untuk dicegah serangan-
serangan dari dicetuskan dengan melaksanakan. Beberapa agonis, seperti
albuterol, bertindak terutamanya dalam sel-sel paru-paru dan mempunyai kesan yang sedikit pada organ-
organ lain, seperti jantung. Dadah ini umumnya bermula bertindak di dalam minit, tetapi kesan-
kesan mereka lepas hanya empat hingga enam jam.Lakonan Longer brochodilators telah dimajukan.
Mereka boleh bertahan sehingga 12 jam. Bronkodilator boleh diambil dalam pil atau bentuk cecair,
tetapi biasanyamerupakan digunakan sebagai alat sedut, yang pergi secara langsung untuk paru-
paru dan mengakibatkan kesan sampingan yang kurang.

STEROID. Dadah ini, yang menyerupai hormon-hormon jasad semula jadi, keradangan blok dan sangat
berkesan dalam melegakan tanda-tanda lelah.
Bila steroiddibawa oleh sedutan untuk satu tempoh yang lama, serangan-serangan asma mengurangi ker
ap sebagai laluan udara menjadi kurang peka untuk alergen. Ini ialah ubatterkuat untuk asma, dan boleh
mengawal kes-kes yang teruk teratur mengenai jangka panjang dan mengekalkan fungsi paru-
paru baik. Steroid boleh menyebabkankesan sampingan banyak,
bagaimanapun, termasuk berdarah dari perut, kehilangan kalsium dari tulang-tulang, riam-
riam dalam mata, dan negeri seperti kencing manis. Pesakit-pesakit menggunakan steroid-steroid
untuk tempoh-tempoh panjang mungkin juga mempunyai masalah-masalah dengan
kesembuhan luka, boleh naikbadan, dan boleh masalah mental terjejas. Dalam anak-
anak, pertumbuhan boleh diperlahankan. Selain disedut, steroid boleh diambil oleh mulut atau menyuntik,
untuk cepat mengawal asma teruk.

PENERANG leukotrien. Penerang leukotrien (montelukast dan zafirlukast) adakah satu jenis
baru dadah yang boleh digunakan sebagai ganti steroid, untuk anak-anakyang lebih tua atau orang-orang
dewasa yang mempunyai segulung ijazah sederhana asma yang berterusan.
Mereka kerja dengan papas leukotrienes, yang ialahbahan-bahan dikeluarkan oleh sel-sel darah
putih dalam peparu yang menyebabkan laluan-laluan udara untuk menjerut dan menggalakkan rembesan
lendir. Penerangleukotrien juga menghalau beberapa bentuk rinitis, satu bonus
tambahan untuk rakyat dengan asma. Bagaimanapun, mereka tidak terbukti
berkesan dalam berjuangalergi-alergi bermusim.

DADAH LAIN. Cromolyn dan nedocromil ialah dadah-dadah anti-radang yang kerap kali digunakan
sebagai rawatan awal untuk menghalang asma menyerangmengenai jangka masa panjang dalam anak-
anak. Mereka boleh juga mencegah serangan apabila diberi sebelum latihan atau
apabila pendedahan untuk satu alergentidak boleh dielakkan. Ini ialah dadah selamat tetapi mahal,
dan mesti diambil sering sekalipun tiada gejala-gejala. Anti dadah kolinergik, seperti
atropina, bergunadalam mengawal serangan-serangan yang teruk apabila ditambah untuk satu menyedut
agonis reseptor beta. Mereka membantu meluaskan laluan udara danmenindas pengeluaran mukus.

Jika patient'asma s disebabkan oleh satu alergen yang tidak boleh dielakkan dan ia menjadi
sukar kepada kawalan gejala-gejala oleh dadah, imunoterapi mungkin
bernilai mencuba. Lazimnya, amaun-amaun yang bertambah alergen adalah menyuntik mengenai
suatu tempoh tiga untuk lima tahun, supaya badan boleh membina satu gerak balas imun berkesan.
Terdapat satu risiko yang rawatan ini boleh sendiri menyebabkan laluan
udara menjadi menyempitkan dan menyebabkan satuserangan asma. Bukan semua pakar-
pakar berminat tentang imunoterapi, walaupun beberapa kajian telah ditunjukkan yang
ia mengurangkan tanda-tanda asmadisebabkan oleh pendedahan untuk debu
rumah hama, debunga rumput ragweed, dan kemarahan kucing.

Menguruskan asma menyerang


Satu serangan asma teruk harus dilayan sebagai dengan cepat yang mungkin. Ia paling penting ialah
untuk satu pesakit menderita satu serangan akut untuk diberioksigen tambahan. Jarang sekali, ia boleh
jadi perlu untuk penggunaan sebuah pengalih udara mekanikal untuk membantu
pesakit bernafas. Agonis reseptor betadisedut berulang kali atau secara berterusan. Jika pesakit itu tidak
menjawab segera dan sepenuhnya, satu steroid dianugerahkan. Satu kursus terapi steroid, diberiselepas
serangan itu ialah mengenai, akan membuat satu perulangan mungkin kurang.

Mengekalkan kawalan
Rawatan asma jangka panjang adalah diasaskan menarik nafas agonis reseptor beta menggunakan
satu alat sedut khas yang meter dos. Pesakit-pesakit mesti diajardalam penggunaan
betul satu penghisap untuk memastikan yang ia akan menyampaikan bilangan dadah betul. Sebaik
sahaja asma telah dikuasai untuk beberapa minggu atau bulan,
ia berbaloi dicuba untuk mengurangkan rawatan dadah, tetapi ini mesti dibuat beransur-
ansur. Dadah terakhir menambah sepatutnya menjadi yangpertama untuk dikurangkan. Pesakit-
pesakit patut dilihat setiap satu hingga enam bulan, bergantung pada frekuensi serangan-serangan.

Memulakan rawatan di rumah, daripada dalam sebuah hospital, menuju kelewatan minimum dan
membantu pesakit keuntungan hampir berasa dalam kawalanmengenai penyakit itu. Semua pesakit patut
diajar bagaimana untuk memonitorkan gejala-gejala mereka supaya mereka akan
tahu apabila satu serangan memulakan, dan itu dengan
sederhana atau asma teruk perlu tahu bagaimana untuk penggunaan satu meter alir. Mereka juga harus
mempunyai bertulis seorang "tindakan plan" untuk mengikuti jika gejala-gejala tiba-tiba menjadi lebih
buruk, termasuk bagaimana untuk menyesuaikan ubat mereka dan apabila untuk meminta bantuan
perubatan.Laporan 2004 berkata yang satu kajian semula kajian
perubatan mendedahkan bahawa pesakit-pesakit dengan pengurusan sendiri menulis rancangan
tindakanmempunyai kemasukan ke hospital kurang, jabatan kecemasan kurang melawat, dan fungsi
paru-paru yang bertambah baik. Mereka juga mempunyai kadar kematianlebih rendah 70%. Jika
lebih rawatan kuat perlu, ia sepatutnya diteruskan untuk beberapa hari. Di Kaunter "remedies" sepatutnya
dielakkan. Bila menentukan sama ada seorang pesakit harus dimasukkan ke hospital, sejarah
silam serangan-serangan tirus, tanda yang teruk, ubat semasa, dan sama ada sokongan
baik tersedia adadi rumah semua mestilah diambil kira.

Rujukan untuk pakar asma sepatutnya dipertimbangkan jika:

terdapat telah menjadi satu serangan asma mengancam nyawa atau teruk, asma berterusan
rawatan untuk tiga hingga enam bulan tidak memenuhi matlamat-matlamatnya

keadaan lain, seperti polips nasum atau penyakit paru-paru kronik, merumitkan asma

ujian-ujian khas, seperti ujian kulit alahan atau cabaran alergen, diperlukan ialah

terapi steroid intensif menjadi perlu

Penduduk khas
BAYI-BAYI DAN ANAK-ANAK KECIL. Ia terutamanya penting untuk memerhati secara
dekat kursus asma dalam pesakit-pesakit muda. Rawatan mengurangkanapabila munasabah dan jika
tiada peningkatan jelas, rawatan lain seharusnya telah mencuba. Jika satu jangkitan
virus membawa ke gejala-gejala lelah teruk, steroidmungkin membantu. Penyedia penjagaan
kesihatan perlu menulis keluar rancangan rawatan asma untuk child'sekolah s. Kanak-
kanak yang mengalami lelah sering memerlukan ubat di sekolah kepada kawalan tanda-tanda akut atau
untuk menghalang serangan-serangan disebabkan senaman. Pemimpin baik akan
biasanyamembenarkan seorang kanak-kanak untuk mengambil bahagian dalam aktiviti-aktiviti bermain.
Hanya sebagai satu jalan terakhir sepatutnya aktiviti-aktiviti menjaditerhad.

TUA. Orang-orang yang lebih tua sering mempunyai jenis-jenis lain penyakit paru-paru, seperti bronkitis
kronik atau emfisema. Ini membuat ia penting untuk tahu untuk apa takat gejala-gejala disebabkan
oleh asma. Memberi steroid untuk dua untuk tiga minggu dapat membantu
menentukan ini. Kesan sampingan dari agonis reseptorbeta dadah (termasuk jantung mempercepatkan d
an gegaran) mungkin lebih lazim dalam pesakit-pesakit lebih tua. Pesakit-pesakit ini
boleh bermanfaat dari menerimasejenis ubat kolinergik anti, bersama dengan agonis reseptor beta. Jika
teofilina diberi, dos harus dihadkan, sebagai pesakit-pesakit lebih tua ialah
kurang berupayamembersihkan dadah ini dari darah mereka. Steroid sepatutnya dielakkan, sebagai
mereka sering dijadikan pesakit-pesakit yang tua memeningkan dan terganggu.Steroid mungkin
juga seterusnya melemahkan tulang-tulang.

Prognosis
Kebanyakan pesakit dengan asma menjawab betul-betul apabila ubat paling
baik atau gabungan dadah didapati, dan mereka berupaya mendahului nyawa agak normal. Lebih
daripada separuh perhentian kanak-kanak yang terbabit mempunyai serangan-serangan bila
mereka mencapai 21 tahun. Ramai orang lain mempunyai kurang kerap dan kurang serangan-
serangan yang teruk sebagai mereka membesar. Lang-
langkah segera untuk mengawal asma menyerang dan rawatan berterusanuntuk mencegah serangan be
rsama penting. Satu sebilangan kecil pesakit kecil akan
mempunyai secara progresif lebih masalah bernafas dan lari satu risiko pergi ke dalam gagal pernafasan,
di mana mereka mesti mendapat rawatan intensif.

Pencegahan
Mengurangkan pendedahan untuk alergen
Terdapat
beberapa cara untuk mengurangkan pendedahan untuk alergen biasa dan merengsakan yang membang
kitkan kemarahan asma menyerang, atau untukmengelak mereka sekali:

Jika pesakit itu sensitif untuk satu haiwan peliharaan keluarga, membuang binatang atau sekuran
g-kurangnya simpan ia keluar dari bilik tidur (dengan pintu bilik tidur menutup),
serta simpan peliharaan jauh dari permaidani dan perabot upholsteri dan rambut dan bulu-bulu R
emoving.

Mengurangkan pendedahan untuk debu


rumah hama, membuang hamparan dinding ke dinding, simpan kelembapan jatuh,
dan menggunakan bantal-bantal khasdan tilam menutup. Mengurangkan barang mainan berisi,
dan membasuh mereka setiap minggu dalam air panas.

Jika alergen lipas menyebabkan serangan-serangan asma, membunuh lipas-lipas


(menggunakan racun, memerangkap, atau asid borik daripada bahan kimia).Menjaga untuk
tidak meninggalkan makanan atau sampah sarap didedahkan.

Simpan udara dalam bangunan bersih dengan memvakum permaidani sekali


dua satu minggu (dengan pesakit tidak hadir), mengelak menggunakan
alatpelembab. Menggunakan penyaman udara semasa cuaca panas (supaya tingkap-
tingkap boleh ditutup).

Mengelakkan pendedahan untuk asap tembakau.

Bukan bersenam di luar apabila paras-paras pencemaran udara adalah tinggi.

Bila asma berkaitan dengan pendedahan di tempat


kerja, mengambil semua ingatan, termasuk memakai satu topeng dan, jika
perlu, penyusunan bekerja dalamsatu bidang lebih selamat.

Lebih daripada 80% rakyat dengan asma mempunyai rinitis dan penyelidikan baru-baru
ini menekankan yang merawat rinitis membantu memanfaatkan ashtma.Preskripsi steroid sengau dan ka
edah-kaedah lain kepada kawalan rinitis (tambahan kepada mengelakkan alergen terkenal) dapat
membantu mencegah serangan-serangan asma. Ia adalah penting juga untuk pesakit-
pesakit untuk biar terbuka komunikasi dengan ahli fizik untuk memastikan bahawa bilangan
ubat correcnt sedang diambil.
Sumber-sumber
Terbitan Berkala
"Ramai Orang Dengan Asma Arent Taking Right Amount
Medication." Obesiti, Kesihatan & Minggu Keadaan Kesihatan (25 September, 2004): 87.

Mintz, Matthew. "Kemas Kini Asma: Berpihak 1. diagnosis, Memantau, Dan Janjang Pencegahan
Penyakit." American Family Physician 1 September, 2004: 893.

Solomon, Gina, Elizabeth h Humphreys, dan Menandakan d miller.


"Asma Dan Persekitaran: Menghubungi Titik-titik: Apa Peranan Buat Pendedahan-
pendedahanPersekitaran Main Dalam Kelaziman Meningkat Dan Keterukan Asma?" Peditatrics Kontemp
orari Ogos 2004: 73-81.

"Whats New dalam: Asma Dan Rinitis Alergi." Denyut 20 September, 2004: 50.

Pertubuhan-pertubuhan
Asas Asma Dan Alahan Amerika. 1233 Street ke-20, NW, Suite 402, Washington, DC 20036. (800) 727-
8462. http://www.aafa.org.

Ibu-ibu Asma, Inc 3554 Merantai Menghubungkan Jalan, Set 200, Fairfax, VA 22030. (800) 878-4403.
Program Pendidikan Asma Nasional. 4733 Bethesda Ave, Set 350, Bethesda, MD 20814. (301) 495-
4484.

Kebangsaan yahudi Pusat Penyelidikan Dan Perubatan. 1400 Jackson Jalan, Denver, CO 80206. (800)
222 LUNG.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

asma /asthma/ (azmah) serangan-serangan berulang dispnea paroksismal, dengan berdehit


disebabkan penguncupan spasmodik bronchi. Ia biasanya adalah sama
ada satu manifestasi alah (alah atau ekstrinsik satu.) atau sekunder untuk
suatu syarat kronik atau berulang (intrinsik satu.). asthmatic

asma bronkus asma.

Dorland's Medical Dictionary for Health Consumers. 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

asthma ( z m , s -)

n.

Asma bronkus.
asma

Atas: bronkiol normal

asthtikar ic (-m t k) adj. & n. Bottom: bronkiol lelah

The American Heritage Medical Dictionary Copyright 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company.
All rights reserved.

asma

[azm]
Etimologi: Gk, mencungap

satu gangguan pernafasan berunsur adegan-adegan berulang dispnea paroksismal, berdehit


pada penamatan dan / atau inspirasi disebabkan oleh pencerutan bronchi,batuk, dan
mukoid likat rembesan-rembesan bronkus. Adegan-adegan boleh
dipercepatkan oleh sedutan alergen atau bahan pencemar, jangkitan, udara sejuk,senaman bertenaga,
atau tekanan emosi. Rawatan mungkin termasuk penyingkiran agen penyebab,
hiposensitisasi, aerosol atau bronkodilator lisan, beta dadahadrenergik, methylxanthines,
cromolyn, perencat leukotrien, dan short- atau kegunaan jangka masa
panjang kortikosteroid. Ubat penenang dan ubat-ubat menumpasbatuk boleh tidak digalakkan.
Juga dipanggil asma bronkus. Lihat juga asma alahan, asma dalam anak-
anak, asma disebabkan senaman, asma intrinsik,debu organik, status asmatikus.

Mosby's Medical Dictionary, 8th edition. 2009, Elsevier.

asma,

n penyakit pernafasan di mana menjerut bronchi dan rembesan-


rembesan bronchoid sukar menyebabkan berdehit dan dispnea paroksismal.

Asma.

Jonas: Mosby's Dictionary of Complementary and Alternative Medicine. (c) 2005, Elsevier.
asma (azm ),

n suatu syarat berunsur berdehit paroksisme dan kesukaran dalam bernafas mengakibatkan dari
bronchospasms. Sering mempunyai satu asas alah dan sekali-
sekala satu punca emosional. Lihat juga status asmatikus.

asma, jantung,

n suatu syarat berunsur kependekan nafas (dispnea paroksismal), rales bergema,


dan cungapan ekspiratori yang menyerupai asma bronkus; berkaitan dengankegagalan jantung.

Mosby's Dental Dictionary, 2nd edition. 2008 Elsevier, Inc. All rights reserved.

asma

suatu syarat ditandai oleh serangan-serangan berulang dispnea, dengan berdehit


disebabkan pencerutan spasmodik bronchi.

Ia juga dikenali sebagai asma bronkus. Serangan-serangan amat berbeza dari tempoh-tempoh sekali-
sekala berdehit dan dispnea kecil untuk serangan-seranganyang teruk yang hampir
mengakibatkan kelemasan.

asma ekuin tirus

serangan-serangan tiba-tiba distres pernafasan dalam kuda-kuda di padang ragut;


dispnea menjawab secara mendadak kepada rawatan dengan
kortikosteroidmenggabungkan dengan antihistamina.

asma alahan

asma ekstrinsik; asma bronkus disebabkan alahan. Memanggil juga asma atopik.

asma atopik
melihat asma alahan (di atas).

asma bronkus

asma.

asma jantung

suatu istilah digunakan ke atas kesukaran bernafas disebabkan edema pulmonari dalam penyakit
jantung, seperti kegagalan ventrikel kiri.

asma felin

melihat felin bronkus asma.

Saunders Comprehensive Veterinary Dictionary, 3 ed. 2007 Elsevier, Inc. All rights reserved

asma

Perubatan dalaman setiap American Thoracic Society, 1987


Asma Ialah Satu [kronik] sindrom klinikal berunsur sambutan bertambah pokok tracheobronchial
untuksatu pelbagai jenis rangsangan. Tanda-tanda lelah utama ialah ledakan yang tiba-
tiba dispnea [terutama menghembuskan udara, diiringi oleh kesesakan dada],berdehit, dan batuk,
yang boleh mengubah dari sederhana dan hampir tidak dapat dikesan untuk teruk dan tidak henti-
henti (status asmatikus). Utama fisiologikalbiasa hyperresponsiveness ini ialah halangan laluan
udara berubah-ubah. Ini boleh mengambil bentuk naik
turun spontan dalam keterukan halangan, kemajuan yangcukup
besar dalam keterukan halangan berikutan bronkodilator atau kortikosteroid,
atau menambah halangan disebabkan oleh dadah atau rangsangan lain. Dari segi sejarah, pesakit-
pesakit dengan asma membawa maut mempunyai
bukti edema mukosa bronchi, penyusupan mukosa bronkus atau submukosa dengan sel-selradang,
terutama eosinophils, dan menggugurkan epitelium dan halangan laluan
udara periferal dengan mukus Memburukkan lagi faktor-faktor Rapid mengubah dalamsuhu atau kelemba
pan, alahan-alahan, URIs, latihan, tekanan atau asap rokok menghitamkan Mortality
18.8/million; orang kulit putih 3.7/millionAS, umur 15-24 Clinical Wheezing, tachypnea, takikardia,
bronchiolitis, memanjangkan penamatan, inter- & penarikan balik subkosta, sengau menyala DiffDx
Aspiration, bronkitis, displasia bronkopulmonari, sistik fibrosis,
GERD, cincin vaskular, pneumonia Workup ABGshipoksia, asidosis pernafasan; CXRinflasi melampau;
PFTs kapasitimustahak, muat baki fungsian, isipadu baki Spirometry FEV1 eosinofilia Makmal,
Hct jika dinyahhidratkan Pathology Bronchial dan oklusi bronchiolar
olehpalam tebal, mukus kenyal, diiringi oleh Curschman berlingkar, hablur-hablur Charcot-
Leyden, penebalan epitelium bronkus, edema dan keradangan dengan eosinophils amat banyak,
saiz kelenjar-kelenjar sub-mukus, hipertrofi otot dinding bronkus Management Bronchodilators
khususnya 2agonis -adrenoreceptor, kortikosteroid; ejen-ejen anti-T-
cell, perencat fosfodiesterase, pengaktif-pengaktif K+-channel, penentang thromboxane
See Asma alahan, asma Cardiac, Asmadisebabkan senaman, Asma pekerjaan, Status asmatikus, Asma
yokohama. Cf COPD

McGraw-Hill Concise Dictionary of Modern Medicine. 2002 by The McGraw-Hill Companies, Inc.

Perbincangan sabar tentang Astma.

Q HOW dilakukan lama tinggal asma dengan seseorang? Anak lelaki saya mempunyai asma sejak
dia berumur tiga tahun. Doktor-doktor terus memberitahukami yang dia akan berkembang daripada ia,
dia kini dua belas. Dan ia malahan mendapat sedikit lebih buruk kemudian pernah.

Satu. sesetengah orang berkembang daripada ia dan beberapa memakai"t, ia mungkin bergantung pada
betapa teruk asma ialah,

Q HOW adakah
saya memberitahu kawan saya merokoknya mempengaruhi asma saya? Saya baru-baru ini telah
didiagnoskan dengan asma. Hari ini sayahampir lalu keluar dari asap jarum
saat kerja @. Rakan sejawatan saya merokok tetapi juga biar pakaiannya merokok dengannya -
Selepas asapnya memecahkansaya benar-benar terpaksa pergi -
dia mengetahui saya mempunyai asma - bagaimana boleh saya memberitahunya tanpa akibat-
akibat dari pengurus dan rakan sejawatan lain atau menjadikannya merasa teruk?

Satu. Saya hanya akan memberitahunya tentang keadaan anda dan yang ia mengganggu anda.
Saya akan meminta dia untuk tidak merokok sekitar anda. Jika dia tidak
bertindak balas terhadap kebaikan anda kemudian saya akan pergi ke Human Resources
atau satu pengurus dan perjanjian dengan ia begitu.
Selain,asapnya patah bermula banyak masa daripada syarikat itu dan menimbangkan kecurian masa.

Q WHAT menyebabkan lelah? Anak lelaki berusia 5 tahun saya mempunyai masalah bernafas kadang-
kadang selepas dia pergi ke sana sini terlalu banyak.Kawan saya disarankan dia mungkin
mempunyai asma. Apa menyebabkan penyakit ini?

Satu. Asma ialah satu penyakit biasa yang anak-anak sering didiagnosis dengan.
Mekanisme fisiologikal yang menyebabkan masalah bernafas ialah malah dikenali: sistem
imun hiper dirangsang di asasnya oleh itu banyak faktor persekitaran, seperti debu, bulu haiwan, asap
rokok atau aktiviti fizikal boleh menimbulkan ia dengan lebih mudah.
Sebab-sebab ini satu rembesan-rembesan siri bahan kimia yang menjurus pencerutan otot licin dalam
bronchi (pernafasan besar "tiub-tiub"), dan perasaanbukan berupaya nafas sering.
Penyakit itu diketahui menjadi secara genetik mengaitkan, dan ia sangat biasa yang anak-
anak didiagnosis dengan asma mempunyai saudara-mara keluargaijazah
pertama dengan penyakit atau saudara-mara yang sering dihidapi alahan-alahan.

Baca lebih lanjut atau bertanya satu soalan tentang Astma

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Asma, Guidelines untuk Treatment / pengurusan

Gejala-gejalaSx FEV1kebolehubahan Strategi Pengurusan


/PEFR

Mild asma terputus-putus

Gejala-gejala 2 X / wk > 80%/< 20% Disedut 2agonis PRN


Nocturnal Sx < 2 X / bulan

Mild asma berterusan

Gejala-gejala > 2 X / wk; < > 80%/2030% Menyedut kortikosteroid (200800 g / hari) atau cromolyn atau
1 X / hari Nocturnal Sx > 2 nedocromil; zafikulast atau zileuton jika Pt
X /bulan > umur 12; bertindak lama 2agonis,
teofilina pelepasan bertahan,terutamanya bagi Sx
Inhaled malam 2agonis PRN
Asma, Guidelines untuk Treatment / pengurusan

Gejala-gejalaSx FEV1kebolehubahan Strategi Pengurusan


/PEFR

Sederhana asma berterusan

Gejala-gejala Nocturnal 6080%/>30% Menyedut kortikosteroid (8002000


Sx setiap hari > 1 X / wk g / hari) Bertindak lama 2teofilina agonis ataupelepasan bertaha
Daily 2agonis dikehendaki n, terutamanya bagi Sx Inhaled malam 2agonis PRN

Asma berterusan teruk

Sx <60%/>30% Menyedut kortikosteroid (8002000


Frequent selanjar eksaserb g / hari) Bertindak lama 2 teofilina agonis ataupelepasan bertaha
asi Sx n, terutamanya bagi Sx Inhaled malam 2agonis PRN,
Frequent malamLimitation kortikosteroidlisan
aktiviti fizikal