Bronchial Asthma

Bronchial Asthma

1. Definition
   Bronchial asthma is a chronic inflammatory disorder of the bronchi that produces recurrent episodes of wheeze, breathlessness, chest tightness and cough, especially at night or early morning.

2. Causes / Etiology

• Genetic predisposition (family history of atopy).
• Allergic exposure to pollen, dust‑mite, mould, pet dander.
• Respiratory infections (especially viral).
• Irritants such as tobacco smoke, polluted air, strong odours.
• Physical factors – cold air, exercise, emotional stress.

3. Types or Classification

• Atopic (allergic) asthma – triggered mainly by inhaled allergens.
• Non‑atopic (intrinsic) asthma – no obvious allergy, often linked to infections or irritants.
• Exercise‑induced asthma – symptoms appear during or after physical exertion.
• Occupational asthma – caused by specific substances encountered at work.
• Nocturnal asthma – worsening of symptoms during night time.

4. Pathology (step‑wise)
   Step 1 → Airway inflammation: eosinophils, neutrophils and mast cells infiltrate the bronchial wall.
   Step 2 → Airway hyper‑responsiveness: inflamed airways become overly sensitive to stimuli.
   Step 3 → Bronchoconstriction: smooth‑muscle spasm narrows the lumen.
   Step 4 → Mucus hyper‑secretion: goblet‑cell proliferation produces thick mucus that further blocks the airway.
   Step 5 → Air‑trapping and ventilation‑perfusion mismatch → clinical breathlessness.

5. Clinical Features

General:

• Recurrent wheeze (high‑pitched whistling on expiration).
• Dyspnoea (shortness of breath).
• Chest tightness.
• Cough, often dry and worse at night/early morning.

Specific:

• Difficulty speaking full sentences during an attack.
• Use of accessory muscles (neck, intercostal) in severe episodes.
• Relief of symptoms after inhalation of a bronchodilator.

6. Complications

Acute:

• Severe asthma attack (status asthmaticus) – can lead to respiratory failure.
• Acute respiratory acidosis due to CO₂ retention.

Chronic:

• Airway remodeling → fixed airflow obstruction resembling COPD.
• Recurrent infections and pneumonia because of mucus stasis.
• Reduced quality of life and school/work absenteeism.

7. Diagnosis / Investigations

Routine:

• Spirometry – shows reduced FEV₁/FVC ratio; reversibility after bronchodilator (>12 % and 200 ml).
• Peak expiratory flow rate – simple bedside monitoring, shows diurnal variation.
• Chest X‑ray – usually normal, helps rule out other causes.

Special:

• Allergy skin‑prick or specific IgE test – identifies offending allergens.
• Methacholine (or histamine) challenge – demonstrates airway hyper‑responsiveness when baseline spirometry is normal.
• Sputum eosinophil count – supports eosinophilic inflammation.

8. Management

General measures:

• Identify and avoid personal triggers (allergens, smoke, cold air).
• Patient education on inhaler technique and self‑monitoring with peak flow.

Modern pharmacotherapy:

• Inhaled corticosteroids (low‑dose daily) – main anti‑inflammatory drug.
• Short‑acting β₂‑agonist (SABA) as rescue inhaler for acute relief.
• Long‑acting β₂‑agonist (LABA) or leukotriene receptor antagonist added when control is inadequate.
• Oral steroids for severe exacerbations (short course).

Dietary advice:

• Balanced diet rich in fruits, vegetables and omega‑3 fatty acids.
• Adequate fluid intake to keep secretions thin.
• Avoid excess dairy or foods that the individual perceives to worsen mucus (if any).

9. Homeopathic Therapeutics (key remedies, 6‑7 points each)

Arsenicum album

• Restlessness, anxiety, fear of death.
• Dry, burning cough with wheeze.
• Worse at night, better with warm drinks.
• History of food poisoning or gastro‑intestinal upset.
• Thin, watery sputum.
• Relief when lying on left side.

Natrum muriaticum

• Nasal congestion, watery discharge.
• Cough with scanty sputum, worse in cold, dry weather.
• Tendency to be introverted, grief‑prone.
• Asthma attacks after emotional upset.
• Better in open air, worse in closed rooms.

Pulsatilla

• Changeable symptoms, alternating cough and wheeze.
• Thick, yellowish sputum that is difficult to expectorate.
• Worse in warm, humid environment; better in cool fresh air.
• Patient is emotional, seeks consolation, weepy.
• Attacks often occur after a cold or after lying down.

Sambucus nigra

• Cough with rattling, expectoration of thick mucus.
• Asthmatic wheeze that improves on walking.
• Symptoms aggravated by cold wind and dampness.
• History of recurrent colds or flu.
• Relief from warm, moist vapour.

Medorrhinum

• Frequent respiratory infections, especially after sexual excesses (in classical materia).
• Cough with profuse, yellow sputum, worse at night.
• Asthma with marked chest tightness and anxiety.
• Patient appears irritable, impatient.
• Better in open air, worse in warm rooms.