BRONCHIAL ASTHMA

• Asthma is defined as a heterogeneous disease usually characterized by chronic air way inflammation. It is defined by history of respiratory symptoms of wheezing, breathlessness, chest tightness and coughing, and by variable expiratory airflow limitation
• The cardinal symptoms of asthma are intermittent dyspnoea, coughing, and high-pitched expiratory wheezing. Allergic (extrinsic) asthma usually develops in childhood and is triggered by allergens such as pollen, dust mites, and certain foods. Non allergic (environmental or intrinsic) asthma usually develops in patients over the age of forty and can have various triggers, such as cold air, medication (e.g. aspirin), exercise, and viral infection

• Family history of asthma
• Past history of allergies
• Atopic dermatitis

Risk factors / Triggers

• Cardinal risk factor: Atopy
• Environmental allergens: pollen , dust mites, animal dander , spores
• Allergic occupational asthma: from exposure to allergens in the workplace (e.g. flour dust) 
• Viral respiratory tract infections
• Cold air
• Physical exertion (exercise-induced asthma)
• GERD : often exists concurrently with asthma 
• Chronic sinusitis or rhinitis
• Medication: aspirin/NSAIDS (aspirin-induced asthma), beta-blockers
• Stress

• Episodic breathlessness, wheezing, cough and chest tightness
• Characteristic pattern of diurnal variability of worsening during night and early morning
• Disrupted sleep due to cough and wheeze
• Increased mucous production which is thick, mucoid and difficult to expectorate
• Wheezing is the most prominent sign especially during expiration
• Dyspnoea
• In severe asthma exacerbation , wheezing may be absent because of severely reduced airflow but exacerbations can be identified by the presence of other signs such as increased respiratory rate, flaring of alae nasi, severe dyspnoea, Pulsus paradoxus, use of accessory muscles of respiration

On Auscultation

• Prolonged expiratory phase with wheezing (dry crackles)
• Tachypnoea

Percussion

• Hyper resonant sound
• Inferior displacement and poor movement of the diaphragm

Pulse oximetry and blood gas analysis (ABG)

Blood gas analysis should be performed if oxygen saturation (SpO2) is < 94%.

In allergic asthma 

• Total IgE, allergen-specific IgE
• CBC: possibly Eosinophilia 
• AEC > 400

Pulmonary function testing (spirometry) 

• First-line diagnostic test for confirmation of the diagnosis in patients ≥ 5 years of age. Asthma is diagnosed by demonstration of reversible airway obstruction in spirometry

Methacholine challenge test(Bronchoprovocation test):

• Evidence of bronchial hyper responsiveness after inhalation of methacholine

Chest X-Ray 

• To exclude differential diagnoses (e.g. pneumonia, pneumothorax)
• Normal in mild cases
• Signs of pulmonary hyperinflation in cases of severe asthma
• Low, flattened diaphragm
• Wide inter costal spaces
• Barrel chest

Skin allergy tests:

• Skin prick testing (SPT) or intra dermal skin testing
• In asthma triggered by infection: elevated inflammatory markers

Sputum sample

• Curschmann spirals (whorled mucous plug in sputum that is formed by shed bronchial epithelium)
• Charcot-Leyden crystals (histopathologic finding in patients with eosinophilic inflammation and/or proliferation)
• Creola bodies (aggregate of desquamated epithelial cells)

• Avoid triggers
• Allergen immunotherapy in allergic asthma 
• Early treatment of infections in infection-triggered asthma
• If GERD is suspected: proton pump inhibitors
• Medications – Bronchodilator, Steroid and Anti-inflammatory

Internal Medicines

• Dashamoola katutraya kashaya
• Nayopayam kashaya
• Elakanadi kashaya
• Svasananda rasa
• Karpoora choorna
• Dhanwantara gutika
• Gorochanadi gutika
• Dashamoolarishta
• Kanakasava + Vasarishta
• Tambula rasayana
• Agasthya rasayana

Procedures 

• Karpooradi taila - ext application on chest
• Busa pinda sweda