Asthma involves episodic airway obstruction, inflammation, and increased reactivity. Asthma arises from interactions between inflammatory cells and airway structures.
Genetically susceptible individuals may experience breathlessness, wheezing, cough, and chest tightness from asthma.
Asthma triggers include allergic factors like pollen and dust mites, and nonallergic causes.
Nonallergic asthma triggers include smoke, cold air, chemicals, exercise, and hormones.
Genetic variation among racial and ethnic groups is influenced by economic, cultural, and environmental factors.
Asthma leads to 1.5 million emergency visits, 500,000 hospitalizations, and 100 million restricted activity days.
Global asthma costs exceed those of tuberculosis and AIDS combined with over half stemming from 10-20% of patients experiencing the most severe disease.
Environmental exposure in sensitized individuals causes airway inflammation in asthma as it increases bronchial reactivity through various inflammatory pathways triggered by different allergens.
Allergen avoidance and environmental control are effective, leading to symptom relief and improved pulmonary function by removing even one environmental allergen.
Genetics cannot solely explain asthma prevalence increases while genetic factors require generations and are not always co-inherited.
Type 2 innate lymphoid cells are linked to inflammatory pathways in asthma conditions.
Late allergic responses may occur 4 to 10 hours later, marked by inflammatory cell infiltration due to cytokine-driven lymphocyte and eosinophil activation.
Proinflammatory cytokines from activated mast cells attract neutrophils and eosinophils that contributes to the late allergic response.
Epidemiology
Asthma prevalence is hard to assess due to varying definitions, but its incidence seems to increase.
Asthma affects over 22 million people, with a prevalence estimated at 10.9%.
Researchers report rising asthma prevalence, morbidity, mortality, and economic burden over the last 40 years globally.
Asthma impacts over 300 million globally with prevalence rising 50% each decade. Asthma prevalence in children under 14 is double in boys compared to girls.
Asthma mortality in inner-city children has increased in the U.S. despite improved treatments and understanding.
Anatomy
Pathophysiology
Test results show high negative predictive value, effectively excluding asthma diagnosis.
A 20% decrease in FEV1 with 8 mg/mL methacholine indicates a positive test.
Testing is discouraged in pregnancy due to asthma attack risks and methacholine’s class C status
Allergen-inhalation challenges are performed in select patients but are generally unnecessary and require specific allergen solutions.
A negative allergy test allows continued allergen exposure, while a positive result suggests avoidance for diagnosing occupational asthma.
Etiology
The causes of allergic and environmental asthma are:
Environmental (Non-Allergic) Asthma
Allergic Asthma
Genetics
IgE-Mediated Hypersensitivity
Air Pollution
Occupational Exposures
Infections
Weather Changes
Genetics
Prognostic Factors
Early diagnosis and treatment with inhaled corticosteroids improve prognosis especially in mild asthma compared to severe cases.
Avoiding allergens and pollution ensures long-term control, while normal lung function enhances overall health outcomes.
Frequent symptoms, exacerbations, and ICU history indicate poor control and higher mortality risk.
Obese asthmatics have worse corticosteroid response; smoking worsens lung function and increases corticosteroid resistance.
Clinical History
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Physical Examination
Respiratory System Examination
Systemic examination
General Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Mild Acute symptoms are:
Wheezing, cough, chest tightness, normal mental status
Severe acute symptoms are:
Severe dyspnea, unable to complete sentences, tachypnea, tachycardia, paradoxical breathing
Differential Diagnoses
Aspergillosis
Bronchiolitis
Emphysema
Foreign Body Aspiration
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment goals include minimizing symptoms, improving quality of life, reducing urgent care needs, normalizing pulmonary function, and decreasing airway inflammation.
Anti-inflammatory medications are crucial for all asthma stages beyond mild intermittent cases.
Intranasal corticosteroids and antihistamines are primary treatments for allergic rhinitis.
Many hospitalized asthma patients do not receive or take their prescribed anti-inflammatory medications.
Inhaled corticosteroids with long-acting beta agonists may reduce severe exacerbation risk in moderate to severe asthma patients.
Omalizumab offered additional clinical benefit for severe allergic asthma with high-dose ICS.
Patients should wear a face mask or use a double-bagged vacuum with HEPA filter.
The annual crude death rate from this treatment is 0.7 per million as uncontrolled asthma increases immunotherapy-related death risks.
Avoid allergen immunotherapy for patients on beta blockers during asthma exacerbations.
Sublingual immunotherapy improves allergic rhinitis and asthma symptoms, with manageable adverse reactions and safe for home use.
In the acute phase, the goal is to restore lung function and prevent respiratory failure.
Pharmacologic therapy is effective in the treatment phase as it includes the use of mast cells stabilization, leukotriene receptor antagonist, and anticholinergic agents.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the immunologist are scheduled to check the improvement of patients along with treatment response.
»
Home » CAD » Allergic and Environmental Asthma
Allergic and Environmental Asthma
Updated :
May 6, 2025
Asthma involves episodic airway obstruction, inflammation, and increased reactivity. Asthma arises from interactions between inflammatory cells and airway structures.
Genetically susceptible individuals may experience breathlessness, wheezing, cough, and chest tightness from asthma.
Asthma triggers include allergic factors like pollen and dust mites, and nonallergic causes.
Nonallergic asthma triggers include smoke, cold air, chemicals, exercise, and hormones.
Genetic variation among racial and ethnic groups is influenced by economic, cultural, and environmental factors.
Asthma leads to 1.5 million emergency visits, 500,000 hospitalizations, and 100 million restricted activity days.
Global asthma costs exceed those of tuberculosis and AIDS combined with over half stemming from 10-20% of patients experiencing the most severe disease.
Environmental exposure in sensitized individuals causes airway inflammation in asthma as it increases bronchial reactivity through various inflammatory pathways triggered by different allergens.
Allergen avoidance and environmental control are effective, leading to symptom relief and improved pulmonary function by removing even one environmental allergen.
Genetics cannot solely explain asthma prevalence increases while genetic factors require generations and are not always co-inherited.
Type 2 innate lymphoid cells are linked to inflammatory pathways in asthma conditions.
Late allergic responses may occur 4 to 10 hours later, marked by inflammatory cell infiltration due to cytokine-driven lymphocyte and eosinophil activation.
Proinflammatory cytokines from activated mast cells attract neutrophils and eosinophils that contributes to the late allergic response.
Asthma prevalence is hard to assess due to varying definitions, but its incidence seems to increase.
Asthma affects over 22 million people, with a prevalence estimated at 10.9%.
Researchers report rising asthma prevalence, morbidity, mortality, and economic burden over the last 40 years globally.
Asthma impacts over 300 million globally with prevalence rising 50% each decade. Asthma prevalence in children under 14 is double in boys compared to girls.
Asthma mortality in inner-city children has increased in the U.S. despite improved treatments and understanding.
Test results show high negative predictive value, effectively excluding asthma diagnosis.
A 20% decrease in FEV1 with 8 mg/mL methacholine indicates a positive test.
Testing is discouraged in pregnancy due to asthma attack risks and methacholine’s class C status
Allergen-inhalation challenges are performed in select patients but are generally unnecessary and require specific allergen solutions.
A negative allergy test allows continued allergen exposure, while a positive result suggests avoidance for diagnosing occupational asthma.
The causes of allergic and environmental asthma are:
Environmental (Non-Allergic) Asthma
Allergic Asthma
Genetics
IgE-Mediated Hypersensitivity
Air Pollution
Occupational Exposures
Infections
Weather Changes
Early diagnosis and treatment with inhaled corticosteroids improve prognosis especially in mild asthma compared to severe cases.
Avoiding allergens and pollution ensures long-term control, while normal lung function enhances overall health outcomes.
Frequent symptoms, exacerbations, and ICU history indicate poor control and higher mortality risk.
Obese asthmatics have worse corticosteroid response; smoking worsens lung function and increases corticosteroid resistance.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Respiratory System Examination
Systemic examination
General Examination
Mild Acute symptoms are:
Wheezing, cough, chest tightness, normal mental status
Severe acute symptoms are:
Severe dyspnea, unable to complete sentences, tachypnea, tachycardia, paradoxical breathing
Aspergillosis
Bronchiolitis
Emphysema
Foreign Body Aspiration
Treatment goals include minimizing symptoms, improving quality of life, reducing urgent care needs, normalizing pulmonary function, and decreasing airway inflammation.
Anti-inflammatory medications are crucial for all asthma stages beyond mild intermittent cases.
Intranasal corticosteroids and antihistamines are primary treatments for allergic rhinitis.
Many hospitalized asthma patients do not receive or take their prescribed anti-inflammatory medications.
Inhaled corticosteroids with long-acting beta agonists may reduce severe exacerbation risk in moderate to severe asthma patients.
Omalizumab offered additional clinical benefit for severe allergic asthma with high-dose ICS.
Patients should wear a face mask or use a double-bagged vacuum with HEPA filter.
The annual crude death rate from this treatment is 0.7 per million as uncontrolled asthma increases immunotherapy-related death risks.
Avoid allergen immunotherapy for patients on beta blockers during asthma exacerbations.
Sublingual immunotherapy improves allergic rhinitis and asthma symptoms, with manageable adverse reactions and safe for home use.
Allergy and Immunology
Identify and minimize exposure to environmental triggers including allergens and irritants.
Monitor lung function and symptoms to guide medication adjustments.
Avoid use of tobacco and smoke to reduce asthma symptoms.
Minimize exposure to outdoor air pollution by staying indoors on days with high pollution levels.
Use safe and effective pest control measures to reduce exposure to cockroach droppings and other allergens.
Patient should do regular physical activity to improve overall health and fitness.
Proper awareness about allergic and environmental asthma should be provided and its related causes with management strategies.
Appointments with immunologist and preventing recurrence of disorder is an ongoing life-long effort.
Allergy and Immunology
Albuterol:
It acts on beta2 receptors in the smooth muscle of the bronchi.
Allergy and Immunology
Ipratropium:
It inhibits acetylcholine-induced bronchoconstriction to block muscarinic receptors in the airways.
Allergy and Immunology
Salmeterol:
It is a long-acting beta2-adrenergic agonist that acts on beta2 receptors in the smooth muscles of the airways.
Allergy and Immunology
Theophylline:
It inhibits phosphodiesterase enzymes to increase in intracellular cyclic adenosine monophosphate.
Allergy and Immunology
Procedural interventions such as bronchial thermoplasty and bronchoscopy, and airway stenting.
Allergy and Immunology
In the acute phase, the goal is to restore lung function and prevent respiratory failure.
Pharmacologic therapy is effective in the treatment phase as it includes the use of mast cells stabilization, leukotriene receptor antagonist, and anticholinergic agents.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the immunologist are scheduled to check the improvement of patients along with treatment response.
Asthma involves episodic airway obstruction, inflammation, and increased reactivity. Asthma arises from interactions between inflammatory cells and airway structures.
Genetically susceptible individuals may experience breathlessness, wheezing, cough, and chest tightness from asthma.
Asthma triggers include allergic factors like pollen and dust mites, and nonallergic causes.
Nonallergic asthma triggers include smoke, cold air, chemicals, exercise, and hormones.
Genetic variation among racial and ethnic groups is influenced by economic, cultural, and environmental factors.
Asthma leads to 1.5 million emergency visits, 500,000 hospitalizations, and 100 million restricted activity days.
Global asthma costs exceed those of tuberculosis and AIDS combined with over half stemming from 10-20% of patients experiencing the most severe disease.
Environmental exposure in sensitized individuals causes airway inflammation in asthma as it increases bronchial reactivity through various inflammatory pathways triggered by different allergens.
Allergen avoidance and environmental control are effective, leading to symptom relief and improved pulmonary function by removing even one environmental allergen.
Genetics cannot solely explain asthma prevalence increases while genetic factors require generations and are not always co-inherited.
Type 2 innate lymphoid cells are linked to inflammatory pathways in asthma conditions.
Late allergic responses may occur 4 to 10 hours later, marked by inflammatory cell infiltration due to cytokine-driven lymphocyte and eosinophil activation.
Proinflammatory cytokines from activated mast cells attract neutrophils and eosinophils that contributes to the late allergic response.
Asthma prevalence is hard to assess due to varying definitions, but its incidence seems to increase.
Asthma affects over 22 million people, with a prevalence estimated at 10.9%.
Researchers report rising asthma prevalence, morbidity, mortality, and economic burden over the last 40 years globally.
Asthma impacts over 300 million globally with prevalence rising 50% each decade. Asthma prevalence in children under 14 is double in boys compared to girls.
Asthma mortality in inner-city children has increased in the U.S. despite improved treatments and understanding.
Test results show high negative predictive value, effectively excluding asthma diagnosis.
A 20% decrease in FEV1 with 8 mg/mL methacholine indicates a positive test.
Testing is discouraged in pregnancy due to asthma attack risks and methacholine’s class C status
Allergen-inhalation challenges are performed in select patients but are generally unnecessary and require specific allergen solutions.
A negative allergy test allows continued allergen exposure, while a positive result suggests avoidance for diagnosing occupational asthma.
The causes of allergic and environmental asthma are:
Environmental (Non-Allergic) Asthma
Allergic Asthma
Genetics
IgE-Mediated Hypersensitivity
Air Pollution
Occupational Exposures
Infections
Weather Changes
Early diagnosis and treatment with inhaled corticosteroids improve prognosis especially in mild asthma compared to severe cases.
Avoiding allergens and pollution ensures long-term control, while normal lung function enhances overall health outcomes.
Frequent symptoms, exacerbations, and ICU history indicate poor control and higher mortality risk.
Obese asthmatics have worse corticosteroid response; smoking worsens lung function and increases corticosteroid resistance.
Collect details including the chief complaint, history of present illness, and medical history to understand clinical history of patients.
Respiratory System Examination
Systemic examination
General Examination
Mild Acute symptoms are:
Wheezing, cough, chest tightness, normal mental status
Severe acute symptoms are:
Severe dyspnea, unable to complete sentences, tachypnea, tachycardia, paradoxical breathing
Aspergillosis
Bronchiolitis
Emphysema
Foreign Body Aspiration
Treatment goals include minimizing symptoms, improving quality of life, reducing urgent care needs, normalizing pulmonary function, and decreasing airway inflammation.
Anti-inflammatory medications are crucial for all asthma stages beyond mild intermittent cases.
Intranasal corticosteroids and antihistamines are primary treatments for allergic rhinitis.
Many hospitalized asthma patients do not receive or take their prescribed anti-inflammatory medications.
Inhaled corticosteroids with long-acting beta agonists may reduce severe exacerbation risk in moderate to severe asthma patients.
Omalizumab offered additional clinical benefit for severe allergic asthma with high-dose ICS.
Patients should wear a face mask or use a double-bagged vacuum with HEPA filter.
The annual crude death rate from this treatment is 0.7 per million as uncontrolled asthma increases immunotherapy-related death risks.
Avoid allergen immunotherapy for patients on beta blockers during asthma exacerbations.
Sublingual immunotherapy improves allergic rhinitis and asthma symptoms, with manageable adverse reactions and safe for home use.
Allergy and Immunology
Identify and minimize exposure to environmental triggers including allergens and irritants.
Monitor lung function and symptoms to guide medication adjustments.
Avoid use of tobacco and smoke to reduce asthma symptoms.
Minimize exposure to outdoor air pollution by staying indoors on days with high pollution levels.
Use safe and effective pest control measures to reduce exposure to cockroach droppings and other allergens.
Patient should do regular physical activity to improve overall health and fitness.
Proper awareness about allergic and environmental asthma should be provided and its related causes with management strategies.
Appointments with immunologist and preventing recurrence of disorder is an ongoing life-long effort.
Allergy and Immunology
Albuterol:
It acts on beta2 receptors in the smooth muscle of the bronchi.
Allergy and Immunology
Ipratropium:
It inhibits acetylcholine-induced bronchoconstriction to block muscarinic receptors in the airways.
Allergy and Immunology
Salmeterol:
It is a long-acting beta2-adrenergic agonist that acts on beta2 receptors in the smooth muscles of the airways.
Allergy and Immunology
Theophylline:
It inhibits phosphodiesterase enzymes to increase in intracellular cyclic adenosine monophosphate.
Allergy and Immunology
Procedural interventions such as bronchial thermoplasty and bronchoscopy, and airway stenting.
Allergy and Immunology
In the acute phase, the goal is to restore lung function and prevent respiratory failure.
Pharmacologic therapy is effective in the treatment phase as it includes the use of mast cells stabilization, leukotriene receptor antagonist, and anticholinergic agents.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the immunologist are scheduled to check the improvement of patients along with treatment response.
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