The lungs are made up of bronchi that branch into smaller bronchioles and terminate in alveoli where oxygen and carbon dioxide are exchanged. When the bronchi become inflamed or infected, it causes bronchitis which makes breathing difficult. Asthma is a chronic lung condition where the airways become inflamed, swollen and constricted due to triggers like allergens, irritants, weather changes and infections. Common symptoms include shortness of breath, wheezing, coughing and chest tightness. Asthma is diagnosed through breathing tests and treated with inhalers and other medications to reduce inflammation and relax the airways.

1. Before identifying the disease
Let's remember the anatomy and physiological of the lung
The lung
Anatomy:
The lungs are connected to the trachea by the right and left bronchi
Bronchi are the main passageway into the lungs. When someone takes a breath
through their nose or mouth, the air travels into the larynx. The next step is through
the trachea, which carries the air to the left and right bronchus. The bronchi become
smaller the closer they get to the lung tissue and are then considered bronchioles.
These passageways then evolve into tiny air sacs called alveoli, which is the site of
oxygen and carbon dioxide exchange in the respiratory system.
Disease if occurring
When the bronchi become swollen due to irritants or
infection, bronchitis results and makes breathing more difficult.
Bronchitis sufferers also tend to have much more mucus and phlegm than
someone without inflamed bronchi.
Normal value of (MRV) minute respiratory volume: {6L/Min}
➔ Reach to alveoli about 350 ml in each respiratory rate and other is called dead
space.

2. Introduction
Asthma
Definition:
asthma have a chronic lung condition that causes their airways to become smaller or
narrower, due to:
- underlying inflammation or swelling.
- increased mucus production.
- contraction of muscles around the airways, or bronchospasm.
This swelling (inflammation) causes the airways to make thick, sticky secretions
called mucus. Asthma also causes the muscles in and around your airways to get very
tight or constrict. This swelling, mucus, and tight muscles can make your airways
narrower than normal and it becomes very hard for you to get air into and out of your
lungs.
The most common symptoms of asthma
➔ shortness of breath
➔ hear wheezing (a whistling or squeaking sound) as air
tries to move through your narrowed airways.
➔ Chest pain, chest pressure
➔ chest tightness
➔ cough → most often at night or early in the morning
You may have days when you have every symptom and other days you may have no
symptoms.

3. Result:
For some students, symptoms may go away in 20 or 30 minutes after they stop
exercising and takes their prescribed medicine. For others, the symptoms may last for
several hours. Students with more severe symptoms may require further treatment
of their asthma attack in an emergency department.
Asthma
can be inherited or passed down to you from your parents through their genes.
you may have no history of asthma in your family.
If you have asthma, your airways are more sensitive than normal. Your airways can
get irritated and tighten very easily by a variety of things called “triggers.”
Examples of “triggers” are:
1- Allergies: If you have allergies, you may also be more likely to have asthma.
➔ This type of asthma often begins in children, but can happen in adults as well.
common allergens (things that cause allergies) are
➔ pollen from weeds, trees, and grass, mold, cockroach droppings,
➔ dander from cats or dogs and dust mites.
➔ These can cause sneezing, wheezing, itchy eyes and a runny nose. If the lungs
are irritated enough, the allergens can cause an asthma attack.
2- irritants: (Respiratory irritant)
➔ environmental tobacco smoke, air pollution, chemicals and strong smells.
Environmental tobacco smoke or second hand smoke – which increase the
number of asthma episodes and the severity of symptoms in an estimated 200,000 to
1 million children annually.
Air pollution → a potent mix of ground level ozone, sulfur dioxide, particulate
matter and nitrogen oxide

4. Chemicals or strong smells → paint/cleaning solutions, chalk dust, lawn and turf
treatments, gasoline fumes
Additional Triggers
➔ Weather changes
➔ Upper respiratory infections
➔ Cold air
➔ Strong emotions
➔ Exercise
Asthma cannot be diagnosed without a breathing test
if you think you may have asthma, tell your health care provider (HCP) about all of
your symptoms. If your HCP thinks your symptoms may be from asthma
1- breathing test called a pulmonary function test or spirometry test
principle:
the most basic test is spirometry. This test measures the amount of air the lungs can
hold. The test also measures how forcefully one can empty air from the lungs.
Spirometry is used to screen for diseases that affect lung volumes. It also is used to
screen for diseases that affect the airways, such as COPD or asthma.
2- additional tests: Blood tests for allergies or for detecting problems with
your immune system may also be ordered.
3- Testing may also be done to test if your symptoms are caused by another
disease such as vocal cord dysfunction
If your asthma is not getting better after you start treatment,

5. Medications will be prescribed that keep your airways open and reduce swelling, so
air can move in and out of your lungs more easily.
1- given an inhaler
i.
2- pill
3- Short-acting (relief or rescue) bronchodilators By relax the muscles around
your airways.
1. albuterol
2. levalbuterol
4- Long-acting medicines (controllers) include
a. inhaled corticosteroids
1. Beclomethasone
2. budesonide
b. inhaled corticosteroids in combination with long-acting
1. bronchodilators (e.g. formoterol or salmeterol).
Reference
American Thoracic Society (ATS)
http://patients.thoracic.org/information-series/index.php
National Heart, Lung, & Blood Institute (NHLBI)
http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/
American Lung Association (ALA)
http://www.lung.org/lung-disease/asthma/
Asthma and Allergy Foundation of America
www.aafa.org