What is Asthma?
Asthma is a chronic inflammatory disorder of airway in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathless, chest tightness and coughing particularly at night and it early morning. These episodes are associated with widespread but variable airflow obstruction within lung that is reversible, either spontaneously or with treatment. This is episodic disease, with acute exacerbations interspersed with symptom-free periods. Typically, most attacks are short-lived, lasing for minutes to hours, and clinically the patient seems to recover completely after an attack.
ASTHMA ICD 10 CODES?
ASTHMA TYPES AND CODES
Mild intermittent asthma
Mild intermittent asthma with uncomplicated – J45.20
Mild intermittent asthma with exacerbation – J45.21
Mild intermittent asthma with status asthmaticus – J45.22
Mild Persistent asthma
Mild Persistent asthma with uncomplicated – J45.30
Mild Persistent asthma with exacerbation – J45.31
Mild Persistent asthma with status asthmaticus – J45.32
Moderate Persistent asthma
Moderate Persistent asthma with uncomplicated – J45.40
Moderate Persistent asthma with exacerbation – J45.41
Moderate Persistent asthma with status asthmaticus – J45.42
Severe Persistent asthma
Severe Persistent asthma with uncomplicated – J45.50
Severe Persistent asthma with exacerbation – J45.51
Severe Persistent asthma with status asthmaticus – J45.52
Unspecified asthma with exacerbation – J45.901
Unspecified asthma with status asthmaticus – J45.902
Unspecified asthma with uncomplicated – J45.909
Exercise induced bronchospasm – J45.990
Cough variant asthma – J45.991
Other asthma – J45.998
HOW COMMON IS ASTHMA?
- Prevalence of asthma increased steadily over the latter part of last century. Current estimation suggests that asthma effects 300 million people world wide, with predicted additional 100 million people affected by 2025.
- Asthma symptoms affect an estimated 26 million Americans, including 20 million adults and 6 million children.
- The rapid rise in prevalence implies that environmental factors use critically important in the development and expression of disease.
TYPES OF ASTHMA:
1.Adult-onset asthma: when asthma is diagnosed in people older than 20 years of age then it is known as adult onset asthma. Generally this type of asthma is more likely observed in women having hormonal changes such as in pregnant women or menopause women, those who take estrogens.
2.Allergic asthma: An allergy is when the immune system mistakes a harmless substance such as pollen as dangerous, body releases chemicals to attack the substance such asthma caused by allergens is called allergic asthma.
3. Exercise-induced Broncho-constriction: This is often known as exercise-induced asthma which is caused by narrowing the air ways causing difficulty in moving air out of lungs during exercise.
4. Nonallergic asthma: The allergic asthma is triggered by allergies but non allergic asthma does not involve any immune response but triggered by other factors.
5. Occupational asthma: The occupational asthma caused due to exposure to an agent at workplace. This is a type of work-related asthma. The agents that can induce occupational asthma can be grouped into sensitizers and irritants.
WHAT ARE THE CAUSES OF ASTHMA?
Factors that contribute to asthma or airway hyper reactivity may include any of the following:
- Environmental allergens ( house dust,mites,animal allergens,fungi)
- Viral respiratory tract infections
- Exercise, hyperventilation
- Gastro esophageal reflux disease
- Chronic sinusitis or rhinitis
- Aspirin or NSAIDS hypersensitivity, Sulphite sensitivity
- Use of beta-adrenergic receptor blockers
- Environmental pollutants, tobacco smoke
- Occupational exposure
- Genetic factors like family history
WHAT ARE THE SYMPTOMS OF ASTHMA?
- chest tightness
- shortness of breath
- rapid breathing
- By physical examinaton
- Nitric oxide test
- Chest X-ray
- Allergy testing
- Sputum eosinophils
CAN WE CURE ASTHMA?
There is no cure for asthma but there are effective treatment available to treat asthma. Asthma can be treated by
- Reducing the symptoms
- Identifying the triggers
- Elimination of exposure to allergens
CLASSIFICATION OF ASTHMA:
Extrinsic asthma ( allergic)
Intrinsic asthma ( Non-allergic)
mainly classified into four categories:
- Mild intermittent asthma: Symptoms occur less than twice a week, and night time symptoms occur less than two times a month.lung function tests are 80% or more than predicted values. the prediction is done based on age, sex, height etc..
- Mild persistent asthma: Symptoms occur three to six times per week. Lung function test are 80% or above. night time symptoms occur three to four times per month.
- Moderate persistent asthma – Symptoms occur daily. Noctural symptoms more than five times per month. The symptoms last for days. reduction of lung function test above 60% or above but below 80 %.
- Severe persistent asthma – Symptoms occur continously, with frequent night time asthma. activities are limited, lung function decreases less than 60 % of predicted values.
MEDICATIONS USE IN ASTHMA:
The right medication depend on many number of things based on patients age, gender, symptoms etc….
- Beta sympathomimetcs: salbutamol, terbutaline, bambuterol, salmetrol, ephedrine
- Methylxanthines: aminophylline, Theophylline, Doxophylline
- Anticholinergics ( muscarnic receptor antagonist) : Ipratropium bromide, Tiotropium bromide
- Leukotriene antagonists: Montelukast, zafirlukast
- Mast cell stabilizers: Sodium cromoglycate, Ketotifen
- Corticosteroids: Systemic- Hydrocortisone,Prednisolone
Inhalational- Beclomethasone dipropionate, budesonide, fluticasone
- Anti IG-g antibody: Omalizumab
Medications are used to treat of asthma divided into two general categories: Quick-relief medications used to treat acute symptoms and long-term control medications used to prevent further exacerbation.
Antibiotics are not generally needed for sudden worsening symptoms
SHORT ACTING: Beta adrenoreceptor agonists, anticholinergic, Corticosteroids
LONG ACTING : Leukotriene receptor antagonists, mast cell stabilizers
Generally metered dose inhalers in combination of asthma spacers or as dry powder inhaler.
The spacer is an plastic cylinder that mixes the medication with air, making easy to receive a full dose of drug. Nebulizers are also used. These nebulizers and spacers are equally effective for mild to moderate symptoms.
Long term use of corticosteroids inhaled at conventional doses carries a minor risk of adverse effects. this may include thrush, development of cataracts, slow rate of growth. high dose may lead to bone mineral density
When asthma is unresponsive to normal treatment then other options are available for both emergency and prevention
- oxygen in hypoxia condition if saturation is below 92
- corticosteroids givven oral route such as prednisone and dexamethasone
- Magnesium sulfate for bronchodilation
- Heliox mixture of helium and oxygen
- salbutamol given intravenous route
- Monoclonal antibody injections such as mepolizumab, dupilumab
- sublingual immunotherapy in allergic rhinitis improve outcomes
HOW CAN ASTHMA BE PREVENTED?
- Decrease risk factors such as smoking, air pollution, chemical irritants
- Dietary restrictions during pregnancy and lactation are not effective hence not recommended.
- Avoid exposure to cold climate
M. Keerthi Kumari