Tuesday, 26 November 2013

Asthma (Respiratory Disease) – The Complications

Respiratory Disease is defined as medical conditions which affect the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and  muscles breathing , etc,.
I. Asthma 
Asthma is a chronic inflammatory disease affecting the air way of the lung with recurring symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. The disease affects people of all ages, and mostly starts during childhood. In the study of 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children, found that for asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan, Uzbekistan, India, and Ethiopia(1). In the United States, approximately, asthma affects 25 million people, 7 million of them are children.
D. Complications
1. Quality of life
In a cross-sectional study explored the relationships among family ritual meaning, cohesion, conflict, and health-related quality of life (both specific to chronic health conditions and in general), and the emotional and behavioral problems reported by youths with asthma, conducted by Faculty of Psychology and Educational Sciences, University of Coimbra, showed that stronger family ritual meaning predicted a more positive family environment (i.e., higher cohesion levels and lower conflict levels), better health-related quality of life, and fewer emotional and behavior problems in youths. Furthermore, family cohesion and conflict mediated the links between family ritual meaning and health-related quality of life, and emotional and behavioral problems(34). In 2007–08, people with asthma were more likely to have taken days off work, school or study in the last 12 months due to a long term condition than people without asthma (although these days off were not necessarily due to asthma). People with asthma rate their health worse than people without the condition, according to the data ofAIHW(35).
2. Corticoid-associated complications
In the stduy to evaluate the frequency and type of side effects and complications of long-term corticosteroid therapy in the elderly, showed that infectious complications were found in 26 cases (39.3%), 11 cases (16.7%) of iatrogenic diabetes, arterial hypertension in 9 cases (13%), skeletal complications in both cases,psychiatric complications in two cases, ophthalmologic complications in one case(36).
3. Subcutaneous and mediastinal emphysema
There is a report of a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal(37).
4. Pneumomediastinum
There is a report of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe atelectasis(38). 
5. Respiratory complications
Children with asthma are at increased risk for obstructive breathing during sleep. Adenotonsillectomy, the treatment of choice for obstructive breathing during sleep, is associated with significant postoperative respiratory morbidity. According to the study by Cincinnati Children’s Hospital, Cincinnati, in children with obstructive breathing during sleep, the presence of asthma is associated with an increased risk of respiratory complications after adenotonsillectomy(39). Other indicated that the frequency of perioperative bronchospasm and laryngospasm was surprisingly low in this cohort of persons with asthma. These complications did not lead to severe respiratory outcomes in most patients. The frequency of complications was increased in older patients and in those with active asthma(40).
6. Potentially (near) fatal asthma (PFA)
Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. According to the study by the Northwestern University Feinberg School of Medicine, a diagnosis of PFA is made when any one of the following are present: (1) history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma despite the use of long-term oral corticosteroids and other antiasthma medications.
In the UK in 2005, over 1300 people died from asthma, and on average one person dies from asthma every seven hours.
7. Etc.
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(1) http://www.ncbi.nlm.nih.gov/pubmed/9643741
(35) http://www.aihw.gov.au/asthma-quality-of-life/
(36) http://www.ncbi.nlm.nih.gov/pubmed/23197053
(37) http://www.ncbi.nlm.nih.gov/pubmed/23182721
(38) http://www.ncbi.nlm.nih.gov/pubmed/20561891
(39) http://www.ncbi.nlm.nih.gov/pubmed/15945558
(40) http://www.ncbi.nlm.nih.gov/pubmed/8853074

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