Friday , 28 November 2014

BRONCHIAL ASTHMA

Bronchial hypersensitivity disorder characterized by reversible airway obstruction as a result of mucosal oedema, bronchial construction and excessive secretion of viscid mucus.

It is clinically characterized by recurrent paroxysmal attacks of wheezing, dyspnoea, cough and mucoid expectoration.

ACUTE ATTACK

Clinical Features
Symptoms:

  • Onset : Sudden.
  • Starts in late night or early morning.
  • Preceded by sensation  of tightness in chest.
  • Dysponea- Gasping, Wants open air.
  • Restlessness.
  • Wheezing.
  • Paroxysmal cough.
  • Expectoration- Difficult, Scanty, Mucoid.
  • Attacks subsides within few hours.
  • In between attacks- patient may feel normal.

The Early Symptoms of Asthma

Early warning signs are changes that happen just before or at the very beginning of an asthma attack. These signs may start before the well-known symptoms of asthma and are the earliest signs that your asthma is worsening.

In general, these signs are not severe enough to stop you from going about your daily activities. But by recognizing these signs, you can stop an asthma attack or prevent one from getting worse. Early warning signs include:

  • Frequent cough, especially at night
  • Losing your breath easily or shortness of breath
  • Feeling very tired or weak when exercising
  • Wheezing or coughing after exercise
  • Feeling tired, easily upset, grouchy, or moody
  • Decreases or changes in lung function as measured on a peak flow meter
  • Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache)
  • Trouble sleeping

ETIOLOGY (Causes):
– Exact cause is not know.
- Genetic predisposition is common.
- Family history is usually positive for

  • Bronchial Asthma
  • Allergic rhinitis
  • Eczema, Urticarea.

– Associated with- Allergic rhinitis, Eczema, Urticaria.
– Predisposing causes

  • Inhalants: House dust, pollens, animal hairs, feathers,mites, smoke, fumes.
  • Ingestants: Egg, fish, prawn, crab, milk, nuts, mushroom, strawberry, chocolates.
  • Infection
  • Worm infestation: Ascariasis, Filariasis.

– Precipitating causes

  • Emotional stress.
  • Physical exertion.
  • Fatigue.
  • Change in temperature.
  • Exposure to cold.
  • Heavy meal.
  • Cigarette smoking.
  • Hormonal: before menses, at menopause.
  • Lowered immunity.
  • Latrogenic: b-blockers.

– Age: onset in childhood.
– Sex: equal incidence in both sexes.

 

Signs

General Examination

  • Facies: anxious.
  • Decubitus: sitting, stooped forward.
  • Respiration: hurried.
  • Pulse: rapid.
  • Blood pressure: raised.
  • Sweating.
  • Cold extremities.
  • Accessory muscles õf respiration active.
  • Jugular veins distended.
  • Wheezing: Expiratory, Audible from a distance.

Chest examination
On inspection

  • Accessory muscles of respiration active.
  • Chest held in state of full inspiration.
  • Respiration predominantly abdominal.
  • Apex beat not visible.

On palpation

  • Chest expansion diminished.
  • Vocal frernitus slightly increased.
  • Apex beat not palpable.

On percussion

  • Bilateral hyper-resonant note.

On auscultation

  • Expiratory phase prolonged.
  • Rhonchi- Bilateral, Diffuse, Wheezing, Marked in expiratory phase, Vocal resonance slightly increased.

STATUS ASTHMATICUS
State of repeated asthmatic attacks without any remission in between. It is a medical emergency and may prove fatal if not treated intensively.

Clinical Features of Bronchial Asthma

Symptoms

  • Severe dyspnoea.
  • Inability to speak.
  • Restlessness, anxiety.
  • Exhaustion.

Signs

  • Dehydration.
  • Central cyanosis.
  • Cold extremities.
  • Tachycardia (>120 / minute).
  • Hypotension.
  • Pulsus paradoxes.
  • On auscultation chest: Silent chest (absent breath sounds).

Peoples feeling:

Complications

  • Sudden death during status asthmaticus.
  • Secondary infection.
  • Emphysema.
  • Bronchiectasis.
  • Pigeon breast due to repeated attacks of asthma in childhood.

Investigations
Blood

  • DLC: eosinophils raised.
  • Absolute eosinophil count: raised.

Sputum

  • Shows eosinophils, charcot-leyden crystals, curschmann’s spirals.

X-Ray chest

  • Early stage: Over-inflation of lung during acute attack.
  • Late stage- Emphysematous changes.

Pulmonary function tests
FEV1 and FEV1/ FVC ratio: reduced.

Prognosis

  • Good with efficient, continued treatmern
  • Inadequate control or persistent aggrav favours development of complicatiom
  • Prognosis is guarded in status asthmaticus.

Miasmatic Cleavage

  • Predominant sycotic disorder.

Therapeutic Aim

  • To control acute attack.
  • To prevent recurrence.
  • To prevent complications.

 

General Management
Acute attack

  • Bed rest.
  • Propped up posture on back rest.
  • Physical and mental rest.
  • Humidified oxygen inhalation.
  • Steam inhalation.
  • Avoid precipitating causes.

General Measures

  • Identifr and eliminate predisposing
  • Education and reassurance.
  • Stop smoking.
  • Regular deep breathing exercises.

Status Asthmaticus

  • Correct fluid and electrolyte imbala
  • Humidified oxygen inhalation.
  • Physical and mental rest.
  • Ventilatory support if patient is drowsy.

 

Homoeopathic Treatment
Acute attack

  • Aralia Racemosa.
  • Arsenicum Album.
  • Blatta Orientalis.
  • Bromium.
  • Coca.
  • Coccus cacti.
  • Dulcamara.
  • Grindelia.
  • Ipecacuanha.
  • Kali Carbonicurn.
  • Lobelia.
  • Natrum Sulphuricum.
  • Pothos.
  • Spongia.

Status Asthmaticus

  • Amylinum Nitrosum.
  • Antimonium Tartaricum.
  • Carbo Vegetabilis.
  • Blatta Orientalis.
  • Cuprum Metallicum.
  • Passiflora.

Intercurrent

  • Medorrhinum.
  • Nux Vomica.
  • Psorinum.
  • Sulphur.
  • Thuja Oc.
  • Tuberculinum.

Pointers to remedies by Tyler

Aconite: Ailments from; fright, shock, vexation, COLD, DRY WINDS. Onset sudden, violent, acute. Anxious, short, difficult breathing with open mouth. Agony; sits straight up, can hardly breath. Pulse thready, sweats with anxiety. Face red; eyes staring. Fear, anxiety, ‘going to die’. Restlessness.

Arsenicurn Album: Periodic spasmodic attacks. Worse night; after midnight, worse hours 1- 2 a.m. lying, cold air, motion, from ice. Better bending forwards, by rocking, heat and hot drinks. Great debility and burning in chest. RESTLESS, ANXIOUS, IN FEAR. ANGUISH; agonizing fear of death.

Cuprum Metallicum: Spasmodic asthma, violent dry spasmodic cough, violent sudden attacks, lasts one to three hours, cease suddenly. Dreadful spasmodic breathing. Great rattling. The more the dyspnoea the more the thumbs will be clenched and fingers cramped. A characteristic; strong metallic taste.

Ipecacuanha: ‘suffocative cough’, stiffens out, turns red or blue, gags or vomits. ‘Hands and feet drip cold sweat’. Worse warmth, better open air. Violent degree of dyspnoea, with wheezing and great precordial weight and anxiety. Has to sit up at night to breath. Gasps for air at the open window. Worse warmth; better open air.

Kalium Carbonicuzn: Worse 2-3 and or 2-4 a.m. Better sitting upright, sitting forwards, head on table on knees; better rocking. Worse lying; lying impossible. Worse drinking; worse motion; sensation of no air in chest. Worse draughts.

Kalium Arsenicum: Worse 2 – 3 a.m.; worse touch, noise. Can’t get too warm, even in summer. Worse every other day, or every third day.

Aralia Racemosa: Asthma; loud wheezing with cough. Worse evening and night; after first sleep. Would suffocate if did not sit up. Expectoration warm and salty.

Sambucus: Attacks 3 a.m., must spring out of bed. Sudden attacks in the night. Child awakes; sits up; turns blue; gasps for breath; seems almost dying. Then it goes to sleep, to wake up with another attack, again and again. Asthma with suffocative attacks; may be well when awake, but sleeps into the trouble. Sambucus has dry heat when asleep, profuse sweat when awake.

Natrium Sulphuricum: Worse 4 to 5 a.m. worse wet weather; warm wet. Great dyspnoea, violent attacks. Profuse greenish purulent expectoration. Dyspnoea with cough and copious expectoration. Humid asthma. If a child, give it as first remedy. From damp weather; cold damp dwellings; night air. Worse lying on left side. In pneumonia of left lower chest. Loose cough with soreness and pain through left chest. Springs up in bed and holds chest. Pain lower left chest.

Dulcamara: Asthma humidum; loose cough and rattling of mucus. Worse cold, wet weather. From suppressed sweat, from going from heat into icy cold.

Ipecacuanha: Violent degree of dyspnoea with wheezing and great precordial weight and anxiety. Asthmatic bronchitis. Suffocates and gasps with cough; spits up a little blood. Has to sit up at night to breath. Gasps for air at the open window. Worse warmth; better open air. ‘Suffocative cough; stiffens out, turns red or blue, gags or vomits. “I-lands and feet drip cold sweat”.

Kalium Nitricum: Asthma with violent dyspnoea; rapid gasping breathing; faintness; nausea. Thirsty but can only drink in sips between breaths. Dull stitches or burning pain in chest Extreme coldness; internal burning.

Stramonium: Violence. Flushed face. Staring look. Desire for light and company. Cannot bear to be alone. Worse in dark and solitude. Yet worse bright light. Looking into light.

Lobelia: Extremely difficult breathing from constriction of chest. Want of breath, hysterical. Asthma with sensation of lump above sternum. Worse shortest exposure to cold during paroxysm. Deep breath relieves pressure in epigastrium. Attack often preceded by prickling all over, even to fingers and toes. Urine; deep red, with much red sediment.

Bromium: Asthma of sailors as soon as they go ashore, Asthma of fair and fat children, gasping, wheezing, rattling, spasmodic closure of glottis. “Can’t breath deeply enough”. Must sit up in bed, constriction. Air passage full of smoke. Peculiar symptom; coldness in larynx. Worse from dust.

 

Intercurrent Miasmatic
Sulphur:
Suited to chronic cases. Adapted to “ragged philosopher type”, warm, hungry; often craves fat kicks off the bed clothes or puts feet out. Ailments from; suppressed eruptions. Dyspnoea with oppression of chest. Every cold ends in asthma.

Psorinum: Asthma; anxious dyspnoea and palpitation. From suppressed eruptions. Worse sitting up; better lying; the wider apart he can keep his arms, the better he breaths. Worse in the open air. Thinks he will die; will fail in business.

Thuja: Short breath from mucus in trachea. From fullness and constriction upper abdomen. Sensation of adhesion of lungs. Drops in sleep. Worse from onions. Cases that follow vaccination; or many vaccinations; or bad vaccination. After zonorrhea, or offensive green discharges. Greenish expectoration. Copious sweat; offensive; pungent; sweetish. Peculiar symptom; sweat only on -‘nonvered parts. Worse cold damp. Left sided remedy.

Medorrhinum: Asthma choking from ess or spasm or epiglottis. Larynx stopped Elat no air can enter. Only better by lying on and protruding tongue. Better seaside. Where asthma is connected, even remotely with gonorrhea.

Luetium: Specially in syphilitic looking kinds. Attacks only at night, after lying down, or during a thunderstorm. Worse from sunset to sunshine. Queer sensation; as if sternum were being drawn to spine.

Mother tincture
Eriodyction Glutinosum (Yerba Santa):
Asthma with coryza and mucus secretions; asthma and chronic bronchitis with profuse secretions. Profuse bronchial secretions which can be easily raised; relief after expectoration. Wheezing; dull pain in right lung.

Grindelia Robusta: Asthma with profuse tenacious expectoration, which relieves. Cannot breath lying dàwn. Wheezing and oppression in bronchitis. Foamy mucus, very difficult to detach.Breathing stops when falling asleep, wakes up with a start and gasps from breath, must sit up to breath.

Ipecacuanha: Asthma, asthmatic bronchitis, humid asthma. Worse during damp weather. Violent dyspnoea with anxiety about stomach; constant constriction of chest. Incessant and violent cough; with every breath, chest seems to be full of phlegm. Spasmodic cough. Nausea.

Lobelia Inflata: Dyspnoea from constriction of chest; sensation of pressure or weight in chest; seems that blood is rushing to chest. Better by walking rapidly.

Passiflora Incarnata: Acute asthma. Cough at night.

Pothos foetidus: Asthma worse inhaling any dust; better by passing stool. Cough spasmodic. Sneezing. Pain in chest, with difficult respiration; troublesome respiration with sudden feeling of anguish and sweat.

Taraxacum: Naso-pharyngeal catarrh; bronchitis. Cough with purulent expectoration. Oppressed breathing. Persistent dyspnoea. Asthma with nightly dysuria.

 

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