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Which Of The Following Are Associated With Extrinsic Asthma

Asthma Pathophysiology Diagnosis And Management

extrinsic and intrinsic Asthma

At the conclusion of this exercise, the learner will be prepared to:

  • Apply the appropriate terms and definitions related to asthma care
  • Formulate an understanding of the pathophysiology of asthma and its various phenotypes
  • Identify the various asthma risk factors and methods for prevention
  • Reference the appropriate tests and evaluations used to diagnose asthma
  • Establish a basic understanding of the various management components and medications used to treat asthma on a daily/chronic as well as an urgent/emergent basis
  • Types Of Asthma Medications

    Asthma medication comes in several forms. These include:

    • Inhalers : These devices deliver medication into your mouth that you immediately inhale.
    • Nebulizers: Asthma medication used in nebulizer machines comes in liquid form. The machine turns the liquid into a mist that you breathe in through your mouth or a mask that covers both your mouth and nose.
    • Biologics: These medications are given through a shot or an IV infusion.
    • Steroidal anti-inflammatories:These medications can be inhaled or taken orally.

    Stage : Your Lung Swell In Response To Potential Danger

    When the lungs are triggered by allergens, the walls of the passages swell. This eventually blocks the air getting into the lungs and decreases oxygen reaching the body.

    Muscles within the breathing tubes of the lungs contract and lead to more narrowing of the airways. This makes it hard the lungs to move and push out air. This difficulty to breathe leads to the typical symptoms of an asthma attack.

    Another problem is that extra mucous is made for added protection. If the irritation of the lungs does not stop immediately, this leads to contraction of these muscles and production of thick mucus. Although this may seem strange, the airways are filled with mucus to block more allergens from entering the lungs.

    In the end, the swelling of the lung airways, constriction of the lung muscles, and production of thick mucus all together cause a narrow passageway for air to get through. Eventually, if the trigger is not removed, the lungs will shut down completely and no air will circulate at all.

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    How Are Both Types Diagnosed

    Even though extrinsic and intrinsic asthmas have the same major symptoms, the diagnosis and treatment stages do differ for both conditions. In order to identify intrinsic asthma, your doctor will have to order a lung X-ray and blood work in addition to a thorough physical examination. Sometimes your physician will also want to perform a spirometry, peak flow, or lung function tests in order to figure out more details about your condition. After that, your doctor will have to perform an analysis on what factor cause your non-allergic asthma. When it comes to diagnosing extrinsic asthma, your physician will likely order all of the abovementioned tests as well as a skin prick test, to see what your body perceives as an allergen.

    Chronic Obstructive Pulmonary Disease

    Copd and asthma

    Smoking is considered to be the main cause of COPD. Smoking can also worsen other conditions that cause wheezing.

    Chronic obstructive pulmonary disease is a progressive lung disease which makes breathing difficult. This can happen because the walls of your air sacs or the walls between air sacs get damaged , or the lining of your airways is constantly irritated leading to the formation of thick mucus , or both.11 Smoking is considered to be the main cause of COPD. Long-term exposure to other things that can irritate your lungs like chemical fumes, air pollution etc. can also lead to COPD. In some cases, people who are genetically deficient in a protein known as alpha-1 antitrypsin can also develop this condition. COPD is usually observed in middle-aged or elderly people.

    Other symptoms that indicate COPD include coughing with or without phlegm, shortness of breath that worsens with activity, and fatigue

    What to do: COPD causes permanent damage to your lungs, however, there are some measures which can stop this condition from getting worse and help to ease symptoms. Your doctor may prescribe medicine and inhalers that can help you breathe better. Pulmonary rehabilitation exercises can also be helpful in teaching you to breathe better.12

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    Implications Of Current Information About Pathophysiology And Pathogenesis And Natural History For Asthma Management

    Airway inflammation is a major factor in the pathogenesis and pathophysiology of asthma. The importance of inflammation to central features of asthma continues to expand and underscore this characteristic as a primary target of treatment. It has also become apparent, however, that airway inflammation is variable in many aspects including intensity, cellular/mediator pattern, and response to therapy. As knowledge of the various phenotypes of inflammation become apparent, it is likely that treatment also will also have greater specificity and, presumably, effectiveness.

    It is also apparent that asthma, and its persistence, begin early in life. Although the factors that determine persistent versus intermittent asthma have yet to be ascertained, this information will become important in determining the type of treatment, its duration, and its effect on various outcomes of asthma. Early studies have indicated that although current treatment is effective in controlling symptoms, reducing airflow limitations, and preventing exacerbations, present treatment does not appear to prevent the underlying severity of asthma.

    Despite these unknowns, the current understanding of basic mechanisms in asthma has greatly improved appreciation of the role of treatment. The Expert Panel’s recommendations for asthma treatment, which are directed by knowledge of basic mechanisms, should result in improved control of asthma and a greater understanding of therapeutic effectiveness.

    Induction Of Regulatory T Cells By Statins: Alternative Therapy For The Control Of Extrinsic Asthma



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  • Madore AM, Laprise C. Immunological and genetic aspects of asthma and allergy. J Asthma Allergy. 2010 3:107-121.

  • Bateman ED, Hurd SS, Barnes PJ. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008 31:143-178.

  • Kim YM, Kim YS, Jeon SG, Kim YK. Immunopathogenesis of allergic asthma: more than the th2 hypothesis. Allergy Asthma Immunol Res. 2013 5:189-196.

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  • Murdoch JR, Lloyd CM. Chronic inflammation and asthma. Mutat Res. 2010 690:24-39.

  • Burchell JT, Strickland DH, Stumbles PA. The role of dendritic cells and regulatory T cells in the regulation of allergic asthma. Pharmacol Ther. 2010 125:1-10.

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  • Liu JN, Suh DH, Yang EM, Lee SI, Park HS, Shin YS. Attenuation of airway inflammation by simvastatin and the implications for asthma treatment: is the jury still out? Exp Mol Med. 2014 46:e113.

  • Holgate ST. Pathogenesis of asthma. Clin Exp Allergy. Jun. 2008 38:872-897.

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    Impact On Asthma Treatment

    While there is no cure for asthma, treatment can control its symptoms and slowif not entirely stopits progression.

    With the pathogenesis and pathophysiology of asthma in mind, doctors can recommend strategies to either minimize or normalize the response, or prevent it from happening altogether. Given the variety of elements involved in these processes, your asthma management plan will very likely be multi-pronged.

    Visit your doctor regularly so they can monitor your respiratory health and alter your treatment plan over time, as needed.

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    Intrinsic Asthma Vs Extrinsic Asthma

    ASTHMA(Intrinsic & Extrinsic) , APPROACHES OF TREATMENTS

    Extrinsic asthma is more common than intrinsic asthma.

    Intrinsic asthma tends to start later in life, is more common in females, and is typically more severe.

    The main difference between the two is the level of involvement of the immune system:

    • In extrinsic asthma, symptoms are triggered by an allergen . The immune system overreacts, producing too much of a substance throughout the body. Its the IgE that triggers an extrinsic asthma attack.
    • In intrinsic asthma, IgE is usually only involved locally, within the airway passages.

    Despite these factors, experts generally agree that there are

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    Control Of Triggering Factors

    Triggering factors in some patients may be controlled with use of synthetic fiber pillows and impermeable mattress covers and frequent washing of bed sheets, pillowcases, and blankets in hot water. Ideally, upholstered furniture, soft toys, carpets, curtains, and pets should be removed, at least from the bedroom, to reduce dust mites and animal dander. Dehumidifiers should be used in basements and in other poorly aerated, damp rooms to reduce mold. Steam treatment of homes diminishes dust mite allergens. House cleaning and extermination to eliminate cockroach exposure is especially important. Although control of triggering factors is more difficult in urban environments, the importance of these measures is not diminished.

    High-efficiency particulate air vacuums and filters may relieve symptoms, but no beneficial effects on pulmonary function and on the need for drugs have been observed.

    Sulfite-sensitive patients should avoid sulfite-containing food .

    Patients with aspirin-sensitive asthma can use acetaminophen, choline magnesium salicylate, or celecoxib in place of NSAIDs.

    Asthma is a relative contraindication to the use of nonselective beta-blockers , including topical formulations, but cardioselective drugs probably have no adverse effects.

    How To Prevent An Asthma Attack

    An asthma attack can be dangerous. Breathing is not something that you can do without. And it becomes a serious problem when you can no longer continue with normal daily activities.

    When it comes to asthma, the best first line treatment is always lifestyle and environmental changes.

    The best protection against asthma is to identify triggers and avoid and control symptoms. While it may not be impossible to remove all allergens, you can perform simple tasks to decrease your risk of exposure.

    If the symptoms of an asthma attack are not controlled, the lungs can undergo irreversible changes. This is called airway remodeling and it is the reason why some asthmatics need to be carefully monitored by a health care team.

    If you know the cause, you can stay away to prevent asthma attacks. There are some common triggers that can invoke an attack, for example cigarette smoke, pollen, or pet hair and dander. Whenever you can, stay away from these agents that can trigger symptoms or cause full-blown asthma attacks.

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    Who Is More Prone To Each Type

    Based on extensive research, experts in the medical world have been able to identify certain characteristics that are associated with sufferers of each asthma type. For example, allergic asthmatic patients are usually younger, while non-allergic ones tend to be older. This is explained by the fact that its harder to get non-allergic asthma while you are relatively young, as your organism is still strong and able to withstand many factors that would cause an older patient to get asthma. Surprisingly gender is also a factor, as the research claims that females are at higher risk to obtain a non-allergic type of asthma compared to males.

    How Can I Help My Child With Allergies

    Asthma: Definition, Diagnosis, Cause,Symptoms and Treatment

    Children with allergies have the same treatment options as adults. For starters, over-the-counter childrens alleergy medicines like antihistamines, decongestants and nasal steroid sprays can be extremely helpful. Just make sure you talk with your childs doctor first.

    With consistent use, these medications can help relieve symptoms and keep them under control. You can also use natural remedies such as sinus rinses as alternatives or in combination with medications.

    Depending on how serious your childs allergies are and whether they also have asthma your doctor may recommend prescription medications or allergy shots.

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    Description Of The Allergic Response

    The allergic response in the airway is the result of a complex interaction of mast cells, eosinophils, T lymphocytes, macrophages, dendritic cells, and neutrophils. More recently discovered is the type 2 innate lymphoid cell , which is a type of innate lymphoid cell implicated in inflammatory pathways in asthma. Inhalation-challenge studies with allergens reveal an early allergic response , which occurs within minutes and peaks at 20 minutes, following inhalation of the allergen.

    Clinically, the manifestations of the EAR in the airway include bronchial constriction, airway edema, and mucus plugging. These effects are the result of mast cellderived mediators. Four to 10 hours later, a late allergic response may occur, which is characterized by infiltration of inflammatory cells into the airway and is most likely caused by cytokine-mediated recruitment and activation of lymphocytes and eosinophils.

    Antigen-presenting cells in the airway capture, process, and present antigen to helper T cells, which, in turn, become activated and secrete cytokines. Helper T cells can be induced by cytokines to develop into TH 1 or TH 2 cells. Regulatory T cells appear to play an important role in TH 2-cell response to allergens. Allergens drive the cytokine pattern toward TH 2, which promotes B-cell IgE production and eosinophil recruitment.

    Newly formed mediators, such as leukotriene C4 and prostaglandin D2, also contribute to the EAR.

    Asm Role In Airflow Obstruction

    It remains unknown whether the mechanism driving ASM hyperaccumulation has a deleterious impact on airway contractile function directly. However, it is clear that excessive ASM mass and airway wall thickening are associated with airway hyperresponsiveness. Furthermore, asthma patients with fixed and severe airflow obstruction have significantly thicker airway walls than those with reversible airflow limitation . Those with fixed airflow obstruction also have longer disease duration , suggesting that airway remodeling contributes to the decline in lung function seen in individuals with asthma. These studies indicate that ASM remodeling contributes to both transient and chronic airflow obstruction in asthma.

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    Box : Definition Of A Patient

    A patient-reported outcome measure is reported directly by a patient or their carer. It is a measure used to assess the outcome and/or the effect that a particular treatment for a long-term condition has on the quality of life of a patient. These reports might include how the condition affects health-related quality of life, a patients perceptions of their health or functional status in relation to their long-term condition and the effect that treatment or care strategies have on the quality of life of the patient.

    Symptoms Of Intrinsic Asthma


    Symptoms of an asthma attack are similar, regardless of the type of asthma you have. These can include:

    • Coughing
    • Drastic changes in weather conditions
    • Vigorous exercise
    • Strong emotions
    • Drugs

    Intrinsic asthma affects more adults than children, and is more likely to be a long-term problem than extrinsic asthma.

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    Remodelling In Severe Asthma

    In severe asthma, airway walls are thicker on HRCT, have more fibroblasts, larger mucous glands and increased ASM,- greater epithelial fragility and increased blood vessels in the lamina propria. There is ASM hyperplasia in severe asthma compared with controls, and with less severe asthma. There is also ASM hypertrophy in both severe and less severe asthma compared with controls. ECM is increased in the ASM although this is in proportion to the increase in ASM. Specific ECM proteins are also increased in asthma, although these may vary across the airway wall.,

    Although structural changes in postmortem lungs following fatal asthma attacks may not necessarily be generalizable to severe asthma, there are similar changes in postmortem and biopsy tissue of non-fatal but clinically severe asthma, relative to mild cases and non-asthmatic individuals., , There are clear-cut differences in wall thickness in large airways between severe and mild-moderate asthma cases. The differences are less pronounced in the small airways,, possibly due to the small absolute size of the airways and variation in airway number and size. However, the small airways are more susceptible to severe narrowing and closure due to the greater wall area relative to the airway lumen area.

    Key Points: Definition Pathophysiology And Pathogenesis Of Asthma And Natural History Of Asthma

    • Asthma is a chronic inflammatory disorder of the airways. This feature of asthma has implications for the diagnosis, management, and potential prevention of the disease.
    • The immunohistopathologic features of asthma include inflammatory cell infiltration:
    • Neutrophils
    • Eosinophils
    • Epithelial cell injury
  • Airway inflammation contributes to airway hyperresponsiveness, airflow limitation, respiratory symptoms, and disease chronicity.
  • In some patients, persistent changes in airway structure occur, including sub-basement fibrosis, mucus hypersecretion, injury to epithelial cells, smooth muscle hypertrophy, and angiogenesis.
  • Gene-by-environment interactions are important to the expression of asthma.
  • Atopy, the genetic predisposition for the development of an immunoglobulin E -mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma.
  • Viral respiratory infections are one of the most important causes of asthma exacerbation and may also contribute to the development of asthma.
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    Whether Its Asthma Allergies Or Both These Conditions Can Be Managed

    With the right care and treatment plan, you can help your child manage their asthma, allergies or both so they can live a happy, healthy life.

    If your child has never been diagnosed with asthma, allergies or is starting to show new symptoms make a primary care appointment. There are many conditions that look similar and your doctor can help demine if your childs symptoms are related to asthma, allergies or COVID-19, or something else.

    With in-person and video visit options, you can choose the appointment type thats most convenient for you.

    If your child has been diagnosed with asthma, allergies or both, you can schedule a visit with an allergy and asthma specialist without a referral.

    Intrinsic Vs Extrinsic Asthma

    Asthma in Children

    Extrinsic asthma is caused by an allergic reaction to something in your environment that your immune system views as “foreign” to your body. Intrinsic asthma is any type of asthma that isn’t caused by an allergy.

    During an asthma attack, inflammation causes your airways to swell and clog with mucous. Muscles around your airways also contract, called bronchospasm. This makes it difficult for your lungs to move air into and out of your body.

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