1. References
   1. American Lung Association, (2016). Asthma Action Plan. Lung Health & Diseases. Retrieved from http://www.lung.org/assets/documents/asthma/asthma-action-plan.pdf.
   2. Gierer, S. (2014). An Update in Asthma Diagnosis and Management. The University of Kansas Hospital. Retrieved from http://www.kansasdo.org/download/springconf2014/Presentations/Gierer-Asthma.pdf.
   3. Huether, S.E. & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
   4. McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
   5. Pollart, S. (2011). Management of Acute Asthma Exacerbations. American Family Physician. 84(1):40-47. Retrieved from http://www.aafp.org/afp/2011/0701/p40.html
   6. Zimbron, J. (2008). Mind maps—Dementia, endocarditis, and gastro-oesophageal reflux disease (GERD) [PDF]. Retrieved from http://MedMaps.co.uk
2. Diagnosis
   1. Wheezing, Cough, Shortness of Breath and Chest Tightness.
   2. Familiar History
   3. Comprehensive Assessment
      1. It is essential to assess the severity of the symptoms by establishing how often they occur.
      2. Whether signs and symptoms are cause nocturnal waking or exercise limitation.
   4. Hypoxemia
   5. Respiratory alkalosis
   6. Obstructive defects in pulmonary function tests
      1. Reduced total lung capacity
      2. Residual volume increased
   7. Hypersensitive reactions (over 20% above or below) in response to a irritant.
   8. Consider chest X-ray
   9. Test Exhaled Nitric Oxide
   10. Pulse Oxygen Level test
   11. Asthma Control Test - allows a clinician to monitor how well current treatments are working.
   12. Chronic asthma cases tends to have persistent and prolonged effects that is not responsive to medications.
3. Clinical Manifestation
   1. Wheezing
   2. Cough
   3. Shortness of Breath
   4. Chest Tightness
   5. Tachypnea or tachycaridia (less frequent in chronic asthma)
   6. Hypoxemia
   7. Low Spirometry - measures lung volumes and airflow.
   8. Low Peak Flow - measures Expiratory Flow Rates.
   9. Acute Asthma Exacerbation versus Chronic Asthma has a considerable spectrum in severity of symptoms. Acuity is based off of symptoms and frequency of exacerbation with needs for steroids.
      1. Intermittent
      2. Mild Persistent
      3. Moderate Persistent
      4. Severe Persistent
4. Treatment
   1. Avoidance of irritants
      1. Dust mites
      2. Pollen and Spores
      3. Dietary
   2. Anti-inflammatory medications
   3. Inhaled corticosteroids
   4. Short- acting, beta-agonist
   5. Use albuterol/levalbuterol puffs, 15 minutes as directed with activity.
5. Pathophysiology
   1. Around 100 different identified genes have been show to play a role in the susceptibility and pathogenesis of asthma.
   2. These genes show expression in asthma patients can often be based off age and irritant exposure.
   3. These genes influence the production of interleukin-4, interleukin-5, immunoglobulin E, eosinophils, B-adrenergic receptors, and mast cells.
   4. Frequent factors that can increase a genes expression of asthma that include exposures to air pollution, smoke or tobacco products, recurrence of upper respiratory infections, gastroesophageal reflux disease, and obesity.
   5. The epithelium becomes damaged and starts to shed creating a hyper-sensitive airway exposing of sensory nerves, allowing the penetration of allergens, and breaking down inflammatory mediators.
   6. Bronchospasms create a quick and sharp contraction of the bronchial smooth muscle adding to the overall narrowing of the airway.
   7. As asthma progresses and is left untreated or not properly managed, the structure of the airway can be remodeled leading to permanent fibrotic damage changing the structural cells and tissues in the lower respiratory tract.
   8. The chronic remodeling of the airway is what characterizes chronic asthma.
6. Epidemiology
   1. 26 million Americans.
   2. 7 million Children in America.
   3. Genetics or familiar history can play a significant role in diagnosis.
   4. Australia and New Zealand have the highest prevalence rates.
   5. United States has a 4-8% prevalence rate with more boys affected than girls.