Intrinsic Asthma
Disease Details
Family Health Simplified
- Description
- Intrinsic asthma, also known as non-allergic asthma, is a type of asthma characterized by airway inflammation and constriction triggered by factors unrelated to allergens, such as stress, exercise, infections, and irritants.
- Type
- Intrinsic asthma, also known as non-allergic asthma, is not clearly linked to a specific type of genetic transmission. Unlike allergic (extrinsic) asthma, which can have more evident hereditary patterns, intrinsic asthma tends to be more idiosyncratic and less understood in terms of genetics. It is typically triggered by factors unrelated to allergens, such as respiratory infections, stress, or irritants in the environment.
- Signs And Symptoms
- Asthma is characterized by recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing. Sputum may be produced from the lung by coughing but is often hard to bring up. During recovery from an asthma attack (exacerbation), it may appear pus-like due to high levels of white blood cells called eosinophils. Symptoms are usually worse at night and in the early morning or in response to exercise or cold air. Some people with asthma rarely experience symptoms, usually in response to triggers, whereas others may react frequently and readily and experience persistent symptoms.
- Prognosis
- The prognosis for asthma is generally good, especially for children with mild disease. Mortality has decreased over the last few decades due to better recognition and improvement in care. In 2010 the death rate was 170 per million for males and 90 per million for females. Rates vary between countries by 100-fold.Globally it causes moderate or severe disability in 19.4 million people as of 2004 (16 million of which are in low and middle income countries). Of asthma diagnosed during childhood, half of cases will no longer carry the diagnosis after a decade. Airway remodeling is observed, but it is unknown whether these represent harmful or beneficial changes. More recent data find that severe asthma can result in airway remodeling and the "asthma with chronic obstructive pulmonary disease syndrome (ACOS)" that has a poor prognosis. Early treatment with corticosteroids seems to prevent or ameliorates a decline in lung function. Asthma in children also has negative effects on quality of life of their parents.
- Onset
- Intrinsic asthma, also known as non-allergic asthma, often has its onset in adulthood, typically after the age of 30.
- Prevalence
- Intrinsic asthma, also known as non-allergic asthma, typically manifests in adulthood and accounts for approximately 10-30% of all asthma cases. Unlike allergic asthma, it is not triggered by allergens but often by factors such as stress, infections, and irritants.
- Epidemiology
- In 2019, approximately 262 million people worldwide were affected by asthma and approximately 461,000 people died from the disease. Rates vary between countries with prevalences between 1 and 18%. It is more common in developed than developing countries. One thus sees lower rates in Asia, Eastern Europe and Africa. Within developed countries it is more common in those who are economically disadvantaged while in contrast in developing countries it is more common in the affluent. The reason for these differences is not well known. Low and middle income countries make up more than 80% of the mortality.While asthma is twice as common in boys as girls, severe asthma occurs at equal rates. In contrast adult women have a higher rate of asthma than men and it is more common in the young than the old. In 2010, children with asthma experienced over 900,000 emergency department visits, making it the most common reason for admission to the hospital following an emergency department visit in the US in 2011.Global rates of asthma have increased significantly between the 1960s and 2008 with it being recognized as a major public health problem since the 1970s. Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world. Asthma affects approximately 7% of the population of the United States and 5% of people in the United Kingdom. Canada, Australia and New Zealand have rates of about 14–15%.The average death rate from 2011 to 2015 from asthma in the UK was about 50% higher than the average for the European Union and had increased by about 5% in that time. Children are more likely see a physician due to asthma symptoms after school starts in September.Population-based epidemiological studies describe temporal associations between acute respiratory illnesses, asthma, and development of severe asthma with irreversible airflow limitation (known as the asthma-chronic obstructive pulmonary disease "overlap" syndrome, or ACOS). Additional prospective population-based data indicate that ACOS seems to represent a form of severe asthma, characterised by more frequent hospitalisations, and to be the result of early-onset asthma that has progressed to fixed airflow obstruction.
- Intractability
- Intrinsic asthma, also known as non-allergic asthma, is typically a chronic condition that can be difficult to manage but is not necessarily intractable. Treatment usually involves a combination of inhaled corticosteroids, bronchodilators, and other medications to control symptoms and prevent asthma attacks. While it may be challenging to achieve complete control in some patients, many people can manage their condition effectively with appropriate medical care and lifestyle adjustments.
- Disease Severity
- Intrinsic asthma, also known as non-allergic asthma, can vary in severity among individuals. The disease severity ranges from mild to severe, depending on the frequency and intensity of symptoms as well as the response to treatment.
- Healthcare Professionals
- Disease Ontology ID - DOID:9360
- Pathophysiology
- Asthma is the result of chronic inflammation of the conducting zone of the airways (most especially the bronchi and bronchioles), which subsequently results in increased contractability of the surrounding smooth muscles. This among other factors leads to bouts of narrowing of the airway and the classic symptoms of wheezing. The narrowing is typically reversible with or without treatment. Occasionally the airways themselves change. Typical changes in the airways include an increase in eosinophils and thickening of the lamina reticularis. Chronically the airways' smooth muscle may increase in size along with an increase in the numbers of mucous glands. Other cell types involved include T lymphocytes, macrophages, and neutrophils. There may also be involvement of other components of the immune system, including cytokines, chemokines, histamine, and leukotrienes among others.
- Carrier Status
- Intrinsic asthma is not typically associated with a carrier status as it is not a single-gene hereditary condition. It is often related to non-allergic triggers such as respiratory infections, stress, cold air, and exercise. Genetic, environmental, and immune factors collectively contribute to the development of intrinsic asthma.
- Mechanism
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Intrinsic asthma, also known as non-allergic asthma, is primarily triggered by non-allergic factors such as respiratory infections, stress, exercise, or cold air. Unlike allergic asthma, it is not associated with typical allergic responses or elevated levels of IgE antibodies.
### Mechanism:
1. **Trigger Initiation**: Intrinsic asthma is often initiated by factors such as viral infections, environmental pollutants, exercise, or stress.
2. **Airway Inflammation**: The exposure to these triggers leads to inflammation and hyperresponsiveness of the bronchial tubes.
3. **Smooth Muscle Constriction**: The inflamed airways cause the surrounding smooth muscles to contract, leading to bronchoconstriction.
4. **Mucus Production**: Increased mucus secretion occurs, further narrowing the airways and making breathing difficult.
5. **Airflow Limitation**: The combined effects of inflammation, bronchoconstriction, and mucus hypersecretion result in significant airflow limitation and asthma symptoms.
### Molecular Mechanisms:
1. **Cytokine and Chemokine Release**: Intrinsic asthma involves the release of various cytokines (such as IL-1, IL-6, and TNF-α) and chemokines which recruit and activate inflammatory cells, including mast cells, eosinophils, and neutrophils.
2. **Toll-like Receptors (TLRs)**: These receptors play a role in recognizing pathogens (like viruses) and initiating the immune response, contributing to airway inflammation.
3. **Epithelial Cell Activation**: Respiratory viruses or environmental factors activate airway epithelial cells, leading to the release of pro-inflammatory mediators.
4. **Nerve Activation**: Sensory nerves in the airways may be activated directly by physical or chemical stressors, leading to neurogenic inflammation and bronchoconstriction.
5. **Oxidative Stress**: Increased production of reactive oxygen species (ROS) may occur due to environmental factors or infections, contributing to inflammation and airway hyperreactivity.
6. **Matrix Metalloproteinases (MMPs)**: Elevated levels of MMPs lead to extracellular matrix remodeling, contributing to airflow obstruction and chronic symptoms.
Intrinsic asthma involves a complex interplay of immune responses, epithelial cell activity, neuronal mechanisms, and oxidative stress, resulting in the clinical manifestations of the disease. - Treatment
-
Intrinsic asthma, also known as non-allergic asthma, is managed through various treatments. These often include:
1. **Medications**:
- **Inhaled Corticosteroids**: Reduce inflammation in the airways.
- **Long-Acting Beta Agonists (LABAs)**: Help to keep airways open.
- **Leukotriene Modifiers**: Block the action of leukotrienes, which can cause inflammation.
- **Theophylline**: Helps to relax muscles around airways.
- **Biologics**: Target specific cells or proteins to reduce asthma severity.
2. **Rescue Inhalers**:
- **Short-Acting Beta Agonists (SABAs)**: Provide quick relief from acute asthma symptoms.
3. **Lifestyle Management**:
- **Avoidance of Triggers**: Identifying and avoiding factors that exacerbate asthma symptoms, such as smoke, pollution, or respiratory infections.
- **Regular Exercise**: Helps in improving lung function, though it should be done under medical advice to avoid exercise-induced asthma attacks.
- **Vaccinations**: Keeping up with flu and pneumonia vaccines to prevent infections that can worsen asthma.
4. **Pulmonary Rehabilitation**:
- Programs designed to improve breathing efficiency and overall lung function through education, exercise training, and behavior change.
5. **Monitoring Devices**:
- **Peak Flow Meters**: Used to regularly monitor lung function at home.
Treatment plans should be tailored to individual needs by healthcare professionals. - Compassionate Use Treatment
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Intrinsic asthma, also known as non-allergic asthma, typically does not respond to common allergic triggers and can be more challenging to manage. When standard treatments do not suffice, compassionate use treatments, off-label, or experimental treatments may be considered. These include:
1. **Biologic Agents**: Monoclonal antibodies like mepolizumab, reslizumab, benralizumab, and dupilumab, although primarily approved for severe eosinophilic asthma, have been considered for use in intrinsic asthma under specific circumstances.
2. **Bronchial Thermoplasty**: This is an FDA-approved procedure for treating severe asthma but is often considered an off-label or last-resort treatment for intrinsic asthma.
3. **Tiotropium**: Originally approved for chronic obstructive pulmonary disease (COPD), tiotropium has shown efficacy in controlling asthma symptoms and is used off-label for intrinsic asthma.
4. **Ketamine**: In cases of severe, life-threatening asthma that is unresponsive to conventional treatment, ketamine has been used experimentally due to its bronchodilatory properties.
5. **Macrolide Antibiotics**: Antibiotics like azithromycin may be used off-label for their anti-inflammatory properties, particularly in chronic cases associated with frequent infections or inflammatory responses.
6. **Experimental Drugs**: Ongoing clinical trials continuously explore new potential treatments involving novel mechanisms, such as cytokine inhibitors and novel bronchodilators.
Use of these treatments should be closely monitored by healthcare professionals, considering their experimental nature and potential side effects. - Lifestyle Recommendations
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For intrinsic asthma, the following lifestyle recommendations can help manage symptoms and reduce flare-ups:
1. **Avoid Triggers**: Identify and avoid non-allergenic triggers such as smoke, strong odors, cold air, and air pollution.
2. **Maintain a Healthy Diet**: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins to support overall health.
3. **Exercise Regularly**: Engage in regular, moderate physical activity to strengthen respiratory muscles. Always warm up before exercise and consult your doctor for personalized advice.
4. **Manage Stress**: Practice relaxation techniques such as deep breathing, yoga, or meditation to reduce stress, which can trigger asthma symptoms.
5. **Stay Hydrated**: Drink plenty of fluids to keep mucus in the airways thin and easier to expel.
6. **Follow a Treatment Plan**: Adhere to prescribed medications and asthma action plans outlined by your healthcare provider.
7. **Monitor Air Quality**: Stay aware of air quality levels and limit outdoor activities when pollution or pollen levels are high.
8. **Get Adequate Sleep**: Ensure you have good sleep hygiene, as poor sleep can worsen asthma symptoms.
Consult with healthcare providers for a personalized management plan tailored to your specific needs. - Medication
- Medications used to treat asthma are divided into two general classes: quick-relief medications used to treat acute symptoms; and long-term control medications used to prevent further exacerbation. Antibiotics are generally not needed for sudden worsening of symptoms or for treating asthma at any time.
- Repurposable Drugs
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Intrinsic asthma, also known as non-allergic asthma, is a type of asthma not triggered by allergens but by factors like stress, exercise, cold air, or respiratory infections. Repurposable drugs that have shown potential benefits include:
1. **Tiotropium**: Originally used for chronic obstructive pulmonary disease (COPD), it can help in managing asthma symptoms by relaxing the airways.
2. **Methotrexate**: While primarily used for certain cancers and autoimmune diseases, it has been explored for difficult-to-control asthma.
3. **Azithromycin**: An antibiotic that may reduce airway inflammation and prevent respiratory infections, potentially beneficial for asthma management.
4. **Montelukast**: Typically used for allergic asthma, but can also help in intrinsic asthma by reducing inflammation.
Nan or sodium (Na) is not typically discussed in the context of intrinsic asthma management. - Metabolites
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Intrinsic asthma, also known as non-allergic asthma, is characterized by airway inflammation and hyperresponsiveness without an allergic trigger. Metabolites associated with intrinsic asthma can include:
1. **Leukotrienes**: These lipid compounds are involved in the inflammatory response and can contribute to bronchoconstriction.
2. **Prostaglandins**: Specifically, prostaglandin D2 (PGD2) has been implicated in asthma due to its role in inflammation and bronchoconstriction.
3. **Nitric Oxide**: Increased levels of exhaled nitric oxide are often observed in asthma due to airway inflammation.
4. **Cytokines**: Elevated levels of various cytokines, such as IL-5 and IL-13, are common and contribute to the inflammatory process in asthma.
5. **Eosinophilic Cationic Protein (ECP)**: This is released from eosinophils and is a marker of eosinophilic inflammation.
Nan (None or Not Applicable) is not relevant here, as metabolites are present in intrinsic asthma. - Nutraceuticals
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There is currently limited scientific evidence specifically supporting nutraceuticals for the management of intrinsic asthma. Nutraceuticals like omega-3 fatty acids, vitamin D, and antioxidants such as vitamin C and E have shown some promise in general asthma management due to their anti-inflammatory and immune-modulating effects. However, more research is needed to establish their efficacy and safety specifically for intrinsic asthma.
As for nan, if you mean nanotechnology, it is still in the experimental stages concerning asthma treatment. Nanotechnology-based approaches, such as nanoparticle drug delivery systems, are being explored to enhance the efficacy and reduce the side effects of asthma medications. However, these are not yet standard treatments and are mostly confined to research settings. - Peptides
- Intrinsic asthma is not associated with external allergens but can be triggered by factors such as respiratory infections, stress, and cold air. Peptides may have roles in immune modulation and inflammation in various diseases, including asthma, but they are not a specific standard treatment for intrinsic asthma. Nan (assuming you mean nano-therapies) represents an advancing field and includes nanoparticles designed for targeted drug delivery systems, which could potentially offer novel treatment approaches by delivering medication directly to inflamed lung tissues. However, their use in intrinsic asthma is still largely experimental.