Bronchospasm: From 3 Different Sources
Temporary narrowing of the bronchi (airways into the lungs) due to contraction of the muscles in the walls of the bronchi, by inflammation of the lining of the bronchi, or by a combination of both.
Contraction may be triggered by the release of substances during an allergic reaction (see allergy).
When the airways are narrowed, the air is reduced, causing wheezing or coughing.
Asthma is the most common cause of bronchospasm.
Other causes include respiratory infection, chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive), anaphylactic shock, or allergic reaction to chemicals.
Muscular contraction of the bronchi (air passages) in the LUNGS, causing narrowing. The cause is usually a stimulus, as in BRONCHITIS and ASTHMA. The result is that the patient can inhale air into the lungs but breathing out becomes di?cult and requires muscular e?ort of the chest. Exhalation is accompanied by audible noises in the airways which can be detected with a STETHOSCOPE. Reversible obstructive airways disease can be relieved with a BRONCHODILATOR drug; if the bronchospasm cannot be relieved by drugs it is called irreversible. (See CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD).)
n. narrowing of bronchi by muscular contraction in response to some stimulus, as in *asthma and *bronchitis. The patient can usually inhale air into the lungs, but exhalation may require visible muscular effort and is accompanied by expiratory noises that are clearly audible (see wheeze) or detectable with a stethoscope. The condition in which bronchospasm can usually be relieved by bronchodilator drugs is known as reversible obstructive airways disease and includes asthma; that in which bronchodilator drugs usually have no effect is irreversible obstructive airways disease and includes chronic bronchitis.
A pharmacological e?ect where the action of ACETYLCHOLINE, a chemical neurotransmitter released at the junctions (synapses) of parasympathetic and ganglionic nerves, is inhibited. The junctions between nerves and skeletal muscles have nicotinic receptors. A wide range of drugs with antimuscarinic effects are in use for various disorders including PSYCHOSIS, BRONCHOSPASM, disorders of the eye (see EYE, DISORDERS OF), PARKINSONISM, and problems of the GASTROINTESTINAL TRACT and URINARY TRACT. (See also ANTISPASMODICS.)... antimuscarine
The transmitted sounds of breathing, heard when a stethoscope is applied to the chest. Normal breath sounds are described as vesicular. Abnormal sounds may be heard when there is increased ?uid in the lungs or ?brosis (crepitation or crackles), when there is bronchospasm (rhonchi or wheezes), or when the lung is airless (consolidated – bronchial breathing). Breath sounds are absent in people with pleural e?usion, pneumothorax, or after pneumonectomy.... breath sounds
Wall. ex Stapf.
Family: Ephedraceae.
Habitat: The drier regions of the temperate and alpine Himalayas from Kashmir to Sikkim from 2,350 to 5,350 m.
English: Ephedra (Ephedra sinica Stapf.)
Ayurvedic: Soma, Soma-valli (substitute).
Folk: Asmaaniyaa, Budaagur (Punjab); Tipat, Traani (Himalayan region).
Action: Circulatory stimulant, bron- chodilator, vasodilator, antiallergic, antiasthmatic (usualy given with expectorants), diaphoretic. Not prescribed with antidepressants.
Key application: Ephedra sinica— in diseases of the respiratory tract and mild bronchospasms. Also in acute coryza, allergic rhinitis and sinusitis. (German Commission E.) In the treatment of nasal congestion due to hay fever, allergic rhinitis, acute coryza, cold, sinusitis and as abronchodilator. (WHO.)Contraindicated in anxiety, restlessness, high blood pressure, glucoma, impaired circulation of the cerebrum, adenoma of prostate with residual urine accumulation, pheochromocy- toma, thyrotoxicosis. (German Commission E.)Ephedra is official in the national pharmacopoeias of China, Japan and Germany. The herb is listed in Ayurvedic Pharmacopoeia. Only its isolated derivatives, ephedrine and ephedrine hydrochloride are official in Indian Pharmacopoeia.Ephedrine is toxic at more than 300 mg in 1 day (Francis Brinker.)Aerial parts yielded ephedrine and ephedroxane. Pseudoephedrine is the most active anti-inflammatory principle of Ephedra sp., it exhibited inhibitory action on a number of acute inflammations. Ephedroxane possesses a minor anti-inflammatory principle. Among the Indian species, Ephedra major, found in Lahul, contains over 2.56% alkaloids of which nearly three fourths is ephidrine. Ephedra gerardiana contains 1.22% total alkaloids and 0.68% ephedrine.On 30 December 2003, the FDA banned ephedra products in the US.... ephedra gerardiana
A device that measures the rate at which an individual can expel air from the LUNGS. This is an indication of the reserve in the capacity of the lungs. Narrowed airways (bronchospasm) slow the rate at which air can be expelled; the peak ?ow meter can assess the severity of the condition. ASTHMA causes bronchospasm and the device can measure the e?ectiveness of treatment with BRONCHODILATOR drugs; this should be done regularly to monitor the progress of the disease.... peak flow meter
An alkaloid (see ALKALOIDS) structurally similar to CAFFEINE, and found in small amounts in tea. Its main use is for the relief of BRONCHOSPASM, where beta-2 adrenoceptor stimulants have failed. It is given intravenously in combination with the stabilising agent ethylenediamine (as aminophylline) for the treatment of severe ASTHMA or paroxysmal nocturnal DYSPNOEA. Formerly used in the treatment of left ventricular failure, it has been largely superseded by more e?ective DIURETICS. When indicated, aminophylline should be given by very slow intravenous injection; acute overdose may cause convulsions and cardiac ARRHYTHMIA.... theophylline
Narrowing or blockage of the respiratory passages. The obstruction may be due to a foreign body, such as a piece of food, that becomes lodged in part of the upper airway and may result in choking. Certain disorders, such as diphtheria and lung cancer, can cause obstruction. Additionally, spasm of the muscular walls of the airway, as occurs in bronchospasm (a feature of asthma), results in breathing difficulty.... airway obstruction
Breathing difficulty in which bronchospasm and wheezing are caused by accumulation of fluid in the lungs (pulmonary oedema). This is usually due to reduced pumping efficiency of the left side of the heart (see heart failure) and is not true asthma. Treatment is with diuretic drugs.... asthma, cardiac
Linn.
Family: Piperaceae.
Habitat: Warmer parts of India, from Central Himalayas to Assam, lower hills of West Bengal; Uttar Pradesh, Andhra Pradesh, Western
Ghats from Konkan southwards to Trivandrum. Often cultivated.
English: Indian Long Pepper, Joborandi.
Ayurvedic: Pippali, Maagadhi, Maagadha, Maagadhaa, Maagad- hikaa, Magadhodbhavaa, Vaidehi, Upkulyaa, Pippalikam, Chapalaa, Kanaa, Krishnaa. Uushnaa, Shaun- di, Kolaa, Tikshna-tandulaa.
Unani: Filfil Daraaz, Daarfilfil.
Siddha/Tamil: Thippili, Arisi thippili. Thippiliver (root).
Action: Fruits—used for diseases of the respiratory tract (cough, bronchitis, asthma); as sedative (in insomnia and epilepsy); as chola- gogue (in obstruction of bile duct and bladder), as emmenagogue, as digestive, appetizer and carminative (in indigestion); as general tonic and haematinic (in anaemia, chronic fevers and for improving intellect). Applied locally on muscular pains and inflammations.
Several aristolactams and dioxoa- porphines have been isolated from Indian long pepper. It also contains the long chain isobutyl amide, longamide, besides guineensine and the lignans, pluviatilol, methyl pluviatilol (farge- sin), sesamin and asarinine.Piperine is the major alkaloid of peppers.Piperine is antipyretic, hypotensive, analeptic, CNS stimulant. It has been reported to exert significant protection against CCl4-induced hepatotoxicity in mice. It improves drug availability in experimental animals, and is used for enhancing the efficacy of co- administered medicaments.Piperine enhanced bioavailability of hexobarbital, phenytoin, propranolol and theophylline. (Sharon M. Herr.) (Piperine is also a component of Piper nigrum.)N - isobutyl - deca - trans - 2 - trans - 4 - dienamide, isolated from the fruit, exhibited antitubercular property.Milk extract of the fruit effectively reduced passive cutaneous anaphylaxis in rats. It protected guinea-pigs against antigen-induced bronchospasm.In China, Piper longum oil constituents were reported to inhibit the increase in serum total cholesterol induced by triton in mice.The root powder exhibited antifer- tility activity.A related species, P. peepuloides Roxb., is known as Saamvali Peepal. It is used specifically against obstinate skin diseases and as a sialagogue.
Dosage: Fruit—1-3 mg (API, Vol. IV); root—1-3 g powder. (CCRAS.)... piper longum
A piece of equipment that measures the maximum speed at which air can flow out of the lungs. A peak-flow meter is useful in assessing the severity of bronchospasm, and is most commonly used to diagnose asthma, monitor patients with asthma, and assess response to asthma treatment. The peak flow is measured by taking a deep breath and breathing out with maximum effort through the mouthpiece.... peak-flow meter
The process in which air passes into and out of the lungs so that the blood can absorb oxygen and give o? carbon dioxide and water. This occurs 18 times a minute in a healthy adult at rest and is called the respiratory rate. An individual breathes more than 25,000 times a day and during this time inhales around 16 kg of air.
Mechanism of respiration For the structure of the respiratory apparatus, see AIR PASSAGES; CHEST; LUNGS. The air passes rhythmically into and out of the air passages, and mixes with the air already in the lungs, these two movements being known as inspiration and expiration. INSPIRATION is due to a muscular e?ort which enlarges the chest, so that the lungs have to expand in order to ?ll up the vacuum that would otherwise be left, the air entering these organs by the air passages. The increase of the chest in size from above downwards is mainly due to the diaphragm, the muscular ?bres of which contract and reduce its domed shape and cause it to descend, pushing down the abdominal organs beneath it. EXPIRATION is an elastic recoil, the diaphragm rising and the ribs sinking into the position that they naturally occupy, when muscular contraction is ?nished. Occasionally, forced expiration may occur, involving powerful muscles of the abdomen and thorax; this is typically seen in forcible coughing.
Nervous control Respiration is usually either an automatic or a REFLEX ACTION, each expiration sending up sensory impulses to the CENTRAL NERVOUS SYSTEM, from which impulses are sent down various other nerves to the muscles that produce inspiration. Several centres govern the rate and force of the breathing, although all are presided over by a chief respiratory centre in the medulla oblongata (see under BRAIN – Divisions). This in turn is controlled by the higher centres in the cerebral hemispheres, so that breathing can be voluntarily stopped or quickened.
Quantity of air The lungs do not completely empty themselves at each expiration and re?ll at each inspiration. With each breath, less than one-tenth of the total air in the lungs passes out and is replaced by the same quantity of fresh air, which mixes with the stale air in the lungs. This renewal, which in quiet breathing amounts to about 500 millilitres, is known as the tidal air. By a special inspiratory e?ort, an individual can draw in about 3,000 millilitres, this amount being known as complemental air. By a special expiratory e?ort, too, after an ordinary breath one can expel much more than the tidal air from the lungs – this extra amount being known as the supplemental or reserve air, and amounting to about 1,300 millilitres. If an individual takes as deep an inspiration as possible and then makes a forced expiration, the amount expired is known as the vital capacity, and amounts to around 4,000 millilitres in a healthy adult male of average size. Figures for women are about 25 per cent lower. The vital capacity varies with size, sex, age and ethnic origin.
Over and above the vital capacity, the lungs contain air which cannot be expelled; this is known as residual air, and amounts to another 1,500 millilitres.
Tests of respiratory e?ciency are used to assess lung function in health and disease. Pulmonary-function tests, as they are known, include spirometry (see SPIROMETER), PEAK FLOW METER (which measures the rate at which a person can expel air from the lungs, thus testing vital capacity and the extent of BRONCHOSPASM), and measurements of the concentration of oxygen and carbon dioxide in the blood. (See also LUNG VOLUMES.)
Abnormal forms of respiration Apart from mere changes in rate and force, respiration is modi?ed in several ways, either involuntarily or voluntarily. SNORING, or stertorous breathing, is due to a ?accid state of the soft palate causing it to vibrate as the air passes into the throat, or simply to sleeping with the mouth open, which has a similar e?ect. COUGH is a series of violent expirations, at each of which the larynx is suddenly opened after the pressure of air in the lungs has risen considerably; its object is to expel some irritating substance from the air passages. SNEEZING is a single sudden expiration, which di?ers from coughing in that the sudden rush of air is directed by the soft palate up into the nose in order to expel some source of irritation from this narrow passage. CHEYNE-STOKES BREATHING is a type of breathing found in persons suffering from stroke, heart disease, and some other conditions, in which death is impending; it consists in an alternate dying away and gradual strengthening of the inspirations. Other disorders of breathing are found in CROUP and in ASTHMA.... respiration
Used in the prophylaxis of ASTHMA, it is administered by inhalation and can reduce the incidence of asthmatic attacks but is of no value in the treatment of an acute attack. It acts by preventing the release of pharmacological mediators of BRONCHOSPASM, particularly HISTAMINE, by stabilising mast-cell membranes. It is of particular use in patients whose asthma has an allergic basis; children over four may respond better than adults. It is less potent than inhaled steroids. The dose frequency is adjusted to the patient’s response but is usually administered by inhalation four times daily. Sodium cromoglycate is also used in the prophylaxis of allergic RHINITIS and to treat allergic conjunctivitis (see under EYE, DISORDERS OF).... sodium cromoglycate
A group of procedures used to evaluate lung function, to confirm the presence of some lung disorders, and to ensure that planned surgery on the lungs will not disable the patient. The tests include spirometry, measurement of lung volume, assessment of the degree of bronchospasm with a peak-flow meter, and a test of blood gases.... pulmonary function tests
n. the alternation of active inhalation (or inspiration) of air into the lungs through the mouth or nose with the passive exhalation (or expiration) of the air. During inhalation the *diaphragm and *intercostal muscles contract, which enlarges the chest cavity and draws air into the lungs. Relaxation of these muscles forces air out of the lungs at exhalation. (See illustration.) Breathing is part of *respiration and is sometimes called external respiration. There are many types of breathing in which the rhythm, rate, or character is abnormal. See also apnoea; bronchospasm; Cheyne–Stokes respiration; dyspnoea; stridor.... breathing
n. an *antimuscarinic drug used as a bronchodilator in the treatment of chronic reversible airways obstruction (see bronchospasm) and to relieve rhinorrhoea resulting from *rhinitis. Side-effects include dry mouth and nasal dryness.... ipratropium
Maidenhair tree. Ginkgo biloba. Sole survivor of its own genus. Seeds, leaves.
Keynotes: brain and lungs.
Constituents: terpenes, tannins, lignans, flavonoids, and gingkolide B which is a platelet activating factor (PAF).
Action: nutritive, tuberculostatic. A compound (BN 52021) from the tree antagonises bronchospasm and tends to resolve breathing difficulties. Circulatory stimulant. Increases brain blood flow, Peripheral vasodilator, Energy enhancer. (JAM, Vol 6, No 2)
Uses: Respiratory complaints, especially asthma. Inhibits platelet clumping: of value in coronary artery disease. Tinnitus. Intermittent claudication. Raynaud’s disease. Thrombosis. Cold hands and feet. Spontaneous bruising. Early stages of Alzheimer’s disease. Cerebral insufficiency in old age. Varicose veins. Some antitumor activity against sarcoma in mice recorded. Piles. Temporal arteritis. Cramp in the calves – walking-distance increased. Tired brain, impaired memory. Coronary artery disease. Hearing loss, depression, vertigo, headache. To increase resistance to adverse environmental factors. Chronic fatigue syndrome (ME). Subclinical neurosis. Headache. Depression. Impaired mental ability. Hangover. Preparations. Thrice daily. Large doses may be required.
Tea (leaves). 1 heaped teaspoon to each cup of water gently simmered 5 minutes. Dose: half-1 cup. Tablets/capsules. 250mg. Maintenance dose: one tablet or capsule increasing to two in acute cases. Chinese Medicine. “Seeds moisten the lungs, stop coughing, and strengthen the body.”
“I have seen a reduction in severity and frequency of asthma attacks and a marked reduction in use of brocho-dilating drugs by the use of Ginkgo.” (Brown D., Phytotherapy Review and Commentary, Townsend Letter to Doctors, October 1990 pp648-9)
German medicine. No drug interactions and very low levels of side-effects. Important remedy to the German Health Service at a cost of 286 million DM in 1989. (Kleijnen J. & Knipschild P. The Lancet 1992, 340, Nov 7)
Tincture. 2 tsp a.m. and p.m. ... ginkgo
(beta-adrenergic receptor blocker) a drug that prevents stimulation of the beta *adrenoceptors at the nerve endings of the sympathetic nervous system. Blockade of ?1 receptors causes a decrease in heart rate and force; blockade of ?2 receptors causes constriction of the airways and the arteries. Beta blockers include *acebutolol, *atenolol, *bisoprolol, *oxprenolol, *propranolol, and *sotalol; they are used to control abnormal heart rhythms, to treat angina, and to reduce high blood pressure (although they are no longer regarded by some experts as the first choice of drug for treating hypertension in the absence of heart disease, being less effective than newer antihypertensive drugs). Beta blockers that block both ?1 and ?2 receptor sites cause constriction of air passages in the lungs, and these drugs should not be used in patients with asthma and bronchospasm. Other beta blockers are relatively selective for the heart (cardioselective) and are less likely to constrict the airways. Some beta blockers (e.g. *carteolol, *levobunolol, and *timolol) reduce the production of aqueous humour and therefore the pressure inside the eye; they are taken as eye drops in the treatment of *glaucoma.... beta blocker
n. inflammation of the bronchi (see bronchus). Acute bronchitis is caused by viruses or bacteria and is characterized by coughing, the production of mucopurulent sputum, and narrowing of the bronchi due to spasmodic contraction (see bronchospasm). In chronic bronchitis the patient coughs up excessive mucus secreted by enlarged bronchial mucous glands on most days for at least three consecutive months in at least two consecutive years; the bronchospasm cannot always be relieved by bronchodilator drugs. It is not primarily an inflammatory condition, although it is frequently complicated by acute infections. The disease is particularly prevalent in Britain in association with cigarette smoking, air pollution, and *emphysema. The combination of chronic bronchitis and emphysema is often referred to as *chronic obstructive pulmonary disease (COPD).... bronchitis
inhalation of regurgitated stomach contents by an anaesthetized patient, which may result in death from anoxia or cause extensive lung damage or pulmonary *oedema with severe *bronchospasm. It is a well-recognized hazard of general anaesthesia in obstetrics and may be prevented by giving gastric-acid inhibitors (e.g. *cimetidine or *ranitidine) or sodium citrate before inducing anaesthesia. [C. L. Mendelson (1913–2002), US obstetrician]... mendelson’s syndrome
see bronchospasm.... obstructive airways disease
n. an abnormal high-pitched (sibilant) or low-pitched sound heard – either by the unaided human ear or through the stethoscope – mainly during expiration. Wheezes occur as a result of narrowing of the airways, such as results from *bronchospasm or increased secretion and retention of sputum; they are commonly heard in patients with asthma or chronic bronchitis.... wheeze
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