Friday, August 7, 2015

What Exactly Is "Reactive Airways Disease" Anyway?

“I think that she has a component of reactive airways disease,” the doctor said, describing her otherwise healthy 22-year-old patient with a lingering cough and chest tightness after a respiratory tract infection. “That’s why she has this persistent, wheezy-sounding cough. I’m going to prescribe a bronchodilator and some inhaled steroids.”

“Reactive airways disease.” What is that? I think that I know what the doctor means, but it is hard to be sure. She probably means that following a viral respiratory infection, her patient has sensitized, inflamed bronchial tubes, with asthma-like “twitchiness,” that will benefit from anti-asthmatic medications to relax bronchial smooth muscle (bronchodilators) and suppress airway inflammation (inhaled steroids). And maybe she is correct. But I object to the term, “reactive airways disease,” used to describe what is going on in her patient’s bronchial tubes. Here’s why.

Although I agree that the patient has lingering symptoms and probable airway inflammation following her respiratory infection, I wonder does she really have a “disease” that is being diagnosed other than a viral bronchitis? A disease characterized by “reactive” (that is, constricting more easily than usual) airways? Isn’t that asthma? “Reactive airways disease” sounds to me like “Asthma-like,” or “Asthma-light,” or perhaps “Asthma-but-I’m-not-sure.” But medical providers have the tools available that will allow us to determine whether she has asthma or not. Peak flow measurements, spirometry, exhaled nitric oxide concentration, and bronchoprovocation challenge – there are multiple tools at our disposal.

I understand that in children too young to perform pulmonary function testing, in whom transient wheezing (without asthma) is common and asthma can be difficult to diagnose with certainty early on, the term “reactive airways disease” makes sense as a kind of “place holder,” until the presence or absence of asthma becomes clearer. But the patient we are discussing is 22 years old. Does she have asthma or not? I think that we should be as clear as we can about her diagnosis, rather than slip into the vagueness and ambiguity of “reactive airways disease.”

Why send patients home thinking that they have a newly-diagnosed disease to deal with, when what they have is a lingering cough following a viral respiratory infection, maybe associated with transient bronchial hyperresponsiveness, which will improve with time and/or with our medications?

Yes, but what about that wheezy cough, or wheezing when the patient was asked to breathe out forcefully? Doesn’t that point to something more than an ordinary cough following a cold? Maybe, and maybe not. Let’s check her lung function. If it is normal, then the wheezing is probably not due to asthma with its diffuse airway narrowing involving thousands of bronchial tubes but to central or upper airway narrowing as can be seen in healthy individuals on forceful exhalation and cough, when pressures inside the chest tending to compress bronchial tubes are particularly high. On the other hand, if lung function testing demonstrates airflow obstruction, we have made a diagnosis of asthma (not reactive airways disease). As the maxim goes, “not all that wheezes is asthma” … and not all that wheezes is a disease.

Another reason to avoid the expression, “reactive airways disease,” is that it can easily be confused with reactive airways dysfunction syndrome or RADS, an accepted medical term used to describe a form of occupational asthma. Most occupational asthma develops after many weeks and months of exposure to an inciting inhaled irritant or allergen. On occasion, a single, particularly intense or toxic exposure can cause airway injury and hyperreactivity, referred to as reactive airways dysfunction syndrome, in which the sufferer newly develops asthma after the exposure. I’m not sure that reactive airways dysfunction syndrome is ideal terminology either, but it has a clearer definition and has acquired a more precise meaning than reactive airways disease. The term, RADS, will likely stay, whereas in my opinion we can let the expression “reactive airways disease” go when speaking of adults with cough and wheeze.

16 comments:

  1. Docbeans Technologies is a Online healthcare video portal and it is a trusted Source of Health information providing health videos being delivered by experts in medical, health and fitness world.

    ReplyDelete
  2. Knowing it, indeed, is very important. Signs and symptoms that may look alike can create big discrepancy in seeking their medical treatments!

    ReplyDelete
  3. It's very good information. I enjoyed your post. Very useful information it had.
    Liv Slim

    ReplyDelete
  4. Emphysema Treatment ought to include, obviously, eliminating exposure to emphysema-bringing about poisons. This includes more than the evasion of tobacco smoke. You ought to look at your everyday life and check for different wellsprings of poisons.

    ReplyDelete
  5. Now more than ever before, it is possible to stay on schedule with your nebulizer treatments while maintaining an active lifestyle. Our travel nebulizers feature
    Nebulizer

    ReplyDelete
  6. Informative article!.. Thanks for sharing this blog with such in depth details about asthma treatment, diagnosis, symptoms and triggers.

    ReplyDelete
  7. As a sign of gratitude for how my husband was saved from asthma , i decided to reach out to those still suffering from this.
    My husband suffered asthma and it was really tough and heartbreaking for me because he was my all and the symptoms were terrible, we tried various therapies prescribed by our neurologist but none could cure him. I searched for a cure and i saw a testimony by someone who was cured and so many other with similar body problem, and he left the contact of the doctor who had the herbal cure to asthma . I never imagined asthma has a cure not until i contacted him and he assured me my husband will be fine. I got the herbal medication he recommended and my husband used it and in one months he was fully okay even up till this moment he is so full of life. asthma has a cure and it is a herbal cure contact the doctor for more info on drwilliams098765@gmail.com on how to get the medication. Thanks for reading my story

    ReplyDelete
  8. Just wanted to say a huge thank you to Dr Williams for everything he have done in my life. I have been in tears for so many years now, having found that my husband is suffering from asthma , lesion after some years of being under extreme stress., . I spent 24 hours freaking out and finally calmed down after reading some testimony on here about Dr Williams herbal medicine to asthma . The moment came and I mumbled out to my husband about Dr Williams product (with a few tears) and he was AMAZE – . He was just worried about his health, been free from this , that was how will order for Dr Williams product on line , after my husband finish taking Dr Williams medicine for just within a period of one month. Will went to the doc together who confirmed that he was asthma free.
    Thank you again for being upfront, truthful and taking this pain away from my family for more information about his product you can email him on drwilliams098675@gmail.com i hope you can also help other terrified people in a similar situation.

    ReplyDelete
  9. I was diagnosed with stage 3 breast cancer in August of 2010. A precious friend told me about Dr Itua Herbal Center in West Africa,She gave me his contact number and email address,I contacted him quickly so he give me guaranty that his herbal medicine will cure my cancer and i will be heal forever I said Okay.I ask him about the process for the cure,he ask me to pay for the fees which i did and within 7 working days he sent me the herbal medicine then he instructed me on how to drink it for two weeks to cure.I told Gomez my friend about the herbal medicine so he gave me go ahead to drink it.So after drinking it for two weeks i was cured I'm so grateful and i promise i will recommend anyone with cancer to him and that what i'm doing.
    Dr Itua told me he can cure the following disease.Cancer,Hiv/Aids,Herpes,Diabetes,Parkison,Copd,Hepatitis.. Here Is His Contact Info......[Email...drituaherbalcenter@gmail.com/Whatsapp...+2348149277967]

    ReplyDelete
  10. Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption.Dr Itua Herbal Medicine makes me believes there is a hope for people suffering from,Cancer,Hiv_ Aids,Herpes,Copd,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara so i contacted him on drituaherbalcenter@gmail.com even talked on whatsapps +2348149277967 believe me it was easy i drank his herbal medicine for two weeks and i was cured just like that isn't Dr Itua a wonder man? Yes he is! I thank him so much so i will advise if you are suffering from one of those diseases Pls do contact him he's a nice man.

    ReplyDelete
  11. It was during my research on HIV/Herpes that I stumbled upon the Hiv/Herpes information; information which is quite easy to find when doing a search for STD on google. I was into conspiracy at the time thought of HIV/Herpes Cured' being a conspiracy was something Ignorance though,I found pretty interesting about herbal medicine. I asked questions about the Herbal cure's on official HIV/Herpes websites and I was banned for doing so by moderators who told me that I was parroting Hiv/Herpes propaganda. This reinforced my belief that there is a cure for Hiv/Herpes Then i found a lady from germany name Achima Abelard Dr Itua Cure her Hiv so I send him a mail about my situation then talk more about it and send me his herbal medicine I drank for two weeks.And today I'm Cured no Hiv/Herpes in my life,I searched for Hiv/Herpes groups to attempt to make contact with people in order to learn more about Hiv/Herpes Herbal Cure's I believed at this time that you with the same disease this information is helpful to you and I wanted to do the best I could to spread this information in the hopes of helping other people.That Dr Itua cure Hiv,Herpes,Hepatitis,Diabetes,Copd,Fibroid,Als, And Cancer. He's a herbal doctor with a unique heart of God, Contact Emal..drituaherbalcenter@gmail.com Phone or whatsapp..+2348149277967.

    ReplyDelete
  12. Grape seed and green tea are included in the Emphysema Herbal Treatment as they provide antioxidant support and have various general health enhancing properties.

    ReplyDelete
  13. Informative Article!... Thanks for sharing this post.doctoriduniya

    ReplyDelete
  14. 6 months ago I was diagnosed with COPD with 55-60% lung capacity. My doctor just said all the crying , stomping your feet will not change it so just accept it and basically patted me on the back and sent me home to die. I was devastated and was afraid to do anything. I stopped riding my bike, I was afraid to do anything that would cause any exertion. It consumed my thoughts with every breath and the fear of what to expect was almost more than I could deal with. So I couldn't get myself all time I decided to find a herbal cure online and I came acrose Doctor Itua on how he cure several people suffering from Hiv, and Herpes I gave him a call on this Number +2348149277967 also chat on whatsapp he gave me all the details about the cure i paid him for the medicine after 5 working days i receieve my herbal medicine ,I use it for two weeks that is how I get Cured and today I'm living healthy and fine I give him thanks also promise him to testify about his work,He Can also cure the following deseases..Copd,Herpes,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Parkinson's Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Hiv,Hepatitis,diabetes,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Asthma.Contact...drituaherbalcenter@gmail.com..Whatsapp Number...+2348149277976

    ReplyDelete