Symptoms of Asthma may occur sporadically, seasonally or perennially. There is usually a family history of atopy. This response results in the release of inflammatory mediators which effect changes in the bronchioles such as smooth muscle contraction, increased vascular permeability, pulmonary vasodilation, increased mucus secretion and edema of the airways. This classification serves as a framework for therapeutic guidelines which are based on pulmonary function tests and symptom presentation. Allergen immunotherapy may be considered when practical.
Strong emphasis is placed on patient education, anticipatory guidance and regular follow-up care.
It is influenced by neuromuscular and humoral factors. The esophageal mucosa, with the help of peristalsis , gravity, its intrinsic buffering mechanism and mucosal integrity,is normally protected from damage which results from extensive exposure to acid reflux. Prolonged or frequently low resting LES tone, impaired esophageal motility, decreased gastric emptying and diminished esophageal mucosal resistance to acid and pepsin contribute to the erosive esophagitis which sometimes develops in GERD 4. Serious complications from GERD include esophageal strictures, Barrett s esophagus, and esophageal adenocarcinoma. It is a highly sensitive and specific test.