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Bronchospasm
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<h2 id="cause">Cause</h2> <p>Bronchospasms can occur for a number of reasons. Lower respiratory tract conditions such as <a href="/facts/Asthma/7GkJvxn3">asthma</a>, <a href="/facts/Chronic_obstructive_pulmonary_disease/ud3oXGCr">chronic obstructive pulmonary disease</a> (COPD), and <a href="/facts/Emphysema/ud3oXGCr">emphysema</a> can result in contraction of the airways. Other causes are side effects of topical decongestants such as <a href="/facts/Oxymetazoline/74hVTwQz">oxymetazoline</a> and <a href="/facts/Phenylephrine/sf4DxQws">phenylephrine</a>. Both of these medications activate alpha-1 adrenergic receptors that result in smooth muscle constriction. Non-selective <a href="/facts/Beta_blockers/PRsWgpLV">beta blockers</a> are known to facilitate bronchospasm as well. Beta blockers bind to the β2 receptors and block the action of epinephrine and norepinephrine causing shortness of breath.<a class="footnote-ref" id="fnref:4" href="#fn:4"><sup>4</sup></a> </p><p>Additionally, the pediatric population is more susceptible to disease and complications from bronchospasm due to their airway diameter being smaller; applying <a href="/facts/Poiseuille%27s_Law/eJkIJ2SV">Poiseuille's Law</a> to the airways it is clear that airflow resistance through a tube is inversely related to the radius of the tube to the fourth power, therefore, decreases in airway results in significant flow impediments.<a class="footnote-ref" id="fnref:5" href="#fn:5"><sup>5</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>Signs and symptoms: </p> <ul><li>Wheezing</li> <li>Diminished breath sounds</li> <li>Prolonged expiration</li> <li>Increase airway pressures (in ventilated patients)</li></ul> <h2 id="treatment">Treatment</h2> <h3>Beta 2 agonists</h3> <p><a href="/facts/Beta2-adrenergic_agonist/pKIQlC91">Beta2-adrenergic agonists</a> are recommended for bronchospasm. </p> <ul><li>Short acting (SABA) <ul><li><a href="/facts/Terbutaline/Tt64rhvD">Terbutaline</a></li> <li><a href="/facts/Salbutamol/s5KYCt8j">Salbutamol</a></li> <li><a href="/facts/Levosalbutamol/vRjhWBH2">Levosalbutamol</a></li></ul></li> <li>Long acting (<a href="/facts/Long_acting_beta-adrenoceptor_agonist/4s6925GS">LABA</a>) <ul><li><a href="/facts/Formoterol/EhK6qGUo">Formoterol</a></li> <li><a href="/facts/Salmeterol/Nml7IKQ5">Salmeterol</a></li></ul></li> <li>Others <ul><li><a href="/facts/Epinephrine/k7vvMI7E">Epinephrine</a> - titrate to effect (e.g. 10-50 mcg IV), especially in setting of hemodynamic compromise</li> <li>increasing anesthetic depth</li> <li>IV magnesium</li> <li>Increase FiO2 to 100% and consider manual ventilation</li></ul></li></ul> <h3>Muscarinic Acetylcholine receptor antagonist</h3> <p class="note">See also: <a href="/facts/Parasympathetic_nervous_system/eNzCI8Yu">Parasympathetic nervous system</a> and <a href="/facts/Sympathetic_nervous_system/hs8psNRd">Sympathetic nervous system</a></p> <p>The <a href="/facts/Neurotransmitter/LlpYFSU3">neurotransmitter</a> <a href="/facts/Acetylcholine/v1d3wRUd">acetylcholine</a> is known to decrease sympathetic response by slowing the heart rate and constricting the <a href="/facts/Smooth_muscle_tissue/mpcpTsHp">smooth muscle tissue</a>. Ongoing research and successful clinical trials have shown that agents such as <a href="/facts/Diphenhydramine/XbbIg1Nv">diphenhydramine</a>, <a href="/facts/Atropine/cJQ0gL4o">atropine</a> and <a href="/facts/Ipratropium_bromide/yH45rpLf">ipratropium bromide</a> (all of which act as <a href="/facts/Receptor_antagonist/PuXHVNdV">receptor antagonists</a> of <a href="/facts/Muscarinic_acetylcholine_receptor/caIdoqrW">muscarinic acetylcholine receptors</a>) are effective for treating asthma and COPD-related symptoms.<a class="footnote-ref" id="fnref:6" href="#fn:6"><sup>6</sup></a> </p> <h2 id="see-also">See also</h2> <ul><li><a href="/facts/Bronchoconstriction/BF5oEMEu">Bronchoconstriction</a></li> <li><a href="/facts/Bronchodilation/IQMu7bra">Bronchodilation</a></li> <li><a href="/facts/Wheezing/fB5zMcwo">Wheezing</a></li></ul> <h2 id="external-links">External links</h2> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Haggerty, Catherine L.; Ness, Roberta B.; Kelsey, Sheryl; Waterer, Grant W. (2003). "The impact of estrogen and progesterone on asthma". Annals of Allergy, Asthma & Immunology. 90 (3): 284–91, quiz 291–3, 347. doi:10.1016/S1081-1206(10)61794-2. PMID 12669890. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>Hatfield. "Asthma in Women". <a href="http://www.webmd.com/asthma/features/asthma-women" target="_blank">http://www.webmd.com/asthma/features/asthma-women</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Marsh, Alex; Gordon, David; Heslop, Pauline; Pantazis, Christina (2000). "Housing Deprivation and Health: A Longitudinal Analysis". Housing Studies. 15 (3): 411. doi:10.1080/02673030050009258. S2CID 154051241. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Ahmed, Rubab; Branley, Howard M. (1 January 2009). "Reversible bronchospasm with the cardio-selective beta-blocker celiprolol in a non-asthmatic subject". Respiratory Medicine CME. 2 (3): 141–143. doi:10.1016/j.rmedc.2008.10.019. ISSN 1755-0017. <a href="https://www.sciencedirect.com/science/article/pii/S1755001708001036" target="_blank">https://www.sciencedirect.com/science/article/pii/S1755001708001036</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Edwards, Lauren; Borger, Judith (June 26, 2020). "Pediatric Bronchospasm". statPearls. PMID 31536291. Retrieved November 22, 2020. <a href="https://www.ncbi.nlm.nih.gov/books/NBK546685/" target="_blank">https://www.ncbi.nlm.nih.gov/books/NBK546685/</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>Moulton, Bart C; Fryer, Allison D (May 2011). "Muscarinic receptor antagonists, from folklore to pharmacology; finding drugs that actually work in asthma and COPD". British Journal of Pharmacology. 163 (1): 44–52. doi:10.1111/j.1476-5381.2010.01190.x. ISSN 0007-1188. PMC 3085867. PMID 21198547. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085867" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085867</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> </ol>