| Abstract | Astma je kronična bolest dišnog sustava te predstavlja jednu od najčešćih kroničnih bolesti, osobito u dječjoj dobi. Procjenjuje se da u svijetu danas od astme boluje oko 330 milijuna ljudi s rastućom prevalencijom od 4,3%, što čini velik javnozdravstveni problem. Najčešći simptomi uključuju nedostatak zraka praćen čujnim zvižducima, tzv. wheezing, stezanje u prsima te kroničan kašalj. Dijagnoza se postavlja na temelju karakterističnih simptoma i varijabilnog otpora protoku zraka u dišnim putovima utvrđenog spirometrijom. Astma je heterogena bolest karakterizirana kroničnom upalnom aktivnošću u dišnim putovima koja s
vremenom može dovesti do ireverzibilnih promjena te razvoja trajne bronhokonstrikcije. Vrsta i intenzitet simptoma, odgovor na terapiju, prognoza, vrsta upalne reakcije, sastav upalnog infiltrata bronhalne stijenke kao i dob u kojoj se bolest javlja uvelike variraju između pojedinaca. Shodno tome, smatra se da je razvoj astme posljedica složenog međudjelovanja genetskih
i okolišnih čimbenika, a stvorene su i brojne podjele na razne podtipove (fenotipove) s obzirom na prethodno spomenute karakteristike. Dobro poznat fenotip, koji je ujedno i najčešći, alergijski je tip astme koji nastaje senzibilizacijom na neki okolišni,
najčešće inhalacijski alergen praćen daljnjim razvojem alergijske reakcije preosjetljivosti u donjim dišnim putovima. Mehanizmi razvoja kronične upale nisu u potpunosti istraženi, kao ni mehanizni koji su u podlozi drugih fenotipova. Brojni čimbenici rizika povezuju se s razvojem astme. Premda za mnoge još uvijek nema dovoljno znanstvenih dokaza, mnogi od njih su ipak prepoznati. Oni mogu ostvariti svoj utjecaj prenatalno, u perinatalnom razdoblju ili tijekom kasnijeg života. Neki od istraživanijih rizičnih prenatalnih čimbenika za razvoj astme su pušenje jednog ili oba roditelja tijekom trudnoće, pretilost majke, izloženost antibioticima (potonje i u dojenačkoj dobi) te prisutnost astme u roditelja (nasljedni čimbenik). U perinatalnom razdoblju rizik čini porođaj carskim rezom, neonatalna hiperbilirubinemija i prematuritet, a u kasnijem životu izloženost brojnim inhalacijskim alergenima, zagađivačima i ostalim kemijskim tvarima uključujući pušenje; pridruženi GERB i pretilost te rinitis. |
| Abstract (english) | Asthma is chronic respiratory disease and it represents one of the most common chronic diseases globally, especially in childhood. Today it is estimated that about 330 millions of people are affected by asthma worldwide, with prevalence up to 4.3% and great public health issue. Most common symptoms include dyspnea followed by expiratory wheezing, chest tightness and chronic cough. Diagnosis is based on characteristic clinical symptoms together with variable airflow limitation established via spirometry. Asthma is heterogeneous disease characterized by chronic inflammatory response in airways which can lead to irreversible condition over time and the development of persistent bronchoconstriction. Symptoms intensity and type, treatment response, prognosis, type of inflammatory response and inflammatory cells composition in bronchial wall, as well as age of onset, differ remarkably between individuals. It is considered that asthma is a result of complex interactions between genetic and environmental factors that together make numerous different subtypes (phenotypes) of asthma. Well recognizable phenotype, allergic asthma, is a result of senzibilisation to some environmental, usually inhalation, allergen and further allergic hypersenzitivity reaction in lower respiratory tract. However, mechanisms of
chronic inflammation evolution are not fully understood, as well as underlying mechanisms of other phenotypes. Many risk factors are associated with asthma development although for majority of those there is no sufficient scientific evidence. They may be present and act prenatally, perinatally or later in life. The most investigated risk factors for asthma in prenatal period include: one or both parents smoking during pregnancy, maternal obesity, using antibiotics during pregnancy (but also in infancy) and parents having asthma (hereditary factor). In perinatal period some of risk factors are C-section delivery, neonatal hyperbilirubinemia and prematurity. Finally, later in life, exposure to numerous inhalation allergens, pollutants and other chemical agents, including smoking, coexisting GERD, obesity and rhinitis are well known risk factors for the development of asthma. |
