Intrinsic Asthma Definition-Symptoms-Treatment

Intrinsic Asthma Definition-Symptoms-Treatment

Intrinsic Asthma Definition

Intrinsic Asthma can be defined as the form of asthma in which the triggering is caused by non-allergy related factors like stress, anxiety, etc. is called as Intrinsic Asthma.

Introduction to Intrinsic Asthma

What is Intrinsic Asthma?

Intrinsic or non-allergic asthma is that form of asthma in which no allergens are found as triggers, and corresponds to 19% of asthma seen in allergy consultations.

Although the term intrinsic was initially used to imply that the cause of the problem was within the body, in order to differentiate it from extrinsic asthma (induced by external agents), it is currently recognized that the etiopathogenesis is unknown, therefore it is a cryptogenic asthma.

Infections of the bronchial tree are a frequent cause of exacerbations in this type of asthma, although the mechanism by which the infection acts has not been demonstrated.

It is also unclear whether intrinsic asthma is due to immunological reactions to infectious agents, or whether these act as non-specific inflammatory factors.

However, these can act by mechanically exacerbating asthma, increasing bronchial obstruction, due to oedema and leukocyte infiltration, together with mucus hyper-secretion.

They are mostly viral in origin, although bacteria can occasionally be responsible for secondary infections. There is no evidence of an IgE-mediated allergic response to bacterial allergens.

Clinical manifestations of Intrinsic Aasthma

It usually affects adults (35 years) with a predominance in women (76%) without a serious previous respiratory history.

Often the first episode of asthma can be associated with an acute respiratory infection, such as bronchopneumonia, acute bronchitis, or a significant upper respiratory tract infection.

The disease once started tends to persist chronically and with variable severity once the first symptoms appear.

These occur most often at night or upon rising in the morning and consist of episodes of coughing, chest tightness, wheezing, and dyspnoea in any combination. Clear, thick sputum like egg white is common.

The duration of the episodes is variable (from minutes to days) and in general many of the patients do not become asymptomatic (without treatment) in the inter-seizures.

Symptoms are perennial, although winter worsening (respiratory viruses) is common.

Many report anosmia and hydrorrhea (see Intrinsic Rhinitis in the Diseases option) and a subgroup of nasal polyposis (12%) and / or intolerance to NSAIDs (7%) (see NSAID asthma in the Diseases option).

There is usually a premenstrual worsening, during pregnancy and with the climacteric.

Non-specific irritants (pollution, tobacco or oil fumes, pungent odors, etc.) as well as ß-blocker medication (oral and / or topical “eye drops”) can also cause exacerbations.

In general, the response to CGDS is insufficient (to assess its efficacy it must be tested for 1-2 months), limited to bronchodilators and good to steroids (aerosol and / or systemic). The family history of atopy is usually negative.

The physical examination does not differ from that of other types of asthma, although nasal polyposis is more common in this one.

Intrinsic vs. Extrinsic Asthma

Asthma is Classified into two subtypes;

Intrinsic Asthma: Also Called as Non-allergic asthma (Stress, Anxiety)

Extrinsic Asthma: also called as allergic (Smoking, Pollens, Chemicals, Dust, Perfume, etc.)

Both Intrinsic and extrinsic asthma types cause the same symptoms.

The difference between them is what triggers and causes asthma symptoms. The treatments are same for each type, even though the prevention strategies differ.

Extrinsic asthma is more common than intrinsic asthma.

Intrinsic asthma tends to start later in life, and is more common in females then men, and is typically more severe also.

The main difference between intrinsic vs extrinsic is the level of involvement of the immune system;

In extrinsic asthma, triggering of symptoms are by external allergen such as pollen, dust, mites, pet dander, or mold etc.

The immune system counter act against and start producing too much of a substance called Immunoglobulin E also called IgE throughout the body.

It’s the IgE antibody that triggers and causes extrinsic asthma attack.

In intrinsic asthma, IgE antibody is usually only locally involved within the airway passages.

Symptoms of Intrinsic Asthma

The symptoms of intrinsic asthma and extrinsic asthma are essentially the same; Symptoms include:

  • coughing
  • rapid breathing
  • wheezing or whistling sounds when breathing
  • chest pain
  • chest tightness
  • mucus in the airways
  • shortness of breath

Diagnosis of Intrinsic Asthma | Treatment of Intrinsic Asthma

A positive bronchodilator test, sputum eosinophilia (> 20%) and / or a FENO determination> 25 ppb and negative skin tests (or not compatible with the medical history) are usually sufficient to reach the diagnosis.

Other supporting data include normal total IgE, peripheral eosinophilia, hyperplastic synopathy (59% of cases), and naso-sinus polyposis (12%).

It may be useful to assess the presence of non-specific bronchial hyperresponsiveness HBI (methacholine test).

A negative methacholine test generally excludes the disease, on the contrary a positive methacholine test does not confirm it, since it can also occur in many diseases and even in a healthy population.

The differential diagnosis should be made mainly with extrinsic asthma (see also Wheezing Dyspnea in Adults in the Cardinal Manifestations option).

Intrinsic asthma treatment

Chronic asthma

Exposure to irritants (fumes, penetrating odours, paints…) should be avoided, avoiding going out to the streets on days of high pollution.

Vaccination against influenza as well as immunization against capsular polysaccharides of Streptococcus pneumoniae is convenient.

Bronchospasm-inducing drugs such as NSAIDs (in intolerant patients) and systemic (propranolol) or topical (timolol eye drops) ß-blockers should be avoided.

If there is suspicion of gastroesophageal reflux (GER), timely treatment should be carried out (see Reflux Asthma in the Diseases option).

Maxillary sinusitis is often present and often exacerbates asthma (see Treatment of Sinusitis). Learn more about Asthma is caused by?

Medication treatment should be established according to the patient’s age, severity and frequency of exacerbations (see treatment of Bronchial Asthma in the Diseases option).

► Start with the administration of an inhaled ß-2 agonist as needed, salbutamol or terbutaline. If the patient requires to use it more than 2 times a week, it is advisable to add an inhaled corticosteroid on a regular basis.

► Start with beclomethasone or budesonide (800 mcg / day) or fluticasone 500 µg / day divided twice a day, regularly and an inhaled ß-2 agonist on demand.

► Assess the patient at 4-8 weeks; if response is insufficient, add a long-acting inhaled beta-2 agonist such as salmeterol and / or add a leukotriene receptor antagonist such as montelukast 10 mg per day.

► If the response is still insufficient, increase the dose of inhaled corticosteroids to a maximum of beclomethasone or budesonide 2000 µg / day or fluticasone propionate 1000 mcg / day, divided into 2-4 doses).

They should always be used with spacers, to prevent complications (candidiasis, dysphonia) and reduce intestinal absorption (especially if beclomethasone is used, less importantly if budesonide or fluticasone is used). Correct inhalation technique should be checked at each visit.

► If the response is insufficient, add an oral bronchodilator regularly: theophylline retard (adjust levels 5-15 µg / ml) and / or oral ß-2 agonist and / or ipratropium bromide 2-4 puff 3-4 times per day.

► If the response is insufficient, add a rapidly metabolizing oral corticosteroid every other day (eg prednisone or deflazacort).

The dose should be adjusted to the minimum amount necessary to keep asthma well controlled (check regularly).

Give calcium and vit supplements. D, especially in postmenopausal women and previous control of Ca in serum and urine.

Acute asthma

Faced with an exacerbation of asthma, its severity should be evaluated. Give high doses of ß-2 agonists using a spacer or nebulizer.

Eg: “Ventolin solution for respirator” 0.5 ml (2.5 mg) plus 2 ml of saline solution applied by aerosol (“De Vilbiss”, “Hudson”).

The medication takes about 7-10 minutes to inhale and if necessary it can be repeated after 20 and 40 minutes; then space it every 2-6 hours (according to response).

In these patients, especially if they are taking steroids, a cycle of oral steroids should be added, eg. oral prednisone 40-60 mg / day for 7 days. If a longer treatment is required, then the dose of steroids should not be abruptly discontinued, on the contrary making a descending pattern of 12-21 days.

Severe asthma exacerbations that do not respond to high doses of ß-2 agonists in the first 20-30 min should be referred to an emergency department without further delay.

During the transfer, the patient should receive oxygen and additional bronchodilators (inhaled ß-2 agonists). (See table)

Intrinsic Asthma Monitoring

At least 1-2 times a year, check-ups should be performed that include physical examination (including ENT), radiological controls (paranasal sinuses), elemental analysis, determination of FENO and pulmonary function.

In patients with moderate or severe asthma who receive high doses of inhaled corticosteroids or frequent courses of systemic corticosteroids, the determination of anti-Chlamydia pneumoniae IgG, plasma cortisol and bone densitometry, and in general the tests deemed necessary according to the history, may be useful.

clinical and physical examination. Daily peak flow measurements carried out by the patient himself at home (for example, when getting up and in the afternoon) are useful to assess the evolution and control of asthma.

Using the Spacer

They are devices that are attached to the inhaler and that allow:

1. Greater ease of correct inhalation.

2. Increased penetration of the drug into the lower respiratory tract.

3. Less deposition of the drug in the oropharynx and larynx (lower incidence of candidiasis and dysphonia with aerosolized corticosteroids).

4. Possibility of using high doses of ß-agonists through the metered dose inhaler in exacerbations of asthma (emergencies).

In Spain several models are available: the Volumatic (Lab. Glaxo), Nebuhaler (Lab. Astra), Fisonaire (Lab. Fisson). All of them have a volume of about 700 cm 3 of air.

They have the disadvantage of being large to carry with you and not being compatible with inhalers from different laboratories.

More useful turns out to be the Aerochamber (Fig. 11) or the OptiChamber. This is smaller and the mouthpiece to attach the inhaler is made of silicone (instead of plastic), which allows inhalers of different brands to be attached to it.

You can find child-friendly tools that make it easy to give asthma inhalers.

There are also spacers with different sizes of masks, which allows the elderly and children under 4 years of age (including infants) to be treated with metered dose inhalers (OptiChamber with mask).

Steps to Use the Asthma Inhaler with the Spacer

• Shake the inhaler vigorously.

• Attach the inhaler to the spacer.

• Raise your head slightly and gently expel the air.

• Press the cartridge to release 1 dose. Then take a slow, deep breath in for about 3-5 seconds.

• Then hold your breath for 10 seconds to allow the medicine to settle into the bronchial tubes.

• Exhale gently.

NOTE: If inspiration is too fast on some devices (AeroChamber or OptiChamber) an alarm beep sounds.

Using the Spacer Inhaler plus Mask

• Remove the cap.

• Shake the inhaler.

• Attach on the spacer.

• Put the mask on the child’s face.

• Download a dose.

• Keep it on the face for 6 breaths.

Check that the mask is well attached to the child’s face, observing if the membrane moves with each breath.

For the baby to breathe through the mouth, gently pinch the nose.


In this article we saw Definiton of intrinsic asthma, asthma is caused by what? Difference between the intrinsic and extrinsic asthma, Symptoms of asthma, Diagnosis of asthma, What is Intrinsic Asthma?, Medications for asthma, how to use asthma inhaler and how to use spacer inhaler Mask.

Hope you liked this Intrinsic vs Extrinsic Asthma, Intrinsic Asthma Definition, Causes, Symptoms of Intrinsic Asthma and Treatment of Intrinsic Asthma as well if yes share this article with all your friends and family.


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