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{{short description|Lower respiratory tract disease that affects the airways leading into the lungs}}
{{Infobox medical condition (new)
| name = Bronchospasm
| synonyms =
| image = Image:Asthma before-after-en.svg
| caption = '''Inflamed airways and bronchoconstriction in asthma'''. Airways narrowed as a result of the inflammatory response cause wheezing.
| pronounce =
| field = [[Pulmonology]]
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'''Bronchospasm''' or a '''bronchial spasm''' is a sudden [[bronchoconstriction|constriction]] of the muscles in the walls of the [[bronchiole]]s. It is caused by the release ([[degranulation]]) of substances from [[mast cells]] or [[basophil]]s under the influence of [[anaphylatoxin]]s. It causes difficulty in breathing which ranges from mild to severe.

Bronchospasms occur in [[asthma]], chronic [[bronchitis]] and [[anaphylaxis]]. Bronchospasms are a possible side effect of some drugs: [[pilocarpine]], [[beta blocker]]s (used to treat hypertension), a paradoxical result of using [[Long acting beta-adrenoceptor agonist|LABA]] drugs (to treat [[COPD]]), and other drugs. Bronchospasms can present as a sign of [[giardiasis]].

Some factors that contribute to bronchospasm include consuming certain foods, taking certain medicines, allergic responses to insects, and fluctuating hormone levels, particularly in women.<ref name=Haggerty2003>{{cite journal |doi=10.1016/S1081-1206(10)61794-2 |pmid=12669890 |title=The impact of estrogen and progesterone on asthma |year=2003 |last1=Haggerty |first1=Catherine L. |last2=Ness |first2=Roberta B. |last3=Kelsey |first3=Sheryl |last4=Waterer |first4=Grant W. |journal=Annals of Allergy, Asthma & Immunology |volume=90 |issue=3 |pages=284–91; quiz 291–3, 347}}</ref><ref name=Hatfield>{{cite web |author=Hatfield |title=Asthma in Women |url=http://www.webmd.com/asthma/features/asthma-women}}</ref>
Bronchospasms are one of several conditions associated with cold housing.<ref>{{cite journal |doi=10.1080/02673030050009258 |title=Housing Deprivation and Health: A Longitudinal Analysis |year=2000 |last1=Marsh |first1=Alex |last2=Gordon |first2=David |last3=Heslop |first3=Pauline |last4=Pantazis |first4=Christina |journal=Housing Studies |volume=15 |issue=3 |pages=411|s2cid=154051241 }}</ref>

The overactivity of the bronchioles' muscle is a result of exposure to a stimulus which under normal circumstances would cause little or no response. The resulting constriction and inflammation causes a narrowing of the airways and an increase in [[mucus]] production; this reduces the amount of [[oxygen]] that is available to the individual causing breathlessness, coughing and [[hypoxia (medical)|hypoxia]].

Bronchospasms are a serious potential complication of placing a [[Tracheal tube|breathing tube]] during [[general anesthesia]]. When the airways spasm or constrict in response to the irritating stimulus of the breathing tube, it is difficult to maintain the airway and the patient can become [[apneic]]. During general anesthesia, signs of bronchospasm include wheezing, high peak inspiratory pressures, increased intrinsic [[PEEP]], decreased expiratory tidal volumes, and an upsloping capnograph (obstructive pattern).  In severe cases, there may be complete inability to ventilate and loss of [[ETCO2]] as well as hypoxia and desaturation.

==Cause==
Bronchospasms can occur for a number of reasons. Lower respiratory tract conditions such as [[asthma]], [[chronic obstructive pulmonary disease]] (COPD), and [[emphysema]] can result in contraction of the airways. Other causes are side effects of topical decongestants such as [[oxymetazoline]] and [[phenylephrine]]. Both of these medications activate alpha-1 adrenergic receptors that result in smooth muscle constriction. Non-selective [[beta blockers]] 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.<ref>{{cite journal |last1=Ahmed |first1=Rubab |last2=Branley |first2=Howard M. |title=Reversible bronchospasm with the cardio-selective beta-blocker celiprolol in a non-asthmatic subject |journal=Respiratory Medicine CME |date=1 January 2009 |volume=2 |issue=3 |pages=141–143 |doi=10.1016/j.rmedc.2008.10.019 |url=https://www.sciencedirect.com/science/article/pii/S1755001708001036 |issn=1755-0017|url-access=subscription }}</ref>

Additionally, the pediatric population is more susceptible to disease and complications from bronchospasm due to their airway diameter being smaller; applying [[Poiseuille's Law]] 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.<ref> {{cite web | last1 = Edwards | first1 = Lauren | last2 = Borger | first2 = Judith | title = Pediatric Bronchospasm | url = https://www.ncbi.nlm.nih.gov/books/NBK546685/ | publisher = statPearls | date = June 26, 2020 | pmid = 31536291 | access-date = November 22, 2020}}</ref>

==Diagnosis==
Signs and symptoms:
* Wheezing
* Diminished breath sounds
* Prolonged expiration
* Increase airway pressures (in ventilated patients)

==Treatment==

===Beta 2 agonists===

[[Beta2-adrenergic agonist]]s are recommended for bronchospasm.
* Short acting (SABA)
** [[Terbutaline]]
** [[Salbutamol]]
** [[Levosalbutamol]]
* Long acting ([[Long acting beta-adrenoceptor agonist|LABA]])
** [[Formoterol]]
** [[Salmeterol]]
* Others
** [[Epinephrine]] - titrate to effect (e.g. 10-50 mcg IV), especially in setting of hemodynamic compromise
** increasing anesthetic depth
** IV magnesium
** Increase FiO2 to 100% and consider manual ventilation

===Muscarinic Acetylcholine receptor antagonist===
{{see also|Parasympathetic nervous system|Sympathetic nervous system}}

The [[neurotransmitter]] [[acetylcholine]] is known to decrease sympathetic response by slowing the heart rate and constricting the [[smooth muscle tissue]]. Ongoing research and successful clinical trials have shown that agents such as [[diphenhydramine]], [[atropine]] and [[ipratropium bromide]] (all of which act as [[receptor antagonist]]s of [[muscarinic acetylcholine receptor]]s) are effective for treating asthma and COPD-related symptoms.<ref>{{cite journal |last1=Moulton |first1=Bart C |last2=Fryer |first2=Allison D |title=Muscarinic receptor antagonists, from folklore to pharmacology; finding drugs that actually work in asthma and COPD |journal=British Journal of Pharmacology |date=May 2011 |volume=163 |issue=1 |pages=44–52 |doi=10.1111/j.1476-5381.2010.01190.x |language=en |issn=0007-1188|doi-access=free |pmid=21198547 |pmc=3085867 }}</ref>

== See also ==
* [[Bronchoconstriction]]
* [[Bronchodilation]]
* [[Wheezing]]

== References ==
{{reflist}}

== External links ==
{{Medical resources
| ICD9 = {{ICD9|519.11}}
| DiseasesDB=1715
}}
[[Category:Bronchus disorders]]
[[Category:Asthma]]

Bronchospasm - Revision history

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