Bronkospasmia

Bronkospasmia is a medical condition defined by sudden constriction of the smooth muscle in the walls of the bronchi, resulting in narrowing of the airways and obstructed airflow. It is a feature of several respiratory disorders and can occur in response to allergens, irritants, infections, exercise, medication, or underlying airway inflammation. The principal consequence is dyspnea with wheezing and a reduced expiratory flow.

Pathophysiology typically involves airway hyperreactivity and inflammation, leading to smooth muscle contraction, mucosal edema, and increased mucus production. Mediators such as histamine, leukotrienes, and prostaglandins contribute to bronchial constriction and bronchial hyperresponsiveness. Triggers vary by individual and may include asthma, chronic obstructive pulmonary disease, allergic rhinitis, aspirin-exacerbated respiratory disease, viral infections, cigarette smoke, cold air, and certain medications.

Clinical presentation includes sudden onset of wheeze, breathlessness, coughing, chest tightness, and rapid breathing. In severe cases, use of accessory muscles, hypoxemia, agitation, or confusion may occur.

Diagnosis relies on clinical assessment supported by objective testing where feasible. Spirometry can show reduced FEV1 and FEV1/FVC ratio with partial reversibility after bronchodilator administration. Peak expiratory flow measurements, pulse oximetry, and arterial blood gas analysis may assist in assessment, particularly during acute episodes. Chest imaging is generally reserved to exclude other causes of airway obstruction.

Management focuses on rapid relief of acute symptoms and prevention of future episodes. Acute treatment includes inhaled short-acting beta-agonists (e.g., albuterol), supplemental oxygen as needed, and systemic corticosteroids for moderate to severe cases. In refractory cases, magnesium sulfate and hospital-level care may be required. Long-term strategies target the underlying condition with controller medications, trigger avoidance, action plans, and patient education.