What Is Reactive Airway Disease?

Reactive airway disease is a general term used by physicians to describe an event in which the respiratory system overreacts to a bronchial irritant, triggering wheezing and shortness of breath. Rather than being a disease in itself, reactive airway disease is a respiratory event placeholder and classifier used before an official diagnosis has been made. For example, it is often used in cases where asthma, chronic obstructive pulmonary disease (COPD), and bronchial infections are suspected but not yet officially diagnosed. Among clinicians, the term has stirred controversy. Some doctors feel the use of this particular terminology is both outdated and imprecise; others who work in pediatrics and emergency medicine feel the term may be useful in these medical specialties. For emergency room doctors, reactive airway disease is understood as a shorthand for a range of symptoms the patient could have, and this shorthand allows staff to prepare the necessary treatment equipment in advance of a patient's arrival by ambulance.

The basic causes, symptoms, treatments, and complications associated with reactive airway disease are described below.

Link To Asthma

Reactive airway disease has a strong link to asthma, and the term is most frequently used in relation to suspected cases of asthma that have not yet been diagnosed. For example, pediatricians may use reactive airway disease as a diagnostic classification for very young pediatric patients who are too young to undergo diagnostic procedures for asthma, including a bronchial challenge test. Reactive airway disease may also be noted on an infant's medical record if clinicians cannot establish a definitive cause for their breathing issues. This notation is done to ensure the baby's breathing is regularly monitored and diagnostic procedures are completed when appropriate.

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Other Included Conditions

In addition to asthma, many other conditions may be found within the classification of reactive airway disease. For example, healthcare providers might use the term to describe instances of suspected chronic obstructive pulmonary disease prior to carrying out tests that specifically diagnose this disease. At other times, it could be employed to describe reactive airways dysfunction syndrome (RADS), a condition characterized by a single episode of coughing, wheezing, or shortness of breath after exposure to excessive gas fumes and vapors. Reactive airway disease can technically include any condition that produces a bronchial spasm, and there is controversy among specialists as to which diseases are encompassed by the term. For example, some specialists would not include chronic obstructive pulmonary disease within the umbrella of reactive airway disease. In fact, the confusion this catchall term has caused is so extensive that some clinicians have said the term lacks any clinical meaning. Ultimately, it is largely up to each doctor to decide which respiratory conditions they wish to describe by using 'reactive airway disease.'

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Common Symptoms

The conditions frequently classified as reactive airway disease tend to share numerous common symptoms. For example, patients generally have a persistent and productive cough (one that produces phlegm). They also experience wheezing normally accompanied by shortness of breath. The conditions classified under the umbrella of reactive airway disease are normally the result of inflammation, and this can cause both swelling and narrowing of the patient's air passages. Breathing restrictions are triggered when the smooth muscles of the lungs become too responsive, leading to constriction of the airways. In addition, patients who have coughing may present with excessive mucus; this clogs the air passages and the alveoli, tiny sacs within the lungs.

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What Causes It

The classification of reactive airway disease serves as a gateway to additional investigations that can determine what causes it. Potential causes of reactive airway disease are varied, and they may include conditions as diverse as cystic fibrosis, congestive heart failure, asthma, bronchiectasis, and granulomatous lung disease. Patients being examined for reactive airway disease might eventually be diagnosed with irritant-induced asthma, a viral infection of the upper respiratory system, gastroesophageal reflux disease, or a pulmonary embolism. To fully investigate the reasons for a patient's symptom and provide an accurate diagnosis, doctors will carry out a range of tests tailored to the patient's medical history. After listening to the patient's heart and lungs, the clinician may recommend for the patient to undergo imaging studies such as chest x-rays, MRI scans, and CT scans to obtain more information about their symptoms. The patient could also need to have lung function tests, including spirometry and diffusion studies; these are especially useful if the healthcare provider suspects a patient might have chronic obstructive pulmonary disease. Patients believed to have asthma will need to undergo peak expiratory flow rate and bronchoprovocation studies, and individuals suspected of having allergies may be asked to have skin prick testing and RAST blood tests to identify potential allergens. Antinuclear antibody blood tests are useful in the diagnosis of autoimmune conditions, and endoscopy may be indicated to confirm the presence of gastroesophageal reflux disease.

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Options For Treatment

Once a cause is identified, the patient's healthcare team will recommend options for treatment. In an emergency situation, treatment may include supplemental oxygen, inhaled or intravenous bronchodilators, and injections of epinephrine. Patients will have their oxygen saturation monitored through pulse oximetry, and arterial blood gas tests may be performed. Treatment for chronic conditions associated with the reactive airway disease umbrella will include close monitoring and frequent checkups from medical personnel. As with testing, treatment will be tailored to the specific condition discovered. For example, patients who have asthma will need to use a controller medicine daily, and they are provided with a rescue medication for use in emergency situations. Individuals with gastroesophageal reflux disease may be prescribed antacids, antibiotics, or proton pump inhibitors to manage their symptoms, and patients diagnosed with allergies could need a combination of lifestyle modification and oral or injectable medications to control their condition.