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In Delhi buy cipro from india antibiotic gum infection, many tube-wells are used to supplement the water supply from Yamuna river order line cipro antibiotics for dogs for kennel cough. Artesian well: The water source for percolation in this case is at a very high level buy 250mg cipro overnight delivery zombie infection nokia 5228. The impervious table sloped down to some place much lower down and water is held up under pressure between the two impervious tables. Some are found in Gujarat in Viram- gam and Dholka Talukas in Ahmedabad, Harij in Mehsana and Radhanpur Taluka in Palanpur. Stepwell: Stepwells are mainly found in the desert areas of Gujarat and Rajasthan, some descending by as many as 170 steps and 46 meters to reach the water. The rainwater percolates down through fine silt, which screens out particulates, until the • A parapet wall 0. When the water level is high, during the monsoon, • A drain 15 to 30 meters long ending into a soakpit, the visitor descends only a few steps to drink or bathe garden or a field. It is preferable to instal a Public health implications: Cyclops which harboured hand-pump or a motor pump if possible. This markedly A stepwell was host not only to human beings but also improves the bacteriological quality of water. Since wells form the most flooding by rain water or to washing in of surface common source of water in the rural areas, it is important impurities from the surroundings. It should have a gutter The ordinary hand-pump made of cast iron is designed to receive the waste water. It has several deficiencies such as • Regular chlorination (at least once a week ordinarily, how discharge, greater manual effort, possibility of twice a week in rainy season and daily when there contamination and shorter lifespan. It is made almost entirely from steel and is galvanised, making it sturdy and long-lasting. Quality control is ensured through its stan- surface area of water column by its depth. Several thousand have been installed = πr2 × W 1000 liters in many other countries of Africa, Latin America and Asia. All the parts are checked and tested so that is found by pumping the well empty and then noting they fit together perfectly. This hand-pump can be main- the depth of water column that accumulates after 24 tained even by village women themselves, with little train- hours. Its main feature are:5 the base of the well may be considered as the apex of • Easily maintainable by village communities requiring a conical zone of filtration. Springs Sometimes it may be necessary to confirm whether pollution is reaching the well from a particular suspected They are formed by groundwater flowing over to the source. This can be done by putting a solution of surface when an impervious formation comes near the fluorescein or Rhodmin B in the suspected source of surface of earth. Springs are cheap, clean and usually pollution and looking for the dye in the well water. They may be shallow or deep as prodigiosum which can be easily identified by its red per the same criteria applicable in case of shallow and colonies. Springs are not a major source of water supply Periodic cleaning of wells is necessary for maintaining in India. Water Supply and Hand-pum ps Quantitative Standards It is desirable to have piped water supply for all comm- 55 Water from a hand-pump is safer than that from open wells. It is the government’s endeavor to provide hand- unities for proper health and cleanliness. A water supply system consists of three Water Quality and components: the source of water, the waterworks refers 8,9 to the purification plant where water is purified and pum- Qualitative Standards ped to a tank at a higher level, often known as service Water is an immediate environment of the human host. Such agents may be biological, chemical by gravity to the city from which service pipes branch or physical, as described below. Approximate requirements for various purposes are given below in liters per capita per day. Biological Use Liters • Viruses-Examples are viruses of infective hepatitis, Dom estic poliomyelitis and Coxsackie group which enter water Drinking 1. Public • Worms-Ova of roundworms may pollute water com- Street washing, flushing of sewers, ing in contact with polluted soil. Water can also be watering of public parks and gardens, building construction and a vehicle for transmission of guinea worm and trema- fire fighting 25. Hardness due to sulfates and chlorides of Allowing for an excess margin of 20%, the Environmental calcium and magnesium may cause digestive upsets. Hygiene Committee of Government of India recommen- Fluorides in excess may cause symptoms of fluoro- ded provision of water at the rate of 180 day for large sis. Fluorine and iodine deficiency may be associated communities and at a lesser rate for smaller communities 6 with caries and goitre respectively. Insoluble matter (without sewerage) (with sewerage) such as sand, clay and mica may cause irritative 1,000-5,000 60 liters 80 liters diarrhea when present in excess. Greater than 2,00,000 180 liters 180 liters Physical National drinking water requirements have been targeted at 40 liters per capita per day in rural areas and Water containing radioactive wastes may be hazardous 110 liters in urban areas. Color Toxic Substances A large collection of water may be apparent as pale blue These are lead, selenium, arsenic, cyanide and mercury. A dilute Substances that m ay Affect Health solution of K2CrO7 and cobalt sulfate in the tintometre • Fluorine: It should be present in a concentration of is used to measure the color. High They are imparted by algae and organic and mineral matter fluoride content has been found in Punjab (up to 44 that reaches water through seepage or from industries. No disagreeable smell • Nitrates: Some water samples may be too rich in is permissible in portable water. They should not be present in That is why boiled, distilled or rainwater has a flat or water in excess of 0. Substances that m ay Affect W ater Acceptability Reaction These include-iron, calcium, copper, zinc, etc. It may be mentioned here that tube-well water in They settle down by storage or on adding alum. Turbidity some parts of Delhi has excessive levels of iron and can be measured by Jackson-Candle turbidimeter. Hardness of W ater Radiological Quality Water is said to be hard when it destroys soap because Increasing pollution of water sources10 with radioactive of the dissolved salts. These salts are bicarbonates, sul- wastes from nuclear reactors has become a problem fates and chlorides of calcium and magnesium. Another source is the radioactive hardness due to the presence of bicarbonates was earlier debris from nuclear fall ou ts. This debris, usually from labelled as temporary hardness as compared to a nuclear detonation, is deposited on the earth after permanent hardness due to other salts. Hardness is expressed as for the upper limit of radioactivity in water are as follows: milliequivalents per liter of the hardness producing ion. Gross alpha activity-3 picocurie/l Thus a sample of water having 50 mg of calcium carbonate per liter would have 1 mEq/L of hardness. Most authorities now insist that water should • Toxic substances be free from all sorts of E.

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Tis may be 34 Chapter 5  Fluid and Electrolyte Balance considerable and are ofen underesti- Table 5 discount cipro 250 mg amex filamentous bacteria 0041. If an organ with a large surface area Cations (meq/L) Anions (meq/L) such as bowel order cipro toronto antibiotic drops for ear infection, is handled and traumatized discount 750 mg cipro bacteria normally carried by about a third of the population, even small degrees of edema can increase Na – 142 (Range 137-148) Cl – 103 (Range 99-108) the extravascular volume considerably. Urine and feces account for The average requirements of sodium and a similar formula is used except that the the rest. Humans are very efcient at con- stituted for the equivalent weight of the serving sodium and can tolerate much lower element. Urine – 1500 intracellular cation, there may be a consider- maintains acid base equilibrium. Feces – 100 able fall in total body potassium before the tial to optimize both sodium balance and c. Skin – 600 as to know the dangers of imbalance of either Total – 2600 Total – 2600 Electrolyte Balance electrolyte. When inorganic salts are in solution as in Maintenance fluid: (Given as per kg the extracellular or intracellular fuids of the Sodium Balance body wt. Ions are of two Sodium is all important in sustaining the cati- The precise water requirements of a kinds! Cations which are electropositive and Total body sodium = 5000 mmol (112 gm temperature. The anions include Children require relatively more water chloride, phosphate, bicarbonate and sul- Regulation than adults. In any solution, the concentrations of (a) Renal: method to calculate their requirements is the cations must be equal to that of anions. Aldosterone - Secreted by the zona glomerulosa of adrenal cortex is the most Disturbance of Water Balance Treatment powerful conservator of sodium. It has Tis is done by increased water intake orally an important infuence on the exchanges ‘Pure’ Water Depletion through a Ryles tube in mild cases and intra- on Na, K and hydrogen in the distal (i. Causes The mechanism involves the renin-angi- ‘Pure’ Water Excess otensin system and results in increased 1. Diminished intake-Tis may result from Causes Na reabsorption by the distal tubule. The commonest cause in the surgical or vasopressin secreted by supraoptic and Tis loss may be as much as 500 ml wards in the large infusions of 5 per- paraventricular nuclei of hypothalamus in excess of the normal insensible cent glucose solution to postoperative and stored in the posterior pituitary. Afer tracheostomy humidif- because of the tendency to salt and water tion from the distal tubules and collect- cation of the inspired air is an impor- retention afer traumatic incidents. Potassium Balance The urinary output is diminished and spe- Clinical Features Potassium is almost entirely intracellular cifc gravity increased. Tere is decreased osmolality of the extra- (98%), only 2 percent is present in the extra- • The increased serum osmolality also causes cellular fuid producing intracellular edema. As the water leaves the cells, it is The patient may become drowsy, stuporous imately. Eventually or even comatose with convulsions due to • Daily requirement ranges from 50 to 100 hypotension and coma occur due to intracel- cerebral edema. Fruit, milk and honey are rich in this serum Na and other electrolyte concentration. Plasma Changes • Excretion-Mainly through urine, a Serum Na and total protein though normal Treatment very small quantity through feces and initially, rise in concentration in the late • Stoppage of 5 percent glucose infusion if sweat. Hb, concentration and with convulsions, diuresis should be 36 Chapter 5  Fluid and Electrolyte Balance induced with frusemide injections. Disturbances of Sodium Balance • Nausea, vomiting and muscle cramps may Reduction of Body Water Absent or be present. Urine is scanty, dark in color, of Low Significance Sodium (and Water) Deficiency of a high specifc gravity and except in 1. The most frequent cause of sodium Treatment is secreted from the posterior pituitary and depletion seen in surgical practice a. Severe diarrhea due to cholera, sodium depleted patient may be calcu- increases with fuid retention and pulmonary acute gastroenteritis, ulcerative colitis, lated as follows. Hyponatremia due to water intoxication Treatment is directed at managing both the (Tere is high level of urinary sodium. Low intake depletion is not of primary importance • If the hypernatremia is a refection of i. Patient has a sick, ketoacidosis in absence of renal failure so that no more than half the water defcit haggard anxious appearance with sunken when large quantities of ketone bodies and should be replaced in the frst 12 to 24 hrs. Potassium is actively secreted by the distal adequate and frequent estimations of serum b. Villous adenoma of rectum – aldosterone and to a lesser extent by cortisol and sion. Severe hypokalemia should be treated in the profuse mucus discharge Deoxycorticosterone. Renal The causes of hypokalemia are enumer- Hyperkalemia means high serum K+ levels i. In (Conn’s syndrome) • Muscular weakness - Potassium depriva- most patients with hyperkalemia, total body • Glucocorticoid excess, e. Muscular potassium remains normal or may even be cushing’s syndrome, exogenous weakness is a feature of this. Addison’s disease - Due to lack of sium defciency may be present even though concentrating ability as renal tubular aldosterone. Diuretics which inhibit K+ secretion, that defciency is to be expected if oral feed- polyuria and polydipsia. Shif of potassium from tissues into the gastrointestinal contents serves as a guide 1. Insulin defciency - It limits tissue An unobtrusive loss of K+ from the cells Treatment uptake and causes hyperkalemia. Milk, fruit Clinical Features i Whenever water is mobilized from the juices and honey or supplementation with The clinical features of K+ retention are cells, e. Whenever cell protein is broken down, practice efervescent tablets of potassium sensory disturbances (Paresthesia) are ofen e. Disturbances of Treatment Whenever the condition is suspected a serum calcium metabolism is not a problem in the Treatment is urgent. In case of metastatic cancer, the treat- and loss of P wave, then the development of ized portion of calcium in blood gives rise to ment is only prophylactic. Impaired function of parathyroid glands Tis occurs in starvation, prolonged admin- ii. Treatment acute pancreatitis, diabetic acidosis and the 50 to 100 ml of 50 percent dextrose along Consists of correction of the underlying late stages of major burns. The Mg++ ion is with 10 to 20 units of plain insulin should cause along with repletion of the defcit. It is given orally or in the form of enema hypercalcemia (15 – 20 gm, 6 – 8 hourly). Malignancy (commonest cause)-Due The diagnosis of Mg-defciency cannot be renal failure, Hemo and peritoneal dialy- to osteolytic metastasis, e.

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To provide supplementary nutrition to vulnerable of nutrients like vitamin A cheap cipro 500 mg on line antibiotics for dogs urinary infection, iron purchase cipro with amex infection types, iodine generic cipro 750 mg fast delivery antibiotics for acne rosacea, protein and groups through locally produced foods. The specific activities of the program are: In general, the main beneficiaries of nutrition pro- • Supplementary feeding. No definite nutrient content children but pregnant and lactating mothers have also has been laid down for the food supplied. The community kitchens and school Program and was transferred to the state sector during gardens could not function properly. The food is provided under the gram lacked effective supervision and has almost Minimum Needs Program. The two main and was extended to the entire country in subsequent 420 activities of the program are: years. The three specific objectives of the program are: way to provide iodine to people. To raise the nutritional status of primary school iodate, the retention of iodine in the salt is increased children, particularly those belonging to low socio- considerably. The beneficiaries are constant and (v) It is technically easy and feasible to children attending the primary school (6 to 11 years of iodise salt in home and large industries. The children belonging to backward classes, ‘Smiling Sun’ is imprinted for the illiterate to identify scheduled castes and scheduled tribes families are to be iodised salt. Ration for each beneficiary is presently Iodine in iodised salt can be ascertained by two methods budgeted at 50 paise per day and is aimed at providing i. Most evaluation studies fail to reveal any significant Spot test kit consists of two solutions kept in 3 increase in the levels of enrollment commensurate with polythene closed tubes – 2 tubes (white in color) the investment made on the scheme. The major contain test solution and 1 tube (red in color) contains bottlenecks include lack of continuity in the supply of food recheck solution. At first one teaspoonful of salt is materials to the feeding centers, pilferage in the channels uniformly spread on a white piece of paper or a white of distribution, non-adherence to the number of feeding plate. One or two drops of test solution are poured days and absence of other health related activities. The upon it; if the salt turns purple or blue it indicates mid-day meal has often been noticed to replace a meal presence of iodine. Then the color is matched with at home and was generally no regarded as supplementary color chart either printed on the body of the kit or to what is consumed at home. The spot matching storage facilities at the schools and lack of local community to closely to one is the rough concentration of iodine involvement also contributed to its poor performance. It aimed at iodine is present; if no color change develops even replacement of ordinary salt by iodized salt, particularly after this, then the salt contains no iodine. The program of universal The Central Government provides case grants for iodization of edible salt was started from first April 1986 health education and publicity campaign for promoting in phases with the aim of total salt iodization by 1992. This was made has been set up at the biochemistry division of the effective on 27. Govt of India with effect from 30-9-2000 vide monitors the iodine content of salt and urine and treatise orders dated 13-9-2000. An allocation of Rs 75000/- per district • Iodine content at manufacturer level-not less than laboratory has been provided for this purpose. International Council for the control of Iodine • Iodine content at retail level-not less than 15 ppm. The indicators include (i) Proportion of households consuming effectively iodised salt (>90%); Prevention of Vitamin A Deficiency (ii) Urinary iodine excretion: proportion below 100 mcg/lt (<50%) and proportion below 50 mcg/lt Promoting consumption of vitamin A rich food: • Regular dietary intake of vitamin A rich foods by (<20%) and (iii) Thyroid size: proportion of school pregnant and lactating mothers and by children children 6–12 years age with enlarged thyroid, by 55 under 5 years of age is to be promoted. Vitamin A deficiency has been recognized to be a major • Feeding of locally available beta-carotene rich food controllable public health and nutritional problem. Even mild vitamin A deficiency along with cereal and pulse to be included in increases morbidity and mortality in children. In addition, consumption The national program for prophylaxis against of milk, cheese, ghee, egg, liver, paneer, etc. Under the program, a massive • Administration of supplemental dose of vitamin A dose of vitamin A is given once in six months to to preschool children at periodic intervals is a simple, preschool children. Nutrition education to mothers effective and most direct intervention short term aimed at promoting the consumption of vitamin A rich strategy. The program is • Under this strategy, each infant 6–11 months and implemented through primary health centers and actual children 1–5 years is to be administered vitamin A distribution is done by paramedical workers. An evaluation of the program has shown A child must receive a total of 9 oral doses of vitamin that in areas where it has been implemented well, there A by its fifth birthday. The reasons for poor coverage with measles vaccine between the ages of 9–12 have been: months. National Prophylaxis Program for Prevention of • Communication strategy for creating awareness Blindness due to Vitamin A deficiency comprises of a about vitamin A must be in place. Vitamin A supplementation has been proposed to be implemented Treatment of Vitamin A Deficient Child through the primary health centers, its subcenters and the anganwadis. All health staffs working in the primary Mild deficiency of vitamin A leads to night blindness and health centers are responsible for administering Vit A conjunctival xerosis, while severe deficiency results in oil to children under 5 years of age and for imparting corneal damage. Infants and young children child per day for 100 days suffering from diarrhea, measles or acute respiratory 6–10 years 30 mg elemental iron + 250 mcg folic acid per infection must be monitored closely and encouraged to child per day for 100 days consume vitamin A rich food. In case, early signs of 11–18 years 100 mg elemental iron + 500 mcg folic acid adolescents* per adolescent per day for 100 days vitamin A deficiency are observed, the above treatment Pregnant women 100 mg elemental iron + 500 mcg folic acid schedule must be followed. If the mother is diagnosed from direct sunlight and stored at room temperature in anemic then 100 mg elemental iron + 500 mcg folic a cold dark room for a minimum of 1 year. Once the acid are given twice daily per day for 100 days; one bottle has been opened, it must be utilized within 6–8 tablet after lunch and one tablet after dinner. Welfare, Department of Family Welfare, Child Health Multiple channels and strategies are required to Division. The fortified salt – common salt fortified with iron; and (ii) suggested prophylactic doses of iron and folic acid double fortified salt – common salt fortified with iron tablets were distributed to the high risk groups by the and iodine. Other sustainable approaches to In depth studies carried out with this strategy have control anemia are food fortification and dietary clearly shown that fortified salts improve hemoglobin diversification. Dietary diversification to improve absorption of Infants between 6 and 12 months, school children iron by lowering inhibitor and increasing promoter 6 to 10 year old and adolescents 11 to 18 years old concentrations has been suggested. This may need have also been included in this program, since sufficient nutrition education and changes in dietary habits of the evidence shows that iron deficiency affects this age group population. For children 6 to 60 months ferrous sulphate and folic acid are to be provided in a liquid formulation Food Hygiene containing 20 mg elemental iron and 100 mcg folic acid per ml of liquid formulation. Dispersible tablets have an Apart from diseases due to deficient or excess intake of advantage over liquid formulation in programmatic food, there are diseases due to food contamination that conditions. There may be areas where iron folate tablets may not Food-borne or Food-related Diseases be effective due to heavy worm infestation.

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Bacterial pneumonia is treated which includes hospital-acquired pneumonia with antibiotics order generic cipro pills bacteria virus. Prevention includes vaccination (seasonal flu Auscultation may reveal reduced breath sounds shot buy cipro 250mg on line antibiotic strep throat, pneumococcal) order 750mg cipro antibiotics for dogs for kennel cough, frequent handwashing, and crackles. Other common bac- disease that can affect almost any part of the terial and viral causes of pneumonia in the United body but is mainly an infection of the lungs. Chapter Eight Diseases and Disorders of the Respiratory System L 149 Prevention PluS! Are antibiotics an appropriate treatment for a viral tions may be inappropriate; four out of five Americans are infection? Take a look at this chart to find out which upper respiratory infections are usually caused by viruses - germs that are not killed by antibiotics. Ask what you should look for at home that might mean you are developing another infection for which antibiotics might be appropriate. Healthy aging Influenza Vaccination Why do we hear about the influenza vaccine every year? The vaccine is recom- should receive the vaccine, including children 6 months mended for all adults age 65 and older. The vaccine formula is different every year only about 60% of those age 65 and older have been because the virus strains are different. The influenza vaccine does not necessarily prevent flu infection but does reduce the severity of symptoms and signs. However, through microscopic droplets released into the the bacteria can become active and multiply air when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs, or sings. Inhaled bacteria infect the lungs and induce a chronic inflammatory response that leads to necrosis or tissue death. The tissue in this site becomes soft and cheeselike, which is why it is described as a caseous lesion. Lung tissue heals with fibrosis and calcification or scarring, wall- ing off the bacteria into pockets for months or years. Signs and symptoms include dys- pnea, frequent coughing, wheezing, tachy- pnea, and tightness in the chest. The exact drugs pulmonary rehabilitation program is to improve and length of treatment depend on the patient’s the quality of life for people with chronic breath- age, overall health, possible drug resistance, the ing problems. Emphysema affects about 5 mil- by airflow limitation that is not fully reversible. The risk fac- The airflow limitation is usually progressive and tors for emphysema include smoking, exposure is associated with an abnormal inflammatory to secondhand smoke, occupational exposure to response of the lungs to noxious particles or dust and chemicals, and genetics (alpha-1-anti- gases. An estimated 12 million people elasticity and surface area required for normal in the United States and 52 million people world- gaseous exchange. Auscultation may reveal decreased breath are two types of bronchitis: acute and chronic. The percussion Acute bronchitis comes on quickly and lasts 2–3 note is hyperresonant. Chronic bronchitis is defined as having toms may include cyanosis, edema of the feet a cough with sputum production that lasts at and ankles, fatigue, headache (especially in the least 3 months for 2 consecutive years. Emphysema patients million people in the United States are diagnosed may develop barrel chest caused by enlarge- with chronic bronchitis each year. Risk factors ment of the lungs and chest wall and the inef- for chronic bronchitis include tobacco use, expo- fective use of breathing muscles. As emphysema sure to secondhand tobacco smoke, exposure to progresses, many patients experience dyspnea irritants on the job, and decreased immunity. Membrane swelling and exhaling through puckered lips, which is a way excess mucus reduce the person’s ability to to make each breath more effective by tending obtain enough oxygen and results in hypoxia, a to hold the airways open so that more air can condition of insufficient oxygenation of the tis- be exhaled. The blocked airways also become suscep- to lean forward and support themselves with tible to infections. Over time, untreated chronic their arms on a surface in front of them or on bronchitis leads to scarring, destruction of cilia, their knees. Auscultation may reveal decreased breath In the vast majority of people, smoking is sounds, wheezing, and crackles. Cigarette ing destroys the air sac linings in the lungs isn’t smoking is the most common cause of chronic known. People exposed to industrial dusts involves a genetic deficiency of alpha-1-antitryp- and fumes in the workplace, such as coal min- sin, which leaves the lungs susceptible to alveo- ers, grain handlers, and metal molders, are also lar destruction. Diagnosis is gradual, many cases are not diagnosed until is based on medical history, physical examina- irreversible damage has occurred. Diagnosis of tion, chest x-ray, pulmonary function testing emphysema may include medical history, physi- (spirometry), and sputum analysis. The also essential for patients with chronic bronchi- goals of treatment are to reduce symptoms and tis. The most ications, inhaled steroids, antibiotics, oxygen important step is smoking cessation. Treatment therapy, pulmonary rehabilitation, and surgery may also include bronchodilators, inhaled ste- (lung reduction surgery to remove damaged lung roids, an alpha-1 protease inhibitor for patients tissue, lung transplant). Prevention includes with familial emphysema, supplemental oxygen, never smoking or quitting smoking, wearing a and surgery (lung reduction to remove damaged mask over your mouth and nose when using tissue or lung transplant). The most effective way lung irritants (paint, paint remover, or varnish), to prevent emphysema is to not smoke, avoid frequent handwashing to reduce exposure to exposure to secondhand smoke, and avoid occu- viruses and bacteria, and getting the seasonal pational exposure to dust and chemicals. Chapter Eight Diseases and Disorders of the Respiratory System L 153 Promote Your Health Smoking Cessation The immediate health benefits of quitting smoking are O Within a few weeks, people who quit smoking have substantial: improved circulation, produce less phlegm, and don’t cough or wheeze as often. O Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal. O Within several months of quitting, people can expect substantial improvements in lung function. O Within a few hours, the level of carbon monoxide in the blood begins to decline. Asthma is a condition in which the bronchial The etiology of asthma is idiopathic. People with tubes in the lungs react to certain stimuli by asthma have very sensitive airways that react and becoming inflamed (Figure 8–11 ). More than 25 narrow in response to many different substances, million Americans suffer from asthma, including activities, and conditions that, in these persons, over 8% of adults and over 9% of children. Asthma diagnosis is based on signs and symp- toms, medical history, physical examination, pulmonary function tests (spirometry, peak flow, and bronchial provocation), chest x-ray, and allergy testing. Signs and symptoms of asthma Smooth muscle include dyspnea, tightness in the chest, cough- ing, and wheezing. During Cross-sectional view normal breathing, the bands of muscle that sur- Asthma attack round the airways are relaxed, and air moves freely. In people with asthma, however, allergy- Contracted smooth muscle causing substances and other triggers make the bands of muscle surrounding the airways tighten Swollen so that air cannot move freely. This causes the mucous asthmatic to feel short of breath, and the air membrane moving through the tightened airways causes a wheezing sound. An asthma attack is defined as a sudden wors- Figure 8–11  (A) Normal bronchiole and (B) bronchiole ening of asthma signs and symptoms.