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ASTHMA Pediatric Critical Care Medicine Emory University Children’s Healthcare of Atlanta

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Page 1: Olumide pidan

ASTHMA

Pediatric Critical Care MedicineEmory University

Children’s Healthcare of Atlanta

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Asthma Episodes of increased breathlessness,

cough, wheezing, chest tightness. Exacerbations may be abrupt or

progressive Always related to decreases in

expiratory (also in inspiratory in severe cases) airflows

Hallmarks: airway inflammation, smooth muscle constriction and mucous plugs

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Epidemiology Most common chronic disease in the world:

varies between regions More prevalent in westernized countries but

more severe in developing countries Yr of cost 2005 >$11.5 billion per year 35/100.000 fatality, mostly pre-hospital &

older pop Seasonal exacerbation pattern but ICU

admission remains constant <10% life threatening exacerbation: 2-20%

with ICU admission; 4% intubation Reduction in mortality (63%) in the 1980’s due

to inhaled steroids

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Asthma Prevalence

4

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Pathophysiology

Airway inflammation, smooth muscle constriction, and airway obstruction

VQ mismatch (<0.1)- decrease vent with normal perfusion

Intrapulmonary shunt is prevented due to collateral ventilation, hypoxic pulmonary vasoconstriction, rarely functionally complete obstruction mild hypoxemia

Worsening of hypercapnea is indicative of impending respiratory failure in combination of lactic acidosis

Worsening of hypoxemia after beta-agonist is common due to removal of hypoxic induced pulmonary vasoconstriction

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Asthma

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HistamineTryptasePGD2

LTC4

IL-4IL-5IL-6TNF-α

Eosinophilic cationic proteinsMajor basic proteinsPlatelet activating factorLTC4, LTD4, LTE4

IL-3IL-4IL-5

GM-CSF

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Pathophysiology

Lactic acidosis: Changes in glycolysis due to high dose

beta agosist; Increased wob, anaerobic metabolism Coexisting profound tissue hypoxia Over production of lactic acid by the

lungs Decrease lactate clearance due to

hypoperfusion

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Pathophysiology

Significantly reduced: FEV1; FEV1/FVC, Peak expiratory flow; maximal expiratory flow at 75%, 50% and 25%, and maximal exiratory flow between 25% and 75% of the FVC

Abnormally high airway resistance: 5-15x normal due to shortening of airway smooth muscle, airway edema and inflammation, excessive luminal secretions.