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Asthmaby
Farshid Mokhberi Shahid Beheshti University of Medical Science
Asthma
Obstructive & Restrictive Lung Diseases.
Definitions:
Obstructive: Limitation of the airflow usually resulting from an incraese in resistance due to partial or complete obstruction at any level. Like: Asthma , Emphysema, Chronic Bronchitis
Restrictive: Reduced expansion of lung parenchyma accompanied by decreased total lung capacity.
Definition & Basics of AshtmaAsthma is a chronic inflammatory disorder of the airways.
This feature of asthma has implications for the diagnosis, management, and potential prevention of the disease.
Inflammatory airways disease
Increased responsiveness
Increased contraction of airway smooth muscles
Hypersecretion of bronchial mucus
Altered airway architecture
Altered immunologic state, e.g., atopy
Idiopathic
Classification of AsthmaIntrinsic Asthma Extrinsic Asthma
Non-allergic
Usually adult onset
Often follows severe respiratory illness
More refractory to treatment
Strong family history of allergies
Usually onset at a young age
History of specific allergic association triggers (e.g. pollen,
animal dander)
Correlation with skin and inhalation responses to specific
antigens
Intrinsic asthma: the absence of atopy
Symptoms are not related to seasons of the year or identifiable allergens.
Provoked by poorly characterized respiratory tract infections (viral infection).
Aspirin (nonsteroidal), cold dry air also provoke asthmatic attacks and are not associated with specific antibody production.
Once exposed and sensitized, these asthmatic can develop chronic asthma despite avoidance of sensitizing chemicals.
Also demonstrate nonspecific bronchial hyperactivity.
Airway Inflammation in Intrinsic TRIGGER
↓
INFLAMMATORY RESPONSE
↓
AIRWAY CHANGES
↓
RESPIRATORY SYMPTOMS
©2010
Extrinsic Asthma
Airway Inflammation in Extrinsic
Early Phase Response
Involves Type I Hypersensitivity
IgE antibody with Mast Cells
Late Phase Response
Involves Type IV Hypersensitivity
T cell mediated response activates eosinophils, B cells, others
Pathophysiology
Airway inflammation
Decreased airway caliber
-Bronchoconstriction-(may cause death on its own)
-Edema of submucosal tissues
-Abnormal airway liquid (mucus plugging)
-Nonspecific hyperreactivity
Air trapping and hyperinflation (CXR and PFTs)
V/Q mismatch compensation occurs during exacerbations
Airway RemodelingVascularDilation Edema
SubepithelialFibrosis
EpithelialDamage
Inflammatory Cell
InfiltrationSmooth MuscleHypertrophy
Mucous GlandHypertrophy
Mucus
Subbasement MembraneThickening
©2010
Normal Airway Looking at the Main Carina
Airway During Asthma Exacerbation
Diagnosis
Asthma DiagnosisSymptoms
Medical history
Physical Exam
Treatment
Treatment:Acute:
B2 Agonist: Albuterol (short acting), Salmeterol (long acting)
Bronchodilation
Chronic:
Corticosteroids: Fluticasone
Inhibits multiple inflammatory cytokines
Thank You
Refrenceshttp://www.webmd.com/asthma/guide/default.htm
http://www.asthma.org.uk/
http://www.mayoclinic.com/health/asthma/DS00021
http://www.nhlbi.nih.gov/health/asthma