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Asthma. Renmin Hospital, Wuhan University Ding Xuhong ( 丁续红 ). DEFINITION A clinical syndrome of unknown etiology characterized by three distinct components (1) Recurrent episodes of airway obstruction that resolve spontaneously or as a result of treatment (clinical manifestation).

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Asthma

Asthma

Renmin Hospital, Wuhan University

Ding Xuhong (丁续红)


DEFINITION

A clinical syndrome of unknown etiology characterized by three distinct components

(1)Recurrent episodes of airway obstruction that resolve spontaneously or as a result of treatment(clinical manifestation)


(2)An exaggerated bronchoconstrictor response to stimuli that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness (Pathophysiologically)(3) Inflammation of the airways as defined by a variety of criteria (Pathogenesis)


Pathology
PATHOLOGY that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

Constriction of airway smooth muscle

Airway epithelium thickening

Mucus plugging


Lung Hyperinflation in Asthma that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness


Thick that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness bronchi with Mucous plugs


Mucous plug in asthma
Mucous plug in asthma that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness


Asthma microscopically
Asthma - Microscopically that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

  • Patchy necrosis of epithelium

  • Sub-mucosal glandularhyperplasia

  • Hypertrophy of bronchial smoothmuscle

  • Eosinophils,mastcells,lymphocytes (Th2) infiltration


Asthma microscopic pathology
Asthma Microscopic Pathology that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

Obstructed

Inflammed

Bronchi


PATHOGENESIS that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

OF ASTHMA


Asthma Pathogenetic Types that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

  • Extrinsic (Allergic/Immune)

    • Atopic - IgE

    • Occupational - IgG

    • Allergic Bronchopulmonary Aspergillosis - IgE

  • Intrinsic (Non-immune)

    • Aspirin induced

    • Infection induced


  • Predisposing Factors that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

  • Atopy

  • Causal Factors

  • Indoor Allergens

    • Domestic mites

    • Animal Allergens

    • Cockroach Allergens

    • Fungi

  • Outdoor Allergens

    • Pollens

    • Fungi

  • Occupational Sensitizers

  • Contributing Factors

  • Respiratory infections

  • Small size at birth

  • Diet

  • Air pollution

    • Outdoor pollutants

    • Indoor pollutants

  • Smoking

    • Passive Smoking

    • Active Smoking

Risk Factors that Lead to Asthma Development


I nducers allergens chemical sensitisers air pollutants virus infections

Airflow Limitation that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

SYMPTOMS

Cough Wheeze

Dyspnoea

Airway

Hyperresponsiveness

Genetic

InducersAllergens,Chemical sensitisers,Air pollutants, Virus infections

INFLAMMATION

Triggers

Allergens, Exercise,

Cold Air, SO2Particulates


Diagnosis of asthma
DIAGNOSIS OF ASTHMA that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

  • History and patterns of symptoms

  • Physical examination

  • Measurements of lung function


Patient history
PATIENT HISTORY that have little or no effect in nonasthmatic subjects, a phenomenon known as airway hyperresponsiveness

  • Has the patient had an attack or recurrent episodes of wheezing?

  • Does the patient have a troublesome cough, worse particularly at night, or on awakening?

  • Does the patient cough after physical activity (e.g playing)?

  • Does the patient have breathing problems during a particular season (or change of season)?



Physical examination
Physical Examination than 10 days to resolve?

  • Wheeze -Usually heard without a

    stethoscope

  • Dyspnoea

  • Rhonchi heard with a stethoscope

  • Use of accessory muscles

    Remember -

    Absence of symptoms at the time of examination does not exclude the diagnosis of asthma


Blood Finding than 10 days to resolve?

  • Blood eosinophilia, elevated serum level of sIgE

  • Arterial blood gases:

    PaO2 between 55 and 70mmHg

    PaCO2 between 25 and 35mmHg


Radiographic finding than 10 days to resolve?

In severe asthma, hyperinflation, pneumomediastinum or pneumothorax may be detected


ECG than 10 days to resolve?

Sinus tachycardia (usually), right axis deviation, right bundle branch block, “P pulmonale”, ST-T wave abnormalities (severe asthma)


Diagnostic testing
Diagnostic testing than 10 days to resolve?

Diagnosis of asthma can be confirmed by demonstrating the presence of reversible and variable airway obstruction using Peak Flow Meter


  • Bronchial challenge test: PC than 10 days to resolve?20<8mg/mL

  • Reversibility test: FEV1 increase more than 12% after inhalation of salbutamol, the absolute value of increase >200ml

  • Variability of PEF diurnally ≥20%


Differential diagnosis than 10 days to resolve?

  • Chronic bronchitis

  • Heart failure (“cardiac asthma”)

  • Hypersensitivity pneumonia

  • Lung cancer


Goals to Be Achieved in Asthma Control than 10 days to resolve?

  • Achieve and maintain control of symptoms

  • Prevent asthma episodes or attacks

  • Minimal use of reliever medication

  • No emergency visits to doctors or hospitals

  • Maintain normal activity levels, including exercise

  • Maintain pulmonary function as close to normal as possible

  • Minimal (or no) adverse effects from medicine


Tool Kit for Achieving Management Goals than 10 days to resolve?

  • Relievers

  • Preventers

  • Peak flow meter

  • Patient education


What are relievers also known as rescue medication
What Are Relievers? than 10 days to resolve?(also known as rescue medication)

  • Bronchodilator (beta2 agonist)

  • Quick relief of symptoms (within 2-3 minutes)

  • Used during acute attacks

  • Action lasts 4-6 hrs

  • Not for regular use


Relievers than 10 days to resolve?

  • Short acting 2 agonists

    Salbutamol (万托林)

  • Anti-cholinergics

    Ipratropium bromide(爱全乐)

  • Xanthines

    Theophylline

  • Adrenaline injections


What are Preventers? than 10 days to resolve?

  • Anti-inflammatory

  • Takes time to act (1-3 hours)

  • Long-term effect (12-24 hours)

  • Only for regular use

    (whether well or not well)



Preventers than 10 days to resolve?

Corticosteroids Anti-leukotrienes

Prednisolone, Betamethasone Montelukast, Zafirlukast

Beclomethasone, Budesonide

Fluticasone Xanthines

Theophylline SR

Long acting 2 agonists Mast cell stabilisers

Bambuterol, Salmeterol Sodium cromoglycate

Formoterol

COMBINATIONS

Salmeterol/Fluticasone

Formoterol/Budesonide


Patient Education in the Clinic than 10 days to resolve?

  • Explain nature of the disease (i.e. inflammation)

  • Explain action of prescribed drugs

  • Stress need for regular, long-term therapy

  • Allay fears and concerns

  • Peak flow reading

  • Treatment diary / booklet


Status Asthmatic than 10 days to resolve?

  • FEV1 < 40%pred with treatment, PaCO2 increases, developing major complication such as pneumothorax

  • Close monitoring

  • Frequent treatments with inhaled β2-agonists, intravenous aminophylline, high-dose intravenous steroid

  • Oxygen supplement

  • Antibiotics – if infection exist

  • If indicated, intubation of the trachea and

    mechanical ventilation


The Pregnant Asthmatic than 10 days to resolve?

  • No departure from the ordinary management of asthma

  • No unnecessary medication should be administered

  • Systemic steroid should be used sparingly

  • Tetracycline, atropine, terbutaline(博利康尼?), iodine-containing mucolytics should be avoided


Key Messages than 10 days to resolve?

  • Asthma is a common disorder

  • It produces recurrent attacks of cough with or without wheeze

  • Between attacks people with asthma lead normal lives as anyone else

  • In most cases there is some history of allergy in the family


  • Asthma can be effectively controlled, although it cannot be cured

  • Effective asthma management programs include education, objective measures of lung function, environmental control, and pharmacologic therapy

  • A stepwise approach to pharmacologic therapy is recommended. The aim is to accomplish the goals of therapy with the least possible medication


Thank you! cured


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