تقرير بحث
حول:
pathophysiology of asthma
تقديم الطالب :
محمد علي حريج كشكول
المرحلة :الرابعة _ مسائي
بأشراف :
د.مهدي مرشد
Asthma
Definition
Reactive airway disease
Chronic inflammatory lung disease
Inflammation causes varying degrees of
obstruction in the airways
Asthma is reversible in early stages
Triggers of Asthma
Allergens
Exercise
Respiratory Infections
Nose and Sinus problems
Drugs and Food Additives
GERD
Emotional Stress
Early and Late Phases of Responses of
Asthma
Fig. 28-1
Asthma
Pathophysiology
Bronchospasm
Airway inflammation
Asthma
Pathophysiology
Early-Phase Response
Peaks 30-60 minutes post exposure, subsides 30-
90 minutes later
Characterized primarily by bronchospasm
Increased mucous secretion, edema formation,
and increased amounts of tenacious sputum
Patient experiences wheezing, cough, chest
tightness, and dyspnea
Asthma
Pathophysiology
Late-Phase Response
Characterized primarily by inflammation
Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity
causing hyperresponsiveness to allergens and
other stimuli
Increased airway resistance leads to air trapping
in alveoli and hyperinflation of the lungs
If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage
Factors Causing Airway Obstruction in
Asthma
Fig. 28-3
Summary of Pathophysiologic
Features
Reduction in airway diameter
Increase in airway resistance r/t
Mucosal inflammation
Constriction of smooth muscle
Excess mucus production
Asthma
Clinical Manifestations
Unpredictable and variable
Recurrent episodes of wheezing,
breathlessness, cough, and tight chest
Asthma
Clinical Manifestations
Expiration may be prolonged from a
inspiration-expiration ratio of 1:2 to 1:3 or
1:4
Between attacks may be asymptomatic
with normal or near-normal lung function
Asthma
Clinical Manifestations
Wheezing is an unreliable sign to gauge
severity of attack
Severe attacks can have no audible
wheezing due to reduction in airflow
“Silent chest” is ominous sign of
impending respiratory failure
Asthma
Clinical Manifestations
Difficulty with air movement can create a
feeling of suffocation
Patient may feel increasingly anxious
Mobilizing secretions may become difficult
Asthma
Clinical Manifestations
Examination of the patient during an acute
attack usually reveals signs of hypoxemia
Restlessness
Increased anxiety
Inappropriate behavior
Increased pulse and blood pressure
Pulsus paradoxus (drop in systolic BP during
inspiratory cycle >10)
Asthma
Complications
Status asthmaticus
Severe, life-threatening attack refractory
to usual treatment where patient poses
risk for respiratory failure
Asthma
Diagnostic Studies
Detailed history and physical exam
Pulmonary function tests
Peak flow monitoring
Chest x-ray
ABGs
Asthma
Diagnostic Studies
Oximetry
Allergy testing
Blood levels of eosinophils
Sputum culture and sensitivity
Asthma
Drug Therapy
Antiinflammatory drugs
Corticosteroids
Do not block immediate response to
allergens, irritants, or exercise
Do block late-phase response to subsequent
bronchial hyperresponsiveness
Inhibit release of mediators from
macrophages and eosinophils
Asthma
Drug Therapy
Anti-inflammatory drugs
Mast cell stabilizers (e.g., cromolyn, nedocromil)
Inhibit release of histamine
Inhibit late-phase response
Long-term administration can prevent and reduce
bronchial hyper-reactivity
Effective in exercise-induced asthma when used 10
to 20 minutes before exercise
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