Asthma

Chronic inflammatory disease of airways

Manifested physiologically by a widespread narrowing of airways
Occurs in all ages but predominantly in early life
Half of cases develop before age 10
Pathogenesis:
Results from a state of persistent subacute inflammation of the airways
Maor cell types that thought to play important role in the inflammatory response : mast cells! eosinophils! lymphocytes and
airway epithelial cells"
Common triggers of asthma:
Protease in house dust mice faeces
#ungal spores
$ry cold air
Pollens
#eathers
%mo&e from tobacco
Pollution'environment
()ercise
Respiratory tract infection
*enetic factors environmental factors
%mooth muscle contraction
+irway inflammation
+irway hyperreactivity
+%,HM+
Clinical features:
- the symptoms consist of a triad
dyspnea
cough
whee.ing
$iagnosis: %pirometry
Classification of asthma according to severity:
Symptoms Daily medications
Day Night
Mild intermittent / 0 days'wee& / 0 nights'month no daily medications needed
Mild persistent 1 0 days'wee& 1 0 nights'month low dose inhaled glucocorticoids
but 2 1 per day
Moderate persistent daily 1 1 night'wee& low to medium inhaled glucocorticoids
and long acting inhaled 30 agonists
%evere persistent continual fre4uent high dose inhaled glucocorticoids
and long acting inhaled 30 agonists
*oals of therapy:
Prevent chronic and troublesome symptoms
Maintain 5near6 normal pulmonary function
Maintain normal activity levels
Prevent recurrent e)acerbation
Provide optimal pharmacotherapy
Meet patient and families e)pectations
Pharmacologic therapy:
Controllers 7 drugs that controls the inflammation
()" 8nhaled corticosteroids
%ystemic corticosteroids
%odium cromoglycate
9edocromil sodium
:ong acting 30 agonists
Relievers 7 immediate relieve of symptoms
()" %hort acting 30 agonist
%ystemic corticosteroids
+nticholinergics
%hort acting oral 30 agonists
Chronic Obstructive Pulmonary Disease (COPD)
Characteri.ed by airflow limitations that is not fully reversible
8s the 5;
th
6 in the boo&! 510
th
6 in the lecture< leading cause of death and affects 11= million individuals
8t is the >
th
leading cause of death in the Phil"
,his includes:
(mphysema
Chronic bronchitis
%mall airways disease
Ris& factors:
Cigarette smo&ers
+irway responsiveness
Respiratory infections
Occupational e)posures 7dust at wor&! coal mining! gold mining! and cotton te)ture dust
+mbient air pollution
Passive or second hand smo&ing e)posure
*enetic factors
$ifferentiation from +sthma:
History COP$ +sthma
+ge of onset 1?0 years old +t young age
Heavy smo&ers'e)-smo&ers @(% M+@A(
Character of breathlessness gradual and progressive episodic attac&s
#eatures COP$ +sthma
%pirometry reduced #eB1'#BC reduced #eB1'#BC
Aronchodilator response improvement is little or none usually present 000ml inc"
in #eB1
spirometer may normali.ed
,wo main systems of COP$:
Areathlessness
Cough
%mo&ing cessation 7 most important way of affecting favorably the outcome of patients at all
stages of COP$
- can be achieved by
initiation
early follow-up
continuing reinforcement
determination
Pharmacotherapy:
8nhaled bronchodilators 7 the first line
,heophylline 7 ust an addition to the medication