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Photo: Colorized scanning electron micrograph of the lung, showing alveoli. Seeley’s Anatomy & Physiology. 10th ed. New York, NY: McGraw-Hill 2010
Respiratory Pathology
Lecture 7
Learning Objective
To provide the basic description, pathogenesis, types,
morphology (gross and microscopic), clinical presentation
(signs & symptoms) and complications of asthma.
Marc Imhotep Cray, M.D. Kumar V and Abbas AK. Robbins and Cotran Pathologic Basis of Disease 8th ed. 2014 3
Respiratory Pathology
Lecture 7
Asthma: Overview
Bronchial asthma is a chronic relapsing inflammatory disorder
presenting with hyperreactive airways that cause episodic,
reversible bronchoconstriction
an enhanced bronchoconstrictor response to type I (allergic) immune
reaction to extrinsic or intrinsic stimuli
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Respiratory Pathology
Lecture 7
Asthma: Pathology
Pathologic characteristics:
Grossly, lungs are overdistended because of overinflation,
although small areas of atelectasis are sometimes evident as well
Most striking macroscopic finding is bronchial and bronchiolar
occlusion by thick, tenacious mucous plugs
Histologically, mucous plugs contain whorls of shed respiratory
epithelium, forming the well-known Curschmann spirals
Numerous eosinophils and Charcot–Leyden crystals (collections of
crystalloids) are present
Basement membrane of bronchial epithelium is thickened,
bronchial walls show edema, and an inflammatory infiltrate is
present
Submucosal glands are increased in size, whereas bronchial wall
muscle is hypertrophic because of prolonged bronchoconstriction
Marc Imhotep Cray, M.D. 11
Respiratory Pathology
Lecture 7
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Klatt EC. Robbins and Cotran Atlas of Pathology, 3rd Ed., 2015
Asthma: Treatment
Pharmacologic therapies used emergently to treat asthma
include:
short-acting β-adrenergic agonists, such as albuterol, and
longer-acting agents such as salmeterol
Theophylline, a methylxanthine, promotes bronchodilation by
increasing cyclic adenosine monophosphate (cAMP), whereas
anticholinergics, such as tiotropium, also produce
bronchodilation
Long-term asthma control includes:
use of glucocorticoids,
leukotriene inhibitors such as zileuton,
receptor antagonists such as montelukast, and
mast cell–stabilizing agents such as cromolyn sodium
Marc Imhotep Cray, M.D. 18
THE END
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Respiratory Pathology
Lecture 7
Textbooks:
Kumar V and Abbas AK. Robbins and Cotran Pathologic Basis of Disease 8th ed.
Philadelphia: Saunders, 2014
Rubin R and Strayer DS Eds. Rubin’s Pathology: Clinicopathologic Foundations of Medicine,
6th Ed. Baltimore: Lippincott Williams & Wilkins, 2012
Marc Imhotep Cray, M.D. 20
Respiratory Pathology
Lecture 7