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Asthma
➤ Defination
➤ Epidemiology
➤ Pathogenesis
➤ Pathology
➤ Clinical Manifestations
➤ Diagnosis
➤ Disease management
recommendations
Definitio
n
Asthma is now defined as a chronic
inflammatory disorder of the airways in
which many cells and cellular elements
play a role, in particular, mast cells,
eosinophils, T lymphocytes, neutrophils,
and epithelial cells.
Definitio
n
In susceptible individuals, this
inflammation causes recurrent episodes of
wheezing,
breathlessness,
chest tightness,
cough,
particularly at night and in the early
Definitio
n
These episodes are usually associated
with widespread but variable airflow
obstruction that is often reversible either
spontaneously or with treatment. The
inflammation also causes an associated
increase in the existing bronchial
hyperresponsiveness to a variety of stimuli.
Epidemiology
➤ morbidity
1%-13%, 1%-4% in China
➤most common chronic disease of childhood
About one-half of the case develop before age 10
and another third occur before age 40
➤higher in developed country
➤higher in urban than in suburb
➤40% with family history
Pathogenesis:
Causes
Host factor (hereditary susceptibility )
FH of asthma or atopy (familial tendency for
allergic reactions)
Acute bronchoconstriction
Airway edema
Chronic mucus plug formation
Airway remodeling
The
症状tip
- - -of iceberg
冰山的一角
Pathology
Normal Asthma
A
Panel A Specimen of Bronchial Mucosa
From a Subject without Asthma.
The epithelium is intact; there is no
thickening of the sub-basement membrane,
and there is no cellular infiltrate.
B
Panel B Specimen of Bronchial Mucosa from
a Subject with Asthma. There is evidence
of goblet-cell hyperplasia in the epithelial
-cell lining. The sub-basement membrane
is thickened, with collagen deposition
in the submucosal area, and there is a
cellular infiltrate.
➤ Airway edema
Physical Examination
Vital signs:
➤ A rapid respiratory rate
➤ Wheezing
Clinical Manifestations
Laboratory Findings
1.Sputum examination
Eosinophils are often seen microscopically,
and eosinophilic granules from disrupted
cells may be seen throughout the sputum
smear.
Clinical Manifestations
2.Chest x-ray
Vary from normal to hyperinflation.
Lung markings are commonly increased,
particularly in chronic asthma.
3.Eosinophil count
Eosinophilia (> 250 to 400 cells/µL) is
common. In many asthmatics, the degree of
eosinophilia correlates with severity of
asthma.
Clinical Manifestations
Laboratory Findings
4.Allergen identification
measuring total serum IgE or specific IgE
antibodies
skin testing
Use appropriately selected allergens
A positive response indicates only potential
allergic reactivity to the tested allergens.
Clinical Manifestations
Laboratory Findings
5.Pulmonary function test
bronchial provocation test (BPT)
bronchial dilation test (BDT)
peak expiratory flow (PEF) variability
Bronchial Provocation Test (BPT)
Cardiac asthma
Chronic asthmatic bronchitis
Lung cancer
Allergic lung diseases :
➤ minimal or no symptoms
➤ minimal asthma episodes / attacks
➤ no emergency visits to hospital
➤ ipratropium bromide
➤may provide added benefit to β 2
agonist
➤ few side effects
Relievers:
methylxanthine
Theophylline :
Bronchodilator
cardiant
diuresis
central stimulant
<1~1.2g/d
Relievers:
systemic steroids
➤ prednisone or prednisolone:
➤2 mg/kg/d
➤IV or PO
➤ generally continue for 5 days
➤simultaneously initiate inhaled steroid
➤Usually <10-14d
➤no need to taper systemic steroids
Controllers:
inhaled steroids
➤ must be scheduled
➤ takes 4 to 5 days to see benefit
➤ minimal systemic adverse effects
Controllers:
long-acting β 2 agonist
➤ salmeterol or albuterol
➤ must be scheduled
➤ Incombination with inhaled steroid
for moderate or severe persistent
asthma
LABA bronchodilation antiinflammation ICS
ICS LABA
Controllers:
leukotriene regulator
zafirlukast
montelukast
methylxanthines
➤sustained release theophylline
Controllers:
systemic steroids
➤2 mg/kg/d (max 60 mg/d)
➤ numerous adverse effects
➤including growth retardation
Management plan for
asthma
➤ classifythe severity of the illness
➤ identify the appropriate regimen that will
maintain control of the illness
➤ review classification and management
plan every 1 to 6 months
➤ gain control as quickly as possible, then
adjust
Mild intermittent
disease
➤ symptoms < 1 / week
➤ nocturnal symptoms < 2 / month
➤ PEF > 80% predicted
➤ PEF variability < 20%