1. describe the pathophysiology of an acute asthma attack in BJ followingexposure to cats
The allergic person forms an abnormally large amount of IgE antibodies and theseantibodies cause allergic reactions when they react with their specific antigen, andin this case, fur from cats. These antibodies are mainly attached to mast cells that lie in the lung interstitium inclose association with the bronchioles and small bronchi. Once JB breathes in fur, towhich he is sensitive to (that is to which he has developed IgE antibodies), thepollen reacts with the mast cell-attached antibodies and causes these cells torelease several different substances. Among them are
histamine, slow reactingsubstance of anaphylaxis
(which is a mixture of leukotrienes),
. The combined effects of all these factors,especially of the slow-reacting substance of anaphylaxis, are to produce (1)localized edema in the walls of the small bronchioles as well as secretion of thickmucus into the bronchiolar lumens and (2) spasm of the bronchiolar smooth muscle. Therefore the airway resistance increases greatly. The bronchiolar diameter becomes more reduced during expiration than duringinspiration in asthma because the increased intrapulmonary pressure duringexpiratory effort compresses the outsides of the bronchioles. Because thebronchioles are already partially occluded, further occlusion resulting from theexternal pressure creates especially severe obstruction during expiration. (anasthmatic person usually can inspire quite adequately but has great difficultyexpiring and this results in dyspnea or “air hunger” ) The functional residual capacity and the residual volume of the lung become greatlyincreased during the asthmatic attack because of the difficulty in expiring air fromthe lungs. Also, over a period of years, the chest cage becomes permanentlyenlarged causing a “barrel chest” and the functional residual capacity and residualvolume become permanently increased.
How Airways Narrow