1.

asthma pathophysiology
 Chronic inflammation disorder of airways
a) Atopic : extrinsic (inflammation mediated by systemic IgE production
b) Non-atopic: intrinsic (inflammation mediated by local IgE production

 Increase in mucus production and there will be eosinophil found

 Increase in the production of goblet cells -> mucus
 Basement membrane thickens
 Increase production in mast cells -> histamine, neutrophils and T helper cekks
 Thicker SMC because of vasoconstriction
 In asthma there are more TH-2 than TH-1, which is not normal
 TH-1: promotes inflammation (cell-mediated immunity), TH-2: promotes inflammation (humoral immunity, anitbody
production)
a) For example if inhaled allergen -> engulfed by dendritic cells, and the columnar epithelial cells will product:
thymic stromal lymphocytes (that will produce chemo attractamt for th2)
b) Active DC will also produce chemoattractant for Th2
c) TH2 promote humoral immunity which will stimulate plasma cells (through IL-13 and IL-4) -> promote IgE
production
d) IgE will bind into mast cells and create IgE-mast cell complex
e) Th2 will also promote mast cell activity through IL-9
f) Th2 will also promote eosinophils production from the bone marrow
g) Chemotaxis will occur and attract eisonophils into the lung
h)

 Symptoms: dspynea, wheeze, chest tightness, dry irritating cough

2. Physiology of coughing
 Definition: short explosive expulsion of air
 When there are irritants detected in the epithelial cells of the lungs, and they are innervated by nervus such as
RARS, SARS, and C-Fiber which are all part of vagus nerve that will return back to the medulla, specifically to the
nucleus of tractus solitarius
 Cough will be initiated if there are
o Chemical : LTD4 (leukotriene 4, to contract SMC resulting in bronchoconstriction and vasoconstriction) and
histamine (allergy)
o Mechanical: foreign body or cancer
 It will synapse with other neurons -> efferent nerve fibers (ex. Phrenic, spinomotor, recurrent laryngeal)
 This will make the effector muscle to act -> respiratory muscle, laryngeal muscle, brochial smooth muscle
 Three main phases:
o Inspiratory phase: stretch expiratory muscle -> increase oressure
o Compress phase : glottis closes but respiratory muscle contracts -> increase even more pressure
o Expiratory phase : glottis opens air is pushed out because of high pressure

3. Spirometry
 X axis : time, y axis: lung volume
 FVC = forced vital capacity, FEV1=forced expiratory volume 1