‫تقرير بحث‬

‫حول‪:‬‬
‫‪pathophysiology of asthma‬‬
‫تقديم الطالب ‪:‬‬
‫محمد علي حريج كشكول‬
‫المرحلة ‪ :‬الرابعة _ مسائي‬
‫بأشراف ‪:‬‬
‫د‪.‬مهدي مرشد‬
 Asthma
Definition

 Reactive airway disease

 Chronic inflammatory lung disease
Inflammation causes varying degrees of
obstruction in the airways
 Asthma is reversible in early stages
 Triggers of Asthma

 Allergens
 Exercise
 Respiratory Infections
 Nose and Sinus problems
 Drugs and Food Additives
 GERD
 Emotional Stress
Early and Late Phases of Responses of
Asthma

Fig. 28-1
 Asthma
Pathophysiology

 Bronchospasm
 Airway inflammation
 Asthma
Pathophysiology

Early-Phase Response
 Peaks 30-60 minutes post exposure, subsides 30-

90 minutes later
 Characterized primarily by bronchospasm

 Increased mucous secretion, edema formation,

and increased amounts of tenacious sputum

 Patient experiences wheezing, cough, chest

tightness, and dyspnea

 Asthma
Pathophysiology
Late-Phase Response
 Characterized primarily by inflammation
 Histamine and other mediators set up a self-
sustaining cycle increasing airway reactivity
causing hyperresponsiveness to allergens and
other stimuli
 Increased airway resistance leads to air trapping
in alveoli and hyperinflation of the lungs
 If airway inflammation is not treated or does not
resolve, may lead to irreversible lung damage
Factors Causing Airway Obstruction in
Asthma

Fig. 28-3
 Summary of Pathophysiologic
Features

 Reduction in airway diameter

 Increase in airway resistance r/t
 Mucosal inflammation
 Constriction of smooth muscle
 Excess mucus production
 Asthma
Clinical Manifestations

 Unpredictable and variable

 Recurrent episodes of wheezing,

breathlessness, cough, and tight chest
 Asthma
Clinical Manifestations

 Expiration may be prolonged from a

inspiration-expiration ratio of 1:2 to 1:3 or
1:4

 Between attacks may be asymptomatic

with normal or near-normal lung function
 Asthma
Clinical Manifestations

 Wheezing is an unreliable sign to gauge

severity of attack
 Severe attacks can have no audible
wheezing due to reduction in airflow
 “Silent chest” is ominous sign of
impending respiratory failure
 Asthma
Clinical Manifestations

Difficulty with air movement can create a

feeling of suffocation
 Patient may feel increasingly anxious
 Mobilizing secretions may become difficult
 Asthma
Clinical Manifestations
Examination of the patient during an acute
attack usually reveals signs of hypoxemia
 Restlessness
 Increased anxiety
 Inappropriate behavior
 Increased pulse and blood pressure
 Pulsus paradoxus (drop in systolic BP during
inspiratory cycle >10)
 Asthma
Complications
Status asthmaticus
 Severe, life-threatening attack refractory

to usual treatment where patient poses

risk for respiratory failure
 Asthma
Diagnostic Studies

 Detailed history and physical exam

 Pulmonary function tests
 Peak flow monitoring
 Chest x-ray
 ABGs
 Asthma
Diagnostic Studies

 Oximetry
 Allergy testing
 Blood levels of eosinophils
 Sputum culture and sensitivity
 Asthma
Drug Therapy
Antiinflammatory drugs
 Corticosteroids

 Do not block immediate response to

allergens, irritants, or exercise
 Do block late-phase response to subsequent
bronchial hyperresponsiveness
 Inhibit release of mediators from
macrophages and eosinophils
 Asthma
Drug Therapy
Anti-inflammatory drugs
 Mast cell stabilizers (e.g., cromolyn, nedocromil)
 Inhibit release of histamine

 Inhibit late-phase response

 Long-term administration can prevent and reduce

bronchial hyper-reactivity
 Effective in exercise-induced asthma when used 10
to 20 minutes before exercise
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