Asthma

by
Farshid Mokhberi
Shahid Beheshti University of Medical Science
Asthma
Obstructive & Restrictive Lung Diseases.

Definitions:

Obstructive: Limitation of the airflow usually resulting from an

incraese in resistance due to partial or complete obstruction at
any level. Like: Asthma , Emphysema, Chronic Bronchitis

Restrictive: Reduced expansion of lung parenchyma accompanied

by decreased total lung capacity.
Definition & Basics of Ashtma
Asthma is a chronic inflammatory disorder of the airways.
This feature of asthma has implications for the diagnosis,
management, and potential prevention of the disease.
 Inflammatory airways disease
 Increased responsiveness
 Increased contraction of airway smooth muscles
 Hypersecretion of bronchial mucus
 Altered airway architecture
 Altered immunologic state, e.g., atopy
 Idiopathic
Classification of Asthma
Intrinsic Asthma Extrinsic Asthma

Non-allergic  Strong family history of allergies

Usually adult onset  Usually onset at a young age

 History of specific allergic
association triggers (e.g. pollen,
Often follows severe animal dander)
respiratory illness  Correlation with skin and
inhalation responses to specific
antigens
More refractory to treatment
 Intrinsic asthma: the absence of atopy
Symptoms are not related to seasons of the year or
identifiable allergens.
Provoked by poorly characterized respiratory tract
infections (viral infection).
Aspirin (nonsteroidal), cold dry air also provoke
asthmatic attacks and are not associated with specific
antibody production.
Once exposed and sensitized, these asthmatic can
develop chronic asthma despite avoidance of sensitizing
chemicals.
Also demonstrate nonspecific bronchial hyperactivity.
Airway Inflammation in Intrinsic
TRIGGER
↓
INFLAMMATORY
RESPONSE
↓
AIRWAY CHANGES
↓
RESPIRATORY SYMPTOMS

©2010
Extrinsic Asthma
Airway Inflammation in Extrinsic

Early Phase Response

Involves Type I Hypersensitivity

IgE antibody with Mast Cells

Late Phase Response

Involves Type IV Hypersensitivity

T cell mediated response activates eosinophils, B cells, others

 Pathophysiology
Airway inflammation
Decreased airway caliber
-Bronchoconstriction-(may cause death on its own)
-Edema of submucosal tissues
-Abnormal airway liquid (mucus plugging)
-Nonspecific hyperreactivity
Air trapping and hyperinflation (CXR and PFTs)
 V/Q mismatch compensation occurs during
exacerbations
Airway Remodeling
Vascular
Dilation Edema

Subbasement
Membrane Subepithelial
Thickening Fibrosis
Mucus Epithelial
Damage
Mucous Gland
Hypertrophy Inflammatory
Cell
Smooth Muscle Infiltration
Hypertrophy
©2010
Normal Airway Looking at Airway During Asthma
the Main Carina Exacerbation
Diagnosis
Asthma Diagnosis
Symptoms
Medical history
Physical Exam
Treatment
Treatment:
Acute:
B2 Agonist: Albuterol (short acting), Salmeterol (long
acting)
 Bronchodilation

Chronic:
Corticosteroids: Fluticasone
 Inhibits multiple inflammatory cytokines
Thank You
Refrences
http://www.webmd.com/asthma/guide/default.htm
http://www.asthma.org.uk/
http://www.mayoclinic.com/health/asthma/DS00021
http://www.nhlbi.nih.gov/health/asthma