Asthma

ix. Definition

4 A condition characterized by episodes of reversible airway narrowing associated with contraction of smooth

muscle within airway wall . Only in children 75 years old

children ( 5 years old : recurrent lower respiratory tract infections ,

chronic rhino sinusitis . tuberculosis , congenital

malformations ,
foreign aspirations

↳ Status asthmatic us : worsening of acute asthma that is not responsive to first line treatments with broncho dilators .

( characterized by
hypoxemia ,

↳ Characteristics of clinical asthma :

Airway obstruction ( reversible )
hypercarbia and secondary
.

respiratory failure
-

Inflammation

.
Hyperresponsiveness

* Etiology

Genetic predisposition :
family history of atopy ( I > OT )
gender

)
. .

.
Exposure of tobacco smoke . breastfeeding

. viral respiratory tract infections . Antibiotic use

"" "" ""

"

! III: :
-
chronic sinusitis

.
Use of aspirin and beta blocker

. Obesity

-
Emotional factors or stress

Environmental allergens

} allergic
.

. Insects ,
plants and chemical fumes
(
pollens

ix.
.
Pathophysiology 4Th 2 cells → T IL y-
,
it -
5 , IL -
g ,
IL 13-
→ Promote eosinophilic

inflammation and IgE production → trigger release of histamine and

I VI Q mismatch chronic
cysteinyl leukotriene

AGO may show respiratory alkalosis ( t Oz & IPC Oz )

 potential chemical mediators : .
Histamine

. leukotriene ( LTC y ,
LTDY . IT Ey )
aspirin & NSAIDs

'
Platelet activating factor

. Prostaglandins

.
Eosinophilic chemotactic factor of anaphylaxis

.
Neutrophil chemotactic factor of anaphylaxis

.
Bradykinin

.
Serotonin ( potent broncho constrictors
✓

preferential shifting to

. Kaki Krein production of leukotriene

t
ASTHMA
exacerbate

K
-
. Phenotypes
FF
. Allergic asthma : commences in childhood w/ family or past history of allergic diseases

. Non -
allergic asthma i sputum shows eosinophils ,
neutrophils and few inflammatory cells

. Adult onset ( late onset ) asthma :

I 7 or

. Asthma with persistent airflow limitation : due to airway remodelling

. Asthma with obesity : little eosinophilic airway inflammation

* .
Pathology

Anatomical : overdistended lungs ,

occluded airways by thick ,
tenacious mucous plugs

Histological : . Edema a cellular infiltrates within bronchial wall ( eosinophils and lymphocytes )

.
Epithelial damage

-
Hypertrophy a hyperplasia of smooth muscle layer

. increased deposition of collagen in the layer beneath epithelium

MUCOUS glands and t goblet cells

.
Hypertrophy of
¥ Clinical features

cough / early morning Santer syndrome / aspirin exacerbated respiratory disease

{
-

worse at night in the - :

-
dyspnea / SOB trimer 'd " ""d ' infection " "" weather ' exercise ' '
Nasal POLYPOSIS
allergen exposure weather changes laughter , irritants,
, ,

-
wheezing smokes or strong smells .
.
Asthma

-
chest tightness
. Aspirin sensitivity

status asthmatic Us : severe attack in patients that is refractory to treatment

Classification

Diagnosis

OF ↳ PF : .
expiratory wheezing on auscultation on Forced

c - expiration
-

wheezing 1 silent chest

-

( old : COPD , laryngeal obstruction , respiratory

infections tracheomalacia inhaled
, ,

foreign body
stiffen on index

↳ Allergy testing

7201 di pop ,
.
(
LABA

72 Mcg form Otero 1 Max ,

④
symbicort
 PDPI
50 MY 250 Mg
( r
i Ob at controller → Seretide ( salmeterol t fluticasone )
↳ ICS , systemic corticosteroid , sodium kromoglikat dan sodium hedokromil teofilin lepas 1am bat , ,
beta
,
-
agonist ,

ketotifenatauantialergi

Corticosteroid

Berdasarkan GINA :

1 .
Intermittent asthma :
no need

2 . Asthma w/ mild persistence : ICS 200 -

400 Mcg / hari become fasone di pre pion at ,
bvdenosid

Asthma w/ moderate persistence : 800 - 2000 Mcg Inari ICS

} .

y .
Asthma w/ severe persistence : Soo -
2000 Mcg lhariatau lebih

sodium Krom 0911 Kat dan sodium Nedokromil

↳ sodium kromoglikat :
inhibit mediator release that is mediated with IgE from mast cell & selective suppression of

other inflammatory cells

Te Ofili n le pas 1am bat → NSAID -

induced asthma

↳ do sis : .
loading dose : 5 mg 1kg BB dalam lo -
15 merit

Methylamine
. maintenance dose : 20mg 1kg BB I 24 5am Max . 1500 mg 124 jam
,

. therapeutic dose : 10 -
20mg 1dL

is fide effects : much ,

mvntdh , kejang ,
kemalian ,
takikardi ,
aritmia

LABA

I s al meteorol
-

↳ e. g . form Otero I

leukotriene s receptor antagonist 3dd ?

LAMA =

4 dos is se di aan : 20mg dan 10 Mg b. i. d

-7 0 bat reliever

SABA Ventolin 2 ddl puff Kala U nebu 3 ddt puff Kal au dia
.
: t glucocorticoid ga gerak Ce Pat

. Systemic corticosteroid

4 30mg 1 day prednisone for 5 -

10 days

.
Anticholinergic

4 e.g . ipratropiumbromida ,
oxitroprium bromide

↳ mo A .
broncho dilator that block efferent vagal nerve

side effects : Munt Kering dan rasa tidakenak

↳
- Short acting theophylline

Kon trot asma : .

Gejala Kron is minimal t nocturnal symptoms

. minimal exacerbations

-
tidal per nah ke IGD

"
Minimal ( or none ) needs for Bz
-
agonist

. No physical restrictions

.
Varia si circadian PEF 2201 .

- PEF normal / Close to normal

.
Minimal side effects from drugs