ASTHMA

Teacher : Yanli Zhang Department : the Third hospital affiliated to ZhengZhou University

OUTLINE
Introduction Laboratory evaluation Pathogenesis Diagnosis PathophysiologyTreatment Pathology Status asthmaticus therapy Clinical manifestations Prevention
recurrence

1. Introduction
Asthma is a chronic inflammation,
which mast cells and eosinophils have key roles. Asthma is a leading cause of chronic illness in childhood. Before puberty, approximately twice as many boys as girls are affected

Three features of asthma
Chronic inflammation of airway. Hyperreactivity of the airways to a
variety of stimuli.

High degree of reversibility of the
obstructive process.

2. Pathogenesis
Data on the inheritance of asthma
are most compatible with polygenic or multifactorial determinants. A genetic predisposition combined with environmental factors may explain most cases of childhood asthma.

3. Pathophysiology
chemical mediators
bronchoconstriction, mucosal edema,excessive secretions

Airway obstruction
Nonuniform ventilation

hyperinflation
Decreased complicance Increased work of breathing

atelectasis
Decreased surfactant

Ventilation and perfusion mismatch acidosis

Pulmoary vasoconstriction

Alveolar hypoventilation

↑Pco2 ↓Po2

4. Pathology
Airway of mild asthma has no pathology. The pathology of severe asthma includes
bronchoconstriction, bronchial smooth muscle hyertrophy, mucus gland hypertrophy, mucosal edema, infiltration of inflammatory cell, eosinophils, neutrophils, basophils, macrophages, and desqumation.

5. Clinical manifestations
The onset of an asthma exacerbation may
be acute or insidious during younger childhood. Acute episodes are most often caused exposure to irritants or allergens. Exacerbation precipitated by viral respiratory infections are slower in onset.

Signs and symptoms of asthma Cough, wheezing, tachypnea, dyspnea
with prolonged expiration and use of accessory muscles of respiration, cyanosis, hyperinflation of the chest, tachycardia. Wheezing may be absent in extreme respiratory distress, only after bronchodilator treatment wheeze can occur again.

Between exacerbations the child
may be entirely free of symptoms and have no evidence of pulmonary disease on physical examination.

A barrel chest deformity is a sign
of the chronic, unremitting airway obstruction of severe asthma.

6. Laboratory evaluation
Eosinophilia of the blood and
sputum occurs with asthma, eosinophil more than 300*106/L in peripheral blood.

IgE levels may be increased,
especially specific IgE.

Allergy skin testing Inhalation bronchial challenge testing Bronchial dilator test Pulmonary function testing peak expiratory flow rate (PEFR)↓
forced expiratory volume in 1 sec (FEV1)↓

7. Diagnosis
Asthma during
younger than 3 years old

Asthma during
older than 3 years old

Cough variant asthma

7.1 Asthma during younger than 3 years old
Wheezing attack more than 3 sequencs;
3 scores Wheezing occur in pulmonary; 2 scores Wheezing attack suddenly; 1 score Other atopy disease; 1 score First or second relatives have asthma,1score

Evaluation standards
Total scores more than 5 can be
diagnosed asthma during younger children. Total scores less than 4 need Inhalation bronchial challenge testing or bronchial dilator test, if test is positive can add 2 scores.

7.2 Asthma during older than 3 years old

Wheezing attack recurrently When wheezing attack, wheeze
occur in pulmonary Bronchioldilator is effective Exclude other pulmonary diseases than lead to wheeze

7.3 Cough variant asthma
Cough attack currently or continually
longer than 1 month, often in the morning or at night, exacerbate after exercise, little sputum. Without inflammation sign or long antibiotic is not effective.

Bronchioldilator is effective Person or family allergy
Exclude other pulmonary diseases
than lead to wheeze

8. Treatment
Avoiding allergens; desensitizer Improving bronchioldilator Reducing mediator-induced
inflammation Systemic or topical inhaled medications are used, depending on the severity of the episode.

Bronchioldilator
β2 -agonist : salbutamol 0.01~0.03ml/kg,
inhalation after 2~3ml NS diluting. Theophylline 4~5mg/kg Inhalation of bronchioldilator aerosols is rapidly effective in reliving symptoms and signs of asthma.

Hormone therapy
 Inhalation of dexamethasone or
beclomethasone 100ug every time,2~4 times every day.

In general , hormone therapy only
used in severe asthma or attack continually.

9.Status asthmaticus therapy
If a patient continues to have significant respiratory distress despite administration of sympathomimetic drugs with or without theophyline, the diagnosis of status asthmatics should be considered, which is defined by increasingly severe asthma that is not responsive to drugs that are usually used.

Principle therapy
Inhalation of oxygen: concentration
40%, 4~5L/min Fluid therapy and rectify disturbances in acid-base status Inject hormone Bronchioldilator Mechanical ventilation

Adaptability of mechanical ventilation
Severe and continual dyspnea. Respiratory reduce and subsequently
wheeze disappear. Respiratory muscles are so fatigue than movement of thorax is limited. Unconscious, even coma cyanosis even after Inhaling 40% oxygen

10. Prevention recurrence
Desensitization Education and management by
parents

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