Programas Educativos " Control del Asma Bronquial

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Programas Educativos " Control del Asma Bronquial"

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NEW !
Clínica de Asma y Alergia Managua, Nicaragua.
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Latest Revision ² Oct 2007 (EPR-3) Adaptaciones para la práctica en Nicaragua , febrero 2012.

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Evidencias de un nuevo paradigma

Remodelamiento.

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€

Reality of pulmonary biochemistry
¾ Mucosal layer x Potential for secretions ¾ Sub-mucosal layer x Potential for mucosal edema x Potential for bronchospasm

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Most common causes of narrowed airways
¾ Secretions, mucosal edema, and

bronchospasm

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Airway Inflammation € Bronchial Hyperresponsiveness € Bronchoconstriction € Bronchial Wall Edema € Excess Mucous Secretions € Airway Remodeling
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TRIGGER q INFLAMMATORY RESPONSE q AIRWAY CHANGES q RESPIRATORY SYMPTOMS
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Type I Hypersensitivity
¾ Immediate Type Hypersensitivity ¾ Involves IgE antibody on mast cell

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Type IV Hypersensitivity
¾ Delayed Type Hypersensitivity ¾ Involves T cell mediated response ¾ Other immune system cells activated

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Early Phase Response
¾ Involves Type I Hypersensitivity ¾ IgE antibody with Mast Cells

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Late Phase Response
¾ Involves Type IV Hypersensitivity ¾ T cell mediated response activates

eosinophils, B cells, others

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Airway hyperresponsiveness³an exaggerated bronchoconstrictor response to a wide variety of stimuli³is a major, but not necessarily unique, feature of asthma
¾ Defined by contractile responses to challenges with methacholine correlates with the clinical severity of asthma ¾ Influenced by inflammation, dysfunctional neuro-regulation, and structural changes

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Treatment directed toward reducing inflammation can reduce airway hyperresponsiveness and improve asthma control.
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‡ ‡

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Dominant physiological event leading to clinical symptoms Allergen-induced acute bronchoconstriction results from an IgE-dependent release of mediators from mast cells Non-IgE dependent bronchoconstriction can be caused by other stimuli including
± ± ± ±

Irritants Exercise Cold air Aspirin and other nonsteroidal anti-inflammatory drugs

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Stress may also play a role in precipitating bronchoconstriction
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As the disease becomes more persistent and inflammation more progressive, other factors further limit airflow These include edema, inflammation, mucus hypersecretion and the formation of inspissated mucus plugs, as well as structural changes including hypertrophy and hyperplasia of the airway smooth muscle. These latter changes may not respond to usual treatment.
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Vascular Dilation Subbasement Membrane Thickening Mucus Mucous Gland Hypertrophy

Edema

Subepithelial Fibrosis Epithelial Damage Inflammatory Cell Infiltration
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Smooth Muscle Hypertrophy
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In some persons who have asthma, airflow limitation may be only partially reversible
± The process of repair and its regulation are

likely to be key events in explaining the persistent nature of the disease and limitations to a therapeutic response ± Structural changes can include thickening of the sub-basement membrane, subepithelial fibrosis, airway smooth muscle hypertrophy and hyperplasia, blood vessel proliferation and dilation, and mucous gland hyperplasia and hypersecretion
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€ € € € € € €

Taken together, these longitudinal epidemiological studies and clinical trials indicate that the progression of asthma, as measured by declines in lung function, varies in different age groups. Declines in lung function growth observed in children appear to occur by 6 years of age and occur predominantly in those children whose asthma symptoms started before 3 years of age. Children 5²12 years of age who have mild or moderate persistent asthma, on average, do not appear to experience declines in lung function through 11²17 years of age, although a subset of these children experience progressive reductions in lung growth as measured by FEV1.
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START study € As knowledge of the various phenotypes of inflammation become € apparent, it is likely that treatment also will also have greater specificity and, presumably
€ The

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Wheezing
‡ tightness ‡ noisy breathing

Cough
especially if € after exertion € breathing cold air € at night € after colds € paroxysmal

Dyspnea
(Breathlessness)

Asthma

especially if: intermittent or variable after exertion at night

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Early warning signs are changes that happen just before or at the very beginning of an asthma episode. These changes start before the well-known symptoms of asthma and are the earliest signs that a person·s asthma is worsening. In general, these signs are not severe enough to stop a person from going about his or her daily activities. By recognizing these signs, you can stop an asthma episode or prevent one from getting worse.
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Frequent cough, especially at night Losing your breath easily or shortness of breath Feeling very tired or weak when exercising Wheezing or coughing after exercise Feeling tired, easily upset, grouchy, or moody Decreases or changes in a peak expiratory flow

Know These Warning Signs!

Signs of a cold, upper respiratory infection, or allergies (sneezing, runny nose, cough, congestion, sore throat, and headache) 



Trouble sleeping or Restless Tickle in throat
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Managua , Nicaragua € Email: jhsdoctor@hotmail.com
€

€ Tel

2278 1169 ¾ 2270-3359 ¾ 8846-5022 ¾ 8882-5513
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Gracias por la oportunidad
Clínica de Asma y Alergia, Dr. Juan Herrera Salazar«Facebook

Managua , Nicaragua. Tel 22781169, 22703359, 88825513

Dr. Juan Herrera Salazar
Favor ver la III Parte«

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€

Clínica de Asma y Alergia, Dr. Juan Herrera Salazar«Facebook.

Foro Médico Nicaragüense € Portales Médicos
€

Medbook € Mi blog de Asma y Alergia
€

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