2. Definition
❖A chronic inflammatory disorder of the airways, in which
many cells and cellular elements play a role(eosinophils ,
❖T lymphocytes, macrophages , neutrophils and epithelial
❖ cells )
❖ Chronic inflammation is associated with airway
❖ hyper-responsiveness that leads to recurrent episodes of
wheezing, breathlessness, chest tightness and coughing,
particularly at night and in the early morning.
3. Theories about its etiology
❖the hygienic theory suggest : less childhood infection
decrease in transformation of Th2 to Th1 lymphocyte this
lead to direct these cells ( Th2 ) to allergic immune response.
❖atopy theory : atopic bases through ( IgE ) mediated.
4. Pathophysiology of asthma
It is multifactorial including interaction between the Genetic ,
environment and psychological factors:
A=Genetic susceptibility classified into
1- EXTRINSIC (ATPOIC) ASTHMA : this type characterized by
early onset , associated with other atopy ( produce high Ig E on
challenge) such as allergic rhinitis , eczema ,the prick skin tests for
allergy usually +ve in 20- 25 % of 1st degree relatives of asthmatic,
most of patients cured in 10-20 years old .
5. .
B=environmental factors these are important when the
patient migrates from one country to other area .The
environment factors can be one of :
-INDOOR factors : this is important in early ( atopic) asthma
where sensitization to house dust , mites, pets , fungal spores
and exposure to cigarette smoke soon after birth.
2-INTRINSIC ( NON –ATOPIC ) ASTHMA: late onset ,usually
persistent ( not cured).
6. -OUTDOOR factors : exposure to NO2 ,Ozone ,Sulphur
dioxide ,wood dust.
-DRUGS : 10 % of patients develop asthma after NSAID (
aspirin ingestion may precipitate asthma especially those
children with nasal polyps) , Beta blockers also can
induce asthma.
-VIRAL INFECTION : viral infections can cause asthmatic
exacerbations such as measles ,mumps ,German measles.
7.
8. Pathological (phases )sequences of asthmatic
attack :
There are complex phases after exposure to triggering agent :
1-inhalation of allergens
2-recruitment of inflammatory cells
3-epithelial shedding
4-microvascular leakage
5- remodeling ( fibrosis)
10. Stages of asthma
According day and night sign and symptoms and PEF (peak expiratory flow)
Steps Days w/sx Night w/sx PEF
1- Mild intermittent <2/week <2/month >80
2- Mild persistent >2/week 3-4/ month >80
3- Moderate persistent Daily >5/month 60-80
4- Severe persistent Continual Frequent <60
11. Investigation of asthma
These tests are used to check the severity and reversibility of
airways obstruction٫ these tests include:
1- spirometry
2- PEF (peak expiratory flow)
3- Standard PFT ( pulmonary function test )
4 - Chest X-ray
5- Arterial blood gases
12. MANAGEMENT OF ASTHMA
Goals of asthma treatment are :
• prevent death and maintain normal life by control of the
diseases .
• prevent complication .
• avoidance of ppt factors .
• limit the drug side effects .
13. The management of asthma is mainly determined by the
clinical state ,it includes :
1-patient education : the patient should be informed about
the nature of the disease , how to avoid stimulus factors
such passive smoking , the proper use of inhaler devices.
2-Drug treatment :
-Controllers ( inhibit inflammation).
-Bronchodilators.
14. Stepwise approach to asthma therapy according to the
severity of asthma and ability to control symptom. ICS,
inhaled corticosteroids; LABA, long-acting B2-agonist;
OCS, oral corticosteroid.
15. HOW TO TREAT ACUTE ASTHMATIC ATTACK
1- High O2 concentration.
2- High dose of inhaled B2 agonist such as Salbutamol given
as nebulized can repeated every30 min.
3- systemic steroid : Hydrocortisone 200mg IV.
4- aminophyline 200 mg IVI (given if little response to
other).
5- mechanical ventilation may be indicate.
16. Complication of asthma
❖ Poorly controlled severe asthma and untreated asthma
attacks can lead to respiratory failure, which is potentially
fatal. Untreated asthma can also lead to chronic inflammation
of the lungs and airway remodeling (structural changes in the
airways).
17. Prognosis of asthma
❖Most adults with asthma achieve good or very good control
of their disease and are able to lead a normal life, punctuated
only by the need to take small amounts of regular medication
and by occasional exacerbations.
