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
