Bronchial asthma Asthma is defined as a chronic inflammatory disease of airways that is characterized by increased responsiveness of the tracheobronchial tree

e to a multiplicity of stimuli. It is manifested physiologically by a widespread narrowing of the air passages, which may be relieved spontaneously or as a result of therapy, And clinically by of dyspnoea, cough, chest tightness and wheezing.

Types A). Clinically Episodic asthma- symptom free in between Episodes Severe acute asthma- live threatening attacks of Dyspnoea Chronic asthma- persistence of Symptoms without any symptom free period B). Aetiologically Extrinsic Asthma (Early onset Asthma/Allergic/Atopic Asthma)Specific immunoglobulin (IGE) are produced in response to allergens Intrinsic Asthma (Late onset Asthma/ idiosyncratic/Non Atopic Asthma) There is no role of allergen in the production of disease. Mixed

EXTRINSIC : - Atopic or allergic : Most common form Usually begins in childhood and have personal & family history of allergies to pollens, dusts, animal dander, moulds some chemical fumes if working in a factory. They have high level of IgE and gives positive skin test with the specific allergen representing Type I hypersensitivity mediated by IgE antibodies.

This is type I reaction which may be immediate & late

Immediate response : - Occurs within minutes Binding of antigen (allergen) with Ig E coated mast cells & releasing Primary mediators Histamine, neutrophil chemotatic factor, eosinophil chemotactic factor & Secondary mediators Cytokines IL-1, TNF & IL6, LeukotrienesB4,C4,D4, Prostaglandin D2, Platelet activating factor There is bronchospasm, eodema, mucus secretion , & infiltration of leucocytes They release a second wave of mediators that cause late reaction

Late phase response : This follows the acute phase. This is due to excessive mobilization of neutrophils, eosinophils and basophils. This results in a continuous & prolonged release of mediators, which accentuate the above mentioned effects. Thers is persistant bronchospasm, oedema, leucocyte infiltration & necrosis of epithelial cells

2) Intrinsic or Idiosyncratic, non atopic : This has been seen in persons due to some unknown intrinsic reason because they do not have any personal or family history of allergies, they are of negative skin test, normal serum IgE in their adult life 3) Mixed type : - Many patient do not clearly fit into any single type having features of both.

Pathophysiological features of Asthma Airway hyper responsiveness- exaggerated Bronchial constriction to a wide range of non-Specific stimuli e.g. exercise, cold air. Airway Inflammation- Muscle thickness, Oedema, increased mucous secretion, mucous plugging, epithelial damage. Airflow limitation- usually reverses spontaneously or with treatment

Morphology

Grossly:
1. The lungs are remarkably distended with air. 2. The airways are filled with thick, tenacious, adherent mucous plugs.

3. Lungs are over inflated with occlusion of air passages by viscid mucus plugs.

cast of the bronchial tree inspissated mucus coughed up by a patient during an asthmatic attack mucus plugs block airways

Microscopically: 1. Plugs contain strips of epithelium and many eosinophils, needle-like Charcot-Leyden crystals, the Curschmann spirals.

Microscopically cont.. 2. Bronchial submucosal mucous glands are hyperplastic. An increase in goblet cells. 3. The epithelial BM appears thickened. 4. The mucosa is edematous and contains a mixed inflammatory infiltrate, including eosinophils. 5. Hyperplasia of bronchial smooth muscle.