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ASTHMA

DR MESHACK SHIMWELA
definition

• Asthma is a chronic inflammatory


pulmonary disorder that is characterized
by reversible obstruction of the airways
and Airway hyper-responsiveness with
excessive mucus secretions.
epidermiology
• It is a heterogeneous disease genetic (a
topic), environmental i.e. occupational
exposure, viruses, allergens.
• Half of cases occur below age of 10years,
with male; female preponderance of 2; 1.
certain environmental exposures i.e.
exposure to glutaldehyde in endoscopy
suites and formaldehyde in darkroom
processing chemicals.
Asthma triggers
• Pharmacologic stimuli
• Infections
• Occupational factors
• Air pollution
• Exercise
• Emotional stress
• Mites
• dust.
Asthma
• The airway narrowing results from multiple
causes, including bronchial smooth muscle
contraction; mucous plugging from mucous
gland hyper secretion;
• sub mucosal, peribronchial, and interstitial
edema from loss of capillary and arteriolar
cellular interconnections; and
• cellular infiltrative changes involving plasma
cells, lymphocytes, macrophages, and
leukocytes,
asthma

• there is involvement of airway smooth


muscle mediators and anatomic elements
of the airway mucosa.
• Immune mediators, such as leukotrienes,
prostaglandins, and platelet-activating
factor, histamine and other broncho
constrictors .
Clinical features
• chest tightness or dypsnoea,
• wheezing due to airflow limitation causing
a high-pitched whistling sound, usually
heard on expiration or on inspiration.
• Cough which results from stimulation of
sensory nerves in the airways by
inflammatory mediators that are released
by various inflammatory cells.
Clinical features

• Also presents with tachypnoea,


tachycardia, mild systolic hypertension,
over inflated & increase of anteroposterior
chest diameter, paradoxical pulse, Anxiety,
Diaphoresis, and Exacerbation with
exercise.
Signs

• Barrel chest
• Global or focal wheezes, Pallor, Pulsus
paradox us,
• Use of accessory muscles,
• Exercise limitation Complications of
asthma often are more apparent than the
direct airway imaging findings that are the
sequelae of asthma.
During asthma attack

• The total lung capacity (TLC), functional


residual capacity (FRC), and residual
volume (RV) increase.
• The hallmark of airway obstruction is a
reduction in ratio of the forced expiratory
volume in 1 second (FEV1) and the FEV1
to the forced vital capacity (FVC).
effects

• the earliest effects of airway disease are


believed to occur in the small airways (<2
mm in diameter), and they are more
difficult to measure reliably with standard
pulmonary function tests (PFTs),
Lung function test in asthma
• Tests commonly used are;-
• forced expiratory flow after 50% of vital
capacity has been expelled (FEF50),
• forced expiratory flow after 25-75% of
vital capacity has been expelled (FEF25-
FEF75) and
• maximum mid expiratory flow rate
(MMEFR).
• Less common evaluations include tests of
airway resistance (RAW) and single-breath
carbon monoxide diffusion capacity
(DLCO/VA).
Peak expiratory flow

This test, an alternative to spirometry,


• Although peak expiratory flow is less
accurate than spirometry in measuring
airway obstruction, it can still play a role in
asthma diagnosis.
spirometer
ASTHMA DDX

Adults
• Laryngeal dysfunction
• Mechanical obstruction
• Chronic bronchitis and emphysema
• Left ventricular failure
• Pulmonary embolus
• Pulmonary infiltrates with eosinophilia
investigations

• spirometry,-confirmatory
• reduced forced expiratory volume in one
second (FEV1) that is reversible with
inhalation of ß-adrenergic aerosols.
• bronchial challenge tests with histamine or
methacholine will reveal bronchial
hyperresponsiveness;
investigations

• gastroesophageal reflux by barium


contrast studies or 24-hour pH monitoring
Other causes of wheeze
• Laryngeal:
• Vocal cord dysfunction syndrome, (VCDS)
Factitious asthma (malingering)
Vocal cord paralysis
Vocal cord dystonia
Vocal cord nodules or polyps
Laryngeal carcinoma
Viral or bacterial infection of epiglottis or larynx
Angioedema of epiglottis or larynx
Other causes of wheeze

• Subglottic:
• Post-tracheostomy scarring/narrowing
Post-intubation scarring/narrowing
Thyroid compression, goitrous or
cancerous
Other causes of wheeze
• Tracheal and Large Airway:
• Foreign bodies, aspirated
Bronchial adenomas
Endobronchial sarcoidosis
Bronchogenic carcinoma and endobronchial
metastases
Peribronchial lymph node compression,
infectious or cancerous
Webs
Vascular rings
Other causes of wheeze

• Small Airways:
• Bronchiolitis, infectious or idiopathic
Lymph angio leiomyomatosis
Eosinophilic granuloma/histiocytosis-x
(Langerhans’ cell disorders)
Other causes of wheeze

• Alveolar and Vascular:


• Cardiogenic pulmonary edema
Fibrosing alveolitis
Pulmonary emboli
treatment
• Quick relief medications –β-adrenergic
agonist.
• Long term control-glucocorticoids (both)
• Combined medications β-adrenergic
agonist and steroids.
• Mast cells stabilizer cromolyn, sodium
cromglycolate,
• Leukotriene modifiers –zileuton .

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