Asthma
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Asthma as PDF for free.
More details
- Words: 714
- Pages: 29
ASTHMA Teacher ： Yanli Zhang Department ： the Third hospital affiliated to ZhengZhou University
OUTLINE Introduction Laboratory evaluation Pathogenesis Diagnosis PathophysiologyTreatment Pathology Status asthmaticus therapy Clinical manifestations Prevention recurrence
1. Introduction Asthma is a chronic inflammation, which mast cells and eosinophils have key roles. Asthma is a leading cause of chronic illness in childhood. Before puberty, approximately twice as many boys as girls are affected
Three features of asthma Chronic inflammation of airway. Hyperreactivity of the airways to a variety of stimuli.
High degree of reversibility of the obstructive process.
2. Pathogenesis Data on the inheritance of asthma are most compatible with polygenic or multifactorial determinants. A genetic predisposition combined with environmental factors may explain most cases of childhood asthma.
3. Pathophysiology chemical mediators bronchoconstriction, mucosal edema,excessive secretions
Airway obstruction Nonuniform ventilation
atelectasis Decreased surfactant
Pulmoary vasoconstriction
Ventilation and perfusion mismatch
hyperinflation Decreased complicance Increased work of breathing
acidosis
Alveolar hypoventilation
↑Pco2 ↓Po2
4. Pathology Airway of mild asthma has no pathology. The pathology of severe asthma includes bronchoconstriction, bronchial smooth muscle hyertrophy, mucus gland hypertrophy, mucosal edema, infiltration of inflammatory cell, eosinophils, neutrophils, basophils, macrophages, and desqumation.
5. Clinical manifestations The onset of an asthma exacerbation may be acute or insidious during younger childhood. Acute episodes are most often caused exposure to irritants or allergens. Exacerbation precipitated by viral respiratory infections are slower in onset.
Signs and symptoms of asthma Cough, wheezing, tachypnea, dyspnea with prolonged expiration and use of accessory muscles of respiration, cyanosis, hyperinflation of the chest, tachycardia. Wheezing may be absent in extreme respiratory distress, only after bronchodilator treatment wheeze can occur again.
Between exacerbations the child may be entirely free of symptoms and have no evidence of pulmonary disease on physical examination.
A barrel chest deformity is a sign of the chronic, unremitting airway obstruction of severe asthma.
6. Laboratory evaluation Eosinophilia of the blood and
sputum occurs with asthma, eosinophil more than 300*106/L in peripheral blood.
IgE levels may be increased, especially specific IgE.
Allergy skin testing Inhalation bronchial challenge testing Bronchial dilator test Pulmonary function testing peak expiratory flow rate (PEFR)↓ forced expiratory volume in 1 sec (FEV1)↓
7. Diagnosis Asthma during younger than 3 years old
Asthma during older than 3 years old
Cough variant asthma
7.1 Asthma during younger than 3 years old Wheezing attack more than 3 sequencs; 3 scores Wheezing occur in pulmonary; 2 scores Wheezing attack suddenly; 1 score Other atopy disease; 1 score First or second relatives have asthma,1score
Evaluation standards Total scores more than 5 can be diagnosed asthma during younger children. Total scores less than 4 need Inhalation bronchial challenge testing or bronchial dilator test, if test is positive can add 2 scores.
7.2 Asthma during older than 3 years old
Wheezing attack recurrently When wheezing attack, wheeze occur in pulmonary Bronchioldilator is effective Exclude other pulmonary diseases than lead to wheeze
7.3 Cough variant asthma Cough attack currently or continually
longer than 1 month, often in the morning or at night, exacerbate after exercise, little sputum. Without inflammation sign or long antibiotic is not effective.
Bronchioldilator is effective Person or family allergy Exclude other pulmonary diseases than lead to wheeze
8. Treatment Avoiding allergens; desensitizer Improving bronchioldilator Reducing mediator-induced inflammation Systemic or topical inhaled medications are used, depending on the severity of the episode.
Bronchioldilator β2 -agonist : salbutamol 0.01~0.03ml/kg, inhalation after 2~3ml NS diluting. Theophylline 4~5mg/kg Inhalation of bronchioldilator aerosols is rapidly effective in reliving symptoms and signs of asthma.
Hormone therapy Inhalation of dexamethasone or beclomethasone 100ug every time,2~4 times every day.
In general , hormone therapy only used in severe asthma or attack continually.
9.Status asthmaticus therapy If a patient continues to have significant respiratory distress despite administration of sympathomimetic drugs with or without theophyline, the diagnosis of status asthmatics should be considered, which is defined by increasingly severe asthma that is not responsive to drugs that are usually used.
Principle therapy Inhalation of oxygen: concentration 40%, 4~5L/min Fluid therapy and rectify disturbances in acid-base status Inject hormone Bronchioldilator Mechanical ventilation
Adaptability of mechanical ventilation Severe and continual dyspnea. Respiratory reduce and subsequently wheeze disappear. Respiratory muscles are so fatigue than movement of thorax is limited. Unconscious, even coma cyanosis even after Inhaling 40% oxygen
10. Prevention recurrence Desensitization Education and management by parents
OUTLINE Introduction Laboratory evaluation Pathogenesis Diagnosis PathophysiologyTreatment Pathology Status asthmaticus therapy Clinical manifestations Prevention recurrence
1. Introduction Asthma is a chronic inflammation, which mast cells and eosinophils have key roles. Asthma is a leading cause of chronic illness in childhood. Before puberty, approximately twice as many boys as girls are affected
Three features of asthma Chronic inflammation of airway. Hyperreactivity of the airways to a variety of stimuli.
High degree of reversibility of the obstructive process.
2. Pathogenesis Data on the inheritance of asthma are most compatible with polygenic or multifactorial determinants. A genetic predisposition combined with environmental factors may explain most cases of childhood asthma.
3. Pathophysiology chemical mediators bronchoconstriction, mucosal edema,excessive secretions
Airway obstruction Nonuniform ventilation
atelectasis Decreased surfactant
Pulmoary vasoconstriction
Ventilation and perfusion mismatch
hyperinflation Decreased complicance Increased work of breathing
acidosis
Alveolar hypoventilation
↑Pco2 ↓Po2
4. Pathology Airway of mild asthma has no pathology. The pathology of severe asthma includes bronchoconstriction, bronchial smooth muscle hyertrophy, mucus gland hypertrophy, mucosal edema, infiltration of inflammatory cell, eosinophils, neutrophils, basophils, macrophages, and desqumation.
5. Clinical manifestations The onset of an asthma exacerbation may be acute or insidious during younger childhood. Acute episodes are most often caused exposure to irritants or allergens. Exacerbation precipitated by viral respiratory infections are slower in onset.
Signs and symptoms of asthma Cough, wheezing, tachypnea, dyspnea with prolonged expiration and use of accessory muscles of respiration, cyanosis, hyperinflation of the chest, tachycardia. Wheezing may be absent in extreme respiratory distress, only after bronchodilator treatment wheeze can occur again.
Between exacerbations the child may be entirely free of symptoms and have no evidence of pulmonary disease on physical examination.
A barrel chest deformity is a sign of the chronic, unremitting airway obstruction of severe asthma.
6. Laboratory evaluation Eosinophilia of the blood and
sputum occurs with asthma, eosinophil more than 300*106/L in peripheral blood.
IgE levels may be increased, especially specific IgE.
Allergy skin testing Inhalation bronchial challenge testing Bronchial dilator test Pulmonary function testing peak expiratory flow rate (PEFR)↓ forced expiratory volume in 1 sec (FEV1)↓
7. Diagnosis Asthma during younger than 3 years old
Asthma during older than 3 years old
Cough variant asthma
7.1 Asthma during younger than 3 years old Wheezing attack more than 3 sequencs; 3 scores Wheezing occur in pulmonary; 2 scores Wheezing attack suddenly; 1 score Other atopy disease; 1 score First or second relatives have asthma,1score
Evaluation standards Total scores more than 5 can be diagnosed asthma during younger children. Total scores less than 4 need Inhalation bronchial challenge testing or bronchial dilator test, if test is positive can add 2 scores.
7.2 Asthma during older than 3 years old
Wheezing attack recurrently When wheezing attack, wheeze occur in pulmonary Bronchioldilator is effective Exclude other pulmonary diseases than lead to wheeze
7.3 Cough variant asthma Cough attack currently or continually
longer than 1 month, often in the morning or at night, exacerbate after exercise, little sputum. Without inflammation sign or long antibiotic is not effective.
Bronchioldilator is effective Person or family allergy Exclude other pulmonary diseases than lead to wheeze
8. Treatment Avoiding allergens; desensitizer Improving bronchioldilator Reducing mediator-induced inflammation Systemic or topical inhaled medications are used, depending on the severity of the episode.
Bronchioldilator β2 -agonist : salbutamol 0.01~0.03ml/kg, inhalation after 2~3ml NS diluting. Theophylline 4~5mg/kg Inhalation of bronchioldilator aerosols is rapidly effective in reliving symptoms and signs of asthma.
Hormone therapy Inhalation of dexamethasone or beclomethasone 100ug every time,2~4 times every day.
In general , hormone therapy only used in severe asthma or attack continually.
9.Status asthmaticus therapy If a patient continues to have significant respiratory distress despite administration of sympathomimetic drugs with or without theophyline, the diagnosis of status asthmatics should be considered, which is defined by increasingly severe asthma that is not responsive to drugs that are usually used.
Principle therapy Inhalation of oxygen: concentration 40%, 4~5L/min Fluid therapy and rectify disturbances in acid-base status Inject hormone Bronchioldilator Mechanical ventilation
Adaptability of mechanical ventilation Severe and continual dyspnea. Respiratory reduce and subsequently wheeze disappear. Respiratory muscles are so fatigue than movement of thorax is limited. Unconscious, even coma cyanosis even after Inhaling 40% oxygen
10. Prevention recurrence Desensitization Education and management by parents
