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    Asthma: Dr. Naima Tariq Assistant Professor

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    Naima Tariq
    Asthma is a chronic inflammatory airway disease characterized by episodic bronchoconstriction, inflammation and increased mucus production. It is caused by an immunological reaction, often due to allergens, that results in hypersensitivity of the airways. The symptoms include wheezing, coughing, chest tightness and difficulty breathing that are usually reversible with treatment.

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    Asthma: Dr. Naima Tariq Assistant Professor

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    Naima Tariq
    29 views19 pages
    Asthma is a chronic inflammatory airway disease characterized by episodic bronchoconstriction, inflammation and increased mucus production. It is caused by an immunological reaction, often due to allergens, that results in hypersensitivity of the airways. The symptoms include wheezing, coughing, chest tightness and difficulty breathing that are usually reversible with treatment.

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    Asthma

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    Asthma is a chronic inflammatory airway disease characterized by episodic bronchoconstriction, inflammation and increased mucus production. It is caused by an immunological reaction, often due to allergens, that results in hypersensitivity of the airways. The symptoms include wheezing, coughing, chest tightness and difficulty breathing that are usually reversible with treatment.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    29 views19 pages

    Asthma: Dr. Naima Tariq Assistant Professor

    Uploaded by

    Naima Tariq
    Asthma is a chronic inflammatory airway disease characterized by episodic bronchoconstriction, inflammation and increased mucus production. It is caused by an immunological reaction, often due to allergens, that results in hypersensitivity of the airways. The symptoms include wheezing, coughing, chest tightness and difficulty breathing that are usually reversible with treatment.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 19

    Asthma

    Dr. Naima Tariq


    Assistant Professor
    BRONCHIAL ASTHMA
     Asthma is a chronic disorder of the conducting
    airways, usually caused by an immunological
    reaction, which is marked by episodic
    bronchoconstriction due to increased airway
    sensitivity to a variety of stimuli; inflammation of
    the bronchial walls; and increased mucus
    secretion.

    • Hyper-reactive airways
    – Episodic, reversible bronchconstriction
    Bronchial Asthma
     Clinically it is manifested by
     Wheezing
     Breathlessness
     Chest tightness
     Nighttime or early morning coughing

     Episodes are usually associated with widespread, but


    variable, airflow obstruction within the lung that is
    often reversible either spontaneously or with
    treatment.

    7/26/2019 3
    Bronchial Asthma

    • Extrinsic / Atopic / Allergic

    – Allergy to exogenous substances

    • Intrinsic / Non-atopic

    – No exogenous factors identified


    Pathogenesis of Asthma
    Pathogenesis
    • Type I HSR with exposure to extrinsic allergens
    • Initial sensitization to an inhaled allergen
    • Stimulate induction of subset 2 helper T cells (CD4 TH2)
    that release interleukin (IL)-4 and IL-5
    • IL-4 stimulates isotype switching to IgE production.
    • IL-5 stimulates production and activation of eosinophils.
    • Inhaled antigens cross-link IgE antibodies on mast cells on
    mucosal surfaces.
    • Release of histamine that stimulate bronchoconstriction,
    mucus production, influx of leukocytes
    Pathogenesis contd.
    • Late phase reaction (4–8 hours later)
    (a) Eotaxin is produced.
    Chemotactic for eosinophils and activates eosinophils
    (b) Eosinophils release major basic protein (MBP) and
    cationic protein that damage epithelial cells and produce
    airway constriction
    • Other mediators involved
    Leukotrienes LTC4-D4-E4 causes prolonged
    bronchoconstriction.
    Acetylcholine causes airway muscle contraction.
    Genetic Susceptibility.
    • It is multigenic and often associated with
    increased incidence of other allergic disorders,
    such as allergic rhinitis (hay fever) and eczema.

    • locus for asthma is located on chromosome 5q,


    near the gene cluster encoding the cytokines IL-3,
    IL-4, IL-5, IL-9, and IL-13 and the IL-4 receptor.

    • Polymorphisms in the gene encoding ADAM33.


    Histopathological changes
    • In BRONCHI
    (1) Thickening of the
    basement membrane
    (2) Edema and a mixed
    inflammatory infiltrate
    (3) Hypertrophy of
    submucosal glands
    (4)
    Hypertrophy/hyperplasia
    of smooth muscle cells
    Histopathlogic changes in the
    bronchioles
    (1) Formation of spiral-shaped mucus plugs
    (a) Contain shed epithelial cells called Curschmann spirals
    (b) Pathologic effect of MBP and cationic protein

    (2) Crystalline granules (galectin 10) in eosinophils coalesce to


    form Charcot-Leyden crystals.

    (3) Patchy loss of epithelial cells, goblet cell metaplasia

    (4) Thick basement membrane

    (5) Smooth muscle cell hypertrophy and hyperplasia


    Clinical Manifestations
    Symptoms: Signs:

     Intermittent dry cough  Expiratory wheezing


     Expiratory wheezing  Prolonged expiratory phase
     Shortness of breath  Decreased breath sounds
     Chest tightness  Crackles/ rales
     Chest pain  Nasal flaring
     Fatigue  Absence of wheezing in
     Difficulty keeping up with severe cases
    peers in physical activities
    Laboratory Findings:
     Spirometery showing Airflow Limitation:
    Low FEV1
    FEV1/ FVC ratio < 0.80

     Bronchodilator response to β-agonist:


    Improvement in FEV1 ≥ 12%

     Exercise challenge:
    Worsening of FEV1 ≥ 15%

     Daily peak flow or FEV1 AM-PM variation ≥ 20%

     Eosinophilia, positive skin tests for allergens

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