Bronchial asthma :-is chronic inflammatory condition of the lung air way resulting in
a episodic air flow obstruction ( this is resulting heightens the
twitchiness of the air way ( air way hyper responsiveness to
.provocative exposure
Or is defined as a paroxysmal , diffuse obstructive
lung dis with hyper-reactivity of the air way to variety of
stimuli & high degree of reversibility of the obstructive
Process which may occur either spontaneously or by
---treatment .
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Asthma management is aimed of reducing air way inflammation :-1- minimizing post inflammation environmental exposures.
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2- using daily controller ( anti inflammatory medication
, control comorbid condition that can worsen asthma ( rhinitis -3
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) sinusitis & G.O.R
.Less inflam is better control with fewer exacerbation •
:--Trigger factors of asthma •
respiratory tract infection like RSV, influenza & para influenza, - 1-1
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rhino virus
, aero allergen in sensitized asthma like ( animal dander -2
indoor allergen(dust mite , molds, cockroaches ) , seasonal aero
) allergen ( trees , grass , weeds
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environmental tobacco smoke -3
air pollution ( sulfure dioxide ,dust , wood , coal burning -4
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)smoke & endotoxin
cold & dry air
6- exercise
7-strong & noxious odor-5
fumes.
8- comorbid condition
9-drug administration
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.(aspirin, NSAID, B-blocker
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;risk factors for persistant asthma in early childhood
parental asthma . 2-allergy ( eczema ,allergic rhinitis , food allergy-1
3-severLRTI as in pneumonia and bronchiolitis 4- wheezing apart
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Attack of asthma occurs in 30% in Ist year of life & 80-90% within 45years of age .
If onset in first year of age & there is family history of asthma or allergic
:- disorder
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those patients have :-- 1- growth retarded unrelated to corticosteriod
2- chest deformity secondary to hyper.inflation & persistant abnormality of PFT
:--Fate of asthma •
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:--in general , the prognosis is good in young children
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of all patients are virtually free of symptoms within 10- 50%- 1
.20years but recurrence are common in adulthood
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children who have mild asthma with onset between 2year & -2
puberty , the remission rate is about 50% & only 5% experience
.sever asthma
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children with sever asthma characterized by steroid - 3
dependant with frequent hospitalization rarely improved & about
. 95% become adult asthma
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Etiology :-the cause of childhood asthma has not been determined , implicated
a combination of environmental exposures , biological , genetic &
. immunological factors
:--Mediators release causing broncho-spasm by •
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direct action on smooth muscle 2-stimulation of vagal-1
.sensory receptor
:-Viral infection trigger asthma through •
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afferant vagal receptor-1
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IgE response to RSV which occur in both infant & children -2
( RSV & PIV trigger asthma in early life while rhino virus & influenza
.virus trigger in adult asthma
: ----Types of asthma :-- classify into •
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a- recurrent wheezing : ( trigger by common respiratory viral
) .infection in early childhood
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b- chronic asthma : associated with allergy that persist into later
.childhood and often adulthood
.C- 3rd type emerge in female who experience obesity ,early puberty •
:--Or classify into •
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extrensic asthma ( allergic type) (has positive skin test & increased-1
IGE& specific IGE agaist allergen
2- intrinsic asthma( non
Pathophysiology ;-- on overhead
ClF :-- into 2 forms ;-a- acute episode :-occurs within minutes which commonly
.happen at night due to decreased patency of air way
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it is usually follow exposures to irritant like cold air , naxious
.fumes like smoke , wet paint , allergen & drug like aspirin
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b- insidious episode :- usually proceeded by viral infection
:-ClF is variable from mild to sever as •
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respiratory distress , wheezing ( S.T without wheezing )just
,cough , may associated with abdominal pain , excessive sweating
.Vomiting is common •
In mild chronic asthma , patient is entirely normal in between attack •
:-In sever attack ( associated with danger sign ) :- characterized by •
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silent chest 2- inability to talk or walk-1
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tripod position 4-cynosis 5- exhaustion -3
:--In chronic asthma : characterized by •
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barrel chest
2- harrison sulci
3- antero lateral -1
depresion of thorax at insertion of diaphragm
4-clubbing of
.fingers which suggest cystic fibrosis
--5--
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Diagnosis :-1- clinical diagnosis by a- recurrent episodic of wheezing or
+ ) coughing ( S.T only persistent cough
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+ b-rapid improvement with using bronchdilator
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c-+ve family history of atopy
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:-laboratory evaluation- 2
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a-eosinophil in blood & sputum
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IgE is increased in allergic type
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b-skin test & RAST
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exercise test- 3
chest x-ray :- ( as hyper-inflation of chest , some time atelactasis as small- 4
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.patches or may associated with pneumothorax or pneumomediastinum
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:-- indication CXR in the following
a- first attack of wheezing b- associated with high fever
c- suspected cx like pneumothorax or pneumo mediastinum
d- if resp rate of more than 60 & pulse rate of more than 160
e- localized wheeze or rales or decreased breath sound
)blood gas analysis ( elevation of pco2 is ominous sign- 5
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pulmonary function test :-important in :-- 5
a- asses degree of air way obstruction & disturbances of gas
exchange
b- in measuring response of air way to inhaled allergen , exercise ,
chemical
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c-asses response to therapeutic agent
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d-in evaluation of long term course of diseases
:-Measuring PEFR & FEV1 before therapy & after broncho-dilator •
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if increased 10% strongly suggestive asthma
:--Failure of response is not exclude asthma due to •
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status asthmaticus
2- near maximal PFT -1
Note :-it is feasible to monitor PEFR 2-3 times per day which •
.provide objective measuring of degree of air way obstruction
:--DD :--of wheezy chest •
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,infection
2- anatomical & congenital ( G.O.R, H-type fistula- 1
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cystic fibrosis , vascular ring )
3- vasculitis
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others like F.B , broncho- pulmonary dysplasia ,psychogenic -4
cough , pul thrombo embolism
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--thank you
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