Asthma Pathology and treatment.
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    Overview  Asthma is a common chronic disease worldwide and affects approximately 24 million persons in the United States. It is the most common chronic disease in childhood, affecting an estimated 7 million children. The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness, resulting in bronchoconstriction.  Asthma symptoms, which include coughing, wheezing, and chest tightness, are common in an asthma attack. Sometimes asthma is called bronchial asthma or reactive airway disease. Asthma can be controlled with proper treatment. Etiology Factors that can contribute to asthma or airway hyperreactivity may include any of the following: ã  Environmental allergens (eg, house dust mites; animal allergens, especially cat and dog; cockroach allergens; and fungi) ã  Viral respiratory tract infections ã  Exercise, hyperventilation ã  Gastroesophageal reflux disease ã  Chronic sinusitis or rhinitis ã  Aspirin or nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, sulfite sensitivity ã  Use of beta-adrenergic receptor blockers (including ophthalmic preparations) ã  Obesity ã  Environmental pollutants, tobacco smoke ã  Occupational exposure ã  Irritants (eg, household sprays, paint fumes) ã  Various high- and low-molecular-weight compounds (eg, insects, plants, latex, gums, diisocyanates, anhydrides, wood dust, and fluxes; associated with occupational asthma) ã  Emotional factors or stress Perinatal factors (prematurity and increased maternal age; maternal smoking and prenatal exposure to tobacco smoke; breastfeeding has not been definitely shown to be protective)    Extrinsic Type I hypersensitivity reaction   Intrinsic unknown mechanism   Allergic (atopic) Respiratory infections (usually viral) Most common type Stress  Allergens: Pollen, dust, food, molds, animal dander etc Exercise Occupational exposure: fumes, gases, and chemicals Cold temperatures Drug induced (aspirin) Sputum cytology: Curschmann spirals: twisted mucous plugs admixed with sloughed epithelium. Eosinophils Charcot-Leyden crystals: composed of eosinophil membrane protein Microbiology Mucous plugs Hypertrophy of mucous glands with goblet cell hyperplasia Inflammation (especially eosinophils) Edema Hypertrophy and hyperplasia of bronchial wall smooth muscle Thickened basement membranes    Pathophysiology The pathophysiology of asthma is complex and involves the following components: ã  Airway inflammation ã  Intermittent airflow obstruction ã  Bronchial hyperresponsiveness Signs and Symptoms People with asthma experience symptoms when the airways tighten, inflame, or fill with mucus. Common asthma symptoms include: ã  Coughing, especially at night ã  Wheezing ã  Shortness of breath ã  Chest tightness, pain, or pressure Early warning signs of asthma include: ã  Frequent cough, especially at night ã  Losing your breath easily or shortness of breath ã  Feeling very tired or weak when exercising ã  Wheezing or coughing after exercise ã  Feeling tired, easily upset, grouchy, or moody ã  Decreases or changes in lung function as measured on a peak flow meter ã  Signs of a cold or allergies (sneezing, runny nose, cough, nasal congestion, sore throat, and headache) Trouble sleeping    Asthma signs and symptoms include: ã  Shortness of breath ã  Chest tightness or pain ã  Trouble sleeping caused by shortness of breath, coughing or wheezing ã  A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children) ã  Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu Signs that your asthma is probably worsening include: ã  Asthma signs and symptoms that are more frequent and bothersome ã  Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working) The need to use a quick-relief inhaler more often Test and diagnosis Lung (pulmonary) function tests to determine how much air moves in and out as you breathe. These tests may include: Spirometry.  This test estimates the narrowing of your bronchial tubes by checking how much air you can exhale after a deep breath and how fast you can breathe out. Peak flow.  A peak flow meter is a simple device that measures how hard you can breathe out. Lower than usual peak flow readings are a sign your lungs may not be working as well and that your asthma may be getting worse. Methacholine challenge.  Methacholine is a known asthma trigger that, when inhaled, will cause mild constriction of your airways. If you react to the methacholine, you likely have asthma. This test may be used even if your initial lung function test is normal. Imaging tests.  A chest X-ray and high-resolution computerized tomography (CT) scan of your lungs and nose cavities (sinuses) can identify any structural abnormalities or diseases (such as infection) that


Jul 23, 2017
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