...Catch the trade winds in your sails, explore, dream, discover
& live.! - Mark Twain
?!*$#
Twenty years from now you will be more disappointed by the
things you didn't do than by those you did.
Bronchial Asthma(Alteration in Oxygenation)
Nia Alma M. Bianson RN Lyceum of the Philippines University
Batangas City04/13/09
Asthma-Pathology -3
Objectives:
At the end of the discussion the students will be able to:
Define Bronchial Asthma Discuss the anatomy and physiology of
the respiratory system Discuss the pathophysiology of bronchial
asthma State the different medical management for bronchial
asthmaShashi
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Diagnosis: Bronchial AsthmaAn 18 year old girl was brought to
the clinic for complaints of Bronchial Asthma. When patient
reported to us, she was having a very severe attack of Asthma. She
complained of breathlessness that was worse from cold drink, cold
water, draft of air, monsoon, getting wet, at midnight. Her
complaints were better during the dry climate and when traveling
out of Philippines. The complaints would also be relieved by taking
warm drinks and tea.04/13/09 Shashi
Asthma-Pathology -5
Diagnosis: Bronchial AsthmaThe cough was productive with white
expectoration. The patient's peculiar features at the time of the
Asthma attack were extreme anxiety and fear of death. She felt
thirsty for little water at a time. She was feeling sensitive to
cold and extremely restless due to the complaints. The patient also
had complaints of cold with watery discharge from the nose and
cracking of the joint 04/13/09 Shashi accompanied by pain.
Asthma-Pathology -6
Diagnosis: Bronchial AsthmaShe had a normal appetite with liking
for sweets, fast food and tea and was averse to eating vegetables.
She would occasionally be constipated. Her sweat was profuse in the
summers, especially in underarms. Her sleep would be frequently
disturbed due to the asthma attacks and due to thoughts on her
mind.04/13/09 Shashi
Asthma-Pathology -7
Diagnosis: Bronchial AsthmaHer birth history was normal. Birth
weight: 8 pounds Age of talking: 1 year Age of teething: 8
months
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Shashi
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Asthma:
Chronic Inflammatory disorder of bronchi characterized by
Episodic, reversible bronchospasm resulting from an exaggerated
bronchoconstrictor response to various stimuli (allergy) Affects
10% of children & 5%-7% adults
04/13/09
Shashi
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Asthma Facts ?Asthma is all in the mind. You will grow out of
it. Asthma can be cured, Not very serious disease and nobody dies
from it. You are likely to develop asthma if someone in your family
has it. You can catch asthma from someone else who has it. Moving
to a different location can cure asthma. People with asthma should
not exercise. Asthma does not require medical treatment.
Medications used to treat asthma are habitforming. Someone with
asthma can provoke episodes anytime. 04/13/09 Asthma can spread to
other persons through Shashi
Asthma-Pathology -10
Percent Change in AgeAdjusted Death Rates, U.S.,
1965-1998Coronary Heart Disease Stroke Other CVD COPD All Other
Causes
Proportion of 1965 Rate 3.0 2.5 2.0 1.5 1.0 0.5 0
59%
64%
35%
+163%
7%Shashi
04/13/09
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
Asthma-Pathology -11
Anatomy Physiology
04/13/09
Shashi
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Human Respiratory System The human respiratory system consists
of two lungs and a set of air passages. The lungs, together with
the heart, sit in the thoracic cavity or chest. This is an air
tight cavity that: provides a large surface area for gas exchange
has moist gas exchange surface areas is associated with the
circulatory system to transport oxygen to the cells and pick up
carbon dioxide produced by every cell 04/13/0904/13/09
Shashi
Asthma-Pathology -13
..continuation of AnatomyThe main function of the respiratory
system is to move air into the lungs so that oxygen can enter the
body and carbon dioxide can be exhaled. During breathing, air
passes from the nose and mouth into the pharynx and through the
larynx into the trachea. The trachea bifurcates to carry air into
each lung. These two tubes are the main stem bronchi; there is a
single left main stem bronchus and a single right main stem
04/13/09 Shashi bronchus for the left and right lungs,
Asthma-Pathology -14
Anatomy and Physiology
04/13/09
Shashi
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Asthma
04/13/09
Shashi
Asthma-Pathology -16
Pathophysiolo gy:
Airway Hyperresponsiveness Genetic*
INDUCERS Allergens,Chemical sensitizers, Air pollutants, Virus
infections
INFLAMMATIONAirflow Limitation
TRIGGERS Allergens, Exercise, Cold Air, SO2 Particulates
SYMPTOMS Cough Wheeze DyspneaShashi
04/13/09
Asthma-Pathology -17
Causal Factors Predisposing Factor >Exposure to indoor Atopy
And outdoor allergens Female gender >Occupational
sensitizers
Contributing Factors >Respriratory infections >Air
pollution >Active/passive smoking >Others diet, small size at
birth
Inflammation Hyperresponsiveness of airways Airflow
limitation
04/13/09
Risk Factors for Exacerbations Allergens Respiratory infections
Exercise and hyperventilation Weather changes Exposure to sulfur
dioxide Exposure to food, additives, medications
Symptoms Wheezing Cough Dyspnea Chest tightness
Shashi
Asthma-Pathology -18
Pathogenesis - Atopic Asthma:
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Mast cells in Asthma Pathogenesis:
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Eosinophils in Asthma Pathogenesis:
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Lung Morphology in Asthma
Bronchial inflammation Edema, Mucousplugging Bronchospasm
Obstruction Over inflation/Atelectasis COPDShashi
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Lung Hyperinflation in Asthma
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Thick bronchi with Mucous plugs
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Asthma Microscopic PathologyObstructed Inflammed Bronchi
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Asthma-Pathology -25
Asthma - Bronchial morphology
inflammation Eosinophils Gland hyperplasia Mucous plug in lumen
Hypertrophy of muscle layerShashi
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Asthma - Bronchial morphology
Inflammatio n Mucous Plug Eosinophils
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Asthma TH2 lymphocytes immunostaining)
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Mucous plug in asthma:
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Eosinophils in Asthma:
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Medical ManagementThere are two basic kinds of medication for
the treatment of asthma: Long-term control medications Quick relief
(rescue) medications04/13/09 Shashi
Asthma-Pathology -31
Long-term control medications
-- used on a regular basis to prevent attacks, not for treatment
during an attack. inhaled steroids (e.g., Azmacort, Vanceril,
AeroBid, Flovent) prevent inflammation leukotriene inhibitors
(e.g., Singulair, Accolate) long-acting bronchodilators (e.g.,
famoterol, Serevent) help open airways cromolyn sodium (Intal) or
nedocromil sodium aminophylline or theophylline (not used as
frequently as in the past) combination of anti-inflammatory and
bronchodilator, using either separate inhalers or a single inhaler
(Advair Diskus)Shashi
04/13/09
Asthma-Pathology -32
Quick relief (rescue) medications-- used to relieve symptoms
during an attack. short-acting bronchodilators (e.g., Proventil,
Ventolin, Xopenex, and others) oral or intravenous corticosteroids
(e.g., prednisone, methylprednisolone) stabilize severe
episodesShashi
04/13/09
Asthma-Pathology -33
New Pathology & Drugs in Asthma:
Leukotriences - significant role in Asthma Mast cells and
Eosinophil - Cytokines. Arachidonic acid - Lipo-oxygenase LTD4
Bronchospasm Cys-LT1 receptor Zileuton Lipoxygenase inhibitor
Montelukast & zafirlukast - inhibit CysLT1 04/13/09
Shashi
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Cell Damage Cell Membrane Phospholipids Arachidonic Acid
Steroids
5-Lipoxygenase
Cyclooxygenas e NSAID Prostaglandins Prostacyclins
Leukotrienes LTC4, D4, E4
5-LO inhibitors Antileukotrienes04/13/09 Shashi
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The Reality
Asthma is not yet curable * Underdiagnosis & Undermanagement
Therapy is still evolving
Hope Better understanding of Pathology New line of Promissing
Drugs. 04/13/09 Shashi Proper management normal
Thank You
Nia Alma M. Bianson RN Lyceum of the Philippines University
Batangas City04/13/09
Asthma-Pathology -37
ReferencesJoyce Black, Medical and Surgical Nursing, 8th
edition, 2005 Saunders, Comprehensive Review for NCLEX, 2006
Brunner And Suddarth, Medical and Surgical Nursing, 6th Edition,
2005 Berto, J.M.; Pelaez, A.; Fernandez E; A new indoor source of
Allergic sensitization & respiratory disease. Allergy, 2002,
57, 155-159 Murray JF, Nadel JA, eds. Textbook of Respiratory
Medicine. Vol. 1, 3rd ed. Philadelphia, Pa.: W.B. Saunders; 2000.
Shier D, Butler J, Lewis R. Hole's Human Anatomy and Physiology.
7th ed. Dubuque, Iowa: William C Brown Publishers; 1996. 04/13/09
www.allrefer.com Shashi