Download Bronchial asthma

Department faculty and hospital therapy
of medical faculty and department
internal diseases of medical prophylactic
faculty.
BRONCHIAL
ASTHMA
Bronchial asthma (BA)
A chronic inflammatory disorder of the
airways hyper-reactivity is accompanied by
bronchial cough, wheezing and asthma, caused
by the violation of bronchial patency varying
degrees and duration.
EPIDEMIOLOGY
From 4 to 10% of the world's population
suffer from bronchial asthma, in children
the prevalence of 10-15%. Predominant
sex: children under 10 years old - male,
adult - female
AETIOLOGY
Risk Factors
Heredity
Contact with the allergens
TRIGGERS (provocateurs)
Respiratory tract infections (especially viral
respiratory infections),  -blockers reception,
air pollutants (SO2, NO2, etc.), cold air,
exercise, aspirin and other NSAIDs in patients
with
"aspirin"
of
bronchial
asthma,
psychological, environmental and occupational
factors , the sharp smell, smoking (active and
passive),
concomitant
diseases
(gastroesophageal reflux, sinusitis, hyperthyroidism,
etc.)
PATHOGENESIS
The pathogenesis of asthma is a chronic inflammation of.
For asthma is characterized by a particular form of
inflammation of the bronchi, leading to the formation of
hyperreactivity (increased sensitivity to various nonspecific
stimuli compared to normal), a leading role in inflammation
owned by eosinophils, mast cells and lymphocytes.
Inflamed bronchial hyperreactivity to respond to the impact of
triggers spasm of airway smooth muscle, mucus
hypersecretion, edema and inflammatory cell infiltration of
the mucous lining of the airways leading to the development
of an obstructive syndrome, clinically manifested in the form
of an attack of wheezing or breathlessness.
PATHOMORPHOLOGY
In the bronchi reveal inflammation, mucus plugs,
mucosal edema, smooth muscle hyperplasia, thickening
of the basement membrane, the signs of
disorganization. When endobronchial biopsies in
patients with asthma reveal desquamation of bronchial
epithelium, eosinophilic infiltration of the mucosa. In
the washing liquid exhibit a high content of epithelial,
mast cells, eosinophils and high levels of lymphocytes.
CLINIC
COMPLAINTS AND HISTORY
Episodic attacks of expiratory dyspnea and / or cough
The appearance of distant wheeze
Feeling of heaviness in the chest
OBJECTIVELY
Expiratory dyspnea
Swelling of the nose wings during inspiration
Excitement, interrupted speech
Participation of the auxiliary muscles in the act of breathing
Forced attitude
For percussion: the development of emphysema box note
Auscultation: listen to the whistling and whirring dry
wheezes and lengthening the exhalation phase
Diagnosis of BA
Ask the patient or the parents are there:
Repeated episodes of wheezing
Painful cough or wheeze at night or early morning
Cough or wheeze after exercise
Coughing, wheezing or feeling of heaviness in the chest after
exposure to allergens or pollutants
Colds, which "falls in the chest" or lasts for more than 10
days
Are asthma medications and if so, how often
Examine, if possible, lung function, peak flow or spirometry
conducted.
Determining the severity of BA
Steps
Step 4.
Severe
persistent
asthma
Step 3.
Moderate
persistent
asthma
The clinical picture before
treatment
Persistent symptoms
frequent exacerbations
Frequent nocturnal symptoms
Physical activity is limited by
manifestations of asthma
PEF or FEV1
 60% of normal
fluctuations> 30%
Daily symptoms
Exacerbations violate activity and
sleep
Night asthma symptoms occur more
than 1 time per week
Daily intake of  2- agonists shortacting
PEF or FEV1
60 to 80% of normal
fluctuations> 30%
Necessary medical
treatment
Long-term preventive
treatment:
high doses of inhaled
steroids-traditional, longacting bronchodilators drugs
and long-term course of oral
glucocorticosteroids
Daily preventive therapy:
Inhaled corticosteroids and
long acting bronchodilators
(especially at night
symptoms)
Determining the severity of BA (continuation)
Steps
The clinical picture before
treatment
Necessary medical
treatment
Step 2.
Mild persistent
asthma
•Symptoms of a once a week or more, but
less than 1 time per day
Exacerbation of disease activity and can
disrupt sleep
Nocturnal symptoms of asthma occur more
than 2 times per month
PEF or FEV1
80% of normal
vibration 20 - 30%
Any anti-inflammatory drug.
Consider adding long-acting
bronchodilators (especially at
night symptoms)
Step 1.
intermittent
asthma
Symptoms of less than 1 time per week
Short acute disease of (from several hours
to several days) Nocturnal symptoms 2
times a month or less. No symptoms and
normal lung function between
exacerbations
PEF or FEV1  80% of normal
fluctuations <20%
Preparation for emergency relief,
imposed only when necessary:
inhaled 2- agonists, short-acting.
Intensity of treatment depends
on the severity of exacerbation:
Is it possible the use of
corticosteroids in pill form
CLASSIFICATION
OF MAJOR PATHOGENETIC VARIANTS BA (according
to the classification, supplemented BG Fedoseyev)
1. Infection-dependent
2. Atopic
3. Autoimmune
4. Dyshormonal
5. Dysovarial
6. Neuropsychiatric
7. Adrenergic imbalance
8. Cholinergic
9. Asthma of physical effort
10.Aspirin asthma (Triad)
The severity
of bronchial asthma
1. Easy
2. During moderate ?
3. Severe
Phase of bronchial asthma
1. Exacerbation
2. Unstable remission
3. Sustained remission (more than 2
years)
Complications
Pulmonary: atelectasis, pneumo thorax,
pulmonary insufficiency, etc.
Extra pulmonary: pulmonary heart,
congestive heart failure.
Differential diagnosis
1) COPD
2) Emphysema
3) Cardiac asthma
Treatment
Preventive control of long-acting
drugs
Drugs that attack stoped
Step 4.
Severe
persistent
asthma
Daily:
· Inhaled corticosteroids, 800-2000
mg or more;
· Long-acting bronchodilator: inhaled
2- agonists or theophylline, and / or
2- agonist tablets or syrup;
corticosteroids orally for a long time
If necessary: ​a short-acting
bronchodilators - inhaled 2agonists
Step 3.
Moderate
persistent
asthma
Daily:
· Inhaled corticosteroids 800-2000
mg;
bronchodilators Prolong-centered
actions, especially when nighttime
symptoms: inhaled 2- agonists or
theophylline, or 2- agonist tablets or
syrup
If necessary (but not more
than 3-4 times a day): a
short-acting bronchodilators
- inhaled 2- agonists
Steps
Treatment (continued)
Name (in
parentheses other
possible names)
Generic name
Corticosteroids
Inhaled:
(adrenococorticoids,
glucocorticoids)
beclomethasone
budesonide
flunizolid
fluticasone
triamcinolone
Sodium
cromoglycate
(cromolyn,
cromolyn
sodium,
cromones)
The mechanism of
action
Anti-inflammatory drugs
Prevent or inhibit the activation
and migration of inflammatory
cells, reduce the swelling of the
bronchial wall, mucus
production and increased
microvascular permeability,
increases the sensitivity of the 2receptor of bronchial smooth
muscle
Anti-inflammatory drug
Treatment (continued)
Name (in parentheses
other possible names)
Generic name
Anti-inflammatory drug
Inhibits the activation of
inflammatory cells and
release of these
mediators
Nedocromil
(Cromones,
nedocromil
sodium)
2-agonists
long-acting
(-adrenergic
drugs long)
The mechanism of
action
Inhaled
salmeterol formoterol
Tablets
salbutamol terbutaline
Bronchodilators
Relax bronchial smooth
muscle, enhance
mucociliary clearance
and reduces vascular
permeability
FORECAST
Prognosis depends on the timeliness of
detection, patient education and its
ability to self-control. Crucial to the
elimination of precipitating factors and
timely treatment for a qualified Medical
Assistance.