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Bronchial Asthma: Altynai Akparalievna

Asthma is a chronic inflammatory disease of the airways that causes attacks of wheezing, breathlessness, and chest tightness. It affects 1-18% of populations and is more common in areas with high air pollution. Asthma is caused by allergic reactions and has triggers like respiratory infections, exercise, and allergens. Symptoms include wheezing, coughing, and shortness of breath. Treatment involves avoiding triggers, combined inhaled corticosteroids and bronchodilators, and oxygen therapy for severe attacks.

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367 views27 pages

Bronchial Asthma: Altynai Akparalievna

Asthma is a chronic inflammatory disease of the airways that causes attacks of wheezing, breathlessness, and chest tightness. It affects 1-18% of populations and is more common in areas with high air pollution. Asthma is caused by allergic reactions and has triggers like respiratory infections, exercise, and allergens. Symptoms include wheezing, coughing, and shortness of breath. Treatment involves avoiding triggers, combined inhaled corticosteroids and bronchodilators, and oxygen therapy for severe attacks.

Uploaded by

Altynay
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BRONCHIAL ASTHMA

Altynai Akparalievna
Definition
Asthma is a chronic inflammatory disease of the airways
which develops under the allergens influence, associates
with bronchial hyperresponsiveness and reversible
obstruction and manifests with attacks of dyspnea,
breathlessness, cough, wheezing, chest tightness and
sibilant rales more expressed at breathing-out.
Epidemiology
According to epidemiological studies asthma affects 1-
18% of population of different countries.

Only in 2006 more than 300 million patients suffered


from asthma all over the world, 250 thousands of patients die
of asthma. The incidence of asthma is higher in countries
with increased air pollution.
causes
Allergic reactions to plants, foreign
bodies in the air way.
Etiology

The allergens are


divided into:
•Communal,
•Industrial,
•Occupational,
•Natural
•Pharmacological
Сommunal allergens are contained in the air of
apartment houses. They are:

House-dust mites which live in carpets ‫ سجادة‬,


mattresses and upholstered ‫ االثاث المنجد‬furniture;

Vital products of domestic insects (e.g.,


cockroach‫;) الصرصور‬

Tobacco smoke during active or passive smoking;

Various communal aerosols and synthetic detergents.


Among the industrial allergens nitric, carbonic, sulfuric oxides,
formaldehyde, ozone and emissions of biotechnological industry -
main components of industrial and photochemical.

The most important occupational allergens are dust of stock


buildings, mills ‫ مطاحن‬, weaving-mills, book depositories etc.

Natural allergens are represented by plant pollen (especially


ambrosia ‫عطور‬, wormwood and goose-foot pollen) and different
respiratory, particularly viral, infections.
Some allergens which may cause asthma

Spittle, excrements,
House-dust mites which live in
carpets, mattresses and hair and fur
upholstered furniture of domestic
animals

Plant pollen

Dust of Pharmacological Food


book agents (enzymes, components
depo- antibiotics, (stabilizers,
sitories vaccines, serums) genetically modified
products)
Asthma Triggers

©2010
Trigger-factors, which provoke bronchospasm,
are: a simultaneous penetration of a large quantity of
allergen, viral respiratory infection, hyperventilation,
physical exertion, emotional stress, becoming too cold,
adverse weather conditions, administration of some
medicines (aspirin, -blockers).
Pathophysiology
Asthma pathophysiology is quite difficult and
insufficiently studied. Undoubtedly, in most cases the
disease is based on 1 type hypersensitivity reaction.
The genesis of any allergic reaction may be divided
into immune, pathochemical and pathophysio-
logic phases.
Classifications of Asthma
1. Spasmodic: sporadic in nature with varying
intervals of free and difficulty due to precipitating
factors often readily defined.

2. Continuous: some shortness of breath on


occasion, transit wheezing on strenuous exercise and
wheezy rales hard deep inspiration.
Classifications of Asthma cont…

3. Intractable: persistent wheezing requiring


regular daily medication for either control of
symptoms or ability to function.

4. Status Asthmaticus: sever attach in which


patient deteriorates in spite of adequate
treatment.
Clinical manifestations
Classic signs and symptoms of asthma are:

Attacks of expiratory dyspnea

Shortness of breath

Cough.

Chest tightness

Wheezing (high-pitched whistling sounds when


breathing out)

Sibilant rales
In typical cases in development of asthma
exacerbation there are 3 periods – prodromal period, the
height period and the period of reverse changes.
At the prodromal period:
vasomotoric nasal reaction with profuse watery
discharge,
sneezing, dryness in nasopharynx,
paroxysmal cough with viscous sputum,
emotional lability,
excessive sweating,
skin itch and other symptoms may occur.
At the peack of exacerbation there are:

expiratory dyspnea

forced position with supporting on arms

poorly productive cough

cyanotic skin and mucous tunics

hyperexpansion of thorax with use of all accessory muscles during


breathing

at lung percussion: tympanitis, shifted downward lung borders

at auscultation: diminished breath sounds, sibilant rales, prolonged


breathing-out, tachycardia.

in severe exacerbations: the signs of right-sided heart failure


(swollen neck veins, hepatomegalia), overload of right heart
chambers on ECG.
At the period of the reverse changes,
Which comes spontaneously or under
pharmacologic therapy.

Dyspnea and breathlessness relieve or disappear.

Sputum becomes not so viscous.

Cough turns to be productive.

Patient breathes easier.


Asthmatic status
The severe and prolonged asthma exacerbation with intensive
progressive respiratory failure, hypoxemia, hypercapnia,
respiratory acidosis, increased blood viscosity and the most
important sign is blockade of bronchial 2-receptors.

Stages:

1st - refractory response to 2-agonists (relaxation of the smooth muscles)

2nd - “silent” lung because of severe bronchial obstruction and


collapse of small and intermediate bronchi;

3rd stage – the hypercapnic coma.


In many cases asthma, particularly intermittent, manifests
with few and atypical signs:

episodic appearance of wheezing;

cough, heavy breathing occurring at night;

cough, hoarseness after physical activity;

“seasonal” cough, wheezing, chest tightness

the same symptoms occurring during contact with


allergens, irritants;

lingering course of acute respiratory infections.


Diagnosis
Typical clinical
manifestations
and lung function
assessment are
sufficient for
diagnosis of
asthma.
Management
1. Avoiding the contact with allergen. If it is impossible, the
specific hyposensitization with standard allergens should be
performed. It is rather effective in case of monoallergy, in
intermittent and mild persistent asthma, in remission phase.

2. Elimination of trigger factors (rational job placement,


changing the residence, psychological and physical adaptation,
careful drug using) is the second condition for successful asthma
treatment.

3. Optimally selected medical care is the base of asthma


management.
Combined inhaled drugs (corticosteroids with 2-
agonists) (nebulasers, turbuhalers, spasers,
spinhalers, sinchroners) enhance the effectiveness of
asthma therapy.
Management of
asthmatic status
Oxygen

Systemic corticosteroids (Hydrocortisone 200mg or Prednisolone 50


mg/day per)

Inhalations of short-acting 2-agonists - Salbutamol 5mg or Fenoterol


2mg through nebulaser – 3 times at 1st hour, then once an hour till
distinct improvement of patient’s condition is achieved; then 3-4 times
a day.

Inhaled anticholinergic drugs or Aminophylline IV.

If ineffective - artificial lung ventilation.


Prognosis
In case of early detection and adequate
treatment the prognosis for the disease is
favourable.

It becomes serious in severe persistent and


poorly controlled (insensitive for corticosteroids)
asthma.
The examination of working capacity

The patients with unfavorable for the disease


conditions of work need the job replacement.

Physical labours with severe asthma are


disable to work.
Prophylaxis
Preservation of the environment, healthy
life-style (smoking cessation, physical training)
– are the basis of primary asthma prophylaxis.
These measures in combination with adequate
drug therapy are effective for secondary
prophylaxis.

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