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CR - Pul Path (iii) Asthma (intro (inflamm mediators (Th2 (IL 4,5,13),…
CR - Pul Path (iii) Asthma
intro
recurrent episodic reversible bronchospasm
exaggerated bronchoconstriction in response to various stimuli
airflow obstruction
chronic inflamm
smooth muscle surround airway becomes oedematous, erythematous, tightened - air in alveoli can't leave
epithelial shedding + damage, possible mucus + plasma exudation
inflamm mediators
Th2 (IL 4,5,13)
eosinophils
mast cells (histamine)
LTs
common
esp in young children, affects boys more
10-15% of children
has good prognosis
7-10% of adults
least common in adolescents
Symptoms
Wheezing
dyspnoea
chest tightness
dry or productive cough
worse in am
heterogenous - wide variety of triggers
antigen-induced
most common type (30-50%)
airborne
pollen, animal dander, house dust mite
occupation-related
animal handlers
wood workers
fumes
environmental pollution
sulphur dioxide
ozone
smoke
drug-induced
b-blockers
ACE inhibitors
Aspirin-exacerbated resp disease (AERD)
aka Samter's triad
asthma
sinus disease with recurrent nasal polyps
sensitivity to aspirin + NSAIDs
viral RTIs
esp in kids
RSV, influenza, rhinovirus
exercise
heat loss from epithelium
esp severe exercise when its cold
stress + anger
cool air
types
allergic
atopy related
increased IgE
immediate hypersensitivity with skin tests
most common childhood asthma
intrinsic (non-allergic)
associated with older age + COPD
no hx of atopy
nasal polyps
drug hypersensitivity (aspirin + penicillin)
prognosis less good, can be difficult to manage
microscopic features
airway infiltration by neutrophils + eosinophils
mast cell degranulation
basement membrane thickening
loss of epithelial integrity
occlusion of bronchial lumen my mucus
hypertrophy of bronchial smooth muscle cells
hyperplasia of globlet cells
Natural Hx
not precisely defined
mostly non-progressive
minority develop irreversible changes to lung function
remissions + exacerbations
mortality declining
better medication
better severity assessment by both Dr + patient
healthcare more accessible