Bronchial asthma.ppt he largely said that he would be a good

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1. Bronchial asthma
Yoshkar-Ola, 2021
Mari state University
Department of internal medicine
Assistant of the Department,
candidate of medical sciences,
Z.V. Kumukova

2. Definition
Bronchialasthmaisachronic,inflammatory
diseaseoftherespiratorytract,whichis
characterizedbybronchialhyperreactivityand
respiratoryobstruction.

3. Etiology
Thedevelopmentofbronchialasthmaisa
multicausalprocess,whichiscausedby
exogenicfactors(environmentalfactors),
andalsobygeneticdispositions.
Importantexogenicactivatorsare:
1.Allergens:environmentalallergens
(housedustmites,pollen),allergenic
worksubstances(flour),foodallergens
2.Toxinsorchemicalirritants
3.Respiratorydiseases
4.Pseudoallergicreactions(PAR)to
analgesics(analgesic-inducedasthma)
5.Physicalexertion(mainlyinchildren)

4. Epidemiology
Asarule,bronchialasthmaalreadyoccursin
infancyandisthemostcommonchronicdiseaseof
thisstageoflife.

5. Classification
Accordingtoetiology
Allergicorextrinsicasthma
Non-allergicorintrinsicasthma
Mixedforms
Accordingtodegreeofseverity
Grade1: Intermittent
Grade2: Persistent, mild(symptomsmorethan
twicea week, butnomorethanonceina single
day)
Grade3: Persistent, moderate(symptomsoncea
dayandmorethanonenighta week)
Grade4: Persistent, severe(symptomsthroughout
thedayonmostdaysandfrequentlyatnight)

8. Pathophysiology
1.Inflammationofthebronchi
2.Bronchialhyperreactivity
3.Endobronchialobstruction

9. Inflammationofthebronchi
Allergensorinfectionselicitaninfectiousreactionofthe
bronchialmucousmembrane.Inallergicasthma,anIgE-
inducedreactionoftheimmediatetype(Type1reaction)
occursimmediatelyafterinhalationoftheallergen.The
mastcellsinthemucousmembranedegranulateand
therebyreleaseinflammationmediatorslikehistamine,
ECF-A,bradykininandleukotrienes("immediate
reaction").Apartfromthisimmediatereaction,therealso
existsanIgG-inducedlatereactionafter6-12hoursora
combinationofbothreactiontypes("dualreaction").Asa
rule,thetriggeringallergencanonlybeidentifiedatthe
earlystageofthedisease.Inthecourseofyears,therange
ofallergensoftenbecomeswider,therebymakingitmore
difficultorevenimpossibleforthepatienttoavoid
allergens.

10. Bronchialhyperreactivity
Anunspecificbronchialhyperreactivitycanbedetected
inalmostallasthmatics.Incaseoftheinhalationof
irritants,thehyperreactivitymanifestsasaverystrong
constrictionofthebronchialtubes,andcanbe
objectifiedbythemethacholinetest.

11. Endobronchialobstruction
Theendobronchialobstructionisquasithefirst
clinicallydiscernible"endproduct"ofthe
pathophysiologicalprocessesofbronchialasthma.
Itdevelopsthroughtheshiftofthebronchiallumen
asaconsequenceofmucosaledema,increased
mucussecretion(dyscrinism)andbronchospasms.

12. Symptoms
Coughwithorwithoutsputum(phlegm)production
Pullinginoftheskinbetweentheribswhenbreathing(intercostal
retractions)
Shortnessofbreaththatgetsworsewithexerciseoractivity
WheezingEmergencysymptomsthatneedpromptmedicalhelp:
Bluishcolortothelipsandface
Decreasedlevelofalertness,suchasseveredrowsinessor
confusion,duringanasthmaattack
Extremedifficultybreathing
Rapidpulse
Severeanxietyduetoshortnessofbreath
Sweating
Othersymptomsthatmayoccur:
Abnormalbreathingpattern--breathingouttakesmorethantwice
aslongasbreathingin
Breathingtemporarilystops
Chestpain
Tightnessinthechest

14. Tests to measure lung function
Spirometry.Thistestestimatesthenarrowingofyour
bronchialtubesbycheckinghowmuchairyoucanexhale
afteradeepbreathandhowfastyoucanbreatheout.
Peakflow.Apeakflowmeterisasimpledevicethat
measureshowhardyoucanbreatheout.Lowerthanusual
peakflowreadingsareasignyourlungsmaynotbe
workingaswellandthatyourasthmamaybegettingworse.
Yourdoctorwillgiveyouinstructionsonhowtotrackand
dealwithlowpeakflowreadings.

15. Additionaltests
Methacholinechallenge.Methacholineisa
knownasthmatriggerthat,wheninhaled,willcause
mildconstrictionofyourairways.Ifyoureacttothe
methacholine,youlikelyhaveasthma.Thistestmaybe
usedevenifyourinitiallungfunctiontestisnormal.
Imagingtests.AchestX-rayandhigh-resolution
computerizedtomography(CT)scanofyourlungsand
nosecavities(sinuses)canidentifyanystructural
abnormalitiesordiseases(suchasinfection)thatcan
causeoraggravatebreathingproblems.

16. Additionaltests
Allergytesting.Thiscanbeperformedbyaskin
testorbloodtest.Allergytestscanidentifyallergyto
pets,dust,moldandpollen.Ifimportantallergytriggers
areidentified,thiscanleadtoarecommendationfor
allergenimmunotherapy.
Provocativetestingforexerciseandcold-
inducedasthma.Inthesetests,yourdoctormeasures
yourairwayobstructionbeforeandafteryouperform
vigorousphysicalactivityortakeseveralbreathsofcold
air.

17. GINA
TheGlobalInitiativeforAsthma(GINA)was
establishedin1993bytheWorldHealth
OrganizationandNationalHeartLungandBlood
Institutetodevelopaglobalstrategyformanaging
andpreventingasthma.GINAreports,nowfunded
independentlythroughthesaleofGINAproducts,
haveprovidedthefoundationformanynational
guidelines.Theyarepreparedbyinternational
expertsfromprimary,secondaryandtertiarycare,
andareannuallyupdatedfollowingareviewof
evidence.

18. Ginasthma

19. Treatment
Non-pharmacologicaltreament
Removalofallergens(especiallypetswithfeathersorfur)
(evidencelevelA)
Structuredpatienteducation: improvedself-management
leadingtobettersymptomaticcontrol, reductionofthenumber
ofasthmaattacksandemergencysituations, improvedquality
oflife, andimprovementinvariousotherparametersofdisease
courseincludingdaystakenofffromschoolorworkanddays
spentinhospital(evidencelevelA)
Physicaltraining(reductionofasthmasymptoms, improved
exercisetolerance, improvedqualityoflife, reducedmorbidity)
(evidencelevelC)
Respiratorytherapyandphysiotherapy(e.g., breathing
techniques, pursed-lipbreathing) (evidencelevelC)
Smokingcessation(withmedicalandnon-medicalaids, if
necessary) (evidencelevelB)
Psychosocialtreatmentapproaches(familytherapy) (evidence
levelC)
Forobesepatients, weightloss(evidencelevelB)

20. Medications for relieving seizures are as
follows:
short-acting beta-adrenomimetics(fenoterol, salbutamol)
anticholinergic drugs(tiotropium bromide, ipratropium
bromide);
combined drugs;
methylxanthines(euphyllinum).
Medications for maintenance therapy of BA
include:
inhaled and systemic glucocorticosteroids(beclometasone,
fluticasone);
combinations of long-acting β2-agonists:formoterol,
salmeterol and GCS:beclomethasone, mometasone;
theophylline with long-lasting effect(theophylline);
antileukotriene drugs(zafirlukast, montelukast).
antibodies to immunoglobulin E.

23. Good luck in
learning the topic!!!