bronchial asthma

Question 1

chronic bronchial asthma

Answer 1

chronic infl disorder of airways
allergic (early onset): IgE production, eosinophil inflitation
non allergic (late onset) ; in response to triggers
persistent infection
mixed

Question 2

causes of bronchial asthma

Answer 2

inducers: induce airway infl. which leades to airway hyperresponsiveness and asthma symptoms
genetic factors 
allergies
infections
environmental factors

triggers: factors that cause smooth muscles of the airway to contaract and asthma symptoms appear secondary to pre existing inflammation or hyperresponsiveness
allegens
pollutants
chemical irritants
tobacco smoke
cold air
emotional stress, aspirin and other nonsteroidal anti infl drugs

Question 3

pathogenesis of bronchial asthma

Answer 3

bronchial hyoerresponsiveness, infl. mucus production and intermittent airway obstruction
airway infl. primary problem. infl. mediators triggers by exposure to allergens irritants cold air or exercise.
mediators cause bronchioconstriction = early phase asthmatic response
eosinophils and neutrophils migrate to airways and cause injury = late phase asthmatic response
results in epithelial damage, plasma leakage, edema, mucus hypersecretion, hyperresponsiveness and muscle contraction
chronic infl leads to structural changes as subepithelial fibrosis, smooth m. hypertrophy and hyperplasia

Question 4

complaints

Answer 4

cough( dry/with sputum)
viscous sticky sputum production (little amount)
exp. dyspnea 
tightness of chest 
increase work of resp muscles

Question 5

physical examination

Answer 5

general: forced position
frightened face cyanosis
cervical veins dilated and marked
barrel chest
use of accessory muscles
intercostal retraction
palpation: TF decreased
percussion: hyperresonant , inf border goes down, diaphragm excursion restricted
auscultation: decreased vesicular breath, diffuse high pitched wheezes, exp > insp, rhonchi at the end of asthma attack
tachycardia, paradoxial pulse, arterial pressure increase, decrease consciousness

Question 6

chronic disease severity : mild intermittent

Answer 6

mild intermittent :
symptoms occur <3times/week
duration <1hr
nocturnal symp <3times/month
sensitive to cold and inf
normal FEV1 
peak flow varies 20%

Question 7

chronic disease severity : mild persistent

Answer 7

accur3-6 times/week
nocturnal symp 3-4 times/month 
react to triggers 
normal FEV1
peak flow varies 20-30%

Question 8

chronic disease severity : moderate persistent

Answer 8

daily symptoms
nocturnal symp >5 times/month
exacerbation last several days
FEV1 60%-80%
peak flow varies 30% or more

Question 9

chronic disease severity: severe persistent

Answer 9

daily wheezing 
frequent nocturnal symp
poor quality of life 
hospital admission common 
FEV1 <60%
peak flow varies 30% or more

Question 10

complications of bronchial asthma

Answer 10

respiratory failure 
pneumothorax
status asthmaticus
death
side effects of medications

Question 11

investigations

Answer 11

sputum analysis:
small amount of sputum 
pearly color 
mucus 
increased eosinophils 
curschmann spirals
charlot-leyden crystals 

blood test: moderate leucocytosis eosinophils

pulmonary function testing:
spirometry shows airway obstruction 
FVC decrease
FEV1 decrease
RV increase
TLC increase 
lung compliance increased
max resp flow rate decreased
peakflow 50-80% svere <50%

paco2 >40

Question 12

treatment

Answer 12

quick relief: SABAs, anticholinergics, system corticoids

long term control: LABAs, leukotreins, inhalaed corticosteroids, methylxanthines