FARHANA I.

PABER LEVEL 2, ADZU-SOM

TRIGGERS INVOLVED IN ASTHMA

ALLERGENS activate mast cells with bound IgE
directly leading to the immediate release of

bronchoconstrictor mediators
resulting in the early response reversed by

bronchodilators.

 Common: Dermatophagoides spp.

cats and other domestic pets Cockroaches Other allergens, including grass pollen, tree pollen, and

fungal spores, are seasonal Thunderstorm Asthma

 VIRUS INFECTIONS rhinovirus, respiratory syncytial virus, and coronavirus. increase in airway inammation + increased numbers of eosinophils and neutrophils. >Type I interferons by epithelial cells from asthmatic patients
increased susceptibility

 PHARMACOLOGIC AGENTS -Adrenergic blockers Angiotensin-converting enzyme inhibitors Aspirin (Asprin Sensitive Asthma)

BRONCHOCONSTRICTION

 EXERCISE common trigger of asthma, particularly in children Hyperventilation

increased osmolality in airway lining uids triggers mast cell mediator release bronchoconstriction

 EIA typically begins after exercise has ended and

recovers spontaneously within about 30 min. EIA is worse in cold, dry climates than in hot, humid conditions.

 PHYSICAL FACTORS Cold air and hyperventilation Laughter strong smells or perfumes

 FOOD Shellfish and Nuts Metabisulte (food preservative) through the release of sulfur dioxide gas in the stomach. Tartrazine (food yellow-coloring agent)

 AIR POLLUTION sulfur dioxide, ozone, and nitrogen oxides

 OCCUPATIONAL FACTORS Occupational asthma is characteristically associated with symptoms at work with relief on weekends and holidays. If removed from exposure within the rst 6 months of symptoms, there is usually complete recovery.

 HORMONAL FACTORS premenstrual worsening of asthma (decrease in progesterone) Thyrotoxicosis and hypothyroidism

 STRESS Psychological factors can induce bronchoconstriction through cholinergic reex pathways.

PATIENTS WITH ASTHMA

CHARACTERISTIC SYMPTOMS Wheezing, Dyspnea, and Coughing Maybe worse at night and patients typically awake in the early morning hours. Tenacious mucus Increased ventilation and use of accessory muscles Prodromal Symptoms

Itching under the chin Discomfort b/w the scapula Inexplicable fear

 PHYSICAL SIGNS Inspiratory and to a greater extent, expiratory Ronchi throughout the chest Hyperinflation Children

Nonproductive cough

INHALED CORTICOSTEROIDS
Most effective contoller for asthma
MOA: anti-inflammatory agent

Reducing inflammatory cells and their activation in the airways. Reduce eosinophils Reduce activated T lymphocytes And Reduce surface mast cells

REDUCTION OF AHR

 SIDE EFFECTS Hoarseness (dysphonia) Oral candidiasis Studies: minimal systemic effects

SYSTEMIC CORTICOSTEROIDS
Intravenously (Hydrocortisone or Methylprednisone)
Treat acute exacerbations SIDE EFFECTS Truncal Obesity, Bruising, Osteoporosis, Diabetes, Hypertension,Gastric Ulceration, Depression and Cataracts. IMPORTANT: MONITOR BONE DENSITY