ASTHMA

Teacher ： Yanli Zhang

Department ： the Third hospital
affiliated to ZhengZhou University
 OUTLINE

Introduction Laboratory evaluation

Pathogenesis Diagnosis
PathophysiologyTreatment
Pathology Status asthmaticus
Clinical therapy
manifestations Prevention
recurrence
 1. Introduction
Asthma is a chronic inflammation,
which mast cells and eosinophils have
key roles.
Asthma is a leading cause of chronic
illness in childhood.
Before puberty, approximately twice as
many boys as girls are affected
 Three features of asthma
Chronic inflammation of airway.

Hyperreactivity of the airways to a

variety of stimuli.

High degree of reversibility of the

obstructive process.
 2. Pathogenesis
Data on the inheritance of asthma
are most compatible with polygenic
or multifactorial determinants.
A genetic predisposition combined
with environmental factors may
explain most cases of childhood
asthma.
 3. Pathophysiology
chemical mediators
bronchoconstriction, mucosal edema,excessive secretions

Airway obstruction
Nonuniform ventilation hyperinflation
Decreased
Ventilation and
atelectasis complicance
perfusion mismatch
Decreased Increased work
surfactant acidosis of breathing
Alveolar
Pulmoary hypoventilation
vasoconstriction
↑Pco2 ↓Po2
 4. Pathology
Airway of mild asthma has no pathology.
The pathology of severe asthma includes
bronchoconstriction, bronchial smooth
muscle hyertrophy, mucus gland
hypertrophy, mucosal edema, infiltration
of inflammatory cell, eosinophils,
neutrophils, basophils, macrophages,
and desqumation.
 5. Clinical manifestations

The onset of an asthma exacerbation may

be acute or insidious during younger
childhood.
Acute episodes are most often caused
exposure to irritants or allergens.
Exacerbation precipitated by viral
respiratory infections are slower in onset.
 Signs and symptoms of asthma
Cough, wheezing, tachypnea, dyspnea
with prolonged expiration and use of
accessory muscles of respiration,
cyanosis, hyperinflation of the chest,
tachycardia.
Wheezing may be absent in extreme
respiratory distress, only after
bronchodilator treatment wheeze can
occur again.
Between exacerbations the child
may be entirely free of symptoms
and have no evidence of
pulmonary disease on physical
examination.

A barrel chest deformity is a sign

of the chronic, unremitting airway
obstruction of severe asthma.
 6. Laboratory evaluation

Eosinophilia of the blood and

sputum occurs with asthma,
eosinophil more than 300*106/L in
peripheral blood.

IgE levels may be increased,

especially specific IgE.
Allergy skin testing
Inhalation bronchial challenge testing
Bronchial dilator test
Pulmonary function testing
peak expiratory flow rate (PEFR)↓
forced expiratory volume in 1 sec (FEV1)↓
 7. Diagnosis
Asthma during
younger than 3 years old

Asthma during
older than 3 years old

Cough variant asthma

 7.1 Asthma during
younger than 3 years old
Wheezing attack more than 3 sequencs;
3 scores
Wheezing occur in pulmonary; 2 scores
Wheezing attack suddenly; 1 score
Other atopy disease; 1 score
First or second relatives have
asthma,1score
 Evaluation standards
Total scores more than 5 can be
diagnosed asthma during younger
children.
Total scores less than 4 need
Inhalation bronchial challenge testing
or bronchial dilator test, if test is
positive can add 2 scores.
 7.2 Asthma during
older than 3 years old
Wheezing attack recurrently
When wheezing attack, wheeze
occur in pulmonary
Bronchioldilator is effective
Exclude other pulmonary diseases
than lead to wheeze
 7.3 Cough variant asthma
Cough attack currently or continually
longer than 1 month, often in the morning
or at night, exacerbate after exercise, little
sputum.
Without inflammation sign or long
antibiotic is not effective.
Bronchioldilator is effective

Person or family allergy

Exclude other pulmonary diseases

than lead to wheeze
 8. Treatment
Avoiding allergens; desensitizer
Improving bronchioldilator
Reducing mediator-induced
inflammation
Systemic or topical inhaled
medications are used, depending on
the severity of the episode.
 Bronchioldilator
β2 -agonist : salbutamol 0.01~0.03ml/kg,
inhalation after 2~3ml NS diluting.
Theophylline 4~5mg/kg
Inhalation of bronchioldilator aerosols
is rapidly effective in reliving symptoms
and signs of asthma.
 Hormone therapy
 Inhalation of dexamethasone or
beclomethasone 100ug every
time,2~4 times every day.

In general , hormone therapy only

used in severe asthma or attack
continually.
9.Status asthmaticus therapy

If a patient continues to have

significant respiratory distress despite
administration of sympathomimetic
drugs with or without theophyline, the
diagnosis of status asthmatics should
be considered, which is defined by
increasingly severe asthma that is not
responsive to drugs that are usually
used.
 Principle therapy
Inhalation of oxygen: concentration
40%, 4~5L/min
Fluid therapy and rectify disturbances
in acid-base status
Inject hormone
Bronchioldilator
Mechanical ventilation
 Adaptability of mechanical
ventilation
Severe and continual dyspnea.
Respiratory reduce and subsequently
wheeze disappear.
Respiratory muscles are so fatigue
than movement of thorax is limited.
Unconscious, even coma
cyanosis even after Inhaling 40%
oxygen
 10. Prevention recurrence
Desensitization
Education and management by
parents