Asthma Pathophysiology Fisiopatología del Asma natural History of asthma

8/2/2019 Asthma Pathophysiology Fisiopatologa del Asma natural History of asthma

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28/02/2012 2Programas Educativos " Control del Asma Bronquial"


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28/02/20123Programas Educativos " Control del Asma Bronquial"


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28/02/2012Programas Educativos " Control del Asma Bronquial" 4

NEW !

Clnica de Asma y AlergiaManagua, Nicaragua.


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Latest Revision Oct 2007 (EPR-3)

Adaptaciones para la prctica enNicaragua , febrero 2012.



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Evidencias de un nuevo paradigma

Remodelamiento.


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Reality of pulmonary biochemistry Mucosal layerx

Potential for secretions Sub-mucosal layer

x Potential for mucosal edema

x Potential for bronchospasm

Most common causes of narrowedairways Secretions, mucosal edema, and

bronchospasm



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Airway Inflammation

Bronchial Hyperresponsiveness

Bronchoconstriction

Bronchial Wall Edema

Excess Mucous Secretions

Airway Remodeling



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TRIGGER

q

INFLAMMATORY RESPONSE

q

AIRWAY CHANGES

q

RESPIRATORY SYMPTOMS



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Type I Hypersensitivity

Immediate Type Hypersensitivity

Involves IgE antibody on mast cell

Type IV Hypersensitivity

Delayed Type Hypersensitivity

InvolvesT

cell mediated response Other immune system cells activated



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Early Phase Response

Involves Type I Hypersensitivity

IgE antibody with Mast Cells

Late Phase Response

Involves Type IV Hypersensitivity

Tcell mediated response activateseosinophils, B cells, others



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Airway hyperresponsivenessanexaggerated bronchoconstrictor responseto a wide variety of stimuliis a major, but

not necessarily unique, feature of asthma Defined by contractile responses to challenges

with methacholine correlates with the clinicalseverity of asthma

Influenced by inflammation, dysfunctional

neuro-regulation, and structural changes Treatment directed toward reducing

inflammation can reduce airwayhyperresponsiveness and improve asthmacontrol.



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Dominant physiological event leading toclinical symptoms

Allergen-induced acute bronchoconstrictionresults from an IgE-dependent release ofmediators from mast cells

Non-IgE dependent bronchoconstriction canbe caused by other stimuli including Irritants Exercise

Cold air Aspirin and other nonsteroidal anti-inflammatory

drugs

Stress may also play a role in precipitatingbronchoconstriction



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As the disease becomes more persistentand inflammation more progressive, otherfactors further limit airflow

These include edema, inflammation, mucushypersecretion and the formation ofinspissated mucus plugs, as well as structuralchanges including hypertrophy and

hyperplasia of the airway smooth muscle. These latter changes may not respond to

usual treatment.



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VascularDilation Edema

SubepithelialFibrosis

EpithelialDamage

InflammatoryCell

InfiltrationSmooth MuscleHypertrophy

Mucous GlandHypertrophy

Mucus

Subbasement

MembraneThickening



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In some persons who have asthma,airflow limitation may be only partiallyreversible The process of repair and its regulation are

likely to be key events in explaining thepersistent nature of the disease andlimitations to a therapeutic response

Structural changes can include thickening ofthe sub-basement membrane, subepithelialfibrosis, airway smooth muscle hypertrophyand hyperplasia, blood vessel proliferationand dilation, and mucous gland hyperplasiaand hypersecretion



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Taken together, these longitudinal epidemiologicalstudies and clinical trials indicate that the

progression of asthma, as measured by declines inlung function, varies in different age groups.

Declines in lung function growth observed in childrenappear to occur by 6 years of age and

occur predominantly in those children whose asthmasymptoms started before 3 years of age.

Children 512 years of age who have mild or

moderate persistent asthma, on average, do not appear to experience declines in lung function

through 1117 years of age, although a subset of these children experience progressive reductions in

lung growth as measured by FEV1.



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The START study

As knowledge of the various

phenotypes of inflammation become

apparent, it is likely that treatmentalso will also have greater specificity

and, presumably



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Coughespecially if

after exertion

breathing cold air

at night

after colds paroxysmal

Wheezing tightness

noisy breathing

Dyspnea(Breathlessness)

especially if:

intermittent or

variable after exertion

at night

AsthmaAsthma



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Early warning signs are changes that happen just beforeor at the very beginning of an asthma episode.

These changes start before the well-known symptoms ofasthma and are the earliest signs that a personsasthma is worsening.

In general, these signs are not severe enough to stop aperson from going about his or her daily activities.

By recognizing these signs, you can stop an asthmaepisode or prevent one from getting worse.



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Frequent cough, especially at night

Losing your breath easily or shortness of breath

Feeling very tired or weak when exercising

Wheezing or coughing after exercise

Feeling tired, easily upset, grouchy, or moody

Decreases or changes in a peak expiratory flow

Signs of a cold, upper respiratory infection, or allergies (sneezing,

runny nose, cough, congestion, sore throat, and headache)

Trouble sleeping or Restless

Tickle in throat

KnowTheseWarning

Signs!



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Managua , Nicaragua

Email:[email protected]

Tel 2278 1169

2270-33598846-5022

8882-5513Programas Educat ivos " Control del Asma Bronquial" 28/02/2012 35


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Gracias por la oportunidad

Clnica de Asma y Alergia, Dr. Juan Herrera

SalazarFacebookManagua , Nicaragua. Tel 22781169,22703359, 88825513

Dr. Juan Herrera SalazarFavor ver la III Parte


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Asthma Pathophysiology Fisiopatología del Asma natural History of asthma

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