?!*$# Twenty years from now Twenty years from now you will be more you will be more disappointed disappointed by the things you by the things you didn't didn't do do than by those you did.” than by those you did.” ...Catch the trade winds in your ...Catch the trade winds in your sails, explore, dream, discover & sails, explore, dream, discover & live….! ” live….! ” - Mark Twain

Bronchial Asthma - Masteral

Embed Size (px)

Citation preview

...Catch the trade winds in your sails, explore, dream, discover & live.! - Mark Twain


Twenty years from now you will be more disappointed by the things you didn't do than by those you did.

Bronchial Asthma(Alteration in Oxygenation)

Nia Alma M. Bianson RN Lyceum of the Philippines University Batangas City04/13/09

Asthma-Pathology -3


At the end of the discussion the students will be able to:

Define Bronchial Asthma Discuss the anatomy and physiology of the respiratory system Discuss the pathophysiology of bronchial asthma State the different medical management for bronchial asthmaShashi


Asthma-Pathology -4

Diagnosis: Bronchial AsthmaAn 18 year old girl was brought to the clinic for complaints of Bronchial Asthma. When patient reported to us, she was having a very severe attack of Asthma. She complained of breathlessness that was worse from cold drink, cold water, draft of air, monsoon, getting wet, at midnight. Her complaints were better during the dry climate and when traveling out of Philippines. The complaints would also be relieved by taking warm drinks and tea.04/13/09 Shashi

Asthma-Pathology -5

Diagnosis: Bronchial AsthmaThe cough was productive with white expectoration. The patient's peculiar features at the time of the Asthma attack were extreme anxiety and fear of death. She felt thirsty for little water at a time. She was feeling sensitive to cold and extremely restless due to the complaints. The patient also had complaints of cold with watery discharge from the nose and cracking of the joint 04/13/09 Shashi accompanied by pain.

Asthma-Pathology -6

Diagnosis: Bronchial AsthmaShe had a normal appetite with liking for sweets, fast food and tea and was averse to eating vegetables. She would occasionally be constipated. Her sweat was profuse in the summers, especially in underarms. Her sleep would be frequently disturbed due to the asthma attacks and due to thoughts on her mind.04/13/09 Shashi

Asthma-Pathology -7

Diagnosis: Bronchial AsthmaHer birth history was normal. Birth weight: 8 pounds Age of talking: 1 year Age of teething: 8 months



Asthma-Pathology -8


Chronic Inflammatory disorder of bronchi characterized by Episodic, reversible bronchospasm resulting from an exaggerated bronchoconstrictor response to various stimuli (allergy) Affects 10% of children & 5%-7% adults



Asthma-Pathology -9

Asthma Facts ?Asthma is all in the mind. You will grow out of it. Asthma can be cured, Not very serious disease and nobody dies from it. You are likely to develop asthma if someone in your family has it. You can catch asthma from someone else who has it. Moving to a different location can cure asthma. People with asthma should not exercise. Asthma does not require medical treatment. Medications used to treat asthma are habitforming. Someone with asthma can provoke episodes anytime. 04/13/09 Asthma can spread to other persons through Shashi

Asthma-Pathology -10

Percent Change in AgeAdjusted Death Rates, U.S., 1965-1998Coronary Heart Disease Stroke Other CVD COPD All Other Causes

Proportion of 1965 Rate 3.0 2.5 2.0 1.5 1.0 0.5 0







1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998

Asthma-Pathology -11

Anatomy Physiology



Asthma-Pathology -12

Human Respiratory System The human respiratory system consists of two lungs and a set of air passages. The lungs, together with the heart, sit in the thoracic cavity or chest. This is an air tight cavity that: provides a large surface area for gas exchange has moist gas exchange surface areas is associated with the circulatory system to transport oxygen to the cells and pick up carbon dioxide produced by every cell 04/13/0904/13/09


Asthma-Pathology -13

..continuation of AnatomyThe main function of the respiratory system is to move air into the lungs so that oxygen can enter the body and carbon dioxide can be exhaled. During breathing, air passes from the nose and mouth into the pharynx and through the larynx into the trachea. The trachea bifurcates to carry air into each lung. These two tubes are the main stem bronchi; there is a single left main stem bronchus and a single right main stem 04/13/09 Shashi bronchus for the left and right lungs,

Asthma-Pathology -14

Anatomy and Physiology



Asthma-Pathology -15




Asthma-Pathology -16

Pathophysiolo gy:

Airway Hyperresponsiveness Genetic*

INDUCERS Allergens,Chemical sensitizers, Air pollutants, Virus infections

INFLAMMATIONAirflow Limitation

TRIGGERS Allergens, Exercise, Cold Air, SO2 Particulates

SYMPTOMS Cough Wheeze DyspneaShashi


Asthma-Pathology -17

Causal Factors Predisposing Factor >Exposure to indoor Atopy And outdoor allergens Female gender >Occupational sensitizers

Contributing Factors >Respriratory infections >Air pollution >Active/passive smoking >Others diet, small size at birth

Inflammation Hyperresponsiveness of airways Airflow limitation


Risk Factors for Exacerbations Allergens Respiratory infections Exercise and hyperventilation Weather changes Exposure to sulfur dioxide Exposure to food, additives, medications

Symptoms Wheezing Cough Dyspnea Chest tightness


Asthma-Pathology -18

Pathogenesis - Atopic Asthma:



Asthma-Pathology -19

Mast cells in Asthma Pathogenesis:



Asthma-Pathology -20

Eosinophils in Asthma Pathogenesis:



Asthma-Pathology -21

Lung Morphology in Asthma

Bronchial inflammation Edema, Mucousplugging Bronchospasm Obstruction Over inflation/Atelectasis COPDShashi


Asthma-Pathology -22

Lung Hyperinflation in Asthma



Asthma-Pathology -23

Thick bronchi with Mucous plugs



Asthma-Pathology -24

Asthma Microscopic PathologyObstructed Inflammed Bronchi



Asthma-Pathology -25

Asthma - Bronchial morphology

inflammation Eosinophils Gland hyperplasia Mucous plug in lumen Hypertrophy of muscle layerShashi


Asthma-Pathology -26

Asthma - Bronchial morphology

Inflammatio n Mucous Plug Eosinophils



Asthma-Pathology -27

Asthma TH2 lymphocytes immunostaining)



Asthma-Pathology -28

Mucous plug in asthma:



Asthma-Pathology -29

Eosinophils in Asthma:



Asthma-Pathology -30

Medical ManagementThere are two basic kinds of medication for the treatment of asthma: Long-term control medications Quick relief (rescue) medications04/13/09 Shashi

Asthma-Pathology -31

Long-term control medications

-- used on a regular basis to prevent attacks, not for treatment during an attack. inhaled steroids (e.g., Azmacort, Vanceril, AeroBid, Flovent) prevent inflammation leukotriene inhibitors (e.g., Singulair, Accolate) long-acting bronchodilators (e.g., famoterol, Serevent) help open airways cromolyn sodium (Intal) or nedocromil sodium aminophylline or theophylline (not used as frequently as in the past) combination of anti-inflammatory and bronchodilator, using either separate inhalers or a single inhaler (Advair Diskus)Shashi


Asthma-Pathology -32

Quick relief (rescue) medications-- used to relieve symptoms during an attack. short-acting bronchodilators (e.g., Proventil, Ventolin, Xopenex, and others) oral or intravenous corticosteroids (e.g., prednisone, methylprednisolone) stabilize severe episodesShashi


Asthma-Pathology -33

New Pathology & Drugs in Asthma:

Leukotriences - significant role in Asthma Mast cells and Eosinophil - Cytokines. Arachidonic acid - Lipo-oxygenase LTD4 Bronchospasm Cys-LT1 receptor Zileuton Lipoxygenase inhibitor Montelukast & zafirlukast - inhibit CysLT1 04/13/09


Asthma-Pathology -34

Cell Damage Cell Membrane Phospholipids Arachidonic Acid



Cyclooxygenas e NSAID Prostaglandins Prostacyclins

Leukotrienes LTC4, D4, E4

5-LO inhibitors Antileukotrienes04/13/09 Shashi

Asthma-Pathology -35

The Reality

Asthma is not yet curable * Underdiagnosis & Undermanagement Therapy is still evolving

Hope Better understanding of Pathology New line of Promissing Drugs. 04/13/09 Shashi Proper management normal

Thank You

Nia Alma M. Bianson RN Lyceum of the Philippines University Batangas City04/13/09

Asthma-Pathology -37

ReferencesJoyce Black, Medical and Surgical Nursing, 8th edition, 2005 Saunders, Comprehensive Review for NCLEX, 2006 Brunner And Suddarth, Medical and Surgical Nursing, 6th Edition, 2005 Berto, J.M.; Pelaez, A.; Fernandez E; A new indoor source of Allergic sensitization & respiratory disease. Allergy, 2002, 57, 155-159 Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. Vol. 1, 3rd ed. Philadelphia, Pa.: W.B. Saunders; 2000. Shier D, Butler J, Lewis R. Hole's Human Anatomy and Physiology. 7th ed. Dubuque, Iowa: William C Brown Publishers; 1996. 04/13/09 www.allrefer.com Shashi