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Asthma:
Asthma in Greek=Panting
Pathogenesis:
-Exposure to Allergensynthesis of IgE these bind with the mast cells in the airway of the
mucosa and triggers the release of mediators of anaphylaxis
-Antihistamines are not used in treatment because there are other substances that are released
other than histamines.
-Leukotrien Antagonists are used because Leukotriens cause bronchospasm and they are more
effective.
-There is cytokine release and IL4, IL5 which are inflammatory mediators. That’s why we use
anti-inflammatory drugs
1-Extrinisic Asthma:
-No IgE
Asthma management:
Intrinsic asthma:
-NOTE:
Once there is an increase in PCO2 then this is an indication that there is a risk of respiratory
failure
d- Regular follow up
Anti-Asthma Agents
2- Corticosteroid Hydrocortisone-Methylprednisolone
Management:
Acute Asthma:
b- Nebulizer
Advantages of Nebulizer:
If the response is good, observe the patient for one hour and if he is stable discharge and send
him home. If the response is not good, this indicates respiratory failure and admit to ICU
Severe asthmatic attack will not respond to B2 agonistB2 receptor becomes insensitive to B2
agonist
There will be wheezing for a day and patient will go into respiratory failure
Chronic asthma:
Patients will have: reduced FEV1 and inflammation so they will have a certain degree of
constriction at all times
Beclomethasone and Bedasonide are the inhaled steroids which are used. They are NOT given
alone, they are given along with B2 agonists.
If the patient still doesn’t improve, Leukotrien Antagonist are added Montelaukast cannot be
used alone. It is added to B2 agonist or inhaled corticosteroids
-if patient has difficulty in breathing we give him systemic steroids but this has more systemic
Side effects
Hallmark signs:
-Wheezing
-Dyspnea
PO240-60
PCO2Normal
Treatment:
-Identify patients
-Intensive care
-O2
-Hydration
-Intubate in ICU
NOTE: old text books say that you must not give them more than 28% O2, but now we know
that you can give them as much O2 as they require.
-The patients have LOW PO2 and INCREASE in PCO2 (normally 35-40 yrs of age)
We must hydrate the patient and Hydration helps hydrate the tracheobronchial tree
Drug:
a- Long half life only one drug per day is needed for 3 days duration and even if you stop the
medication, the blood level will still be high so it will be good for many micro-organisms
COPD
Risk factors
-Smoking
-Pollution
Management:
-Vaccination of patient
NOTE: In winter respiratory tract infections make the disease very severe so annual vaccination
must be given against hemophyllus influenza b
-If the sputum has lots of eosinophils, add steroids to their treatment
NOTE: in these patients it is the hypoxia that drives the respiratory center because their bodies
get used to the increase in CO2 and unlike normal people it is no longer a stimulus for breathing.
So the hypoxia is what drives the respiratory center and If they are given more than 30% O2,
their respiratory center will stop.
Eman Bakhashwain