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88290212 Acute Asthma 2

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88290212 Acute Asthma 2
MANAGEMENT OF
ACUTE SEVERE ASTHMA
Dr DHANNURAM MANDAVI

INTRODUCTION
Asthma is a chronic lung disease with airway obstruction, airway inflammation and airway hyperreactivity to various stimuli, often reversible with bronchodilators and anti-inflammatory drugs.

PATHOPHYSIOLOGY
1)Extrinsic cause(IgE mediated/allergens)
2)intrinsic cause (non IgE mediated/Infection)
Allergens leads to
a) Early Reaction

within 10 min
Due to histamine; leukotriene- C;D;E ;PAF & bradykinin
Mucosal edema; bronchoconstriction ;mucus secretions

Inhibited by B2 agonist

b) Late Reaction


Develop 3-4 hr & peak at 6-12hr
Mast cell Mediator & ILs ;TNF-Alfa;PGs







Inflammatory reaction & Mucosal
Edema
Clinical Asthma
Inhibited by Premedication with

P

Triggering Factors immunologic & non immunologic bronchospasm & inflammation

Airway obstruction & hyper- reactivity
Ventilation perfusion abnormality
VaQ-mismatch
Hypoxemia
Hyperventilation
PaCO2, pH
Hypoventilation
PaCO2 pH Environment
Biological and
- Allergens genetic risk
- Infections
Age - Immune
- Microbes
- Lung
- Pollutants
- Repair
-Stress

Innate and adaptive immune development (Atopy)
- Respiratory viral infections
Lower airway injury
- Aeroallergens
- ETS
- Pollutants/ toxicants
- Persistent inflammation
Aberrant Repair - AHR
- Remodeling
- Airways growth and differentiation
ASTHMA

CLINICAL SIGNS IN ABNORMAL PHYSIOLOGY
Pathology

Clinical presentation

Increased airway resistance Retraction with increasing severity
-Use of accessory muscles
Head bobbing anterior flexion of head during inspiration in infants

Airway obstruction
-Muscle spasm
-Mucosal edema
Excess trapping of air

-prolonged expiration ; silent chest
-wheeze
-rhonchi
-Elevated shoulder
-Increased AP diameter of chest

Excess mucus secretion Wet sounds (crackles) more often predominant in infants

Hypoxia

Irritability,confusion,refusal to feed, semi coma, Hypercarbia

Bounding pulses, warm hands, dilated retinal vessels DIAGNOSIS OF ACUTE


References: - IAP textbook of paediatrics 4th edition (2009)
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