Bronchial Asthma

This is a mind map about bronchial asthma, mainly including overview, etiology and pathogenesis, diagnosis, Treatment etc. Welcome to like and collect!

Edited at 2024-03-15 11:31:54

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Bronchial Asthma

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Outline

Bronchial Asthma

Introduction

chronic airway inflammation

Characterized by airway hyperresponsiveness

Etiology and pathogenesis

mechanism

Airway immunity-inflammatory mechanism

Mechanism of airway inflammation

Asthma-causing biologically active substances

histamine

leukotrienes

prostaglandins

active neuropeptides

eosinophil chemotactic growth factor

inflammatory cells

eosinophils

delayed onset asthma

basophils

early onset asthma

Binds to antibodies to release histamine

Mast cells

immediate onset asthma

Seen in type 1 allergic reactions

IgE

airway hyperresponsiveness

Basic characteristics of asthma

Chronic inflammation of the airways is an important cause of hypersensitivity

neuromodulatory mechanisms

★Asthma does not cause tissue damage/is reversible

★Small bronchial smooth muscle spasm

Pathology → Chronic airway inflammation/reversible obstructive ventilatory disorder (basic characteristics)

Airway subepithelial mast cell/eosinophil/macrophage infiltration

Inflammatory cell infiltration

Goblet cell proliferation → increased secretion

Produces → moist rales (with lots of mucus)

Airway submucosal tissue edema

Increased microvascular permeability

bronchial smooth muscle spasm

Produce → Dry rales (no mucus produced)

ciliated epithelial cell shedding

clinical manifestations

symptom

Difficulty breathing with wheezing

Can be relieved with antiasthmatic drugs

Aggravated at night

Have chest tightness/shortness of breath

specific asthma

cough variant asthma

Chest tightness variant asthma

physical signs

expiratory dyspnea

The patient is forced to sit upright

Reduced voice resonance

Profuse sweating with cyanosis

Inspiratory position

After inhaling air, it is difficult to exhale quickly due to difficulty in exhalation, and the chest becomes full and expanded after inhalation.

Special signs

silent lung

Seen in severe asthma

The wheezing sound weakens/disappears instead

Symptoms of critical condition

★High degree of bronchial stenosis/phlegm blockage

★Cardiogenic asthma

Nocturnal paroxysmal wheezing and coughing up pink frothy sputum

Laboratory functional check

Sputum eosinophil count

Pulmonary function tests

Ventilation function test

Forced vital capacity↓

Residual capacity↑

One second rate FEV1/FVC

Check for airway restriction

FEV1% per second

Degree of airway restriction

Bronchial provocation test (acetylcholine/histamine drugs) (hyperreaction)

Positive (airway hyperresponsiveness)

FEV1 decreases >20%

Bronchodilation test (albuterol/terbutaline) (reversible)

Repeat lung function testing after inhaling bronchodilators

If positive → there is reversible airway obstruction

Helps in diagnosing bronchial asthma

FEV1 increased >12%

★The bronchodilation test is generally preferred

★FEV1 (forced expiratory volume in first second) → FEV1 decrease (the main manifestation of abnormal lung function)

peak respiratory flow PEF

Helps assess asthma conditions

★Generally available after being diagnosed with asthma

image

Remission period → No abnormality in X-ray findings

During the attack → the transparency of both lungs increases

Blood gas changes (PH:7.35-7.45)(PCO2:35-45)

Early PaO2↓ PaCO2 ↓ PH↑

Early hyperventilation → respiratory alkali

★CO2↓

The condition is not serious

The airway has not yet become severely spasmed, and carbon dioxide can be exhaled freely.

Respiratory alkalosis (excessive exhalation of carbon dioxide)

Late PaO2↓ PaCO2↑ PH↓

Advanced airway obstruction, severe spasm, respiratory muscle fatigue, hypoxia and CO₂ retention → acidic breathing

★CO2↑

serious condition

Airway inflammation and spasm, obstructed exhalation of carbon dioxide

Respiratory acidosis (carbon dioxide retention)

★Can be used when unconscious or unconscious

diagnosis

installment

acute attack period

Grading

Mild

Difficulty going upstairs

Moderate

Heart rate 100-120

Three concave signs/paradoxical pulse

Severe

Heart rate＞120

orthopnea

Three concave signs/paradoxical pulse

critical

silent lung

disorder of consciousness

★Abnormal movements of chest and abdomen

chronic duration

Wheezing/coughing/chest tightness of varying frequency/degree over a long period of time, decreased lung function

treat

Antibiotics are ineffective

Drug classification and action characteristics

Glucocorticoids (main control drugs) (severe (drugs used)

Methylprednisolone

Beta 2 agonists (relieve acute attacks)

Chronic phase treatment drugs

Glucocorticoid Long-acting β2-receptor agonist

Acute attack medications

short-acting β2-receptor agonist

Prohibited use of drugs

morphine

acute attack period

severe attack

Invasive mechanical ventilation (drug use is ineffective)