ASTHMA

ASTHMA

Disease effect the alveoli mean restrictive
Disease effect the airway upper or lower mean obstructive like asthma.

Pathology
Inflammation in bronchiole
Bronchiole content mucosa and submucosa
Mucosa have a epithelial and lamina propria and under it submucosa called smooth muscles layer

Cell in propria are WBC eosinophils and inside it called granules
When trigger like viruse or any thing get inside body so that make immune response by eosinophils that catch thise virus then pump it's content of chemical mediators Inside eosinophils like prostaglandins or cytokine or platelets aggregation factors .
That make degradation to viruses. That. Make inflammation.
Submucosa make smooth muscles contract in bronchial constriction
And in trachea goblet cell increase secretion .

Sing and symptoms

Dyspnea and chest tightness come from the inflammation that make less air to get in .

Because when pt get less air that make pt to use extra muscle that increase expansion of chest make it hyperinflation
And that make air to get difficult and get out more difficult by use extra muscle
Make stretch spendle receptor stimuli when muscle stretch by send signals for brain that indicate decrease lung compliance. So pt feel with chest tightness.

Wheezing
From bronchoconstriction from secretions in bronchiole

Productive cough
Mean cough with sputum with green colour and content from..
Charkot lydin crystal like blake needle come from esinophils degeneration.
Also... . .Cersh man spindle from mucous blog in sever cases because mucus blog is big so obstruction is nearly complete.

Tachypnea by increase RR to get more air

Tachycardia.
By stimulate sympathetic to increase HR so heart keep the same volume arrive to tissues..

Hypothermia make hypercapnia by decrease ph. acidosis because increase co2 and decrease o2 .

Pulsus paradoxes ...
Is decrease in systolic Bp with 10 mmhg while inspiration.
When heart make concentrations to pump blood into all body and the blood on other side is return to heart bu superior vena cava is main vein .at the same time of chest hyperinflammation and up normal expansion in inhalation to get more air inside that push the all chest contents with heart and vessels and aorta make venous return of blood more so more preload so more afterload so make right ventricle bigger so increase in diastolic pressure so intraventricular septum between the right and left ventricle so bush the left ventricle make it smaller so make blood decrease in left ventricle that make systolic pressure decrease 10 mmhg with inhalation.

Also fever and pale and cyanosis clubbing finger
Tectle fremetus decrease

Perception...hyper resonance in hyperinflammation
May also dull in exhalation
..

Asthma classs
Depending on severity of symptoms

Intermittent asthma .
Pt stable
Wheezing is so weak
In all asthma wheezing is heard in all lung
With normal or just slightly increase in HR and RR
Pulses paradoxes can't be found
Spo2 normal or 95 %

Mild asthma
Sing and symptoms with more severity just slightly.
More pain just slightly
Spo2 less like 93% or 94 %
Wheezing more obvious but still weak .
No pulse paradoxes

Moderate
High wheezing sounds
RR high
HR HIGH more than 100
No pulse paradoxes
Spo2 93 % or 94 %

Sever persistent asthma
Can't speak with full sentences
Hr more than 110
Rr more than 25
Wheezing
Cyanosis
Spo2 92% no less
You have to give drug direct

Near fatal asthma
Cyanosis
Spo2 less than 92%
Bradycardia
Chest muscles become weak
Tracheal tug or intercostal muscle with up normal deep in chest
Pt start respiratory failure
Avpu scaled decrease or coma
No sound....silent chest
You have to give drug
You can use c .pap 5 to 10 cm .peap
Be prepared to RSI intubation.

.....Treatment .....in hospital
should be given in ladder mean gradually
Give o2 and bronchodilator( mild &intermittent)
Give o2 with 2 type of bronchodilator (moderate)
Give o2 with 2bronchodilator and iv anti-inflammatory (sever)
Give o2 .2 bronchodilator. Iv and orally anti-inflammatory (fatal)

When pt become better you have to start delete drug gradually by reversing the Last step

......treatment....in emergency or prehospital

OHSIT

O ....O2 by nonrebreather

S...Salbutamo (albuterol)l is an B2 agonist so bronchodilator 250 mg with 3 cc NS .nebulizer

I.....Ipratropium
Parasympathetic antagonists
Anti muscarinic
So bronchodilator 0.5 mg iv

H...Hydrocortisone is an anti inflammation
100 to 250 mg iv
Methylpretheslone can also use .

T...Thyiophelin

E....Epnepheren
0.3 to 0.5 mg Sc just just in (fatal asthma )

The 2 bronchodilator like salbutamol and ipratropum mixed in syrangisim procedure

Magnesium sulfate
Dyphynhaidymain byndyral .anti histamin
Duaritic
Cpap.
Intubation

Linked between asthma spreading and 4 seasons :
Asthma and daily life:

......History ...
Have this symptoms from child age or seasonal elergy
Use inhaler at home
Increase at night and early morning becouse histamine increases tend to biologic clock .circadian cycles that regulate by site gabs .
Type of birth after pregnant
Cesarean delivery can highly effected to asthma.