Scribd Logo
Upload

Welcome to Scribd!

  • 142 views

    Asthma Pathophysiology: Ixsy Ramirez, MD, MPH Pediatric Pulmonology University of Michigan, C.S. Mott Children's Hospital

    Uploaded by

    Aru Verma
    Asthma is a chronic inflammatory disease of the airways characterized by variable airflow obstruction. It is caused by an interaction between genetic and environmental factors. The pathophysiology involves inflammation of the airways with increased numbers of mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. This inflammation leads to bronchoconstriction, airway hyperresponsiveness, edema and remodeling of the airways over time with increased smooth muscle and collagen deposition. Symptoms include wheezing, breathlessness and cough, especially at night or in the morning. Treatment focuses on reducing inflammation and relaxing smooth muscle.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Asthma Pathophysiology: Ixsy Ramirez, MD, MPH Pediatric Pulmonology University of Michigan, C.S. Mott Children's Hospital

    Uploaded by

    Aru Verma
    142 views21 pages
    Asthma is a chronic inflammatory disease of the airways characterized by variable airflow obstruction. It is caused by an interaction between genetic and environmental factors. The pathophysiology involves inflammation of the airways with increased numbers of mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. This inflammation leads to bronchoconstriction, airway hyperresponsiveness, edema and remodeling of the airways over time with increased smooth muscle and collagen deposition. Symptoms include wheezing, breathlessness and cough, especially at night or in the morning. Treatment focuses on reducing inflammation and relaxing smooth muscle.

    Original Description:

    Pathophysiology of asthma Medical surgical nursing

    Original Title

    RAMIREZ-_Pathophysiology_of_Asthma

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Asthma is a chronic inflammatory disease of the airways characterized by variable airflow obstruction. It is caused by an interaction between genetic and environmental factors. The pathophysiology involves inflammation of the airways with increased numbers of mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. This inflammation leads to bronchoconstriction, airway hyperresponsiveness, edema and remodeling of the airways over time with increased smooth muscle and collagen deposition. Symptoms include wheezing, breathlessness and cough, especially at night or in the morning. Treatment focuses on reducing inflammation and relaxing smooth muscle.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    142 views21 pages

    Asthma Pathophysiology: Ixsy Ramirez, MD, MPH Pediatric Pulmonology University of Michigan, C.S. Mott Children's Hospital

    Uploaded by

    Aru Verma
    Asthma is a chronic inflammatory disease of the airways characterized by variable airflow obstruction. It is caused by an interaction between genetic and environmental factors. The pathophysiology involves inflammation of the airways with increased numbers of mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells. This inflammation leads to bronchoconstriction, airway hyperresponsiveness, edema and remodeling of the airways over time with increased smooth muscle and collagen deposition. Symptoms include wheezing, breathlessness and cough, especially at night or in the morning. Treatment focuses on reducing inflammation and relaxing smooth muscle.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 21

    Asthma

    Pathophysiology
    Ixsy Ramirez, MD, MPH
    Pediatric Pulmonology
    University of Michigan, C.S. Mott Children’s Hospital
    Definition of Asthma
     Chronic inflammatory disorder of the airways
     Mast cells, eosinophils, T lymphocytes, macrophages,
    neutrophils, epithelial cells
     Causes variable and recurrent episodes of
    wheezing, breathlessness, chest tightness,
    cough – especially at night or early morning
     Associated with widespread, but variable airflow
    obstruction that is often reversible

    NHLBI Asthma Guidelines, EPR-3, Aug 2007


    NHLBI Asthma Guidelines, EPR-3, Aug 2007
    Asthma Pathophysiology
    Individual Inflammation Impact

    Genetic predisposition Inflammation underlies disease Clinical symptoms also vary by


    Intrinsic vulnerability processes individual and over time
    Gene-environment Phenotype varies by individual
    interact: and over time
    Atopy / allergy
    Infection
    Airflow Limitation
     Induced by airway inflammation
     Bronchoconstriction- Bronchial smooth muscle contraction
    that quickly narrows the airways in response to exposure to a
    variety of stimuli
     Airway hyperresponsiveness- an exaggerated
    bronchoconstrictor response to stimuli
     Airway edema- as the disease becomes more persistent and
    inflammation become more progressive, edema, mucus hyper
    secretion, and formation of inspissated mucus plugs further
    limit airflow.

    NHLBI Asthma Guidelines, EPR-3, Aug 2007


    Pathophysiology
    Pathology
    Remodeling
     Reversibility of airflow limitation may be incomplete in
    some patients.
     Persistent changes in airway structure
     Sub-basement fibrosis
     Mucus hypersecretion
     Injury to epithelial cells
     Smooth muscle hypertrophy
     Angiogenesis
    Histopathology of asthma
    Normal Asthma

    Same in both pictures (x 300)

    • Tight structure with a predominance of • Less ciliated cells


    ciliated epithelial cells. • Goblet cells hyperplasia
    • Only few goblet cells in the epithelium. • Epithelium and lamina propia are
    • The lamina propia, is practically cell- highly infiltrated (mainly eosinophils and
    free. lymphocytes)
    • Inflammatory cells are not seen. • Edema
    • Basement membrane thickening
    Laitinen et.al. Allergy Proc 15,6:323, 1994 • Collagen deposition in the sub mucosa
    Consequences of Remodeling in
    Asthma
    Smooth Mucous Inflammatory Fibrogenic Elastolysis
    muscle mass glands cells growth factor
    increase increase persistence release
    Reduced
    elasticity of
    airway wall
    Important mucus
    Collagen
    secretion during
    deposition on
    exacerbation
    RBM and ECM
    Severe Ongoing
    bronchospasm inflammation
    during
    exacerbation

    Bousquet J, et al. Am J Respir Crit Care Med. 2000;161(5):1720-1745.


    Histopathology of Status Asthmaticus
    In fatal exacerbations the pathology is dominated
    by extensive plugging of the conducting airways
    with mucus and extracellular debris
    Changes in the Asthmatic Airway

    Inflammation

    Smooth Muscle
    Changes

    Flow Expiration Flow Expiration

    Volume Volume

    Inspiration Inspiration
    FEV1/FVC < 75-80% = Obstruction
    Causes of Asthma
     Interplay between host factors (primarily genetics),
    and environmental exposures that occur at a
    crucial time in the development of the immune
    system.
     A definitive cause is unknown.
    Causes of Asthma

    NHLBI Asthma Guidelines, EPR-3, 2007


    Clinical Heterogeneity of Asthma
     Allergic versus nonallergic asthma
     Late- versus early- onset asthma
     Exercise-induced asthma
     Nocturnal asthma
     Asthma with prominent symptom of cough
    Pathogenesis of Asthma

    NHLBI Asthma Guidelines, EPR-3, 2007


    Asthma Pathophysiology –Therapeutic
    Implications

    Short and Inhaled


    Long-Acting Smooth Muscle Airway Corticosteroids
    Dysfunction Inflammation
    Beta2-Agonists Leukotriene
    Antagonists

    • Bronchoconstriction • Inflammatory cell


     • Bronchial hyperreactivity

    infiltration/activation
     • Hypertrophy/Hyperplasia
     • Mucosal edema 
    • Inflammatory mediator
     release
    • Cellular proliferation 
    • Epithelial damage 
    • Basement membrane 
    thickening

    Symptoms/Exacerbation
    s

    Adapted from Bousquet et al. Am J Respir Crit Care Med. 2000;161:1720-1745.


    Environmental Factors
     Allergens
     House dust mite
     Alternaria
     Cockroach/mouse
     Pets
     Infections
     Atopic interaction
     RSV, parainfluenza – young
     Rhinovirus
     Others
     Tobacco smoke
     Pollution/Occupation
     Obesity?
    Natural History of Asthma - Children
     Majority of persistent asthma symptoms begin
    before age 3
     Younger onset (< 3yo vs >6 yo) is associated
    with lower FEV1 at 11-16 yrs (Morgan 2005,
    CAMP 2000)
     Majority of asthmatics < 3yo will not wheeze at
    > 6yo
    Asthma in Adults
     Evidence for lower overall lung function in adults
    with asthma (James, 2005)
     Variable information about rate of decline, when
    other factors (smoking, COPD) excluded (Sherrill
    2003, Griffith 2001)
    Questions?

    You might also like