...

Catch the trade winds in your sails,

explore, dream, discover & live….! ”
- Mark Twain ?!*$#

“Twenty years from now

you will be more disappointed
by the things you didn't do
than by those you did.”
 Bronchial Asthma
(Alteration in
Oxygenation)

Niña Alma M. Bianson RN

Lyceum of the Philippines University
Batangas City

04/13/09
Asthma-Pathology -3

Objectives:
 At the end of the discussion the
students will be able to:
 Define Bronchial Asthma
 Discuss the anatomy and physiology of
the respiratory system
 Discuss the pathophysiology of
bronchial asthma
 State the different medical management
for bronchial asthma

04/13/09 Shashi
Asthma-Pathology -4

Diagnosis: Bronchial Asthma

An 18 year old girl was brought to the clinic
for complaints of Bronchial Asthma. When
patient reported to us, she was having a
very severe attack of Asthma.
She complained of breathlessness that was
worse from cold drink, cold water, draft of
air, monsoon, getting wet, at midnight.
Her complaints were better during the dry
climate and when traveling out of
Philippines. The complaints would also be
relieved by taking warm drinks and tea.

04/13/09 Shashi
Asthma-Pathology -5

Diagnosis: Bronchial Asthma

The cough was productive with white
expectoration. The patient's peculiar
features at the time of the Asthma
attack were extreme anxiety and
fear of death. She felt thirsty for little
water at a time. She was feeling
sensitive to cold and extremely
restless due to the complaints. The
patient also had complaints of cold
with watery discharge from the nose
and cracking of the joint
accompanied by pain.
04/13/09 Shashi
Asthma-Pathology -6

Diagnosis: Bronchial Asthma

She had a normal appetite with liking
for sweets, fast food and tea and was
averse to eating vegetables. She
would occasionally be constipated.
Her sweat was profuse in the
summers, especially in underarms.
Her sleep would be frequently
disturbed due to the asthma attacks
and due to thoughts on her mind.

04/13/09 Shashi
Asthma-Pathology -7

Diagnosis: Bronchial Asthma

Her birth history was normal.
Birth weight: 8 pounds
Age of talking: 1 year
Age of teething: 8 months

04/13/09 Shashi
Asthma-Pathology -8

Asthma:
 Chronic Inflammatory disorder of
bronchi characterized by Episodic,
reversible bronchospasm resulting
from an exaggerated
bronchoconstrictor response to
various stimuli (allergy)
 Affects 10% of children & 5%-7%
adults ♥

04/13/09 Shashi
Asthma-Pathology -9

Asthma Facts ?
 Asthma is “all in the mind.”
 You will “grow out of it.”
 Asthma can be cured,
 Not very serious disease and nobody dies from it.
 You are likely to develop asthma if someone in
your family has it.
 You can “catch” asthma from someone else who
has it.
 Moving to a different location can cure asthma.
 People with asthma should not exercise.
 Asthma does not require medical treatment.
 Medications used to treat asthma are habit-
forming.
 Someone with asthma can provoke episodes
anytime.
 Asthma can spread to other persons through
04/13/09 Shashi
Asthma-Pathology -10
Percent Change in Age-
Adjusted Death Rates, U.S.,
1965-1998
Proportion of 1965 Rate
3.0
Coronary Stroke Other CVD COPD All Other
2.5 Heart Causes
Disease
2.0

1.5

1.0

0.5
–59% –64% –35% +163% –7%
0
1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998 1965 - 1998
04/13/09 Shashi
Asthma-Pathology -11

Anatomy Physiology

04/13/09 Shashi
Asthma-Pathology -12

 Human Respiratory System

The human respiratory system consists of
two lungs and a set of air passages. The
lungs, together with the heart, sit in the
thoracic cavity or chest. This is an air tight
cavity that:
 provides a large surface area for gas
exchange
 has moist gas exchange surface areas

 is associated with the circulatory system

to transport oxygen to the cells and pick
up carbon dioxide produced by every cell
04/13/09
04/13/09 Shashi
Asthma-Pathology -13

..continuation of Anatomy
 The main function of the respiratory
system is to move air into the lungs so
that oxygen can enter the body and
carbon dioxide can be exhaled. During
breathing, air passes from the nose and
mouth into the pharynx and through the
larynx into the trachea. The trachea
bifurcates to carry air into each lung.
These two tubes are the main stem
bronchi; there is a single left main stem
bronchus and a single right main stem
bronchus for the left and right lungs,Shashi
04/13/09
Asthma-Pathology -14

Anatomy and Physiology

04/13/09 Shashi
Asthma-Pathology -15

Asthma

04/13/09 Shashi
Asthma-Pathology -16

Pathophysiolo INDUCERS
gy: Allergens,Chemical sensitizers,
Airway Air pollutants, Virus infections
Hyperresponsiveness
Genetic*

INFLAMMATION
Airflow Limitation

TRIGGERS
SYMPTOMS
Allergens, Exercise,
Cough Wheeze
Cold Air, SO2 Particulates
Dyspnea

04/13/09 Shashi
Asthma-Pathology -17 Contributing Factors
Causal Factors >Respriratory infections
Predisposing Factor >Exposure to indoor
Atopy >Air pollution
And outdoor allergens >Active/passive smoking
Female gender
>Occupational >Others diet, small size
sensitizers at birth

Inflammation

Hyperresponsiveness
of airways Airflow limitation

Symptoms
Risk Factors for Wheezing
Exacerbations Cough
Allergens
Dyspnea
Respiratory infections
Chest tightness
Exercise and hyperventilation
Weather changes
Exposure to sulfur dioxide
Exposure to food, additives,
04/13/09 medications Shashi
Asthma-Pathology -18

Pathogenesis - Atopic
Asthma:

04/13/09 Shashi
Asthma-Pathology -19

Mast cells in Asthma

Pathogenesis:

04/13/09 Shashi
Asthma-Pathology -20

Eosinophils in Asthma
Pathogenesis:

04/13/09 Shashi
Asthma-Pathology -21

Lung Morphology in Asthma

 Bronchial
inflammation
 Edema,
Mucousplugging
 Bronchospasm
 Obstruction
 Over
inflation/Atelectasis
 COPD

04/13/09 Shashi
Asthma-Pathology -22

Lung Hyperinflation in Asthma

04/13/09 Shashi
Asthma-Pathology -23

Thick bronchi with Mucous

plugs

04/13/09 Shashi
Asthma-Pathology -24

Asthma Microscopic
Pathology

Obstructed
Inflammed
Bronchi

04/13/09 Shashi
Asthma-Pathology -25

Asthma - Bronchial morphology

 inflammation
 Eosinophils
 Gland
hyperplasia
 Mucous plug in
lumen
 Hypertrophy of
muscle layer

04/13/09 Shashi
Asthma-Pathology -26

Asthma - Bronchial morphology

 Inflammatio
n
 Mucous
Plug
 Eosinophils

04/13/09 Shashi
Asthma-Pathology -27

Asthma – TH2 lymphocytes

immunostaining)

04/13/09 Shashi
Asthma-Pathology -28

Mucous plug in asthma:

04/13/09 Shashi
Asthma-Pathology -29

Eosinophils in Asthma:

04/13/09 Shashi
Asthma-Pathology -30

Medical Management

There are two basic kinds of

medication for the treatment of
asthma:
 Long-term control

medications
 Quick relief (rescue)

medications

04/13/09 Shashi
Asthma-Pathology -31

Long-term control
medications
 -- used on a regular basis to prevent attacks, not
for treatment during an attack.
 inhaled steroids (e.g., Azmacort, Vanceril,
AeroBid, Flovent) prevent inflammation
 leukotriene inhibitors (e.g., Singulair, Accolate)
 long-acting bronchodilators (e.g., famoterol,
Serevent) help open airways
 cromolyn sodium (Intal) or nedocromil sodium
 aminophylline or theophylline (not used as
frequently as in the past)
 combination of anti-inflammatory and
bronchodilator, using either separate inhalers
or a single inhaler (Advair Diskus)

04/13/09 Shashi
Asthma-Pathology -32

Quick relief (rescue)

medications
 -- used to relieve symptoms during
an attack.
 short-acting bronchodilators (e.g.,

Proventil, Ventolin, Xopenex, and

others)
 oral or intravenous corticosteroids

(e.g., prednisone,
methylprednisolone) stabilize
severe episodes
04/13/09 Shashi
Asthma-Pathology -33

New Pathology & Drugs in

Asthma:
 Leukotriences - significant role in
Asthma
 Mast cells and Eosinophil - Cytokines.

 Arachidonic acid - Lipo-oxygenase –

LTD4
 Bronchospasm – Cys-LT1 receptor

 Zileuton – Lipoxygenase inhibitor

 Montelukast & zafirlukast - inhibit

CysLT1
04/13/09 Shashi
Asthma-Pathology -34

Cell Damage

Cell Membrane
Phospholipids
Steroids

Arachidonic
Acid Cyclooxygenas
5-Lipoxygenase
NSAID e

Prostaglandins
Leukotrienes
Prostacyclins
LTC4, D4, E4

5-LO inhibitors
Antileukotrienes
04/13/09 Shashi
Asthma-Pathology -35

The Reality 
 Asthma is not yet curable *
 Underdiagnosis &
Undermanagement
 Therapy is still evolving
Hope 
Better understanding of


Pathology
 New line of Promissing Drugs.

04/13/09
Proper management  normalShashi
 Thank You…

Niña Alma M. Bianson RN

Lyceum of the Philippines University
Batangas City

04/13/09
Asthma-Pathology -37

References
 Joyce Black, Medical and Surgical Nursing, 8th
edition, 2005
 Saunder’s, Comprehensive Review for NCLEX,
2006
 Brunner And Suddarth, Medical and Surgical
Nursing, 6th Edition, 2005
 Berto, J.M.; Pelaez, A.; Fernandez E; A new indoor
source of Allergic sensitization & respiratory
disease. Allergy, 2002, 57, 155-159
 Murray JF, Nadel JA, eds. Textbook of Respiratory
Medicine. Vol. 1, 3rd ed. Philadelphia, Pa.: W.B.
Saunders; 2000.
 Shier D, Butler J, Lewis R. Hole's Human Anatomy
and Physiology. 7th ed. Dubuque, Iowa: William C
Brown Publishers; 1996.
 www.allrefer.com
04/13/09 Shashi