BRONCHIAL ASTHMA

Syamsu
Division of Allergy and Clinical Immunology Department of Internal Medicine Medical Faculty of Hasnuddin University Makassar

SYAMSU DIVISION OFALLERGY AND CLINICAL IMMUNOLOGY DEPARTMENT OF INTERNAL MEDICINE MEDICAL FACULTY HASANUDDIN UNIVERSITY MAKASSAR

SUBTITLES
1. 2. 3. 4. 5. 6. Definition Burden of asthma Risk factors Mechanisms of asthma Diagnosis & Classification Management

DEFINITION
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment (GINA, 2004)

BURDEN OF ASTHMA
150 million asthmatics worldwide Prevalence increasing in most countries Significant cause of school/work absence Health care expenditure very high 1 million unnecessary death each decade Hospitalization and mortality still increase

Nutrisi dan Imunitas

Defisiensi
Kalori mudah terkena infeksi Protein me fagositosis Vitamin dan mineral thd sel T, B, makrofag, neutrofil

Nutrisi yang berlebihan

Mudah terkena infeksi

Gizi seimbang imunitas baik

Pengaruh defisiensi vitamin dan mineral terhadap imunitas

Sel T Sel B +++ ++ ++ +++ + +++ +++ +++ Makrofag Neutrofil

Vitamin A Thiamin Riboflavin B6 B12 Biotin Asam pantotenat Asam folat C D E Niasin dan triptofan

+++ +++ ++ ++ ++

++ + ++ ++ ++ ++

++ ++ ++

RISK FACTORS
HOST FACTORS :-genetics,atopy,race,gender ENVIRONMENTAL FACTORS :
-Indoor allergens : house dust,mite,cockroach etc -Outdoor allergens : pollens, fungi, yeasts -Occupational sensitizers : tobacco, chemicals etc -Air pollution -Respiratory infections -Socioeconomic -Family size -Diet and drugs

TRIGGER FACTORS,

allergens,chemical,infection, Physical,exercise,emotion,smoke,paint,fragrance etc

MECHANISMS OF ASTHMA

NONIMMUNOLOGIC STIMULANTS Viral infection, Chemical or physical CELLS ACTIVATION

EPITHELIAL CELLS MAST CELLS EOSINOPHILS LYMPHOCYTES MACROPHAGES

IMMUNOLOGIC STIMULANTS antigens

AUTONOMIC
NERVOUS SYSTEM
AXON REFLEX NEUROPEPTIDES

INFLAMMATORY MEDIATORS SMOOTH MUSCLE CONTRACTION CHEMOTAXIS

INFLAMMATORY MEDIATORS AIRWAY EDEMA CELLS INFILTRATION SUBEPITHELIAL FIBROSIS PLASMA EXUDATION MUCUS SECRETION MUCOSAL PERMEABILITY

CELLS ACTIVATION
NEUTROPHILS EOSINOPHILS LIMPHOCYTES BASOPHILS MACROPHAGES LYMPHOCYTES

AIRWAYS HYPERREACTIVITY

Mechanism of inflammation, hyperreactivity and asthma

ASTHMA

Mechanisms of the late phase allergic reaction

Histological alternations of the bronchial mucosa in asthma due to inflammatory and remodeling processes

Pengobatan standar OAT Bila disertai difesiensi imun : OAT + levamizol

SUMMARY
Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role that leads to recurrent episode of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. Prevalence and mortality rate still increase in many countries. The risk factors covered host factors and environmental factors The mechanisms involve a cascade of events involving many different kinds of cells, factors and mediators that interact to create the characteristic inflammatory and tissue remodeling processes of asthma

FUTHER READING
1. Kasper DL et a : HARRISONS PRINCIPLES OF INTERNAL MEDICINE, 16TH EDITION, 2005 2. Abbas AK and Lichtman AH : CELLULAR AND MOLECULAR IMMUNOLOGY, 5TH EDITION, 2005

3. Kay AB : ALLERGY AND ALLERGIC DISEASES, 7TH EDITION, 2004

4. OByrne P ET AL : GLOBAL INITIATIVE FOR ASTHMA, 2004