Definition - Chronic inflammatory
- Narrowing of bronchi
- Reversible
- Transient
Risk Factors - FHx
- Parental smoking
- Atopic syndrome
- Eczema
- Atopic dermatitis
- Allergic rhinitis
- Obesity
- Nasal polyposis
- GI reflux
Differential diagnosis - Cystic fibrosis
- COPD
- Bronchiectasis
- Lower lobe crackles, wheezes
- High res. CT
- Foreign body
- PE
- Congestive heart failure
- Vocal cord dysfunction
- Inspiratory AND expiratory wheeze (sound identical)
Epidemiology Aetiology - Genetic
- Environmental triggers
- Allergens
- Infections
- Emotional
- Cold air
- Exercise
Clinical features - Dyspnoea
- Cough
- Recent resp. infection
- Expiratory wheeze
- Reduced PEV
- Responds to short-acting beta-2 agonists
- Creola bodies
Pathophysiology - Bronchial narrowing
- Constriction
- Mucous
- Oedema
- Hyper-responsiveness
- TH2-mediated response
- IL-4 etc
- Mast cells, eosinophils
- Leukotriene release
- Potential for long-term changes
InvestigationsManagementa) conservative- Smoking cessation
- Allergen avoidance
b) medical - Short-acting relievers
- Long-acting inhaled relief
- Oral corticosteroids
- Leukotriene receptor antagonists
c) surgicalPrognosis |
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