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ASTMUL BRONSIC

In Research on June 27, 2008 at 8:27 pm
n 1.1. Definition of Asthma (key words)
n chronic inflamatory syndrome of the airways
n Involving several cells (eosinophils, limfocytes, macrophages, mastocytes, epithelial, smooth m cells etc), citokynes and mediators
n apearing in genetically susceptible individuals
n Bronchial obstructie reversible partially/complete, spontanously/under treatment
BHR to various factors
n Tablou clinic si morfopatologic unitar
tipuri etiopatogenice distincte
u astm extrinsec (alergic)
u astm intrinsec (deseori intricat cu BPOC)
u sensibil la antiinflamatorii nonsteroidiene
u profesional
Prevalenta si mortalitate
n Cresterea prevalentei.
u 1960-1970 prevalenta in populatia neselectionata
F SUA si in Romania 1,5-2 %
u 1990 pana in prezent prevalenta
F SUA 4,3 % (1992)
F Romania 4,5 % (1995)
. Impactul bolii asupra individului
n Copiii astmatici:
u tulburari de personalitate (crestere intr-un mediu familial anxios, complexul de a fi “altfel decat ceilalti”)
u tulburari de scolaritate (lipsa de la scoala, performante mai slabe “justificate”)
u efecte secundare ale medicatiei (teofilina)
u spitalizari uneori frecvente
IMPACT INDIVID cont
n Adultii astmatici:
u tulburari de personalitate (anxiosi, depresivi, complexe de inferioritate, frustratie); profil psihologic “astmatic”
u probleme profesionale (absenteism, handicap fata de unele profesiuni)
u incapacitate de a practica unele sporturi
u sentimentul de handicap social
u dificultate de a intemeia o familie
MORTALITATE
n Factori psihosociali legati de decese:
u depresie sau alte modificari psihiatrice semnificative
u tulburari severe de scolaritate
u alcoolism sau toxicomanie
u tabagism sau fumat pasiv
u stress major familial/familii “cu probleme”
u izolare sociala, fara domiciliu
u saracie severa
n 1. Inflamatia cronica cu eozinofile este principalul substrat patogenic al astmului
n 2. Este o inflamatie de natura diferita de cea din BPOC, bronsectazii, bronsite infectioase sau iritative
n 3. Raspunde cel mai caracteristic la CORTICOSTEROIZI
n 4. NU raspunde la antibiotice
Care sunt Simptomele Astmatice?
n Dispneea
u de obicei dominanta, rareori absenta
u >/< paroxistica
u ± expiratorie
n Wheezing (= respiratie suieratoare audibila la gura, in expir ± inspir)
u insoteste inconstant dispneea
u relativ tipic
Care sunt Simptomele Astmatice?
n Tusea
u rareori dominanta, de obicei insoteste dispneea
u neproductiva / slab productiva (uneori aparent purulenta – eozinofile!!)
u chinuitoare (“spastica”)
n Senzatia de constrictie toracica
u insoteste dispneea, inconstanta
Caracterele Simptomelor Astmatice
n variabile:
u aparitie / agravare cu/fara factori declansatori evidenti
u ameliorare spontana sau sub tratament
n predominant nocturne
sau
n in prezenta unui factor declansator (ex. efort)
Cum se manifesta Simptomele Astmatice?
n Criza astmatica
n Exacerbarea astmatica
n Simptome continui
n Astm tusiv

Urmatorul: Tratamente in astmul bronsic

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