PHRM 514 - Asthma - Fall 2012 (1)

Antigens taken up by antigen presenting cells 2

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Antigens taken up by antigen-presenting cells 2. Antigens presented to T-lymphocytes and response is activated 3. Antigen interacts with IgE on mast cells ü. Pro-inflammatory cytokines and chemokines, histamine, and inflammatory mediators released ü. Eosinophils, neutrophils, alveolar macrophages recruited and activated 4. Bronchoconstriction results n. Lasts ~1 hour after antigen exposure Leader WG. Asthma. In: Chisholm-Burns MA, Schwinghammer TL, Wells BG, et al., eds. Pharmacotherapy: Principles and Practice. 2nd ed. New York: McGraw Hill Medical; 2010:265-267.
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Allergen Induced Bronchoconstriction: Late Phase Allergic Reaction n 4 to 9 hours after exposure to antigen 1. Activated airway cells release inflammatory cytokines and chemokines 2. Milder bronchoconstriction as well as airway hyper-responsiveness and inflammation occur Leader WG. Asthma. In: Chisholm-Burns MA, Schwinghammer TL, Wells BG, et al., eds. Pharmacotherapy: Principles and Practice. 2nd ed. New York: McGraw Hill Medical; 2010:265-267.
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Airway Hyperresponsiveness n Exaggerated bronchoconstrictor response n Occurs in response to stimuli Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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Additional Contributors to Airway Narrowing n Airway edema n Airway smooth muscle contraction n Airway thickening n Mucus hypersecretion Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. . Updated 2011. Accessed October 10, 2012.
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What is Asthma? National Heart, Lung, and Blood Institute Diseases and Conditions Index. . Updated February 1, 2011. Accessed October 16, 2011.
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Airway Remodeling n Airway narrowing may only be partially reversible n Permanent structural changes n Progressive loss of lung function ¡ Airway smooth muscle n Increases due to hypertrophy and hyperplasia n Contributes to increased thickening of airway wall ¡ Blood vessels n Proliferate, dilate, and may contribute to increased airway wall Increases thickness ¡ Mucus hypersecretion n Due to increased number of goblet cells and increased size of submucosal glands Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma. . Updated 2011. Accessed October 10, 2012. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. asthgdln.pdf. Published August 28, 2007. Accessed October 16, 2011.
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Airway Inflammation n Central and peripheral airways inflamed n All cells of airway involved ¡ Epithelial cells ¡ Eosinophils ¡ Lymphocytes ¡ Mast cells ¡ Alveolar macrophages ¡ Neutrophils ¡ Fibroblasts and myofibroblasts ¡ Inflammatory mediators Kelly HW, Sorkness CA. Asthma. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy a pathophysiologic approach. 8th ed. New York: McGraw Hill Medical; 2011:439-448.
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  • Fall '12
  • lipsh
  • chronic asthma, ed. New York, McGraw Hill Medical

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