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천식 Asthma

Review of Disease Asthma목차 1. Introduction 2. Etiology 3. Pathogenesis 4. Asthma Triggers 5. Pathophysiology 6. Clinical Features 7. Diagnosis 8. Treatment1. Introduction a syndrome airflow obstruction that varies markedly, both spontaneously and with treatment2. Etiology3. Pathogenesis4. Asthma Triggers 1) Allergens 2) Virus Infections 3) Pharmacologic Agents 4) Exercise 5) Physical Factors 6) Food 7) Air Pollution 8) Occupational Factors 9) Hormonal Factors 10) Gastroesophageal Reflux 11) Stress5. Pathophysiology Limitation of airflow!! bronchoconstriction (main) airway edema, vascular congestion, and luminal occlusion with exudate ↑ airway resistance ↓ FEV 1 ↓ FEV 1 /FVC ↓ PEFAirway Hyperresponsiveness(AHR) the excessive bronchoconstrictor response to multiple inhaled triggers that would have no effect on normal airways. ↑ AHR ► ↑ frequency of asthma symptoms reduce AHR : aim of therapy!! direct bronchoconstrictors contract airway smooth muscle histamine and methacholine indirect stimuli (most of the triggers) release bronchoconstrictors from mast cells or activate sensory neural reflexes allergens, exercise, hyperventilation, irritant dusts, and sulfur dioxide6. Clinical Features wheezing, dyspnea , and coughing worse at night awake in the early morning hours increased ventilation use of accessory muscles of ventilation Prodromal symptoms itching under the chin, discomfort between the scapulae, or inexplicable fear (impending doom ). expiratory rhonchi throughout the chest7. Diagnosis 1) 비정상시 airway obstruction 의 reversibility 증명 15 min after an inhaled short-acting b 2 -agonist 12% or 200 mL increase in FEV 1 2) 정상시 increased AHR 의 증명 (Provocation test) Metacholine , histamine 20% decrease in FEV 1 by 20% (PC 20 )8. Treatment main drugs for asthma Bronchodilators rapid relief of symptoms relaxation of airway smooth muscle Controllers inhibit the underlying inflammatory process1) Bronchodilator Therapies B 2 -Agonists : albuterol , terbutaline , salmeterol , formoterol Anti- Cholinergics : ipratropium bromide Theophylline : t heophylline , aminophylline 2) Controller Therapies Inhaled Corticosteroids Systemic Corticosteroids Antileukotrienes : montelukast and zafirlukast Cromones : cromolyn sodium, nedocromil sodiumStep-wise approach to asthma therapyReferences Harrison’s Principles of Internal Medicine 17 th edition ; Chapter 248. Asthma{nameOfApplication=Show}

의/약학| 2009.04.01| 15페이지| 1,000원| 조회(269)

호흡곤란, 천식, asthma, Dyspnea, 천식 asthma

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심부전 Heart Failure

1. Definition 2. Etiology 3. Pathogenesis 4. Clinical Manifestations 5. Diagnosis 6. Treatment 7. Prognosis임상 증후군 심장의 구조나 기능의 이상으로 심장이 대사 조직의 요구에 맞추어서 심실이 충분히 혈액을 구혈해내지 못하거나 심실을 충만시킬 수 없는 상태Damage the heart muscle↓ Pumping capacity of the heartLV dysfunction !!Index eventPatients with LV dysfunction may remain asymptomatic. The reason?? Compensatory mechanisms (1) activation of the renin-angiotensin-aldosterone(RAA) (2) adrenergic nervous systems (3) ↑ myocardial contractilityLV dysfunctionHeart FailureNecessary, but not sufficient !!Activation of neurohormonal systems in heart failureDyspnea on Exertion Orthopnea Paroxysmal Nocturnal Dyspnea (PND) Cheyne-Stokes Respiration Acute Pulmonary EdemaMajor CriteriaMinor CriteriaParoxysmal nocturnal dyspneaExtremity edemaNeck vein distentionNight coughRalesDyspnea on exertionCardiomegalyHepatomegalyAcute pulmonary edemaPleural effusionS3 gallopVital capacity reduced by 1/3 from normalIncreased venous pressure(16cmH2O)Tachycardia ( 120bpm)Positive hepatojugular reflexMajor or MinorWeight loss 4.5kg over 5 day's treatment적어도 1개의 Major Criteria + 2개의 Minor Criteria1) General Measures HTN, other risk factor tx., stop smoking, limit alcohol 2) Control of Excessive Fluid Na restriction, diuretics 3) Preventing disease progression Excessive activation of RAAS Adrenergic NS RAAS ; ACE i., ARB, aldosteron antagonists Adrenergic Nervous System ; ß-blocker4) Anticoagulation and Antiplatelet Therapy ↑risk for thromboembolic events d/t stasis warfarin, aspirin 5) Management of Cardiac Arrhythmias Atrial fibrillation 15~30% in HF cause of cardiac decompensation amiodarone dofetilide 6) Device Therapy Cardiac Resynchronization(Biventricular pacing) Implantable Cardiac DefibrillatorsCRT, cardiac resynchronization therapy; ICD, implantable cardiac defibrillator.Functional status is an important predictor. NYHA class II ; 5~10% annual mortality rate NYHA class IV ; 30~70% annual mortality rateHarrison's Principles of Internal Medicine 17th{nameOfApplication=Show}

의/약학| 2009.03.27| 14페이지| 1,000원| 조회(608)

CHF, 심부전, congestive heart fai, Heart, Heart..

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