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  • Potenciais alvos de distrbios patolgicos do

    aparelho respiratrio

  • Doena Pulmonar

    Obstrutiva: aumento na resistncia ao fluxo areo.

    1. Asma

    2. Doena pulmonar obstrutiva crnica

    a) Bronquite crnica

    b) Enfisema pulmonar

    Restritiva: reduo da expanso do parnquima pulmonar

    1. Sndrome do desconforto respiratrio agudo (SDRA)

  • Asma

  • Global Initiative for Asthma

    Asthma is one of the most common chronic diseases worldwide

    with an estimated 300 million affected individuals

    Prevalence is increasing in many countries, especially in

    children

    Asthma is a major cause of school and work absence

    Health care expenditure on asthma is very high

    Burden of asthma

    GINA 2014

  • Global Initiative for Asthma

    Asthma is a common and potentially serious chronic disease

    that can be controlled but not cured

    Asthma causes symptoms such as wheezing, shortness of

    breath, chest tightness and cough that vary over time in their

    occurrence, frequency and intensity

    Symptoms are associated with variable expiratory airflow,

    i.e. difficulty breathing air out of the lungs due to

    Bronchoconstriction (airway narrowing)

    Airway wall thickening

    Increased mucus

    Symptoms may be triggered or worsened by factors such as

    viral infections, allergens, tobacco smoke, exercise and stress

    What is known about asthma?

    GINA 2014

  • Global Initiative for Asthma

    Asthma is a heterogeneous disease, usually characterized

    by chronic airway inflammation.

    It is defined by the history of respiratory symptoms such as

    wheeze, shortness of breath, chest tightness and cough

    that vary over time and in intensity, together with variable

    expiratory airflow limitation.

    Definition of asthma

    NEW!

    GINA 2014

  • Global Initiative for Asthma

    The diagnosis of asthma should be based on:

    A history of characteristic symptom patterns

    Evidence of variable airflow limitation, from bronchodilator

    reversibility testing or other tests

    Document evidence for the diagnosis in the patients notes,

    preferably before starting controller treatment

    It is often more difficult to confirm the diagnosis after treatment has

    been started

    Asthma is usually characterized by airway inflammation

    and airway hyperresponsiveness, but these are not

    necessary or sufficient to make the diagnosis of asthma.

    Diagnosis of asthma

    GINA 2014

  • Global Initiative for Asthma

    Note: Each FEV1 represents the highest of

    three reproducible measurements

    Typical spirometric tracings

    Time (seconds)

    Volume

    FEV1

    1 2 3 4 5

    Normal

    Asthma

    (after BD)

    Asthma

    (before BD)

    GINA 2014

  • Global Initiative for Asthma

    The long-term goals of asthma management are

    1. Symptom control: to achieve good control of symptoms and maintain normal activity levels

    2. Risk reduction: to minimize future risk of exacerbations, fixed airflow limitation and medication side-effects

    Goals of asthma management

    GINA 2014

  • Eosinfilos

    Eosinfilos e asma

    Asmatico Normal

    Busse & Lemanske, N. Engl. J. Med, 2001,

  • Reao alrgica e asma

  • Dose-response curves to inhaled direct agonists (histamine or methacholine) in normal, mild,

    or severe asthma.

    Busse W W Chest 2010;138:4S-10S

    Hiperreatividade brnquica Asma

  • Mecanismos indutores de hiperreatividade

  • Receptores muscarnicos

    e hiperreatividade

  • Doena Pulmonar

    Obstrutiva: aumento na resistncia ao fluxo areo. 1. Asma

    2. Doena pulmonar obstrutiva crnica

    a) Bronquite crnica

    b) Enfisema pulmonar

    Restritiva: reduo da expanso do parnquima pulmonar

    1. Sndrome do desconforto respiratrio agudo (SDRA)

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Definition of COPD

    COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.

    .

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Mechanisms Underlying

    Airflow Limitation in COPD

    Small Airways Disease

    Airway inflammation Airway fibrosis, luminal plugs Increased airway resistance

    Parenchymal Destruction

    Loss of alveolar attachments Decrease of elastic recoil

    AIRFLOW LIMITATION 2014 Global Initiative for Chronic Obstructive Lung Disease

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Burden of COPD

    COPD is a leading cause of morbidity and mortality worldwide.

    The burden of COPD is projected to increase in coming decades due to continued exposure to COPD risk factors and the aging of the worlds population.

    COPD is associated with significant economic burden.

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Risk Factors for COPD

    Lung growth and development

    Gender

    Age

    Respiratory infections

    Socioeconomic status

    Asthma/Bronchial hyperreactivity

    Chronic Bronchitis

    Genes

    Exposure to particles

    Tobacco smoke

    Occupational dusts, organic and inorganic

    Indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings

    Outdoor air pollution

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Spirometry: Normal Trace Showing FEV1 and FVC

    1 2 3 4 5 6

    1

    2

    3

    4

    Volu

    me, lit

    ers

    Time, sec

    FVC 5

    1

    FEV1 = 4L

    FVC = 5L

    FEV1/FVC = 0.8

    2014 Global Initiative for Chronic Obstructive Lung Disease

    Volume expiratrio forado.

    Capacidade vital forada

  • The characteristic symptoms of COPD are chronic and progressive dyspnea, cough, and sputum production that can be variable from day-to-day.

    Dyspnea: Progressive, persistent and characteristically worse with exercise.

    Chronic cough: May be intermittent and may be unproductive.

    Chronic sputum production: COPD patients commonly cough up sputum.

    Global Strategy for Diagnosis, Management and Prevention of COPD

    Symptoms of COPD

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Therapeutic Options: COPD Medications

    Beta2-agonists

    Short-acting beta2-agonists

    Long-acting beta2-agonists

    Anticholinergics

    Short-acting anticholinergics

    Long-acting anticholinergics

    Combination short-acting beta2-agonists + anticholinergic in one inhaler

    Combination long-acting beta2-agonists + anticholinergic in one inhaler

    Methylxanthines

    Inhaled corticosteroids

    Combination long-acting beta2-agonists + corticosteroids in one inhaler

    Systemic corticosteroids

    Phosphodiesterase-4 inhibitors

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Professor Peter J. Barnes, MD

    National Heart and Lung Institute, London UK

  • Doena Pulmonar Obstrutiva Crnica Inflamao crnica e remodelamento das vias areas e

    destruio do parnquima pulmonar.

    Bronquite Crnica

  • Doena Pulmonar Obstrutiva Crnica Inflamao crnica e remodelamento das vias areas e

    destruio do parnquima pulmonar.

    Bronquite Crnica Spina. D, 2011

  • Doena Pulmonar Obstrutiva Crnica

    Enfisema

  • Enfisema

    Metaloproteinases: degradam componentes da matriz extracelular

  • Patologia da DPOC

    Spina. D, 2011

  • Global Strategy for Diagnosis, Management and Prevention of COPD

    Differential Diagnosis: COPD and Asthma

    COPD

    Onset in mid-life

    Symptoms slowly progressive

    Long smoking history

    ASTHMA

    Onset early in life (often childhood)

    Symptoms vary from day to day

    Symptoms worse at night/early morning

    Allergy, rhinitis, and/or eczema also present

    Family history of asthma

    2014 Global Initiative for Chronic Obstructive Lung Disease

  • Professor Peter J. Barnes, MD

    National Heart and Lung Institute, London UK

  • Global Initiative for Asthma

    Definitions

    Asthma

    Asthma is a heterogeneous disease, usually characterized by chronic airway

    inflammation. It is defined by the history of respiratory symptoms such as wheeze,

    shortness of breath, chest tightness and cough that vary over time and in intensity,

    together with variable expiratory airflow limitation. [GINA 2014]

    GINA 2014, Box 5-1

    Asthma

    Asthma is a heterogeneous disease, usually characterized by chronic airway

    inflammation. It is defined by the history of respiratory symptoms such as wheeze,

    shortness of breath, chest tightness and cough that vary over time and in intensity,

    together with variable expiratory

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