ASTHMA

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	ASTHMA
	*ASTHMA*

ASTHMA

Asthma

Introduction

Respiratory Apparatus

1. ANATOMIA

The respiratory apparatus makes a key function for the organism, assuring the passage necessary oxygen for the aerobic metabolism. From the outer air, it supplies of oxygen to the blood and eliminates the released carbon dioxide gas in the metabolic reactions.

The gas interchange between the inspired air and the blood of the capillaries that surround to the alveolos denominates hematosis. This interchange consists of oxygen pick up and carbon dioxide cession.

We can contemplate the respiratory apparatus in relation to three great functional parts:

Vias respiratory through which the air arrives at the blood; the smaller circulation, than puts the blood in contact with the air and the lungs, in which the interchange between the air and the blood takes place.

Although most of the respiratory apparatus is located in the thorax, the respiratory routes begin in the nasal graves and mouth.

SUPERIOR RESPIRATORY VIAS

The air penetrates through the nasal orifices to the nasal graves where it is warmed up and it is freed of impurities. Later it happens to the pharynx that is a crossing between the respiratory routes and the digestive routes.

The aerial-digestive crossing is provided with "security systems" that prevent the simultaneous operation of the inspiration and the swallowing. During this one, epiglotis descends and closes the orifice of the trachea or glottis. Automatically, the nutritional skittle is oriented towards the esophagus, whereas the air goes towards the trachea.

The trachea is a long rectilinear tube of 12 cm in length that goes from the neck to the introtorácica cavity. Here ramifica giving rise to bronchi and bronquíolos that arrive at the lungs and finish in the pulmonary alveolos through which it makes the gas interchange with the capillaries that surround them.

RESPIRATORY VIAS INTRATORÁCICAS

The Trachea is divided in 2 branches of bronchi, left right and, penetrating respectively in the right lung and the left lung.

The bronquíolos are the finest ramifications: of 0.5 to 1 mm of diameter.

All finish in "impasses": the pulmonary alveolos. The membrane of these alveolos constitutes the respiratory membrane, through which the gas interchanges take place. The thousands of alveolos constitute the pulmonary weave itself.

The trachea, the bronchi and the bronquíolos are constituted by 3 layers, of the interior to the outside: mucosa; it castrates muscular and cartilaginous; and it castrates fibrous.

The external fibrous layer receives the glasses and nervous completions coming from the neumogástrico nerve. The bronchi and bronquíolos stay rigid thanks to the cartilaginous ring. Numerous circular smooth muscular fibers constitute the bronchial or traqueal muscle that allows to reduce of important way the caliber of the bronchi and the trachea.

Respiratory mucous the internal layer/) plays a peculiar role in the protection against the strange bodies, the pathogenic agents and the dryness. It is composed by epitelio internal located on corion. Epitelio is covered with cilia. Each cell takes in its edge frees 200 movable cilia approximately, these receive the name of vibratile cilia. Between the ciliadas cells, glandular mucus cells are put in. These secrete a mucous film that covers all epitelio respiratory. The superficial layer is viscous and the inhaled particles adhere to her. The deep layer is fluid and allows the movement of the vibratile cilia (1000 vibrations per minute) that make overcome the mucous carpet with strange particles towards the faríngea zone, in where they are swallowed or expectoradas. A 90% of particles lodged in the bronchi are eliminated in one hour by muco-ciliary route.

This cleaning is facilitated by the reflection of the cough that favors the expectoración.

SMALLER CIRCULATION

Contrary to the greater circulation (artery aorta), the pulmonary circulation takes the poor rich oxygen blood and in carbon dioxide gas towards the pulmonary alveolos. This it is the paper that carries out the arteries pulmonary (right and left).

These divide in arterioles and these, as well, in capillaries through which the gaseous interchanges between the blood and the alveolar air take place.

Once oxygenated, the blood arrives at the heart through the pulmonary veins.

LUNGS

The lungs occupy the parts right and left of the torácica box. In the center is the mediastino, in which they are located: heart, great glasses of the heart, bronchial trachea and ramifications, in addition to the esophagus in the later part.

Each lung is surrounded by the pleura, envelope formed by two layers, visceral (the organ or víscera adheres to) and parietal (it adheres to the wall). The pleura fixes the lungs to the torácica box.

2. PHYSIOLOGY

The respiratory apparatus assures the passage the air to the lungs, that is to say, the pulmonary ventilation.

BREATHING

The inspiration (entered of the air) and the espiración (exit of the air) are carried out by the respiratory movements. These need a bony structure, the torácica box constituted by the ribs, the dorsal vertebrae and the breastbone; as well as one structures muscular that can widen the torácica box. The muscles that move the ribs denominate elevating muscles of the external intercostal ribs and. The essential respiratory muscle is the diaphragm that separates the thorax of the abdomen. The respiratory movements allow the renovation of the air of our lungs.

The inspiration is an active phenomenon. The increase of the volume of the thorax must to the contraction of respiratory muscles. The intercostal ones elevate the costal mass, whereas the low diaphragm compressing the abdominal vísceras. The increase of the volume of thorax-in the three dimensions entails a diminution of the intrapulmonary atmospheric pressure and, therefore, a demand of air.

The espiración, on the contrary, is a passive phenomenon. The muscular relaxation entails a diminution of the volume of the thorax that goes accompanied of an exit from the air retained in the lungs.

Only the forced espiración is an active phenomenon, since this one puts into operation espiradores muscles.

REGULATION OF THE PULMONARY VENTILATION

The breathing is an unconscious automatic phenomenon that is regulated by means of the respiratory centers of the rachidian bulb. These nervous centers constantly receive information about the composition of the blood. Its stimulus is represented by the CO2 content of the blood.

The chemical analysis of gases of the blood, is made through the quimiorreceptores of the cayado one of the aorta, but also bulbares can be made directly by the centers abundantly irrigated by the capillaries.

Hipercapnia (increase of the carbon dioxide gas) causes a hyperventilation. Hipocapnia (diminution of the carbon dioxide gas) causes a hypoventilation.

Sanguineous oxygen also is a stimulus. The hypoxia, causes, also, a hyperventilation.

The third stimulus is pH sanguineous. The acidosis (diminution of pH) causes a hyperventilation.

On the other hand, the respiratory centers bulbares also receive signals from the cerebral crust: the emotions are able to modify the respiratory rate.

The will is able to act on the pulmonary ventilation by means of costal and abdominal muscles although not of indefinite form.

On the contrary, it cannot act on the diaphragm that is a smooth muscle of involuntary answer.

FUNCTIONAL UNIT

As it has already been seen, the respiratory routes are divided more and more in fine ramifications that end at the alveolos.

These alveolos are grouped forming the anatomical and functional units of the lung: the pulmonary lobes. We found of 200 to 300 alveolos by lobe, existing approximately 15,000 lobes.

Each alveolo assures an essential function: the hematosis that simultaneously includes/understands the pick up of oxygen by the blood and the expulsion of CO2.

The alveolar structure totally is oriented to this function. Epitelio of alveolo is constituted by a single layer of a thickness of 1 micron approximately. This fine wall separates, on the one hand, the alveolar air and, on the other hand, the fine sanguineous capillaries. The gaseous interchanges are facilitated by this anatomical structure.

The cells of the alveolar coating secrete a tensioactivo agent, the fosfolipídico surfactante that allows the alveolos to be always open.

The total surface of the 300 million 80 approximately alveolos represents m2. Each inspiration it enters our 500 lungs mililiter of air, of which 350 interchange 150 mililiter and mililiter are left and to the bronchi forming the dead around. These 350 mililiter by 15 inspirations that we made per minute causes that the blood is in almost direct contact with the enemy with the alveolar air at every moment.

Beyond the alveolos, oxygen is fixed and transported to the blood through the hemoglobina.

AVERAGE OF DEFENSE NONCSpecific OF THE RESPIRATORY APPARATUS

The essential has been seen already original and that it is the role played by the respiratory mucosa in the "cleaning" of the respiratory routes. The vibratile cilia and the mucosa assure the transport all particles and dust inhaled from the bronquíolos to the pharynx. It is the muco-ciliary transport that is important for the cleaning of the bronchi.

The physiological cough, also is defense means. It favors the evacuation of particles.

Another means of nonspecific defense exist. The alveolar macrophages have an bactericidal fagocitario power increased by the surfactante (tensioactiva substance that diminishes the superficial tension of the alveolos). They attack the microorganisms, the cellular rest and all inhaled particles.

AVERAGE OF DEFENSE SPECIFIC

We will only remember that in the acquired rough-pulmonary immunity the processes of humoral and cellular immunity take part.

The humoral immunity is in charge of the production of inmunoglobulinas (lg). At level of the bronchial mucosa, the secretion of lg To This one takes place is against to the adhesion of the germs the respiratory mucosa. At level of the lung, they take part lgGs that prepares the alveolar macrophages so that they fagociten to the microorganisms.

The present lymphocytes in the respiratory routes are the people in charge of the cellular immunity.

These specific means of defense explain why, after one second contamination by a germ, the rough-pulmonary cleaning is faster than after the first infection.

Average specific defense nonspecific and average of defense they assure the bacteriological sterility (physiological) of the respiratory routes. It is of a great effectiveness, since we know that the respiratory apparatus is put under at any moment a microbial or bacterial contamination coming from the air that we breathed.

Definition

The asthma is pronounced like an obstruction of the inferior respiratory routes, in relation to espasmo bronchial and edema of the mucosa, being translated clinically as one designs espiratoria paroxística.

The asthma is relatively frequent a respiratory inflammatory disease: from 2 to 5% of the population they suffer it. It is translated in an hyperactivity of the traqueo-bronchial tree to different stimuli.

The factors that cause an asthma crisis are very numerous: atmospheric alergenos (they polen, acaruses, dust of house, pens, contamination...), nutritional alergenos, professional factors, respiratory infections (even chronic sinusitis), medicines, physical exercise, emotional stress. We cannot either emphasize the so detrimental paper of tabajo, or active or passive smoker.

From the physiological point of view, in the bronchial obstruction we can observe 3 aspects:

marked •Disminución of the caliber of the bronchi by espasmos of bronchial muscles.

•Edema of the bronchial wall.

mucous •Hipersecreción (dense and viscous secretions).

Often the crisis appears abruptly and it is developed in two times. He is very frequent that in the heat of night the patient awakes with the breathlessness impression. Seated in the edge of the bed, it has dificualtades to drain its lungs. It designs it intense is espiratoria. The breathing is slow/bradisnea). This noisy episocio lasts of 30 to 60 minutes.

It follows a catarrhal phase marked to him by a persistent cough, producing a characteristic expectoración (esputos viscous, "perlados"). This announces the end of the crisis and the return to a normal breathing. The patient to duer itself to me, exhausted.

These crises are more or less frequent and intense according to the gravity of the disease. It needs treatment and medical pursuit.

The asthma is an inflammatory reaction that shows the conflict between the alérgeno and the inmunoglobulina And takes place in two times.

Fifteen minutes after the inhalation of the alérgeno the liberation of the neuromediadores, broncoconstrictores and of the vasoactivos mediators produce espasmo, edema and bronchial secretion. It is an immediate reaction.

Some hours later, the action of the eosinófilos maintains broncoespasmo, the hypersecretion and edema. It is a slowed down reaction.

Every time with more frequency the paper of the free radicals (superoxidating, toxic oxygen) released is mentioned after an asthmatic crisis. Recent works demonstrate that the antirust enzymes are increased in asthmatic patients.

These results allow to think that the free radicals of oxygen can act like chemical mediators of the inflammation in the asthma. It would be possible to be considered, therefore, a treatment of base with antirust.

Treatment

CLASSIC TREATMENT

In the simple crisis one resorts to broncodilatadores and teofilina. In case of a severe crisis it is necessary to resort to corticoids.

The preventive treatment is based on the specific desensitization and the use of rough-espasmoli'ticos.

FITOTERAPIA

The fitoterapia can respond both to key points of the asthma: the allergic reaction and the bronchial hyperactivity that broncoespasmo causes.

It is possible to be resorted to Efedra, greater Llantén, Marrubio.

Plants adapted for this disease

Efedra

Llantén

Marrubio

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