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Difference between revisions of "Asthma"
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# | '''Asthma''' is a common respiratory disease. It occasionally can be fatal and may be seen in the context of [[forensic pathology]]. | ||
The [[cytopathology]] of asthma is dealth with in ''[[Pulmonary_cytopathology#Asthma|asthma in pulmonary cytopathology]]''. | |||
==General== | |||
*The bread and butter of respirology. | |||
*May be associated with atopy (allergies), medications (e.g. [[NSAID]]s), occupational exposures.<ref name=Ref_PCPBoD8_370>{{Ref PCPBoD8|370}}</ref> | |||
*[[Clinical diagnosis]] - diagnosis based on symtpoms/response to therapy<ref name=pmid20176271>{{Cite journal | last1 = Lemanske | first1 = RF. | last2 = Busse | first2 = WW. | title = Asthma: clinical expression and molecular mechanisms. | journal = J Allergy Clin Immunol | volume = 125 | issue = 2 Suppl 2 | pages = S95-102 | month = Feb | year = 2010 | doi = 10.1016/j.jaci.2009.10.047 | PMID = 20176271 }}</ref> +/-methacholine challenge testing.<ref name=pmid25326695>{{Cite journal | last1 = Lim | first1 = SY. | last2 = Jo | first2 = YJ. | last3 = Chun | first3 = EM. | title = The correlation between the bronchial hyperresponsiveness to methacholine and asthma like symptoms by GINA questionnaires for the diagnosis of asthma. | journal = BMC Pulm Med | volume = 14 | issue = | pages = 161 | month = | year = 2014 | doi = 10.1186/1471-2466-14-161 | PMID = 25326695 }}</ref> | |||
Treatment: | |||
*Bronchodilators. | |||
*+/-Steroids. | |||
===Pathogenesis=== | |||
*T-cell response T<sub>H</sub>2 dominant. | |||
Sequence:<ref name=Ref_PCPBoD8_370-2>{{Ref PCPBoD8|370-2}}</ref> | |||
*Antigen T<sub>H</sub>2 lymphocyte -> IgE B-cell -> [[mast cell]] IgE Fc -> leukotrienes + other mediators -> bronchospasm, edema, leukocyte recruitment -> airway remodeling. | |||
==Gross== | |||
*Lung over-inflation. | |||
*Mucous plugs. | |||
*Focal resorption atelectasis,<ref name=Ref_PCPBoD8_363>{{Ref PCPBoD8|363}}</ref> i.e. collapse. | |||
==Microscopic== | |||
Features:<ref name=Ref_Klatt108>{{Ref Klatt|108}}</ref> | |||
*Edema. | |||
*Mucous (plugs). | |||
*+/-Smooth muscle hypertrophy. | |||
*+/-Inflammation - especially with [[eosinophil]]s. | |||
*+/-Charcot-Leyden crystals (formed from eosinophil granules -- breakdown product). | |||
**Sharp edge, diamond shaped, pink on [[H&E]]. | |||
Notes: | |||
*''Leyden'' in ''Charcot-Leyden'' is also seen written as ''Leiden''. | |||
**Finding associated with hypereosinophilia<ref name=pmid6162378>{{Cite journal | last1 = Dincsoy | first1 = HP. | last2 = Burton | first2 = TJ. | last3 = van der Bel-Kahn | first3 = JM. | title = Circulating Charcot-Leyden crystals in the hypereosinophilic syndrome. | journal = Am J Clin Pathol | volume = 75 | issue = 2 | pages = 236-43 | month = Feb | year = 1981 | doi = | PMID = 6162378 }}</ref> - ''not'' pathognomonic for asthma. | |||
*[[Pulmonary cytopathology]]: | |||
**''Curschmann's spirals'' = spiral-shaped mucous plugs.<ref name=pmid9812228>{{cite journal |author=Cenci M, Giovagnoli MR, Alderisio M, Vecchione A |title=Curschmann's spirals in sputum of subjects exposed daily to urban environmental pollution |journal=Diagn. Cytopathol. |volume=19 |issue=5 |pages=349–51 |year=1998 |month=November |pmid=9812228 |doi= |url=}}</ref> | |||
**''Creola bodies'' = clusters of (ciliated) bronchial epithelial cells.<ref name=pmid2818212>{{Cite journal | last1 = Isohima | first1 = K. | last2 = Takahashi | first2 = K. | last3 = Soda | first3 = R. | last4 = Hukasaka | first4 = N. | last5 = Tanabe | first5 = K. | last6 = Ozaki | first6 = K. | last7 = Nakato | first7 = H. | last8 = Araki | first8 = M. | last9 = Tuzi | first9 = M. | title = [The clinical significance of Creola body in the sputum of asthmatic patients]. | journal = Arerugi | volume = 38 | issue = 7 | pages = 542-8 | month = Jul | year = 1989 | doi = | PMID = 2818212 }}</ref> | |||
DDx: | |||
*Infection - fungal. | |||
===Images=== | |||
<gallery> | |||
Image:Charcot-Leyden_crystals,_HE_3.jpg | Charcot-Leyden crystals. (WC/Patho) | |||
Image:Charcot-Leyden_crystals,_HE_2.jpg | Charcot-Leyden crystals. (WC/Patho) | |||
</gallery> | |||
www: | |||
*[http://www.udel.edu/medtech/dlehman/medt372/Ch-lyd.html Charcot-Leyden crystals (udel.edu)]. | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168024/figure/F1/ Charot-Leyden crystals (nih.gov)]. | |||
==Stains== | |||
Features - crystals: | |||
*PAS-D -ve. | |||
*GMS -ve. | |||
==Sign out== | |||
<pre> | |||
BRONCHIAL CAST, RIGHT LOWER LOBE, REMOVAL: | |||
- CHARCOT-LEYDEN CRYSTALS. | |||
- CELLULAR DEBRIS WITH NEUTROPHILS AND ABUNDANT EOSINOPHILS. | |||
- RESPIRATORY MUCOSA WITH PROMINENT SMOOTH MUSCLE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
GMS and PAS-D stains are negative for fungal organisms. The findings are non-specific; | |||
however, they would be compatible with asthma. Clinical and microbiological correlation | |||
is required. | |||
</pre> | |||
==See also== | |||
*[[Medical lung diseases]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Medical lung diseases]] | |||