1. Asthma Dr. Tseng, Chung-Chia

2. Defintiation Recurrent airflow obstructive pathology, remission by nature,recovery by therapy. Recurrent airflow obstructive pathology, remission by nature,recovery by therapy. s/s dyspnea, expiratory wheezing, chest tightness and cough etc. with much sputum. s/s dyspnea, expiratory wheezing, chest tightness and cough etc. with much sputum. Autopsy: lung hyperinflation, airway with mucus, serum protein,inflammatory cells, cell debris content. Autopsy: lung hyperinflation, airway with mucus, serum protein,inflammatory cells, cell debris content. Microscopy: eosinophil,monocyte,vessel dilation,epithelium destoried. Mast cell, eosinophil, cytokine, chemokine induce inflamatory process Microscopy: eosinophil,monocyte,vessel dilation,epithelium destoried. Mast cell, eosinophil, cytokine, chemokine induce inflamatory process

3. Lung function: air way bronchial hyperresponsiveness and acute airway airflow obstruction Lung function: air way bronchial hyperresponsiveness and acute airway airflow obstruction

4. Bronchial hyperresponsiveness Acute bronchial constriction : IgE-> mast cell -> release histamine, prostaglandin, leukotriene etc. ->smooth muscle constriction Acute bronchial constriction : IgE-> mast cell -> release histamine, prostaglandin, leukotriene etc. ->smooth muscle constriction Bronchial wall swelling : wall edema or combine smooth constriction Bronchial wall swelling : wall edema or combine smooth constriction

5. Chronic mucus plug : secretion of mucus and serum protein of exudation, cell of fragments -> small bronchiole obstruction Chronic mucus plug : secretion of mucus and serum protein of exudation, cell of fragments -> small bronchiole obstruction Bronchial wall deformity Bronchial wall deformity

6. Environment : Virus infection Virus infection Allergy as mite, dust, animal hair, flower pollen, fungus, smoking, air pollution, rapid change of temperature, exercise, emotion change,chemical or drug ( aspirin, NSAID, beta blocker ) Allergy as mite, dust, animal hair, flower pollen, fungus, smoking, air pollution, rapid change of temperature, exercise, emotion change,chemical or drug ( aspirin, NSAID, beta blocker )

7. Diagnosis Interminent dyspnea,wheezing, chest tightness, cough, especial time, midnight or early morning. Interminent dyspnea,wheezing, chest tightness, cough, especial time, midnight or early morning. Clinical evidence 1. symptom subsided naturely 2. medication relief : bronchial dilator and anti- inflammatory drug 3. symptom change by season 4. family history asthma, ectopic dermatitis, allergic rhinitis Clinical evidence 1. symptom subsided naturely 2. medication relief : bronchial dilator and anti- inflammatory drug 3. symptom change by season 4. family history asthma, ectopic dermatitis, allergic rhinitis

8. Others : Others : During exercise with cough or wheezing. During exercise with cough or wheezing. Smoking or inhalation pollution-air with cough, chest tightness, wheezing. Smoking or inhalation pollution-air with cough, chest tightness, wheezing. Catch cold with chest tightness, difficult remission Catch cold with chest tightness, difficult remission Contact animal or flower with symptom Contact animal or flower with symptom Medication,aspirin, or beta-blocker drug with symptom Medication,aspirin, or beta-blocker drug with symptom Medication with bronchial dilator, symptom relief Medication with bronchial dilator, symptom relief

9. Lung function test FEV1 or FEV1/FVC ( normal range > 80 %, children >90% ), FEV1 80 %, children >90% ), FEV1<1 liter ( no desire) PEF PEF

10. Lung function test Bronchial test Bronchial test PEF (interval 12 hours variable vales) PEF (interval 12 hours variable vales) Exercise test Exercise test

11. Allergy evaluation Skin test Skin test Serum (Ig E) Serum (Ig E)

12. Asthma classification As attack frequency, air way obstruction level, variable value As attack frequency, air way obstruction level, variable value Four class Four class 1.Severe persistent 1.Severe persistent 2.Moderate persistent 2.Moderate persistent 3.Mild persistent 3.Mild persistent 4.Mild interminent 4.Mild interminent

14. Medication : Control medication : Control medication : Anti-inflamation drug, (steroid, intal, leukotriene, aminophylline, long acting beta agonist ) Anti-inflamation drug, (steroid, intal, leukotriene, aminophylline, long acting beta agonist ) Release medication : Release medication : Bronchodilator,etc. Bronchodilator,etc. MDI, spacer, nebulizer, DPI MDI, spacer, nebulizer, DPI

15. Ladder step therapy Ladder step therapy Usual one month therapy and well control persistent three month, then step down Usual one month therapy and well control persistent three month, then step down