Abstract
Purpose
This paper reviews the literature on the aetiology and therapy of bronchial hyperreactivity to describe the underlying pathophysiology, identify patients at risk and update knowledge on new and existing therapies.
Source
Information was obtained from monograms on New Drugs for Asthma, Respiratory Medicine: recent advances, Agents and Actions Supplements, Pulmonary Pharmacology, Anesth Analg, the European Journal of Respiration and a Medline literature search.
Principal findings
Reduced airway calibre, increased bronchial contractility, altered permeability of the bronchial mucosa, humoral and cellular mediators, and dysfunctional neural regulation are critical factors for bronchial hyperreactivity, a characteristic feature of hyperreactive airways which results in bronchoconstriction after exposure to varied stimuli. Preoperative anaesthetic considerations in these patients include FEV1 and PEFR testing to assess the severity and for optimal control of the condition. Bronchospasm causing hypoxaemia is the major intraoperative problem anticipated in these patients. Current therapeutic management of bronchoconstriction focusses on the β2 agonists, theophylline and steroids. Besides relaxing the airway smooth muscle these agents are all capable of altering bronchial inflammatory responses. Future developments of therapy are directed towards the inflammatory components of the disease.
Conclusion
This review has presented background information on physiological mechanisms of smooth muscle contractility, pathophysiological alterations of bronchial contractility and the pharmacological basis of therapy in bronchoconstrictive disease. Information is presented to enable the prompt arrest and reversal of airway constriction, and to maintain prophylactic treatment during the perioperative period. Intraopera’tive bronchospasm is managed by adequate oxygenation and reversal of bronchoconstriction
Résumé
Objectif
Cet article parcourt la littérature portant sur l’étiologie et le traitement de l’hyperréactivité bronchique dans le but d’en exposer la physiopathologie, d’identifier les patients à risque et d’actualiser notre connaissance des thérapeutiques nouvelles et actuelles.
Sources
L’information a été recueillie des monographies New Drugs for Asthma, Respiratory Medicine, des progrès récents, des publications Agents and Actions Supplements, Pulmonary Pharmacology, Anesth analg, European Journal of Respiration et une recherche dans Medline.
Constatations principales
Les voies aériennes hyperréactives sont caractérisées par la diminution du calibre des voies aériennes, l’augmentation de la contractilité bronchique, l’altération de la perméabilité de la muqueuse bronchique, la libération de médiateurs humoraux et cellulaires et par le dys-fonctionnement de la régulation neurale. Ces changements provoquent une bronchoconstriction à la suite d’une exposition à des stimuli variés. En préopératoire, il faut tenir compte des épreuves respiratoires du VEMS et du DEP pour évaluer la gravité de la maladie et optimaliser son contrôle. L’hypoxémie provoquée par le bronchospasme constitue le problème périopératoire le plus important à anticiper chez ces patients. La gestion thérapeutique actuelle de la bronchoconstriction fait principalement appel aux agonistes β2, à la théophylline et aux stéroïdes. En plus de relâcher les muscles lisses des voies aériennes, ces agents sont tous capables d’altérer la réponse inflammatoire bronchique. Les progrès futurs du traitement sont, liés à la gestion des composantes inflammatoires de l’asthme.
Conclusion
Ce survol a permis d’offrir des renseignements fondamentaux sur les mécanismes physiologiques de la contractilité du muscle lisse, sur les altérations physiopathologiques de la contractilté bronchique et la base pharmacologique du’ traitement de la maladie bonchoconstritive. L’information pertinente à l’arrêt rapide et à la neutralisation de la constriction des voies aériennes ainsi qu’à l’entretien du traitement préventif à la période périopératoire à été présentée. Pendant l’intervention, le traitement du bronchospasme consiste à oxygéner et à faire lever la bronchoconstriction.
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Perdra, L.M.P., Orrett, F.A. & Balbirsingh, M. Physiological perspectives of therapy in bronchial hyperreactivity. Can J Anesth 43, 700–713 (1996). https://doi.org/10.1007/BF03017956
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DOI: https://doi.org/10.1007/BF03017956