Astmul bronsic la copil (prelegere)
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1 UNIVERSITATEA DE STAT DE MEDICINĂ ŞI FARMACIE "N. TESTEMIŢANU" Departament PEDIATRIE INSTRUCTIUNI METODICE la tema: Astmul bronsic la copil (prelegere) Profesor universitar: Ecaterina Stasii Chisinau 2011
2 Locul desfasurarii prelegerii: auditoriu pentru studenti, baza clinică-icşosmc. I. Scopul instruirii : de a face cunostintă cu problemele actuale privind astmul bronsic si a protocolului national privind conduita astmului bronsic la copil. Se v-a expune informatia privin urmatoarele aspecte contemporane a astmului bronsic la copii: 1. Definiţia contemporană a asmului bronşic la copil. 2. Datele epidemiologice la nivelul global şi national 3. Factorii de risc în formarea astmului bronşic. 4. Patogenia astmului bronsic in viziunea contemporana 5. Despre iniţiativa globală în astmul bronşic GINA privitor la funcţii, rolul şi realizările ultimilor ani. 6. Clasificarea astmului bronsic privind forma clinică, evolutia(severitatea) si nivelul de control. 7. Particularitatile astmului bronsic la lopiii de vârstă fragedă 8. Metodele de investigare functionale si imunologice necesare în astmul bronsic. 9. Diagnosticul diferenţial 10. Terapia pacientului cu astm bronsic: a. Terapia de urgenţă în exacerbare, inclusiv statusul astmatic b. Terpaia de control c. Educaţia pacientului, a părinţilor şi a îngrijitorilor d. Supravegherea de lungă durată 11. Complicaţiile astmului bronşic 12. Prognosticul 13. Profilaxia primară, secundară, terţiară. II. Motivarea. Maladiile alergice cresc în continuu:4 8% din populaţie suferă de astm bronşic, inclusive la copii 5 15 %. Incidenţa astmului bronşic este diferita in diferite tari cu indicele maximum de 30% în diferite 2
3 populaţii : Noua Zelandă circa 30%(copii<5ani) Australia 25% Anglia 8-10% Franţa 7-10% Russia 0,66% (MS RF 2002г.) Moscova -1.1% (2002 г) Sanct-Pererburg 1% (2002 г) Ucraina 0,5% Moldova 0,05% : 700 bolnavi copii; Se presupune că în următorii 10 ani în Europa numărul de bolnavi astmatici va creşte in mediu de la 7% la 12%. Astmul bronsic cauza de deces a 180 mii pacienti/an in lume¹ (2002 ). Se socoate, ca cauzele ce stau la baza cresterii prevalentei maladiilor alergice sant multiple: Predispozitia genetica, schimbările în mediul ambiant, cum ar fi poluările ecologice, administrarea antibioticelor, vaccinarile, igiena; schimbările în alimentaţia obişnuită - diversificare în produse, folosirea grăsimilor în abundenţă, micşorarea cotei cu alimente cu proprietăţi antioxidante; schimbările în modul de viaţă urbanizare, fumatul. Cheltuielile pentru managementul cazurilor de astm şi a bolnavilor alergici cresc continuu. Costul astmului în Europa este de 27 bilioane euros/anual şi va creşte în următoarea decadă la 50 bil pentru astm şi în total la 100 bil anual pentru managementul alergiei la pacienţi In 1992 a fost convocat sedinta de Consensus Internaţional pentru Astm având scop: Fortificarea cunoştinţelor despre astm a lucrătorilor medicali, a autorităţilor publice si a comunităţii si deasemenea perfectărea măsurilor de prevenire şi management prin efort concret comun global. A fost lansata Iniţiativa la Nivel Global pentru Astmul Bronşic (GINA-Global Initiative for Asthma), care reprezinta o strategie globală de management şi prevenire a astmului, alcatuieste si editeaza Ghidul Internaţional, ce reflecta recomandările de bază pentru diagnosticul şi tratamentul AB bazate pe ultimele date ştiinţifice. O mare importanta in conduita clinica copilului cu AB se ofera perfectarii corecte a terapieide control. Reiesind din aceasta educatia mamei, a ingrijitorilor copiilor si a pacientului este de o importanta majora. La moment se propun diferite programe de prevenire primara, secundara si tertiara a AB la copil. III. Legăturile integrale 1. Catedra de ftiziopulmonologie 2. Catedra de chirurgie şi anesteziologie pediatrică(terapia intensiva) 3
4 IV. Literatura pentru cunoştinţele de bază: 1. Protocolul National Astmul bronsic la copil,-chisinau Alergologie//Sub.red.Gr.Popescu.Bucuresti,1998, Asthama: a flow up statement from an international pediatric asthma consensus grup, BotnaruV.Pneumologie.Chisinău Edmonds ML, Camargo CA, Pollack CV et al. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma (Cochrane Review). In: The Cochrane Library, Issue 1, Geormăneanu M. Terapia pediatrică. Bucureşti Guide for Asthma management and prevention for adults and children after 5 years old. Pocketbook. _ Global Initiative for asthma.-uk, Guide for Asthma management and prevention for children <up to 5 years old. Pocketbook _ Global Initiative for asthma.-uk, Germăneanu M. Pediatria. Bucureşti Matcovschii C.,Procopisin V.Ghid farmacoterapeutic.chisinău James P., Judith A. Kemp. Management of Asthma in Children. American family Physician. Vol.63. nr 7. April 1, Judith E Tintalli et all. Ghid Medicina de urgent.-colegiul American a Medicilor de Urgenta.- vol.i, Vol II.- Bucuresti Nelson Pediatrics, 18.edition, v Pediatria.Tratat//Sub.red.E.Ciofu.,C Ciofu.,Bucuresti Popescu V. Astmul bronşic la copil. Bucureşti E. Ciofu, C. Ciofu Esenţial în pediatrie. Editura medicală. Almatea. Bucureşti V. Popescu. Algoritm diagnostic şi terapeutic în pediatrie. Bucureşti. Vol Plotnick LH, Ducharme FM. Combined inhaled anticholinergics and beta2-agonists for initial treatment of acute asthma in children (Cochrane Review). In: The Cochrane Library, Issue 1, Thomson NC, Chaudhuri R, Livingston E. Asthma and cigarette smoking. Eur Respir J 2004;24(5): Van Asperen P, Cahill A, Alexander K et al. Discharge guidelines for children with acute asthma: A consensus statement. Journal of Paediatric Child Health 2001; 37: Аллергические болезни у детей. // Под ред. Студеникина М.Я., Балаболкина И.И. М.: Медицина стр Балаболкин И.И. Бронхиальная астма у детей. М.: Медицина., 2003, 320 стр. 23. А.А. Баранов, И.И. Балаболкин. «Детское аллергология». Руководство для врачей. Москва, А.А. Баранов. «Региональная фармакотерапия детских болезней». Москва, Детская аллергология под ред. // Под ред. Баранова А.А., Балаболкина И.И. М.:«ГОЭТАР- Медиа» стр V. Întrebările pentru autocontrol 1. Noţiuna de astm bronsic 2. Factorii de risc de formare a astmului bronsic 3. Incidenta si pprevalenta prin astm bronsic la copil 4. Schimbarile patofiziologice in astmul bronsic 5. Tipurile de reactii imunopatologice in manifestarea astmului bronsic 4
5 6. Schimbarile imunologice in AB 7. Diagnosticul AB 8. Investigatiile functiilor respiratiei externe: Spirometria. Indicatorii de baza 9. Peak-fluorometria. Indicatorii. Importanta 10. Astmul sugarului. Criterii de diagnostic 11. Clasificarea AB la copil> 5 ani 12. Clasificarea AB la copii < 5 ani 13. Clasificarea exacerbarilor AB in raport de severitate 14. Diagnosticul diferential a AB la copii > 5 ani 15. Diagnosticul diferential a AB pentru copiii < 5 ani 16. Complicatii le AB 17. Diagnosticul specific a AB pentru stabilirea alergenelor cauzale 18. Terapia complexa a AB la copil. Componentele terapiei AB 19. Madicatia interzisa in terapia exacerbarilor a AB 20. Terapia de urgenta a AB(reliver) 21. Terapia de ontrol a AB (controlor) 22. Particularitatile de actiune a preparatelor b2 agoniste de actiune rapida si de lunga durata in AB 23. Particularitatile de actiune a metixantinelor de scurta si de lunga durata in AB 24. Particularitatile de actiune a medicamentelor antiholinergice in terapia AB 25. Preparatele corticosteroide in terapia AB:actiune, indicatii, contraindicatii 26. Preparatele antileucotrienice in terapia de control a AB 27. Principiul de terapie pe trepte a AB 28. Monitoringul copilului cu AB 29. Supravegherea in dinamica la NMP a copiluli cu AB 30. Profilaxia primara, secundara si tertiara a a AB la copil VI. Întrebările pentru autopregătire 1. Particularitatile investigatiilor functiilor respiratoroii externe in diferite varste la copil 2. Caracteristica indicilor obtinuti la spirometrie & peak-fluorometrie 3. Particularitatile astmului in raport de spectrul de sensibilizare 4. Diagnosticul diferential a AB la copii in raport de varsta 5. Factorii triger in declansarea acutizarii AB 6. Actiuni adverse si complicatiile in terapia cu corticosteroizi administrati sistemi 7. Actiuni adverse si complicatiile in terapia corticosteroizi topici 8. Actiuni adverse si complicatiile in terapia cu b2 agonisti de actiune rapida 9. Actiuni adverse si complicatiile in terapia cu b2 agonisti de actiune tardiva 10. Actiuni adverse si complicatiile in terapia cu teofeline de actiune rapida 11. Actiuni adverse si complicatiile in terapia cu teofeline de actiune tardiva 12. Omalizumab. Terapia cu anticorpi in pediatrie 13. Oxigenoterapia la diferite varste 5
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