Asthma is severe. Persistent bronchial asthma

Bronchial asthma- a disease manifested by reversible (in whole or in part) bronchial obstruction, which is based on allergic inflammation respiratory tract and, in most cases, bronchial hyperreactivity. It is characterized by the periodic occurrence of attacks - a violation of the patency of the bronchi as a result of their spasm, swelling of the mucous membrane and hypersecretion of mucus.

Atypical course: in the form of asthmatic bronchitis, spasmodic cough, asthma of physical exertion.

Prevalence bronchial asthma among children and adolescents ranges from 1 to 20 per 1000.

Etiology, pathogenesis.

At the heart of airway obstruction is allergic inflammation, stubborn and persistent, leading to bronchial hyperreactivity and asthma attacks. Violated patency of the bronchi due to spasm, swelling of the mucous membrane, hypersecretion of mucus. Inflammation in the bronchi is not associated with bacterial infection, it is caused by immunological reactions involving mast cells, eosinophils and T-lymphocytes in individuals with a hereditary predisposition. When collecting a family history in 85% of parents and direct relatives, diseases of an allergic nature are detected (br. Asthma, eczema, neurodermatitis, urticaria). In children with atopic diseases, even in early childhood, the level of Ig E is much higher.

At the age of the beginning br. asthma is affected by biological defects that form in the perinatal period (hypoxia of the fetus and newborn), which are the basis for reducing immunological reactivity, reduce adaptation to exogenous and endogenous factors. Early artificial feeding leads to an increased intake of food allergens through the intestines, stimulating the production of Ig E and realizing allergic reactions, more often in the form of atopic dermatitis. In adolescents, inhalation epidermal sensitization joins, asthmatic bronchitis develops without typical attacks. In this case, respiratory disorders can be permanent and manifest as respiratory discomfort. The addition of inhalation dust hypersensitivity contributes to the formation of bronchial asthma.

Environmental factors contributing to the development of br. asthma:

Non-infectious allergens (household, medicinal, animals, plant pollen),

Infectious agents (viruses, fungi),

· Chemical and mechanical irritants,

meteorological factors,

Neuro-psychic stress effects.

BA classification.

1. By form: atopic, non-atopic (infection-dependent).

2. Periods of illness: exacerbation, remission.

3. Severity of the course: mild, moderate, severe.

4. Complications.

Clinic.

1. An attack of suffocation.

2. Broncho-obstructive syndrome.

Bronchospasm is characterized by a dry paroxysmal cough, noisy breathing with difficulty exhaling, dry wheezing. With the predominance of hypersecretion, the cough is wet, various wet rales.

During an attack, breathing is difficult, shortness of breath with prolonged expiration, whistling dry rales - a “sounding” chest. The attack lasts from several minutes to hours and days. An attack can occur suddenly, in the middle of the night. The patient is frightened, the breath is short, the exhalation is lengthened, accompanied by wheezing, heard at a distance and felt on palpation of the chest. The position of the patient is forced - sitting, resting his hands on the bed, the body is tilted forward. The auxiliary muscles involved in the act of breathing are tense. The face is initially pale, then there may be cyanosis, puffiness. Sputum is viscous, light, vitreous. Auscultatory - breathing is weakened, a lot of dry whistling, buzzing, in the form of a "squeak" changeable wheezing. Lungs swollen. Tachycardia, muffled heart sounds.

Complete blood count: eosinophilia, lymphocytosis.

At lung during the course of asthma, no more than 4 attacks of suffocation per year are noted, it is stopped by antispasmodics inside, during the non-attack period the state is good, changes in organs and systems are not determined. moderately severe during the number of attacks more than 4-5, inhaled β-agonists or injections are used, within 2-3 weeks after the attack, indicators of the function of external respiration are changed, from the side of the central nervous system irritability, increased fatigue. heavy course - attacks are frequent, at least once a month, inhaled corticosteroids and injection relief are needed. In the non-attack period, there are violations of all organs and systems, a lag in body weight and growth, asthenia, mental disorders, chest deformity.

Allocate atopic And non-atopic br. asthma.

Atopic br. asthma characterized by immediate hypersensitivity (IHT) under the influence of non-infectious allergens - household, pollen, food. Attacks often occur during sleep, in the morning. During the day, an attack occurs with strong odors, strong positive and negative emotions, cooling, exposure to food. The attack stops when the situation changes, nutrition, disconnection from causally significant factors.

Non-atopic br. asthma(infection-dependent) develops when exposed to infectious allergens, based on delayed-type hypersensitivity (DTH). Such adolescents often suffered from acute respiratory infections with difficulty breathing and wheezing. Gradually, the obstructive syndrome intensifies and, with the next acute respiratory disease, a characteristic attack develops. The attack lasts several hours and days, a clear beginning and end of the attack are not determined.

Periods br. asthma: exacerbations and remissions. The remission period is the period between individual attacks, begins a few weeks after an asthma attack. For moderate and severe course asthma in most patients, there are clinical and functional abnormalities of the organs: shortness of breath during physical exertion, sleep disturbance, fatigue, inattention.

Complications.

1. Atelectasis of the lung - develops during an attack, the patient's condition worsens, local dullness of percussion sound is noted. X-ray - darkening of the lung tissue with clear edges. Often occurs in severe asthma.

2. Pneumothorax - deterioration, pallor and cyanosis of the skin and mucous membranes, complaints of pain in the side, groaning breathing, the chest on the side of the lesion does not participate in breathing. The diagnosis is established radiographically.

3. Subcutaneous and mediastinal emphysema - rupture of lung tissue, air penetrates to the root of the lung, into the mediastinum and into the subcutaneous tissue of the neck.

4. Beginning formation of cor pulmonale due to circulatory disorders in the small circle. Decreases contractile function right ventricle, increased pulmonary vascular resistance.

Diagnostics. Based on the clinical picture - asthma attacks, status asthmaticus, spasmodic coughing attacks, accompanied by acute lung distension and difficulty exhaling. Spirography and pneumotachometry are used to assess the ventilation function of the lungs, to detect bronchial obstruction.

Spirography- a method of graphical registration of respiration, - allows you to determine the respiratory rate (RR), tidal volume (TO), minute respiratory volume (MOD), vital capacity (VC), forced expiratory volume in 1 second, maximum ventilation (MVL).

Pneumotachometry is based on the measurement of airflow velocity during the most rapid inhalation and exhalation. In the presence of bronchial obstruction, the indicators decrease by more than 20% of the due ones.

Greatest diagnostic value at br. asthma have studies that characterize the state of bronchial patency on the level of the small bronchi.

Currently, registration of forced expiration is carried out in patients using peak flow meters. This is the maximum expiratory flow, which makes it possible to judge the severity of br. asthma.

Laboratory methods research: general analysis sputum (a high content of eosinophils is detected), KLA (eosinophilia), a study of total protein and its fractions (increased Ig E).

For the diagnosis of a causally significant allergen, skin tests are used, determination of the concentration of specific Ig E in the blood serum by enzyme immunoassay, cellular diagnostic methods, etc.

Outcomes, forecast. Depends on the severity of the course, the presence of chronic foci of infection and other allergic diseases, the adequacy of treatment.

Treatment. Must be complex.

1. Etiological therapy is determined by the form of asthma.

In the atopic form - isolation of the patient from the "guilty" allergens, with an exacerbation of non-atopic - antibiotic therapy a short course (5-7 days) taking into account the sensitivity of microorganisms and an allergic history. Drugs of choice - cephalosporins, fluoroquinolones, macrolides, antifungal drugs - diflucan, nizoral, levorin.

2.Pathogenetic therapy is aimed at stopping seizures and anti-inflammatory treatment.

At lung current, short-acting β-agonists (terbutaline) and sodium cromoglycate are used.

At moderate asthma, inhaled drugs play a major role anti-inflammatory drugs - sodium cromoglycate, nedocromil, are prescribed daily, for a long time. Are used bronchodilators, predominantly prolonged action (β-agonists, methylxanthines). In acute asthma attacks, short courses of oral glucocorticoids are possible. In a hospital with an acute prolonged attack, parenteral bronchodilators, inhaled glucocorticosteroids (beclomet, ingakort, flixotide) are used with a gradual dose reduction.

At severe current apply inhaled glucocorticoids in combination with systemic drugs ( prednisolone) orally. How anti-inflammatory drug use sodium nedocromil, bronchodilators preparations mainly of prolonged action. When a positive effect is achieved, individual doses of drugs are selected: short-acting β-agonists - salbutamol, terbutaline (brikanil), fenoterol (berotek), domestic ones - saventol, saltos, salben.

For relief of seizures in adolescents 2.4% solution of zufillin is administered intravenously. Theophylline preparations of prolonged action per os: teopec, teobiolong, teotard, teodur, retafil. They are used 1-2 times a day, for a long time, in combination with anti-inflammatory and other bronchodilators.

Currently in use combined preparations:

· ditec in an aerosol, has a bronchodilator, anti-inflammatory and anti-allergic effect, is effective in atopic br. asthma.

· Combipack ( domestic), in tablets.

3. Elimination measures:

Organization of hypoallergenic life (daily wet cleaning, lack of carpets, bookshelves, extra things, replacement of feather pillows, down mattresses with synthetic winterizers, frequent change of bedding),

Avoid contact with pollen allergies,

Hypoallergenic diet for food allergies with the exclusion of obligate allergens and products containing causally significant allergens,

· Separation from pets, birds, home. flowers.

4.Education the patient and parents to the principles of self-observation, keeping a diary, where to note asthmatic symptoms, assessing the functional state of the bronchopulmonary system.

During the remission period:

ongoing supportive therapy

· can be used ketotifen within 3-6 months,

specific hyposensitization (introduction of increasing doses of antigen),

· non-drug treatment: speleotherapy, hypobarotherapy, acupuncture, exercise therapy, psychotherapy, spa treatment.

Patients are sent to the sanatorium in the period of remission, after the rehabilitation of chronic foci of infection, in the absence of severe respiratory and cardiovascular insufficiency, the basis of treatment here is the regime of the day, rational nutrition, exercise therapy, training motor regimen, physiotherapy, hardening, breathing exercises.

Prevention. Distinguish between primary and secondary prevention.

Primary prevention carried out for adolescents at risk with aggravated heredity and allergic anomaly of the constitution, a regime of antigenic sparing is created, maximum exposure to fresh air, timely diagnosis and treatment of allergic manifestations in early childhood, rehabilitation of chronic foci of infection.

Secondary prevention aimed at preventing exacerbation of br. asthma. Elimination of contact with allergens, hypoallergenic diet and everyday life. In the future, rational employment - the exclusion of the chemical industry, construction industries, etc.

Dispensary observation at the pulmonologist.

Teenagers from br. asthma belong to III, IV, V health groups, are disabled. In severe and moderately severe cases, they are exempted from exams and the summer working semester. Physical education classes are held only according to the exercise therapy program.

Chronical bronchitis.

This is a diffuse, usually progressive lesion of the bronchial tree, due to prolonged irritation airways with various harmful agents. It is characterized by a restructuring of the secretory apparatus of the mucous membrane, the development of inflammation involving the deep layers of the bronchial wall. Mucus hypersecretion occurs, the cleansing function of the bronchi is disturbed.

Chronic bronchitis appears permanent or intermittent cough usually with phlegm, and with damage to the small bronchi - shortness of breath.

Prevalence. IN adolescence the level of acute bronchopulmonary pathology is high, as the age increases, it decreases with a minimum level of 15-16 years. The prevalence of chronic nontuberculous lung diseases (COPD) increases with age. In adolescents, in the structure of COPD, more than 70% is chr. bronchitis, and boys are 2 times more than girls.

Etiology and pathogenesis. In the primary chronic formation and course of the disease, most patients go through four stages:

I. Threat situation, there are external and internal risk factors for the disease.

II. Predisease (prebronchitis) with the presence of initial symptoms of the disease.

III. Detailed clinical picture of the disease.

IV. The period of obligate complications in patients with hr. obstructive bronchitis.

In adolescents, another developmental variant predominates with an initial protracted and recurrent bronchitis.

I stage of development disease, or a situation of threat, is created in a practically healthy person by a combination of exogenous and endogenous risk factors.

Exogenous factors:

Tobacco smoking (active and passive),

Inhalation of polluted (vapours of acids, alkalis, fumes, dust), cold or hot air, especially in combination with general hypothermia or overheating of the body,

Abuse of alcohol, especially strong drinks,

aerogenic sensitization by atopic and infectious antigens,

Infection of inhaled air.

Endogenous risk factors:

Diseases of the nasopharynx with a violation of the cleansing and conditioning function of the nose,

Dysfunction of the ANS with a predominance of the activity of the parasympathetic division,

Lack of IgA synthesis, contributing to the activation of autoinfection in the bronchi,

Violation of the excretion of mucus in combination with hyperproduction of mucus in the bronchi,

Violation of the activity of cellular and humoral elements of protection of the bronchi.

In the formation of the disease at the first stage, internal (endogenous) risk factors play a leading role, in particular, the insufficiency of nonspecific protective mechanisms, the increased sensitivity of the bronchial mucosa to external stimuli. Exogenous factors (tobacco smoke and aggressive dust) play a decisive role, undermining the adaptation of the organism to the environment.

Changes in the bronchi at stage I of the development of the disease: hypertrophy of the mucous glands occurs, highly specialized ciliary cells die, bronchial mucus thickens. This facilitates the adhesion and reproduction of pathogenic microbes on the bronchial mucosa, which occurs during episodes of the so-called cold. A bacterial inflammatory process develops, which contributes to the degeneration of the epithelium into a multi-layer flat, losing the ability to remove mucus from the bronchi.

II stage of development- a state of pre-illness - pre-bronchitis, i.e. early manifestations of chronic bronchitis.

It can be manifested by cough and bronchospasm in an active or passive smoker living in an ecologically unfavorable region, a patient with chronic pathology of the nasopharynx and a violation of the cleansing function of the nose. Variants of prebronchitis are also possible in the form of a protracted and recurrent course of acute bronchitis.

Over the past 15-20 years, the number of children who smoke has increased: boys start smoking at the age of 10-12, girls - at the age of 14-15. In families where there were smokers, diseases of the bronchi and lungs in children were much more common (33.3% and 50%).

At this stage of the development of the disease, changes in the bronchial mucosa increase and worsen, mucociliary insufficiency appears with the accumulation of mucous secretions in the bronchi. Mucus is removed by coughing, which is a protective mechanism and indicates the beginning of decompensation of the cleansing function. At the stage of prebronchitis, the reverse development of the disease is possible (with smoking cessation, improvement of the living environment, persistent restorative treatment of protracted and recurrent bronchitis, treatment of diseases of the nasopharynx).

In the secondary chronic variant hr. bronchitis, the decisive etiological significance is not dust, but an infectious factor - a virulent respiratory infection. Of the viruses, the most common are adenovirus, respiratory syncytial virus, influenza, of bacteria - pneumococci and Haemophilus influenzae, which damage the epithelium of the bronchial mucosa.

Stage III- a detailed clinical picture of the disease. The leading factor in the inflammatory process of the bronchial mucosa is a persistent infection. Viruses violate the integrity of the bronchial epithelium and promote the introduction of bacteria (mainly pneumococci and Haemophilus influenzae). On the contrary, pathogenic and pyogenic cocci do not play a significant role in hr. bronchitis.

The drainage cleansing function of the bronchi is significantly impaired, and even during the period of remission, the persistent course of the infectious process continues.

Exacerbations of bronchitis are caused by respiratory viruses, and then the bacterial flora supports the inflammatory process; they differ in a protracted course. The most pronounced immunological deficiency in obstructive forms of bronchitis.

Later, with obstructive bronchitis, pulmonary emphysema is formed, which is an irreversible process in which lung tissue is involved in the pathological process. This is defined by the term chronic obstructive pulmonary disease (COPD), and means attack IV - the final stage of obstructive lung pathology, when there are its complications - chronic cor pulmonale and pulmonary heart failure. This stage is already observed in an adult patient.

Classification. The most acceptable clinical and pathogenetic classification.

By pathogenesis, they distinguish: 1. Primary

2. Secondary bronchitis.

By clinical and laboratory characteristics: 1. "Dry"

2. catarrhal

3. Purulent.

By functional characteristics: 1. Non-obstructive

2. Obstructive.

By the phase of the disease: 1. Exacerbation

2. Clinical remission.

Clinic.

The main symptoms: cough, sputum, shortness of breath with a decrease in exercise tolerance, respiratory discomfort (difficulty, discomfort, feeling of congestion). During the period of exacerbation, symptoms of intoxication: weakness, sweating, fever, malaise, decreased performance.

Cough is the most typical symptom of chronic bronchitis. It can be unproductive, but more often with separation sputum from a few spittles to 100-150 ml per day. Sputum may be watery, mucous, mucopurulent, streaked with blood. Viscous sputum causes a prolonged hacking cough. At I-II stages of the disease, a cough with a small amount of sputum usually occurs after morning awakening (getting out of bed, washing), manifestations of physical activity.

During the day, sputum may be separated periodically due to physical stress, increased breathing. Cough often appears and intensifies in the cold and damp season, with impaired breathing through the nose.

At hr. non-obstructive bronchitis cough occurs during an exacerbation and the patient does not apply for honey for a long time. help. In the presence of obstruction persistent cough, aggravated during an exacerbation, may appear when lying down in bed (cutane-visceral reflex from a cold bed).

Relatively rarely seen hemoptysis, usually in the form of streaks of blood in the sputum at the height of the coughing fit. It is an indication for bronchoscopy.

Dyspnea characteristic of obstructive bronchitis. At the beginning, it occurs with significant physical exertion, but gradually progresses. On the early stages shortness of breath only in the acute phase, later in the remission phase, and patients do not always feel it.

In the acute phase, there may be a feeling respiratory discomfort, a kind of inconvenience when breathing.

Gradually formed bronchospastic syndrome, with its severity, asthmatic bronchitis is diagnosed, according to modern concepts - episodic bronchial asthma. This condition is characterized by hyperreactivity of the bronchial mucosa to nonspecific stimuli.

Inspection the patient in the initial period does not reveal visible changes, with a detailed clinical picture of the disease, cyanosis, acrocyanosis is determined. In the presence of hypoxemia, diffuse cyanosis of the skin and mucous membranes (warm) is noted, especially noticeable on the tongue. On auscultation, breathing may be weakened (for example, with emphysema) or increased. Harsh breathing and dry scattered wheezing, which increase with exacerbation, are characteristic. The level of bronchial damage can be determined by the timbre of dry rales: the higher the timbre of rales, the smaller the caliber of the affected bronchi. Whistling wheezing is characteristic of the defeat of the small bronchi. With the predominance of liquid secretion in the bronchi, moist rales are also heard: small, medium and large bubbling.

From the side of cardio-vascular system with obstructive bronchitis, m.b. tachycardia, in lean patients epigastric pulsation of the right ventricle of the heart is detected.

Chronic non-obstructive bronchitis in adolescents occurs with exacerbations and remissions, exacerbations develop in the off-season - in early spring and late autumn, are characterized by catarrhal or purulent inflammation. With catarrhal bronchitis, sputum is mucous or mucopurulent, intoxication is weak or absent, the temperature is normal or subfebrile; with purulent - purulent sputum, febrile temperature, pronounced intoxication. Difficulty breathing during physical exertion, the transition from a warm room to a cold one. The complication is pneumonia.

Chronic obstructive bronchitis is characterized by the presence of shortness of breath, sputum is scanty, separated with difficulty after a long painful cough.

Diagnostics.

Based on clinical and anamnestic data, exclusion of other diseases, including tuberculosis. Additional research methods are used to clarify the phase, clinical form of the disease. Apply:

§ general blood analysis, in which, with purulent inflammation, moderate leukocytosis is detected with a shift of the leukocyte formula to the left;

§ biochemical analysis blood– determination of total protein and protein fractions, C-reactive protein, sialic acids and seromucoid;

§ cytological examination sputum and flushing of the bronchi obtained during bronchoscopy;

§ Chest x-ray reveals changes in the lungs in obstructive bronchitis.

§ Study of the functional state respiratory system: pneumotachometry, spirography, tests with dosed physical activity, etc., is carried out to confirm the presence of violations of bronchial patency.

Differential Diagnosis carried out with bronchiectasis, cystic fibrosis, bronchial asthma, sinus pathology.

Treatment.

Treatment is carried out on an outpatient basis, if it is ineffective, hospitalization is indicated, usually in a day hospital, with purulent hr. bronchitis - to the pulmonology department for a course of bronchial rehabilitation.

Principles of complex therapy:

§ Elimination or optimal correction of pathogenic exogenous and endogenous risk factors;

§ Impact on sensitization, correction of secondary immunological deficiency;

§ Impact on infection and inflammation;

§ Improvement of bronchial patency.

Indicated for exacerbation of bronchitis bed rest or semi-bed rest depending on the severity of the condition.

With a decrease in appetite nutrition limited to fruits, fresh vegetables and their juices, then the range of dishes expands with the predominance of "alkaline" - vegetable food over acidic - meat, animal (tables No. 5, 10, 15).

The main direction of treatment during exacerbation is the effect on inflammation of an infectious nature, - antibiotics and other chemotherapy drugs depending on the sensitivity of the isolated microflora to them. The most effective are amoxicillin, doxycycline, erythromycin, azithromycin, with a long course of the disease, third-generation cephalosporins and quinolines are used. The drugs are administered within 7-10 days.

If there are symptoms viral infection appoint antiviral agents- rimantadine, locally - interferon or interlock, DNase and RNase. For irrigation of the mucous membrane - iodinol, Lugol's solution, onion and garlic solution diluted with saline 1: 10, 1: 5, 1: 2 in the form of inhalations.

Mandatory rehabilitation of chronic foci infections.

Immunocorrection carried out with an exacerbation of purulent obstructive bronchitis: hemodez, immunoglobulin, immune plasma. With a sluggish course of exacerbation, plantain juice, elecampane, diucifon and levamisole are indicated, with leukopenia - sodium nucleinate, pentoxyl, methyluracil. They stimulate the production of endogenous interferon and increase the nonspecific resistance of the vaccine (bronchovacsome, broncho-munal).

Expectorants - infusions and decoctions of thermopsis, marshmallow, " breast collection”, applied with tablespoons up to 10 times a day, in a warm form. In the presence of very viscous, difficult to separate sputum, prescribe mucolytic drugs - bisolvon, acetylcysteine, lazolvan.

At bronchospasm- inhalation of sympathomimetics through a spacer (berotek, etc.), intal and its analogues, in case of severe obstruction - glucocorticosteroids in inhalations and orally.

vitamin therapy(C, A).

Physiotherapy with subsidence of exacerbation - aeroionotherapy with negative ions, aerosol therapy with iodinol, mineral waters, chest massage, potassium iodide electrophoresis, bronchodilators, biostimulants, exercise therapy. Teach the patient optimal drainage positions.

Prevention.

Primary- at the first stage of the formation of the disease (risk group):

§ elimination of formation bad habits,

§ Sanitation of foci of infection,

§ hardening,

§ physical education,

§ stimulation of nonspecific resistance,

§ rational vocational guidance of a teenager.

Secondary prevention carried out at the second and third stages of the development of the disease:

§ Sanitation of foci of infection,

§ physiotherapy exercises (sound and drainage gymnastics, dosed walking),

§ In the phase of remission, spa treatment.

Clinical examination.

dispensary observation are subject to:

§ Adolescents at risk who are examined at annual periodic examinations, with a minimum of laboratory and instrumental studies,

§ Practically healthy adolescents with borderline conditions: frequent recurrent acute prolonged bronchitis are examined at least 2 times a year using functional diagnostics of the respiratory system with provocative and stress tests, immunological tests;

§ Sick chronic bronchitis, examination 2-4 times a year, consultation with a pulmonologist

Patients with obstructive bronchitis are engaged in physical education according to the method of exercise therapy individually under the supervision of a physician. Adolescents with COB with severe obstruction, emphysema, and symptoms of respiratory failure are exempted from exams, participation in school labor teams, and military service. .
Topic number 3.

Persistent bronchial asthma - inflammatory disease airways with a chronic course, the only manifestation of which is a reversible narrowing of the bronchial lumen. Bronchial hyperreactivity occurs against the background of chronic inflammation of the mucous membrane and is manifested by bronchospasm and hyperproduction of thick sputum. All this leads to the appearance of characteristic symptoms.

Persistent asthma

Causes

Groups of factors that cause the development of persistent asthma:

• internal;
• external;
• triggers (provoke an exacerbation of the disease).

Internal factors determine the development of the disease. These include:

genetic predisposition

• genetic predisposition (it has been proven that the risk of inheriting bronchial asthma is about 70%);
• atopy (increased IgE titer in response to contact with an allergen);
• high airway activity (severe narrowing of the airway lumen in response to an allergen or trigger);
• obesity (affects the mechanism of the act of breathing and contributes to the development of an inflammatory reaction).

External factors provoke the appearance of symptoms of the disease:

Factors that provoke an exacerbation of asthma:

• rapid breathing;
• natural factors (high or low air temperature, wind);
• pharmacological preparations (NSAIDs, beta-receptor antagonists);
• the smell of paintwork materials;
• psycho-emotional stress.

Manifestations of the disease

An exacerbation of the disease occurs after the allergen enters the body and manifests itself in the form of shortness of breath, bouts of unproductive coughing, wheezing, and chest congestion. Sometimes an exacerbation can be caused by increased physical activity.

cough reflex

Mechanism of symptoms:

• irritation of the cough receptors of the bronchi leads to the occurrence of a cough reflex;
• spasm of the smooth muscles of the bronchi contributes to the formation of wheezing, due to the turbulent flow of air through the spasmodic airways;
• due to increased work respiratory systems you experience shortness of breath.

Severity

According to the severity of persistent asthma is divided into:

1. Mild persistent asthma. Symptoms of the disease occur two or more times a week, but not daily. The occurrence of seizures that violate the quality of sleep, more than 2 times a month. Exacerbations negatively affect motor activity. FEV in the first second outside the attack is more than 80% of normal values.
2. Persistent BA of moderate severity. Manifested by everyday symptoms, nocturnal manifestations occur more than once every 7 days, exacerbations reduce motor activity and worsen sleep. Required daily intake beta-2-agonists of short duration.
3. Severe persistent asthma. It is characterized by regular manifestations of symptoms, more than once a day, frequent exacerbations and impaired sleep quality, a significant limitation of motor activity.

Diagnostics

Stages of diagnosing asthma:

Spirometry

1. Collection of patient complaints and clarification of anamnesis.
2. Functional diagnostic methods (spirometry, peak flowmetry).
3. Collection of allergy history.
4. Skin allergy tests.
5. Test with an allergen for the purpose of provocation.
6. Laboratory diagnostic methods.

When analyzing complaints, pay attention to:

• shortness of breath that occurs on inspiration;
• bouts of unproductive coughing;
• heaviness and feeling of pressure in the chest;
• wheezing wheezing.

Assessment of the reversibility of bronchial obstruction is carried out using spirometry. To confirm the diagnosis, the indicator of forced expiratory volume in the first second is important. At first this indicator evaluate without using medicines, then the patient is injected with a bronchodilator drug. After 15-20 minutes, the study is repeated. An increase in FEV1 of more than 12% is in favor of the proposed diagnosis.

Peakflowmetry

Peak flow metering is used to determine peak air velocity. This method is used when it is impossible to conduct spirometry and to monitor the dynamics of the course of the disease. The device is small in size, so it is convenient to use it to identify the influence of provoking factors at work and at home.

When collecting an allergic anamnesis, it is necessary to establish the presence of allergic diseases in the family, to identify the relationship between the onset of symptoms and the action of allergens (contact with animals, the cold season, the manifestation of symptoms after being in certain rooms).

To identify a specific allergen, skin tests with allergens are performed. Samples are carried out in late autumn or winter to exclude the influence of plant pollen on the test results.

Which doctor to contact

If symptoms of the disease appear, it is necessary to contact the local therapist. After making a preliminary diagnosis, the local doctor will refer the patient to highly specialized specialists:

• pulmonologist;
• allergist;
• gastroenterologist.

Required tests

To confirm the disease, it is necessary to donate blood to determine the general and specific immunoglobulin E. You also need to donate sputum or bronchoalveolar fluid to analyze the content of eosinophils.

Sputum examination

Treatment Methods

Pharmacotherapy of persistent asthma is divided into 2 types:

• ongoing maintenance therapy;
• drugs used in exacerbations.

Supportive (basic) therapy is aimed at reducing the frequency of seizures, up to their total absence. For this purpose, drugs with anti-inflammatory activity (inhaled and systemic corticosteroids), prolonged beta-2 agonists are prescribed.

Salbutamol

In case of exacerbation, drugs with the fastest time for the development of effects are used: Salbutamol, Fenoterol.

Forecast

With a correct diagnosis and the appointment of effective therapy, it is possible to achieve a completely controlled course of the disease. The quality of life of such patients almost does not differ from healthy people.

Preventive measures

food allergens

To prevent exacerbation of asthma, patients are advised to exclude foods that cause them to exhibit an allergic reaction. Obese patients need to reduce body weight, which will improve health status and reduce the risk of exacerbation. In addition, it is necessary to exclude active and passive smoking in order to minimize harmful effects on the lungs. Moderate exercise improves cardiopulmonary function. Patients are advised to go swimming to train the muscles involved in the act of inhalation.

Possible Complications

Asthmatic condition is the most severe complication of persistent bronchial asthma. It represents acute respiratory failure and resistance to bronchodilator drugs. Frequent exacerbations of the disease can lead to the development of emphysema, due to overstretching of the lung tissue due to the inability to exhale. Perhaps the development of hypertrophy of the right ventricle of the heart, due to pulmonary hypertension.

Asthma is a formidable disease, with the possibility of developing severe complications. But timely diagnosed disease and properly selected treatment reduce the occurrence of exacerbations to a minimum and prevent possible complications, while maintaining a high quality of life for patients.

Definition of disease. Causes of the disease

Bronchial asthma(BA) is a disease characterized by chronic inflammation respiratory tract, respiratory symptoms(wheezing, dyspnea, chest congestion, and cough) that vary in time and intensity and present with variable airway obstruction.

Asthma occupies a leading position in terms of prevalence among the population. According to statistics, a doubling of the number of patients with this pathology has been recorded over 15 years.

According to WHO estimates, today about 235 million people suffer from asthma, and by 2025 it is projected to increase to 400 million people in the world. Thus, phase 3 studies (ISSAC) also revealed an increase in the global incidence of asthma in children aged 6-7 years (11.1-11.6%), among adolescents aged 13-14 years (13.2-13.7%) .

A number of factors influence the emergence and development of AD.

Internal reasons:

1. gender (in early childhood, boys are predominantly ill, after 12 years, girls);

2. hereditary tendency to atopy;

3. hereditary tendency to bronchial hyperreactivity;

4. overweight.

External conditions:

1. allergens:

• non-infectious allergens: household, pollen, epidermal; fungal allergens;
• infectious allergens (viral, bacterial);

2. respiratory infections.

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of bronchial asthma

The characteristic symptoms of asthma that most patients complain about include:

• cough and heaviness in the chest;
• expiratory dyspnea;
• wheezing.

Manifestations of asthma are variable in their severity, frequency of occurrence and depend on exposure to various allergens and other trigger factors. They also depend on the selected anti-asthma treatment, the number and severity of concomitant diseases. Most often, the symptoms of asthma are disturbed at night or in the early morning hours, as well as after physical effort, which leads to a decrease in the physical activity of patients. Inflammatory changes in the bronchial tree and airway hyperreactivity are the main pathophysiological signs of asthma.

Mechanisms causing the main symptoms of AD

The pathogenesis of bronchial asthma can be visualized in the form of a diagram:

Classification and stages of development of bronchial asthma

Today there are a huge number of classifications of BA. Below are the main ones, they help in understanding the reasons and are necessary for statistics. In addition, given modern approach in considering the problem of asthma, as the allocation of asthma phenotypes.

In Russia, the following classification of BA is used:

BA classification (ICD-10)

Priority is now being given to personalized medicine, which is this moment does not have the ability to create an individual drug and methods for examining or preventing the development of a disease for a particular patient, but it is proposed to single out separate categories. These subgroups of patients are called AD phenotypes, characterized by features in causes, development, methods of examination and therapy.

At the moment there are the following phenotypic forms of AD:

1. allergic BA. This type is not difficult to diagnose - the onset of the disease falls on childhood associated with a burdened allergic history. As a rule, relatives also have respiratory or skin manifestations of allergies. People with this type of asthma have immune inflammation in the bronchial tree. Treatment of patients with this type of BA with local corticosteroids (GCS) is effective.
2. Non-allergic BA. This type of asthma mostly affects adults, there is no history of allergic pathology, heredity for allergies is not burdened. The nature of inflammatory changes in the bronchi of this category is neutrophilic-eosinophilic, small granulocytic, or a combination of these forms. ICS do not work well in the treatment of this type of asthma.
3. Asthma with persistent airway constriction. There is a group of patients who begin irreversible changes in the bronchi, as a rule, these are people with uncontrolled symptoms of asthma. Changes in the bronchial tree are characterized by restructuring of the bronchial wall. The treatment of these patients is complex and requires close attention.
4. Asthma with delayed onset. Most patients, mostly female, develop asthma in advanced years. These categories of patients require the appointment of elevated concentrations of inhaled corticosteroids or become almost resistant to basic therapy.
5. Asthma combined with overweight. This type takes into account that the category of people with excess weight and asthma suffer from more severe attacks of dyspnea and cough, there is always shortness of breath, and changes in the bronchi are characterized by moderate allergic inflammation. Treatment of these patients begins with the correction of endocrinological abnormalities and diet therapy.

Complications of bronchial asthma

If you do not make a diagnosis of bronchial asthma in time and do not choose a therapy that will allow you to control the course of the disease, complications may develop:

1. cor pulmonale, up to acute heart failure;
2. emphysema and pneumosclerosis of the lungs, respiratory failure;
3. lung atelectasis;
4. interstitial, subcutaneous emphysema;
5. spontaneous pneumothorax;
6. endocrine disorders;
7. neurological disorders.

Diagnosis of bronchial asthma

Bronchial asthma is a clinical diagnosis that is established by a doctor, taking into account complaints, anamnestic features of the patient, functional diagnostic methods, taking into account the degree of reversibility of bronchial obstruction, a special examination for the presence of allergic pathology and differential diagnosis with other diseases with similar complaints. The debut of the development of the disease most often occurs at the age of 6 years, less often after 12 years. But the appearance is possible at a later age. Patients complain of episodes of difficulty breathing at night, in the early hours of the morning, or associate complaints with emotional and sometimes physical overload. These symptoms are combined with shortness of breath, with expiratory disturbances, "whistles" in the chest, recurrent cough with a small amount of sputum. These symptoms may resolve on their own or with the use of medicinal bronchodilators. It is necessary to link the appearance of signs of asthma after interaction with allergenic substances, the seasonality of the onset of symptoms, the relationship with clinical signs runny nose, history of atopic disease or asthma problems.

If a diagnosis of AD is suspected, the following questions should be asked:

1. Do you suffer from bouts of wheezing in your lungs?
2. Is there coughing at night?
3. How do you handle physical stress?
4. Are you worried about heaviness behind the sternum, coughing after staying in dusty rooms, contact with animal hair, in the spring and summer?
5. Have you noticed that you are more likely to be sick for more than two weeks, and the illness is often accompanied by cough and shortness of breath?

Specific methods of diagnosis

1. Evaluation of lung function and the degree of recurrence of bronchial constriction

2. Allergy testing. It involves carrying out allergy tests on the skin, provocateur tests with certain types of allergens, laboratory tests to detect specific IgE antibodies. Skin tests are the most common, as they simple methods according to the execution technique, reliably accurate and safe for patients.

2.1. There are the following types of skin allergies by execution technique:

• scarification allergy tests;
• prick tests (prick-test);
• intradermal tests;
• application tests

In order to conduct skin tests, data from the patient's medical history are required, indicating an unambiguous connection between complaints and contact with that allergen or their group in the pathogenesis of the disease, an IgE-dependent type of allergic reaction.

Skin testing is not performed in the following cases:

2.2. Provocative inhalation test. Respiratory Society experts from Europe recommend this study. Before the study, spirometry is performed, and if the FEV1 level does not decrease below 70% of the norm, the patient is allowed to provocation. A nebulizer is used, with which it is possible to dispense certain doses of the allergen by jet, and the patient makes several inhalations with certain dilutions of allergens under the constant supervision of an allergist. After each inhalation, the results are evaluated after 10 minutes three times. The test is regarded as positive when FEV1 decreases by 20% or more from the initial values.

2.3. Methods laboratory diagnostics. Diagnostics in the laboratory is not the main method. It is carried out if another study is needed to confirm the diagnosis. The main indications for the appointment of laboratory diagnostics are:

• age up to 3 years;
• history of severe allergic reactions to skin examination;
• the underlying disease is severe, with virtually no periods of remission;
• differential diagnosis between IgE-mediated and non-IgE-mediated types of allergic reactions;
• exacerbation of skin diseases or structural features of the skin;
• requires constant intake of antihistamines and glucocorticosteroids;
• polyvalent allergy;
• false results are obtained during skin testing;
• refusal of the patient from skin tests;
• skin test results do not match clinical findings.

The laboratories use the following methods for determining general and specific IgE - radioisotope, chemiluminescent and enzyme immunoassays.

Most new approach to the diagnosis of allergic diseases at the moment is molecular allergy testing. It helps to make a more accurate diagnosis, calculate the prognosis of the course of the disease. For diagnosis, it is important to consider the following nuances:

1. the difference between true sensitization and cross-reactions in patients with polyallergy (when there is a wide range of sensitization);
2. reducing the risk of severe systemic reactions during allergy testing, which improves patient adherence;
3. precise determination of allergen subtypes for allergen-specific immunotherapy (ASIT);
4. the most common chip technology is the Immuna Solid phase Allergen Chip (ISAC). It is the most comprehensive platform that includes over 100 allergenic molecules in one study.

Treatment of bronchial asthma

Today, unfortunately, modern medicine cannot cure a patient of bronchial asthma, however, all efforts are reduced to the creation of therapy while maintaining the patient's quality of life. Ideally, with controlled asthma, there should be no symptoms of the disease, persist normal performance spirometry, no symptoms pathological changes in the lower parts of the lungs.

Pharmacotherapy of AD can be divided into 2 groups:

1. Drugs for situational use
2. Permanent use drugs

Seizure medications are as follows:

1. short-acting β-agonists;
2. anticholinergic drugs;
3. combined preparations;
4. theophylline.

Maintenance medications include:

1. inhaled and systemic glucocorticosteroids;
2. combinations of long-acting β2-agonists and corticosteroids;
3. long-acting theophyllines;
4. antileukotriene drugs;
5. antibodies to immunoglobulin E.

For the treatment of asthma, both drugs and methods of introducing these substances into the body and the respiratory tract are important. Drugs can be administered orally per os, parenterally, inhalation.

The following delivery groups are distinguished medicines through the respiratory tract:

• aerosol inhalers;
• powder inhalers;
• nebulizers.

The most modern and researched method of treating allergic asthma with proven efficacy is ASIT (allergen-specific immunotherapy). ASIT is currently the only therapy that changes the course of the disease by acting on the mechanisms of asthma pathogenesis. If ASIT is carried out in time, this treatment can stop the transition allergic rhinitis into asthma, as well as to stop the transition of a mild form to a more severe one. As well as the advantages of ASIT is the ability to prevent new sensitizations from appearing.

ASIT in BA is performed in patients with:

• mild or moderate form of the disease (FEV1 figures should be at least 70% of the norm);
• if asthma symptoms are not fully controlled by hypoallergenic lifestyle and drug therapy;
• if the patient has rhinoconjunctival symptoms;
• if the patient refuses permanent formotherapy;
• if during pharmacotherapy there are undesirable effects that interfere with the patient.

Today we can offer patients the following types of ASIT:

• injection of allergens
• sublingual administration of allergens

Forecast. Prevention

In modern conditions, there is no evidence that environmental, climatic factors, malnutrition can worsen the course of asthma, and the elimination of these triggers will help reduce the severity of the disease and reduce the amount of pharmacotherapy. Further clinical observations are required in this vein.

Allocate primary prevention. It includes:

• elimination of allergens during pregnancy and in the first years of a child's life (hypoallergenic life and hypoallergenic diet);
• lactation;
• milk mixtures;
• nutritional supplements during pregnancy (there are several hypotheses of the protective effect of fish oil, selenium, vitamin E);
• smoking cessation during pregnancy.

Secondary prevention includes:

• avoid pollutants (increased concentrations of ozone, ozone oxides, suspended particles, acid aerosols);
• control of house dust mites;
• do not have pets;
• smoking cessation in the family.

Severe asthma is a type of asthma that does not respond to effective treatment with standard medications such as inhaled corticosteroids and bronchodilators.

Asthma affects more than 26 million people in the US. Severe asthma is relatively rare, occurring in 5-10% of the total number of people with asthma.

The symptoms of severe asthma are difficult to control, which means that such attacks are a great health hazard. Patients with severe asthma it takes the help of a doctor to know how to suppress her attacks.

In addition to medication, it is important to learn to recognize and avoid triggers to prevent asthma attacks.

This article looks at the causes, symptoms, and treatments for severe asthma.

Severe asthma - what is it?

Medicine grades asthma according to how effectively its symptoms respond to treatment. People with severe asthma find it difficult to manage their symptoms with traditional medications.

Severe, persistent asthma manifests itself in symptoms that continue around the clock. Asthma can interfere with activities of daily living as well as at night during sleep—nighttime symptoms often occur in people with severe asthma.

The more difficult the symptoms are controlled, the higher the risk of complications from this disease.

• symptoms that can occur at any time of the day
• sleep waking symptoms, often daily (from 5 years of age)
• for the age category up to 4 years - awakening from symptoms more often than 1 time per week
• symptoms that require repeated short-acting beta-2-agonists to suppress
• symptoms that significantly limit a person's daily activities
• FEV1 less than 60% of normal (age 5+)

FEV1 stands for "forced expiratory volume". This is the volume of air exhaled by the patient during the first second of forced exhalation. This test helps doctors have a better idea of ​​a patient's lung function.

In 2014, an article was published stating that severe asthma is confirmed if its symptoms are not relieved by the following medications:

• inhaled corticosteroids and additional agents, including long-acting inhaled beta-2 agonists, theophylline, or montelukast
• oral corticosteroid treatment for at least 6 months a year

Symptoms

People experience asthma symptoms differently. For most of these, the symptoms are unpredictable, making it difficult to accurately identify severe asthma. However, these symptoms and sensations are common.

Severe asthma makes it difficult for people to carry out daily activities. In the absence of suitable treatment, the symptoms become debilitating.

Sometimes symptoms occur not only during the day, but also at night, leading to awakening.

Asthma symptoms range from minor inconveniences to life-threatening attacks when all factors worsen at the same time.

Symptoms of asthma include the following:

• labored breathing
• cough
• wheezing
• chest pain
• shortness of breath
• tightness in the chest
• asthma attacks

Definition of the diagnosis

A doctor can confirm a diagnosis of severe asthma if the standard asthma medication does not work.

This means that the diagnosis cannot be made immediately - first the patient tries various methods of treatment, and the doctor looks at whether they help or not.

When diagnosing asthma in medicine, three stages are distinguished:

• collection and study of the patient's medical history
• medical examination
• performing breath tests

Also, the doctor may check for the presence of other diseases, accompanied by similar symptoms.

Causes

Medicine still does not know the exact causes of asthma, but many factors, such as allergies, play an important role here.

A 2013 study found that 75.4% of asthmatics between the ages of 20 and 40 were also diagnosed with allergies.

An additional study found an association between tobacco use and an increased risk of asthma, among other respiratory conditions. Children who are around smoking adults may experience the same symptoms.

Many environmental factors can also lead to asthma symptoms. A 2017 study found that air pollution leads to more relapses and more people being hospitalized for asthma.

A report presented in 2014 drew a parallel between asthma and obesity. The American Academy of Allergy, Asthma, and Immunology noted that, according to another study, "general obesity is a contributing factor to the incidence of asthma."

Treatment

The main goal of asthma treatment is to control its symptoms. This includes preventing airway inflammation, minimizing the number of subsequent attacks, and preventing lung damage.

People with severe asthma need to take medication more frequently and in higher doses than those with moderate asthma. To find the best solution in the treatment of these special symptoms, it is necessary to consult a doctor.

If you experience a severe asthma attack, you should seek immediate medical attention. medical care. Asthma attacks can be life-threatening, especially if they don't respond well to medication.

According to asthma experts, the best way to reduce the likelihood of severe asthma attacks is to avoid triggering factors as much as possible and take the necessary medications on time.

You can resort to both symptomatic and long-term treatment.

Back to main symptomatic treatment include taking short-acting beta-2 agonists. This drug should be taken when asthma symptoms appear.

This class also includes:

• orciprenaline
• albuterol (Ventolin HFA, ProAir, Proventil)
• levosalbutamol (Xopenex)

Inhaled corticosteroids have their own side effects, such as oral candidiasis or a fungal infection in the mouth. To prevent the development of infection after using an inhalation aerosol, you need to rinse your mouth.

conclusions

Asthma is a common disease that affects millions of people every day, and its severity can vary.

While in most cases asthma responds adequately to the use of drugs, severe asthma is poorly amenable to the action of the measures taken.

People with severe asthma should try to avoid triggers. Seeing a doctor will also reveal the most effective method treatment.

Bronchial asthma is a chronic disease. It is dangerous for the patient's life due to asthma attacks and has a significant impact on the work of the heart, vascular and respiratory systems. This action is due to seizures that cause disruptions in breathing, swelling of the mucous membranes and an increase in mucus secretion in the bronchial tree.

This disease is very common - it affects up to 10% of the total population of the planet. At the same time, children constitute a special risk category - bronchial asthma is diagnosed in 12-15% of young patients. The disease can be classified according to many features, therefore, different types, forms and phases are distinguished. The effectiveness of therapy and prognosis depend largely on the severity of the disease.

Bronchial asthma is classified as a disease provoked by an allergic reaction to certain irritants, as a result of which the patient's breathing is disturbed. Spasm of the bronchi, swelling of their mucous membranes, increased secretion of mucus leads to a decrease in the flow of oxygen into the lungs, resulting in suffocation.

The disease occurs most often due to extreme sensitivity to allergens, which are present in large quantities in external environment. Often there is a severe form that bronchial asthma acquires due to the lack of qualified treatment.

Symptoms and features of the course of bronchial asthma

The basis of the disease is bronchial hyperreactivity when exposed to external stimuli. This is a very strong reaction, accompanied by a narrowing of the lumen during the formation of edema and the production of mucus in large quantities. Several groups of factors lead to such processes. Firstly, these are the causes of internal origin, which determine the progression of the disease:

• genetic prerequisites - the presence in the circle of relatives of persons suffering from a similar illness or allergies;
• excessive body weight, because in obesity the diaphragm is high, and the lungs are not sufficiently ventilated;
• gender - boys are more prone to the disease due to the narrowness of the bronchial lumen, although women are more susceptible to the disease in adulthood.

Secondly, there are factors of external origin that provoke the development of the disease. These are allergens that cause the body to react in the region of the bronchial tree:

• dust particles in the room;
• products and individual ingredients - chocolate, seafood, dairy products, nuts, etc.;
• pet hair, bird feathers;
• mold or fungi in the premises;
• medicinal products.

allergic type

It is not uncommon to have an allergic reaction to several types of irritants. At the same time, one should not forget about triggers, that is, factors that can directly provoke spasms in the bronchi. These include:

• smoke from smoking tobacco products;
• too high physical activity;
• different in frequency and regularity interaction with household chemicals - powders, perfumes, cleaning products;
• pollutants environment, for example, car exhausts, industrial emissions;
• features of climatic conditions - excessively dry or cold air;
• infectious diseases of the respiratory type.

Bronchial asthma in many cases can develop like normal bronchitis, and not all doctors immediately identify the disease. Symptoms include:

• asthma attacks;
• severe shortness of breath, accompanied by a cough;
• difficulty breathing with audible whistles and wheezing;
• feeling of heaviness in the chest.

Features of the manifestation of symptoms

These typical signs of the disease can spontaneously disappear. In some cases, they are eliminated by taking medications with an anti-inflammatory effect. Symptoms may vary, but the characteristic of the disease is the recurrence of exacerbations under the influence of allergens, due to an increase in air humidity, a decrease in temperature, or heavy loads.

With bronchial asthma, attacks occur, accompanied by suffocation and coughing. They are provoked by inflammatory processes of an immune nature, which are activated by the action of allergens or due to damage to the body by pathogens of respiratory diseases.

At the next stage, biologically active substances are produced, there is a change in the tone of the muscles of the bronchi, which is accompanied by a violation of their functions. The result is the development of edema of the mucous membrane of the bronchi, a change in the amount of secretion secreted with concurrent spasms of smooth muscles.

During the increase in viscosity secreted secret, which begins to clog the lumen of the bronchi. The movement of air through them becomes difficult. The difficulty of exhalation provokes the manifestation of expiratory dyspnea. It is this specific symptom of the disease that should be paid attention in the first place. The result is the appearance of whistles and wheezing when breathing.

If left untreated, a severe form of bronchial asthma can develop - the symptoms become more pronounced and the relief of asthma attacks becomes more difficult. Therefore, timely diagnosis and adequate treatment become the key to rapid relief of the patient's condition, increasing the duration of the remission period. To assess the degree of bronchospasm, a variety of methods are used, for example:

• spirography, which evaluates the volumetric characteristics of breathing;
• peak flowmetry to measure the maximum expiratory flow rate.

It is unacceptable to self-medicate with bronchial asthma, as this can cause complications, and an asthma attack can even lead to lethal outcome. It is possible to eliminate an attack on your own only in cases of an ailment of the atopic type, when the problem is provoked by the flowering of vegetation during certain seasons.

The peculiarity of the course of the disease is that at an early stage it cannot always be accurately diagnosed. Often a false diagnosis of "bronchitis" is made, and therefore adequate treatment is not prescribed during this period. All therapeutic efforts are futile.

Classification of the disease according to severity

The course of the disease is characterized by alternating periods of exacerbation and temporary calm (remission). It is important to correctly assess the severity of the disease. You can do this with several options:

• the number of observed seizures at night during the week;
• the total number of seizures that occur during the day during the week;
• the frequency and duration of the use of drugs with a short-term effect such as "beta2-agonists";
• sleep problems and limitations in the patient's physical activity;
• values ​​of FEV1 and POS parameters and their dynamics during exacerbation of the disease;
• changes in the POS indicator during the day.

The severity of the disease can be different, therefore, when classifying bronchial asthma, the following types are distinguished:

• an ailment with an intermittent type of flow (periodic);
• persistent type disease with a mild course;
• with manifestations of moderate severity;
• severe persistent asthma.

Intermittent asthma

May have an intermittent course. In this case, exacerbations of the disease are short-term, occurring episodically. The duration is several hours, but can reach several days.

Daytime manifestations of suffocation in the form of shortness of breath or cough syndrome occur less than 1 time within 1 week. But at night, an attack can happen up to 2 times in 30 days. The peak expiratory flow rate is 80% of the baseline normal value. Daily speed fluctuations do not exceed 20%.

During remission, asthma in this form does not manifest itself in any way, there are simply no symptoms, so that the functioning of the lungs remains normal.

Attacks usually begin as a result of direct interaction with allergens. There may also be an exacerbation due to colds. Patients note that exacerbation occurs after household work related to cleaning indoors or outdoors.

Inhalation of plant pollen, contact with animals, exposure to odors or smoke from cigarettes become attack provocateurs. In this case, no special changes in the patient's condition are observed, activity does not fall, speech does not change. However, there are some signs to watch out for:

• increased duration of exhalation;
• hard breath;
• the appearance of weak whistles during exhalation;
• breathing becomes more rigid, there are signs of wheezing;
• heartbeat accelerates.

Features of the intermittent type

In this form, the disease is not detected often enough. This is due to a number of factors:

1. The lack of symptomatology and the absence of significant changes in well-being leads to ignoring the signs by the patients themselves.
2. Episodic asthma is similar in its symptoms to other ailments, damaging organs breathing.
3. Provoking factors have a mixed effect - the disease is the result of the action of allergens and infectious diseases.

Diagnosis is made using examinations:

• general blood and urine tests;
• skin allergy tests;
• x-ray examination of the organs of the chest cavity;
• assessment of functional parameters of external respiration under the influence of beta2-agonists.

mild persistent

For a mild course of bronchial asthma in this form, the expiratory flow rate at a peak level of up to 80% of the initial baseline is typical. Within 24 hours, this indicator can vary within 30%. Attacks of suffocation, accompanied by coughing and shortness of breath, occur no more than 1 time per day, but may be less common - only 1 time per week.

Night attacks occur no more than twice in 30 days. Manifesting symptoms associated with an exacerbation of the disease directly affect the patient's performance, can reduce activity during the day, worsen sleep at night.

Persistent moderate

Asthma in moderate form is manifested by symptoms that negatively affect the patient's activity during the day and his sleep at night. If daytime attacks occur almost daily, then at night suffocation is observed at least 1 time per week. Peak expiratory flow is 60-80% of the required level.

Asthma of moderate severity is characterized by the following features:

• indicators of bronchial patency are significantly worsened - breathing becomes stiff, shortness of breath is noted, exhalation is difficult;
• clear wheezing is heard;
• in the process of coughing, sputum may be released;
• the chest is barrel-shaped, with percussion a box sound is heard;
• physical load is accompanied by shortness of breath;
• symptoms of the disease appear even in the absence of an attack.

Asphyxiation attacks are common and can be life threatening. The patient experiences intense fear skin covering turns pale, and the nasolabial triangle acquires a shade of cyanosis. During an attack, a person leans forward and leans with his hands, for example, on a table, while breathing, additional muscles are used.

Severe persistent asthma

Asthma is mixed. Provoking factors are triggers in the form of allergic irritants and infection. Exacerbations are quite frequent, attacks can be repeated every day and every night. The peak speed during expiration does not exceed 60% of the norm. Fluctuations can exceed 30%.

The patient's condition is very serious. Physical activity limited, bronchospasms appear spontaneously without visible reasons. Exacerbations are characterized by high frequency and intensity. The severe course of bronchial asthma cannot be controlled by the patient. To monitor the condition, peak flowmetry is performed every day.

The attack is characterized by a number of manifestations:

• respiratory disorders;
• persistent anxiety, increased panic, fear, the appearance of cold sweat;
• forced posture of the patient;
• whistling sounds when breathing, which can be heard at a distance;
• promotion blood pressure and the appearance of tachycardia;
• strong wheezing dry or wet type when breathing.

Therapy for severe asthma is not always effective, and therefore can be observed when it is necessary to use special devices to maintain vital processes. The reason for this condition may be:

• massive exposure to the allergen;
• joining SARS;
• overdose of beta2-agonists;
• a sharp change in treatment, the rejection of hormonal drugs.

Asthmatic status develops if the attack cannot be stopped within 6 hours. At the same time, the oxygen content in the blood falls, carbon dioxide accumulates, and sputum removal from the bronchi stops. Treatment is carried out exclusively in stationary conditions.

Treatment of bronchial asthma

The effectiveness of therapy depends on the correctness of the treatment. In the early stages, it is required to create conditions to prevent the progression of the disease and maximize the periods of remission. Doctors prescribe short-acting beta2-agonists, as well as theophyllines. The goal is to stop seizures and prevent deterioration of the condition.

The drugs are given in the form of an inhaler or tablets for oral intake. Usually they are used before exercise or before interaction with irritating components. To improve the effectiveness of treatment, the patient is recommended to change his lifestyle. Anti-inflammatory agents are usually not used.

The main directions in treatment

Patients with asthma in a mild persistent form already require serious daily treatment. Prevention of exacerbations is carried out with the help of corticosteroids in the form of inhalers, as well as drugs with sodium cromoglycate, nedocromil, theophyllines.

The dosage of corticosteroids at the initial stage is 200-500 mcg per day. With the progression of the disease, the dose is increased to 750-800 mcg daily. Long-acting bronchodilators should be used before bed.

Patients with moderately persistent asthma are forced to take beta2-agonists and anti-inflammatory drugs every day. Such complex therapy helps prevent the deterioration of the patient's condition. Beclomethasone dipropionate is prescribed, as well as other analogue inhalers containing corticosteroids.

Dosage - 800-2000 mcg (in each case - selected individually!). However, long-acting bronchodilators cannot be dispensed with. They are indispensable for night attacks. Theophyllines are included in the course of therapy.

In severe asthma, the course of therapy is aimed at alleviating the symptoms. The following medications are prescribed:

1. High dose corticosteroids. An acceptable initial dose is one that provides symptomatic control. After the effect appears, the dosage is often reduced. Doctors prescribe systemic glucocorticosteroids. The form of these drugs is different - it can be aerosol inhalers, tablets, drops.
2. Bronchodilators. These drugs include drugs of different groups. Preference is given to methylxanthines and beta2-agonists. They will give a certain effect of anticholinergics.
3. Non-steroidal anti-inflammatory drugs. The use of these medications is associated with a mixed etiology of the disease - asthma occurs due to allergens, physical exertion, and climatic conditions. Use drugs with cromoglycate or nedocromil sodium.

Severe asthma is treated with medications, which often have significant side effects and contraindications. In most cases, treatment is carried out in a hospital setting.

Features in children

Children are characterized by an atopic form of the disease. It is directly related to allergic manifestations. The provoking factor is nutritional problems during the first years of life and environmental conditions. During this period you need:

• ensure regular and continuous breast-feeding newborns;
• introduce complementary foods not earlier than the baby reaches 6 months of age, and it is necessary to exclude foods that can cause allergies;
• create best conditions for the life and development of the baby;
• exclude exposure to allergy-provoking factors, such as cigarette smoke or aggressive household chemicals;
• timely diagnose and treat respiratory diseases in babies.

Adult patients experience asthma as a complication of chronic respiratory diseases or as a consequence of long-term exposure to harmful environmental conditions - tobacco smoke, car exhaust, industrial emissions. Therefore, these factors should be excluded in a timely manner and treatment of diseases of the respiratory system should be started.

Prevention of complications

It is important to take measures aimed at reducing the severity of the disease and preventing exacerbation. This is especially important if patients are diagnosed with severe bronchial asthma. To do this, it is advisable to exclude contact with the allergen, which must first be accurately identified. To minimise harmful effect allergens should:

• regularly carry out wet cleaning, at least 1-2 times in 7 days;
• in the housing of asthmatics, exclude the presence of carpets, upholstered furniture, items on which dust can settle;
• wash bedding weekly using hot water and laundry soap;
• use covers for pillows or mattresses;
• destroy insects;
• do not include in the diet foods that provoke an allergic reaction of the body.

All of these measures will help prevent the development of the disease and increase the effectiveness of therapy.

Prevention of asthma attacks

The set of measures includes actions to prevent allergic reactions and diseases of the respiratory system.

They are especially important for people with a tendency to allergies, as well as people in a state of pre-asthma, when the disease has not yet developed. Preventive measures are necessary for:

• persons with a hereditary predisposition to asthma;
• patients with allergic reactions;
• individuals with immunologically proven sensitization.

They need therapy aimed at desensitization, using antiallergic drugs.