Bronchial Asthma

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Bronchial asthma

The incidence of asthma has increased over the last twenty years and today about 300 million people suffer from the effects of asthma. It is one of the most common chronic diseases in humans, regardless of gender and age. The mortality rate is very high among patients with bronchial asthma. The increase in the incidence of bronchial asthma in children over the last twenty years has prompted such a condition to be viewed not only as a disease but also as a social problem, and maximum efforts have been made to combat it.

Shortness of breath attacks occur at different rates, however remission stage (temporary relief of chronic disease) also preserves the inflammatory process in the airways. In bronchial asthma, airflow disorders include the following components:

• Obstruction of the airways due to spasms of the smooth muscles of the bronchi or swelling of their mucous membranes.
• Blockage of the bronchi by secretion due to hyperfunction of the mucous glands of the respiratory tract.
• Replacement of the bronchial muscle tissue with connective tissue as a result of prolonged progression of the disease, leading to sclerotic changes in the bronchial wall.

Despite the complication, bronchial asthma is well treated, resulting in permanent and long-term remission. Patients ’constant monitoring of their condition saves them from taking adjuvant medications to prevent, reduce, or prevent the onset of shortness of breath attacks, as well as lead an active lifestyle. This helps maintain lung function and completely eliminates the risk of complications.

Etiology of bronchial asthma

The most dangerous factors that develop asthma are exogenous allergens. Laboratory tests confirm a high level of sensitivity to allergens in asthmatic patients and people at risk.

The most common allergens are household allergens - house and book dust, as well as aquarium fish feed, pet dander, plant allergens, and food allergens called nutritives. In 20-40% of patients suffering from bronchial asthma, allergies to drugs, and in 2% to work in workplaces with negative effects, such as working in perfume shops, freeze allergies.

Infectious factors are also an important link in the pathogenesis of bronchial asthma, as microorganisms and their metabolic products can act as allergens and therefore cause sensitization. In addition, constant contact with the infection keeps inflammation of the bronchial tract active.

Non-protein allergens, also known as hapten allergens, enter the human body and bind to its proteins, which also increases the risk of allergic attacks and bronchial asthma. Factors such as cold sores, hereditary history, and stress conditions also play an important role in the etiology of bronchial asthma.

At the heart of the change in the bronchi is the sensitization of the body. As a result of rapid allergic reactions in the form of anaphylaxis, the body produces antibodies, and if the allergen is observed again, rapid histamine release occurs, which leads to swelling of the bronchial mucosa and hypersecretion of glands. Immunocomplex allergic reactions and delayed hypersensitivity reactions manifested by dull symptoms. In recent years, the amount of calcium in the blood has also been seen as a predisposing factor, as excess calcium can lead to spasms, including bronchial muscle spasms.

Pathoanatomical examinations of those who died as a result of shortness of breath noted complete or partial obstruction of the bronchi with sticky, thick mucus and emphysematous pulmonary enlargement due to difficulty in exhalation. Examination of the tissues under a microscope gives a similar picture - a thickened muscle layer, hypertrophied bronchial glands, infiltrative, desquamated state of the bronchial walls.

Classification of bronchial asthma

By origin:

• Allergic bronchial asthma
• Nonallergic bronchial asthma (non-allergic)
• Mixed bronchial asthma
• Undiagnosed bronchial asthma

By weight:

• Intermittent, that is, periodic
• Slightly persistent
• Moderate perspective
• Severe perspective

By status:

• Intensification
• Remission
• Unstable remission
• Stable remission

By level of control:

• Under control
• Partially controlled
• Unmanageable

That is, the diagnosis of a patient with bronchial asthma includes the above features. For example, "Non-allergic bronchial asthma, periodic, controlled, in stable remission."

Signs and symptoms of bronchial asthma

Shortness of breath attacks in bronchial asthma are divided into three stages:

• Period of excitatory effect;
• Rise period;
• The period of backward development.

The period of excitatory effect is more pronounced in patients with bronchial asthma of infectious-allergic nature: vasomotor reactions by nasal-pharyngeal organs (runny nose, incessant wheezing).

The second period (it can start suddenly) is characterized by a feeling of tightness in the chest, which does not allow free breathing. Breathing is sharp and short, and exhalation is long and noisy. Breathing causes a loud wheezing, sticky sputum cough, which causes a respiratory arrhythmia.

During the attack, the patient's position is compulsive, he usually sits forward and tries to bend his elbows to his knees. The face swells and the jugular veins swell during exhalation. Depending on the severity of the attack, the involvement of muscles that help overcome resistance to exhalation can be observed.

In percussion, the sound is clear and similar to the sound you make when you hit an empty box, as the air in the lungs increases, lung mobility is limited, and their boundaries slide down. When the lungs are heard, they are heard breathing with a long and weakened and dry wheezing.

During the period of reversal, sputum production begins gradually, the number of wheezes decreases, and the onset of shortness of breath gradually decreases.

Symptoms that may suggest the presence of bronchial asthma.

• High-pitched wheezing during exhalation, especially in children.
• Recurrent wheezing episodes, shortness of breath, chest pain, and a worsening cough at night.
• Seasonal deterioration of respiratory health.
• Presence of eczema, history of allergic diseases.
• When in contact with allergens, when taking medications, when in contact with smoke, when there is a sudden change in ambient temperature, during acute respiratory diseases, after physical activity and emotional stress, the onset of symptoms or irlashishi.
• Frequent colds in the lower respiratory tract.
• Improvement of general condition after taking antihistamines and antiasthmatic drugs.

Complications of bronchial asthma

Depending on the duration of the shortness of breath and the severity of the disease, bronchial asthma can leave complications such as pulmonary emphysema and secondary heart-lung failure. Overdose of beta-adrenostimulants or a sharp decrease in the dose of glucocorticosteroids, as well as contact with a massive allergen can lead to asthmatic status (Asthmatic status), in which the attacks of shortness of breath occur one after the other and are almost impossible to stop. Asthmatic status can be fatal.

Diagnosis of bronchial asthma

The diagnosis is usually made by a pulmonologist based on the complaints and symptoms. All other research methods are aimed at determining the severity and etiology of the disease.

Spirometry. This helps to assess the degree of bronchial obstruction, to determine its change and recovery, as well as to confirm the diagnosis. bronchial asthma after bronchial asthma In bronchial asthma, the volume of exhalation per 1 second after broncholytic inhalation increased by 12% (200ml). But for more accurate information, spirometry should be performed several times.

Peak flowmetry, or measurement of peak peak exhalation activity, allows monitoring of the patient’s general condition and comparison of results.

Additional diagnostic methods include tests with allergens, assessment of blood gas content, ECG, bronchoscopy, and radiograph.

Laboratory tests are important to confirm the nature of allergic asthma, as well as to monitor the effectiveness of treatment.

• General blood test. Slight increase in eosinophilia and ECHT.
• General sputum analysis. When the sputum is examined under a microscope, it is possible to detect a large number of eosinophils, Sharko-Leiden crystals, Kurshman spirals. Neutral leukocytes can be detected in patients with infection-associated bronchial asthma who are under active inflammatory process.
• Biochemical analysis of blood is not the main method of diagnosis, but is used as an adjunct to determine the patient's condition.
• Study of the state of immunity. In bronchial asthma, the number and activity of T-suppressors decreases sharply, the number of immunoglobulins in the blood increases. The use of tests to determine the amount of immunoglobulin E is important when allergy testing is not available.

Treatment of bronchial asthma

Regardless of whether bronchial asthma is a chronic disease and the frequency of attacks, treatment is based on limiting contact with allergens, following a proper diet, and doing the right thing. If an allergen can be detected, specific hyposensitizing treatment can help reduce the body’s response to the allergen.

Beta-adrenomimetics in the form of aerosols are used to relieve attacks of shortness of breath, which help the bronchi to dilate rapidly and sputum to move. Such preparations are fenoterol hydrobromide, salbutamol, orciprenaline. In each case, the dose is prescribed individually. ipratropium Also drugs of the m-cholinolytic group relieve shortness of breath - ipratropium bromide aerosol and its combination with fenoterol.

Xanthine products are very popular among patients with bronchial asthma. They are prescribed to prevent long-acting, tablet-shaped asthma attacks. In recent years, drugs that inhibit the degranulation of mastocytes (a type of granulocyte) have shown positive results in the treatment of asthma. These are antagonists of ketotifen, sodium cromoglycate, and calcium ions.

Hormonal therapy is used to treat severe forms of bronchial asthma, with a quarter of patients requiring glucocorticosteroids. In the morning take 15-20mg prednisolone and antacids that protect the gastric mucosa. In the hospital, hormonal drugs can be administered in the form of injections.

The peculiarity of the treatment of asthma is the use of the least amount and most effective drugs. Expectorants and mucolytic drugs are prescribed for good sputum secretion. Timely treatment of diseases that contribute to the development of asthma - chronic bronchitis, pneumonia - also plays an important role.

Prevention of bronchial asthma and disease outcome

The course of bronchial asthma consists of periods of exacerbation and remission, when the disease is detected in time, long-term and effective remission can be achieved with appropriate treatment measures. The outcome of the disease depends on how the patient cares about their health and how to follow the doctor’s instructions.

Prevention of chronic bronchitis, smoking cessation, and reduction of contact with allergens are important in prevention. This is especially important for people who are at risk or have a family history.