Bronchial asthma is a chronic noninfectious respiratory disease of inflammatory character. The attack of bronchial asthma often develops after harbingers and is characterized by a short sharp breath and a noisy long exhalation. Usually it is followed by cough with a viscous phlegm and the loud whistling rattles. Methods of diagnostics include assessment of data of spirometry, a pikfloumetriya, , clinical and immunological blood tests. In treatment are used aerosol beta , m-holinolitiki, ASIT, at severe forms of a disease are applied glucocorticosteroids.
For the last two decades incidence of the bronchial asthma (BA) grew, and today in the world about 300 million asthmatics. It is one of the most widespread chronic diseases to which subject all people, regardless of gender and age. Mortality among patients with bronchial asthma is rather high. The fact that in the last twenty years incidence of bronchial asthma at children constantly grows does bronchial asthma not just by a disease, and a social problem the maximum of forces is directed to fight against which. Despite complexity, bronchial asthma will well respond to treatment thanks to which it is possible to achieve permanent and long remission. Constant control over the state allows patients to prevent completely approach of attacks of suffocation, to lower or exclude administration of drugs for knocking over of attacks, and also to lead active lifestyle. It helps to support functions of lungs and to completely exclude risk of complications.
The most dangerous provocative factors for development of bronchial asthma are exogenous allergens on which laboratory tests confirm the high level of sensitivity at patients OH and at persons who enter into risk group. The most widespread allergens are household allergens - it is house and book dust, a forage for aquarian small fishes and dandruff of animals, allergens of a phytogenesis and food allergens who still call nutritive. At 20-40% of patients with bronchial asthma similar reaction to medicines comes to light, and at 2% the disease is got owing to work on harmful production or, for example, in perfumery shops.
Infectious factors are an important link too in an etiopatogeneza of bronchial asthma as microorganisms, products of their activity can act as allergens, causing an organism sensitization. Besides, the continuous contact with an infection supports inflammatory process of a bronchial tree in an active phase that increases sensitivity of an organism to exogenous allergens. So-called gaptenny allergens, that is allergens of nonprotein structure, getting into a human body and communicating his squirrels also provoke allergic attacks and increase probability of emergence OH. Such factors as overcooling, the burdened heredity and stressful states occupy one of important places in an etiology of bronchial asthma too.
Chronic inflammatory processes in respiratory organs conduct to their hyperactivity as a result of which at contact with allergens or irritants, obstruction of bronchial tubes instantly develops that limits the speed of a stream of air and causes suffocation. Attacks of suffocation are observed with different frequency, but even in a remission stage inflammatory process in airways remains. At the heart of violation of passability of a stream of air, at bronchial asthma the following components lie: obstruction of airways because of spasms of smooth muscles of bronchial tubes or owing to hypostasis of their mucous membrane; obstruction of bronchial tubes a secret of submucous glands of airways because of their hyperfunction; replacement of muscular tissue of bronchial tubes on connecting at the long course of a disease because of what there are sclerous changes in a wall of bronchial tubes.
The organism sensitization when at the allergic reactions of immediate type proceeding in the form of anafilaksiya antibodies are developed is the cornerstone of changes of bronchial tubes, and at a repeated meeting with allergen there is an instant release of a histamine, as leads to hypostasis mucous bronchial tubes and to hyper secretion of glands. Immunocomplex allergic reactions and reactions of the slowed-down sensitivity proceed similarly, but with less expressed symptoms. The increased quantity of ions of calcium in blood of the person is considered recently too as the contributing factor as excess of calcium can provoke spasms including spasms of muscles of bronchial tubes.
At a pathoanatomical research of the dead during an attack of suffocation full or partial obstruction of bronchial tubes by viscous dense slime and emphysematous expansion of lungs because of the complicated exhalation is noted. The microscopy of fabrics most often has a similar picture - it is a reinforced muscular layer, hypertrophied bronchial glands, infiltrative walls of bronchial tubes with an epithelium deskvamation.
It is OH subdivided on an etiology, weight of a current, the level of control and other parameters. By origin allocate allergic (including professional OH), not allergic (including aspirinovy OH), not specified, mixed bronchial asthma. On severity distinguish the OH following forms:
- Intermittiruyushchy (incidental). Symptoms arise less often than once a week, an aggravation rare and short.
- Persistiruyushchy (constant current). Is divided into 3 degrees:
- easy - symptoms arise from 1 time a week to 1 time a month
- average - the frequency of attacks daily
- heavy - symptoms remain almost constantly.
During asthma allocate aggravations and remission (unstable or stable). Whenever possible control over pristpua OH can be controllable, partially controllable and uncontrollable. The full diagnosis of the patient with bronchial asthma includes all above-mentioned characteristics. For example, "Bronchial asthma of not allergic origin, intermittiruyushchy, controllable, in a stage of stable remission".
Symptoms of bronchial asthma
The suffocation attack at bronchial asthma is divided into three periods: period of harbingers, period of a heat and period of the return development. The period of harbingers is most expressed at patients with the infectious and allergic nature OH, it is shown by vasomotorial reactions from bodies of a nasopharynx (plentiful watery allocations, continuous sneezing). The second period (it can suddenly begin) is characterized by feeling of constraint in a thorax which does not allow to breathe freely. The breath becomes sharp and short, and exhaled on the contrary long and noisy. Breath is followed by the loud whistling rattles, there is cough with knitting, difficult an otkharkivayemy phlegm that does breath arrhythmic.
During an attack the position of the patient compelled usually he tries to accept a sitting position with the case inclined forward and to find a point of support or leans elbows in knees. The person becomes bloated, and during an exhalation cervical veins bulk up. Depending on weight of an attack it is possible to observe participation of muscles which help to overcome resistance on an exhalation. In the period of the return development the gradual otkhozhdeniye of a phlegm begins, the number of rattles decreases, and the suffocation attack gradually dies away.
Manifestations at which it is possible to suspect existence of bronchial asthma.
- the high-voice-frequency whistling rattles at an exhalation, especially at children.
- the repeating episodes of the whistling rattles, the complicated breath, feeling of constraint in a thorax and the cough amplifying in night time.
- seasonality of deteriorations in health from respiratory organs
- existence of eczema, allergic diseases in the anamnesis.
- deterioration or emergence of symptomatology at contact with allergens, administration of drugs, at contact with smoke, at sharp changes of ambient temperature, ORZ, physical activities and emotional tension.
- the frequent catarrhal diseases which are "going down" in the lower departments of airways.
- improvement a state after reception of antihistaminic and antiasthmatic medicines.
Depending on weight and intensity of attacks of suffocation bronchial asthma can be complicated by emphysema of lungs and the subsequent accession of secondary warm and pulmonary insufficiency. Overdose beta or bystry decrease in a dosage of glucocorticosteroids, and also contact with a massive dose of allergen can lead to emergence of the asthmatic status when attacks of suffocation go one by one and they cannot almost be stopped. The asthmatic status can end with a lethal outcome.
The diagnosis is usually made by the pulmonologist on the basis of complaints and existence of characteristic symptomatology. All other methods of a research are directed to establishment of severity and an etiology of a disease. At percussion a sound clear box because of hyper lightness of lungs, mobility of lungs is sharply limited, and their borders are displaced down. At an auskultation over lungs the vesicular breath weakened with the extended exhalation and with a large number of the dry whistling rattles is listened. Because of increase in lungs in volume, the point of absolute dullness of heart decreases, the tones of heart muffled with accent of the second tone over a pulmonary artery. From tool researches it is carried out:
- Spirometry. The spirography helps to estimate extent of obstruction of bronchial tubes, to find out variability and reversibility of obstruction, and also to confirm the diagnosis. At OH the forced exhalation after inhalation by bronchial spasmolytic in 1 second increases by 12% (200 ml) and more. But for obtaining more exact information the spirometry should be carried out several times.
- Pikfloumetriya. Monitoring of a condition of the patient allows to take measurement of peak activity of an exhalation (PSV), comparing indicators with received earlier. Increase in PSV after inhalation of bronchial spasmolytic for 20% and more from PSV before inhalation accurately demonstrates existence of bronchial asthma.
Additional diagnostics includes carrying out tests with allergens, the ECG, a bronkhoskopiya and a X-ray analysis of lungs. Laboratory blood tests are of great importance in confirmation of the allergic nature of bronchial asthma, and also for monitoring of efficiency of treatment.
- Blood test. Changes in OAK - an eozinofiliya and slight increase of SOE - are defined only in the period of an aggravation. Assessment of gas composition of blood is necessary during an attack for assessment of weight of DN. Biochemical blood test is not the main method of diagnostics as changes have the general character and similar researches are appointed for monitoring of a condition of the patient in the period of an aggravation.
- General analysis of a phlegm. At microscopy in a phlegm it is possible to find a large number of eosinophils, crystals of Sharko-Leiden (the brilliant transparent crystals which are formed after destruction of eosinophils and having the form of rhombuses or octahedrons), Kurshman's spirals (are formed because of small spastic reductions of bronchial tubes and look as molds of transparent slime in the form of spirals). Neutral leukocytes can be found in patients with infectious and dependent bronchial asthma in a stage of active inflammatory process. Allocation of little bodies of the Creole is also noted during an attack - it is the roundish educations consisting of epitelialny cages.
- Research of the immune status. At bronchial asthma the quantity and activity T-supressorov sharply decreases, and the amount of immunoglobulins in blood increases. Use of tests is important for determination of amount of immunoglobulins E in case there is no opportunity to carry out allergologichesky tests.
Treatment of bronchial asthma
As bronchial asthma is a chronic disease regardless of the frequency of attacks, the fundamental moment in therapy is the exception of contact with possible allergens, observance of eliminative diets and rational employment. If it is possible to reveal allergen, then the specific hyposensibilizing therapy helps to reduce reaction of an organism to it.
Apply to knocking over of attacks of suffocation beta in the form of an aerosol quickly to increase a gleam of bronchial tubes and to improve outflow of a phlegm. It is a fenoterola hydrobromide, salbutamol, . The dose in each case is selected individually. Also well medicines of group of m-holinolitikov – aerosols an ipratropiya of bromide and its combination with fenoteroly stop attacks.
Ksantinovy derivatives enjoy wide popularity among patients with bronchial asthma. They are appointed for prevention of attacks of suffocation in the form of the tableted forms of the prolonged action. In the last several years medicines which interfere with degranulation of corpulent cages give positive effect at treatment of bronchial asthma. It , sodium and antagonists of ions of calcium.
At treatment of severe forms OH connect hormonal therapy, nearly a quarter of patients needs glucocorticosteroids, 15-20 mg of Prednisolonum accept in the morning together with antatsidny medicines which protect mucous a stomach. In the conditions of a hospital hormonal medicines can be appointed in the form of injections. Feature of treatment of bronchial asthma is that it is necessary to use medicines in the minimum effective dose and to try to obtain a bigger decrease in dosages. For the best otkhozhdeniye of a phlegm expectorant and mukolitichesky medicines are shown.
Forecast and prevention
The course of bronchial asthma consists of series of aggravations and remissions, at timely identification it is possible to achieve steady and long remission, the forecast depends more on that how the patient shows consideration for the health and observes doctor's instructions. Prevention of bronchial asthma which consists in sanitation of the centers of a chronic infection, fight against smoking, and also in minimization of contacts with allergens is of great importance. It is especially important for people who enter into risk group or have the burdened heredity.