Asthmatic bronchitis is respiratory , proceeding with primary damage of bronchial tubes of average and large caliber. Serve as displays of asthmatic bronchitis pristupoobrazny cough with the complicated forced, noisy exhalation; short wind of expiratory type. Diagnosis of asthmatic bronchitis includes consultation of the pulmonologist and allergist, an auskultation and percussion of lungs, a X-ray analysis of lungs, conducting skin and allergic tests, a research of immunoglobulins and a complement, research FVD, a bronkhoskopiya. Treatment of asthmatic bronchitis consists in purpose of bronchial spasmolytics, expectorant and protivogistaminny medicines, spazmolitik, physiotreatments, LFK, massage.
Asthmatic bronchitis – the infectious and allergic disease of the lower airways which is characterized by hyper secretion mucous, hypostasis of walls, a spasm large and average of bronchial tubes. At asthmatic bronchitis, unlike bronchial asthma, usually there are no attacks of the expressed suffocation. Nevertheless, in pulmonology asthmatic bronchitis is regarded as a condition of preasthma. Most often asthmatic bronchitis develops at children of preschool and early school age with the burdened anamnesis on allergic diseases.
Asthmatic bronchitis has the polietiologichesky nature. At the same time both noninfectious agents, and the infectious factors (virus, fungal, bacterial) coming to an organism aerobronkhogenno or through a GIT can act as direct allergens. Among noninfectious allergens house dust, down, pollen of plants, hair of animals, components of food and preservatives most often come to light. Asthmatic bronchitis at children can be a consequence of a medicinal and vaktsinalny allergy. Quite often the polyvalent sensitization takes place. Often in the anamnesis of patients there are instructions on hereditary predisposition to an allergy (ekssudativny diathesis, neurodermatitis, allergic rhinitis, etc.).
As infectious substratum of asthmatic bronchitis pathogenic staphylococcus in most cases acts. On it the frequent vysevayemost of a microorganism from a secret of a trachea and bronchial tubes, and also the increased level of specific antibodies specifies in blood of patients with asthmatic bronchitis. Quite often asthmatic bronchitis develops after the postponed flu, a SARS, pneumonia, whooping cough, measles. Numerous cases of development of asthmatic bronchitis in patients with a gastroezofagealny reflux disease are noted. Depending on the leading allergic component, an exacerbation of asthmatic bronchitis can arise during the spring and summer period (a season of blossoming of plants) or cold season.
In pathogenesis of asthmatic bronchitis as the leading mechanism serves the increased reactivity of bronchial tubes to different allergens. Existence of neurogenetic and immunological links of the pathological answer is supposed. The place of the conflict "allergen antibody" are bronchial tubes of average and large caliber; small bronchial tubes and bronchioles at asthmatic bronchitis remain intact that explains absence in clinic of a disease of the expressed bronchospasm and asthmatic attacks. As immunopathological reactions allocate atopic and infectious and allergic forms of asthmatic bronchitis. The atopic form is characterized by development of the I type of allergic reaction (the hypersensitivity of immediate type IgE-mediated by allergic reaction); an infectious and allergic form – development of allergic reaction of the IV type (hypersensitivity of the slowed-down type, the cellular mediated reaction). The mixed mechanisms of development of asthmatic bronchitis meet.
As Patomorfologichesky substratum of asthmatic bronchitis serves as a spasm of smooth muscles of bronchial tubes, violation of bronchial passability, inflammatory hypostasis mucous, hyperfunction of bronchial glands with formation of a secret in a gleam of bronchial tubes. Bronkhoskopiya at an atopic form of asthmatic bronchitis reveals a characteristic picture: a pale, but edematous mucous membrane of bronchial tubes, narrowing of segmentary bronchial tubes owing to hypostasis, a large number of a viscous mucous secret in a gleam of bronchial tubes. In the presence of an infectious component the changes of bronchial tubes typical for virus and bacterial bronchitis are defined: hyperaemia and puffiness mucous, existence of a mucopurulent secret.
Symptoms of asthmatic bronchitis
The course of asthmatic bronchitis has recidivous character with the periods of an aggravation and remission. In a sharp phase there are fits of coughing which are quite often provoked by physical activity, laughter, crying. Harbingers in the form of sharply arising congestion of a nose, serous and mucous rhinitis, irritation in a throat, an easy indisposition can precede a paroxysm of cough. Body temperature at an aggravation can be subfebrilny or normal. In the beginning cough usually dry, further within a day can be replaced with dry with damp. Sharp kashlevy the attack at asthmatic bronchitis is followed by the complicated breath, expiratory short wind, the noisy, forced whistling exhalation. The asthmatic status at the same time does not develop. At the end of a paroxysm it is usually observed otkhozhdeny phlegms after what improvement of a state follows.
As feature of asthmatic bronchitis serves persistent repetition of symptoms. At the same time, in case of the noninfectious nature of a disease, the so-called eliminative effect is noted: fits of coughing stop out of effect of allergen (for example, at accommodation of children outdoors, change of character of food, change of seasons etc.). Duration of the sharp period of asthmatic bronchitis can make from several hours to 3-4 weeks. Frequent and persistent exacerbations of asthmatic bronchitis can lead to development of bronchial asthma.
Most of the children having asthmatic bronchitis have other diseases of allergic character – , allergic diathesis on skin, neurodermatitis. Polyorgan changes at asthmatic bronchitis do not develop, however neurologic and vegetative changes – irritability, slackness, the increased perspiration can come to light.
Diagnosis of asthmatic bronchitis demands the accounting of data of the anamnesis, carrying out fizikalny and tool inspection, an allergodiagnostika. As asthmatic bronchitis serves as manifestation of a system allergoz, pulmonologists and allergists-immunologists are engaged in its diagnostics and treatment. At patients with asthmatic bronchitis the thorax is, as a rule, not increased in volume. At percussion the box shade of a sound over lungs is defined. The Auskultativny picture of asthmatic bronchitis is characterized by rigid breath, existence of the scattered dry whistling and mixed damp rattles (large and melkopuzyrchaty).
The X-ray analysis of lungs reveals the so-called "latent emphysema": depression of the pulmonary drawing in lateral departments and a condensation - in medial; strengthening of the drawing of a root of a lung. The endoscopic picture at asthmatic bronchitis depends on presence of an infectious and inflammatory component and varies from almost not changed mucous bronchial tubes to signs catarrhal, sometimes catarrhal and purulent endobronchitis.
In blood at patients the eozinofiliya, the increased content of IgA and IgE immunoglobulins, a histamine, decrease in a caption of a complement decides on asthmatic bronchitis. Conducting skarifikatsionny skin tests, elimination of estimated allergen allows to establish the reason of asthmatic bronchitis. The bakissledovaniye of washing waters of bronchial tubes is made for definition of the infectious activator of a phlegm on microflora with definition of sensitivity to antibiotics, . For the purpose of assessment of extent of bronchial obstruction, and also monitoring of a course of a disease the research of function of external breath is conducted: spirometry (including with tests), a pikfloumetriya, a gas-analytical research of external breath, a pletizmografiya, a pnevmotakhografiya.
Treatment of asthmatic bronchitis
Approach to therapy of asthmatic bronchitis has to be complex and individualized. Carrying out a long specific hyposensitization allergen in the corresponding cultivations is effective. Medical microdoses of allergen increase with each injection before achievement of the most transferable dose, then pass to treatment with the supporting dosages which is continued by not less than 2 years. As a rule, children to the asthmatic bronchitis receiving a specific hyposensitization have no transformation of bronchitis in bronchial asthma.
When performing nonspecific desensitization use injections of a gistaglobulin. Reception of antihistaminic medicines is shown to patients with asthmatic bronchitis (a ketotifena, a hloropiramina, a difengidramina, a klemastina, a mebgidrolina). In the presence of symptoms of a bronchial infection antibiotics are appointed. Complex therapy of asthmatic bronchitis joins bronchial spasmolytics, spazmolitik, mucolytics, vitamins. For knocking over of a fit of coughing inhalers - salbutamol, a fenoterol hydrobromide, etc. can be used.
It is effective the nebulayzerny therapies, chloride and sodium and alkaline inhalations improving to a traffic mucous, reducing viscosity of slime, restoring local ionic balance. From physiotherapeutic procedures at asthmatic bronchitis the medicinal electrophoresis, Ural federal district, the general massage, local massage of a thorax, perkutorny massage are appointed. Holding hydroprocedures, medical swimming, LFK, acupuncture, electroacupuncture is expedient. During the periods of remission of asthmatic bronchitis treatment in specialized resorts is recommended.
Forecast and prevention
Usually the forecast at asthmatic bronchitis favorable, however at 28-30% of patients happens transformation of a disease in bronchial asthma. Allergen elimination, carrying out a nonspecific and specific hyposensitization, sanitation of the chronic centers of an infection is necessary for the prevention of an exacerbation of asthmatic bronchitis. For the purpose of rehabilitation the hardening, remedial gymnastics, aero procedures, water procedures is shown. Patients with asthmatic bronchitis are subject to dispensary observation of the pulmonologist and allergist.