Atopic bronchial asthma is the chronic noninfectious and allergic damage of airways developing under the influence of external allergens against the background of genetically caused tendency to an atopiya. It is shown by episodes of sudden pristupoobrazny suffocation, cough with a poor viscous phlegm. At diagnosis of atopic bronchial asthma the anamnesis, data , clinical and immunological blood test and a bronkhoalveolyarny unleavened wheat cake is estimated. At atopic bronchial asthma the diet, the anti-inflammatory, desensibilizing therapy, bronkholitichesky and expectorant means, a specific hyposensitization is appointed.
Atopic bronchial asthma
Atopic bronchial asthma – allergic bronkhoobstruktivny pathology with a chronic current and existence of hereditary predisposition to a sensitization. Hypersensibility of bronchial tubes to various noninfectious ekzoallergena getting to an organism with the inhaled air and food is its cornerstone. Atopic bronchial asthma belongs to very heavy displays of an allergy, its prevalence makes 4-8% (5% among adult population and 10-15% among children). In recent years in pulmonology the progressing growth of incidence of this option of asthma is observed. Atopic bronchial asthma more than at a half of patients demonstrates already at children's age (up to 10 years), in a third of cases during the period up to 40 years. Asthma at children has mainly atopic character, affects boys more often.
Atopic bronchial asthma is the polietiologichesky pathology developing at confluence of certain internal and external reasons. The great value is allocated for hereditary tendency to allergic manifestations (the raised IgE development) and hyperreactivity of bronchial tubes. More than in 40% of cases the disease is fixed as family, and tendency to an atopiya 5 times more often is transferred on the maternal line. At atopic asthma occurrence of other family forms of an allergy is 3-4 times higher. Presence at the patient of a gaplotip of A10 B27 and a blood type 0 (I) are risk factors of development of an atopic form of asthma.
The main external factors responsible for realization of predisposition to atopic bronchial asthma, noninfectious ekzoallergena (substances of a vegetable and animal origin, household, food allergens) act. Have the most expressed sensibilizing potential house and library dust; wool and waste products of pets; feather of poultry; a forage for fishes; pollen of plants; foodstuff (citruses, strawberry, chocolate). Depending on the leading reason allocate various types of allergic bronchial asthma: dust (household), pollen (seasonal), epidermalny, fungal, food (nutritive). In an initial stage of asthma one pathogenetic option takes place, but in the subsequent also others can join.
The exacerbation of asthma is promoted:
- smoking, smoke, emissions of the industrial enterprises,
- pungent chemical smells
- considerable difference of temperatures
- reception of medicines
Development of an early sensitization in the child is provoked:
- pregnancy toxicoses
- early introduction of artificial mixes
- vaccination (especially, against whooping cough).
The food sensitization, then skin and respiratory arises the first usually.
Immune and not immune mechanisms in which various cellular elements participate are involved in formation of asthmatic reactions: eozinofilny leukocytes, corpulent cages, basophiles, macrophages, T-lymphocytes, fibroblasta, cages of an epithelium and endoteliya, etc. Allergic reactions of the I type are peculiar to an atopic form of asthma (anaphylactic).
In an immunological phase there is a development of a sensitization of an organism to for the first time to the arrived allergen due to synthesis of IgE and IgG4 and their fixing on an external membrane of cages targets. In a patokhimichesky phase the repeated contact of allergen with cages targets starts sharp emission of various mediators of an inflammation - a histamine, tsitokin, hemokin, leykotriyen, a factor of activation of platelets, etc. Early asthmatic reaction (in the period of 1-2 min. to 2 h after allergen influence) in the form of a bronkhoobstruktivny syndrome with hypostasis mucous bronchial tubes, a spasm of the smooth muscles raised by secretion of viscous slime (a pathophysiological phase) develops. The bronchospasm leads to restriction of receipt of an air stream in the lower departments of respiratory tract and to temporary deterioration in ventilation of lungs.
Late asthmatic reaction is followed by inflammatory changes of a bronchial wall - eozinofilny infiltration of a mucous membrane and a submucous layer, a deskvamation of cages of a vibrating epithelium, a giperplaziya of scyphoid cages, growth and a gialinizatsiy basal membrane. Even at permanent remission of asthma in a wall of bronchial tubes the chronic inflammation is supported. At the long course of atopic bronchial asthma irreversibility of changes with a sklerozirovaniye of a bronchial wall is formed. Out of an attack and at the uncomplicated course of change in lungs are not noted.
Children have first respiratory displays of an allergy relating to preasthma, lives can be observed during a second or third. Tipichyony asthmatic symptoms appear later, at the age of 3-5 years. As Patognomonichny symptoms of atopic bronchial asthma serve the sudden attacks of obstructive suffocation which are quickly developing against the background of good health. The congestion and an itch in a nose, sneezing, liquid nasal allocations, sadneny in a throat, dry cough can precede an asthmatic attack. The attack quickly enough breaks spontaneously or after medicinal influence, coming to the end with an otkhozhdeniye of a poor viscous phlegm of mucous character. During the mezhpristupny period clinical displays of a disease usually minimum.
The most widespread - a household form of atopic bronchial asthma is brightly shown during the heating period in connection with increase in dust content of rooms and characterized by effect of elimination – knocking over of attacks at withdrawal from the house and renewal at return. The Epidermalny form of asthma is shown at contact with animals, beginning with an allergic rinokonjyunktivalny syndrome. Seasonal asthma proceeds with aggravations during blossoming of herbs, bushes and trees (spring-summer), fungal – in the period of a sporoobrazovaniye of mushrooms (seasonally or all the year round) with temporary relief after loss of snow and intolerance of drozhzhesoderzhashchy products.
The exacerbation of allergic bronchial asthma is shown by attacks of various intensity. At long contact with big concentration of allergen the asthmatic status with alternation of heavy attacks of suffocation for days and more, with the painful short wind amplifying at any movements can develop. The patient is excited, forced to accept a sitting position or semi-sitting. Breath happens at the expense of all auxiliary muscles, are noted cyanosis of mucous membranes, . Resistance to antiasthmatic means can be noted.
The funktsioyonalny changes developing in time of heavy attacks (a gipoksemiya, a giperkapniya, a gipovolemiya, arterial hypotonia, dekompensirovanny respiratory acidosis, etc.) pose threat for the patient's life in connection with risk of developing of asphyxia, heavy arrhythmia, a coma, respiratory standstill and blood circulation. Bacterial infections of airways, emphysema and lungs, pheumothorax, respiratory insufficiency can become pulmonary complications of atopic bronchial asthma; extra pulmonary - heart failure, pulmonary heart.
Diagnostics of an atopic form of asthma includes survey, assessment of the allergologichesky anamnesis (seasonality of a disease, character of attacks), results diagnostic (skin skarifikatsionny and inhalation provocative), clinical and immunological blood tests, the analysis of a phlegm and washing waters of bronchial tubes. Patients with atopic bronchial asthma have a hereditary otyagoshchennost on atopiya and/or extra pulmonary displays of an allergy (ekssudativny diathesis, eczema, allergicheyosky rhinitis, etc.).
Skin tests allow to establish potential allergens; inhalation tests with a histamine, metakholiny, acetylcholine - pristupoobrazny hyperreactivity of bronchial tubes. The allergic nature of bronchial asthma is confirmed by an eozinofiliya and a high caption of the general and specific IgE in blood serum. Data of a bronkhoalveolyarny unleavened wheat cake define change of cellular structure of a phlegm (an eozinofiliya, presence of specific elements - Kurshman's spirals, crystals of Sharko-Leiden).
Diagnostics of a food sensitization at atopic bronchial asthma includes maintaining the food diary, carrying out eliminative diets and differential and diagnostic medical starvation; provocative tests with products; skin tests with food allergens; definition of specific Ig in blood serum. Difficulties in specification of the dust nature of an allergy are connected with complex anti-gene composition of dust. It is important to distinguish atopic bronchial asthma from obstructive bronchitis, other options of asthma.
Treatment of atopic bronchial asthma
Maintaining patients with atopic bronchial asthma is carried out by the pulmonologist and the allergist-immunologist. As a necessary condition of treatment serves elimination or restriction of ekzoallergen (refusal of carpets, upholstered furniture and pukho-peryevy bedding, keeping of pets, smoking), frequent damp cleaning, observance of a hypoallergenic diet etc., and also self-checking from the patient.
Medicamentous therapy of atopic asthma includes the desensibilizing and anti-inflammatory medicines (kromolin-sodium, corticosteroids). Bronchodilators are applied to knocking over of bad attacks of suffocation. At bronchial asthma preference is given to the inhalation forms of steroids applied in the form of the dosed aerosol inhalers or nebulayzerny therapy. For improvement of passability of bronchial tubes expectorant means are shown.
At an easy form of asthma of rather symptomatic reception of bronchial spasmolytics of short action (orally or it is inhalation), at heavy - daily use of resolvents or inhalation corticosteroids is shown; the prolonged bronchodilators. At the asthmatic status appoint rehydration therapy, correction of microcirculator shifts and acidosis, oxygenotherapy, if necessary – IVL, a bronkhoalveolyarny unleavened wheat cake, a long epiduralny analgeziya. At atopic bronchial asthma the plasma exchange, haemo sorption can be used; out of an aggravation - to be carried out the specific hyposensitization, immunocorrection, LFK, acupuncture, physiotherapy, a speleoterapiya, sanatorium treatment.
Forecast and prevention
The forecast of atopic asthma depends on weight of obstruction and development of complications; in hard cases the lethal outcome from respiratory standstill and blood circulation is possible. Prevention of this option of asthma consists in elimination of profvrednost, house sources of an allergy, drying and fungicide processing of crude rooms, observance of a hypoallergenic diet, change of a climatic zone during blossoming of plants.