Diagnosed with bronchial asthma what to do. Bronchial asthma: causes, signs, how to treat, prevention

is a chronic allergic disease of the respiratory tract, accompanied by inflammation and changes in the reactivity of the bronchi, as well as bronchial obstruction that occurs against this background. Bronchial asthma in children, it occurs with symptoms of expiratory dyspnea, wheezing, paroxysmal cough, episodes of suffocation. The diagnosis of bronchial asthma in children is established taking into account the allergic history; spirometry, peak flowmetry, chest radiography, skin allergy tests; IgE definitions, gas composition blood, sputum examination. Treatment of bronchial asthma in children involves the elimination of allergens, the use of aerosol bronchodilators and anti-inflammatory drugs, antihistamines, conducting specific immunotherapy.

The triggers of bronchial asthma in children can be viruses - the causative agents of parainfluenza, influenza, SARS, as well as a bacterial infection (streptococcus, staphylococcus, pneumococcus, Klebsiella, Neisseria), chlamydia, mycoplasmas and other microorganisms that colonize the bronchial mucosa. Some children with asthma may be sensitized industrial allergens, taking medications (antibiotics, sulfonamides, vitamins, etc.).

Factors of exacerbation of bronchial asthma in children, provoking the development of bronchospasm, may be infections, cold air, weather sensitivity, tobacco smoke, physical activity, emotional stress.

Pathogenesis

In the pathogenesis of bronchial asthma in children, there are: immunological, immunochemical, pathophysiological and conditioned reflex phases. In the immunological stage, under the influence of the allergen, antibodies of the IgE class are produced, which are fixed on target cells (mainly mast cells of the bronchial mucosa). In the immunochemical stage, repeated contact with the allergen is accompanied by its binding to IgE on the surface of target cells. This process proceeds with degranulation mast cells, activation of eosinophils and the release of mediators with a vasoactive and bronchospastic effect. In the pathophysiological stage of bronchial asthma in children, under the influence of mediators, swelling of the bronchial mucosa, bronchospasm, inflammation and mucus hypersecretion occur. In the future, attacks of bronchial asthma in children occur according to a conditioned reflex mechanism.

Symptoms

The course of bronchial asthma in children is cyclical, in which there are periods of precursors, asthma attacks, post-attack and interictal period s. During the warning period, children with asthma may experience anxiety, sleep disturbance, headache, itching of the skin and eyes, nasal congestion, dry cough. The duration of the precursor period is from several minutes to several days.

Actually, an attack of suffocation is accompanied by a feeling of pressure in the chest and lack of air, shortness of breath of the expiratory type. Breath becomes wheezing, with the participation of auxiliary muscles; wheezing can be heard in the distance. During an attack of bronchial asthma, the child is frightened, takes the position of orthopnea, cannot talk, catches air with his mouth. The skin of the face becomes pale with pronounced cyanosis of the nasolabial triangle and auricles covered with cold sweat. During an attack of bronchial asthma in children, there is an unproductive cough with thick, viscous sputum that is difficult to separate.

Auscultation reveals hard or weak breathing with big amount dry wheezing wheezes; percussion - box sound. From the side of cardio-vascular system tachycardia, increased blood pressure, muffled heart tones are detected. With a duration of an asthma attack of 6 hours or more, they talk about the development of status asthmaticus in children.

An attack of bronchial asthma in children ends with the discharge of thick sputum, which leads to easier breathing. Immediately after the attack, the child feels drowsiness, general weakness; he is slow and lethargic. Tachycardia is replaced by bradycardia, increased blood pressure - arterial hypotension.

During interictal periods, children with asthma may feel almost normal. By severity clinical course there are 3 degrees of bronchial asthma in children (based on the frequency of attacks and respiratory function indicators). At mild degree bronchial asthma in children asthma attacks are rare (less than 1 time per month) and are quickly stopped. During the periods between attacks general well-being not disturbed, spirometry indicators correspond to the age norm.

Moderate degree of bronchial asthma in children occurs with a frequency of exacerbations 3-4 times a month; speed indicators of spirometry are 80-60% of the norm. With a severe degree of bronchial asthma, asthma attacks in children occur 3-4 times a month; FVD indicators are less than 60% of the age norm.

Diagnostics

When diagnosing bronchial asthma in children, data from a family and allergic history, physical, instrumental and laboratory examinations are taken into account. Diagnosis of bronchial asthma in children requires the participation of various specialists: a pediatrician, a pediatric pulmonologist, a pediatric allergist-immunologist.

To the complex instrumental examination includes spirometry (children over 5 years old), tests with bronchodilators and physical activity (veloergometry), peak flowmetry, x-ray of the lungs and chest organs.

Laboratory tests for suspected asthma in children include clinical analysis blood and urine, general sputum analysis, determination of general and specific IgE, blood gas analysis. An important link in the diagnosis of bronchial asthma in children is the production of allergic skin tests.

In the process of diagnosis, the exclusion of other diseases in children with bronchial obstruction is required: foreign bodies of the bronchi, tracheo- and bronchomalacia, cystic fibrosis, bronchiolitis obliterans, obstructive bronchitis, bronchogenic cysts, etc.

Treatment of bronchial asthma in children

The main areas of treatment of bronchial asthma in children include: the identification and elimination of allergens, rational drug therapy aimed at reducing the number of exacerbations and relief of asthma attacks, non-drug rehabilitation therapy.

When detecting bronchial asthma in children, first of all, it is necessary to exclude contact with factors that provoke an exacerbation of the disease. To this end, it may be recommended hypoallergenic diet, organization of hypoallergenic life, cancellation medicines, separation from pets, change of residence, etc. Long-term prophylactic use of antihistamines is indicated. If it is impossible to get rid of potential allergens, specific immunotherapy is carried out, which involves desensitization of the body by introducing (sublingual, oral or parenteral) gradually increasing doses of a causally significant allergen.

basis drug therapy bronchial asthma in children are inhalations of mast cell membrane stabilizers (nedocromil, cromoglycic acid), glucocorticoids (beclomethasone, fluticasone, flunisolide, budesonide, etc.), bronchodilators (salbutamol, fenoterol), combined drugs. The selection of the treatment regimen, combination of drugs and dosage is carried out by the doctor. An indicator of the effectiveness of the treatment of bronchial asthma in children is a long-term remission and the absence of progression of the disease.

With the development of an attack of bronchial asthma in children, repeated inhalations of bronchodilators, oxygen therapy, nebulizer therapy, parenteral administration glucocorticoids.

In the interictal period, children with bronchial asthma are prescribed courses of physiotherapy (aeroionotherapy, Code ICD-10

To answer the question of how to diagnose asthma, you need to know the essence of the disease. According to pathogenesis, there are two forms of bronchial asthma: atopic and infectious-allergic.

An allergic disease can cause an immediate response to the penetration of the allergen, literally after a few minutes. But there is also a belated reaction of the body, after four or six hours.

As soon as the first attacks appear, you need to consult a doctor about the diagnosis of the disease. The beginning of the development of asthma in adults and children is characterized by coughing attacks, they occur most often during the period of three or four in the morning.

The onset of the disease occurs without difficulty in breathing. Auscultation of the patient reveals only dry rales. Specially developed diagnostic methods are used to detect latent bronchospasm. Beta-adrenomimetics provoke muscle relaxation, which causes an increase in the amount of air during exhalation.

The later stages of the development of bronchial asthma are characterized by the occurrence of asthma attacks. Allergens can be triggers for the symptom. For example, dust, animal hair, plant pollen. In addition, reasons may be infectious diseases, the influence of heredity.

Asthmatic asthma attack sometimes begins spontaneously. In front of him, the throat begins to tickle, the skin itches, a runny nose appears. This is followed by difficulty with exhalation against the background of a dry cough, there is tension in the chest. Choking continues to grow, accompanied by wheezing, consisting of sounds of various heights. Last stage an asthma attack makes it impossible to take a normal breath.

Differential Diagnosis

AD is difficult to diagnose because it does not have a bright severe symptoms distinguishing it from other diseases respiratory system. The diagnosis made may be inaccurate. Therefore, you need to know how to diagnose bronchial asthma.

Mild asthma can be confused with:

chronic bronchitis; cardiac asthma; tracheobronchial dyskinesia.

They have largely similar symptoms, but there are differences, so the differential diagnosis of bronchial asthma is established upon receipt of additional data on the disease.

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For example, wheezing, shortness of breath, and coughing are common to other types of illnesses. To confirm the diagnosis, a differential diagnosis of bronchial asthma and chronic bronchitis is carried out:

a skin test with allergens shows that bronchitis is not dependent on them; cough in the form of attacks with the appearance of thick mucus is inherent in bronchial asthma, and bronchitis is characterized by a persistent cough with mucopurulent discharge; dry rales with a whistle give out bronchial asthma, and bronchitis has buzzing and moist rales.

To determine tracheobronchial dyskinesia, the following differences in symptoms are taken into account:

with dyskinesia, a monotonous cough without sputum and suffocation occur due to physical actions and laughter; wheezing with shortness of breath is less than with asthma; allergen tests give negative result; bronchological examination reveals that with dyskinesia there is a sagging back wall bronchi and trachea, and BA is characterized by bronchospasm and obstruction.

Cardiac asthma is fixed by the following distinguishing features from BA:

the cause is heart disease in the form of left ventricular failure; Asthma is common among young people, and cardiac asthma among the elderly; shortness of breath increases on inspiration; wet rales are accompanied by a gurgling sound; sputum with blood.

Features of diagnosing asthma in children and adults

Diagnostic methods for AD in children have similar principles to those in adults. But there are also some features. The main symptom of asthma in children is a cough that occurs at night and in the morning. Sometimes there are wheezing with a whistle. Exacerbation is accompanied by a dry cough without sputum, difficulty exhaling. Auscultation reveals not only whistling sounds in the bronchi, but also wet, of a diverse nature.

In young children, the diagnosis is made on the basis of objective data, anamnesis, laboratory research and frequency of episodes. Spirometry is done to children after six years, testing is prescribed by running. Allergological tests are being carried out in the form skin tests and blood test. An eosinophilic blood and sputum test is done in all children, but an increased number of eosinophils does not always indicate asthma.

Diagnosis of bronchial asthma is a complex process. To make a diagnosis of asthma, the disease must be examined by several methods. Differential diagnosis of bronchial asthma is complemented by other examination methods.

Physical examination

The provisional diagnosis of asthma is made on the basis of clinical data and makes up ninety-nine percent of all diagnosis.

First collect anamnestic data by questioning the patient. At the same time, all complaints are clarified, as a result of which a subjective assessment is derived, phased development diseases, a diagnosis is made, which requires clarification.

The doctor will definitely find out from adults about the facts of bronchial asthma in relatives. It turns out by anamnestic way the connection of seizures with:

viral infections;
the influence of exoallergens; signs of non-infectious sensitization.

The doctor will find out if the patient was worried:

chest discomfort; cough in the middle of the night and during awakening.

For diagnosing asthma, information about the seasonal manifestation of asthma symptoms is important. Accompanying a cold with a feeling of tightness in the chest is also important symptom. The patient should talk about the drugs that he took to eliminate the signs of the disease. If taking bronchodilators provided positive effect on the patient's condition, this fact serves as proof of the diagnosis of asthma.

The next step is a clinical examination. After that, a preliminary diagnosis is made, which directly depends on the stage of bronchial asthma and general condition patient's health. Pre-asthmatic state does not reveal special features. Bronchial asthma allergic nature manifested by atopic dermatitis, eczema, polyps in the nose. It is easier to diagnose at a later stage.

Choking is the most significant sign, when an attack begins, a person instinctively takes sitting position with emphasis on hands. This body position makes breathing easier. With suffocation, swelling of the jugular veins in the neck is noticeable. Percussion of the chest is very important in the diagnosis.

Tapping reveals the characteristic high-pitched box sound of air-filled lungs characteristic of an asthmatic. This is due to the expanded chest and increased distances between the ribs. In addition, wheezing of different intensity is well audible.

status asthmaticus is extreme degree manifestations of bronchial asthma. Asphyxiation takes on a progressive character. Cessation of breathing or heartbeat can lead to lethal outcome. Physical examination reveals clinical symptoms, which are most pronounced:

cyanosis, which is expressed by a blue tint of the skin; tachycardia, causing an increase in heart rate; extrasystoles - failures in the work of the heart; inhibition of the activity of the central nervous system, expressed in the form of apathy, drowsiness.

Instrumental Methods

Such research methods for diagnosing bronchial asthma are required to determine its form, to identify the pathogenetic aspects of the disease.

These include:

spirometry and FVD; chest radiography; diagnostics allergic form asthma with provocative tests; peak flowmetry.

FVD and spirometry diagnose the functionality of external respiration. The degree of bronchial obstruction is determined, the reaction to substances that provoke bronchospasm (histamine, acetylcholine) is monitored. For verification, the patient's exercise test is also used. The so-called Tiffno index is revealed, which indicates the throughput of the bronchi. It is expressed as the ratio of FEV1 and VC. Readings of forced expiratory volume in one second, as well as vital capacity of the lungs, are used.

The patient can carry out diagnostics at home using a peak flow meter, making a table. Accounting is necessary to determine the upcoming bronchospasm. The device is used to measure forced expiratory volume.

The procedure is carried out twice a day, in the morning before taking the medication (bronchodilator), and in the afternoon after taking the medication. If, when analyzing the resulting graph, the difference between the two measurements is more than twenty percent, this indicates bronchospasm. This value also indicates the need for modification of treatment. With severe bronchospasm, the OVF indicator is below 200 ml.

A chest x-ray is used to look for symptoms of emphysema and pneumosclerosis. But x-rays for allergic asthma can for a long time show no change.

A challenge test with Methacholine or Histamine provides confirmation, as it causes bronchospasm in almost all patients with asthma. Before the test and two or three minutes after it, FEV1 is determined. A decrease of more than twenty percent indicates positive result samples.

However, inhalation can also lead to bronchospasm in about ten percent. healthy people. This is due to influenza vaccination, past disease respiratory tract, exposure to allergens.

Diagnosis of the allergic form of bronchial asthma determines the special sensitivity to certain allergens. A provocative test is performed with five breaths of an allergen diluted in a ratio of 1:1,000,000. The concentration is gradually increased and brought to 1:100. A positive test is detected when FEV1 decreases by 20 percent. If there is no reaction, the sample is considered negative. If a correctly identified allergen is completely eliminated from the patient's environment, then asthma can be cured.

The diagnosis can be confirmed by determining the presence of IgE antibodies in the blood. This allows you to know the progress of asthma symptoms, to identify the allergic status of the patient. A large number of them indicates increased reactivity. This is also indicated by an increased number of eosinophils, especially in sputum. In addition, asthma-related diseases such as sinusitis, bronchitis or rhinitis are diagnosed. This helps to see a reliable picture of the general health of the patient and prescribe adequate therapy.

Careful and immediate diagnosis increases the patient's chances of recovery. Bronchial asthma, thanks to the diagnosis, is recognized earlier. This reduces the time and increases the productivity of the treatment.

Do you still find it hard to be healthy?

chronic fatigue (you get tired quickly no matter what you do)… frequent headaches… dark circles, bags under the eyes… sneezing, rash, watery eyes, runny nose… wheezing in the lungs…. exacerbation of chronic diseases ...

Bondarenko Tatiana

Project expert OPnevmonii.ru

Not all children have the same asthma symptoms, they are varied and can change from attack to attack.

TO possible indications and symptoms of asthma in a child include:

• Frequent coughing that occurs during play, at night, while laughing or crying
• Chronic cough (may be the only symptom)
• Reduced activity during games
• Frequent shortness of breath
• Complaints of chest pain or tightness
• Whistling during inhalation or exhalation - wheezing
• Fluctuating chest movements due to difficulty breathing
• Choking, shortness of breath
• Muscle tension in the neck and chest
• Feeling weak, tired

If a child has symptoms of asthma, the pediatrician should also evaluate other conditions or diseases that may complicate the breathing process. Nearly half of infants and children preschool age with recurring episodes of wheezing, choking, or coughing (even if symptoms are relieved by asthma medications) are not considered asthma patients under 6 years of age. For this reason, many pediatricians use the term " reactive disease respiratory tract ” or bronchiolitis, describing the condition in children of this age (instead of writing them down as asthmatics).

How common is asthma in children?

Asthma is one of the most common chronic diseases in children, and the trend is not encouraging - the incidence is progressing. Asthma can start at any age (even the elderly), but for many, the first symptoms appear before the age of 5 years.

There are many prerequisites for the development of asthma in children. These include:

• Hay fever () or eczema (allergic skin)
• Family history of asthma or
• Frequent respiratory infections
• Low birth weight
• Exposure to tobacco smoke before or after birth
• Dark color Skin or Puerto Rican ethnicity
• Unfavorable environmental conditions

Why is the incidence of asthma in children on the rise?

Nobody really knows true reason such growth. Some experts believe this is due to the fact that today's children spend more time at home or in enclosed spaces and therefore more susceptible to harmful factors - household dust, contaminated air, passive smoking. Others believe that today's children do not suffer from "childhood illnesses" enough to focus immune system on bacteria and viruses.

How is asthma diagnosed in children?

Diagnosis is based on the history, symptoms, and physical examination findings. When going to the doctor with an infant or older child during an asthma attack, keep in mind that the symptoms may go away by the time you get to the doctor's office. And this is not a reason to stop and turn back. Remember: Parents play a key supporting role for the clinician in staging correct diagnosis.

Medical history and description of asthma symptoms: the pediatrician should be interested in any episodes of trouble breathing you or your child has, including a family history of asthma, skin disease- eczema, or other lung diseases. It is important to describe in detail all the symptoms seen in the child - coughing, wheezing, choking, chest pain or tightness - in detail, including when and how often these symptoms occur.

Tests: many for precise setting Diagnosis will require a chest x-ray, and children 6 years of age and older will have a lung function test called spirometry. measures the amount of air and the rate at which it is exhaled. The results will help the doctor determine the severity of the disease. Other tests may also be done to partially identify triggers for asthma in a child. These tests include: a skin allergy test, a blood test for or to check for sinusitis or gastroesophageal reflux aggravating asthma. You may also be offered a modern diagnostic method that measures the level of oxide during breathing.

How is asthma treated?

Avoiding contact with trigger factors”, the use of prescribed drugs and daily vigilance for symptoms of the disease is the way to effectively control asthma in children of any age. Children with asthma should never be exposed to tobacco smoke. Proper medication is the basis for good disease control.

Based on the child's medical history and observations of asthma, the pediatrician will create a plan of action to control the disease. Make sure you get a written copy of it. The plan should describe when and how the child should take their asthma medication, what to do if symptoms worsen and worsen, and when to call. ambulance". Make sure that the plan is written in a language that is understandable to you and that everything in it is clear to you. If after reading you have any questions, ask your doctor.

An asthma action plan is a very important part of successful asthma control in a child. Also make sure that the caregiver or school teacher always has a copy of such a plan (so that they have an idea how to behave and quickly stop the attack if the baby has it outside the home).

How to give asthma medication to a preschool child?

Preschool children use the same groups of drugs to treat asthma as older children. aerosols - effective drugs for the treatment of asthma. However, in any case, the drugs are given in a different form to children under 4 years of age (inhaler or mask), and the daily dose is less.

Recent asthma control guidelines recommend gradual approximation of treatments and doses for children over 4 years of age. including the use of drugs fast action(eg, salbutamol) for recurrent asthma symptoms. The use of low dose steroid aerosols is the next step. Further treatment should be focused on asthma control. If the child's asthma has been controlled for at least three months, he may reduce the dose of drugs or reduce the level of treatment. Talk to your doctor about taking specific medications and correct dosage.

Depending on the age of the child, inhalers or drugs in the form of solutions are used (sprayers are used - nebulizers ). The nebulizer delivers the drug by transferring it from liquid form in par. couple the child will inhale the drug through the mask. This procedure (inhalation through a mask) lasts 10-15 minutes and can be repeated up to four times a day. The doctor will tell you how often you need to let your child breathe using a nebulizer.

Depending on age, the child may use a metered dose inhaler with a spacer. - a compartment attached to the inhaler and preventing spraying of the entire drug. This allows the child to inhale the drug at an individually suitable speed. Talk to your doctor about using a metered dose inhaler with a spacer.

What are the goals and objectives of treating asthma in a child?

Asthma cannot be cured, but it can be controlled. Your goal and responsibility as parents is to do everything possible to:

• The child could live actively normal life
• Prevent chronicity and worsening of symptoms
• The child could go to school every day
• The child was active during games, sports activities without any effort
• Avoid frequent ER visits or trips to the hospital
• Use asthma corrective medications with the minimum amount or with no side effects

Work closely with doctors and try to learn as much as possible about this disease (how to avoid exposure to asthma triggers, how asthma drugs work and how to use these drugs correctly).

Will my child get rid of asthma with age?

To this day, much remains unexplored and the functioning of the lungs in children. Experts now believe that if an infant or preschool child has three or more episodes of wheezing (usually during a viral infection), they have a 50/50% chance of developing asthma in their lifetime. If a child has an unfavorable family history of asthma, is surrounded by smokers, or is exposed to other harmful factors that provoke asthma, the risk increases. Asthma therapy will not reduce these risks.

In addition, if once the sensitivity of a person's respiratory tract increases, they retain this feature for the rest of their lives. Be that as it may, about half of children with asthma have symptoms that decrease with age, which is why they are sometimes said to "outgrow" their asthma. In the other half, symptoms persist into adulthood. Unfortunately, it is impossible to predict whether an individual's symptoms will decrease or persist with age.

Bronchial asthma is a chronic inflammatory disease of the respiratory tract, which is based on bronchial hyperreactivity, is manifested by a specific clinical picture: recurrent attacks of suffocation with, with wheezing. Attacks pass by themselves or are stopped by drugs, between attacks the condition is satisfactory.

Asthma has been known since ancient times. The term "asthma" (translated as suffocation) was introduced by the ancient Greek poet Homer.

Bronchial asthma affects 8 to 10% of the population. This is a huge problem almost all over the world. Due to its wide prevalence, this pathology has a great social significance. Annual international congresses are devoted to the study of etiology, pathogenesis, methods of prevention and treatment of bronchial asthma.

It must be said that over the past 20 years significant progress has been made in treatment. The emergence of new drugs and new forms of use of anti-asthma drugs has made a real revolution in the management of such patients.

Asthma is still impossible to cure completely, but a timely diagnosis and the right medication allows such patients to manage active image life, sometimes forgetting forever about the attacks that tormented them earlier.

Why in Russia the diagnosis of bronchial asthma is made much less frequently than in other developed countries

In Russia, bronchial asthma is diagnosed in 2.5-5% of the population, which is 2 times less than in other developed countries. Moreover, we take into account patients mainly with severe and moderate forms.

Usually, before such a diagnosis is made, the patient long time(sometimes several years) is observed by doctors with. Sometimes a diagnosis of "chronic bronchitis" is made, and only after some time a diagnosis of bronchial asthma is made. From here, a wrong philistine idea is formed: bronchial asthma is a consequence of chronic bronchitis. The most illiterate patients even blame doctors: bronchitis was poorly cured, it turned into chronic, and then into asthma.

In fact, bronchitis and asthma are absolutely various diseases both in etiology and pathogenesis. Doctors are really to blame here, but only in the fact that, suspecting the diagnosis of bronchial asthma, they do not insist on examination, do not conduct educational work with the patient.

But these are features of our Russian mentality: patients still perceive the diagnosis of "bronchitis" more easily than "asthma" and sometimes they themselves postpone the scheduled examinations for a long time to confirm this disease, and also ignore the prescribed treatment. Until now, there is a certain stereotype of thinking that an inhaler is a sentence, and a patient with asthma cannot be a full-fledged person.

Nevertheless, in recent years there has been a tendency to break this stereotype. Increasingly, the diagnosis is early stages the development of the disease.

The pathogenesis of bronchial asthma

The basis of the pathogenesis of an attack of bronchial asthma is a chain biochemical reaction, it involves several types of cells that release powerful biologically active substances. Basic pathological process in the event of an asthma attack, this is bronchial hyperreactivity.

Schematically, the occurrence of the main symptom of bronchial asthma can be represented as follows:

• There are some triggering factors that indirectly act on special cells of our body (basophils, mast cells, eosinophilic leukocytes) through immunoglobulin proteins. These cells carry receptors for immunoglobulin E. Individuals with a genetic predisposition have an increased production of immunoglobulin E. Under its influence, the number of basophils and mast cells increases many times over. When an allergic agent is re-introduced, it interacts with antibodies on the surface of target cells.

Allergic reaction

• In response to the ingress of an allergen, degranulation (dissolution of the membrane) of mast cells and the release of active substances (histamine, leukotrienes, prostaglandins, etc.) occur, immune inflammation occurs, which manifests itself (i.e., a reduction in smooth muscle cells of the bronchial walls), mucosal edema, as well as increased mucus formation. This phenomenon is called bronchial hyperreactivity.
• As a result of these changes, a narrowing of the lumen of the bronchi occurs, the patient feels suffocation and congestion in the chest. Since the air passing through the narrowed bronchi meets resistance, whistling rales can be heard during auscultation during an attack.

It must be said that the pathogenesis of atopic or (allergic) bronchial asthma is so well studied. The pathogenesis of non-allergic asthma, not caused by increased production immunoglobulin E is still unclear.

What can cause an asthma attack

Only a combination of genetic predisposition and the action of an external agent can cause a disease. Factors that can become a trigger in the development of an attack:

How to suspect bronchial asthma

The diagnosis of asthma is usually made on the basis of a typical clinical picture and accompanying indirect evidence. There are no reliable objective criteria that allow making a diagnosis with 100% certainty.

What are the signs of bronchial asthma?

A typical clinical picture and confirmed reversibility of the obstruction are the main criteria on which the physician relies when making a diagnosis. In addition, to clarify the form of the disease, a blood test for immunoglobulin E, allergological tests, sputum examination and other examinations may be prescribed. If another cause of bronchial obstruction is suspected, various examinations are prescribed to confirm or refute it. This may be chest CT, bronchoscopy, sputum culture, FGDS, ultrasound thyroid gland and other surveys.

Classification of bronchial asthma

There are many classifications of bronchial asthma: according to etiology, severity of the course, level of drug control.

So, according to the etiology, allergic or (atopic) asthma, non-allergic, mixed and unspecified asthma are distinguished.

Until now, some doctors have singled out special forms asthma, which is not international classification, but they are convenient for use, since their etiology is immediately visible in the name:

Classification by severity takes into account such criteria as the frequency of attacks during the day, the frequency of nocturnal symptoms, the number and duration of exacerbations, the degree of physical activity restriction, PEF and FEV1 indicators. Allocate:

1. Intermittent or episodic form.
2. Persistent form, in which light, moderate and severe forms are distinguished.

In the intermittent form, symptoms appear less than 1 time per week, nighttime symptoms less than 2 times a month, PEF and FEV1 are almost normal, and physical activity is not limited.

The persistent form is characterized by more frequent symptoms that impair quality of life. This form requires constant anti-inflammatory treatment.

Classification of asthma according to severity

However, this classification is relevant only before the start of treatment. If the patient receives adequately selected basic therapy, he may not experience symptoms of suffocation, while spirometry indicators may also not be impaired.

Therefore, for clinical practice Classification of asthma by levels of control is increasingly used:

• Controlled (daytime symptoms less than 2 times a week, no night attacks, no exacerbations, normal lung function).
• partially controlled
• uncontrolled asthma

Exacerbation of bronchial asthma is understood as an increase and increase in symptoms. Depending on the severity of the exacerbation (mild, medium degree and severe) on examination, wheezing wheezes are heard, the respiratory rate increases, the pulse quickens, cyanosis (cyanosis) appears. In severe exacerbation, the patient sits, leaning forward, resting his hands on the back of the chair, breathing is heavy, with a prolonged exhalation, speech is intermittent, wheezing is heard by others.

Most formidable complication bronchial asthma - status asthmaticus. It is characterized by an attack of expiratory suffocation that lasts for several hours, which is poorly or not stopped at all by bronchodilators, increasing oxygen starvation, progressively worsening the condition. This complication requires immediate resuscitation.

Treatment of bronchial asthma

Bronchial asthma is an incurable disease. aim medical measures prescribed to patients is only to achieve control over their disease, namely:

1. Prevention of exacerbations.
2. The minimum frequency (and ideally - the absence) of seizures.
3. Maintain physical activity that does not restrict ordinary life patient.
4. Maintaining lung function at a level close to normal.
5. Minimize the side effects of medications.
6. No evidence for emergency care and hospitalizations.
7. Minimal need for drugs to relieve symptoms (beta-adrenergic agonists).

With adequately selected therapy, the patient may not be limited either in everyday life or in professional activities (with the exception of working with allergens).

Drugs prescribed for bronchial asthma are divided into two large groups:

• Means of basic therapy, which are prescribed for continuous use precisely for the purpose of controlling and preventing symptoms.
• Symptomatic drugs (emergency medicines). They are used from time to time to relieve and relieve asthma symptoms.

Basic (basic) remedies for bronchial asthma

Basic anti-inflammatory drugs are prescribed for persistent asthma. These are drugs that are carefully selected at the beginning of treatment, taken constantly and for a long time, under the supervision of a physician. During treatment, the doctor can change the dosage of drugs, replace one drug with another, and also combine drugs from different groups. Forms of basic therapy preparations are different:

1. Aerosol inhalers ("cans").
2. Breath-activated inhalers.
3. Powder inhalers (turbuhalers) with a precisely measured dose in each powder.
4. Liquid forms for inhalation in a nebulizer.
5. Means for oral administration - tablets, capsules.

What groups of drugs belong to basic drugs?

Seizure medications (bronchodilators)

1. Β2-stimulants of short action. Salbutamol, Fenoterol (Berotek). Available in the form of aerosol cans and solutions for inhalation through a nebulizer. The combined bronchodilator drug Berodual (contains fenoterol and ipratropium bromide) can be used both for emergency care and for the prevention of attacks.
2. Anticholinergics. Atrovent, Astmopent.
3. Theophylline preparations. Act directly on smooth muscle cells bronchial tree(relax them). Eufillin is used mainly as an ambulance to relieve an attack (administered intravenously). Teopec, teotard are drugs long-acting can also be used for prevention.

Other additional funds prescribed for asthma:

• Antihistamines (antiallergic drugs)

Features of bronchial asthma in children

Half of the patients with bronchial asthma are children under 10 years old, and in boys this diagnosis is made twice as often as in girls.

The most likely criteria for diagnosis in children are:

In children under 5 years of age, it is difficult to diagnose using spirometry. They often use a method such as bronchophonography.

The debut of bronchial asthma in the early childhood gives hope for favorable outcome to puberty. In 80% of children by this age, the symptoms disappear completely. But 20% of them may relapse after 40 years. Children with aspirin asthma are less likely to go into remission.

Video: bronchial asthma, Doctor Komarovsky

Education for Asthma Patients

In the management of patients with diagnoses such as diabetes and bronchial asthma education is a very important part of the treatment, the success and result of therapy directly depends on the awareness and skills of the patient himself.

The aim of the training is:

For patient education in large polyclinics, special classes at the School of Asthma.

Drugs for the treatment of bronchial asthma are quite expensive. But there is Government program preferential drug coverage for such patients. So in order to receive free medicines, it is not necessary to draw up a disability group. It is enough to confirm the diagnosis with specialists from a bronchopulmonologist and an allergist and register for a dispensary at a polyclinic at the place of residence.

Disability in bronchial asthma can be issued in the case of a severe uncontrolled course with frequent exacerbations, the presence of complications (pulmonary emphysema), the presence of respiratory failure of 2 or 3 degrees. Patients with mild and moderate forms of the course are able-bodied with some restrictions - it is forbidden to work in harmful conditions and contact with allergens (the list of harmful factors and works contraindicated for patients with bronchial asthma is determined by the Order of the Ministry of Health No. 302n)

Alternative methods for asthma

There are many traditional medicine recipes that are recommended, including for bronchial asthma. It is difficult not to get lost in such a variety. Folk remedies may indeed be effective as an adjunct to drug therapy. Particularly attracted the attention of funds with anti-inflammatory and expectorant effect.

But don't lose your head. It must be remembered that asthma in its majority has allergic component and it is impossible to predict whether there will be an allergy to a particular drug or medicinal plant. That's why if you want to try folk recipes follow these simple rules: avoid, if possible, collections from several herbs, try decoctions of one plant first, then add another, etc. Be careful with honey! It can be quite a strong allergen, like essential oils.

Some the most simple and safe recipes:

• Infusion of coltsfoot leaves. 4 tbsp. l. Leaves pour 1 liter of boiling water. Insist 30 min. Drink ½ cup 3 times a day.
• 30 g of licorice root brew 0.5 liters of boiling water, sweat over low heat for 10 minutes. Cool down. Strain. Drink 1 tablespoon 4 times a day.
• 400 g of ginger, peel, grate, pour into a bottle, pour alcohol. Insist 2 weeks in heat. Strain the tincture. Take 1 tsp. 2 times a day after meals along with a small amount of water.

Spa treatment

Before the discovery of anti-asthma drugs, the only way to treat asthma patients was to move to an area with favorable climate. beneficial effect climatic conditions in the diagnosis of bronchial asthma - this is a proven fact. Very often, patients who have moved to another climate zone, note significant improvement and the onset of a long remission.

Not everyone can afford to move to another area, but treatment in sanatoriums also has a positive effect on the condition of patients.

Treatment in sanatoriums or resorts is indicated for patients with bronchial asthma during remission. Preference is given to low-mountain resorts with a mild dry climate, in the zone of coniferous forests, and fresh sea air is also shown.

Since the term of the sanatorium tour is short, a sharp change in climate is not very recommended for patients with bronchial asthma, since the adaptation period can last for several weeks.

Very good effect provides speleotherapy - the air of salt caves. In some sanatoriums, such conditions are created artificially - in salt rooms. This method is called halotherapy.

Video: bronchial asthma in the program "Live healthy!"

>> bronchial asthma

Bronchial asthma(from Greek asthma - hard breath, suffocation) is chronic illness human respiratory system. The incidence of bronchial asthma is approximately 5% of the total population of the planet. In the United States, about 470,000 hospitalizations and more than 5,000 asthma-related deaths are recorded annually. The incidence among women and men is approximately the same.

The mechanism of the onset of the disease is to establish bronchial hypersensitivity against the background of chronic inflammatory process localized at the level of the respiratory tract. The development of bronchial asthma can be caused by various factors: persistent infection of the respiratory tract, inhalation of allergens, genetic predisposition. Prolonged inflammation of the airways (eg. chronic bronchitis) leads to structural and functional changes in the bronchi - thickening of the muscular membrane, increased activity of the glands that secrete mucus, etc. Of the allergens most often causing bronchial asthma, one can name house dust accumulating in carpets and pillows, particles of the chitinous membrane of micromites and cockroaches, pet hair (cats), plant pollen. Genetic predisposition causes an increased sensitivity of the bronchi to the factors described above. Asthma attacks can be triggered by inhalation of cold or hot air, physical effort, stressful situations by inhaling allergens.

From the point of view of pathogenesis, we distinguish two main types of bronchial asthma: infectious-allergic asthma and atopic asthma. Also, some rare forms of asthma are described: exercise-induced asthma, "aspirin" asthma caused by chronic aspirin use.

In allergic asthma, we distinguish two types of response to the inhalation of an allergen: an immediate response (the clinical picture of bronchial asthma develops a few minutes after the allergen enters the bronchi) and a late response, in which asthma symptoms develop 4-6 hours after the inhalation of the allergen.

Methods for diagnosing bronchial asthma

Diagnosis of bronchial asthma it is a complex and multi-step process. initial stage diagnosis is the collection of anamnestic data (questioning of the patient) and clinical examination patients, allowing in most cases to make a preliminary diagnosis of bronchial asthma. Taking an anamnesis involves clarifying the patient's complaints and identifying the evolution of the disease over time. Symptoms of bronchial asthma are very diverse and vary depending on the stage of the disease and individual characteristics every patient.

On initial stages development (pre-asthma), bronchial asthma is manifested by bouts of cough, which can be dry or with a small amount of sputum. Cough occurs mainly at night or in the morning, which is associated with physiological increase bronchial muscle tone in the morning (3-4 am). Cough may appear after a respiratory tract infection. Coughing attacks in the initial stages of the disease are not accompanied by difficulty in breathing. Auscultation (listening to the patient) may reveal scattered dry rales. Latent (hidden) bronchospasm is detected using special methods studies: with the introduction of beta-agonists (drugs that cause relaxation of the muscles of the bronchi), an increase in the fraction of exhaled air (sirometry) is observed.

For more late stages Asthma attacks become the main symptom of bronchial asthma.

The development of an asthma attack is preceded by the impact of one of the provoking factors (see above), or the attacks develop spontaneously. At the beginning, patients may note some individual symptoms the upcoming attack: runny nose, sore throat, itching of the skin, etc. Then comes progressive difficulty breathing. At first, the patient notes only difficulty in exhaling. There is a dry cough and a feeling of tightness in the chest. Respiratory disorders force the patient to sit down with his hands leaning in order to facilitate breathing by the work of the auxiliary muscles of the shoulder girdle. The increase in suffocation is accompanied by the appearance of wheezing, which at first can be detected only by auscultation of the patient, but then become audible at a distance from the patient. For an attack of suffocation in bronchial asthma, the so-called "musical wheezing" is characteristic - consisting of sounds of different heights. Further development an attack is characterized by difficulty in breathing due to the installation respiratory muscles pregnant deep breath(bronchospasm prevents air from being expelled from the lungs during expiration and leads to the accumulation of large amounts of air in the lungs).

Examination of the patient for diagnosis at the stage of preasthma does not reveal any characteristic features. In patients with allergic asthma, nasal polyps, eczema, and atopic dermatitis can be detected.

Most characteristics are detected when examining a patient with an asthma attack. As a rule, the patient tends to take a sitting position and rests his hands on a chair. Breathing is elongated, intense, participation of auxiliary muscles in the act of breathing is noticeable. jugular veins on the neck swell on exhalation and subside on inhalation.

When percussion (tapping) of the chest, a high (box) sound is detected, indicating the accumulation of a large amount of air in the lungs - plays important role in diagnostics. Lower bounds lungs are lowered and inactive. When listening to the lungs, a large number of wheezing is detected different intensity and heights.

The duration of the attack can be different - from several minutes to several hours. The resolution of the attack is accompanied by a tense cough with the release of a small amount of clear sputum.

Especially serious condition is asthmatic status - in which progressive suffocation endangers the life of the patient. At status asthmaticus, all clinical symptoms are more pronounced than with a normal asthma attack. In addition to them, symptoms of progressive suffocation develop: cyanosis (cyanosis) skin, tachycardia (increased heart rate), heart rhythm disturbances (extrasystoles), apathy and drowsiness (inhibition of the function of the central nervous system). With status asthmaticus, the patient may die from respiratory arrest or heart rhythm disturbances.

Additional methods for diagnosing bronchial asthma

Carrying out a preliminary diagnosis of bronchial asthma is possible on the basis of clinical data collected using the methods described above. Determination of a specific form of bronchial asthma, as well as the establishment of pathogenetic aspects of the disease requires the use of additional research methods.

Examination and diagnostics of the function of external respiration (PVD, spirometry) in bronchial asthma, they help determine the degree of bronchial obstruction and their response to provoking histamine, acetylcholine (substances that cause bronchospasm), and physical activity.

In particular, the forced expiratory volume in one second (FEV1) and vital capacity (VC) are determined. The ratio of these values ​​(Tiffno index) makes it possible to judge the degree of bronchial patency.

There are special devices that allow patients to determine the volume of forced exhalation at home. The control of this indicator is important for adequate treatment of bronchial asthma, as well as for preventing the development of attacks (the development of an attack is preceded by a progressive decrease in FEV). The determination of FEV is carried out in the morning before taking a bronchodilator and in the afternoon after taking the medication. A difference of more than 20% between the two values ​​indicates the presence of bronchospasm and the need to modify treatment. Decreased FEV below 200 ml. reveals severe bronchospasm.

Chest radiography – additional method diagnosis allows you to identify signs of emphysema (increased transparency of the lungs) or pneumosclerosis (growth in the lungs connective tissue). The presence of pneumosclerosis is more typical for infectious-dependent asthma. In allergic asthma, radiological changes in the lungs (outside of asthma attacks) may be absent for a long time.

Diagnosis of allergic asthma- is to define hypersensitivity organism in relation to some allergens. Identification of the relevant allergen and its exclusion from the environment of the patient, in some cases, allows you to completely cure allergic asthma. To determine the allergic status, an antibody test is carried out type IgE in blood. Antibodies of this type determine the development immediate symptoms with allergic asthma. An increase in the level of these antibodies in the blood indicates an increased reactivity of the body. Also, asthma is characterized by an increase in the number of eosinophils in the blood and in sputum in particular.

Diagnostics concomitant diseases respiratory system (rhinitis, sinusitis, bronchitis) helps to general idea about the patient's condition and prescribe appropriate treatment.

Bibliography:

• Eds. L. Allegra et al. Methods in asthmology, Berlin etc. : Springer, 1993
• Fedoseev G.B Bronchial asthma, St. Petersburg. : Medical information agency, 1996
• Petrov V.I. Bronchial asthma in children: Modern approaches for diagnosis and treatment, Volgograd, 1998