Bronchial asthma remains a pressing problem in pulmonology, as its incidence is steadily increasing. It belongs to the group of multifactorial pathologies, that is, there are many reasons that directly influence its occurrence.
Based on the causes, there are different types of asthma. Doctors have developed several different classifications that can accurately characterize a patient's condition. In the future, this helps in choosing treatment tactics.
Etiology of the disease
Forms of bronchial asthma are divided into groups based on their occurrence. There are three forms in total:
- Exogenous - symptoms and attacks are caused by a reaction to an allergen or the effect of other external factors on the respiratory system
- Endogenous - bronchial asthma is a consequence of physical stress, emotional stress, or an infectious disease
- Mixed – both external and internal factors led to development
Faculty therapy. Lecture notes Alexander Vyacheslavovich Pisklov, 2005
LECTURE 1. Respiratory diseases. Clinical syndromes in respiratory diseases. Part 1
1. Fluid in the pleural cavity syndrome
2. Pleural murmur syndrome
3. Pleural air syndrome
4. Inflammatory lung tissue consolidation syndrome
Diagnosis of respiratory diseases is based on clinical, instrumental, and laboratory criteria. The set of deviations obtained when using various research methods for any pathological condition is usually called a syndrome.
1. Syndrome of fluid in the pleural cavity.
A typical complaint is shortness of breath. It reflects the degree of respiratory failure due to pleural compression of the lung, which leads to a decrease in the respiratory surface in the lungs as a whole. When examining, pay attention to the protrusion and lag in the act of breathing of the corresponding half of the chest. Voice tremors and bronchotonia are weakened or absent. Percussion reveals a shortening or dullness of sound or a dull sound. On auscultation, breathing is weakened or absent.
2. Pleural murmur syndrome.
Inflammation of the pleural layers can leave behind a pronounced intrapleural adhesive substrate in the form of adhesive cords, adhesions, and fibrinous pleural overlays. Such patients may have no complaints, but with severe adhesions, shortness of breath and chest pain appear during physical activity. When examining the chest, retraction and lag in the act of breathing of the affected half are noted: here you can also detect retraction of the intercostal spaces during inspiration. Voice tremors and bronchophony are weakened or absent. Percussion sound is dull. On auscultation, breathing is weakened or absent. A pleural friction rub is often heard.
3. Syndrome of air in the pleural cavity.
Air may enter the pleural cavity when a subpleural cavity or abscess breaks into it. The communication of the bronchus with the pleural cavity leads to the accumulation of air in the latter, which compresses the lung. In this situation, increased pressure in the pleural cavity can lead to the closing of the hole in the pleura with pieces of damaged tissue, stopping the flow of air into the pleural cavity and the formation of a closed pneumothorax. If the connection between the bronchus and the pleural cavity is not eliminated, the pneumothorax is called an open pneumothorax.
In both cases, the main complaints are rapidly developing suffocation and chest pain. Upon examination, protrusion of the affected half of the chest and weakening of its participation in the act of breathing are determined. Voice tremors and bronchophony with closed pneumothorax are weakened or absent, with open pneumothorax they are enhanced. On percussion, tympanitis is determined in both cases. On auscultation, with a closed pneumothorax, breathing is sharply weakened or absent; with an open pneumothorax, breathing is bronchial. In the latter case, metallic breathing may be heard as a type of bronchial breathing.
4. Inflammatory compaction syndrome of lung tissue.
Compaction of lung tissue can occur not only as a result of the inflammatory process (pneumonia), when the alveoli are filled with exudate and fibrin. Compaction can occur as a result of a pulmonary infarction, when the alveoli are filled with blood, or during pulmonary edema, when edematous fluid—transudate—accumulates in the alveoli. However, compaction of the lung tissue of an inflammatory nature is most common. When an entire lobe of the lung is affected, lobar or lobar pneumonia develops; one or more segments - polysegmental pneumonia; less than one segment - focal pneumonia.
Patients complain of cough, shortness of breath, and if the pleura is involved in the inflammatory process, chest pain. On examination, the affected half of the chest lags behind in the act of breathing, which is typical for lobar pneumonia. Voice tremors and bronchophony in the compaction area are increased. The percussion sound in focal pneumonia is dull (not dull), since the area of compacted lung tissue is surrounded by normal lung tissue. With lobar pneumonia, in the initial stage the sound is dull-tympanic, in the peak stage it is dull, which in the resolution stage is gradually replaced by a clear pulmonary sound.
With focal pneumonia, auscultation reveals mixed (bronchovesicular) breathing. Dry and wet rales are heard, while wet rales are characterized as sonorous, since the inflammatory compaction of the lung tissue around the bronchi promotes better conduction of the wet rales that originate in them to the surface of the chest. If the source of inflammation is deeply located, it is not possible to detect any abnormalities during physical examination. At the same time, a large focus of inflammation, located in close proximity to the visceral pleura, gives the same abnormalities during physical examination as lobar pneumonia.
In case of lobar pneumonia, auscultation on the affected side in the initial stage reveals a weakening of vesicular breathing, crepitus and pleural friction noise; at the height of the stage, bronchial breathing is heard, and there may be a pleural friction noise. In the resolution stage, bronchial breathing gradually gives way to vesicular breathing, crepitus appears, moist sonorous rales due to the penetration of liquefied exudate from the alveoli, and pleural friction noise is possible.
Severity
The stage of bronchial asthma is determined by symptoms. When assessing the condition, the following factors are taken into account:
- Frequency of attacks day and night
- Patient's exercise tolerance
- Intensity and degree of disruption of the respiratory system
There are four degrees of bronchial asthma:
- The first degree is called intermittent. Choking attacks occur no more than once a week, exacerbations are short, attacks do not occur at night, or occur once a month;
- The second degree is intermittent mild - the attack occurs once a week or twice for a month at night. Exacerbations disturb the patient's sleep and reduce physical activity;
- The third is persistent and of moderate severity - attacks appear daily during the day, and at night they occur more than once a week. The patient experiences poor health, disturbed sleep and little physical activity;
- The fourth degree is severe persistent - suffocating attacks occur very often, both during the day and at night, the patient complains of poor health and an almost complete lack of physical activity.
Treatment of bronchial asthma
Asthma can and should be treated. The basis is drug therapy. Depending on the severity of symptoms and type of asthma, specialists select the best medications and adequate dosage. Medicines can act as basic therapy, which is prescribed for every day.
There are also drugs that are used by the patient exclusively during an attack to stop it. The most popular is step therapy. Its essence is to select the lowest dosage and the minimum amount of medications necessary for complete control of asthma.
Stages of exacerbation
Exacerbations of bronchial asthma are accompanied by characteristic symptoms. The onset of an asthmatic attack is indicated by dry nasal mucosa, shortness of breath, difficulty breathing after sputum production.
Classification according to the nature of the development of the attack identifies:
- Mild form of exacerbation - the attack is accompanied by mild agitation, the patient's breathing is somewhat rapid, wheezing is heard when exhaling, the patient cannot speak or move normally. With this form, the saturation of the body and tissues with oxygen is 95% or more
- Moderate - during an exacerbation, the patient is forced to take a sitting position, cannot speak normally, experiences agitation, breathing becomes rapid, tachycardia appears, wheezing on inhalation and exhalation, the degree of decrease in the saturation of organs and tissues of the body is 91%
- In severe exacerbation of bronchial asthma, the patient’s motor activity is minimal, there is strong agitation, and several individual words can be heard in speech. An asthmatic makes more than thirty respiratory movements per minute, inhalation and exhalation are difficult, incessant wheezing is clearly audible, blood oxygen saturation is 10% or lower
- The stage of threat of apnea development - the patient is confused, there is almost no wheezing, bradycardia is manifested. There is a threat to the life of an asthmatic, since respiratory function is completely limited
Separation by control
Types of bronchial asthma based on symptom control:
- Controlled - at this stage the disease manifests itself rarely - 1-2 times a week, there are no exacerbations; the patient feels well and has unlimited physical activity
- Partially controlled - this phase is defined by limited activity, exacerbation once a year, frequent attacks and altered respiratory parameters
- Uncontrolled - the listed symptoms occur three times a week or more often
Classification according to other criteria
There is also a classification that is based on the frequency of occurrence of symptoms of bronchial obstruction. On this basis, two phases of bronchial asthma are distinguished:
- exacerbation phase – when the manifestations of the disease are most striking. There is a cough, shortness of breath increases, the quality of life in this phase can significantly decrease;
- remission phase - when the symptoms of the disease hardly bother the patient or are completely absent. Performance is restored to a level corresponding to the established stage of bronchial asthma. If there are no exacerbations for two years or more, remission is considered stable.
Depending on the complications involved, two types of bronchial asthma are distinguished: with complications and uncomplicated.
Allergic
This form of asthma is observed in both adults and children. Signs appear as the body’s reaction to an irritating factor:
- Pollen or bloom
- Microscopic species of fungi
- Household dust and dust mites
- Cosmetics and household chemicals
- Pet fur and feathers
The frequency and severity of symptoms in allergic asthma depends on the duration of contact between the patient and the allergen. Age, heredity, individual characteristics of the body and other characteristics are also taken into account.
Classification of asthma in children
The classification of bronchial asthma in children is based on the same criteria as in adults. First of all, it takes into account the severity of asthma: it is divided into mild, moderate and severe. Diagnosis criteria depend on age. For children under 5 years of age, an external examination and anamnesis are taken.
Functional tests at this age have little information content. Parents of children who have already had an attack with wheezing need to closely monitor the child’s condition and call a medical team at the first such symptoms.
Infectious
It develops after an infectious disease, more often it occurs in mature patients. Symptoms become acute two to three weeks after the first manifestations. The bacterially dependent form develops as a complication after bronchitis, pneumonia, chronic runny nose and other diseases. Symptoms quickly develop the disease to the phase of status asthmaticus.
Infectious asthma is caused by an infection that affects a person's airways. The patient becomes susceptible to the negative effects of allergens. Among the provocateurs of the disease are the bacteria themselves and products and vital activities. They provoke the development of bronchial asthma.
Cold
Develops in response to low temperatures and cold winds. Among the features of cold asthma is the absence of symptoms if there are no external irritants around. The body's reaction is provoked by cold air. It causes local irritation, damages the cell membrane, releasing histamine, which triggers the onset of an allergic reaction.
Physical effort
This form of asthma occurs in response to intense physical activity. Symptoms occur approximately half an hour after the start of activity and five to ten minutes after the end. The patient experiences shortness of breath, wheezing and other signs of the disease; an inhaler is used to relieve attacks.
Bronchial asthma of this type occurs as a result of improper breathing. During quiet breathing, air masses pass into the lungs through the nose, where it warms up and becomes more humid. When undergoing intense physical activity, a person breathes through the mouth. Getting cold, dry air into the lungs provokes an attack of suffocation. The narrowing of the bronchi provokes a contraction of the smooth muscles of the respiratory tract.
What is bronchial asthma
This disease, which has not been fully studied, is of an inflammatory nature and is considered chronic, predominantly affecting the bronchial tree. The main symptom complex is a spasm of the muscular wall of the bronchi, which occurs due to their sensitization.
The narrowing of the bronchi is combined with shortness of breath, a feeling of lack of air and wheezing, similar to whistling. Drugs for the treatment of asthma are divided into those that are used for daily use and are considered basic, as well as those that are taken at the moment of suffocation. The type of asthma is determined based on many factors: causes, severity of symptoms, level of control, etc.
Aspirin
This is a pseudo-allergic inflammatory reaction of the body that arose as a result of increased sensitivity to non-steroidal medications with an anti-inflammatory effect. They contain acetylsalicylic acid in the composition. Symptoms of aspirin-induced asthma include runny nose, cough, and pulmonary obstruction. The attacks are severe, cannot be stopped with the help of bronchodilators, and glucocorticosteroids are required to stop.
