Bronchial asthma

  • Bronchial asthma in children
  • Bronchial asthma is a disease, clinical manifestation of which is asthma.
    The etiology and pathogenesis. Most authors think that anaphylactic or allergic, theory of the origin of bronchial asthma finds the greatest confirmation of the clinic, although not permit any of the contentious issues of pathogenesis. The occurrence of asthma is associated with a variety of allergens. They can enter the body from external environment (actuallity, or geterofullereny) and formed in the body (antiallergenic, or autoallergy). Actuallity divided into non-infectious, infectious and parasitic. Non-infectious allergens can be of vegetable origin (pollen), "industrial" (chemical substances in the air of industrial cities), household (room dust), food, medicinal, and so on, Allergens infectious and parasitic origin: microorganisms, bacteria, viruses, helminths and protozoa. Antiallergenic occur when there is infection in the bronchi and lungs, pulmonary infections, as well as some non-communicable diseases. Antiallergenic in these cases are not bacteria and viruses, and products denaturation of tissue (change properties of proteins). For the development of the disease to a state of heightened sensitivity of the organism (sensitization). It can be caused by one or more allergens (antiallergenic and actualarray). Allowing an allergen enters the body, usually by airborne. Pathogenetic mechanisms of bronchial asthma development are carried out by type of allergic reactions (see Allergy). Has the value of an inherited predisposition. The presence of previous diseases, promoting occurrence of asthma (inflammatory diseases of the lungs and bronchi, changing the state of the nervous system, and so on), is an important, but not required. In the development attack the main role is played spasm smooth muscles of small bronchi, swelling of the mucous membrane and enhanced secretion of mucous glands of the bronchi. Because of this, comes a sharp narrowing of the bronchi clearance, which causes choking.
    The clinical picture. Asthma attacks can occur in early childhood. A significant number of patients develop during puberty or menopause. Often the first attack occurs after any diseases (pneumonia, measles, whooping cough, diseases of female genital sphere and so on), often after strong excitement and neuropsychiatric surge. Bronchial asthma attack can occur suddenly, but more often there are harbingers: discomfort in the chest, coughing, etc. Often attack occurs at night. The patient usually sits, leaning on his hands, with severe shortness of breath. Breathing rare (up to 10 in 1 million or less), noisy, you can hear in the distance. Thorax in the situation of deep breaths as sharply difficult to exhale. In the breath participate accessory respiratory muscles (sternoclavicular-liner, the muscles of the ribs), cough, dry or with a small number of viscous, it is difficult separated sputum. The patient is normally covered with perspiration, pulse Ochsen, the body temperature is normal. The duration of the attack from 20-30 minutes to several hours or even days.
    Sometimes choking lasts for a few weeks with small intervals. In light percutere - sound box, auscultatory - decreased breath, a large number of dry rales. With the end of bronchial asthma attack disappears and sharp expansion of the lungs. If often repeated bouts with time developing emphysema (see) and greatly disturbed function of external respiration.
    With the termination of asthma and bronchial asthma the patient begins to breathe deeply, otraslevaya large number of sputum. In the sputum can be detected: eosinophil leucocyte, crystals Charcot - Leyden (gloss colorless crystals formed in the decay of eosinophilic white blood cells) and spiral Kortmann (tortuous mucous thread formed in the smallest bronchi when narrowing). In the peripheral blood celebrate eosinophilia, reflecting allergic origin of bronchial asthma.
    Forecast in bronchial asthma relatively favourable. Deaths are rare. The prognosis is better when the intervals between began choking. On the forecast of impact complications and comorbidities.

    Treatment. During the attack apply adrenaline (0.5 ml of 0.1% solution under the skin), atropine (0.3 - 0.5 ml of 0.1% solution under the skin), izadrin as tablets under the tongue or inhalation (0.5% solution). Choking is terminated through 4-5 minutes after applying izadrina. People with severe atherosclerosis or high blood pressure, adrenaline should not be entered. Ephedrine (5% solution of 1 to 2 ml under the skin) is much slower. Bronchial spasm also eliminate intravenous aminophylline (5-10 ml of 2.4% solution in 10 ml of 40% solution of glucose). It is prescribed to patients suffering from simultaneously with bronchial asthma cardiosclerosis, hypertension and other diseases in which the use of adrenaline impractical. Teofedrin and antastman use 1 pill. In severe protracted asthma attacks appoint corticosteroids. To stop the attack used hot foot baths, stories on his back, inhaling the smoke of a different herbs (astmatol, almatin). If the attack cut is not possible, the patient should be hospitalized.
    In the period between attacks carried out the complex therapy.
    In some cases it is possible etiological treatment. It provides for the removal of the allergen: a cease contact with certain substances in occupational allergies, the exclusion of certain foods with food allergies, removal of medicines in drug Allergy, dewormed at helminthiasis, sanitation foci of infection microbial allergies, etc. For the vast majority of patients is the main pathogenetic and symptomatic treatment. Pathogenetic therapy provides for desensitizing, anti-inflammatory and sedative therapy. There are specific and non-specific desensitization (hyposensitization). Specific desensitization is applied in cases, when a known allergen, and consists in the introduction of the allergen in small quantities in increasing doses. Use a variety of microbial and other allergens. Ways of their introduction into the organism of the patient is different: orally, subcutaneously, intradermally. To the methods of non-specific desensitization are lactotherapy, autohemotherapy, tissue therapy, radiation by quartz and other recently used steroid hormones, gistaglobin and other steroid hormone resorted to only when unsuccessful treatment by conventional means (ephedrine, aminophylline and others). Sedation: assign bromides, barbiturates, tranquilizers (trioxazin, meprobamate and other). Infection control exercise antibacterial drugs to conventional circuits.
    To symptomatic means that eliminate the painful symptoms are apparent (kellin 0.02 g, papaverine 0.02 g, tifen 0.03 g 3 times a day); reducing the permeability of the capillary walls (ascorbic acid 0.2 g 3 times a day and others); expectorants (infusion termopsisa); enzymes, razzyzath sputum (trypsin, chymotrypsin); cardiovascular; oxygen, etc. These funds are used depending on the condition of the patient.
    The important place occupied by physical methods (medical physical culture, therapy air ions negative sign, ultrasound and other). Resort treatment the climatic health resort is mainly mountainous and seaside (in summer), subject to patients with bronchial asthma in the phase of remission , or with infrequent and light attacks without obvious signs of respiratory failure (resorts: Kislovodsk, Nalchik, Gelendzhik, the Crimea South coast and others).
    Surgical methods of treatment of bronchial asthma is rarely used.
    Prevention. Patients with asthma should take on dispensary account in allergic rooms. When professional selection is to take into account the sensitivity of the patient.

    Bronchial asthma (asthma bronchiale) - allergic disease characterized by recurrent attacks of suffocation caused by a narrowing of the small bronchi. Narrowing can be caused by the swelling of the mucous membrane of the bronchi; the accumulation of viscous mucus (so-called discrimi); spasm of the bronchial muscles. In different situations and stages of the disease the value of each of these factors varies. Secretion may be scarce - "dry asthma (Gina sicca) or rich - wet asthma (Gina humida).