Bronchial asthma - is an infectious-allergic bronchial tubes disease with the formation of periodic attacks of breathlessness. Seizures occur as a result of sharp bronchoconstriction due to inflammatory edema, muscle spasm and the allocation of viscous mucus. Seizures occur due to contact with allergens or of trigger (triggers) factors.
Causes
The main reasons for the development of asthma are the contacts and formation of allergen hypersensitivity (sensitization) thereto. The major allergens in asthma are:
- pollen (pollen, weeds)
- household (dust, house dust mites)
- drugs (salicylates, antibiotics),
- Fungal (mold fungi),
- infectious.
In addition to allergens there are also a number of precipitating factors that enhance the bronchi sensitivity to allergens - a cold, heat, dry air, dust, noxious fumes. In addition, an important role to the influence of heredity and stress.
As a result of causes and precipitating factors there are special conditions for the development of asthma. These include bronchial inflammatory swelling, excessive production of viscous mucus, as well as a sharp narrowing of the bronchi due to spasm of the small smooth muscle.
All this leads to a sharp narrowing of the inner lumen of the bronchi, the difficulty of carrying him on the air, and the formation of clinical manifestations.
asthma symptoms
Bronchial asthma is manifested typical attacks of breathlessness, and they can be divided during the three steps.
The attack period precursors arise reaction Similar to colds, from the nasopharynx. There is a profuse watery runny nose, sneezing, coughing and sore throat. Usually these symptoms are particularly pronounced when seasonal asthma attacks with infectious or allergic nature of the attacks.
In the next stage of developing an asthma attack itself with the typical symptoms - there is a feeling of tightness, compression in the chest, difficulty breathing, lack of air.
Thus there is a short and sharp intake of breath from the noise and effort, the expiration is extremely difficult, it is noisy and rather long. When breathing, even at a distance can be heard whistling, wheezing, cough can be connected with a viscous and thick sputum, breathing spasmodic, are utilized as the auxiliary muscles - drawn intercostal spaces above and podklyuchinye fossa.
At the time of asthma attacks, patients often rushing, restless and even aggressive, take forced position - the body leaning forward, leaning on hands or knees to ease exhalation. A person may acquire swelling, is blue or red, can clearly expiratory swell cervical vein.
In severe asthma, you can clearly see the participation of accessory muscles of breathing. During the attack the lungs can hear a lot of dry wheezing, swollen lungs, dramatically expanding their boundaries. Muted heart tones. Seizures can be from mild to severe with the formation of status asthmaticus requiring immediate resuscitation.
As subsided attack occurs breath of relief, cough becomes more humid, separated scant amount of viscous glassy phlegm. Gradually the number of wheezing and breathing noise is reduced, recovering the normal depth and rhythm of breathing.
The number of attacks can be from one to two a week to daily, mainly attacks occur at night or morning time, especially in children.
First aid
When new-onset asthma attacks necessary to call an ambulance to her arrival the patient relief from the close clothing, access cool and moist air, inhalation of humidified air or saline, drinking water fine sips. antihistamines (allergy) can take the means.
To cope with the attack begins asthma inhalers help such as
- salbutamol,
- fenoterol (Berotec)
- terbutaline (brikanil).
Ambulance doctors usually injected drug aminophylline, which relieves the attack in a few minutes. It must be borne in mind that aminophylline tablets begins to act only after half an hour.
Diagnostics
Can be suspect asthma according to typical complaints and clinical manifestations - occurrence of seizures when contact with certain substances, shortness of breath and wheezing on exhalation, separation of the viscous vitreous lump sputum. The diagnosis is confirmed by additional research methods are also determined the severity of asthma.
Pikfluometrii method is used, which is defined by the peak expiratory activity, while reducing it below the normal speaks of bronchial obstruction. This may compare expiratory flow to supplementation and after receiving bronchodilators. If the performance difference of more than 20% - the presence of airflow obstruction confirmed.
spirometry method allows to identify and calculate the bronchial obstruction severity, reversibility characteristics and their variability. Spirometry was performed at baseline, and then after inhalation special bronchodilator drugs. If you change the parameters of more than 15-20% of the diagnosis is confirmed. Spirometry and pikfluometriyu carried out repeatedly for confirmation.
Also required:
- conduct allergy tests to detect allergens - skin prick tests and identification of the allergen by a blood test,
- determination of blood gas composition,
- X-ray of the lungs,
- ECG.
Displaying laboratory analysis. In the analysis of blood is investigated eosinophil levelsOn which confirm the allergic nature of the disease and monitor treatment. In sputum exhibit typical for asthma changes - this increase in the number of eosinophils, specific Charcot-Leyden crystals, and special calf Kurshmana. All these manifestations confirm the nature of asthmatic attacks.
It is important to study the immune status of the patient and an increase in the immunological immunoglobulin reaginic type (class E), As well as reducing the number of specific T cells.
Differential diagnosis with obstructive bronchitis, foreign bodies and tumors of the bronchi, with cardiac asthma.
asthma treatment
Treatment of asthma engaged pulmonologists and allergists.
Treatment of asthma involves excluding hypoallergenic dietHypoallergenic life, receiving bronchodilator drugs during attacks (there are about a hundred, each case - a selection of doctor preparation - from eufillina to beroduala) and the basic therapy for a long time (as selected by the doctor individually), it reduces inflammation and hyperreactivity bronchi. In severe cases, hormone therapy is used for inhalation.
Inhalation hormone therapy - is the individual cartridges to beclomethasone, and many other drugs, or mask with Nebulized drugs - used with the selection of doses and formulations.
One of the methods is to eliminate attacks Asit - gradual subthreshold conduct micro-doses of the allergen, developed gradually insensitive to the allergen and the cessation of attacks.
