Bronchial asthma: features of the course, the severity of the disease

Bronchial asthma is a chronic ailment. It is dangerous to the patient’s life due to attacks of suffocation and has a significant effect on the work of the heart, vascular and respiratory systems. This action is caused by attacks of bronchial spasms, which cause disruptions in breathing, edema of the mucous membranes and an increase in mucus secretion in the bronchial tree.

This disease is very common – it affects up to 10% of the entire population of the planet. At the same time, children constitute a special risk category – bronchial asthma is diagnosed in 12-15% of young patients. The disease can be classified according to many characteristics, therefore, different types, forms and phases are distinguished. The effectiveness of therapy and prognosis depend largely on the severity of the disease.

About the disease

Bronchial asthma belongs to the category of diseases provoked by an allergic reaction to certain irritants, as a result of which the patient’s breathing is impaired. Spasm of the bronchi, swelling of their mucous membranes, increased mucus secretion leads to a decrease in the supply of oxygen to the lungs, as a result of which suffocation occurs.

The disease occurs most often due to extreme sensitivity to allergens, which are present in large quantities in the external environment. Often there is a severe form that bronchial asthma acquires due to the lack of qualified treatment.

Symptoms and features of the course of bronchial asthma

The basis of the disease is bronchial hyperreactivity when exposed to external stimuli. This is a very strong reaction, accompanied by a narrowing of the lumen with the formation of edema and the production of mucus in large quantities. Several groups of factors lead to such processes. Firstly, these are the reasons of internal origin that determine the progression of the disease:

  • genetic prerequisites – the presence in the circle of relatives of persons suffering from a similar ailment or allergies;
  • excessive body weight, since in obesity, the diaphragm is located high and the lungs are not sufficiently ventilated;
  • gender – boys are more prone to illness due to the narrowness of the lumens of the bronchi, although women are more susceptible to the disease in adulthood.

Secondly, there are factors of external origin that provoke the development of the disease. These are allergens that cause the body to react in the area of ​​the bronchial tree:

  • dust particles in the room;
  • products and individual ingredients – chocolate, seafood, dairy products, nuts, etc.
  • pet hair, bird feathers;
  • mold or mildew indoors;
  • medications.

Allergic type

Allergic reactions to several types of irritants are not uncommon. In this case, one should not forget about triggers, that is, factors that can directly provoke spasms in the bronchi. These include:

  • smoke when smoking tobacco products;
  • too high physical activity;
  • different in frequency and regularity of interaction with household chemicals – powders, perfumery products, cleaning agents;
  • environmental pollutants, such as car exhaust, industrial emissions;
  • peculiarities of climatic conditions – excessively dry or cold air;
  • infectious diseases of the respiratory type.

Bronchial asthma in many cases can develop like ordinary bronchitis, and not all doctors immediately identify the disease. Among the symptoms are:

  • asthma attacks;
  • severe shortness of breath, accompanied by a cough;
  • shortness of breath with audible whistling and wheezing;
  • a feeling of heaviness in the chest.

Features of the manifestation of symptoms

These typical signs of ailment can spontaneously disappear. In some cases, they are eliminated by taking medications with anti-inflammatory effect. Symptoms can manifest themselves variably, however, the characteristic of the disease is the recurrence of exacerbations under the influence of allergens, due to an increase in air humidity, a decrease in temperature or heavy loads.

With bronchial asthma, attacks occur, accompanied by choking and coughing. They are provoked by inflammatory processes of an immune nature, which are activated by allergens or due to damage to the body by pathogens of respiratory diseases.

At the next stage, biologically active substances are produced, there is a change in the tone of the muscles of the bronchi, which is accompanied by a violation of their functions. The result is the development of edema of the bronchial mucosa, a change in the amount of secreted secretion while spasms of smooth muscles occur simultaneously.

During an asthma attack, the viscosity of the secreted secretion increases, which begins to clog the lumen of the bronchi. The movement of air through them becomes difficult. The difficulty of exhaling provokes the manifestation of expiratory dyspnea. It is on this specific symptom of the disease that you should pay attention in the first place. The result is the appearance of whistles and wheezing when breathing.

In the absence of treatment, a severe form of bronchial asthma can develop – the symptoms become more pronounced and the relief of asthma attacks becomes more difficult. Therefore, timely diagnosis and adequate treatment become the key to quick relief of the patient’s condition, increasing the duration of the remission period. To assess the degree of bronchospasm, a variety of methods are used, for example:

  • spirography, which evaluates the volumetric characteristics of respiration;
  • peak flow measurement to measure the maximum expiratory flow rate.

It is unacceptable to self-medicate with bronchial asthma, as it can cause complications, and an attack of suffocation can even lead to death. It is possible to eliminate an attack on your own only in cases of an atopic type of illness, when the problem is provoked by the flowering of vegetation during certain seasons.

The peculiarity of the course of the disease is that at an early stage it cannot always be accurately diagnosed. A false diagnosis of bronchitis is often made, and therefore no adequate treatment is prescribed during this period. All therapeutic efforts are ineffective.

Classification of the disease by severity

The course of the disease is characterized by alternating periods of exacerbation and temporary calm (remission). It is important to correctly assess the severity of the disease. This can be done using several parameters:

  • the number of seizures observed at night during the week;
  • the total number of attacks that occur during the day during the week;
  • the frequency and duration of the use of drugs with a short-term effect such as “beta2-agonists”;
  • sleep problems and limitations in the patient’s physical activity;
  • the values ​​of the FEV1 and POS parameters and their dynamics during exacerbation of the disease;
  • changes in the PIC indicator throughout the day.

The severity of the disease can be different, therefore, when classifying bronchial asthma, the following types are distinguished:

  • ailment with an intermittent type of flow (periodic);
  • persistent disease with mild course;
  • persistent asthma with moderate manifestations;
  • severe persistent asthma .

Intermittent asthma

Mild bronchial asthma may have an intermittent course. In this case, exacerbations of the disease are short-term, occurring sporadically. The duration is several hours, but it can be up to several days.

Daytime manifestations of choking in the form of shortness of breath or cough syndrome occur less often than 1 time within 1 week. But at night, an attack can happen up to 2 times in 30 days. Expiratory flow at peak level is 80% of the baseline normal value. Daily fluctuations in speed do not exceed 20%.

During remission, asthma in this form does not manifest itself in any way, there are simply no symptoms, due to which the functioning of the lungs remains normal.

Attacks usually begin as a result of direct interaction with allergens. There may also be an exacerbation due to colds. Patients note that an exacerbation occurs after household work associated with cleaning indoors or outdoors.

Inhalation of plant pollen, communication with animals, the action of smells or smoke from cigarettes become attackers. In this case, there are no special changes in the patient’s condition, activity does not decrease, speech does not change. However, there are some signs you should pay attention to:

  • increased duration of exhalation;
  • hard breath;
  • the appearance of weak whistles during exhalation;
  • breathing becomes harder, there are signs of wheezing;
  • heartbeat quickens.

Features of the intermittent type

In this form, the disease is not detected often enough. This is due to a number of factors:

  1. The lack of expression of symptoms and the absence of significant changes in well-being leads to ignoring the symptoms by the patients themselves.
  2. Episodic asthma is similar in symptoms to other ailments that affect the respiratory system.
  3. The provoking factors have a mixed effect – the disease becomes the result of the action of allergens and infectious diseases.

The diagnosis is made using examinations:

  • general blood and urine tests;
  • skin allergy tests ;
  • X-ray examination of the chest cavity organs;
  • assessment of functional parameters of external respiration under the influence of beta2-agonists.

Light persistent

For a mild course of bronchial asthma in this form, an expiratory flow rate at a peak level of up to 80% of the initial baseline is characteristic. Within 24 hours, this indicator can vary within 30%. Asthma attacks, accompanied by coughing and shortness of breath, occur no more than 1 time per day, but may be less frequent – only 1 time per week.

Nighttime attacks occur no more than twice within 30 days. The manifested symptoms associated with an exacerbation of the disease directly affect the patient’s performance, can reduce activity during the day, and worsen sleep at night.

Persistent moderate

Asthma in moderate form is manifested by symptoms that negatively affect the patient’s activity during the day and his sleep at night. If daytime attacks occur almost daily, then at night, choking is observed at least 1 time during the week. The peak expiratory flow rate is 60-80% of the required level.

Moderate asthma is characterized by the following features:

  • indicators of bronchial patency are significantly deteriorated – breathing becomes stiff, shortness of breath is noted, exhalation is difficult;
  • clear wheezing is heard;
  • during the coughing process, sputum may be released;
  • the chest is barrel-shaped, with percussion a box sound is heard;
  • physical stress is accompanied by shortness of breath;
  • symptoms of the disease also appear in the absence of an attack.

Choking attacks are frequent and life threatening. The patient experiences severe fear, his skin turns pale, and the nasolabial triangle acquires a shade of cyanosis. During an attack, a person leans forward and rests with his hands, for example, on a table, additional muscles are used when breathing.

Severe persistent asthma

Asthma is mixed. The provoking factors are triggers in the form of allergic irritants and infections. Exacerbations are frequent enough, attacks can be repeated every day and every night. The peak expiratory flow rate does not exceed 60% of the norm. Fluctuations can exceed 30%.

The patient’s condition is very grave. Physical activity is limited, bronchospasm manifests itself in a spontaneous form for no apparent reason. Exacerbations are high in frequency and intensity. The severe course of bronchial asthma cannot be controlled by the patient. To monitor the condition, peak flowmetry is performed every day .

An attack is characterized by a number of manifestations:

  • breathing disorders;
  • persistent anxiety, an increase in panic, fear, the appearance of cold sweat;
  • forced posture of the patient;
  • whistling sounds when breathing, which can be heard from a distance;
  • increased blood pressure and the appearance of tachycardia;
  • severe dry or wet wheezing when breathing.

Therapy for severe asthma is not always effective, and therefore, the development of status asthma can be observed, when it is necessary to use special devices to maintain vital processes. The reason for this condition may be:

  • massive exposure to the allergen;
  • accession of ARVI;
  • overdose of beta2-agonists;
  • a sharp change in treatment, the rejection of hormonal drugs.

Status asthma develops if the attack cannot be stopped within 6 hours. At the same time, the oxygen content in the blood drops, carbon dioxide accumulates, and the excretion of sputum from the bronchi stops. Treatment is carried out exclusively in a stationary setting.

Treatment of bronchial asthma

The effectiveness of therapy for intermittent asthma depends on the correct treatment. In the early stages, it is necessary to create conditions to prevent the progression of the disease and maximize the periods of remission. Doctors prescribe short-acting beta2-agonists and theophyllines. The goal is to stop seizures and prevent deterioration.

The drugs are prescribed in the form of an inhaler or tablets for oral administration. Usually they are used before exertion or before interaction with irritating components. To improve the effectiveness of treatment, the patient is advised to change his lifestyle. Anti – inflammatories are usually not used.

The main directions of treatment

Patients with mild persistent asthma already require serious daily treatment. Prevention of exacerbations is carried out with the help of corticosteroids in the form of inhalers, as well as drugs with sodium cromoglycate , nedocromil , theophyllines.

The dosage of corticosteroids at the initial stage is 200-500 mcg per day. With the progression of the disease, the dose is increased to 750-800 mcg daily. Long- acting bronchodilators should be used at bedtime .

Patients with moderate persistent asthma are forced to take beta2-agonists and anti-inflammatory drugs every day. Such complex therapy helps prevent the deterioration of the patient’s condition. Beclomethasone dipropionate is prescribed , as well as other analog inhalers containing corticosteroids.

The dosage is 800-2000 mcg (in each case, it is selected individually!). However, one cannot do without the use of long-acting bronchodilators . They prove to be indispensable for nighttime attacks. Theophyllines are included in the course of therapy.

In severe bronchial asthma, the course of therapy is aimed at alleviating symptoms. The following drugs are prescribed:

  1. High dose corticosteroids. An initial dose that is acceptable is one that provides symptom control. After the onset of the effect, the dosage is often reduced. Doctors prescribe systemic glucocorticosteroids . The form of these drugs is different – it can be inhalers with aerosols, tablets, drops.
  2. Bronchodilators . These drugs include drugs of different groups. Methylxanthines and beta2-agonists are preferred . Give a certain effect anticholinergics .
  3. Non-steroidal anti-inflammatory drugs. The use of these medicines is associated with a mixed etiology of the disease – asthma occurs due to allergens, physical exertion, climatic conditions. Apply drugs with cromoglycate or nedocromil sodium.

Severe asthma is treated with medications, which often have significant side effects and contraindications. In most cases, treatment is carried out in a hospital setting.

Features in children

For children, the atopic form of the disease is characteristic. It is directly related to allergic manifestations. The provoking factor is nutritional problems during the first years of life and environmental conditions. During this period, it is required:

  • ensure regular and continuous breastfeeding of newborns;
  • introduce complementary foods no earlier than the baby reaches 6 months of age, and it is necessary to exclude foods that can cause allergies;
  • create the best conditions for the life and development of the baby;
  • exclude exposure to allergy-provoking factors, for example, cigarette smoke or aggressive household chemicals;
  • timely diagnose and treat respiratory diseases in babies.

Adult patients face asthma as a complication of respiratory diseases in a chronic form or as a consequence of prolonged exposure to harmful environmental conditions – tobacco smoke, car exhaust, industrial emissions. Therefore, you should promptly exclude these factors and begin treatment of diseases of the respiratory system.

Prevention of complications

It is important to take measures aimed at reducing the severity of the disease and preventing exacerbation. This is especially important if patients are diagnosed with severe bronchial asthma. For this, it is advisable to exclude contact with the allergen, which must first be accurately identified. To reduce the harmful effects of allergens, you should:

  • carry out wet cleaning regularly, at least 1-2 times every 7 days;
  • in the housing of asthmatics, exclude the presence of carpets, upholstered furniture, objects on which dust can settle;
  • wash bedding weekly using hot water and laundry soap;
  • use covers for pillows or mattresses;
  • destroy insects;
  • do not include in the diet foods that provoke an allergic reaction of the body.

All these measures will help prevent the development of the disease and increase the effectiveness of therapy.

Prevention of attacks of bronchial asthma

The complex of measures includes actions to prevent allergic reactions and ailments of the respiratory system.

They are especially important for people with a tendency to allergies, as well as people with pre-asthma , when the disease has not yet developed. Preventive measures are necessary for:

  • persons with a hereditary predisposition to asthma;
  • patients with allergic reactions;
  • persons with immunologically proven sensitization.

They need desensitization therapy with anti-allergic drugs.

event_note February 6, 2021

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