- Bronchial asthma in children
Bronchial asthma is a disease whose clinical manifestation is asthma attacks.
Etiology and pathogenesis. Most authors believe that the anaphylactic, or allergic, theory of the origin of bronchial asthma is most confirmed in the clinic, although it does not solve all the controversial issues of pathogenesis. The occurrence of bronchial asthma is associated with various allergens. They can enter the body from the external environment (exoallergens, or heteroallergens) and form in the body (endoallergens, or autoallergens). Exoallergens are divided into non-infectious, infectious and parasitic. Non-infectious allergens can be of plant origin (plant pollen), “industrial” (chemicals contained in the air of industrial cities), household (indoor dust), food, medicine, etc. Allergens of infectious and parasitic origin: microorganisms, bacteria, viruses, helminths and protozoa.
Endoallergens occur in the presence of infection in the bronchi and lungs, extrapulmonary infections, as well as some non-infectious diseases. In these cases, endoallergens are not bacteria and viruses, but products of tissue denaturation (a change in the properties of proteins). For the development of the disease, a state of increased sensitivity of the body (sensitization) is necessary. It can be caused by one or more allergens (endoallergens and exoallergens). Resolving allergen enters the body, usually through an aerogenous route. Pathogenetic mechanisms of the development of bronchial asthma are carried out according to the type of allergic reactions (see Allergy). The hereditary predisposition matters. The presence of previous diseases that contribute to the occurrence of bronchial asthma (inflammatory diseases of the lungs and bronchi, changes in the state of the nervous system, etc.) is important, but not necessary. In the development of an attack, the main role is played by a spasm of smooth muscles of the small bronchi, swelling of the mucous membrane and increased secretion of the mucous glands of the bronchi. As a result of this, a sharp narrowing of the lumen of the bronchi occurs, which causes an attack of suffocation.
The clinical picture (symptoms and signs). Attacks of bronchial asthma can appear in early childhood. A significant number of patients fall ill during puberty or menopause. Often the first attack is observed after any illnesses (pneumonia, measles, whooping cough, diseases of the female genital area, etc.), often after severe unrest and neuropsychic overstrain. An attack of bronchial asthma can occur unexpectedly, but precursors are more often noted: discomfort in the chest, cough, etc. Often the attack occurs at night. The patient usually sits leaning on his hands, with severe shortness of breath. Breathing is rare (up to 10 in 1 million or less), noisy, audible from a distance. The chest in the position of deep inspiration, as it is sharply difficult to exhale. Auxiliary respiratory muscles (sternoclavicular-nipple muscles, rib muscles), cough dry or with a small amount of viscous, difficult to separate sputum are involved in breathing. The patient is usually sweaty, the pulse is quickened, the body temperature is normal. The duration of the attack is from 20-30 minutes to several hours and even days.
Sometimes choking continues for several weeks at short intervals. In the lungs, percussion – a boxy sound, auscultation – weakened breathing, a large number of dry rales. With the end of an attack of bronchial asthma, the acute expansion of the lungs also disappears. At often repeated attacks over time, emphysema develops (see) and the function of external respiration is significantly impaired.
With the cessation of an attack of bronchial asthma, the patient begins to breathe deeply, coughing up a large amount of sputum. In sputum, one can find: eosinophilic leukocytes, Charcot-Leiden crystals (shiny colorless octahedrons formed during the decay of eosinophilic leukocytes) and Kurschmann spirals (convoluted mucous filaments formed in the smallest bronchi when they are narrowed). In peripheral blood, eosinophilia is noted , reflecting the allergic origin of bronchial asthma.
The prognosis for asthma is relatively favorable. Fatal outcomes are rare. The prognosis is better, the greater the intervals between the choking starts. The prognosis is affected by complications and concomitant diseases.
Treatment . During an attack, adrenaline (0.5 ml of a 0.1% solution under the skin), atropine (0.3 – 0.5 ml of a 0.1% solution under the skin), isadrine in the form of tablets under the tongue or inhalation are used (0.5 % solution). Asphyxiation stops after 4-5 minutes. after applying isadrine. People with severe atherosclerosis or very high blood pressure should not be given adrenaline. Ephedrine (5% solution of 1-2 ml under the skin) acts much more slowly. Spasm of the bronchi is also eliminated by the intravenous administration of aminophylline (5-10 ml of 2.4% solution in 10 ml of 40% glucose solution ). It is prescribed for patients suffering simultaneously with bronchial asthma, cardiosclerosis, hypertension and other diseases in which the use of adrenaline is impractical. Theofedrine and antastman apply 1 tablet. With severe protracted attacks of bronchial asthma, corticosteroid drugs are prescribed. To stop the attack, use hot foot baths, bikes on the back, inhaling the smoke of various herbs (asthmatol, astmatine). If the seizure fails, the patient needs to be hospitalized.
In the period between attacks, complex therapy is performed.
In some cases, etiological treatment is possible. It provides for elimination of the allergen: termination of contact with certain substances in case of occupational allergy, exclusion of certain foods in case of food allergy, drug withdrawal in cases of drug allergy, deworming in case of helminthiases, sanitation of foci of infection in case of microbial allergy, etc. For the vast majority of patients, the main pathogenetic and symptomatic treatment. Pathogenetic therapy involves desensitizing, anti-inflammatory and sedative therapy. Distinguish between specific and non-specific desensitization (hyposensitization). Specific desensitization is used in cases where the allergen is known, and consists in the introduction of the allergen in small quantities in increasing doses. Apply a variety of microbial and other allergens. Ways of introducing them into the patient’s body are different: inside, subcutaneously, intradermally. The methods of nonspecific desensitization include lactotherapy, autohemotherapy, tissue therapy, irradiation with quartz, etc. Steroid hormones, histaglobin, etc. have recently been used. Steroid hormones are resorted to only with unsuccessful treatment with conventional drugs (ephedrine, aminophylline , etc.). Sedative therapy: prescribe bromides, barbiturates, tranquilizers (trioxazine, meprobamate, etc.). The fight against infection is carried out with antibacterial drugs according to generally accepted schemes.
Symptomatic remedies that eliminate the painful symptoms of the disease include antispasmodics (kellin 0.02 g, papaverine 0.02 g, typhen 0.03 g 3 times a day); reducing the permeability of the capillary walls (ascorbic acid 0.2 g 3 times a day, etc.); expectorant (infusion of thermopsis); sputum thinning enzymes (trypsin, chymotrypsin); cardiovascular; oxygen and others. These funds are used depending on the condition of the patient.
Physical methods occupy an important place (physical therapy, therapy with negative aeroions, ultrasound , etc.). Patients with bronchial asthma in the remission phase or with infrequent and mild attacks without pronounced symptoms of respiratory failure (health resorts: Kislovodsk, Nalchik, Gelendzhik, South Coast of Crimea , etc. ) are subject to spa treatment at climatic resorts, mainly mountain and seaside (in summer) . )
Surgical treatments for bronchial asthma are rarely used.
Prevention . Patients with asthma should be taken to the dispensary in allergological rooms. With professional selection , take into account the sensitivity of the patient.
Bronchial asthma (asthma bronchiale) is an allergic disease characterized by recurrent paroxysmal suffocation, the cause of which is the narrowing of small bronchi. The narrowing may be due to swelling of the bronchial mucosa; accumulation of viscous mucus (the so-called dyskrinia); spasm of the bronchial muscles. In various cases and stages of the disease, the significance of each of these factors is different. Secretion can be scarce – “dry asthma” (asthma sicca) or plentiful – “wet asthma” (asthma humida).
The term bronchial asthma, often used unqualifiedly as asthma, is used to define recurrent generalized airway obstruction that is paroxysmal and reversible at least in the early stages. It should be differentiated from “cardiac asthma” associated with left heart failure, although this term is not quite rightly used at present. The most important clinical manifestations are shortness of breath and wheezing, although with severe asthma, obstruction can be so pronounced that there is no last symptom. In some cases, it is difficult to decide what is the most appropriate diagnostic concept – “asthma” or “bronchitis”. In these patients, cough and sputum, as well as wheezing, are pronounced symptoms, but airway obstruction can still be reversed significantly with drugs such as adrenaline or corticosteroids. The choice of name will depend on what comes to the fore: reversible obstruction or cough with sputum.
The monograph outlines the causes of bronchial asthma and gives their characteristics. The state of the cardiovascular and central nervous systems in bronchial asthma is considered. Much attention is paid to the treatment and prevention of asthma. The work is based on a large personal material of the author and literature data.
The publication is intended for general practitioners.
The purpose of this monograph is to illuminate some aspects of the current state of the issue of bronchial asthma. For this, we used the results of clinical, physiological, biochemical, morphological observations collected by the author and his collaborators at the Hospital Therapy Clinic I of the Leningrad Medical Institute named after Academician I.P. Pavlov (M.P. Berezina, P.I. Bul, V. P Burukhina, L. A. Glinsky, N. Ya. Davidovich, M. V. Eremenko, N. N. Zubtsovskaya, D. M. Zlydnikov, 3. V. Ivanova, Yu. P. Ksenofontov, T. S. Lavrinovich , V. A. Leonova, N. N. Mertsalova, I. G. Nazarov, V. G. Tuzikov, G. B. Fedoseev, E. P. Uspenskaya and others) for the last 20 years of collaboration. Relevant literary sources are also provided that highlight the role and importance of local and general processes that underlie the onset of bronchial asthma.
Such an approach to studying the problem of bronchial asthma, perhaps, will help to understand some issues of etiology, pathogenesis, clinic, pathological anatomy and therapy of this disease.
The desire to consider bronchial asthma from the standpoint of nervousness as an infectious-allergic disease, associated primarily with autosensitization of the body and with the constant participation of the central nervous system with its functional changes, is our task.