Bronchial asthma is a chronic pathological process of an inflammatory nature and non-infectious etiology that affects the respiratory tract. The disease is characterized by recurrent attacks of coughing, shortness of breath, chest tightness and wheezing. As a rule, an attack occurs after some of the manifestations that herald it. Against the background of contact with any irritant, bronchial obstruction develops (the lumen of the bronchi, affected by chronic inflammation, sharply narrows), as a result, suffocation occurs, as a result of a decrease in the rate of passage of inhaled air through the respiratory tract.
The prevalence of bronchial asthma in the world is estimated, according to statistics, at 4-10%. In Russia, according to various estimates, this pathology is observed in 2.2-7% of adults and in 10% of children. Asthma affects people of any age and gender. In about 50% of patients, the disease is diagnosed already in childhood (before the age of 10), another 35% of asthma first manifests itself before the age of 40.
Etiology and pathogenesis of bronchial asthma
Bronchial asthma can be triggered by various factors. Among them:
- hereditary predisposition;
- professional harm;
- the influence of environmental factors;
- the nature of the diet;
- exposure to chemical agents (for example, in contact with household chemicals);
There is also a theory that infectious agents can provoke asthma. The onset of an attack is more often provoked by allergens (plant pollen, wool, household dust, skin particles of dust mites, allergens). In addition, nonsteroidal anti-inflammatory drugs (NSAIDs) trigger shortness of breath caused by airway obstruction in some people.
Regardless of the etiology of the disease, the main link in the pathogenesis is impaired bronchial patency due to their high reactivity. Poor airflow through the airway is due to the following factors:
What the bronchi look like in a healthy person and in an asthmatic
- the lumen of the bronchi narrows, since under the influence of provoking factors, their edema develops or a spasm of the muscles of the respiratory tract occurs;
- the bronchi are clogged with secretion and mucus due to the increased work of the glands of the respiratory tract;
- with a prolonged course of the disease, the inflammatory process damages the elastic smooth muscles of the bronchi, it is gradually replaced by connective tissue, and sclerosis develops.
The classification of bronchial asthma is carried out according to several criteria. Depending on the etiological factors, the following varieties are distinguished:
- asthma of exogenous origin (an attack provokes exposure to allergens that penetrate from the outside with inhaled air);
- asthma of endogenous origin (attacks occur under the influence of infectious agents, physical effort, strong odors, inhalation of cold air, can also play the role of a psychosomatics);
- asthma of mixed origin (attacks occur under the influence of both external and internal factors);
- asthma of unknown etiology.
The severity of the disease is classified into four degrees:
- light persistent;
- persistent moderate;
- severe persistent.
A chronic disease proceeds with alternating remissions and relapses. In the first case, we can talk about unstable or persistent and long-term remission.
Asthma can be controlled, partially controlled, or uncontrolled depending on how well the disease is controlled.
The main symptoms of asthma are observed during an attack. Outside the attacks, the clinical picture of this disease is erased, the manifestations are practically absent. Outside of an attack, a person may experience a sore throat, a constant dry cough, and sometimes a runny nose. There are several signs, the presence of which suggests this disease in a person. Among them:
- well-distinguishable whistle heard on exhalation (more typical for younger patients);
- persistent cough (most often there is a tendency to its intensification at night);
- periodically there are bouts of difficulty breathing, it is accompanied by well-audible wheezing, pain or a feeling of heaviness and tightness in the chest is felt;
- allergy or eczema in a patient;
- manifestation of symptoms at a certain period of the year or constant manifestations with seasonal worsening;
- frequent respiratory diseases, affecting mainly the lower respiratory tract.
The most characteristic manifestations in the clinic of bronchial asthma are asthma attacks. This condition occurs in several stages. First, the person shows signs of an impending attack. It can be prolonged sneezing, a strong flow of watery mucus from the nose, sore throat. The main phase of an attack often begins unexpectedly. The patient feels shortage of air, a feeling of tightness in the chest. He inhales quickly and shortly, exhales with difficulty, loudly, for a longer time than usual. The breathing process is accompanied by wheezing and whistling. A cough also appears, paroxysmal, intense, interfering with normal and rhythmic breathing. A person takes a forced position, he has to use muscles for breathing, which usually do not take part in this process.
After a while, independently or under the influence of medication, the attack passes. The wheezing subsides, breathing is gradually restored. In the midst of an attack, sputum almost does not go away, while its extinction begins its intense discharge.
If signs of asthma appear, you should consult a physician or pulmonologist. The diagnosis, as a rule, is not difficult: the doctor can recognize the disease by the clinical picture by analyzing the patient’s complaints. Methods of laboratory and instrumental diagnostics are necessary to establish the etiology of the disease, its form and severity.
On physical examination, asthma is indicated by signs such as a change in heart rate, shortness of breath, wheezing, clearly audible on exhalation.
The following laboratory tests are prescribed:
- general clinical blood test;
- blood biochemistry;
- sputum examination;
- blood test for immune status.
Allergy tests, blood gas analysis, bronchoscopy and lung x-rays can be done if necessary.
The final diagnosis is based on spirometry data. For more reliable results, this study is recommended to be carried out several times. Spirometry allows you to establish the degree of bronchial obstruction, to determine its reversibility. Also, the peak flow method is used, which is the determination of the peak air velocity during forced expiration.
In the treatment of bronchial asthma, the exclusion of provoking factors is important. Since in most cases the disease is of an allergic nature, it is necessary to limit contact with possible allergens. If an allergen is identified, a so-called desensitizing treatment can be performed. This is a technique in which the patient’s body is exposed to minimal doses of an allergen, teaching the immune system to respond to it less intensely.
The disease is treated with the use of symptomatic agents, the use of which is aimed at stopping seizures, and the main drugs prescribed to suppress the mechanisms and eliminate the causes of the development of the disease. The therapy regimens and dosages are set by the attending physician individually for each patient.
To relieve asthma attacks, drugs of the xanthine group or beta-adrenergic agonists are prescribed. They expand the lumen of the bronchi, which makes it easier for the patient to breathe. They are used in the form of inhalation. At the pharmacy, you can buy pocket inhalers that are convenient to carry with you, since an attack can occur at any time. These drugs are available without a prescription, but only a doctor should prescribe them. Xanthines are used for both seizure prevention and emergency treatment. Produced more often in tablets.
About 25% of patients need to be treated with glucocorticosteroid drugs. They are prescribed in small dosages, the duration of the treatment course is determined by the attending physician. If the patient is treated in a hospital, they are injected intravenously.
Recommended for patients and non-drug treatment: exercise therapy, breathing exercises. Therapeutic massage, speleotherapy and halotherapy procedures are effective.
Forecasts and preventive measures
Despite the study of the pathology and the availability of effective treatment methods, mortality from bronchial asthma continues to be quite high. If the disease is detected in a timely manner, the patient observes the recommendations of the attending physician, then the prospects in most cases are assessed as favorable. With the current therapeutic techniques, sustained remission can be achieved by successfully preventing seizures.
It is necessary to pay attention to prevention for people who have a hereditary predisposition to asthma, as well as those who suffer from allergies, work in hazardous industries, and live in a polluted metropolis. Preventive measures include timely treatment of acute infectious diseases and control over chronic foci of infection, quitting smoking, excluding or minimizing contact with allergic agents.
The most severe and dangerous complication of asthma requiring immediate medical attention is status asthmaticus. This condition is characterized by swelling of the bronchioles, the accumulation of viscous sputum in them, which leads to an increase in suffocation and oxygen starvation. About 5% of cases end in the death of the patient.
In a severe course of the disease, with frequently repeated intense attacks, emphysema may develop. In the future, bronchial asthma may be complicated by the development of pulmonary heart failure.
Bronchial asthma is a deadly pathology. The patient needs to understand that there is no way to get rid of it completely and forever. If the therapy is carried out correctly, the person’s quality of life does not decrease. Medical monitoring of one’s own condition, the implementation of medical recommendations allow you to achieve a stable and long-term remission.