Bronchial asthma remains an urgent problem of pulmonology, as its incidence is steadily increasing. It belongs to the group of multifactorial pathologies, that is, there are many reasons that directly affect its occurrence.
Based on the reasons, various types of asthma are distinguished. Doctors have developed several different classifications that can accurately characterize a patient’s condition. In the future, this helps in choosing treatment tactics.
What is bronchial asthma
This not fully understood disease is inflammatory in nature and is considered chronic, mainly affecting the bronchial tree. The main symptom complex is a spasm of the muscular wall of the bronchi, which occurs due to their sensitization.
The narrowing of the bronchi is combined with shortness of breath, a feeling of shortness of breath and wheezing, similar to a whistle. Medications for the treatment of asthma are divided into those that are used for daily intake and are considered basic, as well as those that are taken at the time of suffocation. The type of asthma is determined based on many factors: the cause, the severity of the symptoms, the level of control, etc.
Disease classification criteria
A single International Classification of Diseases is functioning throughout the world. Each disease has its own code, thanks to which it is easy for doctors from different countries to understand each other. In this document, bronchial asthma is classified only by the severity and the cause of it.
But the disease is spreading more and more, and this is not enough. The classification becomes more complicated, there are several of its types, forms of asthma and types were distinguished. Of great importance for the selection of the correct treatment is the division into clinical forms of asthma. More factors need to be considered to accurately characterize the disease:
- the form of severity before the appointment of therapy by the doctor, since the treatment can blur the real picture;
- the connection between the causes of asthma and the peculiarities of its course;
- the body’s response to correcting the condition with the help of medicines;
- the degree of control during the therapy;
- causes of possible complications.
Classification by etiology
Asthma is classified according to the cause of the attack. Allocate:
- exogenous form of bronchial asthma. An allergen from the outside enters the body, causing a reaction of the respiratory system in the form of bronchospasm. Pollen, pet hair, or dust may trigger the onset of an attack. Separately, consider atopic asthma, which differs from the other genetic predisposition of the patient to bronchial hypersensitivity;
- endogenous – the reason lies within the body. This reason can be physical activity, temperature changes, and stress. Separately, you can distinguish the infectious form of asthma – when attacks occur due to exposure to viruses or microorganisms;
- mixed. An attack of suffocation appears as a result of the reaction of the bronchi to the effects of both external factors and internal stimuli.
Special forms of bronchial asthma
Specialists, in addition to the main types of asthma, distinguish in a special group some stand-alone clinical and pathogenetic options:
- Professional. This form of asthma usually makes its debut with constant and prolonged contact of a person with harmful substances, which in this case act as allergens or irritants. An important point is that the factor is present in the workplace, so seizures develop within the first four hours after exposure. Attacks do not occur on non-working days, but in advanced cases, symptoms may remain even after the cause has been eliminated for a long time. The most effective treatment with this option is the complete elimination of contact with a substance that causes asthma attacks.
- The reflux-induced form develops with a decreased tone of the esophageal sphincter. Most often, such attacks occur at night, since in the supine position, the throwing of food from the stomach into the esophagus is easier. There are two mechanisms for the development of symptoms of suffocation: the contents of the stomach due to the weakness of the sphincter enters the respiratory tract or irritation of the walls of the esophagus occurs, after which bronchospasm reflexively sets in.
- Aspirin asthma is a pseudo-allergic inflammatory reaction of the body caused by the occurrence of hypersensitivity to nonsteroidal anti-inflammatory drugs containing acetylsalicylic acid. This asthma is manifested by rhinitis, attacks of bronchial obstruction and coughing. There is a connection between the attack and the intake of NSAIDs. The course of the attacks is quite severe, bronchodilators act rather weakly on them . Such attacks are stopped with glucocorticosteroids .
- Physical stress – an attack is observed during physical exertion, as well as after exertion. This type of asthma can occur at any age, both in adults and children. With a severe course of an attack, the symptoms of respiratory failure increase, this condition requires urgent medical attention.
- Nocturnal asthma. Attacks occur predominantly at night. It is difficult to establish the reason: it may be a reaction to bedding, temperature changes at night, incorrect posture during sleep, and so on. The presence of nocturnal attacks speaks of improperly selected asthma treatment.
Disease classification according to severity
It is important for a specialist to take into account the severity of the pathology, because this is the main criterion when choosing the best therapy for correcting the condition. The classification of bronchial asthma by severity is:
- mild forms of asthma, the symptoms of which have little effect on the patient’s lifestyle;
- more serious clinically moderate bronchial asthma;
- severe degree, representing the greatest danger.
Kinds:
- Intermittent (in other words, episodic) asthma. The mildest form in terms of manifestations, which is characterized by prolonged remission. Attacks do not occur if the allergen is identified and its effect on the body stops. There is no systematic treatment, medications are used only in case of exacerbation – they use anticholinergics , and also prescribe theophyllines that act for a short time. In case of severe manifestations, it will be advisable to use inhaled glucocorticosteroids .
- Persistent asthma of mild severity. Symptoms appear more often – seizures can occur several times a week, both during the day and at night. This interferes with the patient’s active life, disrupts sleep. With such asthma, prophylactic inhalations of glucocorticoid or theophylline in small doses are already prescribed. At the very moment of the attack, it is best to use anticholinergics in inhalation .
- Persistent asthma of moderate severity. It is characterized by daytime attacks that disturb every day. Nocturnal aggravations occur about twice a week. These attacks greatly worsen the patient’s life. It is necessary to correct the condition daily intake of hormones in the form of inhalations and theophyllines, but in a larger dose. Beta- adrenergic agonists are prescribed to relieve spasms, but you should not use them more than 4 times a day. In the event of a severe attack, hormone pills can be taken.
- Severe persistent bronchial asthma . The symptoms of the disease constantly bother the patient, working capacity is significantly hampered. For their relief, glucocorticosteroids are used , gradually increasing the dosage. The attacks are severe, with prolonged suffocation, often there is a status asthmaticus that requires immediate medical attention.
Control level classification
When choosing a therapy, it is important to monitor the body’s response to the treatment. The specialist should carefully monitor changes in symptoms in response to medications.
With adequate therapy and adherence to all recommendations, the numbers indicating the functions of external respiration change for the better, and the patient’s well-being improves.
The degree of asthma control is:
- Well controlled – the patient notes a significant improvement or complete disappearance of symptoms. No exacerbations.
- Partially controlled – the frequency of attacks has decreased, but they still exist. There are already some restrictions on physical activity, exacerbations 1 or more times a year.
- Poorly controlled – the selected treatment is not effective, the transition of bronchial asthma to a more severe degree is possible. The frequency of exacerbations of the disease is already higher – 1 or more times a week. In this case, you need to find out why there is no result. This may be incorrectly prescribed treatment, serious changes in the patient’s life, non-compliance with medical recommendations, unresolved triggers that cause an attack, and so on. In each specific case, you need to understand separately for all points.
Other classification
There is also a classification, which is based on the frequency of occurrence of symptoms of bronchial obstruction. On this basis, there are two phases of bronchial asthma:
- exacerbation phase – when the manifestations of the disease are most striking. There is a cough, shortness of breath increases, the quality of life in this phase can be significantly reduced;
- the phase of remission – when the symptoms of the disease hardly bother the patient or are completely absent. Efficiency is restored to a level corresponding to the established stage of bronchial asthma. If there are no exacerbations for two years or more, remission is considered stable.
Depending on the accession of complications, two types of bronchial asthma are distinguished: proceeding with complications and uncomplicated.
Classification of asthma in children
The classification of bronchial asthma in children is based on the same criteria as in adults. First of all, it takes into account the severity of asthma: it is divided into mild, moderate and severe. The criteria for making a diagnosis depend on age. In children under 5 years of age, an external examination is carried out, anamnesis is taken.
Functional tests at this age have little information content. Parents of children who have already had an attack with wheezing, need to carefully monitor the condition of the child and call a medical team at the first such symptoms.
Treatment of bronchial asthma
Asthma can and should be treated. It is based on drug therapy. Depending on the severity of the symptoms and the type of asthma, specialists select the best drugs and an adequate dosage. Medications can act as basic therapy that is prescribed for each day.
There are also such drugs that are used by the patient exclusively during an attack to stop it. The most popular is step therapy. Its essence lies in the selection of the lowest dosage and the minimum amount of medications required for complete control over asthma.
Prevention
Prevention plays a big role, because an attack is much easier to prevent than to eliminate its consequences.
You can recommend the timely sanitation of foci of chronic infection, getting rid of addictions and good nutrition.