Persistent bronchial asthma is an inflammatory disease of the airways with a chronic course, the only manifestation of which is a reversible narrowing of the bronchial lumen. Hyperreactivity of the bronchi occurs against the background of chronic inflammation of the mucous membrane and is manifested by bronchospasm and hyperproduction of thick sputum. All this leads to the appearance of characteristic symptoms.
Causes of occurrence
Groups of factors that determine the development of persistent asthma:
- triggers (provoke an exacerbation of the disease).
Internal factors determine the development of the disease. These include:
- genetic predisposition (it has been proven that the risk of inheriting bronchial asthma is about 70%);
- atopy (increased IgE titer in response to contact with an allergen);
- high airway activity (severe narrowing of the airway lumen, in response to an allergen or trigger);
- obesity (affects the mechanism of the act of breathing and promotes the development of an inflammatory reaction).
External factors provoke the appearance of symptoms of the disease:
- indoor allergens (dust mites, pet hair and feathers, insect allergens, proteins of molds and yeasts);
- outdoor allergens (pollen);
- infectious diseases;
- tobacco smoking .
Factors provoking exacerbation of asthma:
- rapid breathing;
- natural factors (high or low air temperature, wind);
- pharmacological drugs (NSAIDs, beta-receptor antagonists);
- nutritional supplements;
- the smell of paints and varnishes;
- psycho-emotional stress.
An exacerbation of the disease occurs after the allergen enters the body and manifests itself in the form of shortness of breath, attacks of unproductive cough, wheezing, and chest congestion. Sometimes an exacerbation can be caused by increased motor activity.
How symptoms occur:
- irritation of the bronchial cough receptors leads to the onset of a cough reflex;
- spasm of the smooth muscles of the bronchi contributes to the formation of wheezing, due to the turbulent air flow through the spasmodic airways;
- due to an increase in the work of the respiratory system, shortness of breath occurs.
According to the severity, persistent asthma is divided into:
- Mild persistent asthma. Symptoms of the disease occur two or more times a week, but not daily. The onset of seizures that disturb the quality of sleep, more often 2 times a month. Exacerbations have a negative impact on physical activity. FEV in the first second outside the attack is more than 80% of normal values.
- Persistent asthma of moderate severity. It manifests itself as everyday symptoms, nocturnal manifestations occur more often than once every 7 days, exacerbations reduce physical activity and worsen sleep. A daily intake of beta-2-adrenergic agonists of short duration is required.
- Severe persistent asthma. It is characterized by regular manifestations of symptoms, more than once a day, frequent exacerbations and disturbances in the quality of sleep, a significant limitation of physical activity.
Stages of asthma diagnosis:
- Collection of patient complaints and anamnesis clarification.
- Functional diagnostic methods (spirometry, peak flowmetry ).
- Collection of allergic anamnesis .
- Skin and allergic tests.
- Test with an allergen for provocation purposes.
- Laboratory diagnostic methods.
When analyzing complaints, pay attention to:
- shortness of breath on inspiration;
- attacks of unproductive cough;
- heaviness and tightness in the chest;
- wheezing wheezing.
The reversibility of bronchial obstruction is assessed using spirometry. Forced expiratory volume in the first second is important to confirm the diagnosis. First, this indicator is assessed without the use of drugs, then the patient is administered a bronchodilator drug . After 15-20 minutes, the study is repeated. An increase in FEV1 of more than 12% is in favor of the presumptive diagnosis.
Using the peak flow determining peak air velocity. This method is used when it is impossible to conduct spirometry and to monitor the dynamics of the course of the disease. The device is small, so it is convenient to use it to identify the influence of provoking factors at work and at home.
When collecting an allergic anamnesis, it is necessary to establish the presence of allergic diseases in the family, to identify the relationship between the onset of symptoms and the action of allergens (contact with animals, cold season, manifestation of symptoms after being in certain rooms).
To identify a specific allergen, skin tests with allergens are performed. Samples are taken in late autumn or winter to exclude the influence of plant pollen on the test results.
Which doctor to contact
If symptoms of the disease appear, you should contact your local therapist. After a preliminary diagnosis is made, the local doctor will refer the patient to narrow-profile specialists:
To confirm the disease, it is necessary to donate blood for the determination of general and specific immunoglobulin E. It is also necessary to donate sputum or bronchoalveolar fluid for analysis for the content of eosinophils.
Pharmacotherapy of persistent asthma is divided into 2 types:
- continuous supportive therapy;
- drugs used for exacerbation.
Supportive (basic) therapy is aimed at reducing the frequency of attacks, up to their complete absence. For this purpose, drugs with anti-inflammatory activity (inhalation and systemic corticosteroids), prolonged beta-2-agonists are prescribed.
With an exacerbation, drugs are used with the fastest time for the development of effects: Salbutamol , Fenoterol.
Provided the diagnosis is correctly made and effective therapy is prescribed, it is possible to achieve a completely controlled course of the disease. The quality of life of such patients is almost the same as that of healthy people.
To prevent exacerbation of asthma, patients are advised to exclude foods that cause an allergic reaction in them. Obese patients need to reduce body weight, which will improve health and reduce the risk of exacerbation. Additionally, active and passive smoking should be excluded to minimize the harmful effects on the lungs. Moderate exercise improves cardiopulmonary function. Patients are advised to engage in swimming to train the muscles involved in the act of inhalation.
The asthmatic condition is the most severe complication of persistent bronchial asthma. It is acute respiratory failure and refractory to bronchodilator drugs. Frequent exacerbations of the disease can lead to the development of pulmonary emphysema, due to overstretching of the lung tissue due to the inability to exhale. Perhaps the development of hypertrophy of the right ventricle of the heart, due to pulmonary hypertension.
Asthma is a formidable disease with the potential for severe complications. But a timely diagnosed disease and correctly selected treatment minimize the occurrence of exacerbations and prevent possible complications, while maintaining a high quality of life for patients.