Bronchial asthma is a disease of the bronchi characterized by chronic inflammation involving eosinophils and the development of bronchial hypersensitivity; in another way, eosinophilic endobronchitis. Translated from Greek, “asthma” means suffocation; attacks of shortness of breath with difficulty exhaling, due to a violation of the patency of the bronchi, are characteristic of this disease (an unapproachable course is less common). The process of bronchial obstruction in this disease is reversible: it is amenable to reverse development either independently or under the influence of treatment.
Asthma is distinguished from chronic obstructive pulmonary diseases (COPD) by the episodic nature of shortness of breath (patients suffering from COPD experience shortness of breath constantly).
Up to 18 years of age, male persons predominate among patients, in adulthood – female.
CAUSES OF BRONCHIAL ASTHMA
There are allergic (atopic, exogenous) and non-allergic (non-atopic, endogenous) forms of the disease.
The atopic variant has a connection with heredity. If one of the parents suffers from bronchial asthma, the disease will develop in the child with a probability of 20%, if both – 75%. A special role is played by contact with various allergens in the first year of a child’s life.
Non-atopic bronchial asthma develops by a different mechanism. Pathological changes in the tissues of the bronchi cause infectious lesions of the respiratory tract (the role of some viruses has been proven), dishormonal conditions or lesions of the nervous system.
The development of the disease occurs as follows: the above factors trigger a chronic inflammatory process in the bronchial wall. In the secret of the bronchial glands, eosinophils accumulate, which secrete substances that damage the lining of the bronchus. The bronchial wall undergoes changes: the smooth muscle layer is hypertrophied, the deposition of collagen in the wall becomes more intense, the glands produce mucus more actively. Due to damage to the inner epithelial layer, nerve endings are exposed. As a result of these changes, hypersensitivity and hyperreactivity of the bronchi develops: in response to the action of various “provocateurs”, which can be allergens, toxic and medicinal substances, infectious agents, sharply smelling substances, cigarette smoke, cold, dust, an inadequate reaction of the bronchi occurs – the bronchi spasm, which manifests as suffocation.
It may take years from the beginning of the inflammatory process in the bronchi to the first attack.
Separately, “aspirin asthma” is considered, which occurs as a side effect of the action of nonsteroidal anti-inflammatory drugs.
SYMPTOMS OF BRONCHIAL ASTHMA
In the absence of attacks of suffocation, asthma can be accompanied by respiratory discomfort (slight shortness of breath, cough, wheezing) and various manifestations of allergies (rhinitis, dermatitis, laryngeal edema).
Seizures include expiratory shortness of breath, wheezing and/or coughing. Seizures, as a rule, occur at 4-5 o’clock in the morning or after contact with “provocateurs”, may have a certain frequency, pass spontaneously or are removed by bronchodilators.
Severe cases of the disease (asthmatic status) are accompanied by signs of hypoxia (cyanosis of the skin, loss of consciousness).
DIAGNOSIS OF BRONCHIAL ASTHMA
It is possible to suspect the presence of the disease by the characteristic clinical picture (paroxysmal course, allergic status, provoking factors). The doctor conducts an objective examination (percussion, auscultation), prescribes blood tests, sputum, examination of the function of external respiration, allergological tests, peak flowmetry. Allergological tests are performed strictly outside the exacerbation of the disease. To exclude other respiratory diseases, an X-ray examination is performed.
TREATMENT OF BRONCHIAL ASTHMA
Intermittent mild bronchial asthma requires treatment with short-acting beta-adrenomimetics in the acute phase. With persistent mild form, inhalers with corticosteroids (beclomethasone dipropionate) are used. In severe forms of the disease, combined aerosols are used, including steroid preparations and beta-adrenomimetics (seritide, symbicort). For more effective delivery of drugs in the form of an aerosol to the bronchial tree, special nebulizer devices are used.
Patients suffering from persistent severe bronchial asthma also take corticosteroid medications orally according to indications.
Therapy of aspirin asthma includes antileukotriene drugs (zafirlukast, montelukast).
With the development of asthmatic status, resuscitation measures (artificial ventilation of the lungs) are carried out.
