Endogenous bronchial asthma is a chronic pathology of the respiratory tract, which is based on the inflammatory process. The cause of such inflammation is the high sensitivity (hyperreactivity) of the bronchi, as well as various diseases of the respiratory tract. A distinctive feature of the endogenous form is the absence of allergic symptoms, which complicates the treatment.
Forms of asthma
According to the International Classification of Diseases, 10th Revision (ICD-10), asthma can be divided into several of the following forms:
- Exogenous form (often referred to as atopic in Russian literature). Triggered by a specific external allergen.
- Endogenous form (in the Russian-language literature it is called infectious-allergic asthma). Provoked by internal stimuli of the body (pneumonia, SARS, etc.).
- Mixed asthma. It is a combination of exogenous and endogenous forms.
- Unspecified form. A form of asthma with an unknown causeappearances.
Symptoms of endogenous asthma
The main symptom is a pronounced attack of shortness of breath (suffocation). In addition, there are a number of signs, by the presence of which one can judge the presence of this disease. These signs look like this:
- Regular chest tightness.
- Frequent difficulty breathing.
- Shortness of breath, wheezing and coughing.
Such symptoms often occur at night, after physical exertion, when certain substances enter the respiratory tract. It is worth paying attention to the relief of the condition after taking bronchodilator drugs. A distinctive feature of endogenous bronchial asthma is a pronounced tendency to progression of the disease. In addition, the patient has hypersensitivity to the products of the vital activity of bacteria, as well as to the bacteria themselves.
Clinical picture of suffocation
There are three periods of development of an asthma attack in endogenous bronchial asthma. Here they are:
- The period of harbingers. It consists in the occurrence some time before the attack (from minutes to hours) of the precursors of its appearance. These include sneezing, nasal congestion, sore throat, itchy skin around the nose, a feeling of sand in the eyes. Occasional coughing may occur.
- The peak period. Actually an attack. It is characterized by a dry, debilitating cough, heaviness in the chest, expiratory suffocation (it is difficult to “breathe freely”).
- The period of reverse development. On theat this stage, the patient's breathing becomes easier, viscous sputum begins to leave.
Outside of an attack, as a rule, the patient feels well. However, with the further development of the pathology, the patient's condition worsens, which can lead to the development of pulmonary and then heart failure.
Seizure help
With a slight attack of suffocation, it is stopped by standard means. Various distractions are also used, such as talking to the patient, mustard plasters or a warm foot bath.
Medium-severe attack is stopped by the introduction of adrenaline subcutaneously. Ephedrine may be used at the same time.
In case of a severe attack, it is necessary to call an ambulance and simultaneously inject epinephrine and glucocorticosteroids.
Severity of disease
The severity of the disease is determined by the intensity of symptoms before treatment. Also, one of the most important indicators of severity is FEV1- forced air volume in 1 second. Today, the following degrees of severity are distinguished:
- The weakest is asthma with mild episodic course. With this form, a rare manifestation of symptoms is characteristic. So, asthma attacks occur no more than once a week, at night the symptoms bother no more than once a month, exacerbations are short, FEV1 reaches 80% of he althy values.
- Pathology with mild persistent course. In this case, suffocation occurs more often than once a week (but not daily), at night the symptoms begin to bother up to 2 times a month, exacerbations lead tosleep and movement disorders. FEV1also reaches 80%.
- With moderate endogenous asthma, symptoms occur every day and more than once a week at night. FEV1 is 60-80% of he althy.
- Finally, when the severity of asthma is severe, the symptoms appear every day. Exacerbations and nocturnal manifestations of symptoms occur more often, physical activity is limited. FEV1while less than 60%.
Diagnosis
For an accurate diagnosis, you must first study the medical history. The endogenous form of bronchial asthma is most often observed in people aged 30-40 years, as a rule, who already have inflammatory changes in the airways and / or have been in contact with irrigants for a long time.
There are a significant number of methods to diagnose asthma. At the same time, it should be borne in mind that one analysis will not give a complete picture; several methods must be applied simultaneously. In addition, you should not engage in self-diagnosis, but it is better to entrust it to professionals. The list of methods, as well as the indicators observed in asthma, are below:
- Complete blood count. Detects severe eosinophilia.
- General sputum analysis. Asthma sputum contains Kurschmann's spirals, Charcot-Leyden crystals, Creole bodies, as well as a high content of eosinophils and cylindrical epithelial cells.
- Biochemical blood test. There is an increase in the level of α- andβ-globulins.
- Immunogram. Shows a decrease in the activity and number of T-suppressors and an increase in immunogloblin levels.
- X-ray of the lungs. During an attack and / or with a long course of the disease, signs of emphysema of the lung (lungs) are visible. At the initial stages of development, outside of attacks, no changes are observed.
- Spirography. Shows decreased vital capacity and FEV1.
- Peakflowometry (measurement of maximum expiratory flow rate). A study conducted not only to diagnose the disease, but also to monitor the patient's condition. It is carried out twice a day throughout the course of treatment using a special device - a peak flow meter.
- Assessment of allergic status. Various types of tests with suspected allergens are used. With the endogenous form they give a negative result.
Treatment
A feature of the treatment of endogenous bronchial asthma is the absence of a hyposensitization procedure due to the absence of a pronounced allergen.
The treatment process has three elements:
- Educational program. It consists in mastering the sick methods of disease prevention and individual control of their condition with the help of a peak flowmeter.
- Direct treatment (medication and physiotherapy). It is divided into several stages.
- Exclusion of factors provoking the development of the disease.
Used drugs
For the treatment of endogenous bronchial asthma are usedthe following drug categories:
- Inhaled glucocorticosteroids ("Fluticasone", "Budesonide", "Flunisolide", etc.). Anti-inflammatory drugs.
- Systemic glucocorticosteroids ("Prednisolone", "Dexamethasone"). Hormonal drugs serve to relieve inflammation.
- β2-short-acting agonists ("Salbutamol"). They stop asthma attacks.
- β2-long-acting agonists ("Salmeterol", "Formoterol"). Relief of bronchospasm and prevention.
- Inhalation M-anticholinergics (ipratropium bromide).
- Methylxanthine preparations ("Eufillin", "Teopek", etc.). Relieve bronchospasm.
The described groups of drugs for endogenous bronchial asthma (with the exception of paragraphs 2 and 6) are taken using a special inhaler.
Use of drugs in practice
Instructions for use for Budesonide for inhalation, Salbutamol, Salmeterol and other similar drugs are very similar, so some general recommendations can be made.
So, to stop the upcoming attack of suffocation, one or two doses of an aerosol are inhaled. To do this, you need to turn the balloon with the valve down and, clasping the mouthpiece with your lips, take one or two deep breaths. If there is no improvement within five minutes, the procedure is repeated. Combinations of several drugs and daily prophylactic dosage are selected by the doctor individually, based on agethe patient and the severity of the disease.
If the instructions for use for "Budesonide" for inhalation or any other drug have been lost, it can be restored using the appropriate search query.
Attention! In no case should you self-medicate and take medicines not according to the instructions. This can lead to side effects (if the dosage is exceeded) and complications (if the dosage is too low).
Treatment steps
Steps of asthma treatment are structured according to the severity of the disease, from the mildest to the most severe form.
Grade 1. Corresponds to mild intermittent asthma. With this degree of treatment, patients are prescribed drugs from the group of short-acting β2-agonists ("Orciprenaline", "Hexaprenaline", "Salbutamol"). Drugs are prescribed both for treatment and for prevention (for example, before physical activity).
Step 2. Corresponds to asthma with mild persistent course. Sodium preparations are prescribed, such as Nedocromil or Cromoglycate. If their effect is not enough, low-dose inhaled glucocorticosteroids, theophylline, or antileukotriene drugs are prescribed. β2-agonists are sometimes used to relieve asthma attacks.
Step 3. Corresponds to the moderate severity of the course of the disease. Inhaled glucocorticosteroids are already used in medium doses. Often combined with β2-agonistslong-acting, theophylline or antileukotriene drugs. In addition, β2-agonists are still used for seizure relief.
Stage 4. Corresponds to the severe degree of the disease. High doses of inhaled glucocorticosteroids are used, and a long course of oral corticosteroids is prescribed.
exercise and sports
Special exercise therapy is often used as an adjunct to standard asthma treatments. The purpose of the use of exercise therapy is to prevent the further development of the disease.
Attention! Performing exercise therapy is allowed only during the remission of the disease, while always having an inhaler for asthmatics with you!
A set of exercises is performed for 10-30 minutes 1-3 times a day and is compiled individually by the attending physician.
Sports are also acceptable for asthma. However, preference should be given to disciplines that develop the diaphragm and shoulder girdle.
Complications
Asthma is often complicated by pulmonary emphysema and secondary pulmonary heart failure.
In the absence of timely treatment, the so-called. status asthmaticus. This complication has three stages:
- Stage 1. It is called the initial compensation stage. It is, in fact, an attack of suffocation prolonged for a long time (more than 12 hours). At this stage, patients stop sputum and develop resistance to bronchodilator (anti-spasm) drugs.
- Stage2. Also known as the decompensation stage. At this stage, there is a violation of the drainage function of the bronchi. Because of this, a violation occurs - a lack of oxygen in the blood and an excess of carbon dioxide.
- Stage 3. Stage of hypercapnic coma. It is characterized by a further decrease in the oxygen content in the blood and an increase in the content of carbon dioxide. Because of this, severe neuralgic disorders, hemodynamic disorders can occur, in some cases the death of the patient is possible.
Prevention
For the prevention of bronchial asthma, they mainly take the fight against occupational hazards, bad habits. You also need to prevent the development of other pulmonary pathologies, always carry an inhaler for asthmatics with you and sanitize foci of chronic infection (especially in the nasopharynx).
