Bronchial Asthma

Symptoms

The characteristic symptoms of bronchial asthma are attacks of suffocation or expiratory dyspnea (extended exhalation). There is swelling of the wings of the nose, persistent or paroxysmal cough, and agitation. Dry whistling rales are heard at a distance, the auxiliary muscles of the chest are involved in the act of breathing.
In a severe attack, the patient's posture is typical: he sits, resting his hands on his knees or the bed.

Sometimes the patient feels the approach of an attack in advance. For 2-3 days, harbingers appear in the form of irritability, anxiety, weakness, drowsiness, apathy. There is redness of the face, tachycardia, dilated pupils, nausea and vomiting.
At night or in the early morning, the patient is tormented by bouts of dry cough. Patients with asthma have an unproductive cough, sputum is hard to come off, thick white mucus.

Signs of bronchial asthma

Symptoms of bronchial asthma are provoked by the presence of causes that cause the disease.

Among the early factors are:

• Genetic allergy susceptibility

• Allergic symptoms such as rashes and itching, as well as swelling of the lips and eyelids.

• The emergence of nasal congestion and lacrimation in the spring and summer when the weather is dry.

• Coughing on touch with pets, inhaling cigarette smoke, or when doing agricultural labour; weakness, lethargy, and increased weariness after physical exercise.
Main signs:

•    Difficulty breathing;
•    Chest tightness;
•    Dyspnea; 
•    Increased nocturnal paroxysmal cough;
•    The emergence of wheezing. 
•    Symptoms emerge more frequently at night, early in the morning, and after interaction with inciting factors.

Treatment

Therapy of bronchial asthma requires control of the disease. Treatment begins with the exclusion of allergens identified during the diagnosis. With nutritional allergies, a strict diet is indicated. All foods that can provoke an exacerbation of the disease are removed from the diet. When reacting to household irritants, it is necessary to replace feather (pood) bedding with synthetic winterizers, get rid of thick curtains, carpets, and give pets into good hands. The situation is more complicated with seasonal attacks, which are caused by flowering plants. Doctors advise to leave for the period of active distribution of flower pollen. If this is not possible, it is recommended to use a medical mask, carry an inhaler with you at all times, and do not visit squares and parks.

Medical treatment:
Complex drug therapy of BA is carried out in several directions:

•    Stabilization of the condition - maintenance of respiratory function;

•    Prevention of exacerbations, rapid relief of paroxysms;

•    Prevention of irreversible bronchial obstruction.

Two groups of drugs for the respiratory system are considered basic - supportive (for continuous use) and situational (to relieve an asthma attack).

The first group includes:
•    Methylxanthines - with a moderate bronchodilatory effect based on theophylline 

•    Systemic anti-inflammatory drugs;

•    Antileukotrienes that prevent increased capillary permeability;

•    Combined cough medicines ;

•    Vasoconstrictor nasal drops - for seasonal use;

•    immunomodulators - to strengthen local and general immunity.
In the treatment of bronchial asthma, glucocorticosteroids are used. The scheme and doses of hormone therapy are selected individually. Self-medication with hormones, at best, can lead to the development of tachyphylaxis (addiction), and at worst, provoke a heart attack or severe bronchospasm.

To eliminate seizures use:
•    Beta-agonists that improve sputum discharge to increase the lumen of the bronchi (orciprenaline, salbutamol );

•    Blockers of the neurotransmitter acetylcholine (trihexyphenidyl, biperiden, etc.);

•    Inhalers - aerosols containing sympathomimetics and fast-acting methylxanthines.
The relief of severe paroxysms is carried out in the hospital. The supply of humidified oxygen through a mask, infusion therapy, hyperbaric oxygenation help to relieve suffocation - saturation of the bronchi with oxygen under high pressure. With the development of status asthmaticus, it is possible to connect the patient to a ventilator. After stabilization of the patient's condition, he remains in the hospital for a course of treatment.

Tests Required for Diagnosis

It is important to distinguish bronchial asthma from acute left ventricular failure (cardiac asthma), obstructive or asthmatic bronchitis. It is impossible to make an accurate diagnosis based on symptoms alone. The diagnostic complex includes:
•    The study of family history, analysis of the patient's premorbid background, identification of skin rashes, allergic rhinitis.

•    Assessment of the patient's clinical condition, disease dynamics, frequency of exacerbations, intensity, duration of attacks.

•    Evaluation of the effectiveness of antihistamines used in allergies.

•    Physical examination. During auscultation, the pulmonologist hears whistling and wheezing sounds, specific lingering noises during inhalation and exhalation. On percussion, low tympanitis is noted - a sound similar to a knock on a cardboard box (box sound).

•    Spirometry is a hardware measurement of volumetric and velocity indicators of air conduction in the bronchi. Conducted to assess external respiration.

•    Peakflowmetry is an instrumental determination of the maximum expiratory flow rate.

•    Bronchoscopy is a study of the bronchi. A flexible endoscope equipped with a video camera and a lighting system is inserted through the mouth. An image of the inner surface of the bronchial passages is displayed on the screen.

•    Electrocardiography (ECG) to assess the functional capacity of the heart.

•    X-ray or CT scan of the chest to assess the condition of the respiratory system.

•    Allergy skin tests - identifying allergens that cause suffocation. Testing consists in maintaining the minimum doses of the allergen. In the presence of an immunological reaction, itching, swelling or rash appears. The method of conducting skin allergy tests is chosen by the pulmonologist - scarification, intradermal, application or prick-test (tests with an injection).

•    Provocative inhalation test with a nebulizer - inhalation of allergens through a mask under the supervision of a doctor.

•    A blood test for the content of immunoglobulins E, a radioallergosorbent test for IgE.

•    The study of the gas composition of the blood - the determination of saturation, partial pressure of oxygen and carbon dioxide, the concentration of bicarbonate anions in the plasma.

•    Clinical analyzes of sputum, blood, urine.