Endogenous bronchial asthma is a chronic pathology of the respiratory tract, which is based on the inflammatory process. The cause of this 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 of the 10th revision (ICD-10), asthma can be divided into several of the following forms:
- Exogenous form (in Russian literature is often referred to as atopic). Called by a specific external allergen.
- Endogenous form (in the Russian language literature is called infectious-allergic asthma). It is provoked by internal stimuli of the body (pneumonia, acute respiratory viral infections, etc.).
- Mixed asthma. It is a combination of exogenous and endogenous forms.
- Unspecified form. A form of asthma with an unknown cause.
Symptoms of endogenous bronchial 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 are as follows:
- Regular chest tightness.
- Frequent breathing difficulties.
- The appearance of shortness of breath, wheezing and coughing.
Similar symptoms often occur at night, after physical exertion, when certain substances get into 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 disease progression. In addition, the patient has hypersensitivity to the vital products of bacteria, as well as to the bacteria themselves.
The clinical picture of suffocation
Three periods of development of an asthma attack with endogenous bronchial asthma are distinguished. Here they are:
- The period of the harbingers. It consists in the occurrence of precursors (from minutes to hours) of the precursors of its appearance. These include sneezing, nasal congestion, sore throat, itchy skin around the nose, feeling of sand in the eyes. Coughing may sometimes occur.
- High season. Actually an attack. It is characterized by a dry, debilitating cough, heaviness in the chest, suffocation of an expiratory type (it is difficult to "freely exhale").
- The period of reverse development. At this stage, the patient's breathing becomes easier, the departure of viscous sputum begins.
Outside of an attack, as a rule, the patient feels satisfactorily. However, with the further development of pathology, the patient's condition worsens, which can lead to the development of pulmonary, and then heart failure.
Help with an attack
With a mild attack of suffocation, it is stopped by standard means. Various distracting actions are also used, such as talking with a patient, mustard plasters or a warm foot bath.
A moderate to severe attack is stopped by the administration of adrenaline subcutaneously. At the same time, the use of ephedrine is possible.
In a severe attack, it is necessary to call an ambulance and simultaneously administer adrenaline and glucocorticosteroids.
Disease severity
The severity of the disease is determined by the intensity of the symptoms before treatment. Also, one of the most important indicators of severity is FEV 1 - the volume of forced air in 1 second. Today, the following severity levels are distinguished:
- The weakest is asthma with a 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 do not bother more than once a month, exacerbations are short, FEV 1 reaches 80% of healthy values.
- Pathology with a slight persistent course. In this case, asphyxiation occurs more often once a week (but not daily), at night the symptoms begin to disturb up to 2 times a month, exacerbations lead to sleep disturbances and physical activity. FEV 1 also reaches 80%.
- In case of moderate severity of endogenous bronchial asthma, symptoms appear every day and more than once a week at night. FEV 1 is 60-80% of healthy indicators.
- Finally, with a high degree of severity, asthma is difficult, symptoms appear every day. Exacerbations and nocturnal manifestations of symptoms occur more often, motor activity is limited. FEV 1 is less than 60%.
Diagnostics
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 old, as a rule, already having inflammatory changes in the airways and / or long exposure to irrigants.
There are a significant number of methods for diagnosing asthma. 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 observed asthma indicators below:
- General blood analysis. Detects severe eosinophilia.
- General analysis of sputum. In asthma, sputum contains Kurshman spirals, Charcot-Leiden crystals, “Creole bodies” and also a high content of eosinophils and cylindrical epithelial cells.
- Biochemical blood test. An increase in the level of α- and β-globulins is observed.
- The immunogram. It shows a decrease in the activity and amount of T-suppressors and an increase in the level of immunoglobins.
- X-ray of the lungs. During an attack and / or with a prolonged course of the disease, signs of emphysema of the lung (lungs) are visible. At the initial stages of development, outside attacks, changes are not observed.
- Spirography. It shows a decrease in vital capacity of the lungs and FEV 1 .
- Peakfluometry (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 with the help of a special device - a pick-up 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 consists of three elements:
- Educational program. It consists in mastering the methods of preventing the disease by the patient and individually controlling his condition with a peak flow meter.
- Directly treatment (drug exposure and physiotherapy). It is subdivided into several steps.
- Exclusion of factors provoking the development of the disease.
Used drugs
For the treatment of endogenous bronchial asthma, the following categories of drugs are used:
- Inhaled glucocorticosteroids (Fluticasone, Budesonide, Flunisolid, etc.). Anti-inflammatory drugs.
- Systemic glucocorticosteroids (Prednisolone, Dexamethasone). Hormonal drugs are used to relieve inflammation.
- β 2 short-acting agonists (Salbutamol). Stop attacks of suffocation.
- β 2 long-acting agonists (Salmeterol, Formoterol). Relief of bronchospasm and prevention.
- Inhaled M-anticholinergics (ipratropium bromide).
- Methylxanthin preparations ("Eufillin", "Theopec", 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.
The use of drugs in practice
Instructions for use with Budesonide for inhalation, Salbutamol, Salmeterol and other similar drugs are very similar, so you can make some general recommendations.
So, to stop the onset of asthma, one or two doses of aerosol are inhaled. To do this, turn the cylinder with the valve down and, clutching 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 a daily preventive dosage are selected by the doctor individually, based on the age of the patient and the severity of the disease.
If the instructions for use with 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 medicine not according to the instructions. This can lead to side effects (if the dosage is exceeded) and complications (if the doses are too low).
Stages of treatment
The structure of asthma treatment steps corresponds to the severity of the disease, from the mildest to the most severe.
Grade 1. Corresponds to a mild intermittent degree of asthma. At this degree of treatment, patients are prescribed drugs from the group of β 2 short-acting agonists (Orciprenaline, Hexaprenaline, Salbutamol). The purpose of drugs is made both for treatment and for prevention (for example, before physical exertion).
Step 2. Corresponds to asthma with a 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. β 2 -agonists are sometimes used to eliminate asthma attacks.
Stage 3. Corresponds to the moderate severity of the disease. Inhaled glucocorticosteroids are already used in medium doses. Often combined with long-acting β 2 -agonists, theophylline, or antileukotriene drugs. In addition, β 2 agonists are still used to relieve seizures.
Step 4. Corresponds to a severe degree of the disease. High doses of inhaled glucocorticosteroids are used, a long course of oral corticosteroids is prescribed.
Exercise therapy and sports
As a supplement to standard asthma treatments, special physiotherapy exercises are often used. The purpose of the 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 it is always necessary to have an inhaler with you for asthmatics!
A set of exercises is performed within 10-30 minutes 1-3 times a day and is compiled individually by the attending physician.
Exercise is also acceptable for asthma. However, preference should be given to disciplines that develop the diaphragm and shoulder girdle.
Complications
Often, bronchial asthma is complicated by the appearance of pulmonary emphysema and secondary pulmonary heart disease.
In the absence of timely treatment, the so-called asthmatic status. This complication is divided into three stages:
- Stage 1. It is called the stage of initial compensation. It is, in fact, prolonged for a long time (more than 12 hours) asphyxiation. At this stage, patients no longer get sputum, develops resistance to bronchodilator (antispasm) drugs.
- Stage 2. 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 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 may occur, in some cases, the patient may die.
Prevention
For the prevention of bronchial asthma, they mainly take measures to combat occupational hazards and bad habits. You also need to prevent the development of other pulmonary pathologies, always carry an inhaler for asthmatics, and reorganize foci of chronic infection (especially in the nasopharynx).