Allergic – allergens trigger a cascade of pathological reactions in the human body. Certain substances and odors trigger an asthma attack;
Neurogenic – as a reaction of the nervous system to human problems. It develops in people with low self-esteem who do not respond well to criticism; can appear in a person with a hysterical personality type when he is trying to attract attention to himself; sometimes such asthma is a response to severe psycho-emotional stress;
Infection-dependent variant – develops in people over 35 years old, asthma exacerbations are accompanied by infectious diseases of the respiratory tract: sinusitis, bronchitis, pneumonia.

Symptoms of bronchial asthma are slightly different for each of the options.

Before the appearance of characteristic asthmatic symptoms, a person develops pre-asthma.

How does allergic asthma begin in adults: pre-asthma

During this period of the disease, there is still no detailed picture, but there are already warning bells. A person often has a stuffy nose, there is an abundant transparent discharge. Problems with the nose can be aggravated in the presence of a certain substance, but sometimes a person takes an allergic rhinitis for a cold and does not consult a doctor for a long time.

Often, at a patient’s appointment, an ENT doctor finds polyps (proliferation of the mucous membrane), which make nasal breathing difficult. They occur against the background of allergic rhinitis.

A person often has a cough, it appears in the form of seizures, the sputum hardly leaves, or it is transparent and scanty. A cough attack catches up at night or in the morning, it is pronounced, sometimes there is a tickling in the throat. Sometimes the cough is so strong that the patient starts to vomit.

After colds, a person with pre-asthma has a cough for a long time, which does not go away while taking antitussive drugs. But it can be stopped if an inhaled drug is used to treat AD.

Allergic asthma symptoms

Upon contact with a certain substance, a person develops an attack of allergic asthma. Before an attack, a person may develop a certain aura – a special condition, after which suffocation always develops. The aura can be different: “water” from the nose, itchy eyes, rashes on the skin, sudden headache. After a certain period of time (it is different for everyone), suffocation develops.

The patient has severe difficulty in exhaling. He calmly inhales the air, but his lungs are no longer able to push it back. The ribcage almost does not move, as if it is swollen (due to accumulated air). At a distance, wheezing is heard: they can be like a whistling or buzzing, if a person has recently been ill, then a slight gurgling appears. At the height of the attack, a small amount of clear glassy sputum leaves and relief comes.

A person with an attack of allergic asthma has a characteristic posture: he sits, leaning heavily on his hands, and leaning forward sharply. This posture is physiological – it facilitates the movement of the chest and helps to improve the patient’s well-being.

The patient’s skin is pale, covered with sweat. If the attack lasts longer, the skin warms up, the face and neck turn red, and constricting pains appear in the region of the heart.

An ultra-prolonged attack can develop into status asthmaticus – this is a serious condition that can result in the death of the patient. Asthma status goes through 3 stages.

In the first suffocation, severe shortness of breath is accompanied by frequent attacks of suffocation. A person repeatedly resorts to the help of an inhaler, but each time its effect is weaker. The patient is sharply agitated, the pupils are dilated, active gestures are observed. With an increase in blood pressure, a severe headache in the occiput may appear. Wheezing strong, whistling.
The second stage is characterized by even more severe and frequent attacks of suffocation. The patient becomes lethargic, apathetic, he feels severe weakness. The muscles of the chest are already too weakened, so the movements in it are weakened, the person breathes with great difficulty. The position of the patient is forced – he either lies on pillows or sits, leaning on his hands. The skin of the face is slightly bluish, the skin of the trunk is moist and cold.
The third stage – the skin of the trunk turns blue, the patient’s confusion is replaced by a coma. A person’s pulse and cardiac activity cannot be heard. This stage often ends with the death of the patient.

Neurogenic asthma

Attacks develop similarly to the allergic variant with the only difference: the person reacts to a traumatic situation. For example, in an insecure person, asthma will overtake at the time of making a decision. Thus, the body postpones an unpleasant moment for itself for a certain time.

Infectious Asthma

The attacks of suffocation are stronger and more severe than in the previous variations. After the end of suffocation, yellow sputum is separated. The disease is provoked by inflammatory diseases and appears mainly in the autumn-winter period.

Diagnostics and examination of bronchial asthma

Diagnostics and examination of bronchial asthma is carried out by hardware methods, laboratory and instrumental studies.
Fluoroscopy and radiography in the early stages of the disease are not informative. With the addition of emphysema on the roentgenogram – increased airiness of the lung tissue.

For a detailed study of the functional capabilities of the lungs, the following are used:

Roentgenokymography. The method is based on the graphic registration of lung movements during breathing. Changes in the kimogram make it possible to judge about external respiration disorders.
Electrokymography – evaluates the ventilation function of the lungs.
X-ray cinematography – filming an X-ray image of the lungs
Peak flowmetry – determines the peak expiratory flow rate (decreases with asthma).
Spirometry measures lung vital volume and expiratory flow rate.
Pneumotachography records the volumes of inhaled and exhaled air in a forced mode, which makes it possible to detect bronchial obstruction.
Bronchoscopy is performed to exclude other causes of bronchial obstruction (foreign body, tumor), as well as to determine the cellular composition of the fluid obtained after bronchial lavage.

Analyzes for bronchial asthma

Analyzes for bronchial asthma are both general clinical and specific to confirm the diagnosis.

General clinical analyzes:

Complete blood count: asthma is characterized by eosinophilia, with an infectious-dependent variant – accelerated ESR, leukocytosis.
Blood biochemistry: in asthma, CRP is detected, an increase in alpha and gamma globulin fractions, an increase in acid phosphatase activity.
General urine analysis
Feces for helminths and protozoa.

Special analyzes:

Microscopy of bronchial sputum: in patients with asthma, eosinophils, macrophages, neutrophils, Charcot-Leiden crystals, and Kurshman’s coils are found.
Bacteriological analysis of sputum for pathogenic microflora and antibiotic sensitivity.
Determination of antibodies to infectious agents in blood serum (chlamydia, fungi and others)
Detection of viral antigens in the nasopharyngeal mucosa by ELISA.
Establishment of the content of steroid hormones in the blood and urine.

Bronchial asthma: symptoms

The characteristic symptoms of bronchial asthma are asthma attacks or expiratory shortness of breath (prolonged exhalation). Bloating of the wings of the nose, persistent or paroxysmal cough, agitation are noted. Dry wheezing 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 with his hands resting on his knees or the bed.
Sometimes the patient senses the approach of an attack in advance. For 2-3 days, precursors appear in the form of irritability, anxiety, weakness, drowsiness, apathy. Redness of the face, tachycardia, dilated pupils, nausea and vomiting are noted.
At night or early in the morning, the patient is tormented by bouts of dry cough. Patients with asthma have an unproductive cough, the sputum comes off heavily, the mucus is thick white.

Signs of bronchial asthma

Signs of bronchial asthma are triggered by the presence of the causes of the disease.

Early factors include:

Hereditary predisposition to allergies
Allergic symptoms with eruptions and itching, with episodes of swelling of the lips and eyelids.
The appearance of nasal congestion, lacrimation in spring and summer in dry weather.
Sudden cough on contact with pets, inhalation of tobacco smoke, while doing agricultural work.
After physical exertion – weakness, lethargy, increased fatigue.

Main signs:

shortness of breath;
feeling of tightness in the chest;
shortness of breath for no apparent reason;
an attack of a sharp lack of air;
increased nocturnal paroxysmal cough;
the appearance of whistling distant wheezing.
Symptoms appear most often at night, in the early morning and upon contact with provoking factors.

Bronchial asthma attacks

Bronchial asthma attacks are mild, moderate and severe.

Conventionally, there are 3 periods in the development of an attack:

Period of harbingers

An attack begins with general excitement, sneezing, paroxysmal cough, shortness of breath. The skin is pale, moist.

Heat period

Severe suffocation, exhalation is difficult. The patient takes a forced position (orthopedic) – sitting on the bed, bending forward, resting his hands on his knees or the bed. The cough is dry, wheezing wheezing, heard from a distance, the phlegm does not go away. The face is swollen with a bluish tinge. The patient is restless, can hardly speak. Pulse of weak filling, tachycardia.

Reverse development period

The sputum becomes more moist, begins to cough up. Breathing is restored.

With a mild attack, the difficulty of breathing is insignificant, movements are not limited, pallor, cyanosis are not noted. Characterized by a moderate pronounced elongated exhalation, small dry wheezing rales. The attack often goes away without outside intervention.

An attack of moderate severity – severe suffocation, pale skin with cyanosis covered with sweat. Forced position – sitting with an emphasis on hands. The auxiliary muscles are involved in breathing. The patient breathes noisily, exhalation is slow, convulsive.

A severe attack is accompanied by spasm of the smooth muscles of the bronchial tree and edema of the mucous membranes. The cough is painful, dry, the phlegm does not go away. The skin turns pale and becomes moist, the chest is swollen (barrel-shaped). Rapid breathing is replaced by a rare one, with loud wheezing wheezing and a long exhalation. With a complicated course and ineffectiveness of treatment, the attack can turn into asthmatic status.

Asthma – what is it?

Asthma – what is it, to what extent can such a disease of the respiratory tract be harmful to a person? Bronchial asthma is a serious disease that affects the bronchial tree. It is of an inflammatory nature, manifests itself in the form of suffocation (broncho-obstructive syndrome). The disease is noted by doctors as a real problem of modern society, which is associated with its progressive course, the complexity of a complete cure.

Having given a definition of bronchial asthma, it is proposed to consider in detail the specifics of its course. Inflammation of the bronchial tract has its own specificity in comparison with other inflammatory processes of the respiratory system. Chronic asthma in its pathogenetic basis contains a dangerous allergic component, expressed against the background of an imbalance of the immune system. This factor explains the reason that an asthmatic person can be in a comfortable state most of the time, and then an asthma attack suddenly occurs.

This is a basic factor, it is appropriate to include a number of auxiliary ones (based on data from representatives of health care structures (WHO)):

Smooth muscle components that are on the bronchial wall differ in case of disorder by excessive hyperactivity, any irritation of them can lead to bronchospasm;
Hazardous factors of the human environment also have an impact on the course of asthma disease. In particular, there is an intense release of harmful mediators of inflammation, allergic disorders (which is amazing, general manifestations of allergy are not observed in this case);
The inflammatory process in the respiratory system in the case of asthma is swelling in the mucous membrane, which in the future leads to a deterioration in the patency of the bronchi themselves;
A factor such as scanty mucus formation is noted. Despite an attack of suffocation, the course and symptoms exclude the phlegm released during coughing or, its minimum amount;
Most often, it is the small and medium bronchi that are affected, a characteristic feature of which is the complete absence of the cartilage framework;
When examining the body of a patient with asthma, a pathology of the lung tissue is found, which is caused by a violation of its natural ventilation. The risk of complications of the disorder, the occurrence of other diseases increases.

In medical practice, there are several smoothly flowing stages of development. Each stage is briefly characterized by the frequency of seizures, the reversibility of obstruction of the bronchial system (therefore, the more often seizures are observed and the longer they last, the higher the stage is).

Defining the concept of asthma stages, they need to be distinguished as follows:

Intermittent stage (otherwise, its mild course);
Mild persistence (the next stage, which is characterized by an increase in the occurrence of attacks, refers to the course of moderate severity);
Moderate persistence (noted in medicine as a severe course of the disease requiring complex nursing care and treatment);
Persistence of a severe stage (a critical stage in the development of the disease, at which the maximum risk of death of the patient is noted).

The above definitions will help you navigate the complexity of the disease. If you can say about yourself that “I have asthma”, but you have no idea exactly what it is and how dangerous the appearance of this ailment can become, then you should read the following information.

If we talk about the disease in general, it can be characterized as a chronic inflammatory process in the bronchial system, proceeding rather sluggishly. The complication is based on a sudden onset of obstruction, with parallel suffocation. The clinical picture is somewhat reminiscent of an allergic disorder caused by unfavorable environmental factors. Analyzing the initial stages, it is noted that the attacks occur quickly and just as quickly stop, bringing the patient minor discomfort. Over time, such manifestations begin to be frequent, they are less exposed to therapeutic effects, and it becomes more and more difficult to cope with their consequences.

How do you get asthma?

Asthma has rather ambiguous causes of its occurrence, given that two types of its manifestation are known in medicine:

Bronchial asthma observed in adults is the result of a spasmodic reaction of the bronchi. A disorder may appear in the case of allergic exposure (as well as the influence of a number of immunological factors). How do you get asthma? In most cases, it is enough to simply belong to the category of people susceptible to allergic disorders and have, in addition, a number of inflammatory processes in the respiratory system. There is also such a cause of asthma as hypersensitivity, noted for a specific category of allergic substances (for example, when they enter the body in excessive quantities, the cells of the immune system begin to synthesize histamine, which in turn causes bronchospasm and swelling in the mucosal area). Asthma is caused by irritating substances that enter the bronchi (in particular, it can be smoke from cigarettes, dust, pollen of plants, microparticles of feathers of birds and animal fur, and much more). If there are risks of developing the disease, it is required to exclude dangerous situations with exposure to allergens. In some cases, the causes of asthma can be hereditary in nature, it should not be discounted, considering the possible factors of influence;
There is a heart-type disease – this disease is based on failure of the ventricle and right atrium, their inability to fully perform the pumping functions assigned to them. Therefore, in order for a cardiac disorder to appear, it is necessary to have congenital or acquired defects of the cardiac system. Violation of the heart will lead to some effusion of the plasma available in the vessels, directly into the bronchi, and edema will begin to form there. The origin of cardiac asthma is closely related to the development and complication of such diseases as: heart valve defects (which causes uneven work of the heart), the course of cardiosclerosis, in which the heart muscles begin to degenerate into connective tissue over time, myocardial infarction. If the first symptoms and suspicions of heart problems appear,

The main signs of asthma

Key signs of asthma are easy enough to check, it is important to pay attention in a timely manner. Treatment is prescribed depending on how accurately the symptoms of asthma are determined (in many respects, its success and reduction of risks depend). The manifestation is characterized by the following visual signs:

A sudden onset of choking or shortness of breath (regardless of whether during the day or at night). The patient can be in comfort with prolonged physical activity, and during rest, there is a manifestation of attacks of bronchial asthma;
With asthma, there is a mandatory cough; it is the dry type that is considered typical. The onset of the syndrome is closely related to shortness of breath, it can be characterized by a kind of annoyance. The cough of a patient with bronchial asthma does not contain sputum, but at the very end of the attack it may have a moist character;
It becomes difficult to breathe (breathing itself becomes frequent, the expiration time is lengthened). In fact, a person suffering from an ailment will not complain about the difficulty of inhaling itself, but about the inability to make a full exhalation. It will take an incredible effort from a person to exhale, and it takes a lot of time, effort;
Chronic asthma also has wheezing symptoms during breathing, which are always dry and a little like wheezing. In some cases, they can be heard, even at a distance from the patient. When auscultation is observed, wheezing increases;
Asthma also has other signs, for example, the patient’s position characteristic of the process under consideration. In medical practice, the position is usually called orthopnosis. The attack looks so that it seems that the patients sit down, after which they hang their legs and begin to firmly grab the bed with their hands. This is due to the need to use auxiliary muscles in order to help the chest to exhale fully.

Not in all cases there is a manifestation of all symptoms at once, there may be two or three of them. But this will be a reason to think about your own health condition and decide to see a doctor, receive treatment and therapy.

Bronchial asthma

Today, in official medicine, it is customary to distinguish four stages in the development of bronchial asthma:

simulating (variable);
light persistent;
moderate asthma;
severe persistent asthma.

It goes without saying that the treatment of this disease in the initial stages is much more effective and practically does not pose a threat to the life of a child or an adult. The reasons for the development of the initial stages can be prolonged contact with the allergen. As a rule, with the exclusion of contact and taking appropriate medications, the symptoms completely disappear.

As for the last stage of development of bronchial asthma, there is already a real threat to human life. If the patient is not provided with timely medical care, then death is not an exception.

Stages of development of bronchial asthma

First stage:

the attack occurs no more than 2 times a week;
night attacks no more than once a month;
exacerbations are short-lived.

Second stage:

the clinical picture manifests itself no more than once a day;
night attacks disturb the patient more often – 3-4 times a month;
insomnia is possible;
unstable blood pressure.

Third stage:

attacks of the disease disturb the patient every day;
frequent nocturnal signs of the disease;
the disease can significantly affect the life of the patient.

Fourth stage:

attacks daily, several times a day;
insomnia, frequent attacks of choking at night;
the patient leads a limited lifestyle.

At the last stage of the disease, an exacerbation of the disease is clearly diagnosed. Seek medical attention immediately.

Aspirin asthma

Among all the possible reasons for the development of this disease in children or adults, acetylsalicylic acid should be especially distinguished, in the common people aspirin. Sensitivity to this drug is observed in 25% of the total population. As a result, a subspecies of bronchial asthma, aspirin asthma, may develop. This subspecies of the disease is characterized by a pronounced clinical picture and a serious condition of the patient.

It should be noted that not only aspirin can provoke an asthma attack or an asthmatic cough. Almost any drug with a similar chemical composition can have such an effect on the body. The stages of development of the disease are the same as in the general clinical picture.

With aspirin asthma, the following symptoms are observed:

asthma attacks;
inflammation of the nasal mucosa;
the formation of polyps on the nasal mucosa.

Aspirin asthma is rarely diagnosed in a child. In the main risk group, women are 30–40 years old. It is noteworthy that initially the disease can manifest itself in the form of influenza or ARVI. Therefore, patients do not seek medical help in a timely manner, which significantly aggravates the situation.

Allergic asthma

This subtype of bronchial asthma is considered the most common among humans. For the first time, the symptoms of pathology appear in childhood and can only intensify over time. The main manifestations of pathology:

frequent sneezing;
cough;
profuse lacrimation;
allergic rhinitis.

Such asthma develops due to an excess of histamine in the body, which begins to be more actively produced due to exposure to allergens.

Most often, the disease develops as a result of prolonged exposure to the body of such allergic substances:

animal hair;
smoke – tobacco, from fireworks and so on;
flavored substances;
dust;
pollen of plants and so on.

Allergic asthma

The main tactic of treatment in this case is the use of antihistamines. They are prescribed by an allergist or immunologist. It is forbidden to “prescribe” drugs to yourself on your own, since you can only aggravate the general condition of the body.

Stress asthma

Signs of the progression of this disease appear, as a rule, during intense physical activity. The patient has shortness of breath, severe cough. The maximum airway is narrowed 5–20 minutes after the start of certain exercises. Treatment of such a condition comes down to the fact that the patient will need to use inhalers to control the occurrence of such attacks.

Cough asthma

The main symptom of the disease is a severe cough that lasts for a long time. Cough asthma is very difficult to diagnose and difficult to treat. Most often, exercise and respiratory infections can provoke the progression of the pathology.

If the patient has repeatedly developed coughing attacks, then it is necessary to immediately consult a doctor for a diagnosis. A test should be passed that will help determine the presence of an ailment – a test of lung functions.

Occupational asthma

The causative agents of this type of asthma are located directly at the human workplace. Most often, a person notes that an exacerbation of the disease develops on working days, and on weekends the symptoms decrease.

The main symptoms are:

cough;
runny nose;
watery eyes.

The development of such asthma is observed in people of the following professions:

the hairdresser;
farmer;
joiner;
artist.

Nocturnal asthma

In the case of the development of this disease, the symptoms appear more intensely at night, during sleep. It is worth noting that, according to statistics, a greater number of deaths due to asthma occurred at night. This is due to many factors:

Bronchial asthma

decreased performance of the lungs during sleep;
horizontal position of the body;
violation of the circadian rhythm, etc.

The main symptoms are:

coughing;
labored breathing;
wheezing.

General information

Over the past two decades, the incidence of bronchial asthma (BA) has increased, and today there are about 300 million asthmatics in the world. This is one of the most common chronic diseases to which all people are susceptible, regardless of gender and age. Mortality among patients with bronchial asthma is quite high. The fact that in the past twenty years the incidence of bronchial asthma in children has been constantly growing, makes bronchial asthma not just a disease, but a social problem, to combat which maximum efforts are directed. Despite its complexity, bronchial asthma responds well to treatment, thanks to which a persistent and long-term remission can be achieved. Constant control over their condition allows patients to completely prevent the onset of asthma attacks, reduce or eliminate the intake of drugs for the relief of seizures, as well as lead an active lifestyle. This helps to maintain lung function and completely eliminate the risk of complications.

Bronchial asthma

The reasons

The most dangerous provoking factors for the development of bronchial asthma are exogenous allergens, laboratory tests for which confirm a high level of sensitivity in BA patients and in those at risk. The most common allergens are household allergens – house and book dust, food for aquarium fish and animal dander, plant allergens and food allergens, which are also called nutritional allergens. In 20-40% of patients with bronchial asthma, a similar reaction to drugs is revealed, and in 2% the disease is obtained as a result of work in hazardous industries or, for example, in perfumery stores.

Infectious factors are also an important link in the etiopathogenesis of bronchial asthma, since microorganisms and their metabolic products can act as allergens, causing sensitization of the body. In addition, constant contact with infection maintains the inflammatory process of the bronchial tree in the active phase, which increases the body’s sensitivity to exogenous allergens. The so-called haptenic allergens, that is, allergens of a non-protein structure, entering the human body and binding with its proteins also provoke allergic attacks and increase the likelihood of AD. Factors such as hypothermia, aggravated heredity and stressful conditions also occupy one of the important places in the etiology of bronchial asthma.

Pathogenesis

Chronic inflammatory processes in the respiratory organs lead to their hyperactivity, as a result of which, upon contact with allergens or irritants, bronchial obstruction instantly develops, which limits the air flow rate and causes suffocation. Asthma attacks are observed with different frequency, but even in the remission stage, the inflammatory process in the airways persists. At the heart of the violation of the patency of the air flow in bronchial asthma are the following components: obstruction of the airways due to spasms of the smooth muscles of the bronchi or due to edema of their mucous membranes; blockage of the bronchi with secretion of the submucous glands of the respiratory tract due to their hyperfunction; replacement of muscle tissue of the bronchi with connective tissue during a long course of the disease, which causes sclerotic changes in the wall of the bronchi.

At the heart of the changes in the bronchi is sensitization of the body, when antibodies are produced during allergic reactions of an immediate type, proceeding in the form of anaphylaxis, and when an allergen is encountered again, an instant release of histamine occurs, which leads to edema of the bronchial mucosa and hypersecretion of the glands. Immunocomplex allergic reactions and delayed sensitivity reactions proceed similarly, but with less severe symptoms. An increased amount of calcium ions in human blood has recently also been considered as a predisposing factor, since an excess of calcium can provoke spasms, including spasms of the bronchial muscles.

In the pathological examination of the dead during an attack of suffocation, there is a complete or partial blockage of the bronchi with viscous thick mucus and emphysematous expansion of the lungs due to difficulty in exhaling. Tissue microscopy most often has a similar picture – it is a thickened muscle layer, hypertrophied bronchial glands, infiltrative bronchial walls with desquamation of the epithelium.

Classification

BA is subdivided according to etiology, severity of the course, level of control and other parameters. Allergic (including professional asthma), non-allergic (including aspirin asthma), unspecified, mixed bronchial asthma are distinguished by origin. According to the severity, the following forms of asthma are distinguished:

Intermittent (episodic). Symptoms occur less than once a week, and exacerbations are rare and short.
Persistent (constant flow). Divided into 3 degrees:

mild – symptoms occur from 1 time per week to 1 time per month
average – daily seizure frequency
severe – symptoms persist almost constantly.

During asthma, exacerbations and remission (unstable or stable) are distinguished. Whenever possible, control over asthma seizures can be controlled, partially controlled and uncontrolled. A complete diagnosis of a patient with bronchial asthma includes all of the above characteristics. For example, “Bronchial asthma of non-allergic origin, intermittent, controlled, in the stage of stable remission.”

What can cause asthma to develop?

Hereditary predisposition (atopy) – it has been proven by more than one study that about a third of patients develop asthma by this mechanism. Such patients are more susceptible to external factors and the wall of their bronchi responds with a violent reaction to seemingly harmless substances inhaled by everyone.

If one of the parents suffers from bronchial asthma, then the probability of developing it in a child is from 20 to 30%. As many as 70-80% of the likelihood of developing asthma in those children whose mom and dad are sick.

Occupational hazards are characterized by constant exposure to the lungs of patients of certain substances. In this case, a response may develop even to those elements that in other conditions would not cause any reaction in the patient.
Poor environmental conditions – the presence in the air of a large amount of dust, other impurities, exhaust gases, soot. This factor is one of those that provides a steady increase in the number of patients with bronchial asthma in recent years.
Eating a lot of salt, spicy foods, food with dyes and preservatives. Conversely, low-fat plant foods reduce the risk of asthma in patients.

What provokes the development of severe attacks of the disease in patients

If the factors that predetermine the increased sensitivity of the bronchi are indicated above, then here we will talk about activators of pathological mechanisms in the lungs.

Allergens are a huge group of trigger factors that can provoke an attack of the disease. This includes plant pollen, animal hair, other mechanical impurities in the air, food and even substances in contact with the patient’s skin (detergents, cosmetics).
Non-steroidal anti-inflammatory drugs are the cause of aspirin asthma. Often the disease is complicated by sinusitis and polyposis of the nasal cavity (in this case, they speak of the aspirin triad). The most severe manifestation of aspirin intolerance is angioedema Quincke.

Clinical manifestations of asthma

Now that the causes of the disease are clear, we can talk about its manifestations. The media and the stories of friends have created in the minds of a large number of patients a misconception about the clinical manifestations of bronchial asthma. The sudden onset of an attack, during which the patient practically stops breathing and risks dying in a few minutes – this scenario is possible, but it is rare.

In fact, the disease does not behave so aggressively, and the signs of bronchial asthma are often erased, which explains the late appeal to doctors in some cases.

A cough that appears for no apparent reason and does not stop with antitussive drugs. In some cases, an attack can last for hours, and sometimes it manifests itself as a slight cough. Each of us coughs several times a day and does not attach importance to this, after all, a defensive reaction.

In order for this symptom not to pass by the patient, it is necessary, with repeated coughing, to observe when it occurs, how long it lasts. The body gets rid of dust trapped in the respiratory tract in several reflex exhalations through the mouth (as scientists call a cough). If an adult or a child has a symptom while walking in parks, communicating with a pet or inhaling tobacco smoke, then you should immediately contact an allergist.

Chest congestion is a specific sensation that occurs when the airway is narrowed. Patients often associate this with bad weather, high ambient temperatures or hard physical work. The situation with children is even worse. parents cannot see or hear this symptom.
Recurrent episodes of shortness of breath. Shortness of breath is a violation of the depth and frequency of breathing. Inhalation becomes less deep, and the number of respiratory movements increases significantly. Normally, an adult should perform from 16 to 20 respiratory movements per minute, all large numbers are shortness of breath. In children, everything is more difficult, since the number of breaths per minute normally differs depending on age (it gradually decreases).

Breathing can become more frequent after physical exertion, at elevated body temperature, diseases of the heart and blood vessels, emotional stress. If, after exercise, the respiratory rate has not returned to normal within a few minutes, then you should be alert. Often, patients simply stop any activity, and their body’s need for oxygen decreases, and after a while, breathing completely returns to normal.

Frequent colds are not a symptom at all, but this should alert the patient. This situation can be explained either by problems with the respiratory tract, or by reduced immunity. In any case, a visit to specialists will not be superfluous.
Sneezing and allergic rhinitis – patients may be aware of the hypersensitivity of the body, but with the help of antihistamines it is relatively easy to cope with the manifestations of the disease. Nevertheless, it is possible that the allergy will continue to proceed in such a mild form and develop into asthma.

The above signs of asthma in adults, as a rule, are associated with the presence of an allergen, can be seasonal and disturb the patient for years. If one of the closest relatives has asthma, then the patient’s alertness should increase significantly

Acute attack of bronchial asthma

It is impossible not to talk about an acute attack of the disease, a condition that forces everyone to seek qualified help.

The patient takes a forced position, which allows you to use the auxiliary muscles in breathing: the legs are spread wide, and the hands rest on the table or window sill.
Since the exhalation process is difficult, the patient takes a shallow short breath, followed by a long and painful exhalation.
During exhalation, wheezing wheezing is heard. They are often so loud that they can be heard at a distance from the patient.
If a person is not overweight, then you can see the retraction of the intercostal spaces.
The cough is painful, accompanied by the discharge of a small amount of vitreous sputum.
The skin becomes cyanotic (bluish), cold to the touch.

Variants of the course of the disease

Almost any disease can occur in various clinical forms. Asthma is no exception and has several varieties, which often becomes the cause of misconceptions and late diagnosis.

Causes of pathology

Bronchial asthma is an inflammatory process in the tissues of the respiratory tract of non-infectious origin. In recent years, the pathology has become more and more common among people of different gender, age and ethnic groups. The disease is chronic in nature and various reasons affecting its development.

As soon as the first attacks appear, you need to consult a doctor about diagnosing the disease. The onset of the development of bronchial asthma in adults and children is characterized by coughing attacks, they occur most often during the period of three or four o’clock in the morning.

To answer the question of how to diagnose asthma, you need to know the nature of the disease. According to the pathogenesis, there are two forms of bronchial asthma: atopic and infectious-allergic.

The most rare is the atopic form, which is based on a hereditary predisposition or disorders in the work of the endocrine and immune systems. With this form of pathology, it is difficult to identify the factors provoking an attack.

In most cases, the causes of chronic pathology are external:

Long course of infectious diseases of viral or bacterial origin. Pathogenic microorganisms and their metabolic products are an antigen that leads to sensitization of the body.
Factors related to the patient’s professional activity. Statistics note a large number of cases when bronchial asthma developed due to the ingress of dust particles, chemicals, prolonged stay in rooms with excessively hot or cold air.
Accommodation in regions with a humid cold climate. Studies have shown that residents of hot, dry areas are subject to bronchial asthma several times less often. The terrain is also of great importance. Residents of megalopolises and industrial centers are diagnosed with bronchial asthma more often than people from rural areas.
As a result of prolonged smoking, the mucous membranes are regularly irritated by nicotine, as a result of which acute inflammation in the bronchi turns into chronic, which in some cases transforms into asthma.
Allergens that provoke an attack can also be drugs such as Aspirin, Ibuprofen, Ketanov, etc. It is important to remember that an attack of suffocation can occur only at the time of interaction with the medication.
Street or household dust, which contains particles of pollen, animal hair, fish food, epithelium and other allergens that can cause an attack.

Differential diagnosis

Bronchial asthma is difficult to diagnose because it does not have pronounced symptoms that distinguish it from other diseases of the respiratory system. The diagnosis made may be unreliable. Therefore, you need to know how to diagnose bronchial asthma.

The mild type of bronchial asthma can be confused:

chronic bronchitis;
cardiac asthma;
tracheobronchial dyskinesia.

They have much similar signs, but there are also differences, therefore, the differential diagnosis of bronchial asthma is established upon receipt of additional data on the disease.

For example, wheezing, shortness of breath, and coughing are common in other types of diseases. To confirm the diagnosis, differential diagnosis of bronchial asthma and chronic bronchitis is carried out:

skin test with allergens shows that bronchitis is not dependent on them;
cough in the form of attacks with the appearance of thick mucus is inherent in bronchial asthma, and bronchitis is characterized by a persistent cough with mucopurulent discharge;
dry wheezing with a whistle give out bronchial asthma, and bronchitis has humming and moist wheezing.

When diagnosing tracheobronchial dyskinesia, the following differences in symptoms are taken into account:

with dyskinesia, a monotonous cough without phlegm and suffocation occur due to physical actions and laughter;
wheezing with shortness of breath is less than with asthma;
tests with allergens give a negative result;
bronchological examination reveals that with dyskinesia there is a sagging posterior wall of the bronchi and trachea, and bronchial asthma is characterized by bronchospasm and obstruction.

Cardiac asthma is recorded by the following signs that are distinguishable from bronchial asthma:

the cause is heart disease in the form of left ventricular failure;
bronchial asthma is common among young people, and cardiac asthma is common among the elderly;
shortness of breath increases with inspiration;
wet rales are accompanied by a gurgling sound;
sputum with blood.

Diagnostic examination methods

Modern diagnostics in the development of bronchial asthma is an important task for a doctor, since adequate treatment can provide complete control over the disease with complete neutralization of symptoms in children and adults. For this, all criteria for asthma are assessed with the exclusion of COPD and a preliminary diagnosis.

Finding out the anamnesis

Bronchial asthma, depending on the degree of morbidity, is diagnosed most often in childhood and adolescence. As a rule, there is a genetic predisposition to the development of asthmatic diseases. In addition, its development is possible against the background of COPD.

A bronchial attack is often associated with the influence of certain factors, provoking characteristic symptoms (shortness of breath, cough, wheezing, weakness, etc.). The attack can appear suddenly. It can be stopped with inhaled bronchodilators. If the seizure persists after using the inhaler, further diagnostic protocols are required, as well as the exclusion of COPD.

Visual inspection during diagnosis

At the initial stage of the disease, professional diagnostics is not able to determine any specific protocols in determining bronchial asthma, except for the exclusion of COPD. During a prolonged attack, a “barrel chest” symptom may occur, which is associated with difficulty exhaling. As a result, a gradual development of emphysema is possible, the criteria and protocols of which depend on the severity of symptoms and the stage of morbidity. Further treatment may depend on the results of the visual examination.

Auscultation and percussion

An important method of professional diagnosis is percussion (percussion) and auscultation (listening) of the lungs. As the attack progresses, wheezing and wheezing may be heard in the lungs. Percussion is effective for long-term disease and emphysema.

Asthma provocateurs

There are many reasons for the onset of asthma, today experts define it as a “heterogeneous” disease, literally, heterogeneous or many causal. But it is known for sure that against the background of chronic inflammation of the mucous membranes of the respiratory tract, most cases of asthma occur, but by no means all diseases can be explained only by this. In asthma, the body does not adequately respond to certain stimuli when the response to the presence of a non-native factor is greater than it should be.

The disease triggering role is most often played by allergens that fill the external environment. As a rule, these are natural allergens, such as house dust, animal hair, flakes of the chitinous cover of insects, and fungal spores. To initiate the process, a microscopic dose of the allergen is sufficient, even a gram is not required. By the way, scientific research confirms that the less often a child encounters such allergens, that is, the cleaner the world around him, the more likely he will develop asthma at the first meeting with a previously inaccessible component of the external environment. So cockroaches were expelled from apartments and the reaction to their allergens became more frequent among the next generations of people who had never met domestic cockroaches.

Promotes the formation of asthma, but does not cause it, gas pollution, occupational hazardous substances, tobacco smoke, food. Triggers are considered a cold, damp climate, significant physical, and in fact almost athletic in an untrained person, loads. By themselves, all of them are not allergens, but they help the allergens to harm, also narrowing the lumen of the bronchi. There is even exercise-induced asthma on exertion, usually associated with inadequate treatment.

Many of us have work-related reasons for asthma, or rather, the work environment. This form is called asthma in the workplace. There are hundreds of substances that can cause disease; house dust is not at all like library, or street, or office dust. With work asthma, the development of an attack is caused by the “work” dust of the office, which does not coincide in composition with the home dust. Similarly, it happens in some kind of production where the dust contains particles of paints and chemicals that are absent in apartments. And it turns out that there is always a reason for asthma.

Internal attitude to asthma

But for the development of asthma, an internal predisposition is also needed. It is assumed that there is a genetic predisposition, because with at least one parent with asthma in half of the cases, the child is at risk of inheriting the disease. But the specific genes responsible for the appearance of the disease have not yet been found. Overweight contributes to the development of asthma, in which abdominal fat pushes the diaphragm into the chest cavity, due to which the volume of breathing decreases, the lower parts of the lungs are “compressed” and bacteria that have flown with the air multiply in the heat and humidity.

An interesting feature of the relationship of the disease with sex. In childhood, boys are more susceptible to asthma, but not because of the “male” chromosome or sex hormones, but they simply have a slightly smaller lumen of the bronchi, therefore, with inflammation, the bronchi are easily blocked by the edematous mucosa, forming a favorable environment for maintaining bacterial inflammation. In adults, asthma is a female disease, and here it seems to be linked to the production of sex hormones, because attacks often coincide with menstruation.

How asthma occurs

Bronchial asthma is based on inflammation of the airways, and the inflammation can be caused by bacteria, viruses, and the simplest microorganisms – anyone. But very often the first attack of the disease occurs precisely after an infection, and since each person, on average, six times a year suffers a viral infection – a cold, the reason for the development of asthma arises quite often. The attack of suffocation itself occurs directly due to a sharp narrowing of the lumen of the bronchi, as a rule, against the background of an already existing inflammatory narrowing.

The mucous membrane in a state of inflammation is saturated with an excess of fluid and immune cells gather in a multitude, ejecting biologically active substances at the slightest reason. A tiny allergen that has flown in with an air stream falls on a loose edematous mucous membrane, and immediately crowds of immune cells rush to it, throwing out products that should kill the allergen, but the allergen is not a living organism, it cannot be killed. The mucous membrane swells even more, narrowing the lumen, and air can pass through the bronchus only with the application of force. Suffocation begins, all normal people are afraid of death from lack of air, and from the release of “fear hormones” the attack intensifies even more.

Asthma attacks are most often triggered by stress, emotional distress, after mental stress and overwork. Asthma is a psychosomatic illness, it not only arises against the background of emotions, the attack is aggravated by emotion, the fear of meeting an allergen and the development of an attack does not pass without a trace for the psyche. In patients under 40 years of age, in nine out of ten cases, a long-standing allergy becomes the cause of the disease. In older people, asthma can also develop asthma, because emphysema and lung disease create a favorable environment.

Choking attacks

Asthma attacks are one of the most common symptoms in bronchial asthma. They develop even at first, at an early stage. The seizures are divided into 3 periods described in the table.

Asthma period	Status description
Harbingers	It develops more often in patients with asthma, the cause of which is the development of an infectious agent. Persistent rhinitis occurs with profuse nasal discharge. Sneezing is frequent, does not stop
High	This is the second period. More often it starts suddenly. The patient feels heaviness, tightness in the chest. Breathing becomes uneven, heavy. Inhale is short, exhale is long, accompanied by a loud noise. Breathing gradually becomes more difficult. Whistling and snoring appear. There is a strong cough, accompanied by copious and thick phlegm
Reverse development	Appears when using antihistamines, steroid drugs. Gradually, the person comes back to normal. His breathing becomes free. the cough disappears. But after the end of the attacks, the state of health remains poor for a long time.

It is on the basis of external signs that the doctor will assume bronchial asthma. But the patient may develop other clinical symptoms as well. Therefore, it is important to take a complete history.

External symptoms

Most patients with the disease have similar symptoms when seizures form. From these precursors, one can understand that a person urgently needs to take medicine. The following characteristic features are distinguished:

the patient becomes ill, he tries to take a sitting position;
the patient does not move, takes a forced position, in which his condition is relieved, usually the body leans forward, the hand tries to find a fulcrum on the knees;
the face is swollen, reddened;
severe shortness of breath;
the veins on the neck become wider, on exhalation they become strongly strengthened;
when inhaling and exhaling, muscles become visible, which help in the act of breathing;
a cough begins with profuse sputum production, after which the person begins to choke.

An attack of spasm of the bronchial tree cannot be eliminated without the use of drugs. Therefore, the patient is advised to carry an inhaler with him at all times in case of relapse. He is selected by a doctor after a complete diagnosis.

The medicine should be constantly with the patient, even if he is in remission, in order to stop the attack in time.

Not only the patient should know about external signs, but also the people around him. If the attack is severe, the patient will not be able to help himself. For example, find a medicine in a bag. Another person will not be able to understand his condition by external symptoms by offering a medicine.

Night cough

If asthma occurs early, many people do not understand why coughing occurs at night. This is due to the lying state of the sick person. Sputum accumulates in his bronchial tree. Since the person does not move, it does not stand out outward. Therefore, a cough reflex occurs in order to eliminate phlegm outward.

The cough can be so severe that the patient has a gag reflex. If a person is asleep at this moment, he may choke in vomit. Therefore, many people who have already been diagnosed sleep in a semi-seated state.

It is recommended to take a semi-sitting position during sleep during an exacerbation, when remission or seizure relief occurs, you can lie down completely.

Since the cough occurs due to the accumulation of phlegm, it often manifests itself in the morning. Over the entire night period, an abundant amount of mucus accumulates.

It is recommended for such patients to constantly do wet cleaning, since the cough reflex manifests itself in conditions of the influence of household dust, house mites from the pillows.

Typical early stage symptoms

Allocate a list of symptoms that distinguish bronchial asthma from other pathologies. Many viral and infectious diseases of the respiratory tract can have a similar clinic, so it is important to know the differences. The following features are distinguished:

the formation of wheezing on inhalation and exhalation is more often inherent in children, but remains in many adults while the disease persists;
the same episodes of all 3 periods of bronchial asthma, accompanied by shortness of breath, wheezing, tightness in the chest;
attacks are most characteristic of the night period;
exacerbation of pathology in certain seasons, for example, the period of flowering trees in spring;
a history of other pathologies of allergic genesis (hay fever, atopic dermatitis, eczema);
exacerbation of an asthmatic condition under the influence of unfavorable factors – cigarette smoke, active physical activity, pressure or temperature drops, infectious and viral diseases, stress;
great susceptibility to colds, the infection quickly descends the bronchial tree, since it is constantly in the process of inflammation.

The state of health of patients improves if the drugs are taken in a timely manner. An exception is the refractory form of asthma. The drugs that patients use in the form of inhalation help better. The active substance directly affects the bronchial tree, the effect manifests itself immediately.

Definition of atypical forms

The atypical form of bronchial asthma is manifested by incomprehensible clinical symptoms. Most often it is mixed, so it is difficult for a doctor to visually determine why it occurs. The following features are distinguished:

slight cough during the daytime, which is worse at night;
lack of sputum production due to a small inflammatory process in the bronchial tree;
whistling in the chest, present due to the heavy passage of air through the bronchi and bronchioles;
malaise, manifested in the form of headache, dizziness, loss of strength;
nasal discharge, sneezing.

According to these signs, the doctor may suggest rhinitis, tracheitis, bronchitis. Therefore, the diagnosis is difficult. It is important to choose a competent therapist who will conduct a complete examination in order to make a diagnosis. It includes the following tests:

general blood analysis;
take a sputum sample for general analysis;
immunogram, determination of allergens;
bronchoscopy, radiography.

These studies are sufficient to determine the exact cause of the illness, cough, and other symptoms. This is how differential diagnosis is carried out. It is also used for patients with obvious signs of asthma. It is impossible to cure the patient without examination. More often, the atypical form is characteristic of mild bronchial asthma, or developing in the early stages.

How is remission manifested?

Remission of bronchial asthma is possible even in the initial stages of the disease. It is formed in cases when the disease was diagnosed on time, the patient timely uses the prescribed medicines, folk remedies. The patient’s well-being is significantly improved. The attacks disappear completely.

If bronchial asthma is chronic, the periods of remission are temporary; under the action of unfavorable factors, attacks will recur.

Doctors remind patients that remission is not about recovery. This fact remains valid even when seizures do not appear for many months. An exacerbation can occur suddenly, catching the patient by surprise. Therefore, you can not refuse to constantly wear the inhaler.

During remission, any clinical symptoms of asthma disappear. Even nasal discharge does not appear. This state can be achieved with basic drug therapy. This type of remission is called pharmacological. The condition can improve on its own, but for this it is necessary to completely eliminate the allergen from the patient’s life.

Complications of bronchial asthma

If you do not diagnose bronchial asthma in time and do not choose a therapy that will allow you to control the course of the disease, complications may develop:

pulmonary heart, up to acute heart failure;
emphysema and pneumosclerosis of the lungs, respiratory failure;
atelectasis of the lungs;
interstitial, subcutaneous emphysema;
spontaneous pneumothorax;
endocrine disorders;
neurological disorders.

Diagnostics of the bronchial asthma

Bronchial asthma is a clinical diagnosis that a doctor establishes, taking into account the complaints, anamnestic characteristics of the patient, functional diagnostic methods, taking into account the degree of reversibility of bronchial obstruction, special examination for the presence of allergic pathology and differential diagnosis with other diseases with similar complaints. The onset of the development of the disease most often occurs at the age of 6 years, less often after 12 years. But the appearance is possible at a later age. [9] Patients complain of episodes of shortness of breath at night, in the early morning hours, or associate complaints with emotional and sometimes physical overload. These symptoms are combined with shortness of breath, with impaired exhalation, “whistling” in the chest, recurrent cough with a small amount of phlegm. These symptoms can be relieved on their own or with the use of medicinal bronchodilators. It is necessary to associate the appearance of AD signs after interaction with allergenic substances, the seasonality of the onset of symptoms, the relationship with clinical signs of a cold, the presence of atopic diseases or asthmatic problems in the anamnesis.

If you suspect a diagnosis of asthma, you should ask the following questions:

Are you worried about wheezing attacks in your lungs?
Do you have a cough at night?
How do you handle physical activity?
Are you worried about the heaviness behind the breastbone, coughing after staying in dusty rooms, contact with animal hair, in the spring and summer?
Have you noticed that you are more often ill for more than two weeks, and the illness is often accompanied by coughing and shortness of breath?

Specific diagnostic methods

1 Assessment of lung function and the degree of reversibility of bronchial constriction

Spirometry is a basic and simple method for studying the severity and reversibility of bronchial obstruction, which is also used for the subsequent assessment of the course of asthma. When conducting FVD, it is possible to identify the type of changes in bronchial breathing (obstructive, restrictive, mixed), to assess the severity of the condition. For an accurate diagnosis of the reversibility of bronchial constriction, a test with bronchodilator drugs can be used. The generally accepted positive test is considered to be an increase in FEV1 ≥12%. The following types of bronchodilators are used: β2-agonists of rapid effect (salbutamol, fenoterol, terbutaline) with response control within 14 minutes. A positive test indicates the reversibility of the values of impairments in AD. [9]
Peak flowmetry. Measurement of peak expiratory flow rate using a special simple apparatus – peak flow meter is often used. It is necessary to explain to patients how to measure PEF in the morning (before using drugs); in this case, we measure the lowest PSV value. Measurement of PSV must be done in the late evening, this will be the highest level of PSV. The variability of the PSV during the day is called the amplitude of the PSV. The PSV should be fixed for about 2-3 weeks. This study evaluates PSV at home and at work, which allows us to determine how environmental factors influence the patient’s well-being (allergens, occupational factors, physical activity, stress and other triggers). [10]
Determination of bronchial hyperreactivity. The presence of hyperreactivity of the bronchial tree is considered an important criterion for the diagnosis of asthma. The most used method for studying bronchial hypersensitivity at the moment is the bronchoconstrictor test with biologically active substances (methacholine, histamine), as well as physical activity. Assessment of research indicators is assessed by changes in FEV1. With a decrease in the RVF1 indicators by more than 20% (from the initial figures), the test can be considered positive. [8]

2 Allergy examination. It implies conducting allergy tests on the skin, provocative tests with certain types of allergens, laboratory tests to detect specific IgE antibodies. The most common are skin tests, as these are simple techniques for performing, reliably accurate and safe for patients.

2.1. There are the following types of skin allergy tests according to the technique:

scarification allergy tests;
prick tests (prick-test);
intradermal tests;
application tests

To carry out skin tests, data from the patient’s medical history are needed, indicating an unambiguous connection between complaints and contact with that allergen or their group in the pathogenesis of the disease, an IgE-dependent type of allergic reaction.

Skin testing is not performed in the following cases:

exacerbation of an allergic disease;
acute viral or bacterial diseases (ARVI, nasopharyngitis, bronchitis, etc.);
severe asthma, its uncontrolled course (FEV1 <70% despite basic therapy);
exacerbation of infectious diseases (tuberculosis, syphilis, etc.);
decompensated phase of diseases in other organs and systems (cardiovascular, endocrine, digestive, urinary, circulatory systems, etc.);
autoimmune diseases (SLE, rheumatoid arthritis, scleroderma, etc.);
the presence of tumors;
mental illness;
pregnancy and breastfeeding;
AIDS;
it is difficult to conduct skin allergy examinations in children under 3 years of age, due to their restless behavior. [10]

2.2. Provocative inhalation test. Respiratory Society experts from Europe recommend this study. Before the study, spirometry is performed, and if the level of FEV1 does not fall below 70% of the norm, the patient is allowed to be provoked. A nebulizer is used, with which it is possible to dispense certain doses of the allergen with a jet, and the patient makes several inhalations with certain dilutions of allergens under the constant supervision of an allergist. After each inhalation, the results are evaluated after 10 minutes three times. The test is regarded as positive with a decrease in FEV1 by 20% or more from the initial values.

2.3. Laboratory diagnostic methods. Diagnostics in the laboratory is a minor method. It is carried out if another study is needed to confirm the diagnosis. The main indications for the appointment of laboratory diagnostics are:

age up to 3 years;
a history of severe allergic reactions to skin examination;
the underlying disease is difficult, with practically no periods of remission;
differential diagnosis between IgE-mediated and non-IgE-mediated types of allergic reactions;
exacerbation of skin diseases or structural features of the skin;
requires constant intake of antihistamines and glucocorticosteroids;
polyvalent allergy;
when conducting skin testing, false results are obtained;
refusal of the patient from skin tests;
skin test results do not match clinical findings.

In laboratories, the following methods for determining general and specific IgE are used – radioisotope, chemiluminescent and enzyme immunoassays.

The newest approach to the diagnosis of allergic diseases at the moment is molecular allergy testing. It helps to more accurately diagnose, calculate the prognosis of the course of the disease. For diagnosis, it is important to consider the following nuances:

the difference between true sensitization and cross-reactions in patients with polyallergy (when there is a wide range of sensitization);
reducing the risk of severe systemic reactions during allergy testing, which improves patient adherence;
precise definition of allergen subtypes for allergen-specific immunotherapy (ASIT);
the most common chip technology is the Immuna Solid phase Allergen Chip (ISAC). It is the most comprehensive platform that includes over 100 allergenic molecules in a single study.

Treatment of bronchial asthma

Today, unfortunately, modern medicine cannot cure a patient from bronchial asthma, but all efforts are reduced to the creation of therapy while maintaining the patient’s quality of life. Ideally, with controlled asthma, there should be no symptoms of the disease, normal spirometry indices, and no signs of pathological changes in the lower parts of the lungs. [1]

European guidelines suggest a stepwise approach to treatment:

BA pharmacotherapy can be divided into 2 groups:

Situational drugs
Permanent use drugs

The drugs for the relief of seizures are as follows:

short-acting β-adrenergic agonists;
anticholinergic drugs;
combination drugs;
theophylline.

Supportive therapy drugs include:

inhaled and systemic glucocorticosteroids;
combinations of long-acting β2-agonists and GCS;
long-acting theophyllines;
antileukotriene drugs;
antibodies to immunoglobulin E.

For AD therapy, both medicinal preparations and methods of introducing these substances into the body and respiratory tract are important. The drugs can be administered orally per os, parenterally, by inhalation.

The following groups of drug delivery through the respiratory tract are distinguished:

aerosol inhalers;
powder inhalers;
nebulizers.

The most modern and well-researched method of treating allergic asthma with proven efficacy is ASIT (allergen-specific immunotherapy). ASIT is currently the only therapy that changes the development of the disease by acting on the mechanisms of asthma pathogenesis. If ASIT is carried out in time, this treatment can stop the transition of allergic rhinitis to asthma, as well as prevent the transition of a mild form to a more severe one. And also the advantages of ASIT are the ability to prevent new sensitizations from appearing.

ASIT for BA is performed in patients with:

mild or moderate form of the disease (FEV1 numbers should be at least 70% of the norm);
if the symptoms of asthma are not completely controlled by hypoallergenic life and drug therapy;
if the patient has rhinoconjunctival symptoms;
if the patient refuses constant form therapy;
if during pharmacotherapy there are undesirable effects that interfere with the patient.

Today we can offer patients the following types of ASIT:

injection of allergens
sublingual administration of allergens

Forecast. Prophylaxis

In modern conditions, there is no evidence that environmental, climatic factors, nutritional disorders can worsen the course of AD, and elimination of these triggers will help to reduce the severity of the disease and reduce the amount of pharmacotherapy. Further clinical observations in this vein are required. [7]

Allocate primary prevention. It includes:

elimination of allergens during pregnancy and in the first years of a child’s life (hypoallergenic life and hypoallergenic diet);
lactation;
milk mixtures;
nutritional supplements during pregnancy (there are several hypotheses for the protective effect of fish oil, selenium, vitamin E);
quitting smoking during pregnancy.

Secondary prevention includes:

avoid pollutants (increased concentrations of ozone, ozone oxides, particulate matter, acid aerosols);
fighting house dust mites;
do not have pets;
smoking cessation in the family.

Signs of a predisposition to asthma

A condition characterized by the risk of developing bronchial asthma is called pre-asthma. It is characterized by the development of allergies of a different nature in combination with inflammation of the respiratory system or vasomotor disorders.

Suspicions of asthma can be caused by the presence of true allergic pathologies of the respiratory system (hay fever, rhinitis, sinusitis, bronchitis, alveolitis), which are characterized by seasonal exacerbations. Their development is most often triggered by various allergens.

The first signs of the disease

Other pathologies join the basic allergic component, which are the cause of the onset of asthma symptoms:

increased activity of smooth muscle of the walls of the bronchi. Any irritating effect on the mucous membranes leads to the development of bronchospasm;
under the influence of some external factors, a massive release of substances involved in the development of inflammatory and allergic reactions is possible. The usual symptoms characteristic of allergies are not observed in such a situation;
the main sign of inflammation is swelling of the mucous membranes. Because of this feature, in asthma, the patency of the bronchi worsens;
decreased mucus production. Against the background of an attack of asthma, there is a lack of mucous secretion with cough syndrome or its minimum amount;
there is a predominant lesion of medium and small bronchi, which lack a cartilaginous framework.
with the development of the disease, a pathological transformation of lung tissue is observed due to impaired ventilation.

There are several degrees of severity of this pathology, the classification is based on the reversibility of bronchial obstruction and the frequency of asthma attacks. The more often the attacks occur and the longer the attacks last, the more severe the degree.

When diagnosing the disease, asthma is isolated:

light flow (intermittent);
moderate (persistent mild);
severe (persistent moderate);
extremely severe (persistent severe).

Based on the information given above, we can say that bronchial asthma is a chronic sluggish inflammatory disease of the bronchi, the cause of exacerbations in which is a reaction to external stimuli, causing an attack of bronchial obstruction, accompanied by suffocation.

At an early stage of the development of the disease, attacks are rare, they are removed quickly. Over time, they appear more often and are less amenable to therapy.

How successful the treatment of this ailment will be depends on the timely detection of pathology.

At an early stage, patients with bronchial asthma develop complaints about the presence of:

shortness of breath or choking. These signs can appear with complete well-being and rest at night, as well as against the background of physical exertion or if polluted air, smoke, dust, pollen of plants enter the respiratory tract. In addition, the occurrence of such symptoms is possible due to changes in air temperature. The main symptom is their sudden paroxysmal appearance;
cough. A typical symptom of bronchial asthma is a dry cough. It appears at the same time as shortness of breath, it is characterized by annoyance. The person seems to be trying to clear his throat, but he can’t. Only by the end of the attack does the cough become moist, a scanty transparent mucous sputum appears;
frequent peripheral breathing with prolonged exhalation. In the process of an asthma attack in adults or children, complaints appear not about difficulty breathing, but about the inability to fully exhale. The exhalation in this case is long; to carry it out, great efforts are required;
wheezing during breathing. As a rule, they are dry, whistling. Sometimes they can even be heard remotely. In the process of auscultation, they listen better;
the need to take a characteristic posture during an attack. Doctors gave the name to this position – orthopnea. The patient in such a situation sits down with his legs lowered, rests his hands on a horizontal surface. In this position, additional muscles are involved, and it is easier for a person to breathe in.

Only some typical signs of the disease characteristic of seizures can signal bronchial hyperreactivity. They are characterized by short duration, independent disappearance, then they do not appear for a long time.

Only over time does the symptomatology become progressive. The main thing is not to miss this moment and consult a doctor in a timely manner, regardless of the frequency of occurrence and duration of attacks.

The main and accompanying symptoms of bronchial asthma

This disease is actually a serious problem, as it is characterized by a progressive course. It cannot be completely cured.

The main complaints of patients with bronchial asthma:

shortness of breath, shortness of breath, shortness of breath. They appear, as a rule, after contact with an allergen;
paroxysmal dry cough, usually at night or in the morning. Sometimes a scanty transparent phlegm resembling mucus is excreted;
dry wheezing – whistling or squeaky sounds that appear during breathing;
Difficulty exhaling during full inhalation. To exhale, a person is forced to resort to the orthopnea posture, which was described earlier.

For bronchial asthma development is characteristic:

acrocyanosis and diffuse cyanosis of the skin;
enlargement of the heart;
symptoms characteristic of pulmonary emphysema (barrel chest [M32], impaired respiratory function);
pathological changes in the structure of the nail plates – they begin to crack, acquire a convex shape;
drowsiness;
concomitant pathologies – dermatitis, eczema, psoriasis, rhinitis (runny nose).

It should be noted that the main clinical manifestations of the disease are very variable. This even applies to the same patient (in one case, the symptoms quickly disappear, in the other they persist for a long time and appear intensively).

Symptoms vary from patient to patient. For some, the ailment does not manifest itself for a long time, and the development of exacerbations is a rare occurrence, others face seizures every day.

Symptoms Not Common to Asthma

Some manifestations characteristic of asthma can appear in other diseases. You can suspect the presence of other pathologies if:

against the background of suffocation, dizziness appears, darkens before the eyes, limbs grow numb;
with a cough syndrome, sputum is always separated, and there is no suffocation;
the patient’s voice changes;
the patient begins to complain of the appearance of symptoms characteristic of asthma only during a cold;
if a person smokes for a long time;
if heart problems have been diagnosed that have caused heart failure.

Signs of an approaching attack

Before an attack, precursors appear in the form of irritability, anxiety, in some cases lethargy, rarely drowsiness and apathy. The duration of this period is 2-3 days.

Also, before the onset of an attack, there may be several signs of bronchial asthma:

hyperemia of the skin on the face;
tachycardia;
dilated pupils;
the appearance of nausea and vomiting is possible.

Sources used and useful links on the topic: https://znanion.ru/zdorovie/astma-simptomy-u-vzroslyh-i-kak-nachinaetsya/ https://mediccare.ru/bronhialnaya-astma-prichiny-simptomy-diagnostika- lechenie-pomosch-pri-pristupe.html https://pulmonary.ru/astma/chto-takoe-astma/ https://SimptoMer.ru/bolezni/organy-dykhaniya/1131-astma-simptomy https: // www. KrasotaiMedicina.ru/diseases/zabolevanija_pulmonology/asthma https://allergolife.ru/pervye-priznaki-bronxialnoj-astmy-kak-ne-upustit-moment/ https://astmatiku.ru/bronhialnaya-astma/diagnostika-bronh / https://medica24.ru/zabolevaniya/bronhialnaya-astma https://netbolezni.net/pulmonologiya/1017-kak-uznat-est-li-astma-u-vzroslogo.html https://ProBolezny.ru/bronhialnaya-astma/ https://bronhialnaya-astma.com/diagnostika/osnovnye-proyavleniya-bronhialnoj-astmy-pervye-priznaki-i-osnovnye-simptomy

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