Canadian Health&Care Mall: Bronchial Asthma
Bronchial asthma is a chronic, non-communicable disease of respiratory tract of inflammatory character. Chronic inflammation of respiratory organs leads to their hyperactivity, a result of which in contact with allergens or irritants, bronchial obstruction develops immediately, which limits air flow and causes suffocation. Asthma attack often develops after precursors and is characterized by sharp breathlessness and wheezing during exhalation. Usually it is accompanied by cough with viscous sputum, and loud wheezing. Bronchial asthma can lead to emphysema and pulmonary heart development, status asthmaticus occurrence.
Over the past two decades, asthma incidence has increased, and today there are about 300 million people who suffer from it. This is one of the most common chronic diseases, which are subject to all people, regardless of sex and age. Mortality among patients with asthma is high enough. The fact that asthma incidence is growing in children in the last twenty years, make asthma not just disease but social problem, fight against which takes a lot of efforts.
Asthma may manifest at varying periodicity, but even in remission inflammation in airway is maintained. In the basis of air flow permeability violations, the following components are included in case of bronchial asthma:
- airways obstruction caused by smooth muscles spasm of bronchial tubes or by mucous membrane swelling.
- bronchial blockage by submucosal glands secretion of respiratory tract because of hyperfunction.
- replacement of muscle tissue in bronchi connecting with long-term disease’s course, which is why there are sclerotic changes in bronchial wall.
Despite complexity, asthma responds well to treatment, through which you can achieve persistent and prolonged remission. Permanent control over condition allows patients to completely prevent onset of breathlessness attacks, reduce or eliminate intake of drugs for attacks relief, as well as an active lifestyle. It helps maintain lung function and eliminate risk of complications.
The most dangerous provoking factor for developing asthma is exogenous allergens, laboratory tests that confirm high level of sensitivity in patients with asthma and in patients who are at risk zone.
The most common allergens are household allergens – home and book dust, fodder for aquarium fish and pet dander, allergens and plant food allergens, also known as nutritional. In 20-40% of patients with asthma it is revealed similar reaction to drugs, and 2% of disease was obtained as a result of working in hazardous conditions or, for example, in perfume stores.
Infectious agents also are an important component in asthma pathogenesis, since microorganisms, their metabolic products can perform as allergens causing sensitization. In addition, continuous contact supports infection inflammation of bronchial tree in active phase, which reduces body’s sensitivity to exogenous allergens.
The so-called haptenation allergens, ie allergens of non-protein structure, getting into human body trigger allergic attacks and increase risk of asthma.
Factors such as hypothermia, family history and stress conditions also occupy an important place in asthma etiology.
At the bottom of bronchi lies organism’s sensitization when under allergic reactions of immediate type, occurring in form of anaphylaxis, antibodies are produced, and at the second meeting with allergen instantaneous release of histamine takes place, which causes bronchial mucosa swelling and glands’ hypersecretion. Delayed immune sensitivity and allergic reactions are similar, but possess less severe symptoms. The increased amount of calcium ions in blood is also recently observed as predisposing factor, as excess calcium can induce spasms, including bronchial muscle spasms.
At postmortem examination of dead during an suffocation attack it was observed partial or complete blockage of bronchi viscous thick mucus and emphysematous lung expansion due to difficulty when exhaling. Microscopic tissue often has a similar picture – thickened muscular layer, hypertrophied bronchial glands, infiltrative wall of bronchus with epithelium desquamation.
Classification of Asthma
- allergic asthma;
- non – allergic asthma;
- mixed asthma;
- unspecified asthma.
According to severity:
- intermittent, that is episodic;
- persistent mild;
- persistent moderate;
- persistent severe.
By exacerbation remission
- unstable remission;
- stable remission.
The level of control:
- partially controlled;
That is, patients’ diagnosis with bronchial asthma includes all of the above characteristics. For example, “non-allergic, intermittent, controlled, in stage of stable remission bronchial asthma.”
Symptoms of Bronchial Asthma
Asthma attacks is divided into three periods: triggers, crisis period and reverse development period. Triggers period was most pronounced in patients with infectious-allergic nature of asthma, it appears vasomotor reactions of nasal organs (profuse watery discharge, incessant sneezing). The second period (it can begin suddenly) is characterized by feeling of tightness in chest, which does not allow to breathe freely. The breath becomes short and sharp, and exhalation is on the contrary prolonged and noisy. Breathing is accompanied by loud wheezing, cough with viscous sputum is observed that makes breathing arrhythmic.
During an attack patient’s position is forced, he usually tries to sit up with body forward, and to find a foothold or rests his elbows on his knees. The face becomes puffy, and during exhalation cervical veins swell. Depending on attack severity, you can watch part of muscles that help overcome exhalation resistance.
At percussion sound is clear due to hyper-airing lung, its mobility is severely restricted, and their boundaries are shifted down. Auscultation of lungs is observed vesicular breathing, weakened with prolonged exhalation, and with lots of dry wheezing. Due to increase in lung volume, point of absolute flatness of heart decreases, cardiac sounds are muffled, with focus of the second tone of pulmonary artery.
In period of reverse development gradual sputum discharge and expressed wheezing are reduced and choking attack is gradually fading.
Manifestations, under which one can Suspect Bronchial Asthma Presence
- wheezing breathing, especially in children.
- recurrent episodes of wheezing, shortness of breath, tightness in chest and cough, worsening at night.
- seasonal deterioration of respiratory system health;
- presence of eczema, allergic diseases in anamnesis;
- symptoms deterioration or emergence when exposed to allergens;
- taking drugs, when in contact with smoke, with abrupt ambient temperature changes, acute respiratory disease, physical exertion and emotional stress;
- frequent cold “going down” in the lower respiratory tract;
- improved condition after taking antihistamines and asthma drugs.
Complications of Asthma
Depending on asthma attacks severity and intensity bronchial asthma can be complicated by emphysema and joining secondary cardio-pulmonary insufficiency. An overdose of beta-agonists, or rapid decline in corticosteroids dosage, as well as contact with massive dose of allergen can lead to status asthmaticus when asthma attacks come one after another and they are almost impossible to stop. Status asthmaticus can be fatal.