Presentation on the topic of asthma in children. Presentation on the topic "sp in bronchial asthma in children" presentation for a lesson on the topic

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Bronchial asthma -

Chronic inflammatory disease of the airways involving mast cells, eosinophils, T-lymphocytes, mediators of allergy and inflammation, accompanied in predisposed individuals by hyperreactivity and variable (reversible) bronchial obstruction, which is manifested by an attack of suffocation, the appearance of wheezing (wheezing), coughing and / or difficulty breathing.

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The prevalence of asthma in Europe has doubled since the early 1980s In Ukraine, the prevalence of asthma among children has increased 1.6 times over the past decade regions suffer from BA much more often

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TYPES OF BRONCHIAL OBSTRUCTION:

Acute - due to spasm of the smooth muscles of the bronchi Subacute - due to swelling of the bronchial mucosa Chronic - blockage of small and medium bronchi with a viscous secret Irreversible - due to the development of sclerotic changes in the bronchial wall with a long and severe course of the disease

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Predisposing factors:

Atopy - a hereditary predisposition to allergic reactions Bronchial hyperreactivity - an increased response of the bronchial tree to specific and nonspecific stimuli Hyperproduction of immunoglobulin E

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Sensitization factors:

Household: house and library dust, waste products of house dust mites, cockroaches, dry fish food, pillow feathers Non-pathogenic fungi (molds, yeasts) Epidermal allergens (cats, dogs) Plant allergens (pollen of trees, weeds, flowers) prematurity due to the immaturity of the lung tissue and the immune system

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Resolving factors (triggers):

Pollutants - compounds of sulfur, nitrogen, nickel, CO - the result of the work of factories, exhaust gases of cars Smoking - active and passive ARVI Food Household, vegetable and other allergens Physical activity Stress Meteorological factors

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Ways to activate the immune response:

Allergen Mast cell Inflammatory mediators Allergen T-helper of the 2nd order Eosinophils, basophils, mast cells, etc. Inflammatory mediators Allergen T-helper of the 2nd order B-lymphocyte IgE Mast cell Types I, III and IV of allergic reactions are involved in the development of AD

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Classification of asthma in children by severity

Mild - attacks no more than 1 time per month, mild, stop spontaneously or with a single use of bronchodilators, there are no symptoms in the period of remission. PSV and FEV1 more than 80% of the norm, daily fluctuations are not more than 20%. Moderately severe - attacks 3-4 times a month, with impaired function of external respiration, are stopped by bronchodilators or parenteral corticosteroids, remission is incomplete. PSV and FEV1 60 - 80% of the norm, daily fluctuations 20 - 30%. Severe - attacks several times a week or daily, severe, are stopped by bronchodilators and corticosteroids parenterally in a hospital, incomplete remission (respiratory failure of varying degrees. PSV and FEV1 less than 60% of the norm, daily fluctuations more than 30%.

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Treatment of asthma in the acute period:

Termination of contact with the allergen Oxygen therapy Inhaled B2-agonists (salbutamol (Ventolin), terbutaline (Berotek)) or combined B2-agonists + M-anticholinergics (berodual, combivent) and systemic glucocorticosteroids

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Basic therapy for AD:

Hypoallergenic diet, regimen Allergen-specific immunotherapy Cromones: sodium cromoglycate (Intal), sodium nedocromil (Tyled) Inhaled glucocorticosteroids: flunisolide (Ingacort), belomethasone dipropionate (Becotide, beclozone, beclocort, aldecine), budesonide (Pulmicort), fluticasone (Flixotide) ) Long-acting B2-agonists: salmeterol (serevent), formoterol (foradil) Antileukotriene drugs: montelukast, zafirlukast

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Bronchial asthma IN CHILDREN

Concept of Bronchial Asthma Asthma is a disease characterized by chronic inflammation of the airways, leading to hyperactivity in response to various stimuli and recurring bouts of bronchial obstruction.

Clinic The main signs of bronchial asthma are asthma attacks. Asphyxiation attacks are divided into the following periods: Harbingers Attacks Post-attacks Interictals

The period of precursors - comes a few minutes or a day before the attack. The period is characterized by: Anxiety Sneezing Itchy eyes Lachrymation Headache Sleep disturbance Dry cough

The attack period is characterized by: Shortness of breath Wheezing Wheezing Pale skin Slight cyanosis Tachycardia, etc. During an attack, a person takes a sitting position and rests his hands on the edge of a bed or chair. The duration of the attack is 10-20 minutes, with a long course of up to several hours.

Risk factors

Internal risk factors genetic predisposition; atopy (hyperproduction of IgE in response to the intake of an allergen); airway hyperreactivity; gender (more often in women); racial identity.

Factors that provoke exacerbation of BA: domestic and external allergens; indoor and outdoor pollutants; respiratory infections; physical activity and hyperventilation; changing weather conditions; sulfur dioxide; food, nutritional supplements, medicines; excessive emotional stress; smoking (passive and active); irritants (house spray, paint smell).

Cells involved in the formation of the inflammatory process in AD: Primary effector cells: mast cells (histamine); macrophages (cytokines); epithelial cells. Secondary effector cells: eosinophils; T-lymphocytes; neutrophils; platelets.

Forms of bronchial obstruction: acute bronchospasm, swelling of the bronchial wall (subacute), chronic obstruction with mucus, remodeling of the bronchial wall. Normal FEV1 (forced expiratory volume in the first second) - at least 75% of VC

Degrees of pulmonary obstruction: - more than 70% - mild; 69-50% - moderate; less than 50% - severe.

CLASSIFICATION OF BA (according to ICD X): BA: atopic (exogenous); non-allergic (endogenous, aspirin); mixed (allergic + non-allergic); unspecified. Asthmatic status (acute severe asthma). Aspirin: PG deficiency is observed in AD, and aspirin (like other NSAIDs) further reduces their level. Salicylic acid is found in a variety of foods, so it's important not to confuse this form of asthma with a food allergy.

ASTH SEVERITY CLASSIFICATION Stage 1: intermittent asthma symptoms less than once a week; short exacerbations; nocturnal symptoms no more than 2 times a month; FEV1 or PSV indicators are 80% or more of the proper values; PEF or FEV1 variability is less than 20%.

Stage 3: persistent moderate asthma daily symptoms; exacerbations can affect physical activity and sleep; nighttime symptoms more than once a week; daily intake of inhaled B2-agonists; FEV1 or PSV indicators are 60-80% of the proper values; the variability in PSV or FEV1 is more than 30%.

Stage 2: mild persistent asthma symptoms more than once a week, but less than once a day; exacerbations can affect physical activity and sleep; night symptoms more than 2 times a month; FEV1 or PSV indicators are 80% or more of the proper values; the variability in PSV or FEV1 is 20-30%.

Stage 4: severe persistent asthma daily symptoms; frequent exacerbations; frequent nocturnal symptoms; limitation of physical activity; indicators of FEV1 or PSV are less than 60% of the proper values.

TREATMENT OF BA Complex therapy of patients with BA 1. Education of patients. 2. Assessing and monitoring the severity of asthma. 3. Elimination of triggers or control of their influence on the course of the disease. 4. Development of a drug therapy plan for permanent treatment. 5. Development of a treatment plan during an exacerbation. 6. Ensuring regular supervision.

Drug therapy I. Asthma control drugs inhaled corticosteroids (beclomethasone dipropionate, budesonide, flunisomide, fluticasone, triamcinolone acetonide); systemic corticosteroids (prednisolone, methylprednisolone); (!) p / e: oral candidiasis, hoarseness, cough from irritation of the mucous membrane; sodium cromoglycate (intal); nedocromil sodium (Thyled); sustained release theophylline (teopec, teodur); long-acting inhaled β2-agonists (formoterol, salmeterol); antileukotriene drugs: a) cysteinyl-leukotriene 1 receptor antagonists (montelukast, zafirlukast), b) 5-lipoxygenase inhibitor (zileuton).

II. Symptomatic remedies (for emergency care a) fast-acting inhaled β2-agonists (salbutamol, fenoterol, terbutaline, reproterone); systemic GCS; anticholinergics (ipratropium bromide (Atrovent), oxitropium bromide); methylxanthines (theophylline IV, aminophylline).

III. Non-traditional treatments acupuncture; homeopathy; yoga; ionizers; speleotherapy; Buteyko method; etc.

Examination methods X-ray Examination of sputum Examination of blood

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BRONCHIAL ASTHMA is a disease that develops on the basis of chronic allergic inflammation of the bronchi, their hyperreactivity and is characterized by recurrent bouts of difficulty breathing or suffocation as a result of widespread bronchial obstruction caused by bronchoconstriction, mucus hypersecretion, swelling of the bronchial wall.

The prevalence of asthma in Russia is from 10 to 25% In Perm, at the end of 2010, more than 3,700 children were registered (growth in 2010 ≈ ≈ 4.1%) In Perm, 400-500 children are diagnosed with bronchial asthma for the first time every year 67% have bronchial asthma asthma manifests in the first 5 years of life (Balabolkin I.I., 2003)

New version of the National Program: “Bronchial asthma in children. Treatment strategy and prevention” 1992 recommendations of the international pediatric group on asthma 1997 on the initiative of the All-Russian Scientific Society of Pulmonologists of Russia developed the first National Program “Bronchial Asthma in Children” in 2005 (second edition) of the National Program “Bronchial Asthma in Children. Treatment strategy and prevention". 2008 . a new version(third edition), revised and supplemented The goal of the program is to form a unified position in the fight against the most widespread lung disease in children. RUSSIAN RESPIRATORY SOCIETY UNION OF RUSSIAN PEDIATRICS NATIONAL PROGRAM “BRONCHIAL ASTHMA IN CHILDREN. TREATMENT STRATEGY AND PREVENTION ((THIRD EDITION)

Heredity The risk of asthma in a child of parents with signs of atopy is 2-3 times higher than in a child of parents who do not have it. Genetic factors determine the predisposition to allergic diseases. Allergic diseases are more often noted in the pedigree along the mother's side. The polygenic type of inheritance is considered predominant.

Atopy This is the body's ability to produce an increased amount of Ig. E in response to exposure to allergens environment. It is detected in 80-90% of sick children.

Bronchial hyperreactivity This is a condition expressed in an increased reaction of the bronchi to an irritant, in which bronchial obstruction develops in response to exposure that does not cause such a reaction in most healthy individuals. This is a universal characteristic of bronchial asthma, its degree correlates with the severity of the disease. There is evidence of the genetic determinism of bronchial hyperreactivity

Etiological factors In children of 1 year of age - food and drug allergies. In children 1-3 years old - household, epidermal, fungal allergies. Older than 3-4 years - pollen sensitization. When living in contaminated industrial areas - sensitization to industrial substances. Lately at bronchial asthma in children, the frequency of polyvalent sensitization has increased.

Causes of respiratory allergies Household allergens: : House dust mites of the Pyroglyphidae family: : DD ermatophagoides pteronissinus, farinae and microceras, Euroglyphus Animal allergens: : Cats, dogs, rodents, horses Fungal allergens: : Mold spores Aspergillus, Candida Pollen allergens Food allergens AD factors are: atmospheric pollutants (exhaust gases, ozone, nitrogen oxide, sulfur dioxide); indoors - tobacco smoke

Factors contributing to the occurrence of bronchial asthma are frequent respiratory infections, the pathological course of pregnancy in the mother of the child, prematurity, the presence of atopic dermatitis, indoor and outdoor air pollution, smoking, including passive smoking.

Factors causing exacerbation of bronchial asthma (triggers) contact with allergens, respiratory viral infection, physical activity, psycho-emotional stress, changes in the weather situation.

Mechanisms of development of bronchial asthma Under the influence of allergens in patients with BA there is hyperproduction of Ig. E B-lymphocytes There is an interaction of causally significant allergens with specific Ig fixed on mast cells and basophils.

This leads to the activation of target cells and the secretion of mediators and cytokines from them, which, in turn, contribute to the involvement of other fixed cells in the lungs and blood cells in the allergic process. Mediators such as histamine, prostaglandins, serotonin, etc. are released from the granules of mast cells. .

An acute allergic reaction develops, proceeding according to the immediate type and manifested by the syndrome of bronchial obstruction. An asthma attack develops 10-20 minutes after contact with a causally significant allergen.

The late phase of an allergic reaction in the bronchi in response to allergen exposure develops after 6-8 hours and is characterized by an influx of pro-inflammatory cells into the lungs, followed by the development of allergic airway inflammation, hyperreactivity and bronchial obstruction.

Bronchial remodeling Massive death of epithelial cells A large number of mucous plugs Thickening of the basement membrane Hypertrophy and hyperplasia of goblet cells and serous glands Hypertrophy of smooth muscles (by 200%) Active angiogenesis

Classification of bronchial asthma Form (atopic, mixed) Stage of the disease (exacerbation with indication of the severity of the attack, remission) Severity of the disease (mild episodic and persistent, moderate, severe) Complications

frequency of attacks: mild intermittent - less than 1 time per month mild persistent - 1-3 times per month moderate - 1-2 times a week severe - 3 or more times a week

severity of attacks: mild asthma - only mild attacks moderate asthma - at least one attack of moderate severity severe asthma - at least one severe attack or history of status

The duration of the post-attack period with mild - 1-2 days moderate - 1 - 2 weeks severe - 2 - 4 weeks

duration of single-stage remission: mild asthma - more than 3 months moderate asthma - 1-3 months severe asthma - 1 month

the effectiveness of basic therapy: mild BA - symptoms are controlled, stage II - - IIIrd stage of basic therapy moderate BA - - IIIIII stage of basic therapy severe BA - - IVIV - - V V stage of basic therapy

CRITERIA FOR ASTHMATIC STATUS 1. 1. duration of non-stopping attack of bronchial asthma for at least 6 hours; 2. 2. violation of the drainage function of the bronchi; 3. 3. hypoxemia (partial pressure of oxygen less than 60 mm Hg) and hypercapnia (partial pressure of carbon dioxide more than 60 mm Hg); 4. 4. resistance to sympathomimetic drugs.

Stages of status asthmaticus Stage I - the stage of relative compensation - clinically represents a protracted asthma attack. It is characterized by severe violations of bronchial patency and resistance to sympathomimetics.

Rapid, difficult noisy breathing, increased emphysema, hard breathing and a significant amount of dry and sometimes wet rales. Delayed expectoration. Severe tachycardia, increased blood pressure. Signs of respiratory failure in the form of anxiety of the child, pallor of the skin, acrocyanosis.

The stage of increasing respiratory failure It develops as a result of total obstruction of the bronchial lumen with a thick viscous secret with the simultaneous presence of pronounced edema of the bronchial tree mucosa and spasm of the smooth muscles of the bronchi.

The weakening and subsequent disappearance of respiratory sounds are characteristic, first in separate segments of the lungs, then in its lobes, in the whole lung. The so-called "syndrome of silence in the lungs" is formed. Simultaneously with the weakening of breathing, diffuse cyanosis increases, tachycardia persists. BP goes down.

Hypoxic coma Deep respiratory failure with the presence of a syndrome of "silence" throughout the field of the lungs, adynamia, followed by loss of consciousness and convulsions. On examination, there is diffuse cyanosis of the skin and mucous membranes, the absence of respiratory sounds in the lungs, muscle and arterial hypotension, and a drop in cardiac activity.

Clinical diagnosis of bronchial asthma in children is based on the identification of symptoms such as: episodic expiratory dyspnea wheezing feeling of chest tightness paroxysmal cough

Clinical manifestations of bronchial asthma in young children An attack of shortness of breath and / or cough is manifested by a pronounced anxiety of the child (“rushing around”, “does not find a place for himself”) Bloating of the chest, fixation of the shoulder girdle in the inspiratory phase Tachypnea with a slight predominance of the expiratory component Violation of conduction breathing in the basal parts of the lungs Severe perioral cyanosis

During a physical examination in the lungs, against the background of uneven breathing, diffuse dry, wheezing rales are heard, as well as moist rales of various sizes. The presence of wet rales is especially characteristic of asthmatic attacks in young children (the so-called wet asthma). and in the morning hours

Anamnestic data Hereditary burden of allergic diseases The presence of concomitant diseases of allergic genesis in a sick child Indications of the dependence of the onset of symptoms of the disease on exposure to certain allergens Improvement after the use of bronchodilators

Laboratory and instrumental methods for diagnosing bronchial asthma 1. 1. Examination of blood smears (increase in the number of eosinophils more than 400 - 450 in 1 μl of blood) 2. 2. Determination of local eosinophilia (eosinophilia index is normally not more than 15 units) 3. 3. Definition cause-significant allergen by skin testing

Laboratory and instrumental methods for diagnosing bronchial asthma (continued) 4. Radioimmune, enzyme immunoassay, chemiluminescent methods for determining specific Ig. E and Ig. G-antibodies in the blood 5. Inhalation provocative tests with allergens 6. Chest X-ray (diffuse increase in the transparency of the lung tissue)

Laboratory and instrumental methods for diagnosing bronchial asthma (continued) 7. 7. Peak flowmetry (decrease in peak expiratory flow rate and forced expiratory volume in the first second) 8. 8. Spirography (impaired bronchial patency at the level of small bronchi and a positive test with bronchodilators) 9. 9. Detection in the bronchial secretion of a large number of eosinophils, as well as Kurschman spirals and Charcot-Leiden crystals

Laboratory and instrumental methods for diagnosing bronchial asthma (continued) 10. Immunological examination 11. Blood gas examination 12. Bronchoscopy 13. Determination of eosinophilic cationic protein 14. Determination of nitric oxide in exhaled air

Primary prevention of bronchial asthma in children elimination of occupational hazards in the mother during pregnancy; smoking cessation during pregnancy; rational nutrition of a pregnant, lactating woman with a restriction of products with high allergenic activity;

prevention of acute respiratory viral infections in the mother during pregnancy and in the child; limiting drug treatment during pregnancy by strict indications; breast-feeding; hypoallergenic environment of the child; cessation of passive smoking; the use of methods of physical rehabilitation, hardening of children; favorable ecological situation.

Hypoallergenic diet Exclusion of causally significant allergens Exclusion of histamine-liberator products (chocolate, citrus fruits, tomatoes, canned food, smoked meats, marinades, sauerkraut, fermented cheeses, etc.)

Pet allergens Get rid of pets if possible, do not get new ones Animals should never be in the bedroom Wash pets regularly

Elimination of pollen allergens Stay indoors more during flowering Close windows in the apartment, roll up the windows and use a protective filter in the car air conditioner while driving outside the city Try to move from your permanent place of residence to another climatic zone (for example, take a vacation) during the flowering season

Elimination of house dust allergens Use protective bed covers Replace down pillows and mattresses, as well as woolen blankets with synthetic ones, wash them every week at a temperature of 6000 C Get rid of carpets, thick curtains, soft toys (especially in the bedroom), do not wet clean less than once a week, and use washing vacuum cleaners with disposable bags and filters or vacuum cleaners with a water tank, pay special attention to cleaning furniture upholstered with fabrics.

Key Points Asthma can be effectively controlled in most patients, but there is no cure. The most effective treatment for asthma is to eliminate the causative allergen. Insufficient diagnosis and inadequate therapy are the main causes of severe asthma and mortality.

The choice of treatment should be made taking into account the severity of the course and the period of bronchial asthma. When prescribing drugs, a “graded” approach is recommended. In complex therapy, non-drug methods of treatment are often used. Successful treatment of asthma is impossible without the establishment of partnerships, trusting relationships between a doctor, a sick child, his parents and relatives.

Means of basic therapy Glucocorticosteroids Leukotriene receptor antagonists Prolonged β 22-agonists in combination with inhaled glucocorticosteroids Cromones (cromoglycic acid, nedocromil sodium) Prolonged theophyllines Antibodies to Ig.

Cromones Cromoglycate sodium (Intal) - 1-2 doses 4 times a day Nedocromil sodium (Tailed) 1-2 doses 2 times a day

IGCS in asthma Beclomethasone Budesonide Fluticasone Beclason Clenil-jet Tafennovolizer Pulmicort Flixotide

Average doses of ICS beclomethasone up to 600 mcg per day budesonide up to 400 mcg per day fluticasone up to 500 mcg per day

Antileukotriene drugs 1. 5-lipoxygenase- (leukotriene biosynthesis) inhibitors: zileuton (Zyflo) is used primarily in the USA 2. Cys. LT 1 antagonists: : montelukast (Singulair), zafirlukast (Accolate), pranlukast (Ono) So-called FLAP inhibitors, which prevent 5-LO activation of proteins, are being clinically studied (not yet in clinical practice). .

Pranlukast. Montelukast. Zafirlukast Recommended dose Chemical name Trade name Accolate Singulair Ono, Ultair 20-40 mg 2 times a day 1 hour before or 2 hours after meals Children over 12 years Children 6-14 years: 5 mg Children 2-5 years: 4 mg 1 once a day, at night, chewable tablet Adults: 225 mg twice a day not registered in Russia Leukotriene receptor antagonists used in clinical practice

Long-acting B22-adrenergic receptor agonists Salmeterol: Serevent Serevent rotadisk Salmeter Formoterol: Oxys Foradil Atimos

Antibodies to Ig. E (omalizumab - Xolair) The drug is: : humanized monoclonal antibodies obtained on the basis of recombinant DNA. Pharmacotherapeutic group: other agents for systemic use in obstructive airway diseases. Included in the international Russian standards treatment of asthma as adjunctive therapy in the absence of control with existing drugs

Verified diagnosis of moderate to severe atopic asthma (the atopic nature of the disease is confirmed by skin tests or radioallergosorbent test (RAST) Anti-Ig. E therapy is indicated for asthma that is poorly or partially controlled by the use of basic therapy: -> 2 severe exacerbations per year requiring the use of systemic GCS Frequent daytime symptoms (> 2 episodes per week) Nocturnal symptoms Significantly restricted lifestyle Age 12 years and older Ig.E levels ranging from 30 to 700 IU/mL

Relief of an attack of bronchial asthma inhalation of a β 22 agonist (salbutamol, berotek) or an anticholinergic (atrovent) or their combination (berodual) at an age dose using PAI (1 dose up to 10 years, 2 doses after 10 years) or through a nebulizer (berodual 1 drop per kg of body weight) if there is no effect after 20 minutes, repeat the drug at the same dose if there is no effect from the second inhalation: call a brigade Ambulance,

Short-acting B22-adrenergic receptor agonists Salbutamol Salamol Eco Lung breathing Ventolin (nebules) Salben Bricanil (Terbutaline) Fenoterol Berotek Hexoprenaline Ipradol Iprotropium bromide/fenoterol Berodual

1. 1. Administer prednisolone IM or IV 2 mg/kg or dexazone 0.3 mg/kg 2. 2. Administer eufillin 2, 4% solution, 8 mg/kg IV drip, 3. 3. if there is no effect within 1-2 hours of the above treatment, prednisone is repeated up to 10 mg/kg or dexazon 1 mg/kg for 6 hours, eufillin 1 mg/kg/hour IV drip (titration),

6. in case of moderate and severe attack, additionally O 22, 7. in case of status: β 22 - temporarily cancel agonists, glucocorticoids up to 30 mg / kg / day, bronchoscopy and lavage of the tracheobronchial tree, mechanical ventilation, correction of acid-base balance, water and electrolyte balance, titration of aminophylline before the status is terminated.

Step 1 Step 2 Step 3 Step 4 Step 5GINA 2006: Steps of Therapy Patient Education Environmental Control ββ 22 - fast acting agonist on demand ββ 22 - fast acting agonist on demand Disease control drug options Select one Add one or more Add one or more Both low-dose ICS ++ ββ 22 -long-acting IGCS in medium or high doses ++ ββ 22 -long-acting agonists Anti-leukotriene drug IGCS in medium or high doses + Anti-leukotriene new drug + p / o GCS ( lowest dose)) Cromon IGCS in low doses plus antileukotriene drug + Theophylline MB + Anti-Ig. E-therapy Low-dose glucocorticosteroids plus theophylline MB Decrease increase

dose adjustment (every two months) In the absence of seizures - a permanent dose reduction If there are only mild attacks that are rarer than those characteristic of the severity of the disease - maintain the dose for the next two months If more frequent mild attacks or an attack of moderate, severe degree - the dose of the drug raise

Non-drug methods of treatment of bronchial asthma in children 1. 1. Diet therapy 2. 2. Respiratory therapy 3. 3. Relaxation and autogenic training 4. 4. Chest massage (vibration, percussion) 5. 5. Physiotherapy exercises with breathing exercises

6. 6. Speleotherapy and halotherapy 7. 7. Physiotherapy 8. 8. Laser therapy 9. 9. Acupuncture 10. Phytotherapy 11. Psychotherapeutic correction of the neuropsychic status of the patient

BRONCHIAL ASTHMA

Completed: 33rd group

What is Bronchial Asthma?

it a disease based on chronic allergic inflammation of the bronchi, accompanied by their hyperreactivity and intermittent attacks of shortness of breath or suffocation as a result of widespread bronchial obstruction caused by bronchial obstruction, mucus hypersecretion, swelling of the bronchial wall.

PATHOGENESIS

Inflammation

respiratory tract

Hyperactivity

bronchi

Limitation

air flow

Acute

bronchoconstriction

remodeling

respiratory tract

edema walls

respiratory tract

education

chronic

mucous plugs

Risk factors for developing Bronchial asthma:

Internal factors

– genetic predisposition

– atopy

– floor

– airway hyperresponsiveness

External factors

- causing development AD in people predisposed to it

- leading to exacerbation of asthma and/ or long-term persistence of symptoms of the disease

Medicines

antibiotics, especially penicillins,
sulfonamides,
vitamins,
acetylsalicylic acid and other non-steroidal anti-inflammatory drugs.

Clinical forms of BA

exogenous (atypical),

endogenous

(non-utopian, cryptogenic),

aspirin,

exercise asthma,

psycho-emotional.

Clinic

Symptoms of AD include:

Wheezing, usually expiratory
Shortness of breath is usually paroxysmal
Feeling of "congestion" in the chest
Cough, often non-productive
Sometimes - separation of white, "glassy" sputum at the end of an asthma attack.

Clinic

With an exacerbation of the disease, the patient can take a forced position of the body, in which the feeling of lack of air worries him less.
There are expiratory dyspnea, swelling of the wings of the nose during inspiration, intermittent speech, agitation, and the inclusion of auxiliary respiratory muscles.
The chest during an attack expands and occupies an inspiratory position.

asthmatic status

A protracted attack of asthma, resistant to ongoing therapy and characterized by severe and acutely progressive respiratory failure caused by obstruction of the airways, with the patient's resistance to adrenostimulating agents formed.

Diagnosis of Bronchial Asthma:

The diagnosis of asthma can often only be made on the basis of history and physical examination.
Evaluation of lung function and, especially, reversibility of obstruction, significantly increases the certainty of the diagnosis.
Allergy status assessment can help identify and manage risk factors .

Features of the anamnesis

factors that provoke exacerbations; seasonal exacerbations;
repeated obstructive bronchitis occurring against the background of normal temperature;

Features of the anamnesis

concomitant allergic diseases (atopic dermatitis, allergic rhinitis, allergic conjunctivitis, etc.);
hereditary burden for allergic diseases, including asthma;
disappearance of symptoms when contact with the allergen is eliminated (elimination effect);

visual inspection

During percussion over the lungs, a box sound is determined, the lower borders of the lungs are shifted down, the mobility of the edges during inhalation and exhalation is sharply limited.
During auscultation, an elongated exhalation is noted, a large number of dry whistling rales are heard.

visual inspection

In the case of status asthmaticus, the number of dry rales may decrease (“silent lung”).

By the end of the attack, buzzing, moist, muffled rales appear.

Laboratory research

There are no characteristic changes in blood tests. Eosinophilia is often detected, but it cannot be considered a pathognomonic symptom.

Sputum examination

during exacerbation, eosinophils, Kurshman spirals, Charcot-Leyden crystals are determined.

Study of the acid-base state and blood gas composition

occurrence of hypocapnia
an increase in the partial pressure of carbon dioxide (pCO2).

X-ray of the lungs

Nonspecificity.
During exacerbations - signs of emphysematous swelling of the lung tissue, the domes of the diaphragm are flattened, the ribs are located horizontally.
With a prolonged attack, atelectasis and eosinophilic infiltrates may develop.
During remissions, radiological changes are most often not detected.

Skin tests

allow you to determine the spectrum of sensitization,

identify risk factors and triggers, on the basis of which further preventive measures and specific allergy vaccination are recommended.

However, it should be borne in mind that in some patients skin tests may be false negative or false positive.

Spirometry

Assess the degree of obstruction, its reversibility and variability, as well as the severity of the course of the disease.
Pulmonary function is considered normal when the ratio of FEV to FVC is more than 80-90%.
Any values below suggest bronchial obstruction.
Inhalation of a bronchodilator in asthma causes an increase in FEV greater than 12%.
Using the same methods, the most effective bronchodilator for this patient is selected.

For the diagnosis of BA, the following indicators are of the greatest importance:
FEV 1 - forced expiratory volume in the first second,
FVC - forced vital capacity
PSV - peak expiratory flow
Indicators of airway hyperresponsiveness

Tests with methacholine, histamine, physical activity.

In AD, at least a 20% drop in FEV 1 is recorded, measured before and between increasing concentrations of the inhaled agent.

self control Peakflowmetry

- determination of peak expiratory flow rate.

In asthma, peak expiratory flow (PEF) increases by at least 15% after inhalation of a bronchodilator.

To control BA, the spread of indicators in the evening and morning hours is also taken into account.

The method allows patients to independently monitor their condition daily for 2-3 months, which is necessary to correct therapy according to a stepwise approach to the treatment of asthma.

Differential Diagnosis

COPD;
aspiration of a foreign body;
bronchiolitis;
cystic fibrosis;
primary immunodeficiencies;
syndrome of primary ciliary dyskinesia;
tracheo- or bronchomalacia;
stenosis or narrowing of the airways associated with the presence of hemangiomas or other tumors, granulomas or cysts;
obliterating bronchiolitis;
interstitial lung disease;
vascular malformations that cause external compression of the airways;

Differential Diagnosis

congestive heart defects;
cardiac asthma;
tuberculosis;
bronchopulmonary dysplasia;
lobar emphysema;
hyperventilation syndrome (Da Costa syndrome);
symptomatic bronchospasm in patients with hysteria;
dysfunction of the vocal cords;
metastatic carcinoid;
bronchospasm in patients with nodular periarteritis;
disseminated eosinophilic collagen disease;
whooping cough;
psychogenic dyspnea.

Differential Diagnosis (survey methods)

radiography of the lungs (detection of pneumothorax, volumetric processes, pleural lesions, bullous changes, interstitial fibrosis, etc.);
ECG, ECHOCG (exclusion of myocardial damage);
general sputum analysis;
general clinical blood test;
bronchoscopy;
tomography;
FVD.

Course and prognosis of BA

In most patients, under the systematic supervision of a doctor and subject to adequate treatment, it is possible to achieve improvements (mainly with moderate severity).

The prognosis of the disease depends on the clinical and pathogenetic variant of the course of BA (in atopic BA it is more favorable), the severity, nature of the course and the effectiveness of therapy.

If we consider the course of bronchial asthma in children, then spontaneous recovery in puberty is possible.
However, in 60-80% of cases, bronchial asthma, which began in childhood, continues into adulthood.

To the concept "recovery" bronchial asthma should be approached with caution, since recovery from asthma, in essence, represents only a long-term clinical remission, which can be disturbed under the influence of various causes.

AD is a life-threatening disease!

Treatment

medical non-drug
compliance with the anti-allergic regimen
medical
non-drug

Inhaled glucocorticosteroids (IGCS)

increase apoptosis and reduce the number of eosinophils by inhibiting interleukin-5 (lL-5),
lead to stabilization of cell membranes, reduce vascular permeability, improve the function of 3-adrenergic receptors both by synthesizing new ones and, by increasing their sensitivity, stimulate epithelial cells.

The main routes of drug delivery to the respiratory tract

metered-dose aerosol inhalers (MDI): conventional, "easy breathing", in combination with a spacer;
metered-dose powder inhalers: disposable, multi-dose reservoir, multi-dose blister;
nebulizers: ultrasonic, jet.

Release forms

aerosol (berotek, salbutamol, etc.);
tablets (saltos, effective for about 12 hours);
powder - salben (salbutamol in the cyclohaler inhaler).

Systemic steroids

Applied with an exacerbation of the disease orally or intravenously in high doses.
With prolonged use, systemic complications form.
Appointment in persistent asthma immediately defines the patient as severe and requires the appointment of high doses of ICS and long-acting inhaled β2-agonists.

Complications arising from long-term use of GC

osteoporosis;
diabetes;
suppression of the hypothalamic-pituitary-adrenal system;
cataract;
glaucoma;
obesity

Non-drug therapy

respiratory therapy (breath training, breath control, interval hypoxic training);
massage, vibration massage;
physiotherapy;
speleotherapy and mountain climatic treatment; physiotherapy;
acupuncture;
phytotherapy;
psychotherapy;
Spa treatment.