The doctor must distinguish and make a diagnosis. With bouts of coughing, difficulty breathing (especially in children!) It is urgent to call an ambulance.

Symptoms of bronchial asthma:

Bronchial asthma often begins with a paroxysmal cough, accompanied by aspiratory dyspnea with a small amount of vitreous sputum (asthmatic bronchitis). A detailed picture of bronchial asthma is characterized by the appearance of mild, moderate or severe asthma attacks. An attack may begin with a precursor (copious discharge of watery secretion from the nose, sneezing, paroxysmal cough, etc.). An asthma attack is characterized by a short inhalation and an extended exhalation accompanied by audible wheezing at a distance. The chest is in the position of maximum inspiration. In breathing, the muscles of the shoulder girdle, back, and abdominal stack take part. When percussion over the lungs, a box sound is determined, a lot of dry rales are heard. The attack, as a rule, ends with the separation of viscous sputum. Severe prolonged attacks can turn into an asthmatic state - one of the most formidable options for the course of the disease.

Symptoms of pneumonia:

Pneumonia is an inflammation of the lungs.

Pneumonia can develop against the background of hypothermia, acute respiratory infections, acute respiratory viral infections, food poisoning, trauma, fracture ...

According to the etiology, acute pneumonia is divided into:
bacterial,

viral,

mycoplasma,

rickettsial,

fungal,

allergic; including drug allergies;

pneumonia arising from the invasion of helminths;

pneumonia caused by the action of physical and chemical factors (mainly thermal, for example, pneumonia with burn disease, and toxic, for example, pneumonia that develops when inhaled vapors of gasoline, kerosene and chemical warfare agents).

With all these types of pneumonia, as a rule, the addition of a bacterial infection is noted. It is generally accepted that the features of the course of acute pneumonia depend on the pathogen.

Pneumonia of different etymologies can have completely different symptoms.

A sudden rise in temperature to 40 degrees, accompanied at first by a dry cough, extremely poor health, shortness of breath (that is, any physical activity, even minimal, causes rapid heavy breathing). In this case, there may be pain in the chest, aggravated by coughing and deep breathing. The pain may radiate to the abdomen, or it may simply hurt only the abdomen. With a deep breath, a coughing fit is possible. Sometimes there is redness of one cheek (on the side where the pain is noted). All this corresponds to the so-called croupous pneumonia, in which the inflammation covers a large part of the lung. Not all of the described symptoms are necessarily present, but fever, cough and severe weakness occur almost constantly.

The disease begins as a common ARVI: runny nose, cough, fever. After a while, the temperature drops, and then rises again and does not decrease any more. This is also a variant of the course of pneumonia.

The temperature does not rise above 38 degrees, but keeps almost constantly at this level, accompanied by cough, weakness. It could also be pneumonia.

In children, the criteria that should alert you to the possible presence of pneumonia are the following: duration of temperature above 38 degrees for three or more days; shortness of breath (rapid breathing); severe lethargy, drowsiness.

A definitive diagnosis can only be made on the basis of a chest x-ray.

Additionally

Bronchial asthma

Bronchial asthma is a chronic disease manifested by recurrent bouts of severe difficulty breathing (suffocation). Modern science considers asthma as a kind of inflammatory process that leads to bronchial obstruction - narrowing of their lumen due to a number of mechanisms:

Spasm of small bronchi

swelling of the bronchial mucosa;

Increased secretion of fluid by the glands of the bronchi;

increased viscosity of sputum in the bronchi.

For the development of asthma, two factors are of great importance: 1) the presence of an allergy in a patient - an excessive, perverted reaction of the body's immune system to the ingestion of foreign proteins-antigens; 2) bronchial hyperreactivity, i.e. their increased reaction to any irritants in the form of a narrowing of the lumen of the bronchi - proteins, drugs, pungent odors, cold air. Both of these factors are due to hereditary mechanisms.

An asthma attack has typical symptoms. It begins suddenly or with the appearance of a dry, agonizing cough, sometimes it is preceded by a sensation of tickling in the nose, behind the sternum. Asphyxiation develops rapidly, the patient takes a short breath and then, almost without a pause, a long exhalation (expiration is difficult). During exhalation, dry whistling rales (wheezing) are heard at a distance. The doctor listens to such wheezing during the examination of the patient. The attack ends on its own or, more often, under the influence of bronchodilators. Suffocation disappears, breathing becomes freer, sputum begins to depart. The number of dry rales in the lungs decreases, gradually they completely disappear.

Long-term and insufficiently treated asthma can lead to serious complications. They can be divided into pulmonary and extrapulmonary, often they are combined. Pulmonary complications include chronic bronchitis, emphysema, and chronic respiratory failure. Extrapulmonary complications - heart failure, chronic heart failure.

The treatment of bronchial asthma is a difficult task, it requires the active participation of patients, for whom special "schools" are created, where, under the guidance of doctors and nurses, patients are taught the right way of life, the procedure for using medications.

As far as possible, it is necessary to eliminate risk factors for the disease: allergens that cause seizures; refuse to take non-steroidal anti-inflammatory drugs (aspirin, drugs for the treatment of pain, joint diseases); sometimes climate change, job change helps.

Inflammation of the lungs - pneumonia

Pneumonia is an inflammatory process in the pulmonary alveoli, adjacent to them the smallest bronchi, microvessels. Pneumonia is most often caused by bacteria - pneumococci, streptococci, staphylococci. More rare pathogens are Legionella, Klebsiella, Escherichia coli, Mycoplasma. Pneumonia can also be caused by viruses, but here, again, bacteria take part in the inflammation.

Pneumonia often occurs in people who have had a respiratory viral infection, smokers, alcohol abusers, the elderly and the elderly, against the background of chronic diseases of the internal organs. Pneumonia that occurs in severe postoperative patients in hospitals is isolated separately.

According to the prevalence of the pneumonia process, it can be lobar and segmental, when the foci of inflammation are large, and small-focal with multiple small foci of inflammation. They differ in the severity of the symptoms, the severity of the course, and also on which pathogen led to pneumonia. X-ray examination of the lungs helps to accurately establish the prevalence of the process.

The onset of the disease with macrofocal pneumonia is acute. There is chills, headaches, severe weakness, dry cough, chest pain when breathing, shortness of breath. The temperature rises significantly and stays at high numbers, if the disease is not treated, 7-8 days. When coughing, sputum with streaks of blood begins to stand out first. Gradually, its amount increases, it acquires the character of purulent. The doctor, when listening to the lungs, determines the altered bronchial breathing. In the study of blood revealed an increase in the number of leukocytes, acceleration of ESR. Radiologically, massive shading in the lungs is determined, corresponding to a lobe or segment.

Focal pneumonia is characterized by a milder course. The onset of the disease can be acute or slower, gradual. Often, patients indicate that before the first signs of the disease appeared, they suffered from acute respiratory infections, there was a cough, a short-term fever. There is a cough with mucopurulent sputum, there may be pain in the chest when breathing, shortness of breath. When examining blood, there may be a moderate increase in the number of leukocytes, an acceleration of ESR. Radiologically, larger or smaller foci of shading are determined, but much smaller than with large-focal pneumonia.

Severe forms of pneumonia with high fever, severe cough, shortness of breath, chest pains are best treated in the hospital, they usually begin treatment with penicillin injections, and then, depending on the effectiveness or ineffectiveness of the treatment, change antibacterial agents. There are also painkillers, oxygen is prescribed. Patients with milder forms of pneumonia can be treated at home, antibacterial agents are prescribed orally. In addition to antibacterial agents, chest massage and exercise therapy have a good auxiliary effect, especially at the final stages of treatment. It is necessary to treat patients with pneumonia vigorously, achieving normalization of the blood picture and, most importantly, until the disappearance of radiological signs of inflammation.

Tuberculosis

Tuberculosis is a chronic infectious disease caused by a tubercle bacillus (Koch's wand - named after the famous German scientist Koch, who discovered the causative agent of tuberculosis). Infection with tuberculosis occurs through the air, into which Koch's sticks fall during coughing, sputum production by tuberculosis patients. Tuberculosis microbes are very resistant to environmental factors, so the possibility of infection with them persists for a long time. Tuberculosis occurs more often in countries with poor social conditions, with inadequate nutrition of people, it often affects prisoners in prisons with AIDS. In recent years, the high resistance of tuberculosis bacteria to those drugs that have been very effective in the treatment of tuberculosis has become a big problem.

Tuberculosis most often affects the lungs, but other organs can also suffer from this disease - bones, kidneys, urinary system.

The disease begins slowly, gradually. There is unmotivated weakness, low-grade fever, a slight cough with a minimum amount of sputum. As a result of the collapse of the lung tissue, cavities (caverns) are formed. There is more sputum, it has no smell, there may be hemoptysis. Cavities are detected by X-ray. Another form of pulmonary tuberculosis is the defeat of the pleura with the accumulation in its cavity of an inflammatory fluid - exudate. Most of all, patients are worried about shortness of breath due to squeezing the lungs with liquid.

In most patients, TB is suspected after an X-ray examination of the lungs. The decisive diagnostic methods are the detection of the causative agent of tuberculosis in sputum, bronchial washings or lung tissue taken during the examination of the bronchi with a special optical device - a bronchoscope.

Treatment of tuberculosis is complex and lengthy. Complexity lies in the combination of treatment regimen, diet and drug treatment. Long-term treatment is due to the slow multiplication of tubercle bacilli and their ability to stay in an inactive state for a long time. Tuberculosis prevention consists in vaccinating children, which makes them resistant to the disease. For adults, the main event is a regular preventive x-ray examination of the lungs.

Bronchial asthma is an inflammation of the bronchi of an allergic nature, which is accompanied by their increased reactivity and reversible bronchial obstruction, resulting in asthma attacks.

Frequency. Among adults, bronchial asthma occurs on average in 5% of the total population, in children - up to 10%.

Causes and pathogenesis of bronchial asthma

There are several reasons for the occurrence of the disease. This is a hereditary factor, bronchial hyperreactivity, and atopy, i.e., an unusual reaction to substances that usually does not cause any problems for most people.

Predisposing factors are substances-allergens. They can be household, food (some food), fungal. The cause of the development of the disease can be the pathological period of intrauterine development of the fetus, premature birth, unbalanced nutrition, atopic dermatitis, respiratory infections, passive and active smoking.

Allergies, viral respiratory diseases, physical and emotional overstrain, changes in climatic living conditions, adverse weather effects, etc. can provoke an attack of bronchial asthma.

Among the causes of asthma, attention has long been drawn to the role of external factors - contact with animals, plants (cat asthma, hay asthma), along with the importance of a special predisposition, often family, from the nervous system and metabolism (the so-called neuro-arthritic diathesis) .

With the development of the doctrine of anaphylaxis and allergies, in which bronchospasm, urticaria, eosinophilia are also observed, and in asthma they began to see a predominantly allergic reaction to certain allergens. From this point of view, the long-known forms of feline asthma, hay catarrh, asthma from primrose, ursola, down pillows, etc., as well as cases of so-called infectious asthma, i.e., special sensitivity of patients to metabolic products of even ordinary microbes, received a scientific explanation. respiratory tract.

However, the allergic theory of asthma does not exclude the leading role in the development of the disease of the neurogenic factor. Allergic manifestations are associated not only with an altered humoral environment, but mainly with altered nervous reactions, including changes in higher nervous activity. There are well-known cases of reflex asthma as a result of irritation of special asthmatic (i.e., asthma-causing) points of the mucosa in diseases of the nose (polyps, deviated septum), lungs (peribronchitis, pneumosclerosis), biliary tract, female genital and other organs distant from the lungs.

From the point of view of reflex reactions, asthma can be viewed as an inappropriate increase in such protective reflexes as sneezing, bronchospasm, larynx when inhaling caustic vapors, etc., which normally protect the deeper lungs in cases of irritation of the upper respiratory tract.

Attention is drawn to the frequent increase in sensitivity to cold in patients with asthma (as in cold urticaria) and to the usual components of food (milk, eggs), inhaled air, objects in contact with the skin due to an altered reactivity of the nervous system that affects the enzymatic - exchange processes. Violation of these processes should explain the possible decrease in the destruction of histamine in the tissues of patients with bronchial asthma, with which they associate reactions called allergic, urticaria, etc.

In patients with bronchial asthma, signs of the predominance of the parasympathetic autonomic nervous system are often found (as in similar intestinal diseases (mucosal colic) and a number of vascular neuroses).

Finally, it is necessary to emphasize very definitely the participation of the cerebral cortex in asthmatic attacks, which, as has long been known, even in cases of apparently typical allergic asthma, are caused only by mental influences. In the stubborn repetition of seizures in individual patients, rooted temporary conditioned reflex connections certainly matter. Cases are well known when a person suffering from "flower" asthma had an attack immediately even at the sight of an appropriate artificial plant, or when an asthma attack was interrupted by an injection of an indifferent solution (instead of adrenaline). Clinically, it was possible to trace the connection of disorders (“breaks”) of higher nervous activity, for example, with skull contusions, with vegetative shifts in the form of an increase in the tone of bronchial muscles during the development of bronchial asthma. Thus, asthma is a cortical-visceral disease accompanied by metabolic disorders, in addition to pronounced neurovegetative and allergic reactions. The high frequency of this disease among persons of sedentary professions and in some cases also suffering from other metabolic diseases (eczema) is explained by the influence of environmental conditions; nutrition, insufficiency of oxidative-enzymatic processes, a violation of the chemistry of tissues and a change in the reactivity of the nervous system. Asthma often develops as a purely central or reflex-nervous disease, with no apparent metabolic predisposition. Like other neuro-allergic diseases, asthma is widespread in the United States.

Bronchial asthma affects both sexes equally often, often for the first time during puberty. In some cases, asthma seems to have the character of an occupational disease, being associated with the action of certain irritants - in pharmacists (exposure to ipecac), furriers (exposure to ursola)? or it can be associated with household repeated exposure to allergens (primrose, rose), however, in these cases, neurogenic factors are no less important, which also underlie cases of asthma that begin after falling into cold water, and in cases of developing asthma after bronchitis, pneumonia , pneumosclerosis, etc.

Pathological anatomy. In rare cases of death from uncomplicated asthma, acute pulmonary distention is found, usually with obstruction of the bronchi by plugs of viscous mucus, distension of the right heart. In asthma associated with bronchopulmonary diseases, anatomical changes in the underlying disease predominate.

Recently, attention has been paid to the frequent combination with asthma of allergic lesions of the vessels of the lungs in the presence of interstitial inflammation.

Bronchoscopically during an attack, "urticaria" of the bronchi was found.

There is an opinion that the main in the development of bronchial asthma is the inflammatory process. It is persistent. If the disease proceeds for a long time, the structure of the respiratory tract changes: the epithelial layer is lost, fibrosis of the basement membrane of the bronchial tree mucosa occurs, angiogenesis increases, serous and goblet cells of the bronchial mucosa hypertrophy.

Classification

• atopic bronchial asthma;
• infectious-dependent bronchial asthma.

According to the etiological factor, they are divided into:

• exogenous;
• endogenous;
• mixed.

Symptoms and signs of bronchial asthma

The patient at the time of the attack assumes a position - sitting, leaning forward and resting his hands on the edge of the bed. Visually, you can see the bulging of the veins of the neck, the swollen wings of the nose, the skin in the area of ​​​​the nasolabial triangle and the nails on the hands turn blue. When listening to the lungs with a stethoscope against the background of uneven vesicular breathing, wheezing is heard. At the end of the attack, a little viscous vitreous sputum leaves. In young children, the onset of bronchial asthma can occur with signs of a respiratory viral disease with obstructive symptoms.

There are 3 degrees of severity of bronchial asthma:

• light;
• moderate;
• heavy.

Light degree characterized by infrequent occurrence of shortness of breath - 1 time per month, and only in the daytime. The course of attacks is mild, they quickly stop either on their own or after a single dose of bronchodilators (using an inhaler or orally). The disease does not lead to disruption of sleep and physical development of the child. The periods of remission last more than 3 months, while the function of external respiration is preserved.

Moderate degree. Attacks of shortness of breath - moderate. The function of breathing has been changed. It is possible to stop attacks with a single dose of bronchodilators, and also prescribe intravenous administration of glucocorticosteroid drugs). Remission is clinically and functionally incomplete.

Severe degree it is distinguished by frequent, also nocturnal, attacks of shortness of breath. They run hard. They can only be stopped by parenteral administration of agents that relax bronchospasm, in combination with glucocorticosteroid hormones. The disease greatly complicates physical activity and sleep. The period between attacks is 1-2 months. Remission for clinical and functional manifestations is not fully achievable.

The most typical for bronchial asthma are acute attacks of suffocation that occur either without apparent connection with any external influence, or during cooling, damp weather, colds of the respiratory tract, or in clear connection with the action of an allergen - through the air, food - at different hours of the day. often at night - from the action of special stimuli - a down pillow, etc., or from the predominance of parasympathetic influences with a physiological decrease in cortical influences at night), often after excitement.

An attack can begin with precursors (aura, as in gout, eclampsia, angina pectoris), which are different for different patients: mood changes, general weakness, itching in the nose, according to which the patient predicts the development of a major attack.

The attack occurs suddenly; the chest is not able to push out the air that inflates it, the patient feels suffocation, especially painful during the first attack in life. He sits in bed with his legs dangling, or jumps up, looking for a relief position, an arm rest, fresh air. Often the attack begins with the separation of watery secretion of the nasal mucosa, persistent sneezing, coughing. The patient himself and those around him hear a whistle in the chest. The face is cyanotic, the veins swell. Finally, scanty vitreous or pearly sputum begins to stand out with difficulty; then breathing becomes easier, the cough becomes wet, there is more sputum, it leaves more easily; the patient can lie down, fall asleep; asthma attack is over. Employability is soon restored.

Much more severe is the "asthmatic condition" (status asthmaticus - indomitable protracted asthma). An hour or two passes, the resolution of the expected attack but comes; there is a feeling of heavy tension, whistling in the chest; sputum, if any, does not bring the desired relief. The patient does not sleep all night, the day finds him in the same position, exhausted, having lost hope of relief; various remedies that usually helped do not work at all or bring a short-term insignificant improvement; the chest does not breathe completely; there comes an even more painful night, the second day. An attack may last up to a week, or attacks may follow each other only at short intervals.

An erased attack may be limited to dry wheezing or a feeling of immobility of the chest - when the legs are cooled, in a smoky room; after about half an hour, the attack passes.

When examining a person suffering from asthma for a long time, one can also distinguish by appearance, a pale cyanotic complexion, incomplete breathing even at rest, and other signs of emphysema. The chest during an attack, and later and constantly, is swollen, the ribs are raised, the sternum is pushed forward, the anterior-posterior diameter of the chest is increased. The intercostal spaces bulge due to increased intra-alveolar pressure. Respiratory mobility of the lungs is almost not determined by eye. During a severe attack, the patient has to be examined, usually sitting in bed or in an armchair. Rough whistling rales are often heard already at the entrance to the room where the patient is located, they are determined by the hand applied to the chest wall. Percussion gives the same airy sound throughout the entire region of the lungs, sonorous, pillow or box. Auscultation reveals an abundance of rales over the entire surface of the lungs, which does not happen in any other disease - musical, whistling, rough, scraping, making it difficult to listen to the heart, which is also covered by swollen lungs. Satisfactory filling pulse, with a tendency to decrease, which, like arterial hypotension, can be associated with parasympathetic predominance; tachycardia is observed in the most severe cases, occurring with vascular collapse. The liver is lowered due to swelling of the lungs; eosinophilia and erythrocytosis are noted.

A short-term increase in temperature is due to excessive muscle tension or irritation of the nerve centers; more often, fever depends on an infectious lesion of the respiratory tract.

Course, forms and complications of bronchial asthma

The course of asthma is highly variable. Two types can be distinguished.

In the first type, which usually begins in young years, asthma attacks recur for several years every month, week, even more often, or, conversely, with breaks for a whole summer or winter, even for a number of years. Asthmatic attacks can stop during acute febrile illnesses, with a change in the room, climate.

Over time, the disease can lose its correct character, manifesting itself only as asthmatic bronchitis with seasonal exacerbations or from other causes, without clear attacks, i.e. persistently recurrent bronchitis occurring with elements of asthma - an excessive amount of wheezing, their sudden appearance and disappearance, the presence of eosinophils in sputum, relieved by ephedrine.

Over the years, asthma, characterized by a regular course or expressed in the form of asthmatic bronchitis, leads to emphysema, usually with the development of pneumosclerosis of one degree or another. Such patients suffer from chronic pulmonary insufficiency. They die from heart failure, associated inflammatory damage to the lungs or atherosclerosis, cholelithiasis, etc.

In another group of patients, asthma joins an already existing chronic broncho-pulmonary lesion, post-measles, post-pertussis bronchiectasis, chronic pneumonia, pneumosclerosis of another etiology, syphilitic lung damage, chemical poisoning, even tuberculosis, manifesting itself for the first time with a typical attack or asthmatic bronchitis in adults. , and in the elderly. However, Rubel emphasized that the development of pulmonary emphysema even at a young age may indicate chronic hematogenous disseminated pulmonary tuberculosis or limited local bronchiectasis. An objective study is dominated by signs of the main pulmonary lesion, often determining the further prognosis - death from suppurative processes, amyloidosis, lung cancer, or, less often, from heart failure.

Diagnosis of bronchial asthma

You can determine the disease on the basis of anamnesis, patient complaints, examination. The methods of laboratory and instrumental diagnostics are as follows: blood test (eosinophilia is typical), urinalysis, biochemical blood test, allergological studies, general sputum analysis, x-ray, spirometry, bronchography and bronchoscopy, electrocardiography.

The main points of the diagnosis of bronchial asthma are:

• asthma attacks - wheezing, especially on exhalation, a feeling of lack of air, acute emphysema, forced posture with fixation of the shoulder girdle;
• paroxysmal cough, aggravated at night and in the early morning, disturbing sleep;
• the disappearance of shortness of breath and cough after taking bronchodilators;
• decrease in PSV or OFB1;
• blood eosinophilia, increased allergen-specific IgE in the blood;
• microscopic analysis of sputum.

Outside of seizures, early diagnosis is based on history alone. Pointing to urticaria, eczema, detection of nasal breathing defects, curvature of the nasal septum, hypertrophy of the shells, polyps are important. The development of emphysema already provides more support for the diagnosis.

The diagnosis of bronchial asthma is often mistaken for acute heart failure, cardiac asthma, myocardial infarction, acute nephritis, coronary sclerosis in hypertensive patients.

An asthma attack that occurs for the first time in old age, as a rule, depends on cardiac asthma, especially if it is accompanied by hypertension, enlargement of the heart, and pain in the region of the heart.

The young age of the patient speaks for bronchial asthma, as well as pneumonia, pleurisy, hemoptysis, urticaria in the past, family cases of asthma, interruption of an attack by adrenaline, duration of asthma attacks (cardiac asthma leads more often to death in the coming years). Sometimes bronchial asthma is combined with cardiac asthma (more often this combination occurs in elderly people with hypertension).

Differential Diagnosis

Bronchial asthma must be distinguished from cystic fibrosis, bronchoasthmatic syndrome with autoimmune pathology (collagenoses, etc.), infectious and inflammatory diseases (bronchitis, pneumonia, etc.), airway obstruction (tumors, foreign bodies, etc.), neurogenic disorders (hysteria and etc.), etc.

Forecast and work capacity

In atopic bronchial asthma, if the allergen is identified and eliminated, the prognosis is relatively favorable. In the infectious-allergic form of the disease, the course and severity of the underlying disease, the age of the patient, the presence or absence of complications affect the prognosis.

Asthma attacks do not usually die, although in the elderly and old people an attack can be dangerous. The disease disables and often requires a change in profession (pharmacist, furrier, etc.). Complications and concomitant diseases of the lungs further reduce the ability to work.

Prevention of bronchial asthma

Prevention of bronchial asthma is reasonable hardening, strengthening of the nervous system, a rational general regimen, systematically conducted physical education. It is necessary to treat diseases of the airways early and avoid professions associated with irritating substances.

Treatment of bronchial asthma

With an intermittent course, the first stage of therapy is carried out. Medications are prescribed only for the relief of seizures.

For this purpose, short-acting bronchodilators in inhalers or beta-agonists (beta-agonists), also inhaled, or beta-agonists inside are used.

With a mild persistent course, the second stage of therapy is prescribed: inhaled glucocorticosteroids for everyday use. Short-acting bronchodilators can be used to relieve an attack that has already begun.

A severe course requires the appointment of a daily intake of budesonide through a nebulizer, and inside - glucocorticosteroids in small dosages.

The treatment of bronchial asthma is reduced to general measures of calming the patient, regulating his higher nervous activity, to neuro-reflex therapy, as well as to the use of various pharmacological agents aimed primarily at influencing individual pathogenetic mechanisms and symptoms of the disease. Treatment should also be aimed at eliminating specific environmental stimuli (including special infectious, nutritional and other factors), as well as treating lesions of other organs that are the focus of irritation, the source of neuroreflex asthma.

In an acute attack of bronchial asthma, treatment is carried out in order to provide urgent assistance. Systematic treatment aims to prevent seizures and restore the patient's health and ability to work.

An attack of bronchial asthma is most reliably interrupted by adrenaline (0.5 ml of a 0.1% solution under the skin or intramuscularly for faster action), more mildly acting ephedrine (an alkaloid from Kuzmich's grass wild in the Urals, Siberia, Central Asia - Ephedra vulgaris) 0.025-0.05 by mouth or subcutaneously (5% solution), re-appointed if necessary, also with atropine injected under the skin or in an alcohol solution under the tongue. Smoking medicinal cigarettes or powder of asthmatol (Abyssinian powder) from the leaves of dope, henbane, belladonna containing atropine and related alkaloids and moistened with a 10% solution of potassium nitrate works well. In mild cases, dry cans, mustard plasters to the chest, hot foot baths, general calming of the nervous system are enough. In the prevention of seizures, an important role is played by the exclusion of individually various provoking moments well known to patients, for example, cooling of the legs.

Asthmatic condition (protracted recurrence of attacks of "indomitable asthma") requires more complex treatment, although already repeated injections of adrenaline in the indicated dose (up to 8-10 times a day) can bring relief. It is also recommended, especially when asthma is complicated by an infection or heart failure, efillin, which vigorously expands the bronchi by direct action on their muscles at a dose of 02.-0.7 in a suppository or 0.2-0.4 intravenously (slowly injected into a vein) or intramuscularly. Glucose also acts against bronchial edema, in addition, it is indicated due to the usual refusal of patients to eat and drink. Under the influence of eifillin, the action of adrenaline is also enhanced. It is also advisable to carry out a novocaine blockade according to Vishnevsky, prescribe hypnotics that prevent an anaphylactic reaction - large doses of paraldehyde, barbiturates (morphine is certainly contraindicated, especially if there is a risk of asphyxia, as it easily causes paralysis of the respiratory center and also increases bronchospasm), inhalation of oxygen (better in a mixture with helium - up to 30%), ionized air. With insufficient action, they resort to suction of the mucous plug with a bronchoscope. For respiratory tract infections, penicillin is used, especially in the form of an aerosol inhalation. In stubborn cases, other new and old anti-asthma drugs deserve to be tested: epinephrine subcutaneously in an oil solution (to prolong the action) or in combination with pituicrin (“asthmolysin”); antispastic agents - platifillin, papaverine, nitroglycerin; potassium iodide, which thins sputum and prevents blockage of the bronchi; antipyrine, aspirin, caffeine, calcium salts, pyryramidone, which alter the reactions of the nervous system. New antihistamines - diphenhydramine, piribenzamine, so effective in urticaria and serum sickness, do not bring definite benefit in asthma.

It is extremely important to carry out systematic treatment outside of attacks to prevent their return: regulation of the general regimen with sufficient sleep, use of fresh air, calming the nervous system, removing things from the room that contribute to the accumulation of dust and are rich in irritants-allergens dangerous for asthmatics (carpets, down bedding). , horse hair), flowers, domestic animals, the exclusion from food of eggs, milk, caviar, etc., sometimes causing asthma attacks.

Drugs that easily cause idiosyncrasy should be avoided, it is forbidden to administer intravenously quinine, serum, whole blood in order to avoid fatal shock; in case of emergency, their introduction is allowed only after preparing the patient with ephedrine, calcium chloride, aspirin, having an adrenaline solution on hand for quick use in case of a severe reaction. Special skin tests with extracts from suspected products can clarify the allergens responsible for the origin of attacks and desensitize the patient by subcutaneous injection of minimal, gradually increasing doses of these extracts. Patients with asthma who suffer attacks at work as a result of contact with ursol, ipecac, fish glue, etc., need to change their working conditions. Foci of irritation are eliminated by sanation of the nasopharynx, radical treatment of sinusitis, pulmonary diseases, cholelithiasis, adnexitis, etc. Long-term administration of antispastic and sedatives, such as ephedrine, luminal, bromides, regulates the nervous system of patients.

At last, reactivity of patients aspires to be normalized by switching shock or irritating therapy; this is carried out, for example, by intramuscular administration of a suspension of sulfur in oil (1-2 ml of a 1% suspension), autohemotherapy, injection of a 5% peptone solution into the muscle, Bogomolets antireticular cytotoxic serum (ACS), intravenous administration of hemolyzed or incompatible blood in small quantities, tissue therapy according to Filatov, for example, in the form of intramuscular injection of 1-5 ml of fish oil, pasteurized for 15 minutes for 3 days (gives painful infiltrates), or in the form of replanting pieces of organs under the abdomen according to Rumyantsev, X-ray therapy of the roots of the lungs, spleen, cervical sympathetic nodes. Physiotherapy in various forms is beneficial, such as: ionogalvanization with calcium and ultraviolet radiation, starting with small doses, which are believed to increase the tone of the sympathetic nerve; diathermy of the chest, spleen; climatotherapy in Kislovodsk, Teberda, on the southern coast of Crimea and other climatic stations (it is difficult to predict the effect in each individual case).

In rare cases, they resort to operations on the autonomic nervous system - cervical sympathectomy.

Bronchial asthma is a chronic disease of the airways characterized by inflammation. It is this inflammation that plays a key role in the manifestation of the clinical signs of the disease; the frequency and duration of the exacerbation and remission phases depend on its intensity.

The pathogenesis of bronchial asthma consists of immunological and non-immunological factors. The trigger for the development of bronchial hyperreactivity, their obstruction is inflammation, which is influenced by various cellular elements (effector cells) and the chemicals released by them (mediators). These cells include:

• mast cells;
• T-lymphocytes;
• eosinophils;
• neutrophils;
• macrophages.

With prolonged exposure to the allergen on the effector cells, a reaction occurs in the form of the release of mediators that cause inflammation of an immediate or delayed type. Accordingly, bronchial inflammation can proceed in two phases.

1. early phase.
   Under the influence of primary effector cells (mast cells) and their main mediators (histamines), a sharp bronchospasm occurs.
2. late phase.
   In this case, inflammation develops already due to the activation of effector blood cells, which, normally, are not present in the bronchi. These are monocytes, eosinophils, neutrophils. They release metabolites of arachidonic acid (leukotrienes), which cause swelling and bronchial obstruction.

Under the influence of mediators of secondary effector cells, chronic inflammation of the bronchi occurs, which determines the duration of the course of bronchial asthma. Their influence on the respiratory tract can manifest itself:

• bronchospasm;
• narrowing of the bronchial lumen due to swelling of the mucosa;
• increased vascular permeability;
• hypersecretion of sputum;
• damage to the bronchial epithelium.

Eosinophils and their mediators are also able to penetrate the tissues under the bronchial epithelium, damaging them and making them more permeable to allergens. Thus, the exacerbation of the disease will now occur under the condition of a less prolonged and intense contact with the stimulus (for the response of the bronchial tree, stimulation with a lower level will be needed).

Phases of an asthmatic condition

Bronchial asthma is characterized by an undulating course: the exacerbation phase is replaced by a remission phase. The duration of these phases can be different.

Outside the exacerbation phase, the disease may not make itself felt in any way, or asthma attacks occur singly, it is possible to stop them on their own without difficulty. But to achieve remission, especially persistent, in which bronchial asthma does not make itself felt for two years or more, is very difficult. To do this, you often have to completely rebuild your life. To prevent exacerbations, doctors recommend:

• identify the causes of the disease;
• Responsibly and fully undergo the prescribed treatment;
• observe hypoallergenic life;
• eliminate or significantly limit contact with the allergen at work;
• follow a diet;
• choose an environment favorable for living (if it is not possible to live outside the polluted city, then it is necessary to at least periodically travel outside it or undergo sanatorium treatment by the sea, in the mountains);
• be physically active (go to the pool, wushu or yoga);
• in order to avoid frequent colds, take measures to strengthen the immune system.

Asthma in the acute phase

Bronchial asthma in the period of exacerbation is characterized by frequent and severe asthma attacks. These seizures have two main causes:

• actual presence of bronchial asthma;
• the presence of factors that cause exacerbation, the so-called triggers (allergen, viral or bacterial infection, physical or psycho-emotional stress, etc.).

To start an exacerbation of the disease, it is necessary that these causes be present in the aggregate.

Choking with exacerbated asthma occurs in three periods:

1. period of harbingers.
   It can start immediately before an asthma attack (within minutes) or long before it (for several days or weeks). An "experienced" asthmatic is able to distinguish between these precursors and take preventive treatment in time. Usually, suffocation is preceded by:

• rhinitis;
• sneezing
• paroxysmal unproductive cough;
• increased shortness of breath.

This period is optional, sometimes asthmatic attacks happen suddenly, without any precursors.

1. Height period.
   Expiratory suffocation occurs at any time of the day, but more often at night. Regardless of the cause, its symptoms are:

• feeling of tightness and constriction in the chest;
• with a short and deep breath, the exhalation is slow, convulsive, difficult;
• rales and whistles audible at a distance on exhalation;
• the forced position of the patient during an attack, which he takes, trying to alleviate his own serious condition;
• cyanosis, pallor;
• cold sweat;
• increased heart rate (sometimes);
• fever to subfebrile (sometimes);
• increased blood pressure (sometimes);
• anxiety and fear.

Sometimes asthmatic suffocation is accompanied by a cough with scanty sputum.

Severe, prolonged exacerbation of asthma, in which attacks of prolonged duration, resistant to standard methods of relief, accompanied by acute progressive respiratory failure, occur, is called status asthmaticus.

1. Regression period.
   It lasts from a few seconds to several days. At this time, shortness of breath, a feeling of weakness, loss of strength, drowsiness, and depression may persist.

How to treat exacerbated asthma?

Treatment of exacerbated bronchial asthma occurs in two stages: outpatient and inpatient.

Outside the pulmonary hospital, a patient with mild to moderate exacerbation of asthma can be treated only if he can adequately assess his condition, is aware of self-help methods and knows how to apply them. He measures the indicators of external respiration with the help of a peak flow meter. It should be noted that this method of treatment has certain risks. In particular, there is a high probability of developing status asthmaticus and even death in some categories of patients (for example, those who take steroid drugs orally, have mental illness, or do not comply with the asthma treatment plan).

Outpatient treatment includes:

• Bronchodilators.

Treatment of bronchial asthma, if it is exacerbated by frequent asthma attacks, occurs with bronchodilators such as theophyllines, short-acting beta-agonists, anticholinergics, hormonal (glucocorticosteroid) drugs.

Glucocorticosteroids, beta-agonists and anticholinergics are available in the form of pocket aerosol inhalers, which an asthmatic should always have at hand. An example of such a drug is Berotek.

Ventolin or Salbutomol can be breathed through a nebulizer. This device must be in the home of an asthmatic.

And theophyllines (Eufillin, Neofillin) are used orally.

• Anti-inflammatory drugs.

These are glucocorticosteroids (betamethasone, dexamethasone, hydrocortisone, prednisolone, others), which relieve bronchial inflammation, that is, they directly treat asthma during an exacerbation.

Many patients with bronchial asthma are afraid to take hormonal drugs because of the risk of adverse reactions. But endocrine, cardiovascular and orthopedic diseases can occur with long-term use of hormones in the form of tablets or injections. Inhaled by inhalation, they act directly on the bronchial tree, adverse reactions are extremely rare.

If treatment with glucocorticosteroids is ignored by the patient, this can lead to a deterioration in his condition.

• Control drugs.

These include long-acting beta-agonists, which keep the bronchial openings dilated.

If, after asthmatic attacks, the patient has a cough, mucolytic drugs (ACC, Bronholitin, Mukaltin and others) will help him to expectorate sputum.

Treatment of a severe exacerbation of asthma occurs in a hospital.

Exacerbation of asthma should not be ignored, even if it manifests itself in a mild form. In addition to a significant deterioration in the patient's condition during this period, complications such as respiratory failure, development of status asthmaticus, emphysema, cor pulmonale, and pneumothorax are possible.

Video: Health School. Bronchial asthma

Editor

Maria Bogatyreva

Inflammatory processes in the lung parenchyma, spreading from the bronchi and bronchioles, are called bronchopneumonia. Its other name is lobular pneumonia.

According to the international classifier, when making a diagnosis, the ICD-10 code - J18.0 is used. The difference between bronchopneumonia and other types lies in its bronchial origin, in which the bronchus wall is the primary source of inflammation.

Etiology and risk factors

The causes of the development of the disease are bacteria, which, getting into the bronchi, provoke an inflammatory process. As a result of the progression of inflammation, peribronchial tissue and lung parenchyma are involved.

As a rule, the pathological process is triggered by the following microorganisms:

• pneumococci - in 80% of cases;
• hemophilic bacillus;
• mycoplasma - affects patients younger than 30 years;
• chlamydia;
• klebsiella;
• golden staphylococcus aureus;
• coli;
• Pseudomonas aeruginosa.

The risk group consists of persons:

• smokers;
• elderly;
• children;
• alcohol abusers;
• those who are immunodeficient, including those undergoing immunosuppressant therapy;
• living in adverse environmental conditions;
• working in hazardous production;
• having diseases of the respiratory tract;
• after operation;
• with chronic ENT diseases;
• with heart failure and congestion in the pulmonary circulation.

What is the difference?

Bronchopneumonia can be called in other words, since the emerging site of inflammation of the lung tissue around the affected bronchus on the x-ray has the shape of a specific focus. This type of inflammation is caused mainly by bacteria.

At the heart of the development of a bronchial variety of pneumonia, the following points are distinguished:

1. The mechanism of development of bronchopneumonia is due to the bronchogenic pathway. As a result of a violation of local immune defense - a decrease in the functions of macrophages, lymphocytes, the production of secretory immunoglobulins - bacteria get the opportunity to spread outside the bronchus.
2. In bronchial pneumonia, the resulting inflammatory exudate is mostly represented by leukocytes, has a purulent character, in rare cases it can be. There are areas of collapse of the alveoli and emphysematous expansions.
3. It develops gradually, not acutely. Most often it is considered the result of a complication of acute respiratory infections, as a result of acute bronchitis, exacerbation of chronic, especially obstructive.
4. Bronchopneumonia can affect the segment, lobule or acinus, be left- or right-sided, bilateral.

The disease, as a rule, ends in complete recovery and does not lead to complications, in some cases gangrene may develop, an abscess or the disease transforms into.

Symptoms

The history of the disease in a patient with bronchopneumonia develops gradually, the signs of the disease increase against the background of the main cause of inflammation of the bronchi. Symptoms of pathology are as follows:

1. New wave of temperature increase.
2. Increasing intoxication- deterioration of the general condition, tachycardia, weakness, headache, loss of appetite, sleep disturbance.
3. Worse cough. In the initial stages, the cough is dry, with the development of peribronchial inflammation, it gradually becomes productive - mucopurulent sputum appears. If the disease is advanced, blood streaks can be seen in the sputum.
4. Cyanotic shade of the lips, redness of the cheeks, excessive sweating.
5. Strengthening or appearance of shortness of breath.
6. Discomfort in the chest area. When you try to take a deep breath, pain is possible.

Diagnostics

Diagnosis of bronchopneumonia is as follows:

1. During auscultation over a certain (affected) area, weakening of breathing is determined, especially on inspiration, fine bubbling rales, whistles may be present.
2. With percussion, dullness of the sound over the focus is noted.
3. On the radiograph, an increase in the pulmonary pattern, expansion, deformation of the roots, focal infiltrate (lobular darkening of the area) of varying intensity are found, the contours are not clear. The infiltrate acquires the greatest clarity at the height of the disease. There may be several foci in bronchopneumonia and they are localized more often in the lower lobes.
4. A clinical blood test is described by an increase in leukocytosis. ESR, formula shift to the left (with a predominance of stab forms, as well as young neutrophils).
5. Bacterioscopic examination of sputum can detect leukocytes, bacteria. It is cultured for sensitivity to antibiotics.

Bronchoscopy is prescribed to verify the diagnosis if it is difficult to make it.

Differentiation

Bronchopneumonia is important to distinguish from:

• asthma.

Since the symptoms of bronchopneumonia, in particular, when it occurs against the background of obstructive bronchitis, are very similar to the clinical signs of bronchial asthma, experts pay attention to a number of signs. In favor of asthma testify:

• no fever;
• aggravated allergic anamnesis;
• characteristic changes in the blood (lack of shift to the left, increased eosinophils, IgE);
• asthma attacks with difficulty breathing;
• lack of effect from antibiotic therapy;
• specific changes in sputum (glassy, ​​Charcot-Leiden crystals and Kurshman spirals).

Treatment

Treatment is based on taking antibacterial drugs, which are selected individually, taking into account the pathogen. 3rd generation cephalosporins, macrolides, a number of drugs from the group of fluoroquinolones are used.

As part of symptomatic treatment, antipyretic drugs, expectorants, bronchodilators (inhaled and non-inhaled) are used. It is necessary to ensure the proper amount of fluid in the body in the form of drinking plenty of fluids or intravenous administration of saline solutions and glucose.

Local methods of physiotherapy are widely used:

• antibiotic;
• infrared irradiation;
• laser therapy;
• magnetotherapy;

Important! Physiotherapy is prescribed only after the temperature returns to normal.

A patient with pneumonia must comply with bed rest.

And other changes.

Prevention

The prevailing areas of prevention:

• to give up smoking;
• strengthening local immunity of the respiratory tract and general body resistance;
• vitamin prophylaxis;
• vaccination against pneumococcal and hemophilic infections;
• minimizing the risks of infection in predisposed persons (limiting visits to crowded places during periods of rising incidence of acute respiratory viral infections, the use of a respirator, personal hygiene);
• timely and complete treatment of bronchitis, acute respiratory infections, which can lead to bronchopneumonia.

Conclusion

Early diagnosis of the disease at the stage of bronchitis helps prevent aggravation of inflammation and bronchopneumonia. With the unconditional fulfillment of all the requirements of the doctor, the disease is cured completely and without complications. You can talk about complete recovery after a month from the start of therapy. Upon recovery, an x-ray should be taken to make sure that there are no more lesions.

No, see your doctor on time and follow the recommended regimen!