Bronchial asthma is a disease of allergic origin, the main symptom of which is attacks of suffocation caused by impaired bronchial patency due to bronchospasm, swelling of the bronchial mucosa and hypersecretion of mucus. All other manifestations of the disease (including increased sensitivity of the bronchi to various irritants, leading to spasm and impaired air flow) are secondary and directly depend on the severity of allergic inflammation of the bronchi.
Bronchial asthma has been known for a long time. In Ancient Greece, more than two thousand years ago, signs of this disease were described. The constant study of a “strange” disease, which can suddenly manifest itself with attacks of suffocation, and then not reveal itself for some time, has provided a lot of new information about the nature of this disease. Doctors have learned to achieve longer remissions.
Bronchial asthma is widespread throughout the world and its incidence is constantly increasing. Environmental pollution, the emergence of new artificially synthesized substances, changes in the nature and quality of nutrition, and the increasing use of pharmaceuticals in the treatment of various diseases are the main reasons for the increase in the incidence of bronchial asthma.
The number of cases of bronchial asthma is often underestimated due to difficulties in differential diagnosis with a number of diseases that cause asthma attacks (chronic obstructive bronchitis, emphysema, cardiac asthma, cystic fibrosis, bronchiectasis, etc.).
Asthma can develop at any age, but it usually occurs in children and young people under 40 years of age. Females are more often affected, although among children under 5 years of age it affects more boys than girls. Statistics show that this disease is more common among residents of cities than villages, which is explained by greater environmental pollution.
Causes and mechanisms of development of bronchial asthma
A factor in the development of bronchial asthma is the congenital or acquired sensitivity of the bronchi to various allergens. Irritants coming from the environment are called exoallergens, and substances formed in the body itself and causing asthma attacks are called endoallergens. These allergens enter the bronchi during breathing. Household allergens - house dust, dust particles from clothing, bedding, furniture, paper, books, building materials, domestic insects and various bacteria. In damp rooms these are mold fungi, various types of mites, especially the genus Dermatophagoides, living in feather pillows, mattresses, carpets, upholstered furniture, as well as spores of bacteria, fungi and yeast. The development of bronchial asthma attacks at night often occurs due to mites of the genus Dermatophagoides. They measure about 0.3 mm in length and are almost invisible to the naked eye. Each tick leaves about 20 particles of feces per day - active allergens measuringabout 5 microns. Such particles easily enter the human respiratory tract, especially when shaking the bed. Allergy to mites is characterized by nocturnal attacks of bronchial asthma in combination with allergic rhinitis, a year-round course of the process and an improvement in the condition when changing place of residence. Household allergens also include aquarium fish food, which contains Daphnia and Gamarus powder.
Pollen allergens – flower pollen, pollen of cereal plants (rye, fescue, timothy, bluegrass, etc.) and some trees. For a person prone to allergies, pollen from any plant can become an irritant. The reaction to various plant allergens is often combined with intolerance to a number of products of plant origin. For example, an allergy to wormwood pollen is combined with intolerance to citrus fruits, honey, and sunflower. An allergy to birch pollen is often accompanied by intolerance to apples, pears, plums, apricots, potatoes, peppers, eggplants, and carrots.
Epidermal allergens– these are animal dander and hair, bird feathers, fish scales, etc. Allergens can also be found in the saliva, feces, and urine of animals.
Insect allergens.These include allergens that are part of the saliva of biting and stinging insects, as well as various particles of their integument, tissues and secretions.
Food allergens.Food allergies as a cause of bronchial asthma occur in 2–6% of cases, especially in childhood. Allergens can be various foods, but the most active among them are cow's milk, fish (especially red fish meat, cod), honey, egg whites, wheat and products made from it, beans, tomatoes, strawberries, chocolate, coffee, etc. Various food additives - dyes, flavors - can also be allergens that cause asthma attacks.
Drug allergens.Any drug or product of its chemical transformation in the body can cause an allergic reaction.
Infectious allergens.Allergens that can cause the development of bronchial asthma include various pathogens of infectious diseases (bacteria, fungi, viruses).
The development of bronchial asthma in some cases is preceded by a state of pre-asthma, or a period of precursors, which is characterized by the appearance of copious watery secretions from the nose, sneezing, that is, symptoms of allergic rhinitis, then a paroxysmal cough with elements of bronchospasm, dry or with the release of a small amount of viscous sputum, and dry wheezing. At the same time, skin manifestations may occur - itching and allergic rashes. At the time of an attack, the inhalation is usually short, the exhalation is significantly prolonged, becomes convulsive and is accompanied by loud wheezing, audible at a distance. Sometimes they can be interrupted by a cough, and if sputum begins to come out, the patient’s condition worsens. In more severe cases, sputum does not come out or is difficult to release due to increased thickness and viscosity. During an attack, the patient takes a forced position - sitting, leaning his elbows on his knees or placing emphasis on the edge of the bed, which facilitates participation in the act of breathingtion of accessory muscles and helps in exhalation. The patient's face suddenly turns pale, and cyanosis of the nasolabial triangle may appear. The skin is also pale, moist, body temperature does not change. The chest is in the position of maximum inspiration due to the increased air content in the lungs and the difficulty of removing it. A condition called acute pulmonary emphysema occurs.
Drug treatment of bronchial asthma
Despite the fact that the causes and basic mechanisms of development of bronchial asthma have now been sufficiently studied, there are no strictly defined treatment regimens for the disease. However, it can be stated that the basic principles of treatment for the disease have been developed in great detail and allow patients suffering from asthma to maintain a certain standard of living and feel like full-fledged members of society. It is fundamentally important to orient the patient immediately after diagnosis to the need for long-term treatment under regular medical supervision.
The therapy is based on the principle of a purely individual approach to patients, taking into account the causes of development, clinical features of the course of bronchial asthma, the form and phase of the disease. The peculiarity of the treatment of bronchial asthma leads to the fact that treatment and prevention of the disease are practically inseparable and cannot be considered separately. All the main drugs used to treat patients with bronchial asthma can be divided into two large groups:
– drugs for emergency assistance, relief of asthma attacks;
– long-acting drugs to relieve the inflammatory process in the bronchi and prevent symptoms of the disease.
To relieve an attack of bronchial asthma, short-acting drugs are used: salbutamol, fenoterol (Berotec), albuterol, etc. (so-called beta 2 agonists). They are usually prescribed in inhalation form due to their pronounced therapeutic effect. Iprotropium bromide (Atrovent), oxytropium bromide (anticholinergic inhalation drugs), aminophylline are usually prescribed 10 ml of a 2.4% solution intravenously by drip or stream (refers to short-acting methylxanthines).
We know and know how to make the life of a patient with asthma better and his breathing easier. But we can only overcome the disease together.
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