September 24, 2021
Bronchial asthma is a chronic lung disease that causes obstruction of the bronchi
Bronchial asthma is a chronic lung disease in which obstruction of the bronchi occurs. In healthy bronchi, the lumen is free and allows inhaled and exhaled air to pass through the respiratory tract unhindered.
Due to the development of inflammation, swelling of the walls of the bronchi occurs, it thickens, and at the same time, a contraction of the muscle fibers of the bronchi occurs with the development of bronchospasm. In the spasmodic bronchi, mucus accumulates, which disrupts the free passage of air flow, resulting in a feeling of lack of air, shortness of breath, and wheezing.
In modern society, asthma is considered a serious problem due to the progressive course of the disease, which bothers patients with frequent attacks and causes a deterioration in their quality of life. Today, more than 100 million people in the world suffer from bronchial asthma, which on average for each country is 4-8% of the adult population. Every year, asthma causes the death of 250 thousand people.
The mechanism for the development of a spasmodic reaction of the bronchi is always an allergy. There are many reasons for its development; in addition, there are a number of factors of bronchial asthma that contribute to the development of the disease as a whole and the occurrence of individual attacks: a hereditary predisposition, which is observed in a third of patients.
If one of the parents is sick, then the probability of the child developing this disease is about 30%, and if both parents are sick, then more than 70%; bacterial or viral infections that are constantly present in the body; any dysfunction of the immune system; bad habits, primarily smoking; work in an atmosphere contaminated with small particles; living in poor environmental conditions; chronic poor nutrition; uncontrolled use of pharmacological drugs.
To make an accurate diagnosis and appropriate treatment, bronchial asthma is divided according to several factors. Regarding its origin, the following varieties are identified: allergic; non-allergic; mixed; unspecified.
Symptoms of bronchial asthma
What should you be wary of? Among the early signs of bronchial asthma are the following:
Choking or shortness of breath. The condition can occur both during physical activity and at complete rest, as well as when inhaling air contaminated with allergen particles.
Cough. It occurs simultaneously with shortness of breath and has an annoying character. The cough is unproductive, and only at the end of the attack is it possible to release a small amount of sputum.
Shallow breathing. An asthma attack is accompanied by frequent shallow breathing and the inability to take a deep breath
Wheezing. They accompany a person’s breathing during an attack and are sometimes heard even remotely.
Orthopnea position. This is the position that a person reflexively takes during an attack - sitting, dangling his legs, tightly grasping a chair, bed or other object with his hands. This pose promotes deeper exhalation.
With exacerbation of asthma, these symptoms may include bloating of the chest, difficulty speaking, drowsiness, and rapid heartbeat. In atopic bronchial asthma, asthma attacks are often accompanied by a runny nose (stuffy or watery discharge, sneezing) and itchy skin, especially when in contact with an allergen (for example, when staying in a dusty room). The symptom intensifies during active games, stressful situations (during crying, fear), at night.
BRONCHIAL ASTHMA: FIVE MAIN MISCONCEPTIONS
16.Dec.2020
Misconception 1: Asthma is a lifelong disease. It is impossible to be cured.
Reality: bronchial asthma is a chronic inflammatory disease of the respiratory tract, manifested by a host of symptoms. Although doctors cannot guarantee a permanent cure for asthma, the disease can be successfully controlled. This means that with proper treatment and following the recommendations of a specialist, a person can live without exacerbations.
Misconception 2. Asthma can develop as a result of untreated colds, acute respiratory viral infections, and bronchitis.
Reality: Frequent colds and viruses are not the root cause of asthma. However, an infection can be a provocateur that triggers an exacerbation of an already existing disease in the body that has not been diagnosed. In reality, three conditions are always required for asthma to occur. The first is a specific, non-infectious inflammation of the respiratory tract. The second is an excessive reaction of the bronchi to the slightest provocateurs, which healthy people simply do not notice. And third, the reversibility of all respiratory symptoms. This means that asthma can go away temporarily with medication or even on its own. But the severity of the external manifestations of the disease can vary significantly. Many asthmatics are bothered only by an occasional cough, only rare episodes of wheezing in the chest or discomfort when breathing.
Misconception 3. An asthmatic is a martyr, forced due to illness to deny himself all the joys of life.
Reality: A properly treated asthmatic differs from a healthy person in only one way: a person with asthma needs to breathe in an inhaler twice a day. If you follow this rule, then you can do everything the same as others: travel, play sports, go to the bathhouse, give birth to children, work intensively. However, a patient with asthma must avoid factors that provoke exacerbation of the disease. The patient must know the characteristics of his illness and navigate the symptoms. So, if a person has a severe allergic form, then it is important to limit contact with the culprit allergen. If an aggravation is caused by a professional factor, you need to change your place of work. If an asthmatic reacts sharply to house dust, it is necessary to remove carpets from the house, store books behind glass and carry out regular wet cleaning of the apartment. If a person is allergic to animal fur, then he should avoid being around pets.
Misconception 4. Asthma is a weather-dependent disease.
Reality: most asthmatics do not tolerate wet, windy weather, dampness, or cold. Therefore, they feel worse in late autumn, winter and early spring. When leaving a warm room, they may experience cold bronchospasm. But this is a property of a particular person, and not a pattern. In the same way, a group of citizens sit down for whom it doesn’t matter what the weather is like outside, but the flowering of a poplar or contact with an animal is a real test for them.
Misconception 5. Asthma medications are addictive; the patient will no longer be able to live without them.
Reality: with some variants of the individual course of asthma, a person is forced to use an inhaler for a long time, sometimes for life. But not because I got hooked on the medicine, it is not a drug, but because this is the essence of the disease. In some people, the course of treatment leads to many months of remission, and this contributes to a temporary cessation of medication. For others, stopping the inhaler causes a deterioration, usually with nightly attacks of coughing and suffocation. In this case, you need to constantly take medications in an optimal manner. Don't be afraid of getting used to the medicine. This doesn't happen. It’s just that sometimes a person experiences an exacerbation, during which it is necessary to increase the dosage or change the treatment regimen.
Diagnostics
Diagnosis is based on an analysis of complaints, life and disease history, medical examination data, laboratory tests, special functional and allergological tests. A careful study of complaints and medical history (especially first-time attacks) allows us to suspect asthma in 70% of cases. For this purpose, there are special questionnaires developed by allergists. Instrumental diagnostic methods are also widely used: x-rays of the chest and sinuses; electrocardiography; study of external respiratory function with peak flowmetry; diagnostic bronchoscopy; tests for bronchial reactivity under the influence of various drugs and physical activity
spirometry.
The main method for diagnosing bronchial asthma is spirometry (external respiration function test). Spirometry must also be carried out to monitor the progress of asthma treatment: it is necessary to focus not only on the presence or absence of complaints during treatment, but also on the objective indicators that spirometry provides. There are simple devices (peak flow meters) for independent use by asthma patients.
During the interictal period, pulmonary function may be normal; sometimes in these cases provocative tests are performed, usually with methacholine. A negative test with methacholine excludes bronchial asthma, but a positive test does not yet confirm this diagnosis. The methacholine test is positive in many healthy people; it may be positive, for example, for several months after a respiratory viral infection.
Chest X-ray is mandatory for severe attacks, as it allows us to identify hidden complications that require immediate treatment. To identify provoking factors, allergic status is determined. Blood and bronchial mucus tests determine the severity of the disease. The examination plan is developed by the attending physician individually for each patient, taking into account the recommendations received during consultation with an allergist, pulmonologist and ENT specialist.
How to properly treat asthma
Komsomolskaya Pravda spoke with medical pulmonologist Yulia Aleksandrovna Zonova about the causes, diagnosis and treatment of bronchial asthma.
1. Can an adult get asthma if there were no breathing problems or suspicions of this disease in childhood?
You can get asthma at any age. There are so-called internal risk factors for the occurrence of bronchial asthma (BA), for example, increased sensitivity of the bronchi to various irritants (cold air, odors, etc.), obesity. The most important role is played by genetic predisposition, about which the person was not aware. It is known that the presence of bronchial asthma in one of the parents doubles the risk of the disease, and in both parents it quadruples the risk. Predisposing genes can be compared to a disease code that remains hidden until a specific code is entered. This code is the external factors that provoke bronchial asthma (allergens, respiratory infections, various occupational hazards, tobacco smoke, medications, stress, hormonal changes in the body), which can appear at any age.
2. Why treat asthma daily if symptoms do not occur every day and quickly stop after inhaling salbutamol?
For the treatment of bronchial asthma, two categories of drugs are used: drugs for rapid relief of symptoms (emergency drugs) and therapeutic agents (basic, planned therapy). The first category includes short-acting substances with bronchodilator properties, which are usually delivered to the bronchi using an inhaler. These include salbutamol, fenoterol, berotec, berodual, ipraterol, etc. These medications only relieve asthma symptoms, but do not cure the disease. Medicines of the second group are not intended (with some exceptions) for quick “relief” of symptoms, they are not used “as needed”, the purpose of their use is to influence inflammation, that is, to treat bronchial asthma. These drugs are used daily, for a long time, in the dosages and frequency ratios indicated by the attending physician. The decision to change the dosage or discontinue these drugs can only be made by a doctor.
3. If you have an allergy to your pet, which results in asthma attacks, but you are using anti-inflammatory drugs daily to treat the disease, is it possible to leave your pet at home?
Unfortunately no. The basic rule in the treatment of bronchial asthma is to eliminate contact with the factor that provokes symptoms. Symptoms and exacerbations of bronchial asthma can occur even against the background of properly selected anti-asthma therapy. In addition, constant contact with the provoking factor will not allow achieving the main goal of therapy - controllability of the disease.
4. Why did the doctor prescribe a hormonal inhaler? Are there really no other medications for routine treatment of asthma, since constant use of hormones is dangerous?
Drugs for routine treatment of asthma include inhaled hormones (ICS) and non-hormonal drugs (antileukotrienes, theophylline, long-acting bronchodilators, various classes of antibodies). ICS (hormonal drugs) are currently the most effective drugs and constitute the first line of therapy. With regular use, they relieve symptoms, improve lung function, reduce the need for emergency medications and the risk of exacerbations, and improve quality of life. When using ICS in recommended dosages, a local effect occurs on the bronchi; the drugs are not absorbed and do not have systemic effects, like hormonal tablets or injections. All other drugs are second-line drugs for planned treatment of BA, which have either less effectiveness and influence on the prognosis, or significant side effects, or are used only for severe uncontrolled BA according to strict indications.
5. After being prescribed medication for asthma, will I have to use inhalers for the rest of my life?
In reality, it's partly up to you. With strict adherence to all medical recommendations and achievement of controllability of bronchial asthma, in most cases it is possible to gradually reduce the amount of planned therapy or completely cancel it. Current recommendations are to manage the disease with the fewest medications possible to maintain control of asthma. If bronchial asthma remains under control with minimal therapy, the doctor may attempt to cancel it.
About the specialist: Yulia Aleksandrovna Zonova, pulmonologist, candidate of medical sciences, associate professor of the department of hospital therapy at Kirov Medical University, member of the Russian Respiratory Society, member of the European Respiratory Society.
You can make an appointment with a pulmonologist by calling; 22-03-03
