What is Bronchial Asthma

Bronchial asthma is a chronic respiratory disease of the airways in which many cells and cellular elements play a role (mast cells, eosinophils, T lymphocytes, macrophages, neutrophils and epithelial cells).

In susceptible individuals this inflammation leads to rekurent episodes bronhoobstruktsiya mostly early morning.

Cardinal features

Bronchial asthma are characterized by increased susceptibility or hipereaktivnost the lower respiratory tract and bronchi to various infectious, immunological and irritant incentives vkl.tsigaren or other smoke, physical and / or emotional stress and cold air.

Manifested by massive reverzibelna airway obstruction due to bronchospasm and inflammatory inflammation.

Prolonged ekspiraciя diffuse wheezing on physical examination.

HF polyphonic wheezing.

Classification

Bronchial asthma is subdivided into:

  1. Outside: when identifying external causes
  2. Internal or cryptogenic: when you can not be ustavnovena The reasons for asthma.

The outer asthma is observed frequently in individuals with atopy.

Cryptogenic asthma is usually seen in patients of middle age.

Etiology

The most common triggers are:

  1. Atopy: familial asthma
  2. Allergy: pollen, animal hair, spores and other
  3. Cold air
  4. Smoking, passively or actively
  5. Pollution of stratospheric air
  6. Climate Change
  7. Emotions
  8. Medicaments, aspirin, beta blockers, anaphylaxis
  9. Food and drink: food allergies
  10. Syndrome Churg – Shttraus (rarely)

Enhance and predisposing factors

Positive family anmneza

A positive history of atopy

Prenatal smoking

A positive history of life in terms of available industrial pollutants.

epidemiology

About 5,000 new cases per 100 000 population per year.

Age of patients: 50% of the cases to the fifth year, 33% of varzrast patsienitte are 14-44 years old, late-onset asthma is 17% of asthmatics.

pathogenesis

The main features of asthma include: (1) a variable degree of bronhoobstruktsiya associated with swelling, inflammation and hypersecretion; (2) increase in pulmonary pressure; (3) airway inflammation.

acute inflammation

Inhaled allergen induced early phase allergic reaction which may be followed by a late phase response.

Immune response is mediated by IgE antibodies.

The first step in the immunological response to the antigen in bronchial asthma is the activation of macrophages and mast cells in bronchial tree. They emit proinflammatory mediators such as histamine, and ekozanoidi reactive oxygenated particles that cause contraction of muscle glabdaka in the bronchial tree, mucus secretion and vasodilatation. Bronchial microcirculation plays a key role in this inflammatory process because inflammatory mediators induce microvascular leakage by exudation of plasma into the lumen of the bronchial tree, which destroys its epithelial integrity, and also reduce mucus clearance.

Late fazofata allergic reaction began its development 6-9 hours after allergen challenge and includes engagement and activation of eosinophils, the CD4 & the T cells, basophils, neutrophils and macrophages.There is selective retention of T cells in the epithelium of the bronchial tree, expression of adhesion molecules and release of proinflammatory mediators and cytokines.

Chronic inflammation

In chronic inflammation are certainly be involved both central and peripheral airways.

Chronic inflammation is pantsetopenichno for bronchial tree, comprising: basophils, macrophages, T cells, mast cells, epithelial cells, myocytes and fibroblasts.

These cells also participate in the process of chronic inflammation by removal of cytokines and growth factor administration.

Remodeling of the airways

Acute inflammation is a nonspecific response of tissues to injury, leading to restoration of the normal structure and function.

In contrast, chronic inflammation occurs remodeling of the bronchial tract, and here it is a “defective” recovery.

The recovery comprises substitution of the injured tissue with parenchymal cell of the same type and replacement of connective tissue and its “maturation” to tissue rich in fibroblasts and smooth muscle.

Precise mechanism of remodeling of the airways in the process of intensive research.

Clinical presentation

Asthma is presented most often with intermittent wheezing and dyspnea.

Symptoms occurs after exposure to saotvatniya arlergen or without notice.

Bronchial asthma in adults may present with persistent cough.

Symptoms

Cough and Chronic dry, often at night.

Intermittent hriptene.

Dyspnea.

Disturbed sleep due to coughing.

Daily variability of symptoms.

signs

There may not be any symptoms between episodes.

High wheezing in vsechki lung fields.

Tahypneya.

Prolonged ekspiraciя.

Tachycardia.

Under heavy attack, the use of additional respiratory muscles, and intercostal hiperrezonans etraktsiya.

Life-threatening symptoms: inability to speak or swallow water, changes in mental status, pulsus paradoksus quiet lung and cyanosis.

Associated diseases

Other atopic diseases, eczema and allergies.

GERD.

Allergic granulomatosis, Churg – Shttraus: rhinitis and asthma symptoms, eosinophilia, vasculitis of small blood vessels, extravascular granulomatosis.

Allergic bronchopulmonary aspergillosis: wheezing, cough, fever and general fatigue, eosinophilia, reditsivirashti pneumonia.

Chronic sinusitis.

Diagnostic decision

A diagnosis of asthma should be based on amnesia, review and spirometry data.

Episodic, reversible bronhoobstruktsiya diagnostic criteria.

Should exclude alternative diagnoses.

There are 4 categories of asthma:

  1. Mild intermittent asthma, symptoms are present for, or in less than two days a week or 2 or fewer nights per month.
  2. Mild persistent asthma, symptoms persist for more than 2 days per week or more than two nights a month.
  3. moderate persistent asthma: daily living simpotmatika and sometimes dressing such.
  4. Severe persistent asthma: symptoms daily living and often dressing such.

Laboratory researches

Spirometry.

Sightseeing graphy lung – to the exclusion of other pulmonary or cardiac pathology.

Peripheral blood blood count and analysis of sputum are of little benefit.

Tests for the identification of allergy.

Bronchial provocation test metilholin or histamine.

Laryngoscopy to exclude laryngeal pathology.

differential diagnosis

XOBB

Chronic obstructive bronchitis is ireverzibelna bronhoobstruktsiya that occurs with chronic cough, expectoration, and dyspnea.

Often, positive history of smoking.

Other causes include silicosis and alpha 1 antitrypsin deficiency.

Typically occurs after the fourth decade.

Symptoms occurs mostly during the day, while asthma symptoms is mainly Bedside time.

Congestive heart failure

This disease is characterized by the inability of the heart to pump enough oxygenated blood amount required to satisfy the metabolic needs of the organism. Develops congestion in the systemic and pulmonary circulation. Dyspnea and wheezing sometimes termed “cardiac asthma” but there is no bronchospasm.

The most common clinical manifestations are: dyspnea, orthopnoea and dressing paroxysmal dyspnea.

There pulmonary venous kogestiya, peripheral edema and increased levels of beta-type natriuretic peptide.

Pneumothorax

It is characterized by an accumulation of air in the pleural space., Resulting in a collapse of the lung.

Dyspnea and pleural pain.

Ipsilateral decrease in the respiratory noises.

Hiperrezonansen perkutoren tone.

Pulmonary embolism

Dyspnea can be the only symptom.

Pleuritic chest pain.

Hemoptysis, if pulmonary infarction.

Cardiovascular collapse if tezhkostepenna thrombosis.

Nyama bronchial obstruction.

Send sounds locates only one lung, while asthma are involve all lung fields.

Obstruction of the large airways

Mainly due inhalorano foreign body.

Stridor with an unexpected start.

Monomorphic wheezing.

Vocal cord dysfunction

Vocal cord dysfunction can mimic asthma, and these two conditions may occur together.

Inspiratory stridor.

Dyspnea.

Nachyalo sharp and resolution of symptoms.

The symptoms were not influenced by the administration of antiasthmatic drugs.

Laryngoscopy during the acute attack gives difinitivna diagnosis of disease.