Internal illnesses. Bronchial asthma (etiology, pathogenesis, classification, clinical picture, diagnosis) (most important)

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Internal illnesses. Bronchial asthma (etiology, pathogenesis, classification, clinical picture, diagnosis) (most important)

Lecture notes, cheat sheets

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34. BRONCHIAL ASTHMA (ETIOLOGY, PATHOGENESIS, CLASSIFICATION, CLINIC, DIAGNOSIS)

A chronic inflammatory disease of the airways in which many cells and cellular elements play a role. Chronic inflammation causes a concomitant increase in airway hyperresponsiveness, leading to recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night or in the early morning. These episodes are usually associated with widespread but variable airflow obstruction.

Etiology. The causes that cause the development of the disease are divided into internal factors (innate characteristics of the body) and external factors (modify the likelihood of developing the disease in predisposed people).

Pathogenesis. A specific inflammatory process is formed in the bronchial wall in response to damaging risk factors (activated eosinophils, mast cells, macrophages, T-lymphocytes), bronchial obstruction develops, bronchial hyperreactivity increases.

Airway obstruction has 4 forms: acute bronchoconstriction (due to spasm of smooth muscles), subacute (due to swelling of the mucous membrane of the respiratory tract), obstructive (due to the formation of mucous plugs), sclerotic (sclerosis of the bronchial wall with a long and severe course of the disease).

Classification. Asthma can be: with a predominance of an allergic component, non-allergic, mixed.

When making a diagnosis, the etiology, severity of the course, and complications are taken into account.

Clinic. The period of precursors is characterized by a runny nose, sneezing, watery eyes, a feeling of sore throat, and a paroxysmal cough appears.

In the extended period, patients take a forced position (orthopnea), there is expiratory dyspnea, distant dry wheezing, deep rare breathing, diffuse cyanosis, swelling of the cervical veins, auxiliary muscles are involved in the act of breathing, there is an expansion of the intercostal spaces. Percussion is determined by hard breathing, a lot of dry wheezing. Increasing tachycardia.

During the period of resolution, a cough appears with difficult-to-discharge glassy viscous sputum, and distant wheezing disappears. Percussion is determined by the reduction of boxed sound. Auscultation - reduction of dry wheezing.

Diagnostic research. A general blood test is performed, where leukocytosis, eosinophilia, and an increase in ESR are detected. The allergic status (presence of IgE) is determined, skin tests with allergens are performed. Sputum is examined (macroscopically - viscous, transparent; microscopically - eosinophils, Charcot-Leiden crystals and Kurshman spirals, neutrophils). A functional study of the lungs is carried out (a study of OVF1, FZhEL, PSV), samples with bronchodilators are put (a study of airway hyperreactivity). A non-invasive measurement of airway inflammation markers is carried out (sputum examination for the presence of eosinophils or metachromatic cells after inhalation of hypertonic saline or spontaneously isolated). NaECG: overload of the right ventricle.

Flow. More often progressive, periods of exacerbations and remissions.

Author: Myshkina A.K.

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