The doctor's conclusion about the severity of asthma symptoms, determining the severity does not mean the final determination of the severity of the disease.

BA differs, for example, from chronic bronchitis (CB) in greater variability of the course, even more complete reversibility of impaired bronchial patency with adequate therapy.

Therefore, the prognosis of the course of BA is significantly aggravated in the presence of chronic bronchitis against the background of it, since the reversibility of the obstructive syndrome in such cases is less likely.

With a combination of BA and CB, the interictal period is less clear according to subjective and objective data due to the predominance of the infectious-inflammatory process in the bronchial tree. Such a course of BA against the background of chronic bronchitis is more often associated with the concept of infectious (non-atopic) asthma.

Figure 7. The sequence of using the peak flowmeter:
a - put the mouthpiece head on the peak flowmeter; b - stand up and hold the peak flow meter horizontally, make sure that the slider is stationary and is at the beginning of the scale; c—d inhale deeply, clasp the mouthpiece with your lips and exhale as quickly as possible; note the result, repeat stages b-d twice, choose the highest result, compare the obtained data with the due ones; e - explain to the children that you need to exhale so that you can extinguish the candles on the birthday cake.

These differences are clearly demonstrated by V.I. Pytsky et al. (1999) in the table of differential diagnosis of various forms of bronchial asthma.

We borrowed the clinical and pathogenetic data of these authors and adapted them taking into account the clinical and pathogenetic ideas (Table 22) about allergic and non-allergic BA.

Table 22. Diagnosis and clinical manifestations of allergic and non-allergic bronchial asthma

In the primary diagnosis of asthma, it is often difficult to differentiate between non-allergic asthma and chronic bronchitis or the cough variant of asthma and tracheobronchial dyskinesia, central lung cancer, and chronic bronchitis.

In the differential diagnosis of BA and CB, it is necessary to take into account the presence of biological markers characteristic of these two diseases (see diagnosis and classification of BA and CB).

In tracheobronchial dyskinesia (TBD), in contrast to BA, there is no allergic history, there is no variability in peakflowetrin values ​​when monitoring them during the day (more than 20-30%).

Research by V.P. Skiba (1994) show that most often TBD is characterized by a paroxysmal "barking" cough during the day (in 90.9% of cases) or at night (in 18.1% of cases); in 47.3% of patients, the cough ends with shortness of breath, turning into pronounced attacks of suffocation (more often against the background of physical activity due to an increase in expiratory intrathoracic pressure, which increases prolapse into the lumen of the trachea and large bronchi of the membranous wall).

A very revealing study in TBD is the recording of forced exhalation with the presence of negative teeth in the form of dips in the segment characterizing the "flow-volume" of large bronchial structures.

The fibrobronchoscopy picture in TBD is very peculiar. Depending on the severity, expiratory prolapse of the membranous wall of the respiratory tract can be traced in the area from 1/2 to 2/3 of the lumen of the trachea and bronchi. In such patients, during exercise, along with paroxysmal cough, expiratory dyspnea may occur. With TBD in singers, in the process of performing an aria, when such a pronounced expiratory prolapse occurs on exhalation, the melody may suddenly break off or a paroxysmal cough may occur due to bulging of the membranous part of the posterior wall - a strong irritation of the vagus receptors (reflexogenic cough zone) by expiratory collapse of the posterior wall of the trachea and bronchi.

It should be noted that the presence of spontaneous or paroxysmal cough is possible due to swelling (edema) of the mucous membrane of the large bronchi, trachea due to inflammation of allergic origin or slowly increasing cough due to edema of infectious and inflammatory origin. A similar situation may arise in the process of differential diagnosis of these conditions, which are easily eliminated during treatment.

However, if the cough reaction does not disappear, an in-depth examination of the patient with the help of fibrobronchoscopy is necessary to exclude neoplasms with histomorphological studies of suspicious areas of the mucous membranes to detect metaplasia, anaplasia, hyperplasia.

Bronchial asthma with nocturnal attacks of suffocation

In differential diagnosis, it is not always possible to make an unambiguous decision in patients with manifestations of nocturnal asthma attacks or nocturnal paroxysmal cough reactions. Along with the so-called "nocturnal bronchial asthma" in such patients, it is necessary to exclude gastroesophageal reflux with microaspiration of gastric contents, as well as cardiac asthma due to subacute (or acute) systolic insufficiency. It would seem that these states are fundamentally different from each other.

However, they can create certain difficulties in establishing the final diagnosis. Moreover, the presence of an allergic history, sensitization to exoallergens with an increase in the content of general and specific IgE, interleukins (IL-4, IL-5, IL-6) play a decisive role in the diagnosis of atonic BA (reaginic type), while in non-allergic ( non-atopic) asthma, these criteria may not be present. In such cases, a wide range of other clinical diagnostic markers must be taken into account.

As noted by S.T. Holgate (1997) and others, in the case of atopic and non-atopic BA in the study of the cellular composition of bronchiolar-alveolar lavage, biopsy of the mucous membrane of the bronchial tree, along with lymphocytes, the content of mast cells and eosinophils, their expression products - histamine, tryptase, eicosanoids - prostaglandin D2 is increased , cystenyl-leukotrienes, which ultimately, through neural effector mechanisms, provoke a cough and bronchospastic reaction.

An increase in the content of nitric oxide (NO) in the exhaled air has a certain significance in the diagnosis of asthma. This is an interesting new diagnostic test. NO is produced by many cells of the respiratory tract and significantly increases in the exhaled air due to the activation of inflammatory cells (S.A. Kharitonov et al., 1997).

Thus, based on the main pathogenetic argument about inflammation in asthma, a number of biological markers of inflammation have now been proposed that make it possible to differentiate asthma from other conditions that provoke nocturnal asthma attacks. However, this is not enough and a number of additional studies are required. Attacks of nocturnal coughing and suffocation associated with reflux esophagitis, microaspiration of gastric contents, saliva or mucus-like mass during inflammation of the nasopharynx can be deciphered with an in-depth examination of the relief of the mucous membrane of the nasopharynx, examination of the gastrointestinal tract.

With regard to diseases of the cardiovascular system associated with the primary initial presence of systolic insufficiency of the left ventricle and observed episodes of cardiac asthma, the following should be excluded:

• IHD with atherosclerotic or postinfarction sclerosis of the myocardium;
• dilated myocardiopathy;
• pressure overload of the left heart (hypertension, aortic stenosis);
• diastolic volume overload (aortic valve insufficiency), etc.

This takes into account: the absence of an allergic history, the presence of inspiratory dyspnea during physical exertion, the presence of tachycardia, concentric, eccentric or asymmetric hypertrophy of the left heart, a decrease in systolic and pulse pressure, high efficiency in nighttime asthma attacks not only of β2-agonists, but of nitrates and other pathogenetic therapy for cardiovascular pathology (the use of antihypertensive drugs for hypertension).

Differential diagnosis and diagnosis of occupational bronchial asthma. The development of occupational bronchial asthma due to sensitization of workers to allergens in the workplace depends on many circumstances (V.G. Artamonova, V.F. Zhdanov, E.L. Lashina, 1997) and can be predicted when:

1) predisposition due to hereditary burden and own allergic history;
2) the inhalation route of the allergen, since the respiratory organs are the most sensitive system in the formation of allergies;
3) the presence of strong allergens of the 1st hazard class (ursol, bichromate, salts of nickel, cobalt, phenylenediamine, chlorpromazine, fodder yeast, etc.);
4) periodic excess of the maximum allowable concentrations of haptens in the air, since the concentration of the allergen matters during primary sensitization, while with the development of allergies, bronchial asthma attacks are provoked by allergens at a concentration significantly lower than the maximum allowable;
5) the combined effect of allergens with other harmful factors (non-allergens), various pollutants (dust, gaseous and oily aerosols), which have a damaging effect on physiological barriers and contribute to the fact that even weak allergens can cause sensitization.

There are three main options for the formation of professional bronchial asthma:

1) an allergic form that occurs primarily without previous allergic lesions of the upper respiratory tract, skin;
2) an allergic form in combination with occupational allergic dermatitis that developed primarily in places of the greatest exposure to the industrial allergen in open areas of the skin (hands, skin of the neck, face), rhinoconjunctivitis;
3) allergic and non-allergic - a mixed form of asthma that developed against the background of previous chronic occupational bronchitis. In this situation, a variant of non-allergic asthma is possible.

The first two variants of occupational bronchial asthma develop in workers in contact with allergens of the 1st and 2nd hazard class. At the same time, an increase in allergospecific IgE is observed.

The third variant of occupational asthma (mixed or endogenous forms) is detected in workers in contact with pollutants, which contain weak or moderate allergens. The risk threshold in this case can be 10-12 or more years of work in contact with allergens, the concentration of which exceeds the maximum allowable.

Occupational allergic history - the appearance of allergic reactions at work and their disappearance outside it - is an important clinical and diagnostic criterion for the disease.

Monitoring of external respiration parameters, in particular portable peak flow measurements before, during and after work, is a very important and often decisive objective test for occupational allergic anamnesis in the diagnosis of asthma.

Along with functional monitoring of external respiration parameters, scarification skin tests and intradermal allergy tests with standardized occupational allergens are carried out according to generally accepted diagnostic criteria.

Provocative inhalation diagnostic tests with professional agents are performed in cases where there is no correlation between the data of the allergic anamnesis, exposure tests and skin testing data. A provocative inhalation diagnostic test with occupational allergens is carried out in prescribed and permitted concentrations (not higher than MPC) in the interictal period in a hospital setting. When testing non-bacterial allergens of animal or plant origin containing 10,000 PNU, two-fold dilutions are prepared (1:2, 1:4, 1:8, etc. up to 1:2048), for inhalation samples with chemical allergens - ten-fold dilutions ( 1:100, 1:1000, etc. up to 1:100,000) of a chemical compound if it is a liquid.

Before the provocative inhalation test and 30-90 minutes and 24 hours after it, auscultatory data and functional indicators of external respiration are recorded in the form of monitoring, and a mast cell destruction test (TDTC) is also performed. TDTK data 24 hours after the provocative inhalation test with professional allergens sharply increase compared to the initial ones (before the test) due to the induction of allergy-specific IgE in the presence of sensitization to the industrial allergen with which the provocative test was performed.

Currently, in the diagnosis of occupational bronchial asthma, blood cell reactions to hapten in vitro are used (the reaction of specific agglomeration of blood leukocytes - RSA, the reaction of specific damage to blood basophils - RSPB), serological reactions with chemical allergens (complement fixation reaction - RSK, passive hemagglutination reaction - RPGA), specific cellular hypersensitivity reactions in vitro (reaction of inhibition of cell adhesion - RTPC, reaction of specific rosette formation - ROCK, reaction of inhibition of migration of blood leukocytes - RTML).

Formulation of the diagnosis

1. Bronchial asthma, allergic form, mild episodic course, remission phase, DN0. allergic rhinitis. Sensitization to household allergens.
2. Bronchial asthma, allergic form, mild persistent course, exacerbation, DN0—I. Pollinosis, rhinoconjunctival syndrome. Sensitization to wormwood pollen.
3. Bronchial asthma, non-allergic form, moderate persistent course of moderate severity, exacerbation phase. Chronical bronchitis. Aggravation. DNI-II
4. Bronchial asthma, mixed form, moderate course, exacerbation phase. Emphysema, DH1. Sensitization to epidermal allergens (cats, dogs).

There are a large number of respiratory diseases that are very similar to each other. For this reason, doctors have to analyze the symptoms of the patient and compare them with the symptoms of various diseases. Often, diseases such as bronchial asthma and COPD (chronic obstructive pulmonary disease) are required. These ailments are easily confused, which requires additional comparisons.

Bronchial asthma (BA) is a disease characterized by thickening of the bronchial walls due to a chronic inflammatory process. As a result of the above changes, the patient complains of respiratory failure, which requires constant monitoring and.

COPD disease is incurable and is characterized by the manifestation of bronchitis (a large amount of sputum is formed in the lungs) and emphysema of the lungs (lung volume decreases due to an increase in the number of alveoli). Also, this disease requires special monitoring by the medical staff.

From the characteristics of the ailments under consideration, it can be seen that their manifestations are almost the same - in both cases, an inflammatory process occurs in the respiratory organs and the patient experiences. Differential diagnosis will help to identify the disease that has arisen, which will allow you to prescribe the right course of treatment and alleviate the patient's condition.

IMPORTANT! If the doctor doubts about the diagnosis, the differential diagnosis will be the ideal option. The method consists in the exclusion of diagnoses similar in symptoms.

Investigations that the patient must undergo for the application of differential diagnosis

In order to establish a diagnosis, the doctor first of all sends the patient to a number of studies, including:

From the above analyzes, it will be possible to compile a general picture of the patient's state of health. An x-ray will show the condition of the lungs, the presence of foci of inflammation and other manifestations. Examination of the secreted fluid from the respiratory organs will reveal the presence of bacteria and the condition of the lungs, and studies of the functions of external respiration will show the volume of the lungs, disturbances in normal breathing and the degree of its severity.

Having all the test results, the doctor can proceed to the diagnostic method by excluding the symptoms of other diseases. In this case, a parallel is drawn between the symptoms of bronchial asthma and chronic obstructive pulmonary disease.

Manifestations of bronchial asthma

Bronchial asthma is often of a nature, so the doctor without fail clarifies this information. The disease manifests itself as follows:

• the patient is tormented by coughing attacks mainly in the morning and evening;
• during coughing, sputum may be released, but in very small quantities;
• the patient experiences spontaneous shortness of breath during periods of an attack;
• physical capacity for work falls during the presence of an attack, i.e. during a period of calm, the patient has enough strength;
• asthmatics often observe allergic manifestations on their body.

It should also be taken into account that the manifestations of bronchial asthma are observed in early childhood, children can inherit this disease.

Bronchial asthma varies in severity:

1. Light form. The disease practically does not excite the patient. Symptoms of the disease appear no more than 1 time per week (in the afternoon). At night, the manifestation of the disease also occurs rarely - no more than 2 times in 30 days.
2. Medium form. appears in the patient almost every day. At night, symptoms occur more than once every seven days.
3. Severe form. The patient experiences constant attacks every day, which regularly occur at night. This condition requires immediate treatment and refusal or abstinence from exercise.

IMPORTANT! Whatever the form of severity of bronchial asthma in a patient, he should be under dispensary observation. This is especially true for young patients, because babies are very vulnerable to various ailments.

Manifestations of chronic obstructive pulmonary disease

Consider the symptoms of chronic obstructive pulmonary disease in more detail. So:

• the patient experiences shortness of breath, which intensifies over time;
• the patient has right ventricular failure and cor pulmonale is formed;
• the patient loses weight;
• cyanosis appears, i.e. cyanosis;
• a person's general health is rapidly deteriorating.

In order for the symptoms of the disease to manifest themselves to a lesser extent and the disease does not progress, one should consult a specialist. Timely diagnosis, medical examination and treatment appointment will have a positive impact on general well-being and will not aggravate the condition.

Differential diagnosis of bronchial asthma and COPD

In order to accurately determine the patient's diagnosis, the patient's manifestations should be compared with the characteristic signs of COPD and asthma, i.e. carry out differential diagnosis. It is necessary to pay attention to the fact that babies practically do not get sick with chronic obstructive pulmonary disease, this disease is acquired over the years.

Let us consider in detail the distinctive characteristics of the above diseases, necessary for differential diagnosis:

IMPORTANT! In order for the diagnosis to be reliable and accurate, the doctor must refer the patient to all the necessary studies and study the medical history in detail. Such an event will allow free differential diagnosis.

Any disease negatively affects human health in general. You should lead a healthy lifestyle, strengthen the immune system and avoid contact with all kinds of allergens. In the event of unwanted symptoms, do not delay a visit to the doctor. Only he will be able to carry out the necessary diagnosis, make an accurate diagnosis and prescribe an adequate course of treatment. Be healthy!

Diagnosis of bronchial asthma should only be carried out by an experienced specialist. Bronchial asthma (BA) is a chronic inflammation of the airways. Plant pollen, animal hair, weather factors, various foods, bacterial and viral diseases of the lower and upper respiratory tract, and some drugs can provoke the appearance of unpleasant symptoms.

A pulmonologist can diagnose bronchial asthma. First of all, the doctor listens to the patient's complaints and collects an anamnesis. For these purposes, the specialist asks if the patient has shortness of breath or asthma attacks that occur after contact with any allergens. Bronchodilators are used to stop such attacks.

The diagnosis directly depends on the presence or absence of dyspnea in the patient at night. To determine the severity of the disease, the frequency of night and day attacks is taken into account. The doctor will definitely find out if the patient had relatives in the family who suffered from attacks of bronchial asthma.

The doctor also takes into account the seasonality of the disease. The fact is that asthma often makes itself felt at certain times of the year. Most often, attacks become more frequent in spring and summer, when plants bloom.

After collecting an anamnesis and listening to complaints, the pulmonologist conducts a general examination. The specialist pays attention to the skin of the patient. How to determine bronchial asthma by the skin is a fairly common question. With this disease, allergic rashes often appear on the skin in the form of redness and bumps.

After this, the lungs are auscultated for the presence of wheezing. With bronchial asthma, the patient complains of loud wheezing, prolonged exhalation and wheezing. Sometimes there is a feeling of fear, restless behavior and blanching of the skin of the face.

How to detect asthma with an allergy test, blood test and sputum test? The doctor conducts allergy tests, which involve applying a small amount of extracts of various allergens to the skin. After that, doctors observe the reaction of the skin to these allergens. If redness appears on it, then we are talking about an allergy.

Next, a blood test is required. If during the study a lot of eosinophils are found in the blood, then this indicates the appearance of an allergy. Doctors also measure antibodies in the blood. In the presence of the above disease, an increased level of antibodies is most often observed.

Diagnosis of asthma involves the study of blood gases. When the disease (regardless of its severity) there is a decrease in the concentration of oxygen in the blood and an increase in carbon dioxide. Such indicators clearly indicate the development of asthma.

When examining sputum, special elements can be detected, which include mucus and decay products of eosinophils. You can identify them with a microscope. Also, with the above disease, the content of eosinophils in sputum increases.

How to diagnose asthma with a chest x-ray is a frequently asked question. Doctors note that it is impossible to determine the presence of the above-described disease only with the help of a chest x-ray.

Such a study, as a rule, is carried out only to exclude other serious ailments that affect the lungs.

Doctors perform peak flowmetry, which evaluates peak expiratory flow. If the patient has developed bronchial asthma, then this figure will be underestimated. To conduct such a study, a special preparation is used - a peak flow meter. After a deep breath, the patient must exhale forcefully into this device. The exhalation rate is calculated automatically.

Methods for diagnosing bronchial asthma involve spirometry. This diagnostic method is used to determine the expiratory rate and lung volumes. As in the previous case, a drug specially designed for this purpose is used for such a study.

If the diagnosis of bronchial asthma is doubtful or it is necessary to identify the substance that caused the onset of unpleasant symptoms, then doctors perform a provocative inhalation test. To begin with, the pulmonologist uses spirometry to measure the volume of air exhaled with force in 1 second. As soon as this value is measured, the patient inhales a suspension of the allergen at a very low concentration. After about a quarter of an hour, spirometry is repeated (all results can later be seen by the doctor in the table). If the volume of forced air after inhalation of the provoking mixture is significantly reduced (by more than 20%), then asthma is most likely caused by this particular allergen.

Often the cause of the onset of seizures is increased physical activity. In this case, the diagnosis of asthma is carried out as follows: experts measure the volume of forced air in 1 second (FEV) before and after exercise. For these purposes, a bicycle ergometer or a treadmill is used. If FEV decreases by more than 25%, then the disease is most likely provoked by increased physical activity.

What is the differential diagnosis for bronchial asthma? To make a definitive diagnosis, it is imperative to exclude diseases that may be accompanied by the same symptoms as asthma. So, a persistent cough is one of the main symptoms of chronic bronchitis. Chronic bronchitis can be excluded by allergens that are applied to the skin. Unlike bronchial asthma, with bronchitis, the skin does not react in any way to the effects of the allergenic substances used. Another difference between these diseases is that during the disease, coughing fits are observed, which can either appear or disappear, and at the end of the attack, sputum is released. In chronic bronchitis, the cough does not disappear at all and is accompanied by mucous and purulent secretions.

The differential diagnosis of bronchial asthma should exclude tracheobronchial dyskinesia. With this disease, bouts of severe coughing and suffocation appear after physical activity or during laughter (no sputum is observed). Wheezing with tracheobronchial dyskinesia is not as strong as with bronchial asthma. The latter is characterized by bronchospasm and bronchial obstruction, and tracheobronchial dyskinesia - sagging of the main bronchi and the posterior wall of the trachea.

If such a disease is suspected, then the differential diagnosis of bronchial asthma should exclude a lung tumor. Symptoms such as shortness of breath and coughing often accompany lung tumors. With the help of a cough reflex, the sick body tries to rid the airways of sputum. With this disease, shortness of breath occurs both on exhalation and on inspiration. Rattling is present but cannot be heard from a distance. To listen to them, the doctor uses a special device - a phonendoscope. To confirm the presence of a tumor in the lungs, specialists perform a bronchoscopic examination and x-rays.

The diagnosis of bronchial asthma is made only after cardiac asthma is excluded. These diseases have several significant differences. First, cardiac asthma develops only as a consequence of heart disease. Bronchial asthma is preceded by allergies or any lung disease. Secondly, cardiac asthma most often affects the elderly, and bronchial - young people. Thirdly, cardiac asthma is characterized by wet and "gurgling" rales, and bronchial - dry and wheezing.

Currently, doctors know how to diagnose asthma in a patient in a short time to prevent complications and ensure timely initiation of treatment.

Treatment of the disease

If the answer to the question of how to determine bronchial asthma is found, then doctors begin to treat a serious illness. Unfortunately, it is currently impossible to completely get rid of this disease.

Bronchial asthma is treated with basic and symptomatic drugs. The action of basic agents is aimed at eliminating allergic inflammation in the bronchi. We are talking about glucocorticoid hormones and cromones. Basic drugs are prescribed for long-term use, as they do not have a quick effect.

Symptomatic agents are prescribed to restore bronchial patency and relieve brochospasm. Doctors prescribe bronchodilators and bronchodilators. Such drugs bring a quick positive effect. The suffocation disappears after a few minutes. Symptomatic medications should be used as needed.

Everyone should know how to recognize asthma. Despite such knowledge, in no case should you hesitate to go to the doctor and self-medicate. In some cases, a frivolous attitude to one's health can lead to very sad consequences. Be healthy!

Differential diagnosis of bronchial asthma

Chronic obstructive bronchitis. Most often, bronchial asthma has to be differentiated from chronic obstructive bronchitis. Significant assistance in this regard can be provided by the list of supporting diagnostic signs of chronic bronchitis according to Vermeire (cited by A.L. Rusakov, 1999):

actual bronchial obstruction - decrease in FEV1< 84% и/или снижение индекса Тиффно < 88% от должных величин;

Irreversibility / partial reversibility of bronchial obstruction, variability (spontaneous variability) of FEV1 values ​​during the day< 12%;

stably confirmed bronchial obstruction - at least 3 times during the year of observation;

age, usually over 50 years;

often found functional or radiological signs of emphysema;

smoking or exposure to industrial air pollutants;

Progression of the disease, which is expressed in increasing shortness of breath and a steady decrease in FEV1 (annual decrease by more than 50 ml).

Tracheobronchial dyskinesia. Tracheobronchial dyskinesia syndrome is an expiratory collapse of the trachea and large bronchi due to prolapse of a thinned and stretched membranous wall, partially or completely blocking the lumen of the trachea and large bronchi during the exhalation phase or when coughing. Features of the clinical picture of tracheobronchial dyskinesia - paroxysmal cough and expiratory dyspnea. Coughing attacks are caused by physical activity, laughter, sneezing, acute respiratory viral infection, sometimes a sharp transition from a horizontal to a vertical position. The cough has a bitonic character, sometimes a rattling, nasal tone. Coughing attacks cause short-term dizziness, darkening in the eyes, and a short loss of consciousness. During a coughing fit, there is a pronounced shortness of breath of the expiratory type, up to suffocation.

Diseases causing obstruction and compression of the bronchi and trachea

Significant breathing difficulties, especially exhalation, can occur when the trachea and large bronchi are compressed (compressed) by benign and malignant tumors, sharply enlarged lymph nodes, and aortic aneurysm. Tumors can cause obstruction of the bronchus when growing into the lumen of the bronchus.

In the differential diagnosis of bronchial asthma, it should be taken into account that in the situations mentioned above, auscultatory symptoms (wheezing dry rales, sharply prolonged exhalation) are observed in one direction, and not over the entire surface of the lungs, as in bronchial asthma. It is also necessary to analyze the clinical symptoms characteristic of diseases that cause occlusion or compression of the trachea and bronchi (bronchial cancer, lymphogranulomatosis, lymphocytic leukemia, mediastinal tumor, aortic aneurysm). With a tumor of the mediastinum, the syndrome of the superior vena cava is characteristic (cyanosis and swelling of the neck and face, swelling of the cervical veins). To clarify the diagnosis, bronchoscopy, mediastinal X-ray tomography, and computed tomography of the lungs are performed.

Carcinoid

Carcinoid is a tumor of the APUD system, consisting of cells that produce serotonin, bradykinin, histamine, prostaglandins. Usually the tumor is localized in the gastrointestinal tract, in 7% of cases - in the bronchi. With bronchial localization of carcinoid, a clinic of bronchospasm appears. Unlike bronchial asthma, in carcinoid syndrome, along with bronchospasm, there are flushes with severe facial redness, venous telangiectasia, profuse diarrhea, endocardial fibrosis of the right heart with the formation of tricuspid valve insufficiency (diagnosed using echocardiography), urinary excretion of a large amount of 5- hydroxyindoleacetic acid - a product of serotonin metabolism.

cardiac asthma

Cardiac asthma is a manifestation of severe left ventricular failure.

Pulmonary embolism

With pulmonary embolism (PE), a sudden feeling of lack of air and severe shortness of breath appear, dry wheezing is determined during auscultation, which makes it necessary to differentiate PE and bronchial asthma.

Violations of the nervous regulation of breathing

Patients suffering from neurosis, hysteria, especially women, often have attacks of shortness of breath, which makes it necessary to differentiate this condition from bronchial asthma. As a rule, patients suffering from neurogenic respiratory disorders associate a feeling of lack of air and shortness of breath with an acute psycho-emotional stressful situation, and are often very neurotic. The main diagnostic feature that distinguishes neurotic or hysterical asthma from bronchial asthma is the absence of wheezing during auscultation of the lungs.

Foreign body in the trachea or bronchi

When a foreign body enters the trachea or bronchi, an asthma attack occurs, which may resemble an attack of bronchial asthma. However, in the presence of a foreign body in the respiratory tract, a strong cough and cyanosis appear; at the same time, rales are not heard on auscultation of the lungs. Anamnestic data and bronchoscopic examination help in making the correct diagnosis.

Reflux-induced bronchial asthma. Reflux-induced asthma is asthma attacks caused by aspiration of gastric contents due to gastroesophageal reflux. An asthma attack associated with aspiration of gastric contents was first described by Oder in 1892.

The prevalence of gastroesophageal reflux disease (GERD) among the population of the United States and in some European countries is 20-40%, and among patients with bronchial asthma, this figure reaches 70-80% (Stanley, 1989). The main factors in the pathogenesis of GERD are a decrease in the tone of the lower esophageal sphincter, an increase in intragastric pressure, a weakening of esophageal peristalsis, and a slowdown in esophageal clearance.

The pathogenesis of bronchial asthma that occurs against the background of GERD is associated with the following factors (Goodall, 1981):

development of bronchospasm due to reflux (microaspiration) of gastric contents into the lumen of the bronchial tree;

stimulation of vagal receptors in the distal esophagus and induction of a bronchoconstrictor reflex.

The clinical features of bronchial asthma that occurs with GERD are:

the occurrence of an asthma attack mainly at night;

The presence of concomitant clinical manifestations of GERD: heartburn, belching, regurgitation, pain in the epigastrium or behind the sternum, when food passes through the esophagus;

The appearance or intensification of asthma attacks, as symptoms of GERD, under the influence of abundant food, a horizontal position after eating, taking medications that damage the mucous membrane of the stomach and esophagus, physical activity, flatulence, etc .;

Dominance of symptoms of bronchial asthma over other manifestations of GERD.

Nocturnal bronchial asthma. Nocturnal bronchial asthma is the occurrence of asthma attacks in patients with bronchial asthma at night or early in the morning.

According to Turner-Warwick (1987), one third of patients with bronchial asthma suffer from nocturnal asthma attacks.

The main pathogenetic factors of nocturnal bronchial asthma are:

Increased contact of a patient with bronchial asthma with aggressive allergens at night (high concentration of spore fungi in the air on warm summer nights; contact with bedding containing allergens - pillow feathers, ticks - dermatophagoids in mattresses, blankets, etc.);

maximum synthesis of IgE - antibodies (reagins) in the period from 5 to 6 am;

influence of gastroesophageal reflux at night;

The influence of a horizontal position (mucociliary clearance worsens in a horizontal position and during sleep, the tone of the vagus nerve increases and, consequently, its bronchoconstrictor effect);

The presence of circadian rhythms of changes in bronchial patency (maximum bronchial patency is observed from 13 to 17 hours, the minimum - from 3 to 5 hours in the morning;

· daily fluctuations in barometric pressure, relative humidity and air temperature. The airways of patients with bronchial asthma are hypersensitive to lower ambient temperatures at night;

circadian rhythm of cortisol secretion with a decrease in its level in the blood at night;

Decrease in the blood concentration of catecholamines, cAMP and the activity of beta 2-adrenergic receptors at night and in the early morning hours;

The presence of sleep apnea syndrome, especially the obstructive form, contributes to the development of attacks of nocturnal bronchial asthma.

Based on the comparative characteristics of these diseases and the patient's condition, it is possible to putclinical diagnosis :

Bronchial asthma, interictal period, atopic, moderate. Emphysema of the lungs.

Concomitant diseases: chronic tonsillitis.

Bronchial asthma is a chronic inflammatory process localized in the respiratory tract, characterized by an undulating course, the leading etiopathogenetic factor of which is.

In this article, you will learn which diseases are similar in course to bronchial asthma, what are their differences from each other, what complications it can provoke, and also get acquainted with this disease. Let's start.

Differential Diagnosis

Asthma attacks in bronchial asthma occur after the patient comes into contact with the allergen.

An asthma attack is not necessarily a sign of bronchial asthma - some other diseases have similar manifestations, the main of which are:

• respiratory diseases (), foreign body in the bronchi, spontaneous pneumothorax, bronchial tumors, bronchoadenitis);
• diseases of the cardiovascular system (pathology of the heart muscle - heart attack, cardiosclerosis, cardiomyopathy, myocarditis; thromboembolism of the branches of the pulmonary artery, acute arrhythmias, heart defects, hypertensive crisis, systemic vasculitis);
• hemorrhagic stroke (bleeding in the brain tissue);
• acute nephritis;
• epilepsy;
• sepsis;
• heroin poisoning;
• hysteria.

Let's take a closer look at some of these diseases.

Especially often, a specialist has to differentiate bronchial asthma from asthma associated with cardiac pathology. Attacks of cardiac asthma are typical for elderly people suffering from acute or chronic pathology of the heart and blood vessels. The attack develops against the background of a rise in blood pressure, after physical or mental overstrain, overeating or taking large amounts of alcohol. The patient experiences a feeling of a sharp lack of air, shortness of breath is inspiratory (i.e., it is difficult for the patient to take a breath) or mixed. The nasolabial triangle, lips, tip of the nose, fingertips turn blue at the same time, which is called acrocyanosis. , frothy, often pink - stained with blood. When examining a patient, the doctor notes the expansion of the boundaries of the heart, moist rales in the lungs, an enlarged liver, and swelling of the extremities.

In the case of the symptoms of bronchial obstruction do not go away even after taking drugs that expand the bronchi, this process is irreversible. In addition, there are no asymptomatic periods in this disease, and there are no eosinophils in the sputum.

When the airways are blocked by a foreign body or a tumor, attacks of suffocation similar to attacks in bronchial asthma can also occur. At the same time, the patient breathes noisily, with a whistle, and remote wheezing is often noted. In the lungs, rales are usually absent.

Young women sometimes have a condition called hysteroid asthma. This is a kind of violation of the nervous system, in which the patient's respiratory movements are accompanied by convulsive crying, groaning, and hysterical laughter. The chest is actively moving, both inhalation and exhalation are strengthened. Objectively, there are no signs of obstruction; there are no wheezing in the lungs.

Complications of bronchial asthma

Complications of this disease are:

• cor pulmonale;
• spontaneous pneumothorax.

The most dangerous for the patient's life is status asthmaticus - a prolonged attack that is not stopped by taking medications. At the same time, bronchial obstruction is persistent, respiratory failure is steadily increasing, and sputum ceases to come out.

The course of this state can be divided into 3 stages:

1. The first stage, in terms of clinical manifestations, is very similar to the usual prolonged asthma attack, however, the patient does not respond to bronchodilator drugs, and sometimes after their administration, the patient's condition deteriorates sharply; mucus stops coming out. An attack can last 12 or more hours.
2. The second stage of status asthmaticus is characterized by an aggravation of the symptoms of the first stage. The lumen of the bronchi is clogged with viscous mucus - air does not enter the lower sections of the lungs, and the doctor, listening to the patient's lungs at this stage, will detect the absence of respiratory noises in the lower sections - "silent lung". The patient's condition is severe, he is lethargic, the skin with a blue tint is cyanotic. The gas composition of the blood changes - the body experiences a sharp lack of oxygen.
3. In the third stage, due to a sharp lack of oxygen in the body, a coma develops, often ending in death.

Principles of treatment of bronchial asthma

Unfortunately, it is currently impossible to completely cure bronchial asthma. The goal of treatment is to improve the patient's quality of life as much as possible. In order to determine the optimal treatment in each case, criteria for controlling bronchial asthma have been developed:

1. Current controlled:
   • there are no exacerbations;
   • daytime symptoms are completely absent or recur less than 2 times a week;
   • no night symptoms;
   • physical activity of the patient is not limited;
   • the need for bronchodilator drugs is minimal (less than 2 times a week) or absent altogether;
   • indicators of the function of external respiration were within the normal range.
2. Control over the disease is partial - every week any of the signs is noted.
3. The course is uncontrolled - 3 or more signs are noted every week.

Based on the level of control of bronchial asthma and the treatment received by the patient at the moment, the tactics of further treatment is determined.

Etiological treatment

Etiological treatment is the exclusion of contact with allergens that cause seizures, or a decrease in the body's sensitivity to them. This direction of treatment is possible only in the case when substances that cause bronchial hypersensitivity are reliably known. At an early stage of bronchial asthma, the complete exclusion of contact with the allergen often leads to a stable remission of the disease. To minimize contact with potential allergens, the following recommendations should be followed:

• if you suspect - as far as possible, reduce contacts with her up to a change of residence;
• in case of allergy to pet hair - do not get them and do not contact them outside the home;
• if you are allergic to house dust - remove soft toys, carpets, wadded blankets from the house; cover mattresses with washable material and regularly (at least once a week) carry out their wet cleaning; keep books on glazed shelves, regularly carry out wet cleaning in the apartment - wash floors, wipe dust;
• if you are allergic to food - do not use them and other products that can increase the symptoms of allergies;
• in case of occupational hazards - change jobs.

In parallel with the implementation of the above measures, the patient should take drugs that reduce the symptoms of allergies - antihistamines (drugs based on loratadine (Lorano), cetirizine (Cetrin), terfenadine (Telfast)).

During the period of stable remission in the case of a proven allergic nature of asthma, the patient should contact the allergic center for specific or nonspecific hyposensitization:

• specific hyposensitization is the introduction into the body of a sick allergen in slowly increasing doses, starting with extremely low ones; thus the body gradually gets used to the effects of the allergen - sensitivity to it decreases;
• non-specific hyposensitization consists in the subcutaneous administration of slowly increasing doses of a special substance - histoglobulin, consisting of histamine (allergy mediator) and human blood gamma globulin; as a result of treatment, the patient's body produces antibodies against histamine and acquires the ability to reduce its activity. In parallel with the introduction of histoglobulin, the patient takes intestinal sorbents (Atoxil, Enterosgel) and adaptogens (tincture of ginseng).

Symptomatic therapy

Inhalation of salbutamol or any other bronchodilator will help relax the muscles of the bronchi - eliminate an asthmatic attack.

Symptomatic remedies, or emergency drugs, are necessary to stop an acute attack of bronchospasm. The most prominent representatives of the funds used for this purpose are short-acting β 2 -agonists (salbutamol, fenoterol), short-acting anticholinergics (ipratropium bromide), as well as their combinations (fenoterol + ipratropium, salbutamol + ipratropium). These funds are the drugs of choice when an attack of suffocation begins, capable of weakening or preventing it.

Basic therapy of bronchial asthma

With this disease, in order to achieve maximum control over it, daily intake of drugs that reduce inflammation in the bronchi and expand them is necessary. These drugs belong to the following groups:

• (beclomethasone, budesonide);
• systemic glucocorticosteroids (prednisolone, methylprednisolone);
• inhaled β 2 -agonists (bronchodilators) of prolonged action (Salmeterol, Formoterol);
• cromones (sodium cromoglycate - Intal);
• leukotriene modifiers (Zafirlukast).

The most effective for the basic therapy of bronchial asthma are inhaled glucocorticosteroids. The route of administration in the form of inhalation allows you to achieve the maximum local effect and at the same time avoid the side effects of systemic glucocorticosteroids. The dose of the drug depends on the severity of the course of the disease.

In the case of a severe course of bronchial asthma, systemic glucocorticosteroids may be prescribed to the patient, however, the period of their use should be as short as possible, and the dosages should be minimal.

β 2 -agonists of prolonged action have a bronchodilator effect (i.e., dilate the bronchi) for more than 12 hours. They are prescribed when therapy with medium doses of inhaled glucocorticoids has not led to the achievement of control over the disease. In this case, instead of increasing the dose of hormones to the maximum, in addition to them, prolonged-acting bronchodilators are prescribed. Currently, combined preparations (fluticasone-salmeterol, budesonide-formoterol) have been developed, the use of which makes it possible to achieve control over bronchial asthma in the vast majority of patients.

Cromones are drugs that cause a series of chemical reactions that result in a reduction in the symptoms of inflammation. They are used for mild persistent bronchial asthma, and are ineffective at more severe stages.

Leukotriene modifiers are a new group of anti-inflammatory drugs used to prevent bronchospasm.

For the successful control of bronchial asthma, the so-called step therapy: each stage implies a certain combination of drugs. With their effectiveness (achieving control over the disease), they move to a lower level (lighter therapy), if they are ineffective, they go to a higher level (more severe treatment).

1. 1 step:
   • treatment "on demand" - symptomatic, not more than 3 times a week;
   • short-acting inhaled β2-agonists (Salbutamol) or cromones (Intal) before anticipated allergen exposure or exercise.
2. 2 step. Symptomatic therapy and 1 basic therapy daily:

• low-dose inhaled corticosteroids, or cromones, or a leukotriene modifier;
• short-acting inhaled β 2 agonists if necessary, but not more than 3-4 times a day;
• if necessary, switching to medium doses of inhaled corticosteroids.

1. 3 step. Symptomatic therapy plus 1 or 2 basic therapies daily (choose one):

• in high dosage;
• a low-dose inhaled glucocorticoid daily plus a long-acting inhaled β 2 agonist;
• low dose inhaled glucocorticoid daily plus leukotriene modifier;
• short-acting inhaled β 2 agonists as needed, but not more than 3-4 times a day.

1. 4 step. Step 3 treatment is supplemented with corticosteroid tablets at the lowest possible dosage every other day or daily.

Nebulizer therapy

is a device that converts liquid into an aerosol. especially indicated for persons suffering from chronic lung diseases - bronchial asthma and chronic obstructive pulmonary disease.

The benefits of nebulizer therapy are:

• no need to coordinate inspiration with inhalation of the drug;
• fast delivery of the drug to the destination;
• inhalation does not require forced inspiration, therefore it is easily accessible to children, the elderly and exhausted patients;
• you can enter a large dose of the drug.

Among the drugs intended for the treatment of bronchial asthma, there are those that are indicated for use with a nebulizer. If the patient has the opportunity to use this device for treatment, do not neglect it.

Treatment of status asthmaticus

The most powerful anti-inflammatory and decongestant effects are provided by drugs from the group of glucocorticoids, therefore, in the case of asthmatic status, they are primarily used - large doses of the drug are administered intravenously, repeating the injection or infusion every 6 hours. When the patient becomes better, the infusion is continued, however, the dose of the hormone is reduced to a maintenance dose - 30-60 mg is administered every 6 hours.

In parallel with the introduction of the hormone, the patient receives oxygen therapy.

If the patient's condition does not improve during the administration of a glucocorticoid, ephedrine, adrenaline and eufillin are administered, as well as solutions of glucose (5%), sodium bicarbonate (4%) and reopoliglyukin.

To prevent the development of complications, heparin and humidified oxygen inhalations are used.

In the case when the above therapeutic measures are ineffective, and the dose of hormones is increased by 3 times compared to the original, the following is carried out:

• the patient is intubated (a special tube is inserted through the trachea through which he breathes),
• transferred to artificial lung ventilation,
• the bronchi are washed with a warm solution of sodium chloride, followed by suction of the mucus - a sanitation is carried out.

Other treatments

One of the very effective methods of treating bronchial asthma is speleotherapy - treatment in salt caves. The therapeutic factors in this case are a dry sodium chloride aerosol, a constant temperature and moisture regime, a reduced content of bacteria and allergens in the air.

In the remission phase, massage, hardening, acupuncture can be used (more about it in our article).

Prevention of bronchial asthma

The method of primary prevention of this disease is the recommendation not to marry people with asthma, because their children will have a high risk of developing bronchial asthma.

In order to prevent the development of exacerbations of the disease, it is necessary to carry out prevention and timely adequate, as well as to exclude or minimize contact with potential allergens.