Any statement of the problem begins with its definition. We will try to determine what is bronchial asthma. Already from the name of this disease it becomes clear that it is associated with the bronchi, which means it is necessary to explain what the bronchi are, or, as they are called in medicine, the bronchial tree. The bronchial tree is a part of the lungs, which is a system of tubing dividing like tree branches. The trunk of the tree is the trachea, and the branching branches of the bronchi extending from it. Now imagine a tree turned upside down – here is a bronchial tree. The number of divisions or divisions of the bronchi amounts to 23. Until the fourth division order, there are 19 bronchi (they are called segmental, since one segment corresponds to the bronchus – an independent part of the lung). Further pair division of the segmental bronchi increases their number to millions of thin twigs. Moreover, the lowermost ones, called small ones, have a diameter of less than 1 mm. The air is carried along these tubes to the alveoli, where the blood becomes saturated with oxygen. Inside the bronchi are covered with mucus, which displays with special cilia, like an escalator tape on a subway, dirt, dust entering the air, microbes and other particles from the bottom up into the throat where it is spat out or unnoticed by humans is swallowed. So the air is cleaned and simultaneously warmed in the bronchi.
Now you know that the main function of the bronchi is to conduct and purify the air necessary for ensuring normal breathing. And now imagine that the patency of the tubes was disrupted due to their narrowing or obstruction in them. In this case, shortness of breath and difficulty in breathing, whistling and wheezing in the lungs appear. And the biggest trouble is that asthma disrupts the passage of the small bronchi, which, as you already know, have 1 mm or less. Therefore, attacks of difficulty breathing or heavy suffocation are so painful. Violation of the patency of the bronchi at the onset of the disease is mainly due to their spasm caused by special substances (in medicine they are called mediators of allergic inflammation). These substances are released during allergic and other reactions in the body and, in addition to bronchospasm, cause inflammation and swelling of the respiratory mucosa. All of you, probably, experienced difficulty in nasal breathing in case of swelling of the nasal mucosa – the bronchial mucosa swells in the same way, further narrowing their lumen. Violation of the patency of the bronchi complicates the movement of mucus, and this is manifested by the fact that after the attack a cough appears and coughing up mucus plugs, or sputum from the bronchi. As the disease progresses, seizures become more and more lengthy and more difficult, and it is more difficult to remove bronchodilator drugs. It happens
due to the progression of inflammation and impaired mucus formation in the bronchial tree. Almost every asthma patient at the beginning of the disease coughs up a small amount of sputum, and after a few years, its amount increases. The reason for this is that as a result of chronic inflammation, the number of mucous cells in the bronchial tree increases 10-20 times.
Further progression of asthma is associated with the addition of a secondary infection as a result of frequent colds or acute respiratory diseases. Often, the uncontrolled use of antibacterial drugs without the recommendation of doctors leads to the formation of microbial flora that are insensitive to almost all antibiotics, which further accelerates the progression of asthma. Frequent exacerbations of the infectious process in the airways are the cause of chronic inflammatory changes, the formation of sclerosis along the bronchial tree, loss of elasticity (emphysema) and airiness of the lung tissue (pneumosclerosis). These complications lead to irreversible disruption of the patency of the bronchial tree and the development of respiratory failure with subsequent complications on the cardiovascular system.
Thus, summing up the above, the following definition of bronchial asthma can be given: it is a chronic bronchopulmonary disease, manifested by recurring asthma attacks, due to bronchospastic reactions and progressive deterioration of the airway patency.
From all this, you should draw at least two conclusions for yourself:
- The absence of asthma attacks at any stage of your life does not mean the absence of the progression of your asthma.
- Only continuous supportive therapy can stop the progression of the disease and save you from health problems.
After all you have read, you may have the question: “I have no seizures for a long period of time, and if I assume that my illness really progresses, then why do I not feel this because of my well-being?” The answer is very simple: you adapt to worsening your condition by gradually reducing physical activity and endurance. And if you try your hand at any physical exercise, you will quickly see for yourself. Sometimes it happens, and vice versa, that some patients who lead an active lifestyle, constantly training themselves with physical exercises, developing endurance to violations of bronchial patency, do not feel the progression of their disease, which sooner or later will make itself felt. In this regard, you should remember that no physical culture will not replace a full-fledged treatment, but it will effectively complement it!
Now we will try to answer the last question: why do patients with bronchial asthma die? The answer is as follows: the majority of patients (with rare exceptions) die from the fact that their bronchi are not only spasmed and narrowed, but also completely obstructed (clogged) with mucus plugs that do not cough up in the form of sputum, and breathing becomes impossible. Asthmatics who have been to resuscitation departments more than once will probably remember how a large amount of sputum, often yellow-green, begins to cough after recovering from a serious condition. And for those who are not lucky enough to survive once again, at the autopsy from the lungs, like a sponge, the pathologist squeezes this mucus to reliably confirm the cause of death. Some patients, reading these lines, may object: “I have been ill for a very long time and almost never cough up my sputum and, nevertheless, I feel quite well.” Responding to such an objection, the following can be said: firstly, exceptions are in very different cases, secondly, the absence of sputum does not mean that it does not gradually accumulate and does not obturate the bronchial tree and, thirdly, as your own health , and the actual situation in the lungs also depends on what kind of permanent treatment the patient receives. As for well-being, I repeat once again: the way you feel in the vast majority of cases does not reflect the true state of affairs in the bronchial tree. I often had to deal with patients whose well-being was satisfactory from their point of view, and the objective situation was catastrophic. And sometimes, on the contrary, very poor health did not correspond to quite satisfactory results of the survey. How, then, to establish the true state of affairs, if you have asthma? The answer is unequivocal: only by evaluating the function of the lungs and, first of all, by the state of the bronchus of all calibers – large, medium and small.
Currently, special computer spiro-analyzers (mainly of foreign production) have been developed and are widely used to evaluate pulmonary volumes and reserves, expiratory power, airflow rate at the level of large, medium and small bronchi, and calculating these figures as a percentage of your proper values (taking into account age, sex, height and weight) to give an opinion on the degree of impaired bronchial patency. And if you, suffering from asthma, have never been examined in this way, hurry to do it. If you wish, you can assess your condition by the results of the survey. You just have to look at the following indicators: FEV1 – forced expiratory volume in the first second (or expiratory power), P25, P50, P75 – expiratory air velocity at the level of large, medium and small bronchi. In the international classification, this is denoted respectively: FEV1 and V (FEF, MEF) 25%, 50% or 75%. If, as a result of the survey, it turned out that FEV1 is above 80% a P25, P50 and P75 not lower than 40-50%, then your situation is satisfactory, and the treatment is quite effective. If FEV1 is 60-80%, and P25, P50, P75 – 20-40% of the norm, your condition is regarded as moderate and you need to make adjustments in the treatment. Results in which FEV1 is less than 60%, and P25, P50 and P75 are less than 20% indicate that your condition is serious enough and you need to conduct an in-depth examination, as well as serious inpatient or outpatient treatment.
In addition to assessing the condition, computer spirometry helps in the selection of the most effective bronchodilator drugs. For this purpose, the examination is carried out several times: initially and after inhalation of a bronchodilator. The maximum improvement in performance after a particular drug is the objective basis for its preferred use.
In many cases, computer spirometry helps to recognize the onset of the disease. For example, you are allergic to any allergens (pollen of trees, herbs, food) and suddenly there was a constant cough. What if this is the beginning of asthma? Computer spirometry will answer this question – it is enough to conduct special bronchial provocation tests. And if this is the beginning of asthma, a course of preventive treatment will save you from many problems later on.
Now you already know quite a lot about asthma, but probably the question is still not clear: if the causes of asthma are well known, why is it not possible, by eliminating a specific cause, to cure this disease? The answer is the following: in addition to the cause of asthma and feeding its existence, there are a number of pathological mechanisms (congenital and acquired) that do not allow to stop the course and progression of the disease.
Imagine the situation: you cut your hand with a knife, the blood finally stopped, the knife – the cause of the injury is gone. Suddenly, the place of the cut begins to blush, swell and ache. That is, being started by any reason, the disease continues to evolve and progress according to its inherent biological laws. And if in this particular case, an infection also joins the wound, the case may end in gangrene. The original cause of asthma is similarly related to the mechanisms and pathological factors that support it. All of the above does not mean at all that one does not need to try to eliminate the specific cause of the disease, for the cause in itself not only triggers, but also constantly “feeds” the disease, being its basis. What are the specific causes of asthma? This question is perhaps the most difficult for modern science. Probably, you yourself have heard in the clinic, and in the hospital, and from other patients that there is asthma “infectious”, “allergic”, “food”, “neuropsychic”, “aspirin” and many other options, which are often considered as an independent form of the disease. Western science used to believe that there are only two main options (forms) of bronchial asthma: EXOGENOUS – associated with external causes, mainly allergies, occupational hazards (for example, dust, chemicals, etc.) and ENDOGENOUS – associated with internal causes, so far in detail and not exactly clarified. It is endogenous asthma (I call it non-atopic, that is, non-allergic) and manifests itself in a variety of forms (infectious, food, aspirin, etc.). The question of whether the infection, food intolerance, neuropsychiatric injuries and other causes of the disease has not yet been fully clarified. It is more likely that these are simply factors that aggravate the course of the disease, but not its original cause. And the last thing I would like to say, ending this chapter. At present, the quantitative ratio between exogenous asthma (in which the causes of the development of an attack are more often known) and endogenous (in which the main cause of the spasm of the bronchi is generally impossible to identify) has changed towards the predominance of the latter.
That est, the main number of patients with bronchial asthma suffers precisely from the ENDOGENOUS form of the disease, the most severe and least studied. Probably therefore, the number of patients with disabilities increased and their prospects worsened.