Bronchial asthma is a chronic lung disease that requires long-term therapy and regular monitoring by a doctor. Treatment tactics depend on the characteristics of the course of the disease and the severity of symptoms. The classification of asthma assesses the clinical picture of the disease and allows you to choose the direction of therapy.
What are the criteria by which asthma is classified?
The classification of bronchial asthma is based on several factors:
- etiology – the cause of the development of the disease is assessed;
- severity – the frequency of exacerbations is taken into account;
- the effect of drugs and other signs.
In medical practice, the classification according to the Global Initiative for Asthma from 2010 is used. It is based on the severity of the clinical picture of the disease.
There are several types of bronchial asthma, depending on the etiology of its occurrence.
- The exogenous type is due to the action of external environmental factors. If the cause of the formation of pathology becomes the hypersensitivity of the body in response to any allergen, they speak of the atopic nature of the disease. The pathogenesis of this form is based on the reaction to the antigen. When it enters the body, a pathological process is formed, during which antibodies are released. A repeated collision of the immune system with a foreign substance triggers a cascade of reactions, the result of which is the release of inflammatory mediators from the mast cells. At this stage, histamine, prostaglandins, cytokines and other substances increase the permeability of the vessels and expand their lumen, resulting in edema, and the compounds also cause contraction of the smooth muscles of the bronchi. This pathological reaction leads to an attack of bronchospasm . The development of the disease is associated with a familial predisposition. Many clinical studies have shown that in the focus group of patients in about 40% of cases, there is a connection with genetic inheritance from the closest relatives of bronchial hyperreactivity and excessive production of class E immunoglobulin. The manifestation of the disease, as a rule, occurs in childhood in the form of pollinosis. The clinic can manifest itself in the form of rhinitis, conjunctivitis, skin pathologies, less often Quincke’s edema . As you grow older, there is a gradual formation of reversible obstruction. Most often, the first attack occurs at the age of three to five years. With a prolonged course of the disease with frequent exacerbations, a barrel-shaped chest may form in a child. When typical symptoms appear, a wide range of tests are performed, which are prescribed by the attending physician, according to clinical guidelines.
- The endogenous form is diagnosed if, during the examination, no external factor was identified that causes the clinical symptoms of asthma. The causes of the pathology are not associated with the development of an allergic reaction. The main triggers of the onset of symptoms are acute respiratory viral infections, chronic bronchitis. In addition, these patients have sensitivity to certain types of bacteria. Endogenous bronchial asthma is difficult to treat with beta-2-adrenergic agonists. The initial manifestations of the disease occur mainly after 30-40 years or in old age. In this case, the disease is characterized by steady progression, severe course and the formation of an asthmatic form of chronic obstructive pulmonary disease. The diagnosis is confirmed on the basis of anamnesis data, the results of laboratory and instrumental studies. To relieve symptoms, patients are given glucocorticosteroids .
- Aspirin asthma is a special form of the disease associated with the body’s response to non-steroidal anti-inflammatory drugs. According to statistics, most often adults are exposed to illness after 30 years. Pathogenesis consists in changing the metabolism of arachidonic acid when NSAIDs enter the body. As a result of biochemical reactions, a large number of cysteine leukotrienes are formed , which, by binding to specific receptors of the lungs, cause spasm of smooth muscles, increased vascular permeability and severe pulmonary edema. Patients with aspirin asthma are advised to adhere to a special diet, since many vegetables and fruits contain salicylates, which can cause bronchospasm . Therefore , tomatoes, citrus fruits, berries – raspberries, strawberries are excluded from the diet . The clinical picture of pathology includes the typical triad of Fernand-Vidal , which is: recurrent attacks of suffocation; polypous rhinosinusitis – a chronic ailment characterized by the formation of growths on the nasal mucosa , consisting of immune cells – eosinophils, neutrophils; intolerance to non-steroidal anti-inflammatory drugs. The manifestations of the aspirin form of the disease facilitate diagnosis. To relieve symptoms and prevent exacerbations, patients receive therapy with adrenergic agonists and hormonal drugs.
- The mixed form is a combination of endogenous and allergic asthma.
By the severity of the flow
The classification of asthma by severity is based on the severity of clinical manifestations, which are recorded before starting therapy:
- The intermittent form is characterized by rare episodes of exacerbation – less than once a week. Night attacks occur twice a month or less. Based on functional examinations, intermittent bronchial asthma is set if the forced expiratory volume per second corresponds to 80% or more of the normal values.
- Mild persistent asthma is diagnosed if clinical symptoms occur more often than once a week, but less than once a day. At this stage, seizures moderately reduce physical activity. The onset of symptoms at night exceeds twice a month.
- Persistent bronchial asthma of moderate severity is manifested by daily periods of exacerbation, a decrease in FEV1 to a level of 60-80%. Patients complain of a marked decrease in the quality of life and frequent attacks during sleep. In addition, the daily use of adrenergic agonists is characteristic .
- Severe persistent asthma is characterized by a malignant course, in which the patient experiences a pronounced limitation of activity, frequent attacks both during the day and at night, while the decrease in FEV1 reaches 60% or less from the norm. This form is associated with multiple pathologies of internal organs and the first group of disabilities.
The severity of the disease is also determined depending on the effect of treatment:
- the mild form lends itself well to therapy of the first and second stages, which include the use of adrenomimetics in case of exacerbation and low doses of glucocorticosteroids ;
- moderate means the local use of glucocorticosteroids and long-acting adrenergic agonists ;
- severe bronchial asthma responds to fourth and fifth stage therapy – high doses of hormones and additional drugs. This form leads to a serious decompensation of the functions of the respiratory and cardiac systems.
If the duration of choking is 12 hours or more, and the symptoms are not relieved by the use of adrenergic agonists , the pathology is defined as asthmatic status. The condition requires the provision of specialized medical care and rehabilitation.
The course of the disease is divided into:
- period of exacerbation;
- subsiding exacerbation;
In modern guidelines, there is an additional category in the classification of the disease, taking into account the effectiveness of treatment. Allocate:
- controlled form – during therapy, the patient has no symptoms of the disease;
- partially controlled – despite taking medications, the patient has manifestations of the disease;
- uncontrolled – there is no effect of treatment with essential drugs.
Classification of bronchial asthma helps to prescribe the required amount of treatment, to select drugs and to speed up the process of rehabilitation of patients. An incorrect definition of the type or severity of the disease can lead not only to a lack of effect from the therapy, but also to complications. The main classifications of the disease are reflected in the clinical guidelines, which are mandatory for the doctor to follow.