Persistent bronchial asthma. Chronic bronchial asthma

Persistent bronchial asthma – for many months, even years, there are constant symptoms (sighting, chest tightness, shortness of breath and coughing) and lifestyle restrictions. It is characterized by small periods when there are no symptoms or no remissions at all, there is a chronic pathology of the respiratory tract with large variations in the daily peak flow data. Symptoms appear in response to the action of a certain factor or even without it. Regular intake of beta-2-AG, often GCS, is required. Occasional, intermittent bronchial asthma – episodes of seizures (obstruction of the bronchi or cough) are replaced by asymptomatic periods when treatment is not required. Symptoms may recur (usually at night, early in the morning) daily, weekly, monthly or yearly. The attack can be severe and require treatment for several days or even weeks. This form is more common in young people with atopy (for example, allergic rhinitis). There is a complete reversibility of bronchial obstruction, during remission there is no airway obstruction and symptoms. Chronic bronchial asthma (usually severe, with frequent exacerbations) – clinically, these individuals have a combination of symptoms of asthma (FEV1 less than 70%; its annual decrease is 25–38 ml) and COPD (damage to the small respiratory tract) with the development of chronic kidney disease and chronic lung disease (asthmatic form) COPD). The clinical picture of bronchial asthma is composed of the following syndromes. • Bronchial obstructive – choking and sighting – noisy breathing with the presence of sound, distance rales associated with breathing, decreased FEV]. • Bronchopulmonary – cough, sputum production, chest pain, shortness of breath, intoxication, hypoxia. • Cardiopulmonary – tachycardia, increased blood pressure, pulmonary hypertension, decreased ESD, on ECG – heart rhythm disturbances or syndromic coronary pathology. • Allergic – the occurrence of an asthma attack in contact with a known allergen, positive skin scarification tests, urticaria, skin itching, blood eosinophilia. • Neuropsychic – develops with prolonged hypoxemia and hypercapnia, manifests itself as respiratory encephalopathy – varying neurological symptoms: headache, drowsiness, irritability and even aggressiveness, tremor, euphoria, inadequate behavior. With any variant of the course of bronchial asthma, the main clinical symptoms are the same (but variable, transient, usually worsen at night and are triggered by triggers). Often there is an attack of expiratory suffocation, labored and wheezing (sighting), spastic cough, or a combination of these symptoms against a background of a sharp decrease in PSV; less commonly, chest severity, aggravated by FN. In the development of an asthma attack, three periods can be conditionally distinguished: precursors (sometimes they are not) -> height -> reverse development. Harbingers may appear several minutes or hours before the onset of an attack. So, with atopic bronchial asthma, it can be a profuse separation of sputum mucosa, sore throat, “sand” in the eyes, vasomotor reactions from the nasal mucosa or itchy skin around the nose; with endogenous bronchial asthma – the appearance of a dry, repeated and painful cough, often arising in a dream, which wakes the patient. An attack of bronchial asthma can occur anytime, anywhere. Moreover, in a number of individuals, unexpectedly, with inexplicably pronounced obstruction of the airways due to bronchospasm (sudden asphyxial bronchial asthma). During the period of the attack, subjective complaints can vary (adaptation to bronchial asthma changes). So, they can quickly disappear if the patient promptly inhales beta-2-AH. The height of the attack is characterized by a sudden appearance of expiratory suffocation (“one cannot breathe freely”), heaviness in the chest (“air is difficult to pass” through the respiratory tract) more often in the morning, when getting out of bed (morning mobility), or at a certain time at night (attack -“alarm clock”). Night suffocation is often caused by diurnal fluctuations in cortisol, catecholamines in the blood (maximum reductionlevels at night) and maximum histamine levels at this time; increased vagal tone; an increase in the level of allergens of feather pillows, bed mites; accumulation of sputum per night; inhalation of organophosphorus insecticides (which process bedding, furniture); direct aspiration or gastroesophageal reflux (due to acid stimulation of the receptors of the lower esophagus, causing bronchoconstriction). An attack of bronchial asthma can reach very great strength in a few minutes. It can be classified by severity as light, moderate and heavy.

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