Bronchial asthma

Bronchial asthma is an allergic disease, manifested by periodic attacks of suffocation, caused by violation of bronchial patency due to spasm, edema of the mucosa and increased secretion.

Two-thirds of children develop asthma in early and preschool age. Mostly sick boys. The incidence in different regions ranges from 0.3 to 1% of the child population.

Etiology and pathogenesis. Hereditary predisposition to allergic diseases, exudative-catarrhal diathesis plays a large role. Allergens can be food products (especially in infants), drugs, dust particles, plant pollen, etc. Repeated exposure to an allergen sensitizes the body and stimulates the production of antibodies, primarily reactants belonging to the IgE class. Allergic reactions of immediate and delayed type develop, biologically active substances are released that cause bronchospasm, edema of the bronchial mucosa, increased secretion of mucus. A certain role is played by dysfunction of the central and autonomic nervous system, adrenal dysfunction.

Clinical picture. The asthma attack in children is characterized by the presence of a prodromal period during which certain deviations from the respiratory organs are observed (plenty of liquid discharge from the nose, sneezing and itching in the nose, dry cough, pharyngitis, puffiness of the tonsils, single dry wheezes, etc.). , Nervous system (excitability, irritability, restless sleep, motor anxiety, etc.), gastrointestinal tract and skin (polymorphic rash, loose stools or constipation).

An attack of bronchial asthma, especially in young children, usually occurs against a respiratory disease and only a small percentage of cases are provoked by a stressful situation. In young children, the asthma attack develops more slowly due to the slow build-up of hyperemia and edema of bronchial mucosa. The attack is accompanied by expiratory dyspnea, noisy, wheezing and audible breathing at a distance: its duration ranges from several minutes to several hours and days. The severity of an attack is determined by the degree of bronchial obstruction. Clinically and radiologically, emphysema is determined, atelectasis is possible. If the attack is delayed for 6 hours or more and is not allowed under the influence of sympathomimetic drugs, then this condition is called status asthmaticus. At the end of the attack, there is a gradual relief, clear, foamy, and then thick sputum, breathing becomes easier, cyanosis disappears. Eosinophilia is present in the blood, eosinophils, macrophages, and less often Charcot-Leiden crystals and Kurshman spirals are microscopically detected (in children, not always).

Complications can be in the form of asphyxia, heart failure, atelectasis, spontaneous pneumothorax (rarely), mediastinal and subcutaneous emphysema. In rare cases, during an attack, death may occur. With the long-term course of asthma, deformity of the chest, pneumosclerosis, emphysema, chronic pulmonary heart, bronchiectasis can develop.

The diagnosis is based on anamnesis and clinical symptoms, the detection of high levels of IgE and eosinophilia in the blood, Kurshman spirals and Charcot-Leiden crystals in the sputum.

Differential diagnosis is usually performed with aspiration of a foreign body, pertussis, croup, mediastinal tumor. For these diseases, expiratory dyspnea is not characteristic; In whooping cough, the nature of the cough and the epidemiological history are important.

Treatment. Dissociation of a patient with an allergen source, fresh, but non-cold air, a treatment-and-protective regime. During an attack, a hot (40-50 g. C) foot or hand bath, inhalation of aerosols Novorina, Izadrin, Solutane, Euspyran, Beroteka, Ventolin. For lung attacks, ephedrine is administered internally (at the age of 6-12 months - 0.002-0.003 g, 2-5 years-0.003-0.01 g, 6-12 years-0.01-0.02 g per reception). The greatest effect is given by euphyllin in a single dose from 3-4 to 12-16 mg / kg - day). For moderate and severe attacks, parenteral sympathomimetics are prescribed (0.15-0.5 ml of a 1% solution of epinephrine, in combination with a 5% solution of ephedrine in a single dose of 0.5-0.75 mg / kg); In cases of ineffectiveness, enter into / in the euphyllin (slowly for 5-7 minutes) in 10-15 ml of 20% glucose solution or in a hospital in a drip in a 150-200 ml isotonic sodium chloride solution at a rate of 4-6 mg / kg or 1 Ml of a 2.4% solution per year of life. In severe respiratory failure resort to oxygen therapy, the introduction of glucocorticoids in / m or IV (prednisolone - 1-2 mg / kg or hydrocortisone - 5-7 mg / kg). In the interictal period, stable remission can be achieved by inhalation of the intala (1 capsule 3-4 times a day for 2-4 months), appointment is delayed (0.025 mg / kg 2 times a day 6-9 months), histaglobulin (5 injections at intervals 3 4 days), the introduction of allergoglobulin (5 ml IM every 15 days for 2 months). Hypersensitization with a causally significant allergen is also shown.

The prognosis with active treatment and absence of concomitant diseases is favorable.