Asthmatic bronchitis: treatment, symptoms, causes
The content of the article:
- The reasons
- Pathogenesis and pathomorphology
- Asthmatic bronchitis symptoms
- Diagnostics
- Asthmatic bronchitis treatment
- Forecast and prevention
- Video
Asthmatic bronchitis is an infectious and allergic disease of the lower respiratory tract, characterized by hypersecretion of the mucous membrane, edema of the walls, spasm of large and medium bronchi. With such bronchitis, in contrast to bronchial asthma, attacks of severe suffocation usually do not occur. Nevertheless, in pulmonology, this form of bronchitis is regarded as a condition of pre-asthma. Most often, the disease develops in children of preschool and early school age with a history of allergic diseases (exudative diathesis, neurodermatitis, allergic diathesis, allergic rhinitis, etc.).
Children with asthmatic bronchitis have other types of allergies.
The reasons
Bronchitis with an asthmatic component has a polyetiological nature. Direct allergens can be both non-infectious agents and infectious factors (viral, fungal, bacterial) entering the body through the respiratory tract or through the gastrointestinal tract.
Among non-infectious allergens, house dust, fluff, pollen, animal hair, food components and preservatives are most often detected. Asthmatic bronchitis in children can be the result of drug and vaccine allergies. Polyvalent sensitization often occurs. Often in the history of patients there are indications of a hereditary predisposition to allergies.
In most cases, the pathogenic staphylococcus is an infectious substrate. This is indicated by the frequent sowing of the microorganism from the secretions of the trachea and bronchi, as well as the increased level of specific antibodies in the blood of patients. Often, bronchitis with an asthmatic component develops after suffering from influenza, acute respiratory viral infections, pneumonia, whooping cough, measles, laryngitis, tracheitis, viral bronchitis. There have been repeated cases of the development of the disease in patients with gastroesophageal reflux disease.
Depending on the leading allergic component, exacerbations of bronchitis can occur in the spring-summer period (flowering season) or the cold season.
Pathogenesis and pathomorphology
In the pathogenesis of bronchitis with asthmatic bias, the leading mechanism is the increased reactivity of the bronchi to various kinds of allergens. The presence of neurogenic and immunological links in the pathological response is assumed. The place of conflict "allergen-antibody" is the bronchi of medium and large caliber; small bronchi and bronchioles with this form of bronchitis remain intact, which explains the absence in the clinic of the disease of pronounced bronchospasm and asthmatic attacks.
According to the type of immunopathological reactions, atopic and infectious-allergic forms of the disease are distinguished. The atopic form is characterized by the development of type I allergic reaction (immediate type hypersensitivity, IgE-mediated allergic reaction); infectious-allergic - the development of an allergic reaction of type IV (delayed-type hypersensitivity, cell-mediated reaction). There are also mixed mechanisms of development.
The pathomorphological substrate is a spasm of the smooth muscles of the bronchi, impaired bronchial patency, inflammatory edema of the mucous membrane, hyperfunction of the bronchial glands with the formation of secretions in the lumen of the bronchi.
Bronchoscopy with an atopic form of the disease reveals a characteristic picture: a pale but edematous mucous membrane of the bronchi, narrowing of the segmental bronchi due to edema, a large amount of viscous mucous secretion in the lumen of the bronchi. In the presence of an infectious component, changes in the bronchi are determined, typical for viral-bacterial bronchitis: hyperemia and swelling of the mucous membrane, the presence of mucopurulent secretions.
Asthmatic bronchitis symptoms
The course of the disease is recurrent with periods of exacerbation and remission. In the acute phase, coughing attacks occur, which are provoked by physical exertion, laughter, and crying. Paroxysm of cough may be preceded by precursors in the form of a sharply arising nasal congestion, serous-mucous rhinitis, sore throat, and slight malaise. Body temperature during an exacerbation can be subfebrile or normal. At first, the cough is usually dry, during the day it becomes moist.
An acute cough attack is accompanied by shortness of breath, expiratory shortness of breath, noisy, forced wheezing exhalation. At the same time, status asthmaticus does not develop. At the end of the paroxysm, sputum discharge is usually observed, followed by an improvement in the condition.
A feature of bronchitis with an asthmatic bias is the persistent repetition of attacks. At the same time, in the case of a non-infectious nature of the disease, the so-called elimination effect is noted: coughing attacks stop outside the action of the allergen (for example, when children live outside the home, change the nature of their diet, change seasons, etc.). The duration of the acute period can range from several hours to 3-4 weeks. Frequent and persistent exacerbations of the disease can lead to the development of bronchial asthma.
Most of the children suffering from asthmatic (allergic) bronchitis have other allergic diseases - hay fever, allergic diathesis, neurodermatitis. Multiple organ changes in this form of bronchitis do not develop, however, neurological and autonomic changes can be detected - irritability, lethargy, increased sweating.
Diagnostics
Making a diagnosis requires taking into account the history data, physical and instrumental examination, allergy diagnostics. Since bronchitis with an asthmatic component is a manifestation of systemic allergy, pulmonologists and allergists-immunologists are engaged in its diagnosis and treatment.
The chest, as a rule, is not enlarged. With percussion, the boxed tone of the sound above the lungs is determined. The auscultatory picture is characterized by hard breathing, the presence of scattered dry wheezing and wet rales of various sizes (large and small bubble).
During auscultation with bronchitis with an allergic bias, hard rales are heard
Radiography of the lungs reveals the so-called latent emphysema: rarefaction of the pulmonary pattern in the lateral regions and thickening in the medial; strengthening of the drawing of the root of the lung. The endoscopic picture depends on the presence of an infectious and inflammatory component and varies from almost unchanged bronchial mucosa to signs of catarrhal, sometimes catarrhal-purulent endobronchitis.
In the blood of patients, eosinophilia, an increased content of immunoglobulins IgA and IgE, histamine, and a decrease in the titer of complement are determined. The cause can be determined by carrying out scarification skin tests, elimination of the alleged allergen. To determine the infectious pathogen, sputum bacterial culture is performed on the microflora with the determination of sensitivity to antibiotics, bacteriological examination of bronchial lavage water.
In order to assess the degree of bronchial obstruction, as well as monitor the course of the disease, a study of the function of external respiration is carried out: spirometry (including with samples), peak flowmetry, gas analysis of external respiration, plethysmography, pneumotachography.
Asthmatic bronchitis treatment
The approach to therapy should be comprehensive and individual. It is effective to carry out long-term specific hyposensitization with an allergen in appropriate dilutions. Therapeutic microdoses of the allergen are increased with each injection until the maximum tolerated dose is reached, then they switch to treatment with maintenance doses, which continues for at least 2 years. As a rule, in patients who have received specific hyposensitization, the transformation of bronchitis into bronchial asthma does not occur.
When carrying out nonspecific desensitization, histaglobulin injections are used. Patients are shown taking antihistamines (Ketotifen, Chloropyramine, Diphenhydramine, Clemastine, Mebhydrolin). Antibiotics are prescribed if there are signs of bronchial infection. The complex therapy includes bronchodilators, antispasmodics, mucolytics, vitamins. To stop a coughing attack, inhalers can be used - Salbutamol, Fenoterol hydrobromide, etc.
Complex drug therapy, antihistamines, anti-inflammatory and facilitating sputum excretion drugs are used
Effective nebulizer therapy, sodium chloride and alkaline inhalations improve mucosal trophism, reduce mucus viscosity, restore local ionic balance. From physiotherapeutic procedures, medicinal electrophoresis, UFO, general massage, local chest massage, percussion massage are prescribed. It is advisable to carry out hydro-procedures, therapeutic swimming, exercise therapy, acupuncture, electroacupuncture. During periods of remission, treatment at specialized health resorts is recommended.
Forecast and prevention
Usually, the prognosis for bronchitis with an asthmatic bias is favorable, however, in 28-30% of patients, the disease transforms into bronchial asthma.
To prevent an exacerbation of bronchitis with an asthmatic component, it is necessary to eliminate the allergen, carry out non-specific and specific hyposensitization, and sanitize chronic foci of infection. For the purpose of rehabilitation, hardening, remedial gymnastics, aerial procedures are shown. Patients are subject to dispensary observation by a pulmonologist and an allergist.
Video
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
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