Pulmonary emphysema is a serious chronic complication of bronchial asthma. At this condition the alveolus (blisters, of which lungs tissue consists) are excessively stretched and lose their ability to sufficient reduction due to what oxygen supply to blood and removal of carbon dioxide from organism worsens.
Usually lungs are affected completely (so-called diffuse emphysema). If overblown areas of lungs alternate with normal tissue, they are called bullas (globules), and emphysema is called bullous.
At narrowed fine bronchi the exhalation is more complicated than inspiration at asthma. There is an excessive air in alveolus and its pressure increases. Alveolus stretch excessively and become denser. Excess air doesn’t take part in respiration that leads to deficient work of lungs.
Patients with diffuse emphysema complain of dyspnea which becomes more intensive at exercise stress. Bullous emphysema often proceeds imperceptibly being shown by complication – a rupture of bulla with air injection into pleural cavity (development of pneumothorax). Urgent surgery is required at pneumothorax.
Emphysema without treatment progresses, work of respiratory and cardiovascular systems is broken. The patient has an expressed dyspnea, cyanotic skin (also tongue, lips, fingernails), increased thorax volume of barrel shape, decrease of respiratory movements.
Gradually progressing dyspnea turns into threat for the patient’s life.
At initial stages of disease to patients position on stomach with lowered head and shoulders gives alleviation. At severe emphysema patients are compelled even to sleep in sitting position.
Bronchial asthma can be combined with a reflux disease. Such kind of asthma is called a reflux – induced. Acidic gastric contents at first gets to esophagus, and then last to lumen of bronchial tree. There is an irritation of esophagus nerve endings and reflex spasm of bronchi at reflux.
Pathological refluxes most often occur at night when in horizontal position of the person gastric contents appear in esophagus and bronchi.
The reflux-induced asthma is shown by an attack, with emergence of dyspnea, wheezes, tussis, feeling of air shortage, breast compression. At first tussis may be absent, but later it nevertheless appears, dry and excruciating at the beginning, then it is followed by expectoration, discharging with great difficulty. Later the sputum fluidizes and the health of the patient improves.
Patients with reflux – induced asthma have such symptoms: heartburn, retrosternal pain, gaseous eructation, heaviness in the top part of stomach, strong salivation in sleeping condition, tussis, and dyspnea. Symptoms arise after the use of the “provocative” products in food.
At treatment of the patients suffering from reflux-induced bronchial asthma inhalation agents, corticosteroids are included into the main therapy. It is important to reduce the damaging action of acidic contents of stomach by the mucosa of esophagus, to prevent its penetration into lumen of bronchi. For fast decrease or elimination of heartburn and pain antacid medicines are used.
Professional asthma is caused by close contact of the person to substances which are at his work. So, physicians have an allergy to latex gloves, workers of chemical industry to ammonia. Work sensitization with the gluing materials, varnish and shellac, epoxies, plastic, polyurethane foam and rubber, dyes constitute danger (especially in the textile industry), insulating materials, and synthetic detergents. Quite often there is an allergy to platinum, chrome, nickel, welding gases. Allergens are many substances of vegetable and animal parentage – dust of cotton, hemp and flax, wool and a skin of animals.
To learn that the problem is covered in a working situation is possible if asthma symptoms become aggravated in working time, and at home patient feels well irrespective of how long he doesn’t go to work (days off, holiday).
Professional asthma is shown by symptoms of a classical attack, such as tussis, compression in breast, dyspnea and the whistling complicated respiration. Also eyes may water, clogged-up nose and rhinitis disturb.
After carrying out necessary tests, the specialist in treatment of professional asthma prescribes treatment in which drugs are included – bronchodilators, inhalation steroids.
For prevention of attacks of professional asthma it is important to avoid its originators at work. It is necessary to consult to the doctor what precautionary measures to take. In the last resort may be necessary to change a job.
Pneumothorax is a rupture of lung tissue of at which air gets to a thoracic cavity between pleura leaves. This infrequent but dangerous complication of neglected bronchial asthma when in the patient emphysema (over stretching of alveolus) developed.
The lung is deflated and practically deleted from respiration process. Easy to distinguish pneumothorax: there is an acute pain in a side, dyspnea grows, at fast entering of air shock develops in a pleural cavity of the patient.
The left-side pneumothorax sometimes is taken for a myocardial infarction. Right-hand can imitate perforation of stomach ulcer. In all cases heart is displaced on the struck side that is well noticeable on the X-ray.
The patient needs to be given the first aid; he is threatened by mortal danger. The patient is put to bed in a semi-sitting position, under a skin Morphine is injected for putting off pain and exaltation, possible tussis. Oxygen is applied; it is best of all through the nasal catheter bridged to a cylinder where rate of current of oxygen is regulated.
At development of an acute cardiovascular failure intravenously 1% solution of Novocain or 2% of Papaverin is injected. At closed pneumothorax when air in a thoracic cavity accumulates and props up surrounding organs, a puncture made between ribs with a thick needle and putting-on a rubber tube one end of which is immersed in water. When bubbles of air stop coming out, the place of a puncture is bandaged. Sometimes the persistent drainage is required.
For the infection prevention high doses of antibiotics are prescribed.
Night asthma with such symptoms as compression in breast, tussis and a goose breathing, dyspnea can interrupt sleep or absolutely does not allow falling asleep. The person cannot have a good rest; the whole next day feels tired and flaccid.
Symptoms of asthma are hundred times more severe when become aggravated in the sleeping person. The night goose breathing, breathing disorder and tussis are common symptoms potentially life-threatening. Many people underestimate gravity of night asthma.
The majority of the fatal cases caused by complications of asthma occur at night. Attacks of night asthma cause serious sleep problems so not getting enough sleep, fatigue, drowsiness, irritability in the afternoon. The patient’s life generally worsens; control over symptoms becomes complicated in the afternoon.
There is a set of hypotheses explaining why exacerbations of asthma arise at night. It is close contact of the sleeping person to allergens, strong cooling of respiratory tracts during sleep, night discharge of hormones, body horizontal position. The dream itself changes work of lungs and respiratory tracts.
Also an excessive myxopoiesis and sinusitis are referred to the causes of night asthma. During sleep respiratory tracts are narrowed, slime blocks them. It causes tussis during sleep provoking larger narrowing of respiratory tracts. Flow from nasal sinuses at body horizontal position can also cause an asthmatic attack in sensitive respiratory tracts.
Irrespective of whether in the afternoon or at night the patient sleeps, the exacerbation of night asthma happens only during sleep. The asthmatics working at nights may suffer from attacks in the afternoon when they sleep. Indicators of lungs capacity for worsen in 4-6 hours later after dream coming.
Solutions injection of probable allergens into a nose gives good diagnostic results when determining the substance causing attacks of allergic (atopic) bronchial asthma. Nasal tests with bacterial allergens don’t give a progress, perhaps, because of low concentration of provocative antigens in vaccines.
Results of nasal tests well coincide with indicators of skin tests. If the nasal test is negative but this substance nevertheless causes suspicions it is possible to use inhalation test.
Tenfold dilution of allergen in dissolvent (normal saline solution) for nasal test is prepared. One half of nose is considered as control, the second – experimental.
4 drops of control liquid (pure physical solution) is instilled into experimental half. The patient is observed for 10 minutes. If the patient feels well and nature of respiration through nose didn’t change and there are no changes at a rhinoscopy test with allergen is carried out.
With 30-minute intervals of experimental part of nose 4drops of each allergen dilution is instilled on. Initial concentration is selected individually. In 10-30 minutes after introduction of every nature of nasal respiration is estimated and nasal cavity is examined. Signs of positive reaction are: an itch and burning sensation, difficult nasal respiration in the experimental half of nose, sneezing, watery discharges. At rhinoscopy reddening of mucosa becomes perceptible, edema, narrowing of passages, secretion intensifying.
Test is stopped after identification of the first positive signs. Wash out with warm physical solution the experimental half of the nose, instill in it vasoconstrictive medicines, give to the patient inside an antihistamine preparation. Only one provocative test can be carried out per one day.
Corticosteroids (glucocorticoid hormones) have a strong action but give mass of side effects. Therefore they are applied at rather serious illnesses and states when other medicines are not effective.
In treatment of bronchial asthma corticosteroids are used as inhalations at medium severe form, prescribed inside and intravenously at the asthmatic status and long-term bronchospasm. Steroid hormones don’t expand bronchi.
Indications to application of corticosteroids are: asthmatic status, long-term course and serious attacks of bronchial asthma, cases when bronchodilators are not effective.
Usual doses of corticosteroids:
- Prednisolone is prescribed to adult inside for 40-60 mg once per day, to children for 1-2 mg per day per kilogram of weight within 3-7 days.
- Hydrocortisone is injected intravenously for 200 mg every 4-6 hours to the adult, for 4-6 mg on kilogram of weight to children.
It is possible to increase a dose of corticosteroids if the improvement doesn’t come within a day from the beginning of treatment.
Inhalations corticosteroids are not soaked up in blood from bronchi therefore don’t possess systemic action on organism. At treatment of bronchial asthma they are applied in combination with bronchodilators, and at long-term disease – independently.
It is necessary to gargle mouth and throat with water after each inhalation to avoid mouth candidiasis (thrush caused by yeast funguses) and irritation in throat.
Mouth candidiasis, irritation in throat and hoarseness are side effects of inhalation corticosteroids. They disappear at dose decrease or after cancellation of medicines. Use of buffer nozzles reduces local side effects. After long-term treatment with corticosteroids the dose is gradually reduced.
At suspicion on allergic (atopic) form of bronchial asthma it is important to reveal the allergen which became its cause. The skin tests, at their simplicity giving quite exact results, are widespread.
For carrying out skin tests solutions of probable allergens are used: pollen, herbs, epidermis of animals, poison of insects, components of nutrition, drugs.
There are following types of tests:
- Cutaneous (application) tests. Thus the gauze wad is moistened with solution of allergen and imposed on intact skin areas.
- Scarification tests. At their carrying out on clean skin of forearm drops of allergens are placed through drop with disposable scarifier small scratches are made.
- Prick-tests. On skin of forearm drops through which disposable needles give mild injections (depth makes 1 mm) of allergens solutions are applied.
For one time more than 15 allergy tests are done. The qualified allergist at special treatment room for medical procedures at allergology department has should carry them out.
If the person has an allergy to any substance there is a reddening or swelled in tested area of skin. Depending on allergen type dermal tests are estimated in 20 minutes, 5-6 hours or 1-2 days later. The list with results is issued to the patient. They are estimated on the following scale: positive, light-positive, negative, uncertain.
24 hours before to carrying out skin tests the patient should refuse reception of antihistamine medicines. Before tests the skin is processed with spirituous solution. Skin tests are painless. They won’t be carried out at allergy aggravation, acute infections, treatment by corticosteroids, pregnancies, for patients elder 60 years
Cough-variant asthma is a special type of asthma at which main symptom is dry tussis without sputum. It doesn’t relieve of the slime which is accumulated in respiratory tracts. Patients with a cough-variant asthma usually have no classical symptoms of asthma – a goose breathing or dyspnea.
Cough-variant asthma is called chronic tussis which can last from one and a half to two months. Attacks of cough occur both at day time and at night. Night asthma prevents to sleep. Sometimes people with cough-variant asthma complain to intensifying of tussis at exercise stresses. Tussis can also intensify at contact to the asthma originators, substances causing allergy – dust, strong smells.
Any person in any time can fall ill with cough-variant asthma. But more often it becomes perceptible in children. Cough-variant asthma sometimes leads to development of classical asthma. Asthmatics often are ill with sinusitis (an inflammation of adnexal sinuses of nose).
Dry tussis belong to cough-variant asthma and begins after use of beta-blocking agent – drugs which are used for blood pressure decrease, heartbeat retardation. Asthma can be caused with eye drops. it occurs at hyper-sensibility to Aspirin.
It is difficult to diagnose cough-variant asthma. Often single available method of diagnostics is treatment. The doctor prescribes a standard set of drugs; if they help to win against tussis, it is possible to make the diagnosis of cough-variant asthma.
Cough-variant asthma is treated with the same methods as its classical form. The doctor can prescribe an inhaler with Albuterol, inhalation steroids (anti -inflammatory). Marked improvement of state comes in six-eight weeks.
The inhalation test at allergic bronchial asthma is the most exact. At extract inhalation the allergen directly contacts to the tissue of the affected organ. The bronchial provocative test is capable to give a positive result where dermal tests don’t work. It can be applied for hyper sensitivity extent estimation of bronchi and efficiency of treatment.
The inhalation test may cause severe clinical implications of asthma therefore it has to be carried out with discretion. Provocative inhalation tests should be used only if necessary at the non-interaction between data of dermal testing and patient interview.
Via aerosol inhaler the patient is allowed to inhale a control liquid (solution on which allergen extract is prepared) within 3 minutes. 5-10 minutes later the condition of the patient and indicators of external respiration are estimated. If there are no changes in comparison with initial state, researches with allergen is started.
When carrying out trial test of the patient via inhaler inhales within 2-3 minutes the allergen extract in concentration which has shown poorly positive reaction at dermal test. If the patient has tussis, irritation in throat the inhalation should be immediately stopped and first aid given.
The patient is observed within an hour, at absence of changes in his state the next concentration of allergen in larger quantity is tried, up to undiluted extract. At positive test examination is stopped.
The examination procedure takes 5-6 hours and is tiresome for the patient. It is necessary for determination of sensitivity of bronchi to allergen, but for the purpose of diagnostics not always is necessary to carry out the complete test.