Definition
BA - inflammatory diseases of the respiratory tract, binding mechanism which is hyperactivity of bronchus and reversible bronchial obstruction caused by acute bronhospasm, edema bronchial wall, the formation of mucous plugs, followed by restructuring of bronchial wall. Bronchial asthma is a predisposing factor for atopy.
The basic principles of treatment of bronchial asthma are:
1. Elimination (termination), or reducing exposure to casual sense allergen;
2. Pharmacy therapy;
3. Specific immunotherapy.
Pharmacotherapy of Bronchial asthma is determined the gravity of disease (see below). IT is the main method of treating patients with atopic BA.
Indications for IT in patients with atopic BA are standard:
1. the impossibility of ending contact with the patient and allergen;
2. clear evidence of the role of allergens (pollen plants, household allergens, house dust mites, poison Hymenoptera, fungi, bacteria);
3. confirmation of IgE-dependent mechanism of sensitization;
4. age from 5 to 50 years.
Contraindications to the SIT in patients with BA:
BA worsening, the availability expressed complications, pulmonary heart with the phenomenon of chronic insufficiency of the functions of external respiration and blood circulation, pregnancy, tumors, chronic infection in the process worsening, autoimmune disease, severe diseases of internal organs , Nervous and endocrine systems, mental illness in the process of worsening, acute infectious diseases, blood diseases.
Survey
1. Required laboratory tests:
Analysis of clinical blood (1 every 10 days);
Analysis of blood biochemistry (bilirubin, ALT, AST, urea, glucose);
RW, HIV;
An analysis of sputum general;
Bacteriology sputum flora and sensitivity to antibiotics;
Analysis of urine common.
2. Additional laboratory studies:
Determination of protein fractions;
Determining the level of IgA, IgM, IgG in serum;
Blood tests: cortisol;
Urine analysis of the 17-CDR (for patients receiving GKS systemic action).
3. Allergy mandatory survey:
Skin tests with allergens;
Determining the level of total IgE;
Determining the level of specific IgE.
4. Allergy survey added:
Provocative tests with allergens (conjunctival, nasal, inhalation);
Determining the level of specific IgG;
Test braking natural emigration of leukocytes.
5. Binding Instrument Research:
X-ray of the thorax;
Radiography subordinate nasal sinus;
electrocardiogram (ECG), 1 times (in pathology - again);
Study external respiration 2 times.
6. Additional research tool:
Diagnostic bronchoscopy;
bronchomotor tests (estimate external respiration after exposure bronchial spasmolytic, bronchoconstrictors, physical exertion).
7. Mandatory counseling professionals:
ENT;
Allergist;
Pulmonology.
8. For more expert advice - on the grounds.
Characteristics of treatment
Treatment of patients with BA, is provide to reduce the specific and nonspecific hyperactivity of bronchus.
Recommended:
To ensure peace, to create an environment of comfort;
Delete the emotional and physical stress;
Delete or reduce contact with allergens;
Exclude the impact of provocative attacks of suffocation factors (smoking, household goods, cosmetics, etc.);
Exclude the possibility of the use of drugs in their intolerance;
Ensure hypoallergic diet;
Recommend to eliminate the influence of adverse occupational factors.
Medication.
Medication should be directed to stopping acute attacks bronchospasm, bronchospasm prevention, rescue pockets of chronic infection.
Means of emergency (stopping acute attacks):
sympathomimetics, beta2-agonists short steps;
Methylxanthine with short steps;
Glucocorticosteroids systemic action;
Anticholinergic drug.
In case of heavy and medium attack of BA used drugs for parenteral introduction.
For stopping touch suffocation can be used drugs in metered-dose inhalers or enteral(oral).
In order to prevent attacks bronhospazma used reference tools and anti protivoallergicheskoy therapy: GKS, drugs kromoglitsievoy acid receptor antagonists leykotrienovyh, Antihistamines drugs with a stabilizing effect on mast cell membranes (ketotifen), mucolytic - in accordance with the severity of BA.
