Daily Archive 14.01.2020

Bronchospastic syndromes

Bronchospastic syndromes are secondary syndromes that develop in diseases of various organs and systems, in the clinical picture of which bronchospasm is the dominant or one of the main symptoms. Depending on the leading pathogenetic symptom, the following types of bronchospastic syndrome are distinguished: allergic bronchospastic syndromes hemodynamic bronchospastic syndromes; syndromes bronchospastic infectious and inflammatory; bronchospastic irritative syndromes; bronchospastic drug syndromes; bronchospastic neurogenic syndromes; obstructive bronchospastic syndromes; bronchospastic syndromes in autoimmune diseases; bronchospastic syndromes with rare diseases; bronchospastic syndromes with tracheobronchial dyskinesias; syndromes bronchospastic endocrine-humoral. 

Allergic bronchospastic syndromes

Allergic bronchospastic syndromes – bronchospastic syndromes that develop with respiratory tract diseases, which are based on immunological damage of various types. Allergic bronchospastic syndromes are observed with allergic bronchopulmonary aspergillosis, allergic exogenous bronchioalveolitis, allergic pulmonary vasculitis, pulmonary eosinophilia.
Pulmonary vasculitis is associated with allergic bronchospastic syndrome and Leffler syndrome. In particular, with periarteritis, nodular allergic bronchospastic syndrome can appear in the form of a prolonged stage of a generalized form of the disease: a variant of classical nodular periarteritis can be the Charch-Strauss syndrome, which develops in people with atopy and is characterized by persistent asthma, bronchial, skin vasculitis, and multiple neuritis. Involvement in the process of other organs (kidneys, gastrointestinal tract, central nervous system) is not typical for the disease. Allergic bronchospastic syndromes can accompany various pulmonary eosinophilic diseases, including those caused by parasitic infections: nematodes, trematodes, cystodes, which cause Leffler’s syndrome and asthmatic attacks, the number of eosinophils in the peripheral blood increases significantly with unusually high levels of immunoglobulin E (pulmonary symptoms usually during the passage of parasites through the lungs during the specific phase of their life cycle). Hemodynamic bronchospastic syndromes can develop with drug allergies.

Hemodynamic bronchospastic syndromes

Hemodynamic bronchospastic syndromes – bronchospastic syndromes that form with hemodynamic disorders in the pulmonary circulation.
Hemodynamic bronchospastic syndromes develop with primary pulmonary hypertension, thrombosis and embolism in the pulmonary artery system, venous congestion in the pulmonary circulation (heart defects, cardiosclerosis, anomalies of development and aneurysm of large vessels).
To conduct rational therapy, it is important to distinguish between asthma attacks of bronchial and cardiac, especially in old age, when chronic infectious and inflammatory diseases of the respiratory system are often combined with hypertensive and coronary heart disease, cardiosclerosis, especially since asthma is bronchial infectious-allergic and cardiovascular diseases first occur in the same age group. In a number of cases, mixed cardiac and bronchial asthma have been reported.
Bronchoconstriction stimulating bronchial asthma is sometimes observed in patients with an embolism in the pulmonary artery system. The frequency of embolic asthma has not been established, but may be high in patients with cardiac asthma. In the pathogenesis of acute bronchoconstriction during embolism, stimulation of pulmonary irritant receptors by serotonin released from aggregated platelets is important; the role of other mediators is less defined. With extensive embolism in the blood serum, lactate dehydrogenase is detected, levels of bilirubin and fibrinogen increase; ECG shows signs of a pulmonary heart, and an X-ray examination reveals lung infiltration. In difficult cases, selective angiography is used. 

Bronchospastic infectious and inflammatory syndromes

Bronchospastic infectious and inflammatory syndromes that develop during infectious and inflammatory processes in the respiratory tract: chronic bronchitis, chronic pneumonia, bronchiectasis, pulmonary tuberculosis, adenovirus, fungal, parasitic and protozoal infectious diseases.
Most often, there is a need for differential diagnosis of bronchospastic infectious and inflammatory syndromes and bronchial infectious-allergic asthma. The differential diagnosis of bronchospastic infectious and inflammatory syndromes developing in chronic obstructive bronchitis and bronchial asthma is also difficult. Typical signs of this kind of bronchospastic infectious and inflammatory syndromes are the duration of the disease, cough with mucous mucous sputum. A history of prolonged exposure to occupational hazards and smoking. In bronchial asthma, a reversible obstruction of the airways is more often observed, which is determined using a functional test with bronchodilators ( 15–20% improvement in FEV1 is noted ). A set of diagnostic criteria includes physical data, lung radiography, bronchoscopy, bronchoalveolar lavage, microbiological examination of sputum, detection of eosinophilia in peripheral blood and secrets.

Irridative bronchospastic syndromes 

Irridative bronchospastic syndromes – bronchospastic syndromes that develop with mechanical, physical, chemical. and thermal influences (dust, powder, acid, alkali, etc.).

Medicinal bronchospastic syndromes

Medicinal bronchospastic syndromes – bronchospastic syndromes that develop due to the main pharmacological effect of the corresponding drugs.
Medicinal bronchospastic syndromes can form with the use of medications that block adrenergic B receptors, especially with lung pathology; monoamine oxidase inhibitors, rauwolfia preparations, etc. Bronchospasm in these cases is not a consequence of allergic reactions, but is due to the pharmacological properties of certain drugs.

Neurogenic bronchospastic syndromes

Neurogenic bronchospastic syndromes – bronchospastic syndromes that develop with disorders of the central and autonomic nervous systems of a functional nature. Neurogenic bronchospastic syndromes occur with hysteria, irritations (reflex, toxic, compression) of the vagus nerve. Along with neurogenic bronchospastic syndromes, there are states of suffocation that do not have an organic basis: hyperventilation da Costa syndrome, autonomic neurotic dysregulation of respiration, “neurotic asthma”. The state of suffocation is also accompanied by laryngospasm, while wheezing in the lungs is absent. A history of “neurotic asthma” is the impact of psychotraumatic factors, a pronounced tendency to neurotic (especially hysterical) reactions, daily and often seasonal fluctuations in the affective state. The disease begins most often between the ages of 15-25 and 35-45 years. Dyspnea in neurogenic bronchospastic syndromes is associated with paroxysmal hyperventilation, characterized by respiratory arrhythmia with periodic deep breaths and a subsequent short-term breath-holding. Cyanosis and bronchospasm in patients are absent, wheezing in the lungs is not heard; functional systolic murmur at the apex of the heart is possible; sputum does not stand out. Signs of cardiopulmonary failure do not appear even with a long course of neurogenic bronchospastic syndromes. Blood saturation with oxygen is normal, hypocapnia, compensated respiratory alkalosis are noted (in some patients – in combination with compensated metabolic acidosis). With neurogenic bronchospastic syndromes, tranquilizers, antidepressants, antipsychotics, psychotherapy are effective. 

Obstructive bronchospastic syndromes

Obstructive bronchospastic syndromes – bronchospastic syndromes accompanying bronchial occlusion diseases.
Obstructive bronchospastic syndromes develop in the presence of malignant tumors of the trachea, bronchi and lungs, foreign bodies in the bronchi, broncholithiasis, cystic fibrosis, mediastinal formations: cysts, teratomas, angiomas, thymomas. They are caused either by endobronchial obstruction (bronchogenic carcinoma, foreign bodies, endobronchial tuberculosis, bronchial
adenoma, allergic bronchopulmonary aspergillosis), or extrabronchial compression (enlargement of radical lymph nodes in sarcoidosis, lymphoma, tuberculous lymphadeniosis, various;
In the presence of foreign bodies in the bronchi, the symptoms of obstructive bronchospastic syndromes can be different and depend on the type of object, its location and the duration of the bronchi. Foreign bodies can cause bilateral bronchospasm, however, unilateral, appearing or intensifying in the supine position is more typical: inspiratory and expiratory shortness of breath is characteristic. In the case of an undeleted foreign body, obstruction may progress due to increased local edema and inflammation, and obstructive emphysema, atelectasis, or lung abscess may develop depending on the nature of the foreign material. Plant foreign bodies (particularly nuts) are particularly prone to cause severe tracheobronchitis and pneumonia. The diagnosis of Obstructive Bronchospastic Syndrome is easily diagnosed with radiopaque foreign bodies. However, most foreign bodies are not radiopaque; in these cases, special studies are required. Only 2-4% of foreign bodies clears their throat spontaneously, so the main treatment method is to remove them using direct laryngi or bronchoscopy. For the diagnosis of obstructive bronchospastic syndromes using a range of methods, special radiographic study on inhalation and exhalation, tomography, bronchoscopy, bronchial biopsy. 

Bronchospastic syndromes in autoimmune diseases

Bronchospastic syndromes in autoimmune diseases – bronchospastic syndromes associated with lung lesions in collagen diseases (dermatomyositis, rheumatoid arthritis, systemic scleroderma, periarteritis nodosa).

Bronchospastic syndromes in rare diseases

Bronchospastic syndromes with rare diseases Bronchospastic syndromes that develop with rare diseases of various organs with a variety of pathogenesis: systemic mastocytosis, A1 antitrypsin deficiency, Goodpasture syndrome, pulmonary alveolar fibrosis, sarcoidosis, pulmonary fibrosis, idiopathic pulmonary fibrosis, mydrolinosis, pulmonary fibrosis, and pulmonary fibrosis; manifestations in combination with skin lesions and high eosinophilia), certain types of pat ogy gastrointestinal system (foreign bodies, hernia or stenosis of the esophagus, esophageal reflux).
Severe emphysema in the lower parts of the lungs in adolescents suggests a deficiency of a1-antitrypsin. Intensive discharge of mucopurulent sputum in a patient younger than 25 years of age requires examination for the presence of cystic fibrosis.
In some patients with systemic mastocytosis, bronchospastic syndrome can simulate bronchial asthma. In contrast to asthma, with this type of syndrome, a pronounced symptomatic effect of antihistamines is observed. The most reliable method of confirming the diagnosis is a skin biopsy.

Bronchospastic syndromes in tracheobronchial dyskinesias

Bronchospastic syndromes with tracheobronchial dyskinesias – bronchospastic syndromes that form with abnormalities in the development of the trachea and bronchi.
Bronchospastic syndromes in tracheobronchial dyskinesias can simulate bronchial asthma. These include: tracheobronchomegaly (Mounier-Kuhn syndrome); tracheobronchomalacia; Williams-Campbell syndrome; bronchioloectatic emphysema.
Bronchioloectatic emphysema affects the peripheral parts of the bronchial tree and is associated with a defect in elastic fibers (the lesion is usually diffuse, bilateral). It occurs at any age, is manifested by symptoms of chronic obstructive emphysema, stubborn cough, wheezing, constant dry and mixed wet rales, frequent pneumonia, severe respiratory failure; spontaneous pneumothorax is possible. The disease can occur with asthma attacks, sometimes it becomes asthmatic. Patients develop rapidly pulmonary heart. Diagnostics – radiological (bronchography). Williams-Cambell syndrome is characterized by a deficiency of cartilage rings in the wall of the bronchi from III to VI-VIII. It is usually detected in children of early and primary school age. This syndrome may be erroneously interpreted as bronchial asthma. It begins after respiratory diseases, repeated infections provoke its exacerbation. In patients, obstruction of the small bronchi progresses, pulmonary emphysema develops, often segmented or lobar atelectasis. The course of the syndrome is chronic, with frequent exacerbations; pulmonary heart is formed. Sick children lag behind in growth and development; they have a barrel-shaped chest, a symptom of “drumsticks”, shortness of breath with minimal load; during auscultation, constant or periodic dry rales are heard. The diagnosis is established using x-ray examination. Tracheobronchomalacia is characterized by excessive softness of the cartilage of the trachea and large bronchi, is manifested by symptoms of stenosis of the trachea and main bronchi (stridor, “sawing breathing”, “barking” cough, asthma attacks that cannot be stopped by bronchodilators), obstructive type of ventilation disorders is observed. Diagnosed with x-ray and bronchoscopy. Tracheobronchomegaly is most often found in men (the ratio between sick men and women is 6: 1), is characterized by a pronounced expansion of the trachea and main bronchi, combined with chronic respiratory infections. Tracheobronchomegaly is characterized by a long history of pulmonary disease, frequent exacerbations of the inflammatory process with a loud, vibrating cough of a specific timbre (“goat bleating”), hoarseness, profuse purulent sputum, expiratory dyspnea. Attacks of coughing and suffocation can occur with a change in body position. The course is stubborn, difficult to treat, the condition worsens all the time, patients die from infectious complications and respiratory failure. The diagnosis is made using tomoy bronchography. The function of external respiration is characterized by the obstructive type of ventilation disorders. Tracheobronchial dyskinesia is detected (the forced expiration curve has a stepwise character). 

Endocrine-humoral bronchospastic syndromes

Endocrine-humoral bronchospastic syndromes are bronchospastic syndromes that develop with endocrine disorders due to the release of biologically active substances with bronchoconstrictive action or other endocrine-humoral mechanisms.
Endocrine-humoral bronchospastic syndromes occur with carcinoid syndrome, hypothalamic syndrome and hypoparathyroidism. They are detected in approximately 20% of patients with carcinoid syndrome, in 7% of cases there is a primary bronchial carcinoid.