Daily Archive 11.02.2020

Bronchial asthma with concomitant diseases of various organs

Bronchial asthma in concomitant diseases of various organs – features of the clinical course of bronchial asthma in various concurrent diseases. The most common in patients with asthma are allergic rhinitis, allergic rhinosinusopathy, vasomotor rhinitis, nasal and sinus polyposis, arterial hypertension, various endocrine disorders, pathology of the nervous and digestive systems. The presence of arterial hypertension in patients with bronchial asthma is a generally recognized fact. The frequency of the combination of these diseases is increasing. The main factor in increasing systemic blood pressure is central and regional hemodynamic disorders: an increase in peripheral vascular resistance, a decrease in pulse blood supply to the brain, and hemodynamic disturbances in the pulmonary circulation. The increase in blood pressure is promoted by hypoxia and hypercapnia accompanying chronic bronchial obstruction, as well as the influence of vasoactive substances (serotonin, catecholamines and their predecessors). There are two forms of arterial hypertension in bronchial asthma: hypertension (25% of patients), which proceeds benignly and slowly progresses, and symptomatic “pulmonary” (the prevailing form, 75% of patients). In the “pulmonogenic” form, blood pressure rises mainly during severe bronchial obstruction (attack, exacerbation), and in some patients it does not reach the norm and increases with exacerbation (stable phase). Bronchial asthma is often combined with endocrine disorders. A known correlation of asthma symptoms with female genital function. In the puberty period in girls and premenopausal women, the severity of the disease increases. In women suffering from bronchial asthma, premenstrual asthmatic syndrome is often encountered: exacerbation 2-7 days before the onset of menstruation, less often – simultaneously with it; with the onset of menstruation, significant relief comes. Marked fluctuations in bronchial reactivity are not observed. Most patients have ovarian dysfunction. Severe asthma occurs when combined with hyperthyroidism, which significantly disrupts the metabolism of glucocorticosteroids. A particularly severe course of bronchial asthma is observed against the backdrop of Addison’s disease (a rare combination). Sometimes bronchial asthma is combined with myxedema and diabetes mellitus (about 0.1% of cases). Bronchial asthma is accompanied by disorders of the central nervous system of a different nature. In the acute stage, psychotic states with psychomotor agitation, psychoses, and coma are observed. In a chronic course, autonomic dystonia is formed with changes at all levels of the autonomic nervous system. Asthenoneurotic syndrome is manifested by irritability, fatigue, sleep disturbance. Vegetative-vascular dystonia is characterized by a number of signs: palm and foot hyperhidrosis , red and white “dermographism”, tremors, vegetative crises such as sympathoadrenal (sudden shortness of breath with a respiratory rate of 34-38 in 1 mn, fever, tachycardia up to 100-120 in 1 min , rise in blood pressure to 150 / 80-190 / 100 mm Hg. Art., frequent profuse urination, urge to defecate). Crises develop in isolation, mimic an asthmatic attack with a subjective sensation of suffocation, but there is no difficulty in exhaling and wheezing in the lungs. Symptoms of autonomic dystonia occur with the onset of bronchial asthma and become more frequent in parallel with its exacerbations. Autonomic dysfunction is manifested by weakness, dizziness, sweating, fainting and prolongs the period of coughing, asthma attacks, residual symptoms, more rapid progression of the disease and relative resistance to therapy. Concomitant diseases of the digestive system (pancreatic dysfunction, liver, intestinal dysfunction), which are found in a third of patients, especially with prolonged glucocorticosteroid therapy, can have a significant effect on the course of bronchial asthma. Concomitant diseases complicate the course of bronchial asthma, complicate its treatment and need appropriate correction. The treatment of arterial hypertension in bronchial asthma has certain features. “Pulmogenic” arterial hypertension, observed only during asthma attacks (labile phase), can normalize after bronchial obstruction has been eliminated without the use of antihypertensive drugs. In cases of stable arterial hypertension, the combined treatment uses hydralazine, ganglion blockers (arpenal, fubromegan, merpanite, temechin, peitamine), hypothiazide, veroshpiron (has the properties of an aldosterone blocker, corrects electrolyte metabolism disorders) 100-150 mg per day for three weeks . A-blocking adrenergic drugs, in particular pyrroxan, can be effective, calcium antagonists (corinfar, isoptin) are used. Ganglioblockers and anticholinergics can affect the neurogenic components of an attack of bronchial asthma (can be used in combination with bronchodilators: arpenal or fubromegan – 0.05 g three times a day; halidor – 0.1 g three times a day; temehin – 0.001 g three times a day day), which are recommended for mild attacks of a reflex or conditioned reflex nature, with a combination of bronchial asthma with arterial hypertension and pulmonary hypertension. These drugs must be used under the control of blood pressure; they are contraindicated in case of hypotension. For the treatment of patients with a predominance of the neurogenic component in pathogenesis, various variants of novocaine blockades are used (provided novocaine is tolerable), psychotherapy, hypnotic suggestive therapy, electrosleep, reflexology, and physiotherapy. These methods can eliminate the state of fear, conditioned reflex mechanisms of attacks, anxious mood. Treatment of concomitant diabetes is carried out according to the general rules: diet, antidiabetic drugs. Moreover, for the correction of carbohydrate metabolism, it is not recommended to use biguanides, which, due to the increase in anaerobic glycolysis (sugar-lowering mechanism), can aggravate the clinic of the underlying disease. The presence of esophagitis, gastritis, gastric and duodenal ulcers creates difficulties for glucocorticosteroid therapy. In cases of acute gastrointestinal bleeding, it is more advisable to use parenteral glucocorticosteroid drugs, an alternative treatment regimen is preferred. The optimal way to treat bronchial asthma, complicated by diabetes mellitus and peptic ulcer, is the appointment of glucocorticosteroid maintenance inhalation therapy. With hyperthyroidism, there may be a need for increased doses of glucocorticosteroid drugs, since an excess of thyroid hormones significantly increases the speed and changes the metabolic pathways of the latter. Treatment of hyperthyroidism improves the course of bronchial asthma. In cases of concomitant arterial hypertension, angina pectoris, and other cardiovascular diseases, as well as hyperthyroidism, it is necessary to use B-stimulating adrenergic drugs with great care. It is advisable to prescribe enzyme preparations (festal, digestin, panzinorm) for people with impaired digestive function, which reduce the absorption of food allergens and can help reduce shortness of breath, especially in the presence of food allergies. Patients with a positive result of tuberculin tests and a history of tuberculosis during prolonged glucocorticosteroid therapy are prescribed prophylactically tuberculostatic drugs (isoniazid). The use of adrenergic preparations of B-stimulating and methylxanthines in elderly patients is undesirable due to their side effects on the cardiovascular system, especially in coronary atherosclerosis. In addition, the bronchodilating effect of adrenergic drugs decreases with age. When a significant amount of liquid sputum is excreted in patients with bronchial asthma of this age group, anticholinergics are useful, which in some cases are more effective than other bronchodilators. There are recommendations on the use of synthetic androgens for older men suffering from bronchial asthma with a sharp decrease in the androgenic activity of the sex glands (Sustanon-250 – 2 ml intramuscularly with an interval of 14-20 days, course – three to five injections); while remission is achieved faster and the maintenance dose of glucocorticosteroid drugs is reduced. There are indications of the advisability of using antiplatelet agents, in particular dipyridamole (curantyl) – 250,300 mg per day – and acetylsalicylic acid (in the absence of contraindications) – 1.53.0 g per day, especially in elderly patients who have bronchial asthma associated with cardiac pathology -vascular system. In case of microcirculatory disorders and changes in the rheological properties of blood, heparin is used in a dose of 10-20 thousand units per day for 510 days. Concomitant pathology of the upper respiratory tract is being treated.