Differential diagnosis. Bronchial asthma is differentiated with other allergic lung diseases (allergic bronchopulmonary aspergillosis, allergic exogenous bronchioalveolitis, chronic bronchitis, many bronchospastic syndromes that develop in various pathological conditions). Within the framework of bronchial asthma itself, various forms and variants are diagnosed.
Differential diagnosis of allergic and bacterial inflammation in the bronchopulmonary system in bronchial asthma is difficult. Activation of the bacterial inflammatory process in bronchial asthma is accompanied by an increase in the number of microbes in sputum (the main pathogens are pneumococcus and hemophilic bacillus, there is a significantly higher frequency of detection of opportunistic microorganisms, especially staphylococcus, than with other chronic non-specific lung diseases).
The treatment of bronchial asthma is still difficult. There are four basic rules for the treatment of bronchial asthma, an
individual approach with the determination of the leading factor in the etiology, pathogenesis and clinic of the disease;
elimination of the cause (complete or partial elimination of antigen), non-specific irritants, provoking factors;
the implementation of specific hyposensitization when it is impossible to eliminate the antigen;
conducting complex nonspecific therapy with an unknown etiology and the presence of contraindications for hypersensitivity.
Nonspecific complex therapy consists in the rehabilitation of infectious and inflammatory processes in the bronchopulmonary system (antibacterial agents, bronchial tree sanitation) and foci of infection outside the respiratory tract, the elimination of airway obstruction, the improvement of alveolar ventilation, the effective dilution and evacuation of sputum using hydrating and mucolytic drugs immunocorrecting and desensitizing non-specific therapy, sanatorium and other treatment.
One of the main places is the treatment of bronchial obstruction, which in bronchial asthma has a complex nature. Medicines of various classes contribute to its elimination: bronchodilators (relieve bronchospasm), expectorants (dilute and remove sputum), glucocorticosteroid drugs (eliminate allergic inflammation), antibacterial agents (eliminate bacterial inflammation).
Due to the pronounced allergenic properties of many drugs, especially antibiotics and sulfonamides, as well as the tendency of patients to drug allergies, a careful choice of therapy is necessary in each case. Drug allergy in bronchial asthma is most often manifested by an increase and aggravation of asthma attacks, the formation of asthmatic status. The treatment failure, especially in the absence of activation of the infectious and inflammatory process in the lungs and steroid dependence, indicates the need to review the therapy in terms of the possibility of drug allergy.
Treatment of individual forms and options A. b has featurs.
Mild attacks are stopped by oral administration of theophedrine or ephedrine, as well as by inhalation of adrenergic drugs, especially B2 stimulants. At the same time, distracting means (banks, mustard plasters, hot foot baths) are used. In the absence of effect, ephedrine or adrenaline is administered subcutaneously, and in the case of contraindications to their use, aminophylline is administered intravenously, atropine is subcutaneous. Highly effective B2-stimulants with parenteral administration. Adequate hydration is required, moistened oxygen is used. In severe bronchial asthma, resistance to adrenergic drugs is often observed. In this case, euphyllium is introduced (4 mg per 1 kg of body weight) – slowly intravenously, moistened oxygen is given. With resistance to adrenergic drugs and methylxanthines, parenteral administration of glucocorticosteroid drugs is indicated, especially for patients receiving maintenance doses of these drugs. It is preferable to use hydrocortisone (hemisuccinate, phosphate), since a high plasma concentration is achieved within a short time. In patients not receiving hormones, an infusion of 100-200 mg of hydrocortisone every 6 hours can give a satisfactory result . For steroid-dependent patients, large doses are required, in some cases the effect does not occur until the concentration of glucocorticosteroid drugs in the plasma reaches 1 μg / ml (corresponds to dose of 4 mg per 1 kg of body weight every 2 hours). The response to glucocorticosteroid drugs correlates with a decrease in the number of eosinophils (absolute amount) by 50% or more. Treatment of severe, non-stopping attacks of asthma, passing into asthmatic status, is in the nature of intensive care.
Specific hyposensitization in the treatment of bronchial asthma refers to pathogenetic methods of therapy, is carried out according to general rules in the absence of exacerbation of bronchial asthma and inflammatory processes in the foci of infection after thorough rehabilitation. Most allergist clinicians assess hyposensitization as the primary treatment for atopic bronchial asthma. It is most developed and effective in atopic dust bronchial asthma and pollen etiology. The effectiveness of treatment with food extracts in cases of suspected food allergies has not been confirmed. the number and frequency of allergen injections depend on the severity of sensitization and patient tolerance. The duration of specific desensitization is at least two years, with a significant decrease in symptoms, a break is made, when symptoms return, treatment is resumed. There are a number of reports on the greater effectiveness of inhalation immunotherapy for asthma with dust etiology (carried out according to the same scheme as injection, aerosols are sprayed with AI-1 inhalers), note a long duration of remission, and it is recommended to conduct three courses of local immunotherapy in a row. There are no reliable criteria for determining the duration of treatment: in each case this is determined by the clinical situation. The specific hyposensitization of infectious bronchial asthma is less developed and less effective. The points of view on the effectiveness of bacterial vaccines are different. There is evidence in favor of both auto and hetero vaccines. Significantly more often than with atopic bronchial asthma, exacerbations during hypersensitivity by microbial allergens are described.