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Bronchial asthma - the chronic inflammatory disease of respiratory tracts characterised by reversible bronchial obstruction and a hyperreactivity of bronchuses.

The inflammatory nature of disease bound to influence of specific and nonspecific factors, shows in morphological changes of a side of bronchuses - infiltrations by cellular elements, first of all eosinocytes, dysfunctions of cilia of a ciliary epithelium, a destruction of epithelial cells, up to a desquamation, disorganisation of the basic material, a hyperplasia and a hypertrophy of mucous glands and goblet cells. Other cellular elements, including mast cells, lymphocytes, macrophages participate in inflammatory process also. Long flow of an inflammation leads to the irreciprocal morphofunctional changes characterised by a sharp thickening of a basal membrane with disturbance of microcirculation, and a sclerosis of a side of bronchuses. Described changes lead to formation of the broncho-obstructive syndrome caused bronchoconstriction, an edema mucous, a dyscrinism and sclerotic changes. Depending on the etiological factor of disease, gravity of flow and a disease stage this or that component of bronchial obstruction can prevail. Basic pathophysiological sign considers a hyperreactivity of the bronchuses a consequence of inflammatory process in a bronchial side and defined as hypersensitivity of respiratory tracts to stimulants, indifferent for healthy faces. A specific hyperreactivity of bronchuses perceive hypersensitivity of a bronchial arbour to certain allergens, under nonspecific - to various stimulants of not allergenic nature. Bronchial asthma can be categorised into aetiologies and severity levels. Till now there is no uniform world classification a bronchial asthma under the etiological factor, however the majority of explorers is excreted a bronchial asthma atonic (exogenous, allergic, immunologic) and not atopic (endogenous, not immunologic). By the atopic mechanism of a course of a disease mean the immunologic reaction mediated specific Ig. V children this mechanism of a course of a disease is the core. It is shown, that the atony can be inherited more than in 30 % of cases. By not atopic variant mean the disease which does not have the mechanism of an allergic sensibilization. At this form of disease as starting agents respiratory infection contaminations, disturbances of a metabolism of arachidonic acid, endocrine and psychological disorders, disturbances of receptor balance and an electrolytic homeostasis of respiratory tracts,

professional factors and aeropollutant not the allergenic nature can act. It is necessary to notice, that, despite evidence of a causal role of the majority of etiological agents not atopic the bronchial asthma, mechanisms of formation of this form of disease are not up to the end studied. Last years the special value in formation not allergic the bronchial asthma is given to contamination of atmosphere by products urbanisation to activity of the human, including nitrogen and sulphur dioxides, ozone. Into severity levels a bronchial asthma categorise on easy, moderately severe and serious disease. Gravity of flow is defined by the doctor on the basis of a complex of the clinical and functional signs including frequency, gravity and duration of attacks expiratory Dyspnoe, and also a condition of the patient in the seasons, free from attacks. Severity level of flow of disease can be characterised following criteria. At easy severity level disease flow is usually characterised by absence of the classical developed attacks of a dyspnea, symptoms become perceptible less often than 1-2 times a week and are short-term. The night sleep of patients is characterised by awakening from respiratory discomfort less often than 1-2 times a month. In between the semeiotic season a condition of patients the stable. The assessment of functional indicators for definition of gravity of disease is spent to the season of absence of episodes expiratory Dyspnoe. PEF or FEV1> 80 % from due sizes, daily disorder of indicators less than 20 %. Investigated indicators accept normal due value after inhalation of bronchodilators. The asthma of moderately severe flow is characterised by occurrence of the developed attacks of the dyspnea, 1-2 times arising to brake in a week. Attacks of a night asthma recur more often than two times a month. The daily requirement for sympathomimetics becomes perceptible. PEF or FEV1 compounds 60-80 ' % from the due sizes, recovered to normal value after inhalation bronchial spasmolytic, the daily disorder of indicators fluctuates within 20-30 %. The asthma of serious flow is characterised by the frequent exacerbations of disease representing danger to life of the patient, long symptoms, frequent night symptoms, depression of physical activity, presence of remaining symptoms in the season between attacks. PEF or FEV1 <60 % from due sizes, are not

recovered to normal value after inhalation of broncholitic preparations, daily disorder of indicators more than 30 %. T The complex medical program a bronchial asthma includes: E Educational program of patients the Dynamic control of gravity of disease and adequacy of spent therapy by m means of clinical and functional researches E Elimination or the control of causative factors W Working out of the plan of medicamental therapy Preventive maintenance of an exacerbation and working out of the plan of its t treatment Dynamic observation over the patient It is known, that in most cases the causes of unsatisfactory results of treatment of patients a bronchial asthma are bound to insufficient knowledge of the patient of the disease. Formation of the patient should begin in an office of the doctor. It is necessary to give to the patient of data on the causes and character of its disease, the basic mechanisms leading to symptoms of disease. It is necessary to learn also the patient to the correct technics of inhalation therapy, application of spacers, peak flow metre use. Conducting by the patient of a diary of introspection where it could reflect changes of symptoms, and also dynamics of indicators of a peak flow metria is important at daily and more long monitoring. The plan of bolstering actions and treatment, and also the plan of behaviour in a disease exacerbation should be offered the patient. The great value has influence on monogynopaedium of the patient for the purpose of acquaintance with features of disease both necessary sanitary-andhygienic and preventive actions. It is necessary to induce building of the organisations which purpose is training of patients in various forms. Initial gravity of disease and intensity of spent medical actions, their volume and adequacy are defined by means of the dynamic control over a clinical condition of the patient, and also changes of functional pulmonary tests. As the most accessible, inexpensive and convenient in out-patient practice the method of independent definition of a peak expiratory rate by means of a peak flow metre is offered. The dynamic peak flow metria allows to judge voltage of daily allowances fluctuation PEF as about criterion of adequacy of spent therapy, about the importance of exogenous industrial or household factors in disease flow, about efficacyy of spent treatment, and also can testify to offensive of an

exacerbation of disease. In the big percent of cases disease, in particular at children, is bound to exogenous influence of sensitising factors allergen ache also not allergenic nature. The isolated medicamental therapy at a remaining exposition of a causative factor can be insufficiently effective. In this connection conducting the patient should begin with elimination attempt (if it probably) or decreases of an exposition of influence of the given agent. The sensibilization allergens of a household environment of the patient that forces to apply the actions referred on depression of their concentration in dwelling of the patient has the special importance. Presence professional the bronchial asthma forces to survey a question on change of a workplace of the patient. The major aspects of sanitaryand-hygienic actions are observance of the hypoallergenic diet entering into a rank of obligatory actions in the presence of a food allergy, maintenance of cleanliness of air in dwelling of the patient, abandoning of smoking. At scheduling of medicamental treatment the bronchial asthma is obviously necessary to define a spectrum of the basic antiasthmatic preparations. It is n necessary to carry to them: t the antiinflammatory: Cromoglycate, Ndcromil sodium and new generatings a membrane of s stabilising preparations G Glucocorticosteroids inhalation, parenteral, peroral s symptomatic agents: S Selective 2- the short and prolonged action X Xanthines of the short and prolonged action Inhalation M cholines The differentiated schemes of therapy depending on disease severity level are offered. Treatment of a bronchial asthma of easy severity level assumes, depending on clinical symptoms, constant or incidental (before an expected exercise stress or contact to allergen) application Sodium cromoglycate. Inhalation 2- are applied on requirement, but not more often three times a week. Medicamental therapy of a moderately severe bronchial asthma provides daily use of antiinflammatory preparations (inhalation glucocorticosteroids in a dose to 1000 mkg a day, Sodium cromoglycate), daily reception 2- on requirement, but no more than 3-4 times a day. Application prolonged

bronchial spasmolytic is possible, especially at appearance of night attacks of a dyspnea. In some cases including in the scheme of treatment of inhalation cholinolytics is expedient. Treatment of a bronchial asthma of serious flow includes daily reception Inhaled glucocorticoids to a dose over 800 mkg a day under the control of the doctor, probably system application glucocorticoids, use prolonged bronchial spasmolytic in a combination to planned reception inhalation 2-agonists of short action in the morning and on requirement within days, but no more than 3-4 times a day is shown. The specific immunotherapy in treatment of an atonic bronchial asthma is applied only at easy flow of disease, and indications and a scheme choice should be carried out by the allergist-immunologist. Complex therapy of a bronchial asthma does not exclude application not the medicamental methods of treatment rendering in basic symptomatic and is rarer pathogenetic influence, however expediency of their appointment should be compounded with the attending physician. Preventive maintenance of exacerbations of a bronchial asthma includes high-grade formation of the patient, elimination or the control of causative factors, following to recommended schemes of medicamental therapy, dynamic observation over the patient. However set of the specified actions does not exclude offensive of an exacerbation of disease (a respiratory infection contamination, an excessive physical and emotional load, contact by high concentration of allergen etc.) Educational program provides training of the patient to the actions referred on change of basic therapy in case of an exacerbation of disease. At the same time it is necessary to stipulate conditions of the reference of the patient behind the qualified medical aid. The plan of action is established for each patient taking into account its specific features. Treatment of the patient with an exacerbation of a bronchial asthma in the conditions of a hospital is defined proceeding from gravity of a condition at entering and is based on the basic antiasthmatic preparations in a combination to the actions referred on struggle against complications of disease. The important condition of success of conducting the patient of a bronchial asthma and continuity maintenance at various stages of treatment is the establishment of dynamic observation over the patient in which course the control over change of gravity of a condition of the patient and in this connection

therapy correction is carried out.

Knowledge storage, Brochial Asthma, 2009, Available at : http://knowledge-storage.com/medicine/37-medicine/107-bronchialasthma [citied on October 3rd 2009]