Bronchial asthma: symptoms and treatment
Bronchial asthma does not currently have any generally accepted definition, but despite this, there are certain criteria underlying this disease, on the basis of which it, in fact, is isolated. Bronchial asthma, the symptoms of which distinguish it as a chronic relapsing disease, is accompanied by a primary lesion of the respiratory tract with a concomitant change in bronchial reactivity against the background of the influence of the immunological and / or immunological mechanism.
This definition of the disease, which we will consider today, is, of course, highly generalized, and it is to clarify the general provisions on it that we, in fact, invite you to familiarize yourself with the content of this article.
So, first of all, we note that bronchial asthma is characterized by certain clinical manifestations, such as an attack of suffocation, as well as an actual asthmatic status. And if by the fact that an attack of suffocation is, the reader can make up a «sketch» a certain idea, then the asthmatic status in the allocation of signs accompanying bronchial asthma requires appropriate explanations.
So, asthmatic status is such a serious complication of the disease in question, which determines for the patient a serious threat to life. The asthmatic status develops, as a rule, against the background of a prolonged uncorrectable (unremovable) attack of bronchial asthma, accompanied by edema of bronchioles and concomitant accumulation of thick sputum in them, due to which, in turn, there is an increase in asthma in combination with hypoxia. Hypoxia is a condition accompanied by a decrease in the body’s oxygen content or a decrease in it in separately considered tissues / organs. Against the background of the accompanying processes, vital organs undergo a number of irreversible changes, the liver, heart, central nervous system, and kidneys are most sensitive to this lack of oxygen. The asthmatic status, which initially interests us, requires immediate implementation of intensive care measures, it is important to take into account that this condition accounts for 5% mortality.
As for the prevalence of bronchial asthma, it is largely conditioned by the natural and climatic conditions that are relevant for the patient’s place of residence. What is noteworthy, in the conditions of developed countries, the incidence is significantly higher than the number of cases compared with those obtained for underdeveloped countries. According to various data, the prevalence of the disease within the framework of adult population is around 6%. A significant cause for concern is the fact that there are many different unidentified forms of the disease we are considering. Basically, it includes forms of the lung, masked under such diagnoses as «chronic (obstructive) bronchitis.» For children, the incidence is even higher, exceeding 20% for some regions. Similarly, for children there is also an unidentified form of the disease, respectively, the rates for such morbidity are even higher. In addition, we can add that in recent years there has been an increase in the incidence rate, which is relevant both for our country and for countries abroad.
Bronchial asthma: causes
The basis of development of bronchial asthma is such a pathogenetic mechanism, in which the hypersensitivity of the immediate type of manifestation develops, this mechanism most often works at the basis of allergic diseases. It is characterized by the fact that from the moment when the allergen has arrived, until the moment when the symptoms corresponding to the disease begin to develop, there is a minimum of time — this is almost a matter of minutes. This option, meanwhile, is relevant only for those patients who have appropriate sensitization with respect to a particular substance (that is, an allergic predisposition to it). Thus, a patient with bronchial asthma with the actual allergy to cat hair, having found himself in the apartment in which the cat lives, begins to experience the corresponding manifestations of the disease, which consist in the occurrence of an attack of suffocation.
Bronchial asthma can develop due to the urgency of a number of the following factors predisposing to it:
- Heredity. Heredity as a predisposing factor is prominent in many diseases, and bronchial asthma is not an exception. Previously conducted studies in the results obtained from them determined, for example, cases of concordance. Under such cases, the presence of a background of heredity of bronchial asthma is implied in both identical twins. It was also revealed that in a mother with this disease, children are similarly affected by the development of bronchial asthma. If we focus on precisely such a factor as heredity, then basically we are talking about a form of the disease, like atopic bronzial asthma. In this case, the presence of asthma in one of the parents determines for their child a 20-30% probability of its development, while if this disease is present in both parents, then this probability reaches 75%. However, on the basis of another study that monitored the process of formation of newborn atopy, as well as observation of this process in identical twins, it was determined that, despite the urgency of the genetic predisposition factor, it is possible to exclude the development of bronchial asthma . This is achieved through the exclusion of allergens provoking it, as well as through the implementation of measures aimed at correcting the immune response, in particular, effectiveness is achieved through exposure during the entire period of pregnancy. In addition, it can be noted that among the studies on the study of bronchial asthma, it was found that the time of birth, as well as the birthplace of the child — all this should not be considered as predisposing factors to the development of allergic reactions, as well as bronchial asthma.
- Features of professional activities. Mineral, cotton, flour, wood, biological and other types of dust, as well as various vapors and harmful gases as a generalized factor provoking the development of respiratory pathologies, were taken into account for some time in the study of the order of more than 9 thousands of people. It was found that most women are mostly exposed to biological dust, and men, in turn, are several times more likely to encounter mineral dust, as well as evaporation and harmful gases. In addition, it was also revealed that the occurrence of chronic cough with accompanying sputum discharge is mainly relevant for persons who come into contact with this type of harmful factors, it was precisely for this group of patients that cases of bronchial asthma that first arose were detected. At the same time, it was revealed that even with the reduction of the subsequent exposure to harmful factors that triggered bronchial asthma, the nonspecific form of bronchial hyperreactivity in so-called «occupational asthma» is not subject to extinction over time. With regard to the severity of the course of the disease caused by the factor in question, it is determined on the basis of the duration of its course, and also on the basis of the general manifestation of symptoms.
- Environmental factors. Based on one of the studies conducted over 9 years and involving the observation of several more than 6,500 healthy patients exposed during this time to the effects of certain factors, it was found that about 3% of them after the completion of this study subsequently appeared complaints that indicate the actual damage to the respiratory system. Among such factors, as the reader may assume, smoke, harmful fumes, exhaust fumes, increased humidity, etc. are noted. Based on further statistical analysis of clinical, epidemiological and demographic data, it was also found that, on average, in 3-6% of cases of the disease, the effect of pollutants (pollutants in natural environments consisting of a chemical Connection or component.)
- Power Features. Based on the studies conducted in various countries, focused on the study of the relationship between the characteristics of the diet and the course of the disease, it was found that those whose diet consists predominantly of products of vegetable origin and juices saturated with vitamins, fiber And antioxidants, are more likely to manifest bronchial asthma. Similarly, we can draw the opposite conclusion to this picture of the diet, that is, based on the fact that foods saturated with fats, products of animal origin, as well as foods saturated with easily assimilated refined carbohydrates and proteins act as factors that provoke a severe course of the disease, Frequent exacerbations.
- Alcohol. Alcohol has some interesting results obtained within the framework of research conducted on its account. In particular, they are based on the assertion that the moderate consumption of alcohol can reduce the risk of developing asthma. So, with alcohol consumption in the amount of 10-60 ml, the chances of developing asthma are leveled against animal protein substances, inhalation of house dust, plant pollen and cockroaches. The standard of the foreign «drink» is 10 «cubes» of alcohol, which, in turn, corresponds to the volume of an incomplete glass of wine or a bottle of ordinary light beer. At the same time, alcohol abuse or its complete exclusion — all this is considered only as factors that increase the risk of «acquiring» bronchial asthma.
- Impact of detergents. Again, based on studies conducted across 10 EU countries, it is clear that various types of detergents contain in their own ingredients such components that contribute to The development of asthma in adults, this factor accounts for about 18% of cases.
- Stress (acute, chronic form).
Considering these factors in a slightly more abbreviated form, you can define for them a classification in accordance with the principles of impact. So, if the attacks occur against the background of the allergen that enters the respiratory tract through the external environment (mold fungi, animal hair, dust mites, pollen of plants, etc.), this, in turn, determines
Bronchial asthma: stages of development, manifestation forms
Bronchial asthma can develop in two main variants of manifestation, which distinguishes two corresponding states for it, the state of predation and the clinically established state of bronchial asthma. The condition of the pre-asthma (we’ll discuss it in more detail below) is a condition in which there is a threat of developing asthma, which is important for acute or chronic bronchitis, for pneumonia (acute or chronic), for vasomotor edema, urticaria, vasomotor Rhinitis, neurodermatitis, migraine and some combinations of these conditions. As for the indicated clinically established condition, actually bronchial asthma, here we are talking about the very asthma, indicated by the appearance of the patient’s first attack or by the allocation of an appropriate status for this disease.
Depending on the actual pathogenetic features that triggered bronchial asthma, the following variants of the mechanisms of development of this disease are distinguished. In particular, this is the atopic mechanism , which specifies the specific allergen / allergens, the mechanism is infectious-dependent , which specifies the specific infectious agents, as well as the characteristics of the nature of the infection, Autoimmune mechanism, mechanism dyshormonal (in this case, a specific endocrine organ that has undergone changes in its functions is indicated). In addition, it is an neuro-psychic mechanism, identifying the characteristics of which is accompanied by the definition of a specific type of neuropsychic disorders. Other mechanisms are also allowed, including their combinations.
Depending on the degree of manifestation of symptoms, bronchial asthma can manifest itself in the following variants:
- Intermittent light form of bronchial asthma. Manifestations of the disease are observed less than once a week, night attacks can occur at most twice a month and even less. Exacerbations in manifestations are of a short-term nature. The parameters for PSV (peak expiratory flow) exceed 80% in the age-related norm, fluctuations of this criterion per day are less than 20%.
- Persistent lung form of bronchial asthma. Symptomatic of the disease manifests itself from once a week or more, but at the same time, less often than once a day (when considering, again, weekly indicators of manifestations). Against the background of frequent exacerbations, daily life of patients is subject to disruption, which is reflected in particular on their daily activity and on night rest. In addition, the disease is accompanied by night attacks, and in this form they manifest more often than twice a month. PSV indicators exceed 80%, the level of daily fluctuations averages 20-30%.
- Bronchial asthma in moderate severity of manifestation. Symptomatic of the disease becomes daily in its own manifestation, against the background of accompanying exacerbations, the daily («daytime») life and night sleep are subject to deterioration. Manifestations of nocturnal symptoms are noted more often than once a week. This period of the development of the disease requires the daily intake of appropriate drugs (beta-agonists) for a short-term period of action. PSV indicators correspond to the age-appropriate level within the limits of 60-80%, the daily fluctuations of PSV exceed 30%.
- Bronchial asthma in severe severity of manifestation. Symptomatic becomes constant, the onset of asthma attacks is observed on average 3-4 times a day, the exacerbations of the disease also increase. Nighttime symptoms manifest themselves more often (from once every two days, maybe more). Tangible difficulties also accompany the daily physical activity of patients.
There are separate phases during the course of the disease, this is the aggravation phase, the phase of the calming exacerbation, and the remission phase.
Bronchial asthma can, like other diseases, provoke certain complications. Thus, the complications of bronchial asthma are divided into two main groups, these are pulmonary complications (pulmonary insufficiency, pulmonary emphysema, pneumothorax, etc.), extrapulmonary complications (heart failure, pulmonary heart disease, myocardial dystrophy etc.).
Predastema: Symptoms, Main Features
Symptoms of bronchial asthma will be considered below, as the other part of this disease, which has not yet been considered, we have a state of predation, so we will single out the main features that characterize it. First of all, we note that trauma is characterized by the presence of several main groups of symptoms, there are only four of them: clinical symptoms, laboratory symptoms, functional symptoms and anamnestic symptoms.
Clinical symptoms imply the appearance in patients of symptoms associated with bronchitis, as well as the appearance of allergic-type syndromes. In the overwhelming majority of cases, patients who are in a state of predation are already having a chronic form of obstructive bronchitis, they are less likely to have asthmatic chronic bronchitis, and bronchitis is recurrent.
Patients with obstructive chronic bronchitis in a state of pre-asthma differ from those patients who also develop this condition, but with asthmatic or recurrent bronchitis, the differences are in particular in the sex and age characteristics, and also in the nature of the course of their disease. Basically, these are men belonging to the older age group, that is, their age varies within 47 years. For the most part, this group of patients has been for a long time in terms of the characteristics of professional activity in unfavorable conditions, or they have a long «experience» in terms of the impact of a somewhat different factor, as such, in this case, smoking is considered. Basically, in the study of such patients it was determined that coughing preceded the development of the state of predation, often a medical form of allergy was diagnosed, and there was sometimes a hereditary predisposition for allergic diseases.
As for patients in the state of pre-asthma with actual asthmatic or recurrent bronchitis, mainly in such a group of patients are women of the young age group (32-35 years), without the influence of factors in the form of harmful production or smoking. In this case, according to the results of the study of patients, a significant role is played by the heredity factor with respect to allergic diseases, in particular, this factor is relevant for asthmatic bronchitis. These patients basically had this or that form of allergy. Thus, for order of more than half of them, food allergy was relevant, one-third of patients had polyalgia, in a few more rare cases, a medical allergy was diagnosed.
Allergic syndromes diagnosed in patients within the pre-asthma range are mainly related to the occurrence of vasomotor rhinitis (for approximately 65% of patients), as well as to urticaria (an average of 56%). Quincke edema (about 9%) is much less frequent, as well as migraine (on average, 3% of patients).
On the whole, the state of predation is based, on the basis of some available data, on average for the adult population within a population of 5 to 10%. Based on data from the 15-year follow-up period, it was found that approximately 18% of patients with pre-asthma subsequently acquired bronchial asthma. This, in turn, allows us to assert that the risk of such a transformation is quite real for the general group of patients with a trauma. Remarkably, for the indicated number of patients in whom such a transformation took place, appropriate treatment measures were implemented, which, apparently, was not effective for the subsequent development of the disease. The risk of a transition from pre-asthma to bronchial asthma also increases with the reinforcement of this condition by its aggravating factors (previously considered causes that provoke the disease).
Bronchial asthma: symptoms
The main symptoms of the disease are the following manifestations: shortness of breath, a choking attack, the appearance of whistles or wheezing in the chest. Strengthening of whistles can be observed during deep breathing. As a rather frequent sign of bronchial asthma, there is also a paroxysmal cough, mainly due to the nature of the manifestation, such a cough is dry, but it is also possible for a certain amount of sputum to disappear, which in particular occurs at the end of the attack. In addition, we note that it is dry paroxysmal cough that can be the only sign on the basis of which you can suspect bronchial asthma in the patient. If the disease manifests itself in this way, then bronchial asthma is secreted into a separate, cough form.
The average severity of bronchial asthma, as well as severe severity, can determine such an additional symptom of the disease as dyspnea. It occurs during physical activity, its intensification is noted in the period of exacerbation of asthma.
What is noteworthy, often enough, and so that the symptomatology of the disease manifests itself only during periods of its exacerbation, thus, absent the rest of the time. Actually, exacerbations can develop at any time of the day, but almost «classic» is the manifestation of exacerbations at night. This is accompanied by the allocation by the patient himself of the factors, the aggravation of the provoking, which, for example, can be a stay at a particular moment in the room in which the animals are in a dusty room, as well as in the room in which cleaning is carried out,
Part of the patients (especially this moment is specific for patients of the childhood age group) face seizures after suffering significant physical exertion. This variant of the manifestation of asthma allocates it to the appropriate form — it is an asthma of physical stress. Meanwhile, the specified definition is somewhat outdated, so also attacks directly related to physical activity, and, accordingly, asthma, it is customary to define as a bronchoconstriction.
The periods of exacerbation in patients are combined with a more intense reaction to nonspecific types of stimuli, such as smell of smoke, temperature changes, pungent odors, etc. This feature indicates activity in the bronchi of the inflammatory process, which, in turn , Determines the need to implement appropriate measures of drug therapy.
As for the frequency of exacerbations, it is based on a specific type of allergen that provokes the reaction, as well as on how frequent the patient’s contact with such an allergen is. For example, an allergy to plant pollen determines for patients clearly traceable seasonality of exacerbations for the respective periods (spring / summer).
While listening to the patient, his weakened vesicular breathing is revealed, as well as the wheezing type of wheezing. In periods not related to exacerbation of the disease, such listening may not have any specific characteristics. As a characteristic symptom associated with manifestations of bronchial asthma, the apparent efficacy achieved through the use of antihistamines, and in particular with inhalation using drugs that promote bronchial dilatation, is considered.
Let us dwell in more detail on the attack of asthma, more precisely — on what it is and how it actually manifests itself. During an attack of asthma in bronchial asthma, the patient takes a forced position, bending forward slightly and holding his hands to the table or nearby objects, the upper shoulder girdle is in a raised position. The chest also changes; in shape, it becomes cylindrical. Short inhalations of the patient are accompanied by not bringing relief the excruciating exhalations, combined with rales. For breathing in general, the involvement of the auxiliary musculature from the chest, abdominal and shoulder girdles is required. There is an expansion of intercostal spaces, their elongation and horizontal orientation.
Preceding the attack of suffocation can also be the so-called aura of attack. By the aura as a whole is meant the appearance of any experiences or sensations that regularly appear before the attacks (epilepsy, asthma, etc.), actually the aura itself can also act as an attack in certain cases. Returning to the aura that accompanies the attack of bronchial asthma, we note that it can manifest itself in the form of coughing, sneezing, runny nose, urticaria.
The actual attack, as already noted, can be accompanied by a cough with a certain amount of sputum, it can also separate and end the attack. Gradually, as the patient leaves the sputum during an attack, wheezing appears less often, and breathing becomes tougher. It should also be noted that wheezing may not appear at all, which is important for patients with severe exacerbations against a background of severe restriction of ventilation and airflow. Periods of exacerbation may be accompanied by cyanosis (cyanosis of the skin and mucous membranes), tachycardia (rapid heartbeat), drowsiness and difficulty speaking. Already noted swelling of the chest occurs due to the increase in pulmonary volume, that is, because of the need to provide for the airway spreading while simultaneously opening the bronchus small size.
Also, the already considered variant of cough bronchial asthma is most relevant for children, more often it is manifested at night with no manifestations in the daytime. Bronchial asthma, whose seizures occur as a result of physical stress, is characterized by some additional features. Attacks mostly occur after 5-10 minutes from the moment of completion of physical stress under load, but in rare cases the attack occurs directly during it. In some cases, patients suffer from a prolonged attack of cough that ends on their own within the next 30 to 45 minutes. Primarily, there are seizures when running, a separate role in this case is given to the inhalation of cold dry air. The diagnosis of «bronchial asthma» indicates, again, the effect of specific drugs used in attacks, in particular (inhalation), as the main diagnostic method for identifying this type of bronchial asthma, is the test with an 8-minute run.
Bronchial asthma in children
To develop in children this disease can regardless of belonging to a particular age group, but more often the manifestation of the disease falls on the period after 1 year. In particular, the risk of developing bronchial asthma in children with heredity, in which there are allergic diseases, as well as those in children who have already had allergic diseases in the past, is great. Often, bronchial asthma is masked in children under obstructive bronchitis, and therefore if there are four episodes of obstructive bronchitis within the period of one year, then this situation can be considered as a signal for the subsequent immediate visit to the allergist.
Allergic bronchial asthma: pregnancy and its features
With the existing disease, the main measures of exposure are reduced to eliminating or minimizing the effects of allergens, while creating a hypoallergenic environment for the period of pregnancy. On a mandatory basis, smoking should be eliminated, both in its active form and passive. Treatment measures are determined based on the severity of the disease.
So, for example, with a light and episodic course prescribe drugs that promote the expansion of the bronchi, their application is based on individual needs. Preferred in this version is Atrovent.
The next variant of the course of bronchial asthma is a persistent mild form of bronchial asthma. In this case, it is prescribed cromoglycate sodium (inhalation form) — Tileed, Intal. The lack of effectiveness in the use of drugs of this type requires replacement, which reduces to the use of inhaled glucocorticosteroids in small dosages. Patients in pregnancy most preferred options for use are considered derivatives of budesonide and beclomethasone. In addition, it is possible to consider the option of taking another type of corticosteroids by those patients who achieved successful control of the disease with their help before they had a pregnancy.
In case of moderate disease, averaged doses of inhaled corticosteroids are prescribed.
A separate place is occupied by a severe form of asthma. In this case, high doses of corticosteroids in the inhalation form are prescribed. If necessary, in the use of significant doses of inhaled corticosteroids during pregnancy, budesonide and its derivatives are the most preferable option. Also, tableted corticosteroids (in particular prednisolone) are allowed in accordance with the observance of a discontinuous scheme for its consumption.
Childbirth should only take place in a hospital. Immediately upon admission of the mother in the maternity ward, electronic monitoring of the fetus is provided, but this condition can be excluded as mandatory if it is possible to achieve a sufficiently effective degree of control of bronchial asthma. Assessment of the function of breathing is carried out from the very beginning in the parturient of labor, then every 12 hours from the moment of delivery. With sufficient anesthesia, the risk of possible development of paroxysmal suffocation during labor is reduced directly during labor activity. If there is a need for a cesarean section, then the most preferred option is considered peridural anesthesia, an analgesic, for this used — fentanyl. It is better, if the delivery will take place in a natural way — the caesarean section determines rather high risks for a possible exacerbation of bronchial asthma.
With regard to the period of breastfeeding, it consists in the realization during the pregnancy of antiasthmatic measures of therapy. The undesirable option is Teofilin, as well as its derivatives, which is caused by direct toxic effects on the fetus.
Diagnosis of bronchial asthma when a primary attack occurs requires the delivery of a standard type of assays, and this is a blood test (for sugar, biochemical and general analysis), urinalysis. To detect or exclude concomitant cardiac abnormalities, an ECG is performed. Fluorography is also considered as a mandatory further measure of general diagnosis. With productive cough (that is, with such a cough, which is accompanied by the discharge of a patient’s sputum), a general sputum analysis is given. If there is a predisposition to frequent occurrence of infectious diseases in the respiratory tract, it is also necessary to pass a sputum analysis — this time to study its microflora with the concomitant detection of the degree of sensitivity with respect to antibiotics. A dry paroxysmal cough requires taking a smear from a sick person for the presence of a fungus.
As a mandatory method of research, a method is considered in which the function of external respiration is studied, it is called spirography. In the course of carrying out this method of diagnosis, the patient must breathe in the tube attached to the special equipment. There are some recommendations on this procedure, in particular, they consist in the previous exclusion of inhalers (berotek, salbutamol, etc.), bronchodilators (euphilin, etc.). In addition, you should also exclude smoking before this procedure (here, of course, you can make and some supplement: smoking is not recommended in principle for those patients who have certain bronchio-pulmonary diseases). Spirography is indicated for patients aged 5 years.
In case of suspicion of the presence of bronchial asthma, the patient undergoes a special test using bronchodilators. It consists in carrying out spirography, then — several inhalations (salbutamol or analog), then — repeated spirography. As the main goal in this scheme is considered the determination of the degree of patency of the bronchi caused by the influence of this group of drugs.
A method of peakflowmetry using a device that determines the maximum rate of a patient’s exhalation is somewhat simpler, and also much more accessible. This device is purchased for independent daily monitoring, it does not require additional consumables, its cost is quite affordable. The indicators obtained by using it are compared with the table of reference values. As the main advantage when using this device, it can be indicated that with it it is possible to determine in advance when the exacerbation of the disease begins — the peak expiratory flow rate decreases in the period a few days before when it actually begins to manifest itself. In addition, this method allows not only to diagnose the future exacerbation, but also provides an opportunity to control the course of bronchial asthma objectively.
Based on the significant prevalence of diseases accompanying bronchial asthma with lesion of the nasopharynx, it is additionally recommended to visit the otolaryngologist, as well as to monitor the condition of the paranasal sinuses (x-rays).
As an extremely important direction in the examination of patients for bronchial asthma, a study aimed at the isolation of specific allergens that provoke allergic inflammation due to contact with them is a study. A test is performed to determine the sensitivity of the main groups of allergens (fungal, domestic, etc.). For this, a method of setting skin tests or a blood test for the presence of a specific type of immunoglobulin can be used.
Treatment of bronchial asthma can be based on the application of several major groups of medications, we will discuss them below. Dosing, duration of use and the possibility of combining — all these moments are determined in each case by the attending physician, based on the severity of the disease and other factors accompanying its course. Separately note that for today the most dominant principle of treatment is a principle in which the methods of treatment of bronchial asthma and, in fact, measures implemented for this disease, are subject to revision every three months and, if necessary, adjustments. With regard to specific drugs used in the treatment of bronchial asthma, they include the following:
- beta agonists (or inhaled bronchodilators with a short exposure period) — are used as medications that make it possible to relieve the symptoms of suffocation; The therapeutic effect, as such, no, but the symptoms, as indicated, are eliminated;
- preparations based on cromoglic acid — such preparations can be used in the form of powders, solutions or aerosols for inhalation; Have an anti-inflammatory therapeutic effect with concomitant stabilization of the disease itself, but without affecting the actual symptomatology at the moment;
- inhaled glucocorticosteroids — of this type of drugs are used most often, with their help a pronounced anti-inflammatory, therapeutic effect is achieved; The basic form of release — the metered aerosols for inhalations, solutions for inhalations
- beta-agonists (inhaled bronchodilators) — long-acting drugs, used as one of the components in the treatment of moderate to severe disease
- corticosteroids — oral medications are useful in treating extremely severe forms of the disease, with inadequate efficacy from inhalation therapy
As one of the most important areas in the treatment of the disease under consideration is the implementation of allergen-specific immunotherapy, aimed at achieving immunity to the effects of allergens that provoke the development of a patient’s inflammation and allergic reaction. Such therapy is carried out exclusively by a specialist, within the period without exacerbation (mainly in autumn / winter). Such therapy consists in introducing allergens solutions to patients with a gradual increase in their dosages, which, in turn, leads to a gradual development of tolerance to them. The earlier this therapy is started, the more effective the results are.
If symptoms appear that indicate bronchial asthma, you should contact an allergist-immunologist, pulmonologist or a pediatrician / therapist.