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Cough with asthma
Last reviewed: 19.11.2021
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Cough with asthma is accompanied by attacks of suffocation. However, cough with bronchial asthma can be without choking or with minor episodes of shortness of breath. In such cases, it is more difficult to assume the presence of asthma, but cough remains a characteristic symptom. It is likely to be paroxysmal, more often at night, and with "cough" asthma, it can only be night. Can be accompanied by remote "whistling" or "wheezing."
[What causes cough in asthma?
Provoking factors are revealed. Cough with asthma atopic form is provoked by contact with allergens:
- contact with pets with epidermal allergy:
- apartment cleaning with sensitization to household, epidermal and fungal allergens:
- departure from the city, phytotherapy, the use of certain products for pollen allergies;
- visit a wet, basement room, use of fermentation products for fungal allergies.
Cough provocation can also be pollutants, sharp smells, cold air (or a sharp change in air temperature), loud laughter, forced breathing, physical activity. In such cases, we can talk not about allergies, I and the manifestation of hyperreactivity of the bronchi on nonspecific stimuli.
One of the factors that enhance the reactivity of the bronchi is ARVI. In this case, a prolonged dry cough after ARI may be a manifestation of asthma.
How does a cough develop with asthma?
Cough with asthma can be seasonal, that is, it appears every year in certain months. In the case of pollen allergies, it is usually combined with rhinitis, rhinoconjunctivitis. However, not only with pollen, but also with other forms of asthma, cough often combines with allergic rhinitis.
Cough with asthma, and at the end of an attack there may be a small amount of thick, viscous, "vitreous" sputum. At the same time, with non-atopic asthma or when joining a respiratory infection, sputum may have other characteristics and be released in larger quantities. With a cholinergic variant of asthma, a significant amount of light mucous sputum can be cough. In some of these patients, the clinical manifestations of bronchial obstruction are minimal, and the patient accentuates his attention (and the attention of the doctor) on a damp cough.
It should be borne in mind that there is a high probability of having asthma in blood relatives.
How to recognize a cough with asthma?
For bronchial asthma, especially during an exacerbation, eosinophilic leukocytosis is characteristic. With "cough" asthma, the number of eosinophils of peripheral blood is usually in the range of 5-10%. In some forms of asthma (fungal sensitization, asthmatic triad, combination with parasitic infestation), the number of eosinophils can reach 15% or more.
Eosinophilia of sputum and bronchoalveolar lavage is also considered a characteristic sign of bronchial asthma. It should be borne in mind that inhaled glucocorticoids can eliminate sputum eosinophilia, and the use of systemic hormones reduces the amount of eosinophils in the peripheral blood to 0% (thus we can get "steroid leukocytosis" - 10-11x10 9 / l).
In addition, in the sputum of patients, Kurshman spirals are sometimes defined (they are less common with obstructive bronchitis, pneumonia, lung cancer). Kuršmana spirals are mucus bands, consisting of a central dense axial filament and spiral-wrapped mantle, into which leucocytes (often eosinophilic) and Charcot-Leiden crystals are interspersed (colorless octadrons of different sizes, reminiscent of the compass needle). The Charcot-Leiden crystals consist of a protein released during the decay of eosinophils, and more of them in stale sputum.
Allergic examination reveals allergens that provoke a cough with asthma in this patient. Skin allergic tests are conducted only by an allergist-immunologist. As an additional, provocative inhalation tests with allergens, as well as the determination of the level of the general (usually elevated for atopic asthma) and the presence of allergen-specific IgE in serum can be used.
The FVD test allows to determine the nature of the ventilation disorders that cause coughing with asthma. In many cases, coughing (pharyngitis, tonsillitis, postnasal edema syndrome, acute respiratory viral infection, psychogenic, reflex cough) spirogram will be normal. If pulmonary tissue is damaged (pneumonia, bronchiectasis, interstitial lung diseases, left ventricular failure), primarily restrictive ventilation disorders (decrease of the ZHEL) will be revealed. Days of development of bronchial obstruction (BA, obstructive bronchitis) are characterized by impaired pulmonary ventilation according to the obstructive type (reduction of FEV1, FVC, Tiffno index, PSV). The main difference between obstructive bronchitis and asthma is the reversibility of bronchial obstruction - with AD it is reversible.
On the roentgenogram of the chest with "cough" asthma, changes are usually not observed. If the cause of the cough are other conditions, then the changes will correspond to the underlying disease. With the nose and paranasal sinuses on the radiograph, the corresponding changes will be detected in the paranasal sinuses.