Stages of development of bronchial asthma

Biological defects in practically healthy people

This stage is characterized by the fact that still practically healthy people do not have any clinical signs of bronchial asthma, but there are certain biological defects that predispose to development of bronchial asthma in the future.

According to G. G. Fedoseyev (1996), biological defects are to be understood as "not manifested clinically in violation of the functioning of various organs and systems at the subcellular, cellular, organ and organism levels that are detected in practically healthy people when using various stress tests, but on the cellular and subcellular levels - through special laboratory studies. " As a rule, we are talking about the increased sensitivity and reactivity of the bronchi in relation to various bronchospastic substances, physical activity, cold air. These changes can be combined with violations of the functional state of the endocrine, immune and nervous systems that do not manifest clinically, but are detected using special techniques. In a number of cases, biological defects and disorders in the system of general and local immunity are found; in the "rapid response" system (mast cells, macrophages, eosinophils, platelets); mucociliary clearance; metabolism of arachidonic acid. In particular, it has been established that a large number of eosinophils are determined in practically healthy people with bronchial hyperreactivity in bronchoalveolar lavage.

The state of betrayal

Predastma is not an independent nosological form, but a complex of signs that indicate a real threat of development of clinically pronounced bronchial asthma. Preadastoma precedes the onset of bronchial asthma in 20-40% of patients.

The condition of the pre-asthma is characterized by the presence of acute, recurrent or chronic nonspecific diseases of the bronchi and lungs with reversible bronchial obstruction in combination with one or two of the following symptoms:

• hereditary predisposition to allergic diseases and bronchial asthma; (in 38% of persons with a predawn, blood relatives suffer from allergic diseases);
• presence of extrapulmonary manifestations of allergy (vasomotor rhinitis, urticaria, neurodermatitis, Quincke vasomotor edema, migraine);
• eosinophilia of the blood and / or a large number of eosinophils in sputum.

Clinically pronounced bronchial asthma

This stage of bronchial asthma occurs with typical attacks of suffocation or without them, in the form of peculiar equivalents of attacks (paroxysmal cough, especially at night, respiratory discomfort); it is especially important if they are combined with extrapulmonary symptoms of allergy.

Clinico-pathogenetic variants of bronchial asthma

Clinic and diagnosis of clinical and pathogenetic variants of bronchial asthma are described below. Allocation of these variants is very expedient, since it allows to prescribe individual treatment and prevent disease.

Clinico-pathogenetic variants of bronchial asthma in Fedoseev's classification can be divided into rubrics (blocks) of ICD-10. So, atopic asthma can be attributed to the block 45.0 - allergic asthma; all other clinical and pathogenetic variants - to block 45.1 - non-allergic asthma; a combination of clinical and pathogenetic options - to block 45.8 - mixed asthma; if it is not possible to clearly establish the clinical pathogenetic variant, block 45.9, unspecified asthma, is used.

Degrees of severity of bronchial asthma

GB Fedoseev describes the severity of bronchial asthma as follows.

• Mild - exacerbation no more than 2 times a year, relief of symptoms does not require parenteral administration of drugs. In the phase of remission, short-term breathing difficulties are possible not more often than 2 times a week, nocturnal symptoms are no more often than 2 times a month. The maximum achieved PSV, FEV1 is more than 80%, the daily variability is less than 20%.
• Of moderate severity - exacerbation 3-5 times a year, asthmatic conditions are possible, relief of the symptoms of exacerbation requires parenteral administration of drugs, including (sometimes) glucocorticoid drugs. During the remission phase, breathing difficulties can occur more often 2 times a week, nightly symptoms more often 2 times a month. The maximum achievable levels of PSV, FEV1 60-80%, daily variability 20-30%.
• Severe - a continuously recurring course, asthmatic conditions, for the relief of the symptoms of an exacerbation, parenteral administration of drugs is required. Often, a constant glucocorticoid (inhalation or oral) therapy is necessary. The maximum achievable PSV, FEV1 levels are less than 60%, the daily variability is more than 30%.

As can be seen, the severity of bronchial asthma in the presentation of G. B. Fedoseev significantly differ from those proposed in the report "Bronchial asthma. Global Strategy ". It should be noted that a practical doctor should now be used, of course, with modern criteria for the severity level, because they are now recommended to orientate in the treatment of patients with bronchial asthma (a stepwise approach to treatment, ie, the volume of therapy should increase with increasing severity disease).

The phases of the course of bronchial asthma

The phase of exacerbation is characterized by the appearance or increasing frequency of suffocation or other manifestations of respiratory discomfort (with an uncontaminated course of the disease). Seizures occur several times a day, worse stop with the usual means for the patient. If the exacerbation of the disease is severe, asthma status may develop.

The phase of unstable remission is a transition from a phase of exacerbation to a phase of remission. This is a kind of intermediate stage of the disease, when the symptoms of exacerbation have significantly decreased, but did not completely disappear.

The phase of remission - during this phase the symptoms of the disease disappear completely.

The phase of stable remission is characterized by a long (more than 2 years) absence of manifestations of the disease.

Complications of bronchial asthma

All complications of bronchial asthma (pulmonary, extrapulmonary) are listed, which is of great importance for assessing the severity of the disease, choosing a treatment program, assessing the patients' ability to work.

Concluding the discussion of this section, I would like to note that at present there is no unified classification of bronchial asthma that would reflect all the most important aspects (etiology, clinical course, clinical and pathogenetic forms, phases, complications). Thus, ICD-10 reflects only the etiological forms of bronchial asthma, in the report "Bronchial asthma. Global strategy "- the disease is classified only in terms of severity. At the same time there are no sections of the disease phase that are customary for the practical doctor and its complications.

[1], [2], [3], [4], [5], [6], [7]