Stages in the development of bronchial asthma

Biological defects in apparently healthy people

This stage is characterized by the fact that practically healthy people do not have any clinical signs of bronchial asthma, but they have certain biological defects that to a certain extent predispose to the further development of bronchial asthma.

According to G. B. Fedoseyev (1996), biological defects should be understood as "clinically undetectable dysfunctions of various organs and systems at the subcellular, cellular, organ and organism levels, which are detected in practically healthy people using various load tests, and at the cellular and subcellular levels - by means of special laboratory studies." As a rule, we are talking about increased sensitivity and reactivity of the bronchi in relation to various bronchoconstrictors, physical activity, cold air. The specified changes can be combined with disorders of the functional state of the endocrine, immune and nervous systems, which are not clinically manifested, but are detected using special techniques. In some cases, biological defects and disorders are found in the system of general and local immunity; in the "rapid response" system (mast cells, macrophages, eosinophils, platelets); mucociliary clearance; arachidonic acid metabolism. In particular, it was established that in practically healthy people with bronchial hyperreactivity, a large number of eosinophils are detected in the bronchoalveolar lavage.

Pre-asthma condition

Pre-asthma is not an independent nosological form, but a complex of signs indicating a real threat of developing clinically expressed bronchial asthma. Pre-asthma precedes the development of bronchial asthma in 20-40% of patients.

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

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

Clinically manifest 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); especially important if they are combined with extrapulmonary signs of allergy.

Clinical and pathogenetic variants of bronchial asthma

The clinical picture and diagnostics of clinical and pathogenetic variants of bronchial asthma are described below. Identifying these variants is very useful, as it allows for individual treatment and disease prevention.

Clinical and pathogenetic variants of bronchial asthma in the classification of G. B. Fedoseyev can be distributed among the headings (blocks) of ICD-10. Thus, atopic asthma can be assigned to block 45.0 - allergic asthma; all other clinical and pathogenetic variants - to block 45.1 - non-allergic asthma; a combination of clinical and pathogenetic variants - to block 45.8 - mixed asthma; if it is impossible to clearly establish the clinical and pathogenetic variant, block 45.9 - unspecified asthma is used.

Severity of bronchial asthma

G. B. Fedoseev describes the severity of bronchial asthma as follows.

• Mild - exacerbations no more than 2 times a year, symptom relief does not require parenteral administration of drugs. In the remission phase, short-term breathing difficulties are possible no more than 2 times a week, night symptoms no more than 2 times a month. The maximum achieved levels of PSV, FEV1 are more than 80%, daily variability is less than 20%.
• Moderate severity - exacerbation 3-5 times a year, asthmatic conditions are possible, relief of exacerbation symptoms requires parenteral administration of drugs, including (sometimes) glucocorticoid drugs. In the remission phase, breathing difficulties are possible more than 2 times a week, night symptoms more than 2 times a month. Maximum achievable levels of PSV, FEV1 60-80%, daily variability 20-30%.
• Severe - continuously relapsing course, asthmatic conditions, parenteral administration of drugs is required to relieve exacerbation symptoms. Constant glucocorticoid (inhalation or oral) therapy is often necessary. Maximum achievable levels of PEF, FEV1 less than 60%, daily variability more than 30%.

As can be seen, the severity of bronchial asthma as presented by G. B. Fedoseyev differs significantly from those proposed in the report "Bronchial Asthma. Global Strategy". It should be noted that a practicing physician should, of course, use modern criteria for severity at the present time, because they are now recommended as a guideline when treating patients with bronchial asthma (a step-by-step approach to treatment has been adopted, i.e. the volume of therapy should increase with an increase in the severity of the disease).

Phases of the course of bronchial asthma

The exacerbation phase is characterized by the appearance or increase in the frequency of asthma attacks or other manifestations of respiratory discomfort (in the case of an asymptomatic course of the disease). Attacks occur several times a day and are less easily relieved by the patient's usual means. With a pronounced exacerbation of the disease, asthmatic status may develop.

The unstable remission phase is a transitional state from the exacerbation phase to the remission phase. This is a kind of intermediate stage in the course of the disease, when the symptoms of exacerbation have significantly decreased, but have not disappeared completely.

Remission phase - during this phase, the symptoms of the disease disappear completely.

The phase of stable remission is characterized by a long-term (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, and assessing the ability of patients to work.

In conclusion of the discussion of this section, I would like to note that at present there is no single classification of bronchial asthma that would reflect all the most important aspects (etiology, clinical course features, 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 by severity. At the same time, there are no sections of the disease phase and its complications that are familiar to a practicing physician.

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