Classification of bronchial asthma

Currently in the classification of bronchial asthma, the main are two approaches: on the one hand, bronchial asthma is classified by etiology; on the other hand - by the severity of the disease.

[1], [2], [3], [4],

Degrees of severity of bronchial asthma

[5], [6], [7], [8],

Light episodic course (intermittent asthma)

• short-term symptoms less than 1 time per week;
• short exacerbations of the disease (from several hours to several days);
• nighttime symptoms 2 times a month or less;
• absence of symptoms and normal function of external respiration between exacerbations;
• PSV or FEV1
  • > 80% of the norm;
  • daily fluctuations <20%

Light persistent asthma

• symptoms 1 time per week or more often, but not every day;
• exacerbations of the disease can disrupt physical activity and sleep;
• night symptoms of asthma occur more often 2 times a month
• PSV or FEV1
  • > 80% of the norm;
  • daily fluctuations of 20-30%

Moderately severe persistent asthma

• daily symptoms;
• exacerbations of the disease disrupt physical activity and sleep;
• nighttime symptoms of asthma occur more often 1 time per week;
• PSV or FEV1
  • from 60 to 80% of the norm;
  • daily fluctuations> 30%

Severe persistent asthma

• persistent symptoms;
• frequent exacerbations;
• physical activity is limited by manifestations of bronchial asthma;
• PSV or FEV1
  • <60% of the norm;
  • daily fluctuations> 30%

Notes:

1. The term "symptoms" here is identical to an attack of suffocation.
2. The degree of severity should be judged only on the basis of the entire complex of the listed characteristics and the PSV and FEV indicators.
3. The presence of even one characteristic related to a more severe variant of the course of the disease makes it possible to evaluate the course of bronchial asthma as more severe.
4. PSV - peak expiratory flow. FEV1 is the volume of forced expiration in the first second.
5. Patients with any degree of severity can develop severe exacerbations even with a threat to life.

Similarly, the severity of bronchial asthma is assessed in the National Agreement of the Republic of Belarus on diagnosis, prevention and treatment of bronchial asthma (1998). The difference is only in the frequency of asthma attacks with a mild episodic course of bronchial asthma (not more often 1-2 times a week) and with light persistent flow (more often 2 times a week, but not daily).

Of great practical interest is the classification of Professor G.B. Fedoseev (1982), which has become widespread. The advantage of classification is the identification of the stages of development of bronchial asthma and clinico-pathogenetic variants, which creates opportunities for individual diagnosis, therapy and prevention.

Classification of bronchial asthma according to ICD-10

Class X. Diseases of the respiratory system

J45	Asthma
J45.0	Mostly allergic asthma
	Allergic bronchitis
	Allergic rhinitis with asthma
	Atopic asthma
	Exogenous allergic asthma
	Hay fever with asthma
J45.1	Non-allergic asthma
	Idiosyncratic asthma
	Endogenous non-allergic asthma
J45.8	Mixed asthma
J45.9	Unspecified asthma
	Asthmatic bronchitis
	Late emergence of asthma
J46	Asthmatic status
	Acute severe asthma

The predominantly etiological principle of the classification of bronchial asthma was reflected in ICD-10 (International Classification of Diseases - X Revision), prepared by WHO in 1992.

As can be seen from the table, depending on the etiology, allergic, non-allergic, mixed and unspecified asthma are distinguished.

The main pathophysiological sign of bronchial asthma is the presence of hyperreactivity of the bronchi, which develops as a result of the inflammatory process in the bronchial wall. Hyperreactivity is the increased sensitivity of the airways to stimuli indifferent to healthy individuals. The degree of hyperreactivity of the bronchi closely correlates with the severity and prevalence of the inflammatory process and, accordingly, with the severity of bronchial asthma.

The hyperreactivity of the bronchi can be specific (develops in response to the action of certain allergens) and non-specific (develops under the influence of various stimuli of non-allergenic nature). Consequently, allergic bronchial asthma is a bronchial asthma that develops under the influence of certain allergens and is characterized by a specific hyperreactivity of the bronchi; Non-allergic bronchial asthma is bronchial asthma, which develops under the influence of non-allergic etiological factors (for example, aerosols, production hazards, neuropsychiatric, endocrine disorders, physical activity, drugs, infection) and characterized by nonspecific hyperreactivity of the bronchi.

Mixed bronchial asthma is caused by the combined effect of allergic and non-allergic factors and is accordingly characterized by specific and nonspecific hyperreactivity of the bronchi.

[9], [10], [11],

Classification of bronchial asthma GB Fedoseev (1982)

1. Stages of development of bronchial asthma
   1. Biological defects in practically healthy people.
   2. The state of betrayal.
   3. Clinically pronounced bronchial asthma.
2. Clinical and pathogenetic variants of bronchial asthma
   1. Atopic.
   2. Infectious-dependent.
   3. Autoimmune.
   4. Glucocorticoid.
   5. Diszovarial.
   6. Severe adrenergic imbalance.
   7. Cholinergic.
   8. Neuropsychic.
   9. Aspirin.
   10. Primarily altered bronchial reactivity.
3. Severity of the course of bronchial asthma
   1. Easy flow.
   2. The course of medium gravity.
   3. Heavy current.
4. The phases of the course of bronchial asthma
   1. Exacerbation.
   2. Unstable remission.
   3. Remission.
   4. Persistent remission (more than 2 years).
5. Complications
   1. Pulmonary: emphysema, atelectasis, pneumothorax, pulmonary insufficiency, etc.
   2. Extrapulmonary: pulmonary heart, heart failure, etc.

[12], [13]