Synonyms Asthma

 

Bronchial asthma Synonyms Asthma generally refers to bronchial asthma (medical disease) This entry is provided by the "Science China" Science Encyclopedia entry writing and application work project. Bronchial asthma is an abnormality characterized by chronic inflammation of the airway that is characterized by a variety of cells (such as eosinophils, mast cells, T lymphocytes, neutrophils, airway epithelial cells, etc.) and cellular components. Qualitative disease. This chronic inflammation is related to airway hyperresponsiveness. It is usually extensive and variable reversible expiratory airflow limitation, resulting in recurrent wheezing, shortness of breath, chest tightness and/or coughing symptoms, intensity Change with time. It usually occurs at night and (or) early in the morning, and most patients can relieve themselves or after treatment. If bronchial asthma is not diagnosed and treated in time, it can cause irreversible airway narrowing and airway remodelling with the extension of the disease course. English name bronchial asthma Respiratory department Common bronchi Common symptoms of recurrent wheezing, shortness of breath, chest tightness and/or cough Expert interpretation Inhaled hormones for bronchial asthma Regular inhaled hormone therapy is the most commonly used asthma treatment, and it has been used more and more widely. Popular Science China Committed to authoritative science communication This entry certification expert is Xu Wenbing丨Chief physician Peking Union Medical College Hospital Respiratory Medicine Audit He Zhihong丨Chief Physician Department of Respiratory Medicine, Shijiazhuang First Hospital National Health Commission Authoritative medical science popularization network platform Disease Overview Popular Science Articles (9) Popular Science Video table of Contents 1 Cause 2 Clinical manifestations 3 check 4 Diagnosis 5 Differential diagnosis 6 treatment 7 Prognosis 8 Education and management of asthma Basic Information English name bronchial asthma, common disease site, respiratory department, common disease site, common bronchial symptoms, repeated episodes of wheezing, shortness of breath, chest tightness and (or) coughing Cause 1. Genetic factors Individual allergies and the influence of the external environment are risk factors for the disease. Asthma is related to polygenic inheritance. The prevalence of relatives of asthma patients is higher than the group prevalence, and the closer the relationship, the higher the prevalence; the more severe the patient’s condition, the higher the prevalence of their relatives. 2. Allergen (1) Indoor and outdoor allergens Dust mites are the most common and most harmful indoor allergens. They are an important cause of asthma worldwide. Dust mites exist in secretions such as fur, saliva, urine and faeces. The fungus is also one of the allergens in indoor air, especially in dark, humid and poorly ventilated places. Common outdoor allergens: Pollen and grass meal are the most common outdoor allergens that cause asthma attacks, and other specific and non-specific inhalants such as animal dander, sulfur dioxide, and ammonia. (2) The common allergens of occupational allergens are grain powder, flour, wood, feed, tea, coffee beans, silkworm, pigeon, mushrooms, antibiotics (penicillin, cephalosporin), rosin, reactive dyes, persulfuric acid Salt, ethylenediamine, etc. (3) Drugs and food Aspirin, propranolol (Propranolol) and some non-corticosteroid anti-inflammatory drugs are the main allergens of asthma caused by drugs. Also Besides, foods such as fish, shrimp, crab, eggs, and milk can induce asthma. 3. Precipitating factors Common air pollution, smoking, respiratory infections, such as bacterial, viral, protozoan, and parasite infections, pregnancy, strenuous exercise, and climate change; various non-specific stimuli such as inhalation of cold air, distilled water mist, etc. can induce asthma attacks. Also Besides, mental factors can also induce asthma. Clinical manifestations Paroxysmal dyspnea accompanied by wheezing or paroxysmal cough, chest tightness. In severe cases, people are forced to sit or breathe upright, dry cough or cough a lot of white foamy sputum, or even cyanosis. Sometimes a cough is the only symptom (cough variant asthma). Some adolescent patients have chest tightness, coughing and dyspnea during exercise as their only clinical manifestations (exercise asthma). Asthma symptoms can be onset within a few minutes, and after a few hours to a few days, bronchodilators can be used to relieve or relieve themselves. Some patients may have another attack a few hours after remission. Attacks and exacerbations at night and early morning are often one of the characteristics of asthma. an examination 1. Physical examination During the attack, the chest was hyperinflated, the chest was swollen, and the percussion was clean. Most of them had extensive expiratory wheezing and prolonged expiratory sounds. Severe asthma attacks often have signs of laboured breathing, profuse sweating, cyanosis, abnormal chest and abdomen movements, increased heart rate, and abnormal pulses. There may be no abnormal signs in the remission period. 2. Laboratory and other inspections (1) Routine blood examinations Some patients may have increased eosinophils during attacks, but most of them are not obvious. For example, concurrent infections may have increased white blood cell counts and an increased proportion of classified neutrophils. (2) Sputum examination smear shows more eosinophils, such as respiratory tract bacterial infection, sputum smear Gram stain, cell culture and drug sensitivity test can help the diagnosis of pathogenic bacteria and guide treatment. (3) Pulmonary function examination During the remission period, the lung ventilation function is mostly in the normal range. During an asthma attack, due to the limitation of the expiratory flow rate, the expiratory flow rate indicators are significantly reduced, manifested as the forced expiratory volume in the first second (FEV1), the one-second rate (FEV1/FVC%) (forced expiratory volume in 1 second) Occupied vital capacity ratio), maximum mid-expiratory flow rate (MMER), maximum expiratory flow (MEF50% and MEF75%) at 50% and 75% expiratory capacity, peak expiratory flow (PEFR), and maximum expiratory flow ( PEF) are reduced. Lung capacity indicators can reduce effective vital capacity, increase residual capacity, increase functional residual capacity and total lung capacity, and increase the percentage of residual air in total lung capacity. Can gradually recover after treatment. If the disease is prolonged and repeated, its ventilation function may gradually decrease. (4) Blood gas analysis During a severe asthma attack, due to airway obstruction and uneven ventilation distribution, the ventilation/blood flow ratio is unbalanced, which can cause the alveolar-arterial oxygen partial pressure difference (A-aDO2) to increase; there may be hypoxia, PaO2 And SaO2 decreased, PaCO2 decreased due to hyperventilation, pH value increased, showing respiratory alkalosis. Such as severe asthma, the disease progresses further, airway obstruction is serious, hypoxia and CO2 retention may occur, PaCO2 rises, and respiratory acidosis is manifested. If hypoxia is obvious, metabolic acidosis can be combined. (5) Chest X-ray examination In the early stage of an asthma attack, the transparency of both lungs can be seen to increase, showing an over-inflated state; there is usually no obvious abnormality in the remission period. If the respiratory tract infection is complicated, the lung texture and the shadow of inflammatory infiltration can be seen. At the same time, pay attention to the existence of complications such as atelectasis, pneumothorax, or mediastinal emphysema. (6) Detection of specific allergens Most asthma patients are accompanied by allergies and are sensitive to numerous allergens and irritants. Determination of allergic indicators combined with medical history can help diagnose the cause of the patient and get rid of allergenic factors. However, allergic reactions should be prevented. (7) Others. Skin allergen test, inhaled allergen test, and patient-specific IgE in vitro can be tested as appropriate. diagnosis For patients with typical symptoms and signs, a clinical diagnosis can be made after wheezing, shortness of breath, chest tightness, and cough caused by other diseases are excluded; for atypical cases, bronchodilation or provocation test should be performed, and positive patients can be diagnosed. Differential diagnosis 1. Wheezing dyspnea caused by left heart failure More common in the elderly. The reasons are hypertension, coronary atherosclerosis, mitral valve stenosis, or chronic nephritis, etc. The attacks are more common at night. The symptoms are chest tightness, shortness of breath and difficulty, coughing and wheezing. In severe cases, there are cyanosis, dark complexion, cold sweats, nervousness and fear, similar to acute asthma attacks. In addition to wheezing, patients often spit out a lot of thin watery or foamy sputum or maybe pink foamy sputum, and have typical wet rales at the bottom of the lungs, the heart expands to the left, heart valve murmurs, and heart sounds may be irregular or even Gallop. Chest X-ray shows that the heart shadow may be enlarged, and the left atrial appendage is often enlarged in patients with mitral valve stenosis. The lungs have signs of pulmonary oedema, and the shadows of blood vessels are blurred. Due to pulmonary oedema, the interlobular septum becomes wider, and the interlobular line can move down to the basal lung lobe, which is helpful for identification. 2. Chronic obstructive pulmonary disease It is more common in middle-aged and elderly people, with a history of chronic cough, wheezing exists all year round, and there is an exacerbation period. Most patients have a history of long-term smoking or exposure to harmful gases, signs of emphysema, and wet rales may be heard in both lungs. However, it is sometimes difficult to strictly distinguish between chronic obstructive pulmonary disease and asthma in clinical practice. It may be helpful to use bronchodilators, oral or inhaled hormones for therapeutic diagnosis, and sometimes the two can exist at the same time. 3. Allergic lung infiltration This is a group of pulmonary eosinophil infiltration diseases, including simple eosinophilic pneumonia, persistent eosinophilic pneumonia, asthmatic eosinophilic pneumonia, tropical pulmonary eosinophilia and pulmonary necrotizing vasculitis, etc. Diseases can be included in this group of diseases, and they may all have asthma symptoms, especially asthmatic eosinophilic pneumonia. The disease can be seen at any age, most of which are related to lower respiratory tract bacterial infections. The patient is allergic to Aspergillus, so it is also called allergic bronchopulmonary aspergillosis. The patient often has a fever, and chest X-ray examination shows multiple, one after another light patch infiltration shadow, which can disappear on its own or recur repeatedly. Lung tissue biopsy can help identify. 4. Trachea and main bronchial lung cancer Because cancer compresses or invades the trachea or the main bronchus, the upper airway lumen is narrowed or incompletely blocked, coughing or wheezing occurs, and even wheezing occurs. However, patients usually have no history of asthma attacks, sputum can be bloody, wheezing symptoms are mostly inspiratory dyspnea, or wheezing sounds are limited, and anti-asthmatic drugs are ineffective. As long as the disease is taken into consideration, it is not difficult to distinguish it by further chest X-ray examination, CT, sputum cytology and fiberoptic bronchoscopy. treatment Currently, there is no specific treatment method, but adherence to long-term standardized treatment can make asthma symptoms well-controlled, reduce recurrence or even no longer attack. 1. Treatment goals (1) Complete control of symptoms; (2) Preventing the onset or exacerbation of disease; (3) The lung function is close to the best value of the individual; (4) Normal activities; (5) Improve self-awareness and ability to deal with acute exacerbations, and reduce the chance of emergency or hospitalization; (6) Avoid adverse drug reactions; (7) Prevent irreversible airway obstruction; (8) Prevent death from asthma. 2. Basic clinical strategies for asthma prevention (1) Long-term anti-inflammatory treatment is the basic treatment, and inhaled hormones are the first choice. Commonly used inhaled drugs include beclomethasone (BDP), budesonide, fluticasone, mometasone, etc. The latter two have stronger biological activity and longer-lasting effects. Usually, it takes regular inhalation for more than a week to take effect. (2) The first choice for emergency relief of symptoms is inhaled, β2 agonists. β2 agonists mainly activate the β2 receptors of the respiratory tract, activate adenylate cyclase, increase the content of cyclic adenosine monophosphate (cAMP) in cells and decrease free Ca, thereby relaxing bronchial smooth muscles. It is the first choice for controlling acute asthma attacks drug. (3) If the disease control is not satisfactory after regular inhalation of hormones, it is advisable to add inhaled long-acting β2 agonists, or sustained-release theophylline, or leukotriene modulators (combined medication); also consider increasing the amount of inhaled hormones. (4) In patients with severe asthma, if the above-mentioned treatment still recurs for a long time, intensive treatment may be considered. That is, according to the treatment of severe asthma attacks, give high-dose hormones and other treatments, and gradually reduce the number of hormones after 2 to 4 days after the symptoms are fully controlled, the lung function is restored to the optimal level, and the PEF fluctuation rate is normal. Some patients are well controlled after the intensive treatment phase. 3. Comprehensive treatment measures (1) Eliminate the aetiology and inducing causes. (2) Prevent and treat coexisting diseases, such as allergic rhinitis, reflux esophagitis, etc. (3) Immunomodulatory therapy. (4) Frequently check whether inhaled medicine is used correctly and compliance with doctor's orders. Prognosis The outcome and prognosis of asthma vary from person to person and are closely related to the correct treatment plan. Through the active and standardized treatment of childhood asthma, the clinical control rate can reach 95%. Mild disease is easy to recover, severe disease, airway reactivity is obviously increased, or other allergic diseases are difficult to control. If chronic obstructive pulmonary disease (COPD) or pulmonary heart disease occurs for a long time, the prognosis is poor. Education and management of asthma The education and management of asthma patients is an important measure to improve efficacy, reduce recurrence, and improve the quality of life of patients. Doctors should develop a prevention and treatment plan for each newly diagnosed asthma patient so that the patient understands or masters the following: 1. I believe that through long-term, appropriate and adequate treatment, asthma attacks can be effectively controlled; 2. Understand the triggers of asthma, combine each person's specific situation, find out their own triggers, and avoid the triggers; 3. Briefly understand the nature and pathogenesis of asthma; 4. Familiar with the aura manifestations of asthma attacks and corresponding treatment methods; 5. Learn to monitor the changes of the condition at home and make assessments, focusing on the use of peak flow meters, and record asthma diaries if possible; 6. Learn simple emergency self-treatment methods during an asthma attack; 7. Understand the effects, correct dosage, usage and adverse reactions of commonly used anti-asthmatic drugs; 8. Master the correct usage of different inhalation devices; 9. Know when to go to the hospital for treatment; 10. Work with the doctor to prevent the recurrence of asthma and maintain long-term stability.