BRONCHIAL ASTHMA .


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Definition. Asthma is a constant provocative sickness of the aviation routes which creates under the allergens impact, partners with bronchial hyperresponsiveness and reversible hindrance and shows with assaults of dyspnea, windedness, hack, wheezing, mid-section snugness and sibilant rales more communicated at breathing out..
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BRONCHIAL ASTHMA Prof. Vatutin N.T.

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Definition Asthma is a constant provocative malady of the aviation routes which creates under the allergens impact, partners with bronchial hyperresponsiveness and reversible check and shows with assaults of dyspnea, windedness, hack, wheezing, mid-section snugness and sibilant rales more communicated at breathing out.

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Epidemiology According to epidemiological reviews asthma influences 1-18% of populace of various nations. Just in 2006 more than 300 million patients experienced asthma everywhere throughout the world, 250 thousand s of patients kick the bucket of asthma. The occurrence of asthma is higher in nations with expanded air contamination.

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As a sthma is a respiratory unfavorably susceptible illness, the impact of allergens saturated into the creature through aviation routes is fundamental for the infection improvement. The allergens are partitioned into : Etiology collective, modern, word related, characteristic pharmacological

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Сommunal allergens are contained in the demeanor of flats. They are: house-tidy vermin which live in floor coverings, sleeping pads and upholstered furniture; drool, waste products, desquamated epidermis, hair and hide of household creatures; essential results of local creepy crawlies (e.g., cockroach); mycelial yeast-like parasites ( molds); tobacco smoke amid dynamic or aloof smoking; different mutual mist concentrates and engineered cleansers.

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Among the modern allergens nitric, carbonic, sulfuric oxides, formaldehyde, ozone and emanations of biotechnological industry - fundamental parts of mechanical and photochemical brown haze - must be specified. The most imperative word related allergens are tidy of stock structures, plants, weaving-factories, book vaults and so on. Regular allergens are spoken to by plant dust (particularly ambrosia, wormwood and goose-foot dust) and diverse respiratory, especially popular, contaminations.

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Some allergens which may bring about asthma S pittle, fertilizers, hair and hide of local creatures H ouse-clean bugs which live in floor coverings, sleeping pads and upholstered furniture P lant dust D ust of book depo - sitories F ood parts ( stabilizers, hereditarily altered items ) Pharmacological a gentlemen ( chemicals, anti-infection agents, immunizations, serums )

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Genetic variations from the norm which prompt to inordinate generation of allergen-particular antibodies (Ig E) is called atopy - noteworthy calculate asthma beginning in numerous patients. A considerable measure of instances of atopy are acquired, and late epidemiological reviews demonstrated relentless increment in number of individuals with high serum level of Ig E. Trigger-elements , which incite bronchospasm, are: a concurrent entrance of an expansive amount of allergen, viral respiratory disease, hyperventilation, physical effort, enthusiastic anxiety, turning out to be excessively chilly, unfavorable climate conditions, organization of a few drugs (ibuprofen, b - blockers).

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Pathophysiology Asthma pathophysiology is very troublesome and deficiently considered. Without a doubt, as a rule the illness depends on 1 sort touchiness response. The beginning of any unfavorably susceptible response might be isolated into invulnerable, pathochemical and pathophysio-rationale stages.

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Allergens Immune stage Allergen-particular IgE B-cell After including into the aviation routes allergens initiate immunocompetent cells. Thus B-lymphocytes create antibodies of Ig E class. In the event of asthma T-lymphocytes are restrained, so the actuation of B-lympocytes and Ig E generation are intemperate, surpassing typical needs. Lymphocyte

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Further these antibodies tie to the surface of pole cells, basophils and eosinophils of bronchial mucous. At the point when another segment of allergen includes the respiratory framework, it associates with IgE-antibodies. This is a to start with, insusceptible period of unfavorably susceptible response.

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Pathochemical stage As a consequence of antigen-immunizer response the particular "blast" happens. The films of pole cells, basophils and eosinophils of bronchial mucous wreck with yield of naturally dynamic substances ( histamine, serotonin, chemotaxis variables, heparin, proteases, thromboxane, leukotrienes, prostaglandins) , which instigate hyperergic irritation, mucous edema, fit of smooth myocytes, organs hypersecretion, gooey exudate arrangement in bronchial lumen. Aviation route load with bodily fluid Muscles contract Airways swell

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Asthma worsening, happening accordingly, is a clinical sign of the 3 rd , pathophysiolo-gical , period of hypersensitive response. The showed system is particular for atopic (exogenous) asthma beginning. I n expansion to this, autosensibilization of harmed pneumonic tissue, neuropsychic unsettling influences, corticoid inadequacy, adrenergic irregularity, hindrance of arachidonic corrosive digestion system, hereditary and some different elements presumably assume a specific part in beginning of nonatopic (endogenous) asthma.

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Pathologic life structures Macroscopic changes: thick mucous/mucopurulent mucus aviation route dyskinesia with zones of spastic compression and incapacitated extension of bronchi impediment of aviation route lumen lung emphysema, pneumosclerosis RV and RA hypertrophy and widening

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Microscopic changes : B ronchial divider invasion with pole cells, eosinophils, basophils and T-lymphocytes E dema of mucous and submucous tunic s D estruction of bronchial epithelium Hypertrophy of bronchial smooth muscles, H yper plasy of submucous organs M icrovessels expansion

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Classification Depending on etiology asthma is partitioned into exogenous (atopic) and endogenous (non-atopic). By clinical course asthma is partitioned into discontinuous (starting, early) and determined (endless, late). Contingent upon recurrence of intensifications, impediments of patient\'s physical movement and lung work constant asthma is separated into mellow, direct and extreme (lung capacity is surveyed by constrained expiratory volume in 1 second (FEV1) and pinnacle expiratory stream (PEF) and day by day fluctuation of these parameters). There are likewise abatement stage and intensifications .

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Clinical course, seriousness Daytime asthma side effects Nighttime renewals FEV1, PEF Intermittent < 1/week 2 and </month >80% anticipated. Day by day inconstancy < 20% Mild steady  1/week however not every day > 2/month >80% anticipated. Day by day inconstancy – 20-30% Moderate determined Daily > 1/week > 60 yet < 80% anticipated. Variability>30%. Extreme determined Persistent, which restrict typical action Daily <60% anticipated. Inconstancy > 30%. Asthma seriousness order

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In proposals of Global Initiative for Asthma (GINA) asthma is arranged on the base of control appraisal and is partitioned into all around controlled, in part controlled and uncontrolled. Asthma control is considered as: daytime side effects  2/week; capacity to take part in typical every day action; the nonattendance of evening time enlightenments as an aftereffect of asthma side effects; require in bronchodilators organization  2/week; the nonappearance of asthma intensifications; ordinary or close typical lung work parameters.

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Clinical appearances Classic signs and indications of asthma are: assaults of expiratory dyspnea shortness of breath hack mid-section snugness wheezing (sharp shrieking sounds when breathing out) sibilant rales

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In common cases being developed of asthma compounding there are 3 periods – prodromal period, the tallness time frame and the time of turn around changes . At the prodromal period: vasomotoric nasal response with bountiful watery release, wheezing, dryness in nasopharynx, paroxysmal hack with gooey sputum, enthusiastic lability, extreme sweating, skin tingle and different manifestations may happen.

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At the peack of fuel there are: expiratory dyspnea constrained position with supporting on arms inadequately profitable hack cyanotic skin and mucous tunics hyperexpansion of thorax with utilization of every single adornment muscle amid breathing at lung percussion: tympanitis, moved descending lung fringes at auscultation: reduced breath sounds, sibilant rales, delayed breathing out, tachycardia. in extreme intensifications: the indications of right-sided heart disappointment (swollen neck veins, hepatomegalia), over-burden of right heart chambers on ECG.

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At the time of the switch changes , which comes suddenly or under pharmacologic treatment, dyspnea and windedness ease or disappear, sputum gets to be distinctly not all that thick, cough swings to be gainful, patient inhales easi er .

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A sthmatic status The serious and delayed asthma intensification with escalated dynamic respiratory disappointment, hypoxemia, hypercapnia, respiratory acidosis, expanded blood consistency and the most vital sign is bar of bronchial b 2-receptors. Stages: 1 st - unmanageable reaction to b 2-agonists (might be confusing response with bronchospasm exacerbation) 2 nd - "quiet" lung due to serious bronchial hindrance and crumple of little and middle of the road bronchi; 3 rd organize – the hypercapnic unconsciousness.

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In many cases asthma, especially irregular, shows with few and atypical signs : long winded appearance of wheezing; hack, overwhelming breathing happening during the evening; hack, dryness after physical action; "occasional" hack, wheezing, mid-section snugness (e.g., amid dust time of ambrosia); similar manifestations happening amid contact with allergens, aggravations; waiting course of intense respiratory diseases.

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The difficulties of asthma intensifications are: pneumothorax lung atelectasis pneumonia intense or subacute cor pulmonale asthmatic status. Steady asthma causes : fibrosing bronchitis little bronchi disfigurement and annihilation emphysema pneumosclerosis, constant respiratory disappointment ceaseless cor pulmonale. Asthma confusions Asthma in youth

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