Bronchial asthma. Carrying out diagnostics for bronchial asthma Percussion sound for asthma

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Moscow Medical Academy named after. THEM. Sechenov

Department of Faculty Therapy No. 2, Faculty of Medicine

STORY DISEASES

Bronchial asthma

Moscow 2007

Disease history

1. Surname,NameAndsurname

2. Age 63 years old (8/12 - 43)

3. Floor female

4. Timereceipts 23.09.07

5. Profession pensioner

6. Diagnosis,installedatadmissionVhospital Severe COPD, exacerbation stage.

Clinicaldiagnosis:

combined:

complications:

Complaintsatadmission:

For shortness of breath of an expiratory nature at rest, worsening with physical exertion, attacks of suffocation, relieved by inhalations of "Beroteka", a sharp cough with the release of sputum of a mucopurulent nature, general weakness, an increase in temperature to 38.1 0 C, pain in the right half of the chest.

Anamnesis Morbi

Considers himself sick since 1973. Over the past 10 years, the number of exacerbations has increased to 3 times a year. Each exacerbation was accompanied by hospitalization. Attacks of suffocation occurred, which were relieved by taking “Beroteka”. The first attacks were associated with exposure to allergic factors - pollen from flowering plants. The attacks were resolved by difficult-to-clear sputum. She took methylprednisolone (Metypred) orally in combination with inhaled glucocorticosteroids. Deterioration of the condition over the last 3 - 4 days, manifested by the appearance of severe attacks of suffocation that cannot be relieved by taking Berotek. Change in the nature of sputum from mucous to mucopurulent. Temperature rises to 38.1 0 C. Suffering from stage II, stage III hypertension since 1996.

Anamnesis Vitae

Born on 12/08/43. She grew and developed normally, and in her physical and mental development she did not lag behind her peers.

Previous illnesses: in childhood - denies childhood infections. Subsequently, periodically influenza, ARVI. Denies the presence of diabetes, tuberculosis, viral hepatitis, and sexually transmitted diseases. Chronic gastritis. Fracture of the femoral neck in 1980.

Epidemic history: not burdened.

Allergological history: - an allergy to penicillin antibiotics, as well as to aspirin, pollen of flowering plants, and household dust was revealed. The allergic reaction was manifested by the appearance of bronchospasm.

Heredity: not burdened

Obstetric and gynecological history: two pregnancies ending in childbirth. The birth proceeded without complications.

Status Praesens

General condition: moderate severity. Consciousness is clear. Position active.

Facial expression: calm.

No postural abnormalities were detected, and gait was not impaired.

The physique is correct. The constitution is normosthenic.

Skin: acrocyanosis, cyanosis of the lips, the skin is clean, dry, turgor is not reduced.

The nail plates are of normal transparency, the surface is smooth. Hair growth is not affected.

Subcutaneous tissue: evenly distributed.

Lymphatic system: lymph nodes are not palpable

Muscular and musculoskeletal system. The musculoskeletal system is without visible changes, the muscles are painless. The joints have a normal configuration; swelling, deformation, painlessness on palpation, redness of the skin in the joint area, and changes in periarticular tissues are not observed. There are no pain, crunching or crepitus during movements.

Respiratory system

Breathing through the nose is difficult. The number of respiratory movements per minute is 24. The breathing rhythm is correct. There is no discharge from the nasal passages. The voice is clear. Upon examination, the pharynx is not hyperemic, the tonsils do not extend beyond the edges of the palatine arches. The chest is barrel-shaped, there are no deformations or recesses. Palpation of the chest: painless. When feeling the ribs, their integrity is not broken, the surface is smooth. Voice tremors: weakened, expressed equally over symmetrical areas of the lungs. Comparative percussion: with comparative percussion over the entire surface of the left lung, a box sound is determined; upon percussion of the right lung, a dullness of the percussion box sound is determined in the IX intercostal space along the scapular line.

bronchial asthma diagnosis complication

Topographic percussion

Top standing height

Front right: 4.5 cm above the level of the collarbone.

Front left: 4.5 cm above the level of the collarbone.

Posterior right: at the level of the spinous process of the VII cervical vertebra.

Posterior left: at the level of the spinous process of the VII cervical vertebra.

Width of Krenig's fields: right - 8 cm, left - 7.5 cm.

Lower borders of the lungs

Topographical
Parasternal
Midclavicular
Anterior axillary
Middle axillary
Posterior axillary
Scapular
Paravertebral	spinous process XII thoracic vertebra	spinous process XII thoracic vertebra

Mobility of the lower edges of the lungs (in cm)

Auscultation of the lungs: - during auscultation over symmetrical areas of the pulmonary fields on the right and left, hard breathing and scattered dry wheezing are heard; moist fine bubbling rales in the lower part on the right.

The cardiovascular system

Inspection of the precordial area.

The area of the heart and large vessels is not changed. Pathological pulsations in the precordial region are not visually detected.

Inspection of superficial vessels: - The pulsation of the superficial arteries of the neck is determined. The saphenous veins of the neck and limbs are not changed.

Palpation of the precordial area.

The apical impulse is palpated in the 5th intercostal space along the midclavicular line. No other pathological pulsations, systolic and diastolic tremors are detected upon palpation of the precordial area.

Limits of relative cardiac dullness:

right - along the right edge of the sternum in the IV intercostal space;

left - 2 cm outward from the left midclavicular line, in the 5th intercostal space;

upper - at the level of the third intercostal space.

The diameter of the relative dullness of the heart is 17 cm.

The boundaries of absolute dullness of the heart: it is impossible to accurately determine due to the phenomena of pulmonary emphysema.

The right and left borders of the vascular bundle are located in the second intercostal space along the corresponding edges of the sternum.

The diameter of the vascular bundle is 5 cm.

Auscultation of the heart Heart sounds are significantly muffled, the rhythm is correct. At the apex, tone I is louder than tone II. Noises over other auscultation points are not detected. The number of heart contractions is 92 minutes.

Study of blood pressure and arterial pulse.

At the time of the study, blood pressure (BP) in the right arm was 130/90, in the left arm 130/80 mm. rt. Art.

The pulse on the radial arteries is rhythmic, satisfactory filling, tense, rhythmic, the number of pulse beats is 92 per minute.

The pulsation on the common carotid artery is symmetrical on both sides. The pulsation above the collarbone at the outer edge of the sternocleidomastoid muscle (a. subclavia) is symmetrical on both sides. The pulsation of the axillary and brachial arteries on both sides is also symmetrical.

Ripple in other peripheral temporal arteries (aa. temporalis); femoral (aa. femoralis); popliteal (aa. poplitea); posterior tibial (aa. tibialis posterior); the dorsum of the foot (aa. dorsalis pedis) is not weakened, symmetrical on both sides.

Digestive system

Appetite is reduced. The mucous membrane of the inner surface of the lips, cheeks, soft and hard palate is pink in color; There are no rashes or ulcerations. The gums are pale pink in color and do not bleed. The smell is normal. The oral cavity has been sanitized. The tongue is of normal size and shape, pink in color, moist, clean. The papillae of the tongue are well expressed. The pharynx is pink in color. The palatine arches are well contoured. The tonsils do not protrude beyond the palatine arches. The mucous membrane of the pharynx is not hyperemic, moist, its surface is smooth.

The abdomen is of normal shape and symmetrical. Actively participates in the act of breathing. There is no pathological peristalsis visible to the eye. There is no dilatation of the saphenous veins of the abdomen. The navel is of normal shape. Stools are normal, he denies constipation and dyspeptic disorders.

Superficial palpation of the abdomen.

On superficial (approximate) palpation, the anterior abdominal wall is soft, pliable, and painless. There is no tension in the abdominal wall muscles. Shchetkin-Blumberg's symptom is negative. Palpation at McBurney's point is painless. When examining the “weak spots” of the anterior abdominal wall (umbilical ring, aponeurosis of the white line of the abdomen, inguinal rings), no hernial protrusions were found.

Upon percussion of the abdomen, tympanitis of varying severity is noted. Free fluid in the abdominal cavity is not detected by percussion and fluctuation.

With deep methodical sliding palpation of the abdomen using the Obraztsov-Strazhesko-Vasilenko method, it was established:

The sigmoid colon is palpated in the left iliac region at the border of the middle and lower thirds of l. umbilioiliaceae sinistra, over 15 cm in the form of a smooth, moderately dense cord with a diameter of a thumb, easily moving during palpation within 4-5 cm; not rumbling.

The cecum is palpated in the right iliac region at the border of the middle and outer thirds of l. umbilioiliaceae dextra, in the form of a smooth soft-elastic cylinder with a diameter of two transverse fingers, with a rounded bottom; painless, moderately mobile, rumbling on palpation. The appendix is not palpable.

Terminal ileum: - palpated in the right iliac region in the form of a smooth, dense, mobile, painless cord 12 cm long with a diameter of the little finger. On palpation, rumbling is noted.

The ascending and descending sections of the colon are palpated in the right and left lateral areas (flanks) of the abdomen at the level of the navel in the form of cylindrical formations with a diameter of 2 cm, mobile, moderately dense, painless, with a smooth surface, not rumbling.

Transverse colon - palpated in the umbilical region, in the form of a moderately dense cylinder, approximately 2.5-3 cm in diameter, with a smooth surface, horizontally located, arched downwards, painless, easily moved up and down.

The small intestine is not palpable.

Stomach: - the lower border of the stomach, determined by auscultation (asculto-friction), is located 3.5 cm above the navel. The sound of splashing (using the succussion method) over the stomach is not detected.

The greater curvature of the stomach is determined by palpation in the form of a soft, smooth ridge running transversely along the spine on both sides of it, limited mobility, painless, rumbling upon palpation. The lesser curvature is not palpable. The pancreas is not palpable. There is no pain in the Shofar area and Desjardins' pancreatic point. When auscultating the abdomen, normal peristaltic bowel sounds are heard.

Hepato-biliary system

Liver percussion:

Upper border absolute stupidity liver:

along the right parasternal line - V intercostal space,

along the right midclavicular line - VI rib,

anterior axillary line - VII rib.

Lower border absolute stupidity liver:

along the right anterior axillary line - X rib;

along the right midclavicular line - the edge of the costal arch;

along the right parasternal line - 2 cm below the edge of the costal arch;

along the anterior midline on the border of the upper and middle third of the line connecting the base of the xiphoid process with the navel.

The left border of absolute hepatic dullness is along the left parasternal line; hepatic dullness downwards does not protrude beyond the costal arch.

Dimensions hepatic stupidity:

along the right anterior axillary line - 11 cm;

along the right midclavicular line - 10 cm;

along the left parasternal line - 9 cm.

Dimensions liver By M.G.Kurlov:

the first direct size (l. media clavicularis) is 9 cm.

second straight size (l. mediana anterior) - 8 cm.

oblique size - 7 cm.

In a horizontal position of the patient, the liver is not palpable.

The gallbladder is not palpable. There is no pain on palpation at the point of the gallbladder.

Spleen

The spleen is not palpable. Percussion, the anterior edge of the long spleen does not extend beyond the anterior axillary line; posterior - beyond the left scapular line. The upper limit of splenic dullness is located at the level of the IX rib, the lower - at the level of the XI rib. Percussion dimensions of the length of the spleen are 11 cm, diameter is 4 cm.

Urinary system

No complaints. When examining the kidney area, no pathological changes are detected. The kidneys are not palpable. There is no pain on palpation in the area of the upper and lower ureteral points. Pasternatsky's symptom is negative on both sides.

There are no dysuric phenomena.

Endocrine system

No complaints. When examining the anterior surface of the neck, no changes are noted. The lateral lobes of the thyroid gland are not palpable, and the isthmus is palpable in the form of a transversely lying, smooth, painless ridge of dense elastic homogeneous consistency. The width of the isthmus does not exceed the width of the middle finger. The gland is not fused to the skin and surrounding tissues and is easily displaced when swallowing.

Graefe's, Moebius', and Stellwag's symptoms are negative.

Organsfeelings

No pathologies identified

Neuropsychic sphere

The patient is well oriented in space, time and her own personality. Contact. Perception is not impaired. Attention is not weakened. Memory is significantly reduced. Thinking is not impaired. The mood is even. Behavior is appropriate. No focal neurological symptoms are identified.

There are no meningeal symptoms.

Preliminarydiagnosis: Bronchial asthma of mixed form, severe severity, in the acute stage. Emphysema. Pneumosclerosis.

Planexaminations:

1. Clinical blood test

2. General clinical urine test

3. Biochemical blood test

4. General sputum analysis

5. Wasserman reaction

6. ECG

7. X-ray of the chest organs.

8. FVD.

9. Reaction to HBs hypertension

10. Reaction to anti-NS AG

11. Reaction to antibodies to HIV

12. The result of bacteriological examination of stool for dysbacteriosis.

DatalaboratoryAndinstrumentalmethodsexaminations.

1 . clinicalanalysisblood.

2 . biochemicalanalysisblood

Index	Result
Total protein
Urea
Creatinine
Cholesterol
Total bilirubin

Alanine aminotransferase
Aspartate aminotransferase
Lactate dehydrogenase
Cretin phosphokinase
Seromucoid
Alkaline phosphatase


Fibrinogen

3 . generalanalysisurine

Index	Result	Units
Quantity
	Straw yellow
Transparency
Relative density

	Not detected
	Not detected
Ketone bodies	Not detected
Reaction to blood	Not detected
Bilirubin	Not detected
Urobilinoids	Not detected
Bile acids	Not detected
	Not detected

Microscopydrafturine

4 . ReactionWasserman Negative.

5 . ReactiononHBsAG Negative.

6 . Reactiononanti - HCAT Negative.

7 . ReactiononantibodiesToHIV Negative.

8 . ECG: The rhythm is sinus. Heart rate 93 per minute. Horizontal position of the electrical axis of the heart. Slowly pass along the anterior branch of the left bundle branch. Moderate changes in the myocardium with signs of overload in all chambers of the heart.

9 . Radiographyorganschestcells: In the lungs on the right in the lower lobe there is inhomogeneous infiltration. The pulmonary pattern is strengthened and deformed. Pneumosclerosis phenomena. The sinuses are free. Shadow of the aorta and heart with age-related changes.

Clinical diagnosis :

Bronchial asthma of mixed form, severe severity, in the acute stage. Emphysema. Pneumosclerosis.

combined: hypertension stage II, degree III

related: chronic gastritis in remission

complications: focal pneumonia in the lower lobe of the right lung, II degree DN

Rationale clinical diagnosis

· Bronchial asthma of mixed form, severe severity, in the acute stage.

Dry wheezing on auscultation of the lungs. Periodic attacks of suffocation (3-4 times a year), relieved by taking beta-agonists, occurred in response to the action of an allergic factor - pollen, household dust. The attacks also occurred in the cold. Thus, asthma attacks are associated with exposure to various types of allergens, which is a mixed form of bronchial asthma.

· Emphysema.

Barrel-shaped chest, decreased mobility during breathing, boxy percussion sound, disappearance of the zone of absolute cardiac dullness, drooping of the lower border of the lungs and limited excursion of the pulmonary edge.

· Pneumosclerosis.

Increased pulmonary pattern, sclerotic changes on chest x-ray

Focal pneumonia in the lower lobe of the right lung

Based on the patient’s complaints (increase in body temperature to 38.1 0 C, change in the nature of sputum to mucopurulent, pain in the right half of the chest, shortness of breath with minimal physical exertion, general weakness, malaise), it can be assumed that he has intoxicationsyndrome, as well as the syndrome of general inflammatory changes and inflammatory changes in the lung tissue characteristic of pneumonia.

Objective examination data (chest x-ray : in the lungs on the right in the lower lobe - inhomogeneous infiltration; dullness of percussion sound, moist fine rales in the lower parts of the right lung) confirm the presence of the previously listed syndromes, namely the syndrome of inflammatory changes in the lung tissue, which makes it possible to assume with a high degree of probability that the patient has pneumoniaVbottomsharerightlung.

Treatment

Bronchial asthma

· Berodual aerosol 2 puffs 3 times a day, Foradil - aerosol 2 puffs 4 times a day; inhaled corticosteroids - beclazone 250 mcg, 2 puffs 4 times a day

· Teopek 1 tablet 2 times a day

Prednisolone 5 mg: 2 tablets in the morning - 5 days

ACC 600 mg 1 tablet 1 time per day

Beta-agonists (short and long-acting) are prescribed to relieve bronchospasm. Corticosteroids - as an anti-inflammatory agent to relieve and prevent swelling of the bronchial mucosa, which plays an important role in the development of bronchospasm. ACC is prescribed to facilitate sputum discharge.

Pneumonia

Azithromycin 1 tablet 0.25 g per day

Cefuroxime 1 tablet 0.5 g 2 times a day

· IV levofloxacin 0.5 g once a day

Hypertensive illnesses

· Verapamil 1 tablet of 40 mg 3 times a day (continuously)

Enalapril 1 tablet 20 mg 1 time per day

Hydrochlorothiazide 1 tablet 12.5 mg 1 time per day

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Causes of bronchial asthma

In most cases, bronchial asthma is allergic in nature and is hereditary.

Classification of bronchial asthma

There are two main forms of asthma: atopic, when non-infectious agents act as an allergen (plant pollen, animal hair, bird feathers, house dust, fish food, food products) and infectious-allergic, associated with bacterial and viral infections. At the same time, staphylococci and neisseria, influenza and parainfluenza viruses, and rhinoviruses are of great importance in the formation of bronchial asthma. Separately, aspirin bronchial and physical exertion asthma are also distinguished.

Factors that provoke exacerbation of bronchial asthma:

contact with an allergen
aggressive environmental factors (stress, tobacco smoke, air pollution, etc.)
infectious diseases
taking non-steroidal anti-inflammatory drugs for aspirin-induced bronchial asthma.

Symptoms of bronchial asthma

With an exacerbation of bronchial asthma or an acute attack, the appearance and increase in difficult, noisy breathing, with predominantly difficult exhalation, is noted. There may be a paroxysmal dry cough. Precursors of an attack are often itching in the nasopharynx, sore throat, sneezing, and nasal congestion. The attack is accompanied by anxiety, a feeling of fear, rapid pulse, and sweating. To facilitate breathing, the patient at the time of the attack assumes an orthopneic position - sitting, leaning on his hands. When listening to breathing (auscultation) at the time of an attack, hard breathing and dry wheezing are detected in the lungs, especially on exhalation.

As respiratory failure progresses and there is no response to previously effective medications, a dangerous condition called “status asthmaticus” may develop. With status asthmaticus, the patient's shortness of breath and anxiety intensify, the work of the auxiliary respiratory muscles increases extremely, pallor of the skin, and acrocyanosis (blueness of the fingers, toes, and tip of the nose) are noted. The patient cannot speak, quickly becomes exhausted, excitement gives way to apathy, and consciousness is confused. During auscultation, areas of “silent zones” appear above the lungs, where respiratory sounds are not heard. As a result, the patient falls into a state of hypercapnic coma. Death occurs from paralysis of the respiratory center.

If the applied therapy is successful, the obstruction during an attack of bronchial asthma is reversible. Shortness of breath decreases, a cough with the discharge of viscous, usually mucous (white) sputum may be noted. The general well-being of the patient improves. There is a decrease in dry wheezing in the lungs. Moist rales may appear, indicating resolution of the attack.

Diagnosis of bronchial asthma

To establish a diagnosis, a detailed questioning of the patient, analysis of the medical history, and patient complaints are important.

In a clinic or hospital, the doctor conducts an examination and objective examination of the patient, and performs instrumental studies. The main research method is spirography - measuring lung function. A mandatory method for diagnosing bronchial asthma is a test with a bronchodilator drug, which helps to identify the presence of a bronchospastic component in the patient. An allergy examination is carried out. The patient consults an ENT doctor or a somnologist. When diagnosing asthma, to exclude other lung diseases, a chest x-ray is often prescribed, sometimes a computed tomography scan, and in difficult cases, other examination methods.

Treatment of bronchial asthma

The principles of treatment of bronchial asthma are based on a stepwise approach, recognized in the world since 1995. The goal of this approach is to achieve the most complete control of the manifestations of bronchial asthma using the least amount of drugs. The quantity and frequency of taking medications increases (step up) as the course of the disease worsens and decreases (step down) when therapy is effective. When prescribing therapy, the form of bronchial asthma is taken into account, provoking factors are identified and eliminated, and foci of chronic inflammatory processes in the body are sanitized.

Basic anti-inflammatory anti-asthmatic drugs include:

Cromones – sodium cromoglycate (intal), sodium nedocromil (Tyled)
Glucocorticosteroids
Specific immunotherapy.

Help with an attack of bronchial asthma

take a comfortable position that makes breathing easier - sitting, resting on your hands, or reclining with the head end of the bed raised high. Try to relax and control your breathing.
perform inhalation of the drug prescribed by the attending physician.

Using a pocket inhaler

Using a special device - a nebulizer

Using a spacer.

As a rule, a drug is used from the group of beta 2-adrenomimetics (salbutamol, fenoterol, terbutaline, etc.), anticholinergics (atrovent) or consisting of two components - berodual (fenoterol hydrobromide (b2-AM) + ipratropium bromide (cholinomimetic)).

Resistance created by the patient when exhaling (tightly closed lips or a handkerchief applied to the mouth) helps to ease breathing.
If sputum appears, try to cough it up immediately. Evacuation of viscous secretions from the lumen of the bronchi will significantly improve breathing.
If possible, resort to outside help - perform gentle pats on the back with your palm.
If there is no effect from the measures taken, or shortness of breath increases, you should urgently consult a doctor!

To monitor the effectiveness of the treatment received, assess the response to therapy at the time of an attack, and predict exacerbations, it is advisable for each patient with bronchial asthma to have and be able to use an easy-to-use device - a peak flow meter. It is used to determine the maximum speed of passage of air during exhalation - peak expiratory flow (PEF). The stronger the bronchospasm, the less PEF. During exacerbation of bronchial asthma, it is the exhalation phase that suffers to a greater extent. The peak flow meter provides specific data on the state of bronchial patency. Peak expiratory flow (PEF) is individual, so it is best to focus on your own indicators in the interictal period (the highest numbers that are determined during the treatment process).

Prevention of exacerbations of bronchial asthma

Breathing exercises are used as prevention, diet, physical therapy, hardening, treatment of chronic inflammatory, endocrine diseases, nervous diseases. Hyposensitization of the body is carried out. An important role is played by the identification and elimination of allergens from the patient’s environment. All activities are carried out under the supervision of the attending doctor.

When performing auscultation for bronchial asthma, the doctor may hear whistling, hoarse sounds of a varied nature. They are heard especially well when the patient holds his breath while inhaling and when breathing weakens while exhaling.

What is auscultation

This is one of the methods of diagnostic examination of a patient. With its help, the doctor listens to the patient, determining a possible disease by the nature of the noise coming from inside the body. There are two ways to do this research:

direct auscultation, in which the doctor listens to the person who comes to the appointment by putting his ear to his body (that is, directly);
indirect, in which the doctor uses a special device - a stethoscope.

Modern doctors do not use the first method, since the second is more informative and accurate, due to the special sensitivity of the instrument used. By auscultating the chest, the specialist analyzes the sounds that appear during inhalation and those that occur during exhalation. Comparing both results, he draws appropriate conclusions and enters them into the patient’s outpatient record.

To determine the auscultated points and conduct the study itself, the doctor may ask the patient to sit down or stand up. If the patient is too weak, then you can listen to him in a lying position. The anterior part of the chest is heard, then the lateral and posterior parts. To obtain a more accurate result, the patient's breathing should be deep.

In some cases, bronchophony is indicated. This is a separate type of listening. During the procedure, the doctor asks the patient to whisper words containing the letters “P” and “C”. If the doctor easily identifies the words spoken by the patient, then the conclusion is drawn that the lung is compacted or there are hollow spaces in it. Such signs correspond to bronchial asthma. If the body is healthy, then during this study only rustling or soft sounds are heard. This means that there is no bronchophony.

After carefully listening to the patient’s lungs, the doctor evaluates the results of auscultation:

whether the noise is the same at two points located symmetrically;
what is the type of noise at all listened points;
Is there any collateral noise that is not characteristic of the patient’s condition?

Auscultation is important for diagnosing bronchial asthma. But modern doctors have more modern devices in their arsenal to obtain accurate results. Therefore, to make a diagnosis after this study, a number of others are carried out: radiography, tomography, bronchography and others. Audible noises in the respiratory organs are of 3 types: main (respiratory), secondary and those that arise from friction of the pleura.

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Breathing sounds

In medicine, there are two types of breathing - bronchial and vesicular. To hear the first, the doctor listens to the following areas:

above the location of the larynx;
above the trachea;
in the anterior part of the chest (above the bronchi);
behind in the area of the 7th vertebra of the cervical spinal column.

This type of breathing has a rough sound. It is heard during both respiratory phases - exhalation and inhalation. When exhaling, it is longer and rougher than when inhaling. It is formed in the area of the vocal cords in the larynx. This breath sounds like the sound “x” if you pronounce it with your mouth open.

If the doctor listens to the rest of the chest, the noise is not at all heard. This is another type of breathing - vesicular. It is born in the alveoli of the lungs. The air flow entering them affects their walls - they straighten out. This happens as you inhale. And as you exhale they fall off. Very similar to the sound "f". It differs from bronchial breathing in its greater strength and duration during inhalation.

This breathing is changeable. Physiological reasons or various pathologies are to blame for this. It intensifies with physical activity in people whose constitution has a thin chest. Bronchitis and various diseases that cause narrowing of the bronchial lumen make vesicular breathing too rough, rather uneven and excessively harsh. With pneumonia associated with croup, it is loud, felt directly under the ear, and has a high pitch. In diseases such as bronchopneumonia, the foci of inflammation are so widespread that they merge. Bronchial breathing occurs. But unlike lobar inflammation, it is quieter and lower in timbre.

Another reason that a patient experiences bronchial breathing is the formation of voids (cavities) in the lungs. The sound of such breathing is not too loud, reminiscent of emptiness, and has a low timbre. Breathing can be mixed, that is, one in which both types of respiratory sounds are observed. This condition is observed in patients with tuberculosis or bronchopneumonia.

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Side noise type

Among such noises, two types are distinguished: wheezing (dry and wet, depending on the secretion present) and crepitus. Wheezing can be dry or wet depending on the secretion. The cause of dry wheezing is that the bronchial lumen narrows. This is observed in patients with bronchial asthma, swelling in the bronchi, and various types of inflammation in them.

There are high and low wheezes. High ones occur in smaller bronchi, and low ones in medium and large ones. Depending on how hard a person breathes, wheezing is barely audible or audible at a considerable distance. For example, in asthma, the intensity of wheezing is so great that it can be heard at a distance from the patient.

Sometimes wheezing is localized to a small area of the lungs, as with tuberculosis. Or they can disperse over its entire area, as in bronchial asthma. Dry wheezing is variable. Over a short period of time, they appear and then disappear. You can listen to them in both stages of the respiratory process - both during inhalation and exhalation. If there is fluid (exudate or blood) in the lungs, then wet wheezing occurs. The air flow passing through the liquid creates a gurgling wheeze. Moist rales form in the cavities of the lungs. They are heard during both phases of breathing, but doctors prefer to do this during inspiration.

There is another type of noise that differs in character from dry and moist wheezing.

This is crepitation. It is born in the alveoli when there is exudate in them. This is a very important sign for diagnosis. Crepitation is clearly audible when the patient inhales. Wheezing can disappear with coughing, and crepitus is unchanged. It appears like an explosion, at one moment, and wheezing is a longer-lasting phenomenon. Crepitation is typical for patients with lobar pneumonia. Sometimes it is observed without lung diseases. For example, in older people or in patients who are bedridden.

Bronchial asthma is usually called a disease that is accompanied by temporary disturbances in the patency of the bronchial tree. The degree and duration of these disorders may vary. The latter determines the stage of the disease at diagnosis. There can be five stages of bronchial asthma in total. It is important to determine the stage of the disease according to its severity, because the treatment of the disease depends on the stage. It is now believed that the mentioned disorders of bronchial obstruction are associated with a chronic inflammatory process in the lungs, exacerbations of which give rise to the characteristic clinical manifestations of the disease: cough, shortness of breath, suffocation.

Constant inflammation in the bronchial mucosa increases the strength of its reaction to an external stimulus, that is, it makes the bronchi hyperreactive.

In order to promptly recognize the disease and begin the necessary treatment, it is important to know the signs of bronchial asthma. Treatment of the disease can either be purely medicinal or support the patient’s lungs with folk remedies. Breathing exercises are also sometimes used. At the same time, the doctor must know about every step the patient takes. This is important, since exacerbations of the disease can have serious consequences: the patient may experience severe respiratory failure, even death due to lack of oxygen - suffocation. Only by choosing the right treatment and following all the specialist’s recommendations can you avoid severe attacks and bring the patient to a quality standard of living. Then the disease will not become the only important, constant and painful event for the patient.

To recognize bronchial asthma and make the correct diagnosis, it is necessary to obtain as much information as possible about the patient and his disease.

It is important to study his complaints, examine lung function: both inhalation and exhalation, conduct an objective examination of the patient and draw the right conclusions. Additional studies may also be performed to confirm the diagnosis of the disease.

A patient's visit to the doctor usually begins with the doctor collecting anamnesis. Anamnesis is the information that can be obtained through questioning the patient. It is these patient memories that usually constitute the main, basic vector for subsequent diagnostic searches. Typically, the doctor spends five to fifteen minutes to collect anamnesis. Often the patient’s first complaints indicate lung damage.

The first clinical manifestations of the disease can be very unstable, but it is important to recognize them. Usually the patient complains that more and more often he feels that his exhalation is difficult. He is also bothered by a dry, strong cough, attacks of which occur along with shortness of breath. However, the cough does not bring relief. It is important to ask the patient how his coughing and shortness of breath episodes go away. In a carrier of the disease, the onset of an attack is usually associated with hypothermia, physical exertion or anxiety, and the end either occurs spontaneously, or the patient has to use medications, for example, bronchodilators.

The medical history must include information about whether exacerbations occur again, how often this happens and what the patient associates with them: season, contact with allergens and other factors. Symptoms of bronchial asthma in working adults may also be associated with contact of the mucous membrane of the lungs with irritating substances inhaled at work - pollutants.

The latter may include chemical compounds of paints and varnishes, dust, and metal fumes.

History is the basis for diagnosis. If the patient’s history clearly shows constant exacerbations, manifested by a dry cough, shortness of breath or suffocation, moreover, associated with some third-party factor, for example, contact with an allergen, the diagnosis of bronchial asthma for the doctor, of course, comes to the fore.

Objective examination of the patient

An objective examination is all the information that a doctor can obtain through his own senses: smell, consistency, sound, appearance, palpation.

An objective examination usually begins with an examination. A patient with bronchial asthma, if he has been ill for some time, may develop external signs of the disease. The latter include a barrel-shaped chest, as if frozen after inhalation. The patient's supraclavicular fossae usually seem to sink in and become very pronounced.

If a doctor observes a patient during an exacerbation of the disease, he can see the wings of the patient’s nose flaring when breathing, the patient’s speech is intermittent, he is excited, and additional muscles begin to participate in the respiratory act: the shoulder girdle, for example. In this case, the patient usually tries to lean on the back of the bed or chair with his hands to make it easier to connect additional muscles. The doctor may also hear wheezing and a dry cough, which soon depletes the patient’s strength, but does not bring him tangible relief.

After the examination, percussion is performed, that is, percussion, of the lungs on the surface of the chest. When the breathing apparatus is functioning normally, the sound produced by tapping is called clear pulmonary. It has a rich, almost musical, coloring. When a patient has bronchial asthma, it is difficult to exhale; the lung tissue is filled with air. The latter circumstance gives the so-called box percussion sound. Approximately the same sound can be heard if you percussion a cardboard box or pillow stuffed with goose feathers.

Next, auscultation of the lungs is performed. Auscultation is listening to breathing sounds over the surface of the chest, which is performed using a special device - a stethoscope. On one side of the device there is a funnel: this section allows you to hear low-frequency noise well, on the other side of the device there is a membrane. The physics of reception is such that the membrane cuts out low-frequency noise and enhances high-frequency noise. When listening to an asthmatic during an attack, it is usually possible to distinguish dry rales that are scattered. This is due to the fact that different parts of the bronchial tree are narrowed to different degrees. During the period between attacks, wheezing may be heard or not appear at all.

Additional Research

To confirm the diagnosis, the doctor resorts to various additional studies. The latter can even help in determining the cause of the disease, for example, if asthma is of an allergic nature.

To assess the so-called allergic status of the patient, special provocative tests are used. Their essence lies in the fact that in a limited area of the skin the patient comes into contact with suspected allergens. If there is an allergy, then signs of inflammation will appear at the site of contact: redness, burning, pain. In addition, usually patients with an allergic form of bronchial asthma have relatives with the same disease.

You can also examine the level of immunoglobulin E, which is involved in allergic reactions, in the patient's blood serum. In some people it is elevated. This condition is called atopy, and bronchial asthma of this nature is called atopic.

In addition to immunoglobulin E, other indicators are important in a blood test. During an exacerbation, an increase in blood eosinophils - cells involved in hypersensitivity reactions or hyperreactive reactions - is usually also detected. There is also an increase in the number of leukocytes - white blood cells, an increase in ESR - erythrocyte sedimentation rate, which under normal conditions is 8-15 mm/hour.

When a patient's sputum is analyzed, so-called Charcot-Leyden crystals are detected. They are crystals of enzymes of eosinophil cells that move to hyperreactive areas of the bronchial mucosa. Sputum analysis also detects Kurshman spirals. Kurshman's spirals are long, thick, glass-like mucus casts. The shape of the spirals is due to the fact that before the patient was released into the external environment, they filled the small bronchi.

Also, a good and reliable method is to study the functions of external respiration: spirometry and peak flowmetry are used for this, which the patient can subsequently carry out independently and, based on the results, keep a special diary, by looking into which one can understand whether the treatment he is taking is effective.

To carry out spirometry, a special device is used - a spirometer, which is designed in such a way that it can quantitatively assess the patient's tidal volumes and lung capacity, that is, record his breathing parameters. Important indicators are forced expiratory volume in the first second, or FEV1, and peak expiratory flow, or PEF. In asthmatics, this figure increases significantly over time, usually by more than 12% of normal values.

For the patient, peak flowmetry is of greater importance. A small device, a peak flow meter, can be carried with you at all times.

It allows you to control the degree of obstruction or narrowing of the patient’s bronchi by peak exhalation flow. The patient conducts the test twice a day and records the results in a special diary. This approach allows for dynamic monitoring of bronchial patency over a long period of time, as well as timely noticing the deterioration of an asthmatic’s condition and taking appropriate measures.

Using a peak flow meter, you must proceed in the following order:

(NB) If the patient has difficulty understanding how to use the device, you need to explain to him that he should exhale as if he were about to blow out birthday candles on a cake.

Sometimes, when examining an asthmatic, they resort to the x-ray method. However, this method serves rather to refute other possible pathologies, and not to confirm the diagnosis of bronchial asthma as such. Typically, the x-ray shows an increase in the airiness of the lung tissue.

Overview of treatment measures

Treatment of bronchial asthma involves establishing and maintaining the patient’s quality of life. It is important to try to achieve results in which the patient can exercise at least moderate physical activity without problems.

Treatment of the disease during an exacerbation, especially if the patient experiences respiratory failure, should only be medicinal. However, if in the interictal period the clinical manifestations of the disease are moderate, the attacks themselves are rare, and the attending physician does not mind, the patient can resort to non-drug methods to maintain his good condition. The latter include treatment with folk remedies and breathing exercises.

It is important to remember that drug therapy has strict indications. They must not be neglected. To ensure that the indications for the use of certain medications are clearly defined and correctly implemented, an asthmatic must be regularly observed by a specialist. Before treatment begins, the patient must be taught competent, correct behavior within the framework of his illness.

Drug therapy for bronchial asthma

Treatment of bronchial asthma involves the use of two large groups of drugs. Firstly, bronchodilators are used, and secondly, anti-inflammatory drugs that have a beneficial effect on the inflamed mucous membrane of the narrowed bronchi. Bronchodilators include inhalants, short- and long-acting β-adrenergic agonists. Anti-inflammatory drugs include those used locally by inhalation, as well as systemic glucocorticosteroids, leukotriene receptor antagonists and mast cell membrane stabilizers. In addition, theophylline preparations are sometimes used.

(NB) Specific medications and treatment regimens are prescribed ONLY by a doctor for a specific patient! In this case, you should not self-medicate, because drugs used for bronchial asthma require strict consideration of contraindications.

Non-drug treatments

Of the non-drug methods of treating bronchial asthma, the most used are breathing exercises and treatment with folk remedies.

You can promote the patient’s good condition using the following folk remedies:

It is better to once again consult with your doctor which folk recipes can be safely used for bronchial asthma.

Breathing exercises can also be used for bronchial asthma. One of the good methods is considered to be gymnastics by A.N. Strelnikova. The technique is based on active inhalation and passive exhalation, which are performed by the patient quickly and regularly. Inhaling in this case resembles sniffing, and exhaling occurs without the patient’s efforts, independently through the mouth. Typically, inhalation and exhalation are done four or eight times, after which the patient rests for a few seconds. Then the series of inhalation and exhalation is repeated. Classically, the patient repeats 20 series of inhalation-exhalation in one session. If breathing exercises are performed correctly and regularly, the patient’s breathing parameters improve; gymnastics helps to ensure that exacerbations of bronchial asthma occur less frequently in the patient.

As soon as an asthmatic begins to feel the onset of an attack of the disease: it is difficult to exhale, the cough is strong and dry, he wants to lean his hands on something solid, he is recommended to immediately take a sharp breath. After this, repeat the series of exhalation and inhalation several more times. Sometimes this allows you to immediately reduce the symptoms of the disease and alleviate the course of the disease during its exacerbation. However, if the symptoms of the disease do not decrease, you should immediately seek emergency medical help.

Summary

In order to promptly recognize the disease and begin its treatment, it is important to know how bronchial asthma manifests itself. Typically, the patient complains that he has a severe dry cough that is difficult to stop, exhalation is difficult to the point of suffocation, and symptoms appear regularly. An important point for making a diagnosis is a correctly collected anamnesis. Often, the patient’s history shows a connection between attacks of illness and hypothermia, anxiety, or contact with some allergenic substance. If, after anamnesis has been collected and an objective examination has been carried out, the diagnostic search is somewhat difficult, additional diagnostic methods are used to confirm the diagnosis: clinical blood test, sputum test, spirometry and peak flowmetry, x-ray examination.

The symptoms of bronchial asthma manifest themselves most clearly during its exacerbation. Difficulty exhaling, exhaustion of the additional respiratory muscles that the patient uses to breathe, and severe coughing lead to the patient quickly developing respiratory failure. He needs timely medical attention.

Non-drug measures, such as breathing exercises or traditional medicine recipes, may be suitable for the treatment of bronchial asthma. However, it is important for the patient to be regularly monitored by a doctor and resort to drug therapy if necessary. It is also necessary to carry out self-monitoring using a peak flow meter and keep a special log of peak expiratory flow, which will allow you to track the patient’s condition over time and notice a deterioration in time, if it occurs.

It is important that the doctor trains the patient to correctly perceive his own illness. To do this, direct conversations are carried out with the patient, and short educational brochures are also issued, which are usually available to patients at the medical institution.