Bronchial asthma, referred to as asthma, is a common chronic inflammatory airway disease, with the main characteristics ofAirwaySymptoms such as wheezing, shortness of breath, chest tightness or cough occur repeatedly, often at night and in the early morning.The onset of asthma is related to genetic and environmental factors, among which genetic factors mainly determine the predisposition of patients, while environmental factors such as variousallergenAir quality, smoking, exercise, etc. are specific trigger factors.The common types of bronchial asthma include exercise, medication, occupation and allergy.
The main symptoms of asthma are wheezing, shortness of breath, chest tightness or cough. In severe cases, dyspnea and hypoxemia may occur.For patients who have been diagnosed with asthma, when the symptoms worsen or interfere with daily life, it is recommended to see a doctor in time.It is worth noting that asthma is not an infectious disease, so there is no need to worry about transmission through air or contact.
For the treatment of asthma, there is no complete cure at present, but the disease can be controlled through drugs to improve the quality of life.Commonly used drugs mainly include control drugs and relief drugs. The former is used for long-term disease control, such as inhalationGlucocorticoidEtc;The latter is used to alleviate acute attacks, such as short acting β 2 receptor agonists.In addition, some patients with severe or refractory asthma can try non drug treatment such as bronchial thermoplasty.
As there is no radical cure, the prevention of asthma is particularly important.Routine preventive measures include avoiding the environment and substances that induce asthma, and actively treatingupper respiratory tract infectionPay attention to maintaining good living and eating habits.Although there is no cure, most asthma patients can obtain good quality of life through regular and standardized treatment and management.
Heredity and environment are two essential factors for asthma patients.Heredity only determines the allergic constitution of patients, that is, they are prone to asthma. Whether such patients develop asthma or not is closely related to environmental factors.
Pathogenesis
Genetic factor
Asthma has a polygenic genetic tendency, and its incidence has a certain family clustering phenomenon, that is, the closer the kinship is, the higher the prevalence rate is, but its incidence is often formed by the joint action of multiple genes and exogenous factors.
Non pathogenic factors, such as air pollution, smoking, exercise and obesity, may also cause asthma.
Predisposing factors
Climatic factors
Including air pressure, temperature, wind force and humidity, which may cause asthma when changing.
Sports factor
Clinically, most patients with asthma or allergic rhinitis often have asthma attacks or cough and chest tightness after exercise.Sprinting, long-distance running and mountaineering are especially easy to promote mild asthma or stable asthma attack, while swimming has relatively mild impact, so it is more suitable for asthma patients.
It can obviously affect the attack and severity of asthma.
Microelement deficiency
withIron deficiencyandZinc deficiencyIt is common that the deficiency of these trace elements can cause the decline of immune function and lead to asthma.
Drug factors
There are two kinds of asthma attacks caused by drugs: specific allergy and non-specific allergy. The former is the most common allergy caused by biological products, and the latter is often caused by sympathetic blockers, such as propranolol and drugs that enhance parasympathetic effects.
symptom
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Asthma patients often have symptoms such as wheezing, shortness of breath, chest tightness or cough. Generally, they can relieve themselves or use antiasthmatic drugs.
Typical symptoms
The general symptoms are recurrent wheezing, shortness of breath, chest tightness or cough;Severe attack may cause dyspnea and hypoxemia in a short time.
Premonitory symptoms
Before the attack, there are often symptoms such as nasal congestion, sneezing and itchy eyes.
Symptoms during acute attack of asthma
light
When walking or going upstairs, you may feel short of breath, anxiety, slightly increased breathing rate, and can hear scattered wheezing sounds.
moderate
A little activity makes you feel short of breath, and speech is often interrupted. Sometimes you feel anxious, and your breathing rate increasesTriple concave sign(It refers to the obvious depression of the suprasternal fossa, supraclavicular fossa and intercostal space when inhaling). Hear loud and diffuse wheezing sounds, and the heart rate increases.
severe
When resting, I feel short of breath, sit upright and breathe, which can only be expressed in words, often with anxiety and irritability, sweating profusely, breathing rate>30 times/minute, oftenTriple concave signHear loud and diffuse wheezing sounds, and the heart rate increases more than 120 times/minute.
critical
The patient cannot speak, is lethargic or has vague consciousness, wheezes are weakened or even disappeared, and the pulse rate is slow or irregular.
Accompanying symptoms
Asthma patients may be accompanied by fever, night sweats, sore throat, pharyngeal itching, cyanosis, fatigue, lower limb edema and other symptoms.
Medical treatment
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When patients feel wheezing, chest tightness, shortness of breath, asthma symptoms aggravate or interfere with daily life, they need to go to the hospital in time.When you wake up at night and need to use emergency medicine, and when adverse reactions occur after taking asthma drugs, you should seek medical advice in a timely manner.
diagnostic criteria
Generally, diagnosis is made through the following typical clinical symptoms, signs and lung function examination results, excluding wheezing, shortness of breath, chest tightness and cough caused by other diseases.
Clinical symptoms and signs of typical asthma
Repeated attacks of wheezing, shortness of breath, with or without chest tightness or cough, frequently occurring at night and in the morning, are often associated with exposure to allergens, cold air, physical and chemical irritation, upper respiratory tract infection, exercise, etc.
During the attack, scattered or diffuse wheezing sounds can be heard in both lungs, and the expiratory phase is prolonged.
The above symptoms and signs can be relieved by treatment or self relief.
Objective inspection of airflow restriction
The bronchial provocation test was positive.
Positive bronchodilation test, that is, FEV after inhalation of bronchodilatorone(forced expiratory volume in the first second) increased by>12%, and the absolute value of FEV1 increased by>200 ml.
The diurnal variation rate of the average daily peak expiratory flow (PEF) is more than 10% or the weekly variation rate of PEF is more than 20%.
Visiting department
Respiratory Medicine or Allergy Clinic.
Relevant inspection
Chest X-ray
In addition to general chest plain film, chest X-ray examination sometimes requires chest CT examination, which is helpful in the diagnosis and identification of asthma and the estimation of asthma severity.
Pulmonary function test
Bronchial provocation testandBronchodilation testIt is helpful to establish the diagnosis of asthma and is the most commonly used indicator to objectively judge asthma.Bronchial relaxation test can also help to estimate the possible efficacy of β 2 receptor agonists and provide reference for drug selection.
Expiratory nitric oxide (FeNO) detection
It can be used as an indicator to evaluate whether to initiate inhaled glucocorticoid therapy, and it is helpful for asthma management during pregnancy.
It is one of the indicators to evaluate the airway inflammation of asthma, and also a sensitive indicator to evaluate the response to glucocorticoid treatment.
Allergen test
Find out the allergic substances, which can help prevent the recurrence of asthma.
Most of the patients are middle-aged and elderly people with a long history of coughing and expectoration, and the symptoms worsen in cold seasons.A person can be diagnosed as chronic bronchitis if he continuously coughs for more than three months every year for two consecutive years and excludes other causes of cough and expectoration.
If there is continuous airflow restriction (FEV1/FVC<70% after using bronchodilator in stable period), it is diagnosed as chronic obstructive pulmonary disease.
The etiology is complex, which is still not very clear, and is generally related to long-term smoking, air pollution, indoor micro environment pollution (cooking fume), etc.The symptoms of cough and wheezing caused by cough and wheezing often become progressively worse, often with cough and blood sputum or a small amount of blood sputum. Antiasthmatic drugs are ineffective.
Often caused by tuberculosis, chest fluoroscopy and chest X-ray can be distinguished from asthma.Tuberculous pleurisy patients generally have fever, night sweats, chest pain and other symptoms.
It is mostly related to blood stasis, vascular intima damage, etc., manifested as obvious chest tightness, suffocation, and dyspnea. These symptoms can make patients restless and extremely unbearable. Blood gas analysis shows obvious hypoxemia, but generally no wheezing sound can be heard in the lungs, and antiasthmatic drugs are ineffective.
treatment
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Asthma can not be eradicated and is generally treated with drugs.Drug treatment is divided into control drugs and relief drugs.
Controlled drug
Daily medication that requires long-term use, mainly through anti-inflammatory effect to maintain clinical control of asthma, including inhalationGlucocorticoid, all overhormone，Leukotriene Modifiers , long-acting β 2 receptor agonist, sustained-release theophylline,Sodium cromoglycate, anti IgE monoclonal antibodies and other drugs that can help reduce the amount of systemic hormones.
Palliative drug
Also called emergency medicine, these drugs can relieve asthma symptoms by rapidly relieving bronchospasm, including quick acting inhaled and short-term oral β 2 receptor agonists, systemic hormones, inhaled anticholinergic drugs, short-term theophylline, etc.
Acute treatment
Mild acute attack of asthma
Salbutamol or m-hydroxyshuning aerosol can be used for inhalation treatment, which usually works within a few minutes, or it can be taken orallyβ 2 receptor agonist。
Acute attack of moderate asthma
After inhalation of bronchodilators, symptoms are only partially improved, so it is often necessary to use beclomethasone propionate or budesonide aerosol inhalation in combination.
Patients with acute moderate asthma often have nocturnal asthma attacks and exacerbations of symptoms. They often need to use long-acting sustained-release theophylline and other drugs to effectively prevent nocturnal asthma attacks.
Acute attack of severe asthma
At this time, the effect of inhaling β 2 receptor agonist and glucocorticoid is not obvious, and they often need to be sent to hospital for emergency treatment.
General treatment
Cause specific treatment: antibiotic treatment is required for respiratory tract infection.
Symptomatic treatment: in case of wheezing, spasmolysis and antiasthmatic treatment are required;If it is difficult to breathe, it is necessary to keep the respiratory tract unobstructed, take oxygen and even give mechanical ventilation treatment.
Keep warm, rest and avoid getting cold.
medication
Glucocorticoid
Glucocorticoid is the most effective drug to control airway inflammation. The administration routes include inhalation, oral and intravenous administration.
Route of administration
characteristic
Adverse reactions
Treatment measures
Inhalation
The first choice for long-term treatment of asthma.Systemic adverse reactions were less;It directly acts on the respiratory tract and requires a small dose.
The local adverse reactions of oropharynx included hoarseness, pharyngeal discomfort and candida infection.
Rinse the mouth and throat with clean water in a timely manner after inhalation, select dry powder inhaler or add a mist receiver.
Oral administration
It is used for patients who are ineffective in inhaling hormone or need intensive treatment.
It can cause osteoporosis, hypertension, diabetes, inhibition of hypothalamus pituitary adrenal axis, obesity, cataract, glaucoma, dermatoglyphics and ecchymosis caused by thin skin, and muscle weakness.
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Intravenous administration
Intravenous application in severe acute asthma attack.
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β 2 receptor agonist
Short acting β 2 receptor agonists (SABA), commonly used drugs such as salbutamol and terbutaline.
Route of administration
characteristic
Adverse reactions
Inhalation
It is the first choice for relieving mild to moderate acute asthma symptoms, and can also be used for sports asthma.
It should not be used for a long time, singly or excessively, or it may cause skeletal muscle tremor, hypokalemia, arrhythmia and other adverse reactions.
Oral administration
It is suitable for the prevention and treatment of asthma patients at night.
Heart palpitations, skeletal muscle tremor and other adverse reactions were more obvious than those when inhaled.
Patch administration
The effect can last for 24 hours.
It can reduce systemic adverse reactions.
Long acting β 2 receptor agonist (LABA) is suitable for long-term treatment of patients with moderate to severe persistent asthma.
It is not recommended to use LABA alone for long-term treatment of asthma clinically.
Leukotriene Modifiers
It can reduce the daily dose of inhaled hormone for patients with moderate to severe asthma, and improve the clinical efficacy of inhaled hormone therapy, especially for patients with aspirin asthma, sports asthma, and asthma with allergic rhinitis.
theophylline
It has the function of relaxing bronchial smooth muscle, strengthening heart and diuresis, expanding coronary artery, stimulating respiratory center and respiratory muscle.
Route of administration
Indications
Adverse reactions
Treatment measures
Oral administration
For mild to moderate asthma attack and maintenance treatment.
When combined with β 2 receptor agonists, heart rate increases and arrhythmia easily occurs.
Use with caution and reduce the dosage appropriately.
Intravenous administration
It is suitable for patients with acute attack of asthma who have not used theophylline drugs in the past 24 hours.
It can cause arrhythmia, blood pressure drop and even death.
Monitor the blood drug concentration and adjust the concentration and dropping speed in time.
Anticholinergic drug
asIpratropium bromide、Tiotropium bromideIt can block the efferent branch of the postganglionic vagus nerve and relax the bronchus by reducing the tension of the vagus nerve.Women in early pregnancy, patients with glaucoma and prostatic hypertrophy should use with caution.
Anti IgE treatment
It can be used in patients with asthma whose serum IgE level is increased. At present, it is mainly used in patients with severe allergic asthma whose symptoms have not been controlled after the combined treatment of inhaled glucocorticoid and LABA.
Other asthma drugs
Antihistamines such asKetotifen、loratadine、Astemizole、TerfenadineIt has anti allergic effect.It plays a weak role in the treatment of asthma, and can be used for the treatment of asthma patients with allergic rhinitis. The adverse reaction of the drug is mainly somnolence.
Astemizole and terfenadine can cause serious cardiovascular adverse reactions, which should be used with caution.
Other oral antiallergic drugs such asTranister、REPISTERIt can be used in the treatment of mild to moderate asthma, and its main adverse reaction is lethargy.
surgical treatment
Perioperative asthma management
It refers to patients with asthma history and other diseases requiring surgical treatment or exploration, who need asthma assessment to avoid the factors inducing asthma.
Preoperative preparation: asthma assessment shall be conducted at least 1 week before operation.Routine pulmonary function examination is recommended.For elective surgery, it can be performed after good asthma control;For emergency surgery, the advantages and disadvantages must be weighed.
Intraoperative management: Neuromuscular blockers are the most common drugs to induce allergic reactions, such as micuronium.
Postoperative management: good postoperative analgesia, enhanced respiratory training, and control of gastroesophageal reflux may help reduce the risk of acute asthma attack.
Bronchoplasty
Bronchoplasty is a non drug therapy for asthma.It uses the bronchial thermoforming system to transmit heat energy to the airway wall, so that the bronchial smooth muscle will dissolve, and then coagulative necrosis will occur, so that asthma patients will not produce excessive bronchoconstriction reaction when they are stimulated by the outside, thus reducing the attack of asthma.
Patients with severe or refractory asthma can take bronchial thermoplasty when they still cannot control after using the maximum dose of drugs and multiple drugs.Although this operation can not cure asthma, it can significantly reduce the acute attack of asthma and improve the control level of asthma.
TCM treatment
The TCM treatment of the disease is not supported by evidence-based medical evidence, but some TCM treatment methods or drugs can alleviate symptoms, so it is recommended to go to regular medical institutions and treat under the guidance of doctors.
prognosis
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Asthma is not easy to cure, but after long-term standardized treatment and management, more than 80% of patients can achieve clinical control of asthma.
The air flow obstruction of the patient can not be controlled for a long time, and the residual air volume of the lung is increasing, which leads to the destruction of the alveolar structure and the formation of emphysema.Further development, compression of the blood vessels around the alveoli, increased pulmonary circulation resistance, and the formation of chronic pulmonary hypertension, which in the long run will lead to right heart dysfunction and chronic pulmonary heart disease.
It refers to serious complications of sudden stop of breathing in asthma patients.Most of them are due to the patient's coughing or eating, which can also occur after the patient's slight activities.
Pneumothorax and mediastinal emphysema are prone to occur when patients suddenly exert force or carry heavy objects due to serious damage to the lung structure.The lungs should be dilated as soon as possible.
Allergic bronchopulmonary aspergillosis
The allergic reaction of the body to the aspergillus antigen is manifested as fatigue, emaciation, cough, night sweat, clubbing fingers, brown small pieces of secretion in sputum, Aspergillus fumigatus in fungal culture, and wandering lung infiltration in chest radiograph.
Asthma patients, especially those who get sick or repeatedly develop asthma when they are young, often cause chest deformities, the most common ones are barrel chest, chicken chest, rib valgus and other chest deformities, which may affect respiratory function in serious cases.
Education and management
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The education and management of asthma patients is to improve curative effect, reduce recurrence and improve patientsQuality of lifeAs an important measure, doctors should formulate prevention and treatment plans for each newly diagnosed asthma patient, so that patients can understand or master the following:
It is believed that asthma attack can be effectively controlled through long-term, appropriate and adequate treatment;
Understand the motivating factors of asthma, and find out their own motivating factors and ways to avoid incentives according to each person's specific situation;
Simply understand the essence of asthma andPathogenesis；
Be familiar with the aura of asthma attack and the corresponding treatment;
Learn to monitor the change of illness at home and assess it, focus on the use of peak current meter, and record asthma diary if possible;
Learn to carry out simple emergency self treatment when asthma attacks;
Master the correct use of different suction devices;
Know what's going onNext shouldGo to the hospital for treatment;
Work with doctors to develop a plan to prevent asthma recurrence and maintain long-term stability.
Daily attention
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Attention of asthma patients in daily life: avoid contactAllergen: Use hot water to clean bed sheetssheets；No carpet, regular cleaningAir conditioning filter element；Do not raise animals at home, do a good job of indoor hygiene, and keep dry;pollenDuring the peak period, reduce going out, avoid respiratory tract infection, and avoid strenuous exercise and mood fluctuations to avoid inducing asthma attacks.
