Bronchial asthma(asthma bronchiale; Greek asthma, heavy breathing, suffocation) is a disease the main symptom of which is attacks or periodic states of expiratory suffocation caused by pathological hyperreactivity of the bronchi. This hyperreactivity manifests itself when exposed to various endo- and exogenous irritants, both those that cause an allergic reaction and those that act without the participation of allergic mechanisms. The above definition corresponds to the idea of bronchial asthma as a nonspecific syndrome and requires coordination with the tendency to preserve in diagnostic and treatment practice what developed in the USSR in the 60-70s. isolation from this syndromic concept of allergic bronchial asthma as an independent nosological form.
To relieve and prevent attacks bronchial asthma use bronchodilators orally or by inhalation. Orciprenaline sulfate (alupent, asthmapent) is used in the form of inhalations (1-2 breaths) or orally 1/4 - 1/2 tablets, fenoterol (Berotek), salbutamol (ventolin), as well as aminophylline, antasman, theophedrine, solutan, sometimes adrenaline . Salbutamol and ventolin in metered-dose manual inhalers are prescribed to children under 7 years of age in a single dose of no more than 1 breath, over 7 years - up to 2 breaths. Antastman and theophedrine are given to children from 2 to 5 years old 1/4 - 1/3 tablets per dose, from 6 to 12 years old - 1/2 tablets. A single dose of solutan is 1 drop per 1 year of life. If necessary, stop a moderate attack bronchial asthma adrenaline is administered in the form of a 0.1% solution subcutaneously at a rate of 0.01 mg by 1 kg child's weight in combination with a 5% ephedrine solution (at the rate of 0.5-0.75 mg by 1 kg masses). If there is no effect, the injection of adrenaline should not be repeated, because Usually we are talking about blockade of bronchial b-adrenergic receptors, which is often caused by frequent use of inhaled b-adrenergic agonists.
In case of a moderate attack, aminophylline is administered intramuscularly (24% solution) or diluted with a 2.4% solution in 50 ml isotonic sodium chloride solution for intravenous drip administration at the rate of 4-5 mg by 1 kg child's weight (no more than 5-7 mg by 1 kg weight per day). For severe attacks bronchial asthma in addition to aminophylline, prednisolone is administered intravenously at the rate of 2 mg by 1 kg masses. For asthmatic status, aminophylline is administered intravenously up to 15-20 mg by 1 kg weight per day; intravenous administration of prednisolone is repeated every 3-4 h(until 7-10 mg by 1 kg weight per day). Protease inhibitors and heparin are also used. In case of asphyxial syndrome, the patient is transferred to mechanical ventilation, and sputum is washed out of the bronchi through a bronchoscope. Sometimes hemosorption is used. Diphenhydramine and pipolfen can increase the viscosity of sputum, so they are prescribed only to young children who have bronchial asthma exudation and hypersecretion in the bronchi are pronounced and the sputum is rarely viscous.
In the interictal period, sanitation of foci of chronic infection is carried out, treatment with inhalation of intal or ketotifen (zaditen) orally for 3-6 months, as well as specific hyposensitization, and in case of polyallergies or an unidentified allergen - treatment with histaglobulin. Hardening and therapeutic exercises play an important role. Acupuncture is often effective. Sanatorium treatment in local specialized sanatoriums is indicated.
Children, sick bronchial asthma, are being monitored by a local pediatrician and an allergist.
The main difference in the prognosis in children is that with mild and moderate course bronchial asthma recovery occurs much more often than in adults (usually in the prepubertal period). Prevention in its principles does not differ from that in adults.
Bibliography: Balabolkin I.I. Bronchial asthma in children, M., 1985, bibliogr.; Respiratory diseases in children, ed. S.V. Rachinsky and V.K. Tatochenko, s. 381, M., 1987; Bronchial asthma, ed. M.E. Gershwin, trans. from English, M., 1984, bibliogr.; Kokosov A.N. and Streltsova E.V. Therapeutic physical culture in the rehabilitation of patients with lung and heart diseases, L., 1987; Therapeutic physical culture, ed. V.A. Epifanova, p. 135, M., 1987; Pytsky V.I., Adrianova N.V. and Artomasova A.V. Allergic diseases, p. 114, M., 1984; Respiratory allergoses in children, ed. S.Yu. Kaganova, s. 79, L., 1980; Chuchalin A.G. Bronchial asthma, M., 1985, bibliogr.; Shatalyuk B.P., Borisko A.S. and Kartysh A.P. Therapeutic exercise for bronchial asthma, Kyiv, 1985, bibliogr.
The purpose of the study is to determine the height of the apexes of the lungs in front and behind, the width of the Kroenig fields, the lower borders of the lungs and the mobility of the lower edge of the lungs. Rules for topographic percussion:
percussion is carried out from the organ giving a loud sound to the organ giving a dull sound, that is, from clear to dull;
the pessimeter finger is located parallel to the defined boundary;
the border of the organ is marked along the side of the pessimeter finger facing the organ that produces a clear pulmonary sound.
Determination of the upper boundaries of the lungs is made by percussion of the pulmonary apexes in front above the collarbone or behind the spine of the scapula. In front, a finger-pessimeter is placed above the collarbone and percussed upward and medially until the sound becomes dull (the fingertip should follow the posterior edge of the sternocleidomastoid muscle). From the back they percussion from the middle of the supraspinatus fossa towards the VII cervical vertebra. Normally, the height of the apex of the lungs is determined in front 3-4 cm above the collarbone, and in the back it is at the level of the spinous process of the VII cervical vertebra. The patient is in a standing or sitting position, and the doctor is standing. Percussion is performed with a weak blow (quiet percussion). Topographic percussion begins with determining the height of the apexes and the width of the Krenig fields.
Diagnosis of bronchial asthma: basic methods
Bronchial asthma is a chronic disease of the respiratory system associated with increased reactivity of the bronchi to certain environmental factors. Diagnosis of bronchial asthma is an important task in the daily practice of a general practitioner, since proper treatment can ensure control of the disease and the complete absence of symptoms of suffocation in patients.
Physical examination
First of all, the doctor must interview the patient, collect anamnesis, and, using methods of auscultation and percussion of the chest organs, make a preliminary diagnosis.
History taking
- As a rule, the disease begins at a young or childhood age; genetic prerequisites for the development of the disease can be traced. Blood relatives have other allergic diseases or bronchial asthma.
- The attack can be associated with the influence of a specific provoking factor (or factors), it develops acutely, shortness of breath with difficulty exhaling, and a feeling of congestion in the chest occur. Such a factor (trigger) can be physical effort, cold air, plant pollen, animal fur and skin, bird feathers, house dust, mold, certain foods and much more.
- Patients take a forced position. which facilitates the participation of auxiliary muscles in the breathing process. Whistling, labored breathing can be heard from a distance. An attack can last from several minutes to several hours; after inhaling a bronchodilator, normal breathing is very quickly restored. The attack ends with the discharge of a large amount of light, glassy sputum, which brings relief to the patient.
Patient examination
At the initial stages of the disease, examination of the patient does not provide any special findings in terms of confirming the diagnosis of bronchial asthma. However, with a long course of the disease and frequent attacks, a symptom such as “barrel chest” develops. Indeed, due to difficulty in exhaling, emphysema of the lungs gradually develops, their volume increases, and the chest expands.
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Treatment for bronchial asthma should be selected individually, taking into account the course of the disease,
Bronchial asthma
Bronchial asthma is a chronic disease that occurs with relapses, with predominant damage to the respiratory tract, which is based on chronic allergic inflammation of the bronchi, accompanied by their hyperreactivity and periodic attacks of difficulty breathing and suffocation as a result of widespread bronchial obstruction, which is caused by bronchospasm, hypersecretion of mucus, edema bronchial walls.
There are two forms of bronchial asthma - immunological and non-immunological - and a number of clinical and pathogenetic variants: infectious-allergic, atopic, autoimmune, adrenergic imbalance, dyshormonal, neuropsychic, primary altered bronchial reactivity, cholinergic.
Etiology and risk factors for bronchial asthma in children: atopy, bronchial hyperreactivity, heredity. Causes (sensitizing): household allergens (house dust, house dust mites), epidermal allergens of animals, birds, and other insects, fungal allergens, pollen allergens, food allergens, drugs, viruses and vaccines, chemicals.
The general pathogenetic mechanism is the altered sensitivity and reactivity of the bronchi, determined by the reaction of bronchial patency in response to the influence of physical, chemical, and pharmacological factors.
Topographic percussion of the chest
Using topographic percussion of the lungs, the following is determined:
a) lower borders of the lungs;
b) the upper borders of the lungs, or the height of the apexes of the lungs, as well as their width (Kroenig fields);
c) mobility of the lower edge of the lungs.
The volume of one or both lungs may increase or decrease in various diseases. This is detected by percussion by a change in the position of the pulmonary edges compared to normal. The position of the edges of the lungs is determined during normal breathing.
Rice. 30. Determination of the boundaries of the lungs:
a, b, c – lower front and back and its diagram;
d, e, f - upper front, back, and its measurement.
The lower boundaries of the lungs are set as follows. They recut, moving the pessimeter finger along the intercostal spaces from top to bottom (starting from the 2nd intercostal space) until the clear pulmonary sound is replaced by an absolutely dull sound. In this case, as noted, weak percussion is used. It is carried out along all identifying vertical lines on both sides, starting from the parasternal and ending with the paravertebral (Fig. 30, a, b). It is quite difficult to determine the lower edge of the lung along the left midclavicular and sometimes along the anterior axillary lines, since here it borders on the air-containing stomach. Having determined the position of the lower edge of the lung along all lines and marking this place with dots at the level of each of them, the latter are connected by a solid line, which will be the projection of the lower edge of the lung onto the chest (Fig. 30, c). The lower edge of the lung in a healthy person, when percussed in a vertical position, runs along the parasternal line on the right - along the upper edge of the VI rib, on the left - along the lower edge of the IV (here is the upper limit of absolute dullness of the heart), as well as along the right and left midclavicular lines - along the lower edge of the VI rib, along the anterior axillary - on the VII rib, middle axillary - on the VIII, posterior axillary - on the IX, scapular - on the X rib and along the paravertebral lines at the level of the spinous process of the XI thoracic vertebra.
Textbook of medicine / Propaedeutics of internal diseases / Bronchial asthma
Expiratory shortness of breath, characterized by sharply difficult exhalation, while the inhalation is short and the exhalation is prolonged; attacks of suffocation that occur at any time of the day, especially in frosty weather, in strong winds, during the flowering period of certain flowers, etc. paroxysmal cough with the discharge of a scanty amount of viscous glassy sputum. Attacks of suffocation last from several hours to 2 or more days (status asthmaticus).
Anamnesis in a patient with an infectious-allergic form of bronchial asthma: indications of past diseases of the upper respiratory tract (rhinitis, sinusitis, laryngitis, etc.), bronchitis and pneumonia, the occurrence of the first attacks of suffocation after them. The frequency of occurrence of asthma attacks in subsequent years is determined, their connection with cold and damp weather, acute respiratory diseases (influenza, bronchitis, pneumonia). The duration of the attack and interictal periods of the disease, the effectiveness of treatment in outpatient and inpatient conditions, the use of medications, and corticosteroids are assessed. Complications include the formation of pneumosclerosis, pulmonary emphysema, and the addition of respiratory and pulmonary-heart failure.
History of a patient with atopic bronchial asthma: exacerbations of the disease are seasonal, accompanied by rhinitis, conjunctivitis; Patients have urticaria and Quincke's edema, intolerance to certain foods (eggs, chocolate, oranges, etc.), medicines, odorous substances, and a hereditary predisposition to allergic diseases.
BRONCHIAL ASTHMA - chronic inflammatory disease of the respiratory tract, in which the bronchial tree becomes constantly sensitive (hyperreactive); occurs with attacks of suffocation. When bronchial hyperreactivity develops under the influence of various stimuli, bronchial obstruction develops as a result of the complex interaction of inflammatory cells (eosinophils, mast cells), mediators, on the one hand, and cells and bronchial tissues, on the other. It is caused by spasm of the smooth muscles of the bronchi, edema and swelling of the mucous membrane and blockage of the small bronchi with secretions; clinically, bronchial obstruction is manifested by exacerbation of the disease - cough, shortness of breath and characteristic attacks of suffocation.
Changes in the reactivity of the bronchi can be primary (congenital or acquired under the influence of chemical, physical, mechanical factors and infection) or secondary (as a result of changes in the reactivity of the immune, endocrine and nervous systems). In many patients, it is possible to identify heredity burdened by allergic diseases (atopy - the ability to increased production of immunoglobulin E in response to exposure to allergens), a history of infectious or allergic pathology (eczema, hay fever) In cases where the allergic nature of the disease is not associated with an infectious process, aromatic compounds play a special role among this group of allergens - odors. cosmetics, flowers, plant pollen, etc. Often an attack of bronchial asthma is provoked by house dust (the main allergic component is house mites) and epidermal allergens (dander and animal fur). Cold, nervous stress, physical activity, infection can also cause it. attacks of bronchial asthma. In patients with the “aspirin triad” (bronchial, aspirin intolerance, nasal polyps), any non-steroidal anti-inflammatory drug (aspirin, analgin, voltaren, etc.) can cause a severe attack of suffocation.
Clinical picture. The main symptoms of bronchial asthma are constant or recurring wheezing or difficulty breathing, a feeling of chest compression, and attacks of suffocation. Sometimes an attack of bronchial asthma is preceded by a bad mood, weakness, a feeling of congestion, soreness along the trachea, dry, itchy nose, sneezing, copious discharge of watery secretion from the nose, a feeling of chest immobility. However, as a rule, it occurs suddenly at any time of the day, more often at night: the patient wakes up with a feeling of tightness in the chest and acute lack of air. He is unable to push out the air filling his chest, and in order to enhance exhalation, he sits up in bed, resting his hands on it or on the knees of his lowered legs, or jumps up, opens the window and stands, leaning on the table, the back of a chair, thus turning on the act of breathing not only respiratory, but also the auxiliary muscles of the shoulder girdle and chest. The face is cyanotic, the veins are swollen; characteristic swelling of the wings of the nose when inhaling (especially in children). Already at a distance you can hear whistling sounds against the background of noisy, difficult exhalation. The chest seems to freeze in the position of maximum inspiration, with raised ribs, increased anteroposterior diameter, and bulging intercostal spaces. Upon percussion of the lungs, a box sound is determined, their boundaries are expanded, auscultation reveals a sharp prolongation of exhalation and extremely abundant various sounds (wheezing, rough and musical). Listening to the heart is difficult due to emphysema and an abundance of wheezing. normal frequency or accelerated, full, usually relaxed, rhythmic. Blood pressure can be low or high. The apparent enlargement of the liver, sometimes revealed by palpation, can be explained (in the absence of congestion) by its being pushed down by the inflated right lung. Patients are often irritated, fearful of death, and groan. A short-term increase in body temperature may occur. If the attack is accompanied by a cough, a small amount of viscous glassy sputum is difficult to clear.
The course of attacks, even in the same patient, can be different: from “erased” (dry, whistling with a relatively mild feeling of suffocation for the patient) and short-term (an attack lasts 10-15 minutes, after which it goes away on its own or through the use of dosed inhalations of beta- adrenomimetics) to very severe and prolonged, turning into an asthmatic state. The pathogenesis of the asthmatic condition is based on blockade of bronchial beta-adrenergic receptors and mechanical obstruction of the bronchi by sputum. The causes of the asthmatic condition may be uncontrolled use of sympathomimetics, abrupt interruption of long-term therapy with corticosteroids, abuse of sleeping pills, sedatives, use of narcotic analgesics and beta-blockers, exacerbation of a chronic or the occurrence of an acute inflammatory process in the bronchopulmonary apparatus.
The asthmatic condition lasts from several hours to many days. The attack does not stop, or the “light intervals”, when breathing becomes somewhat easier, are very short, and one attack follows another. The patient does not sleep, greets the new day sitting, exhausted, and without hope. Breathing remains noisy and whistling all the time, there is no sputum, and even if it is released, it does not bring relief. Beta-agonists, which previously quickly stopped the attack, do not work or provide a very short-term and insignificant improvement. There are (usually up to 150 beats per minute while maintaining the correct rhythm) a red-bluish complexion, the skin is covered with drops of sweat. An increase in blood pressure is often observed, which creates additional stress on the heart. A discrepancy between the obvious deterioration of the patient's condition and auscultatory data is characteristic: upon auscultation, a decrease or complete disappearance of wheezing is noted due to blockage of the small and medium bronchi with mucus plugs (“silent lungs”). Gradually the patient weakens, breathing becomes shallow, less frequent, the feeling of suffocation becomes less painful, blood pressure decreases and increases. There is a risk of developing a coma and respiratory arrest. Loss of consciousness may be preceded by the patient's agitation, stuporous state, etc.
Clinical criteria The asthmatic condition is thus a rapid increase in bronchial obstruction, increasing respiratory failure and lack of effect from beta-agonists. There are three stages of the asthmatic condition, based on the following criteria: Stage I - a prolonged attack of bronchial asthma with no effect from beta-agonists; Stage II is characterized by the appearance of “silent” zones on auscultation of the lungs; in Stage III, blood pressure develops and falls.
Diagnosis. The clinical picture of bronchial asthma with a characteristic triad of signs (breathing difficulties, wheezing) usually does not create diagnostic difficulties. Pulmonary function studies - spirometry, peak fluorimetry with assessment of indicators initially and after inhalation of beta-agonists - help to assess the degree of bronchial obstruction, its fluctuations and reversibility. Eosinophilia is detected in blood and sputum.
Differential diagnosis carried out primarily with cardiac asthma (see Dyspnea). It is very important not to forget that the signs of bronchial asthma - whistling against the background of noisy, difficult exhalation - can be a consequence of swelling and spasm of the bronchi that arose against the background of acute coronary insufficiency, hypertensive crisis, etc., i.e. in cases where it is possible think about the occurrence of left ventricular failure and cardiac asthma, accompanied by spasm of the bronchi and swelling of their mucous membrane.
In chronic lung diseases, for example, chronic bronchitis, emphysema, pneumosclerosis and cor pulmonale, periods of sharp increase in shortness of breath often occur; they can be distinguished from an attack of bronchial asthma by the absence of its characteristic signs (sudden onset, vigorous participation of auxiliary muscles in the exhalation phase, whistling, “musical” sounds against the background of sharply difficult exhalation). In these cases, there is no eosinophilia in the blood and sputum.
Sometimes it may be necessary to differentiate an attack of bronchial asthma and the so-called stenotic dyspnea, which occurs when there is scar narrowing of the larynx or bronchi, narrowing of their lumen due to compression from the outside by a tumor, aneurysm, or entry of a foreign body into the trachea or bronchi: this has an inspiratory nature (prolonged noisy inhalation, accompanied by retraction of the intercostal spaces, suprasternal and supraclavicular fossae), there is no acute emphysema and other characteristic symptoms of bronchial asthma. Finally, attacks of suffocation in nervous patients (“hysterical shortness of breath”) occur without orthopnea (patients can lie down), frequent shallow breathing is not accompanied by wheezing and sharply prolonged exhalation, the general condition of patients remains satisfactory.
Treatment bronchial asthma is aimed, on the one hand, at suppressing inflammation of the bronchial tree (basic therapy), on the other, at weakening or eliminating asthma symptoms by improving bronchial patency. The most important role is played by correct, systematic, ongoing treatment of the disease. First-line drugs include inhaled forms of cromolyn and nedocromil sodium, beta-agonists and corticosteroids. (Intal) and nedocromil sodium (Tyled) suppress the activation of mast cells and the release of mediators from them. The drugs are used in the form of a dosed aerosol, 2 breaths 4 times a day. Among inhaled beta-agonists, preference is given to long-acting drugs (Foradil, Serevent). Inhaled corticosteroids (beclomethasone, triamcinolone) are prescribed 2 puffs 4 times a day 5-10 minutes after the injection of beta-agonists. After using inhaled corticosteroids, mouth rinse is necessary (prevention of oral candidiasis). Chronic oral corticosteroids are a “desperate therapy” and should only be used when frequent severe asthma attacks continue despite maximal therapy. Long-term administration of hormones in tablets leads to osteoporosis, arterial hypertension, diabetes mellitus, cataracts, obesity and other complications. Long-acting theophylline preparations (retafil, teopek, etc.) are second-line drugs in the treatment of bronchial asthma. These medications are indicated for children and adults with severe manifestations of encephalopathy (when it is impossible to teach the patient how to use an inhaler), for severe shortness of breath (when it is impossible to take a deep breath), and for severe exacerbation of the disease (when it is necessary to maintain a constant concentration of the drug in the blood).
Therapy during an attack of bronchial asthma begins with dosed inhalations of short-acting beta-agonists (salbutamol, Berotec); in most cases, the effect is observed after 5-15 minutes. Beta-blockers relax the smooth muscles of the bronchi and reduce vascular permeability. The inhalation route of administration increases the selectivity of the action of drugs on the bronchi, allowing for maximum therapeutic effect with a minimum of side effects. - the most common complication of metered dose aerosol therapy; excitement and are rarely observed. It should be borne in mind that frequent use of short-acting beta-agonists can worsen the course of asthma; these drugs are the drug of choice for stopping an attack, but not for permanent therapy.
In order for the patient to independently stop mild attacks of bronchial asthma, he must be taught the correct technique for using the inhaler. Inhalation is best done while sitting or standing, tilting your head back slightly so that the upper respiratory tract straightens and the drug reaches the bronchi. After vigorous shaking, the inhaler should be turned upside down. The patient exhales deeply, clasps the mouthpiece tightly with his lips and, at the very beginning of the inhalation, presses the canister, after which he continues to inhale as deeply as possible. At the height of inhalation, you need to hold your breath for a few seconds (so that the medicine settles on the walls of the bronchi), then calmly exhale.
In the absence of inhalation agents or the impossibility of using an inhaler (for example, with a very pronounced decrease in the patient’s intelligence and the impossibility of teaching him how to use an inhaler), it is necessary to switch to the subcutaneous administration of a 0.1% solution of adrenaline, which often stops the attack within a few minutes after the injection. Therapy is started with small (0.2 - 0.3 ml of 0.1% solution) doses, if necessary, the injection is repeated after 15 - 20 minutes (up to three times). With repeated injections, it is important to change the injection site of the drug, since adrenaline causes local vascular contraction, which slows down its absorption. It should be borne in mind that sometimes intradermal (lemon peel) administration of adrenaline gives an effect in cases where the same dose of the drug administered subcutaneously did not bring relief. In elderly patients with atherosclerosis of the blood vessels of the brain and heart, even such a moderate dose of adrenaline as 0.5 ml of a 0.1% solution can cause vascular disorders and arrhythmia, so only small doses should be administered with careful monitoring of the state of the cardiovascular system. The possibility of a paradoxical increase in bronchospasm instead of the expected bronchodilator effect with frequent repeated administration of adrenaline limits its use in cases of prolonged intractable attack of bronchial asthma and asthmatic condition.
In case of a severe attack of bronchial asthma, as well as in cases where the use of high doses of beta-adrenergic agonists is impossible, it is advisable to start slow intravenous administration of 10 ml of a 2.4% aminophylline solution (1-2 ml per minute, or administered intravenously). Rapid administration of the drug may be accompanied by side effects (palpitations, pain in the heart area, a sharp drop in blood pressure, convulsions), which are especially dangerous in elderly patients with severe cerebral vascular sclerosis. The combined use of aminophylline and beta-agonists is not recommended, since the therapeutic effect is not enhanced and the risk of complications increases.
In cases where the attack is prolonged, turns into an asthmatic state, and conventional antispasmodic therapy is ineffective, further use of adrenergic agonists is contraindicated due to the possibility of a “ricochet” effect - increased bronchospasm due to functional blockade of beta-adrenergic receptors. In such a situation, hormonal therapy is necessary (hydrocortisone 250-300 mg or 90-120 mg intravenously in 200 ml of isotonic sodium chloride solution). The administration of corticosteroids is repeated every 2 hours; if there is no effect, oral hormones are added. Corticosteroids prevent or inhibit the activation and migration of inflammatory cells, reduce swelling of the bronchial wall, mucus production and increased vascular permeability, and increase the sensitivity of beta receptors of bronchial smooth muscle.
The issue of hospitalization is decided taking into account the general course of the disease and the patient’s condition during interictal periods. In case of an intractable attack and an asthmatic condition, the patient must be hospitalized immediately, since only in a hospital can the full scope of emergency care be applied, including, in especially severe cases, therapeutic bronchoscopy and forced ventilation (transfer to mechanical breathing). The method of transportation (patient position, accompaniment) depends on the patient’s condition.
The mortality rate for bronchial asthma is a fraction of a percent. The immediate cause of death may be blockage of mucus or phlegm in the bronchi, leading to acute asphyxia; acute failure of the right heart and blood circulation in general; gradually increasing suffocation as a result of lack of oxygen, accumulation of carbon dioxide in the blood, causing overexcitation and decreased sensitivity of the respiratory center. The development of these complications, signs of which may include increasing pain, the appearance of shallow breathing, weakening of breathing and a decrease in the number of dry rales during auscultation, the appearance of a thread-like pulse, swelling of the neck veins, swelling and severe pain in the liver, especially likely with a prolonged (so-called intractable) attack, and so more in asthmatic conditions.
The patient's condition is of moderate severity, the position is forced - orthopnea, no disturbances in posture and gait are observed. When examining the head and neck, no pathological changes are observed. Consciousness is clear, the patient responds adequately to the environment. The physique is correct, normosthenic. Height 158, body weight 75 kg.
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General information about the patient.
Last name First name Patronymic *****
Gender female
Education 9th grade high school
Profession pensioner, disabled Group II
Marital status married
Place of residence *****
Complaints.
- for severe shortness of breath during exercise
- attacks of suffocation accompanied by difficulty inhaling and exhaling
- persistent unproductive cough with viscous mucous sputum
- headaches and dizziness
- pain behind the sternum of a compressive nature, radiating to the left shoulder blade
- attacks of rapid heartbeat
- general weakness
- pasty feet
History of the disease ( ANAMNESIS MORBI).
The first attack of the disease was in 1978. When working with des. solutions, I felt an attack of suffocation, accompanied by difficulty in exhaling. After 6 months I went to see a doctor. A diagnosis of bronchial asthma was made and he was suspended from work with dez. solutions.
She received inpatient treatment: she underwent therapy in a halochamber, had a massage, and received 10 injections of aminophylline in the spring and fall. During this period, the patient notes improvements in her health.
In 2000, the patient received group 2 disability of a general disease.
Repeated cases of pneumonia, the last in October 2001. The patient notes an increase in temperature to 39 0 C, increased cough, shortness of breath, general weakness. She was treated as an inpatient and received antibiotic therapy and mucolytics. Based on therapy, my health status improved.
Exacerbations of the disease were observed in the autumn-spring period. The frequency of attacks increased (reaches 5-6 per year). After hypothermia, the patient notes increased coughing, increased sputum production, and a feeling of lack of air.
In June 2003 she was hospitalized in Kl. Vasilenko with a diagnosis of exacerbation of bronchial asthma. She received bronchodilators and benclomethasone, and as a result of therapy, her health improved.
In March of this year, I felt increased shortness of breath, a persistent unproductive cough, an attack of suffocation, and an increased need for β 2 Short-acting adrenergic agonists, for which reason she was hospitalized in Cl. Vasilenko.
History of life (AN AMNESIS VITAE).
Born in ******* region, mother's age at the time of birth was 33 years old, she was the 6th child in the family. She was breastfed and started walking until she was one year old. At 9.5 months she suffered from bilateral pneumonia. At the age of 6 I went to school. I studied well and did not lag behind in mental and physical development. I finished 7th grade and started working at the age of 12 due to the difficult financial situation in my family.
She worked at a construction site as a watchman, as a teacher in a kindergarten, in a canteen as a waitress, at the airport washed airplanes, in a laundry as an ironer, for 31 years she worked as an administrator in a boarding house and part-time as a cleaner there. Occupational hazards working with disinfectants. solutions, hydrochloric acid.
Eating without restrictions, irregular, frequency approximately 2-3 times a day, no addiction to spicy, fatty foods
Family history:Married since 22 years old. Has 2 children: daughter (44 years old), son (39 years old). Lives in a 2-room apartment with her husband, the apartment has central heating, sewerage, electricity, running water.
Gynecological history:Menstruation began at the age of 14, heavy, regular, painful, long-lasting. Pregnancies 8, births 2, abortions 6. At 50 years old hysterectomy.
Past diseases:At 9.5 months she suffered from bilateral pneumonia. 1959 puncture of the maxillary sinus, 1963 appendectomy, 1983 surgery for fibrocystic mastopatitis, 1988 hysterectomy for fibroids, since 1990 he has suffered from hypertension, angina pectoris. Against the background of slight physical exertion, shortness of breath, headache, pain behind the sternum, and blood pressure at rest appear 170\100. The patient takes nitrosorbide, validol, and preductal with good effect. In 1998, she was hospitalized for otitis in a district clinic, received antibiotic therapy, and subsequently developed right-sided hearing loss. Since 2000, the patient has been suffering from hemorrhoids, has an anal fissure, complains of pain during defecation, and stool contains blood. Suffering from chronic cholecystitis.
Allergy history:Quincke's edema on rheopirin.
Heredity:The mother died at the age of 77 from pneumonia, the father died at the front in 1941. The maternal grandparents died early, the patient does not remember the cause of death. My paternal grandfather suffered from dust allergies.
Bad habits: The patient denies.
STATUS PRAESENTS.
The patient's condition is of moderate severity; the position is forced; there is orthopnea; there are no disturbances in posture or gait. When examining the head and neck, no pathological changes are observed. Consciousness is clear, the patient responds adequately to the environment. The physique is correct, normosthenic. Height 158, body weight 75 kg.
Body temperature: 36.7 "C.
The skin is pale, cyanosis of the lips, acrocyanosis, a large pulsating hemangioma on the back, painful on palpation, multiple papillomas throughout the body, no skin rashes are observed. The skin is elastic, normal moisture. Hair growth is not affected. The nails are not changed. Visible mucous membranes are not changed: the oral cavity is pink, without rashes. There is no coating on the tongue. Subcutaneous fat is moderately developed and evenly distributed. The mammary glands are not visually changed. Swelling of the legs, pasty feet.
Upon examination lymph nodesnot visible. Occipital, postauricular, parotid, submental, superficial cervical, supraclavicular, axillary, ulnar, inguinal, popliteal lymph nodes are not palpable; single submandibular lymph nodes are palpated, equally pronounced on both sides, 1 cm in diameter, soft-elastic consistency, painless, not fused with surrounding tissues.
Skeletal systemupon examination of the bones of the skull, chest, spine, pelvis, and limbs, no deformation or pain was noted.
Muscular systemis developed normally, but there is general muscle wasting. Hyperkinetic disorders are not detected. There is no pain on palpation.
Joint examination:joints have a normal configuration; swelling, deformation, pain on palpation, redness of the skin in the joint area, and changes in periarticular tissues are not observed. The range of active and passive movements in the joints is completely preserved; There is no pain, crunching or crepitus during movements.
Respiratory system examination
Breathing through the nose is free, there is no feeling of dryness in the nose, there is no discharge from the nasal passages; There are no nosebleeds, the sense of smell is preserved. No pain was noted at the root and dorsum of the nose, in the area of the frontal and maxillary sinuses. The voice is loud and clear. Persistent, unproductive cough with the discharge of viscous mucous sputum. The cough is worse in the morning.
The chest is barrel-shaped, symmetrical, with slight kyphosis. The anteroposterior size is increased, the intercostal spaces are increased, the course of the ribs is close to horizontal, the supra- and subclavian fossae are poorly defined, equally pronounced on the right and left. The epigastric angle is obtuse. The shoulder blades fit tightly to the chest. Accessory muscles are not involved in the act of breathing. Excursions of the chest +\- 1 cm. Type of breathing is mixed, predominantly thoracic; breathing rate 24 per minute, breathing rhythm is correct. Voice tremors are diffusely weakened.
Palpation: there is no pain in the chest; elasticity is normal. Comparative percussion: percussion box sound over the entire surface of the lungs.Topographic percussion:bilateral descent of the lower border of the lungs:
|
Topographical |
Right lung |
Left lung |
|
parasternal |
V II intercostal space |
|
|
midclavicular |
VI II rib |
|
|
anterior axillary |
VIII rib |
VIII rib |
|
middle axillary |
IX rib |
IX rib |
|
posterior axillary |
X edge |
X edge |
|
scapular |
X I rib |
X I rib |
|
paravertebral |
spinous process of the XI thoracic vertebra |
The mobility of the pulmonary edges is reduced by 1 cm:
|
Topographic lines |
Mobility of the lower edge of the lung, cm |
|||||
|
Right |
left |
|||||
|
while inhaling |
on |
in total |
while inhaling |
on |
in total |
|
|
midclavicular |
12 |
12 |
24 |
|||
|
middle axillary |
23 |
23 |
46 |
23 |
23 |
46 |
|
scapular |
12 |
12 |
24 |
12 |
12 |
24 |
Width of Krenig fields:on the right 6 cm, on the left 6.5 cm.
The height of the tops and the width of the Krenig fields have been increased.
Standing height of the apex of the lungs:
|
Right |
Left |
|
|
Front |
4 cm above the level of the collarbone |
4.5 cm above the level of the collarbone |
|
Behind |
At level V I ost. neg. cervical vertebra |
1 cm above the level of the rest. neg. V II vertebra |
Auscultation: Breathing is harsh, weakened over the entire surface of the lungs, exhalation is prolonged. Dry whistling (treble) scattered rales, in the lower parts on both sides there are not ringing moist fine bubbling rales.
Circulatory system
Examination of the heart area:there is no cardiac hump, cardiac impulse, pulsation in the epigastrium are not visible.
Palpation the apex beat is not detected. There is no heartbeat, epigastric pulsation, or cat purring. Percussion: limits of relative dullness of the heart:the right border is 2 cm outward from the edge of the sternum, the left (2 cm inward from the midclavicular line in the VI intercostal space) and the upper (lower edge of the III rib) - the borders are shifted to the right;limits of absolute dullness of the heartnot determinedvascular bundle width6.5 cm (second intercostal space 2 cm from the right edge, 1 cm from the left edge of the sternum).
Auscultation: Muffled heart sounds, systolic murmur at all points of auscultation.
Blood pressure 170/100 (on both arms). Auscultation of the arteries revealed no pathological changes. Pulse on the radial artery regular, soft, complete, alternating; frequency 96 beats per minute; the same on both hands. There is no pulse deficit. There is no capillary pulse.
The veins of the neck are swollen. Varicose veins of the leg.
Digestive system
At the time of supervision there are no complaints, the appetite is good, taste sensations are not changed. There is no thirst. Chews food well, does not notice pain when chewing; Swallowing is free and painless. Bowel activity is regular. Stool every day, in the evening; stools have a regular consistency, brown in color, with small amounts of blood (hemorrhoids). The passage of gases is free and moderate.
The pharynx is pink in color, the tonsils do not protrude beyond the palatine arches, the mucous membrane of the pharynx is not hyperemic, moist, its surface is smooth.
Abdominal examination: the stomach is of normal shape and symmetrical. No pathological peristalsis, skin changes, or scars were noted. The muscles of the abdominal wall are involved in the act of breathing. There are no limited protrusions of the abdominal wall during deep breathing.
Palpation: at superficial indicative palpationthe abdomen is soft and 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 are noted.
Deep methodical sliding palpation of the abdomenThe sigmoid colon is palpated in the left groin area at the border of the middle and outer thirds linea umbilicoiliaceae sinistra over 15 cm, cylindrical in shape, 2 cm in diameter, densely elastic consistency, with a smooth surface, mobile within 45 cm, painless and non-rumbling. The cecum is palpated in the right groin area in the middle third linea umbilicoil i aceae dextra over 12 cm, cylindrical in shape, 3 cm in diameter, densely elastic consistency, with a smooth surface, mobile within 34 cm, painless and non-rumbling. The remaining parts of the colon are not palpable.
Percussion: tympanitis of varying severity is noted. Mendel's sign is negative.
Auscultation: Normal peristaltic bowel sounds are heard.
Percussion of the borders of hepatic dullness: liver dimensions (according to Kurlov): 9-8-7 cm.Liver palpation:the liver is palpated 1 cm below the edge of the costal arch (along the right midclavicular line); the edge of the liver is dense, smooth, rounded, painless.
The gallbladder is not palpable, there is no pain on palpation at the point of the gallbladder. Symptoms of CourvoisierTerrier, Ortner, Zakharyin, Vasilenko, Murphy, Georgievsky-Mussy are negative.
Percussion of the spleen:along the scapular-umbilical line, the length of the spleen is 10 cm; the spleen is not palpable.
Urinary system
At the time of supervision there are 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.
Endocrine system.
Thirst, appetite is not increased. The nature of hair growth according to the female type. There is no tremor of the fingers, eyelids, or tongue. The thyroid gland is not enlarged. Graefe and Mobius symptoms are negative.
Nervous system
At the time of supervision there are no complaints. The patient is oriented in space, time and her own personality. Perception, attention, memory are not impaired. Behavior is appropriate.
Sleep is disturbed due to frequent coughing attacks. There is no loss of sensitivity.
List of consultants.
General blood test. 03/25/04
Hemoglobin 125 g/l 130 175 g/l
red blood cells 4.0 * 10 12 \l 3.9* 10 12 4.6* 10 12 \ l
CPU 0.93 0.8 1.05
leukocytes 5.3* 10 9 \l 4.0*10 9 9.0*10 9 \l
neutrophils 43%
lymphocytes 32% 19 37%
monocytes 5% 3 11%
eosinophils 20% 0.5 5%
platelets 250*10 9 \l 180 320 *10 9 \l
ESR 5 mm/h 2 -15 mm/h
Biochemical blood test. 03/25/04
total protein 6.6 g/dl 6.5 8.5 g/dl
albumin 3.8 g/dL 4 5 g/dL
Glucose 100 mg/dL 60 100 mg/dL
creatinine 0.8 mg/dL 0.5 1.6 mg/dL
uric acid 4.3 mg/dl 2 - 6.4 mg/dl
cholesterol 175 mg/dl 120 250 mg/dl
triglycerides 47 mg/dl 50 - 250 mg/dl
VLDL-C 9.4 mg/dL 10 - 13 mg/dL
ALT 12 units/l 5 - 30 units/l
AST 11 units/l 8 - 40 units/l
ALP 61 units/l
sodium 144 mmol/l 130.5 156.6 mmol/l
HbsAg , RPR will put 4+, RPGAwith treponemal antigen weakly positive, ELISA - negative.
Immunoglobulins.
A 250 mg\%, M 234 mg\%, C 1050 mg\% A 103 104 mg\%
M 55 -141 mg\%
Coagulogram within normal limits. G 664 1400 mg\%
General urine analysis. 03/25/04
beat weight 1011 ml (N 800-1500ml) no red blood cells ( N)
glucose no (N ) epithelium. class flat a little
acetone negative (N ) bacteria a little ( N)
protein negative (N ) mucus moderately ( N)
bile pigments negative ( N)
leukocytes unit. in sight ( N)
Stool analysis. 03/26/04
Within normal limits: occult blood negative, reaction to stercobilin negative, worm eggs, protozoa not found.
Sputum analysis. 03/25/04
Consistency viscous Leukocytes 10-20 in a cluster
Character mucous No red blood cells ( N)
The smell is normal. Macrophages are the same. ( N)
color gray Epithelium: cyllind. A little ( N)
there is no Kurshman spiral ( N ) flat meaning quantity
There are no Charcot-Leydan crystals ( N ) Eosinophils in a cluster up to
elastic fibers, atypical class No ( N ) sparsely
B.K. no (N)
Sputum culture: Streptococcus pneumonia 10 7 , Streptococcus gr. Viridans 10 7
ECG. 03/26/04
Sinus rhythm with heart rate 75 per minute. Normal EOS.
FVD dated 03/29/04
Mixed form of ventilation failure with severe obstruction at the level of all bronchi.
VC 43%
FEV 1 27%
PSV 16%
MOS 75%-13%
MOS 50%-13%
MOS 25%-18%
ECHO-KG26.03.04
The aorta is dense, sclerotic, dilated to 4.0 cm (in the ascending section up to 3.6 cm).
LA 4.2 cm,
LV 4.7 cm,
IVS 1.3-1.4 cm,
ZS 1.15cm,
GOC 2.5,
PP - 4.4 cm.
PV 70%,
MPAP 50 mm Hg.
UO 56 ml.
Conclusion: Compared to June 2003 data. - pulmonary hypertension increased. Signs of venous return deficiency appeared.
Ultrasound of the abdominal cavity from 03/27/04
Severe flatulence. Free fluid in the abdominal cavity is not detected. The left lobe of the liver is 58+81 mm, the right one is 106+160 mm, smooth contours, parenchyma of increased echogenicity, compacted along the portal tracts. The portal vein is 10.4 cm. The gallbladder is 97 x 40 mm, the walls are compacted, thickened, the bile is heterogeneous with small dense inclusions. The pancreas is of normal size, smooth contours, parenchyma with steatosis. The spleen is not enlarged. Both kidneys are located lower than usual, dimensions 115 x 54 mm, wavy contours, uneven parenchyma 14020 mm. The abdominal aorta is not dilated, the hepatic veins are 11 mm.
ENT consultations from 03.25.04
Allergic rhinitis. Right-sided chronic sensorineural hearing loss. Chronic subatrophic pharyngitis. Aldecin is recommended 1 breath x 2 times a day.
Computed tomography from 03/26/04
The chest is enlarged in sagittal size. No foci of infiltrative changes were identified. The middle lobe is slightly reduced in volume, the bronchi are brought closer together, the walls are thickened and compacted due to fibrosis, the lumens are preserved. In the mediastinal projection of the posterior segment of the upper lobe of the left lung against the background of limited fibrosis, cylindrical bronchiectasis is determined4-6mm without signs of peri-focal inflammation, interlobar pleura is compacted and tightened. In the remaining parts of the lungs, pneumatization and vascularization of the lobes and segments are not changed. The thickening of the walls of large bronchi with the presence of small nodules of bone density is determined. Similar changes, but to a lesser extent, are observed in the trachea. The differentiation of the mediastinum and the roots of the lungs is preserved. Intrathoracic lymph nodes are not enlarged. There is no effusion in the serous cavities. The shape and size of the heart correspond to the patient’s age, the pericardial layer is thin. The skeletal structure of the studied level is without any features. Main vessels of regular caliber.
Conclusion: changes revealed by CT examination may correspond to osteoplastic tracheobronchopathy (FBS is required). CT scan shows signs of peribronchial fibrosis of the middle lobe, local deforming bronchitis with the formation of cylindrical bronchiectasis in C2 of the left lung.
Clinical diagnosis and its rationale.
Bronchial asthma, mixed form, severe, exacerbation stage. Chronic obstructive bronchitis, exacerbation stage. Cylindrical bronchiectasis C2 of the left lung. Emphysema. Pneumosclerosis. DN II Art. Chronic cor pulmonale, stage of decompensation.
IHD: exertional angina III F.K. Atherosclerosis of the aorta, coronary and cerebral arteries. Atherosclerotic cardiosclerosis. Hypertension II Art. NK II A. Right-sided chronic sensorineural hearing loss.
- Bronchial asthma, mixed form, severe, exacerbation stage.
Periodically occurring attacks of suffocation with difficulty in exhaling. Eosinophilia in the general blood test, the presence of eosinophils in the sputum. Dry whistling (treble) scattered rales in the lungs. Frequent and long periods of exacerbation (5-6 times a year), exacerbation of the disease in the autumn-spring period. Allergic rhinitis (ENT consultation). Elevated concentrations Ig A, Ig M (according to biochemical blood analysis).
Periodic attacks of suffocation were initially associated with exposure to allergic factors - disinfection solutions (occupational hazards), then attacks of suffocation occur after hypothermia, apparently also due to the addition of a bacterial infection frequent pneumonia (spasm -> swelling + germs -> inflammation) and bronchitis begins to play a role in bronchial obstruction (sputum is copious, viscous, mucous in nature). Thus, asthma attacks are associated with exposure to various types of allergens and sensitization of the body to infectious factors, which is a mixed form of bronchial asthma.
- Chronic obstructive bronchitis.
Persistent, unproductive cough, with the discharge of mucous sputum, worsening after hypothermia. Expiratory shortness of breath that occurs after slight physical exertion. Hard breathing, whistling dry wheezing, a small amount of moist fine bubbling wheezing (there is sputum). Reduced external respiration rates. The presence of predisposing factors frequent pneumonia.
- Cylindrical bronchiectasis C2 of the left lung (based on CT data), cough, worse in the morning.
- Emphysema.
Barrel-shaped chest, decreased mobility during breathing, weakened vocal tremor, 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, weakening of vesicular breathing.
- Respiratory failure II Art.
Shortness of breath that occurs with little physical exertion. Lip cyanosis, acrocyanosis. Mixed type: because both speed indicators of external respiration (FEV1-27%) and volumetric indicators (VC 43%) are reduced.
Literature.
- A.L. Grebnev “Propaedeutics of Internal Diseases”: Textbook. - 5th edition, Medicine, 2001.
- Ivashkin V.T. Sheptulin A.A. "Propaedeutics of internal diseases"
- A.L. Grebnev A.S. Trukhmanov “Handbook of main clinical symptoms and syndromes”, Moscow 1991.
- A.L. Grebnev A.A. Sheptulin “Direct examination of the patient”, Textbook, Moscow 1992.
PAGE 18
grandfather was sick, suffered from dust allergies
father, died at the front
sick, suffering br. asthma
mother, died at age 77 from pneumonia
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Bronchial asthma is a disease of the chronic respiratory system, which is characterized by a high level of bronchial reactivity to a number of certain environmental irritants. Diagnosis of this disease is an important component for each patient, since based on the data obtained, the attending physician prepares a treatment that can not only minimize, but also completely eliminate attacks of suffocation.
You can find out more about bronchial asthma at the following link:
Auscultation: highlights
Auscultation - listening to sounds. It is a diagnostic examination that is necessary for bronchial asthma. This method allows the attending physician to listen to the patient’s lungs and, based on the sounds heard during breathing, determine the severity of the disease. Auscultation of the lungs is carried out in two main ways:
- Direct method, characterized by the doctor listening to the patient with his ear attached to the body
- An indirect method in which a stethoscope is used for listening.
Modern medicine uses an indirect diagnostic method to detect bronchial asthma, since it allows one to obtain more reliable data, on the basis of which one can obtain a complete picture of the ongoing disease. By auscultating the patient's chest area, the specialist analyzes all the noises that appear during breathing, both during inhalation and exhalation. All research results are reflected in the patient’s outpatient record.
For a more accurate examination, the doctor performs auscultation in a standing and sitting position. For weak patients, listening with a stethoscope can be done in a lying position, but the doctor must examine the breathing of all parts of the chest, so it is important that the patient takes deep breaths.
Carrying out the procedure for bronchial asthma
A number of cases require additional examination of the patient’s breathing and conducting bronchophony, which is a special type of listening to the lungs. During the procedure, the patient must whisper words containing the letters “P” and “C”. If, with the help of a stethoscope, the doctor can easily distinguish the words that the patient speaks, then this indicates the presence of compaction in the lung area, as well as the presence of hollow spaces. These symptoms correspond to bronchial asthma in the patient. In the absence of any pathologies in the lung area, when listening, the doctor will hear only soft hissing sounds, but not words.
After listening to the chest, the doctor should examine the data obtained:
- At two points of the lungs located symmetrically, the noises are the same or not
- What type of noise is it at each of the listened points?
- Is there any extraneous noise that is not typical for bronchial asthma?
To diagnose this pathology of the respiratory system, auscultation is practiced for each patient, although today there are a number of more accurate diagnostic tests, such as radiography. The patient's breathing may be accompanied by three types of noises:
- Basic
- Side effects
- Noises arising from friction of the pleura.
Side noises
Adverse noises are divided into two main types: wheezing and crepitus. Depending on the nature of the secretion that predominates in the patient’s lungs, wheezing can be dry or wet. Dry wheezing occurs when the bronchial lumen is narrow. This symptom can be observed in patients with asthma and inflammatory processes occurring in the tissues of the lungs.
Wheezes are divided into low and high. Depending on the force with which the patient breathes, wheezing can be heard at a certain distance. The impulsiveness of wheezing in asthma is so strong that it can be clearly heard even at a distance of several steps from the patient.
Bronchial asthma is characterized by the fact that wheezing is evenly distributed over the entire area of the lungs, and is not localized in small areas, which is typical for tuberculosis. Dry wheezing may disappear for a while, but then appear again. They are heard during the patient's breathing, both during inhalation and exhalation.
If there is any fluid (sputum, blood, etc.) in the lung area. then this is the cause of the formation of moist rales. When the patient breathes, the air flow, passing through the fluid in the lungs, forms wheezing of a “gurgling” nature. The place of their formation is the cavity of the lungs. They are heard when the patient breathes, but experts prefer to do this while inhaling.
If you listen to a patient with bronchial asthma during an attack, you will notice not only slow and heavy breathing, but also scattered dry wheezing. The reason for this phenomenon was the fact that during an attack, different parts of the bronchial tree begin to narrow to varying degrees. In the intervals between asthma attacks, wheezing may not be heard at all.
Percussion
Percussion, which is carried out for bronchial asthma, is a diagnostic study, the essence of which is to tap areas of the lungs. The sounds that appear during this process make it possible to determine the hardness, elasticity and airiness of the lung tissue.
Percussion of the lungs is carried out by a specialist in the area where the lung tissue should fit tightly to the walls of the lung. It is in these places that when tapped, a clear and distinct sound should appear. When a doctor examines a patient's breathing with asthma, these areas cannot always be accurately identified. In order to identify any pathological processes occurring in the lungs, the specialist conducts comparative percussion, after which topographical percussion allows one to determine the boundaries of the lungs and the mobility of the lower edge.
In asthma, tapping the chest produces a high-pitched sound, like an empty box. This is a sign of a large amount of air accumulating in the lungs.
Bronchial asthma can be determined using several diagnostic procedures, each of which has characteristic signs of the presence of this disease.
