Additional methods of examination

Clinical blood analysis: without significant changes, sometimes secondary erythrocytosis; in progression assess leukocytosis, neutrophilia, accelerated ESR, eosinophilia (allergic reaction).

Sputum analysis: the character of the sputum depends on the stage of disease: in initial stage the sputum is mucous; in progression or later stage - muco-purulant, tenacious or tenacious thick consistency, glass-like or with yellow traces, odorless and absent of layersness. In microscopic study are revealed a lot of columns ciliated epithelium, leucocytes, alveolar macrophages, eosinophils, fibrin fibers, Charcot-Leyden crystals and large amount of microorganisms (bacterial flora).

X-ray examination: augment and deformity of lung picture over increased in transparent lung tissue.

Test of ventilatory function (spirometric recording and pneumotachymetry): in patients with no obstructive bronchitis results of spirometric recording is comparable with healthy subjects; in patients with bronchial obstruction assess decreased respiratory reserve (75 % of maximum lung ventilation and lower), and decreased Votchal-Tiffeneau index.

ECG: deviation of electric axis of the heart to the right, P-pulmonale in II, III, AVF leads.

Bronchial asthma

A pulmonary disease characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli. Obstruction persisting for days or weeks is known as status asthmaticus.

In the base of the disease lays chronic inflammatory process in bronchi due to the bronchi smooth muscles spasm (acute obstruction), mucus edema (subacute obstruction) and bronchi obstruction by tenacious secret (chronic obstruction). On longterm duration of disease via fibrosis in bronchial wall develops sclerotic obstruction.

Etiology

/. The risk factors:

- genetic factors;

- atopia (ability of the organism to the increased production of IgE owing to the allergens);

- bronchi hyperreactivity.

//. The cause factors:

- allergens;

- endogenous factors;

- impaired arachidonic acid metabolism;

- bronchi hyper reactivity to physical load;

- nervous and psychological factors;

- dyshormonal state.

///. The initiate factors:

- respiratory infections;

- airs pollutants;

- smoking.

Classification

Bronchial asthma is classificated according to the complex of clinical and functional signs of bronchial obstruction.

Category	Symptoms	Pulmonary Function
Mild intermittent	Symptoms ≤ 1 times a week No symptoms and normal PEF between exacerbations Exacerbations brief (from a few hours to a few days); intensity may vary Nighttime symptoms ≤ 2 times a month	FEV1 or PEF ≥ 80% predicted PEF variability < 20%
Mild persistent	Symptoms > 1 times a week but not daily Exacerbations that sometimes limit activity Nighttime symptoms > 2 times a month	FEV1 or PEF ≥ 80% predicted PEF variability 20-30%
Moderate persistent	Daily symptoms Daily use of inhaled short-acting β2-agonist Exacerbations that limit activity Exacerbations ≥ 2 times a week; may last days Nighttime symptoms > 1 time a week	FEV1 or PEF > 60% predicted PEF variability > 30%
Severe persistent	Continual symptoms Limited physical activity Frequent exacerbations Frequent nighttime symptoms	FEV1 or PEF ≤ 60% predicted PEF variability > 30%

FEV¹ - forced expiratory volume in 1 second; PEF - peak expiratory flow.

Classification of the bronchial asthma aggravations (according to the anamnesis, intensity of the clinical signs, respiratory and cardiovascular dysfunction):

Degree I- effortless;

Degree II- moderate grave;

Degree III - grave;

Degree IV- risk of breathing stop.

Symptoms	Effortless	Moderate grave	Grave	Risk of breathing stop
Dyspnoea	At walking	At speaking	At rest	-
Conversation	Sentences	Phrases	Words	-
Consciousness	Normal	Exiting	Exiting	Deranged
Breathing rate	Increase	Increase	>30/min	-
Participation of the additional muscles	Absent	Present	Present	Paradox thoracoabdominal breathing
Whistling breathing	At the end of expiration	Loud	Loud	Absent
Pulse/min.	<100	100-120	>120	Bradycardia
FEV1 after taking broncholytic, % from normal level	> 80 %	60-80 %	< 60 %	Absent
PaO2	Normal	>60 mm Hg	<60 mm Hg	-
PaCO2	<45 mm Hg	<45 mm Hg	>45 mm Hg	-