Acute bronchitis usually occurs soon after an acute respiratory illness (ARVI). First, the patient has symptoms characteristic of SARS, then after 3-4 days a cough appears. And often it is paroxysmal, painful, dry. A little later, a dry cough is replaced by a cough with mucopurulent sputum. With the transition of inflammation to the larynx, the cough becomes barking, hoarseness appears.

After painful coughing, there is a feeling of rawness in the chest. Body temperature is usually normal or moderately elevated for 2-3 days. When acute bronchitis is complicated by pneumonia, chills and fever occur, and the temperature rises to 39 ° and above. When the bacterial flora is attached to viral bronchitis, the course of the disease changes: a high temperature persists for a long time, fever is observed, cough with sputum, in which there may be streaks of blood. But such a severe course of acute bronchitis is rare, usually in very young or, conversely, very old people. The acute form of the course of the disease can manifest itself in debilitated patients. The duration of acute bronchitis is 7-14 days.

In the treatment, acetylsalicylic acid (aspirin), ascorbic acid, vitamin A (retinol) is used. Oxolinic ointment, which is a good antiviral agent, is used at the very beginning of the disease. If the disease has gone far, then antibiotics are used: tetracycline, oleandomycin, as well as sulfanilamide preparations - biseptol, sulfadimezin, suldimethoxin.

In addition to these drugs, expectorants, mainly of plant origin, are prescribed to patients without fail. These are marshmallow root, wild rosemary grass, anise fruits, elecampane rhizome, oregano grass, coltsfoot and plantain leaves, licorice root, pine buds, thermopsis grass, violets, thyme. In addition to them, you can apply special nursing fees.

Those who do not tolerate herbs or cannot use them due to allergic reactions are prescribed drugs mukaltin, bromhexine, bisolvon, broncholitin.

In addition, home physiotherapy is very important: mustard plasters on the chest and back, circular jars, paraffin or mud applications. In severe cases of the disease, erythromycin, ampicillin, biseptol-480 are used.

After passing through the acute stage of the disease, therapeutic massage is prescribed 3-4 times a week. As you recover, massage is applied 1-2 times a week (prophylactic or general health).

Acute pneumonia

Acute pneumonia is an inflammation of the lung tissue, mainly of a bacterial nature.

In some cases, the disease begins suddenly, against the background of complete health, with an increase in body temperature to 39-40 °, chills, chest pain, cough, initially dry, then with sputum, sometimes with hemoptysis. This is croupous pneumonia.

Clinic of focal pneumonia: fever, chills, cough. But it does not begin as suddenly as croupous pneumonia. Usually, a few days before this, signs of SARS or flu appear: runny nose, cough, malaise, aches all over the body, and a slight temperature. The second wave of the disease is characterized by fever, increased cough, weakness, and sweating.

In some cases, pneumonia is characterized by a somewhat blurred picture of the course of the disease. Under the guise of SARS, pneumonia can be hidden. Its signs: low temperature, weakness, malaise, moderate cough.

In all cases, you should consult a doctor, since only after listening to the patient, x-ray examination and blood test, you can diagnose acute pneumonia and choose a remedy for treatment.

For all types of acute pneumonia, antibiotics must be used, which are best administered by injection several times a day. In addition, expectorants, bronchodilators that promote sputum separation, as well as physiotherapeutic methods are used.

After recovery, it is necessary to take multivitamins for a month. This is due to the fact that during an illness, antibiotic treatment kills many beneficial microorganisms that produce B vitamins.

With pneumonia, special attention is paid to the diet of the patient. Medical nutrition, prescribed in combination with pharmacotherapy, usually contributes to the extinction of the inflammatory process, reduces intoxication of the body, and spares the organs of the cardiovascular system and the digestive tract. When prescribing a diet, the condition of the patient and the stage of the disease are taken into account. After recovery, you can apply a complex of cleansing diets (they will be discussed below).

After the acute phase of the disease has passed, therapeutic massage and physical education are prescribed. At the stage of recovery, they should be used without fail so that the body can return to normal functioning. It is recommended to do breathing exercises daily, to do exercises that increase the mobility of the chest and improve breathing. Such exercises help stretch possible adhesions after pneumonia, strengthen the respiratory muscles and abdominal muscles. Such gymnastics is recommended for everyone, but it is especially important for the elderly, since fluid stagnation can occur in the lungs, and this, in turn, worsens breathing and can cause a relapse of the disease.

It is to remove congestion in the lungs that therapeutic massage is used. You should not refuse it, even if it seems that the body will cope with the disease without it. Massage will help speedy recovery, as well as strengthen the body as a whole.

During the recovery period, it is necessary to be in the fresh air as much as possible. Timely begun and correctly carried out treatment of pneumonia in most cases leads to complete recovery. This occurs 3-4 weeks after the onset of the disease. After recovery, special attention should be paid to preventive measures to prevent a recurrence of the disease. In the case of a complicated course of pneumonia, the patient needs to be under the supervision of a doctor for 6-12 months, periodically undergo control X-ray examinations of the lungs, and also do a blood test.

Chronical bronchitis

Chronic bronchitis is a disease in which chronically occurring inflammatory processes are accompanied by a cough with sputum. Before making a diagnosis, the patient is observed by a doctor for about 3 years.

Currently, the treatment of chronic bronchitis is a major medical problem, as the level of morbidity (and, unfortunately, mortality) is increasing every year.

According to doctors, one of the main causes of the disease is smoking (in 82% of patients). Other causes of bronchitis include air pollution and occupational factors.

Air pollution is mainly due to the entry into the atmosphere of waste from modern production, exhaust gases; Usually SO2, NO2 and smoke concentrations are used as indicators of air pollution.

Of the professional factors, the most important is the dust content of industrial premises with organic (cotton, flour) and inorganic (coal, quartz, cement, etc.) dust, toxic vapors and gases (ammonia, chlorine, acids, sulfur dioxide, carbon monoxide, ozone, phosgene and etc.). The high air temperature in hot shops, drafts, low temperatures and other features of the microclimate in production also adversely affect. Of great importance in the occurrence of chronic bronchitis are viral and bacterial infections.

What effect do the listed pathological factors have on the bronchi? The surface area of ​​the lungs is 500 m2. During the day, 9000 liters of air pass through the lungs (Fig. 1). Resistance to constant external factors (dust particles, microbes, toxic substances) is provided by a complex defense mechanism, which in chronic bronchitis is depleted and ceases to function due to exposure to constant stimuli. As a result, thick viscous mucus accumulates in the bronchi, which clogs the small bronchi and prevents the passage of air to the large bronchi (Fig. 2). Stagnation in the bronchi and the penetration of infection cause an inflammatory process. The carriers of the infection can be bacteria that previously perfectly coexisted with the "owner" without causing pathological processes. When the protective functions of the body are weakened, they begin to behave aggressively. A constantly recurring inflammatory process leads to a violation of the structure of the bronchi: they become denser, deformed, the lumen narrows, and the protection functions weaken even more. As a result, the supply of oxygen to the lungs, which is necessary for all tissues, is reduced. The body begins to experience oxygen starvation, respiratory failure occurs, and then heart failure.

The clinical manifestations of chronic bronchitis are an almost constant or recurrent cough with sputum. At the beginning of the disease, cough usually occurs in the morning and is accompanied by the separation of a small amount of sputum. The cough is worse in the cold and damp season, and on warm and dry summer days it may completely stop.

Over time, bouts of hacking cough appear, and this is already a sign of an advanced disease. Despite the discomfort caused by such a cough, patients often do not go to the doctor for a long time. Later, shortness of breath appears, which first occurs during physical exertion or exacerbation of chronic bronchitis, and then at rest. This is a sign of respiratory failure. As chronic bronchitis progresses, heart failure develops. Appears heart palpitations, edema, enlargement of the liver, decreased diuresis.

With an exacerbation of the disease, the cough intensifies, the amount of sputum secreted (often purulent) increases, sometimes hemoptysis appears, the temperature may rise, the person feels weakness throughout the body, and malaise. It should be noted that the usual cough in the morning in smokers is nothing but a sign of chronic bronchitis.

The treatment of chronic bronchitis is a very difficult task, which is almost unsolvable unless the pathological causes, and mainly smoking, are eliminated. With an exacerbation of the disease, antibiotics are prescribed: ampicillin, tetracycline, metacycline, doxycycline. Sulfonamides are used: sulfadimethoxine, sulfapyridazine, biseptol-480.

Antibacterial treatment depends on the type of pathogen, which is determined after sputum examination. Patients with chronic bronchitis are prescribed expectorants and drugs that dilate the bronchi - bronchodilators: eufillin, atrovent inhalers, salbutamol, berotek, etc. They promote expectoration, reduce oxygen deficiency in the lungs.

As a rule, patients with chronic bronchitis in hospitals undergo oxygen therapy with the help of special devices. It is recommended to take daily walks, preferably out of town, and regularly ventilate the room.

The appearance of respiratory failure in patients with chronic bronchitis - shortness of breath - requires the use of peripheral vasodilators: nitrosorbide, prazosin, etc., as well as calcium antagonists: nifedipine, corinfar, which improve the blood supply to the lungs, reduce the increased pulmonary vascular resistance in chronic bronchitis. If there are signs of heart failure (edema, liver enlargement, palpitations), diuretics should be used - such as veroshpiron, etc., cardiac glycosides. It should not be forgotten that diuretics should be used very carefully.

All patients with chronic bronchitis have reduced immunity, so it is recommended to conduct a course of treatment with immunostimulants. Under the supervision of a doctor (in a hospital), T-activin, Vamizol, Decaris are used. At home, you can take pantocrine, eleutherococcus, lemongrass tincture, ginseng root, pentoxyl, aloe. The course of treatment is 3-4 weeks.

Mandatory components of the treatment of chronic bronchitis are exercise therapy and massage. Particular attention is paid to chest massage, and a very important technique is vibration, which improves bronchial drainage.

Of great importance for patients with chronic bronchitis is a balanced diet. It should be borne in mind that in chronic bronchitis there may be large losses of protein (during sputum discharge). Sometimes the absorption of protein in the intestine is disturbed due to oxygen starvation of the body, so the food of such a patient should contain a sufficient amount of protein. The consumption of carbohydrates should be limited, since their metabolism produces carbon dioxide, the amount of which is already increased in chronic bronchitis due to impaired gas exchange. The food of the patient should be rich in vitamins. It is advisable to use raw vegetables and fruits, juices, brewer's yeast. If signs of heart failure appear, you need to limit the intake of salt and fluid, increase the proportion of foods containing potassium.

Bronchial asthma

Bronchial asthma is a disease that is accompanied by asthma attacks resulting from spasm, swelling and increased sputum production in the bronchi. The cause of bronchial asthma can be allergic and non-allergic factors. Bronchial asthma in one of the parents doubles the risk of the disease of the child, while asthma in both parents increases the possibility of the disease by 5 times.

Most often, bronchial asthma occurs due to the development of allergies. It is known that an allergy is a perverse reaction of the body to a substance. Such allergen substances can be food, drugs, odors, dust, etc. Upon contact with an allergen in a patient with bronchial asthma, various biologically active substances are produced in the body that cause spasm, inflammatory swelling of the bronchi and increased formation of thick viscous mucus. The so-called mast cells are especially active in allergic reactions. They got their name due to the fact that they abundantly secrete physiologically active substances and participate in the process of inflammation. These substances include histamines, serotonins, prostaglandins, leukotrienes, etc. Often, bronchial asthma occurs in patients under the influence of household allergens: house dust, animal hair, bird feathers, fish food, insect excrement (cockroaches, bedbugs).

In recent years, it has been established that the allergenicity of house dust is largely determined by the presence of mites in it (more than 30 species are now known). 1 g of dust can contain several thousand insects. Ticks are ubiquitous except for areas with arctic and mountain climates. The greatest accumulation of ticks is observed in mattresses, pillows, blankets, upholstered furniture, carpets, bed linen.

Allergens are not only found in homes, they are widely distributed in the environment. These are plant pollen, fungal spores, insect particles and other components of the air environment. Most often, allergic reactions are caused by the following pollen plants: meadow timothy, dandelion, daisy, nettle, plantain, ragweed, wormwood, sorrel, lupine, poppy, tulip, dog rose, elderberry, lilac, hazelnut (hazel), birch, oak, ash, poplar, willow, pine, alder, chestnut, etc.

The importance of food allergy in bronchial asthma was previously underestimated, although it, as established by experts in recent years, affects almost half of the patients.

Occupational asthma can develop in workers in the agricultural, food, woodworking, chemical, textile, cosmetics, and hairdressing industries.

Allergens can be almost any drug. Drug intolerance (skin rashes, acne, itching, eczema) occurs in many patients with bronchial asthma. However, asthmatic drug action is observed relatively rarely. Usually drugs are the cause of bronchial asthma in people who have constant professional contact with them.

Often in bronchial asthma, the allergen is acetylsalicylic acid (aspirin). Many patients sensitive to acetylsalicylic acid also react to tetracycline and benzoic acid salts used in the food industry. Therefore, food products containing salicites should be excluded from consumption. These are apples, apricots, grapefruits, grapes, lemons, melons, peaches, oranges, plums, cherries, blackberries, raspberries, strawberries, gooseberries, blackcurrants, cucumbers, peppers, tomatoes, potatoes. You should not consume mints, drinks made from root vegetables, ice cream, soda water, confectionery. Theofedrin, indomethacin and other drugs of this group are contraindicated in such patients.

Bronchial asthma, which develops after contact with the above allergens, is called atonic. This term in 1923 was called a "strange" disease that occurs under the influence of substances that are widespread and harmless to most people.

In some patients, seizures occur due to infection - acute respiratory disease, acute bronchitis, pneumonia. Such bronchial asthma is referred to as infectious. In some cases, bronchial asthma develops after stress, with endocrine changes (during pregnancy or menopause), against the background of other diseases (nodular periarteritis, etc.), during physical exertion.

Bronchial asthma has rather bright clinical manifestations. These are attacks of shortness of breath, suffocation that occurs due to spasm, swelling and excessive formation of mucus in the bronchi. Painful manifestations in the bronchi prevent normal ventilation, and exhalation is more difficult, since it is during exhalation that the bronchi are subjected to additional compression due to an increase in intrathoracic pressure. However, subjectively, the patient may feel difficulty in both exhalation and inhalation.

In the development of an attack, three stages are sometimes distinguished: precursors, a period of suffocation, and resolution of an attack. In the initial period, allergic rhinitis, itching of the eyelids, dry cough may appear, then shortness of breath develops, often accompanied by dull wheezing, wheezing, which can be heard even at a distance. The patient is usually in a state of anxiety and excitement, forced to take a sitting position with the torso tilted forward, with an emphasis on the hands. The muscles of the shoulder girdle, chest, and abdominal muscles participate in the act of breathing. The attack ends with the discharge of thick, viscous sputum.

With an exacerbation of bronchial asthma, such attacks are repeatedly repeated. The most common and dangerous complication of bronchial asthma is status asthmaticus, which threatens the life of the patient and requires emergency intensive care. Asthmatic status is a severe attack of bronchial asthma that cannot be relieved with conventional medications (bronchodilators, aminophylline). It is characterized by severe respiratory failure, progressive disorders of gas exchange, acid-base state of the blood.

Asthmatic status occurs either with a sudden re-contact with an allergen to which the patient already had hypersensitivity, or against the background of an exacerbation of bronchial asthma. A certain role is played by the uncontrolled use of drugs (usually inhalers), unjustified dose reduction or the abolition of hormonal drugs.

The prognosis for bronchial asthma varies. In about 1/3 of patients, especially in children under 16 years of age, seizures may stop on their own; the second third have periodic mild exacerbations; the latter has a severe course of the disease with frequent exacerbations, the development of respiratory failure, and the occurrence of chronic bronchitis. To a large extent, this prognosis depends on the correctness of the treatment of the patient.

A patient with bronchial asthma needs to know the causes of attacks, find their allergens and, if possible, exclude or limit contact with them. The room where the patient is located should be cleaned daily with a vacuum cleaner.

You should not acquire plush toys, down pillows, wadded blankets. The mattress must be covered with impermeable plastic. Wet cleaning should be carried out at least once a week. It is necessary to avoid clutter in the apartment, place books on glazed shelves, change linen regularly, wash wallpaper. It should be remembered that high humidity in the room creates favorable conditions for the development of mites and fungus. Therefore, the use of room humidifiers is undesirable. Sometimes it is necessary to change your place of residence and move to an area or city with a drier warmer climate and at least not live in a lowland or near a body of water.

With professional bronchial asthma, you should switch to another job. Persons with hypersensitivity to pollen of plants during their pollination are not recommended to visit the forest. The highest concentration of pollen in the air falls on dry windy weather, daytime and evening. To reduce the amount of pollen in the air, indoor filters and air conditioners are used.

To identify allergens, there is a method of skin tests. A variety of allergens are introduced to the patient, and sensitivity to them is checked. These tests are performed only in special allergological centers. Samples are taken necessarily at a time when the disease is not exacerbated. In the future, treatment can be carried out to help reduce the perverted reaction to a specific allergen.

One of the main methods of treating bronchial asthma is diet therapy. It allows in most cases to reduce the increased disposition of the patient to allergic reactions to foods that can provoke an exacerbation of the disease.

Non-drug treatment of bronchial asthma, in addition to diet therapy, includes reflexology, physiotherapy, treatment in salt mines, hypnosis, therapeutic fasting, herbal medicine, spa treatment. The latter is best done in local sanatoriums, where most often there are no difficulties with acclimatization for patients with bronchial asthma.

Phytotherapy has recently attracted more and more attention, since the content of a significant amount of macro- and microelements, amino acids and enzymes in wild herbs has a powerful effect on all physiological processes of the body.

Drug therapy of bronchial asthma consists of two stages: treatment of exacerbation and remission of the disease. With an exacerbation, hospitalization of the patient is advisable. During this period, inhalers with bronchodilator drugs are usually used: berotek (fenoterol), salbutamol (ventolin, albuterol), alupent, asthmapent, novodrin, eustiran, berodual. These drugs stabilize the mast cell membrane, prevent the release of substances involved in an allergic reaction, and therefore reduce spasm and swelling of the bronchi.

It should be remembered that an overdose of these drugs is dangerous, as it can lead to a deterioration in the patient's condition - to the development of status asthmaticus. When using these drugs, you may experience palpitations, dizziness, weakness, flushing of the face. In elderly patients, especially with heart disease, arrhythmia often occurs, angina attacks may become more frequent, hypokalemia may develop, so taking these drugs is undesirable.

The second group of drugs used for exacerbation of bronchial asthma is eufillin, theofidrin. They are administered intravenously by stream, drip or taken in the form of tablets. These medicines also block allergic reactions in the bronchi. Expectorants must be used to expel mucus.

If an exacerbation of bronchial asthma is associated with an infection, antibiotics are prescribed, but only on the advice of a doctor, since almost all are potential allergens. In bronchial asthma, it is necessary to identify and eliminate all foci of infections, especially in the nasopharynx (rhinitis, sinusitis), as well as dental caries.

In case of exacerbation of bronchial asthma in the period between attacks, treatment with intal is carried out. If intal is ineffective (it should be remembered that the effect of the drug does not appear immediately, but after 3-4 days), they resort to ketotifen or zaditen, which, like in-tal, block the mast cell, but in a slightly different way. Both drugs can be combined with intal.

If the exacerbation of bronchial asthma is not relieved by the indicated methods, hormonal preparations are used that have a pronounced anti-allergic and anti-inflammatory effect. Only a doctor can prescribe and cancel these medicines. After the effect is achieved, the drug is stopped.

When taking hormones, you should limit your sugar intake, eat more potassium-rich foods, and if you have fluid retention in the body, resort to diuretics. Hormones are best used in accordance with the rhythm of their production by the body in two doses: in the morning and in the afternoon. You should not go to the other extreme and independently reduce or increase the dose of the hormone. In this case, the risk of developing complications increases: increased blood pressure, obesity, stomach ulcers, diabetes mellitus, arrhythmias, and mental disorders.

For the treatment of bronchial asthma, hormonal inhalers are produced - becotide, beclamet, as well as prednisone, dexamethasone and other hormonal agents in the form of intravenous infusions and tablets.

The asthmatic status is treated only in a hospital. A non-severe attack of bronchial asthma, patients usually stop (eliminate) themselves, using inhalers, aminophylline, sometimes theofedrine. It should be remembered that theofedrine is contraindicated in aspirin bronchial asthma.

You can also try non-pharmacological methods: inhalation of warm humidified air, breath-holding, hot foot baths, reflexology or acupuncture, acupressure and vibrating massage.

But we should not forget about the usual massage, which should be used between attacks, in remission or in case of complete recovery.

Pleurisy (inflammation of the pleura), as a rule, occurs as a result of a complication of pneumonia, such as pneumonia, when the disease is neglected, or if it is not completely cured.

There are two types of pleurisy - dry and exudative (exudative). With effusion pleurisy, fluid is observed in the pleural cavity, with dry it is absent.

The disease should not be started, as it has various severe complications.

Emphysema

Emphysema occurs due to the expansion of the pulmonary alveoli. This disease is divided into diffuse and limited. In the first case, emphysema spreads to all lungs, and in the second - only to their individual fragments. In addition, emphysema can be acute or chronic.

This disease is very serious, as it affects all respiratory organs. This, in turn, often leads to a general immobility of the chest.

Pulmonary dystonia

Pulmonary dystonia is a deviation in the normal functioning of the lungs. With the disease, the patient constantly has shortness of breath, he feels compression in the chest. This is caused by improper distribution of blood in the pulmonary circulation. Therefore, in the treatment of this disease, much attention is paid to the proper functioning of the heart. Therapeutic massage is aimed at stimulating blood circulation in the pulmonary zone.

For the treatment of all the above diseases, massage is used. The following are the techniques that can be used when massaging.

The doctor must distinguish and make a diagnosis. With bouts of coughing, difficulty breathing (especially in children!) It is urgent to call an ambulance.

Symptoms of bronchial asthma:

Bronchial asthma often begins with a paroxysmal cough, accompanied by aspiratory dyspnea with a small amount of vitreous sputum (asthmatic bronchitis). A detailed picture of bronchial asthma is characterized by the appearance of mild, moderate or severe asthma attacks. An attack may begin with a precursor (copious discharge of watery secretion from the nose, sneezing, paroxysmal cough, etc.). An asthma attack is characterized by a short inhalation and an extended exhalation accompanied by audible wheezing at a distance. The chest is in the position of maximum inspiration. In breathing, the muscles of the shoulder girdle, back, and abdominal stack take part. When percussion over the lungs, a box sound is determined, a lot of dry rales are heard. The attack, as a rule, ends with the separation of viscous sputum. Severe prolonged attacks can turn into an asthmatic state - one of the most formidable options for the course of the disease.

Pneumonia is an inflammation of the lungs.

Pneumonia can develop against the background of hypothermia, acute respiratory infections, acute respiratory viral infections, food poisoning, trauma, fracture.

According to the etiology, acute pneumonia is divided into:
bacterial,

allergic; including drug allergies;

pneumonia arising from the invasion of helminths;

pneumonia caused by the action of physical and chemical factors (mainly thermal, for example, pneumonia with burn disease, and toxic, for example, pneumonia that develops when inhaled vapors of gasoline, kerosene and chemical warfare agents).

With all these types of pneumonia, as a rule, the addition of a bacterial infection is noted. It is generally accepted that the features of the course of acute pneumonia depend on the pathogen.

Pneumonia of different etymologies can have completely different symptoms.

A sudden rise in temperature to 40 degrees, accompanied at first by a dry cough, extremely poor health, shortness of breath (that is, any physical activity, even minimal, causes rapid heavy breathing). In this case, there may be pain in the chest, aggravated by coughing and deep breathing. The pain may radiate to the abdomen, or it may simply hurt only the abdomen. With a deep breath, a coughing fit is possible. Sometimes there is redness of one cheek (on the side where the pain is noted). All this corresponds to the so-called croupous pneumonia, in which the inflammation covers a large part of the lung. Not all of the described symptoms are necessarily present, but fever, cough and severe weakness occur almost constantly.

The disease begins as a common ARVI: runny nose, cough, fever. After a while, the temperature drops, and then rises again and does not decrease any more. This is also a variant of the course of pneumonia.

The temperature does not rise above 38 degrees, but keeps almost constantly at this level, accompanied by cough, weakness. It could also be pneumonia.

In children, the criteria that should alert you to the possible presence of pneumonia are the following: duration of temperature above 38 degrees for three or more days; shortness of breath (rapid breathing); severe lethargy, drowsiness.

A definitive diagnosis can only be made on the basis of a chest x-ray.

Bronchial pneumonia - causes, symptoms and treatment

Bronchial pneumonia is a type of pneumonia. Harmful bacteria and viruses, together with the inhaled air, enter the lungs and affect the smallest branches of the bronchial tree.

What causes bronchopneumonia

Bronchial pneumonia can be caused by many viruses and bacteria. In most cases, the inflammation is the result of an upper respiratory tract infection. For example, bronchitis or SARS can lead to the development of the disease. The most common pathogens are bacteria such as streptococcus, pneumococcus, and many viruses.

Pneumonia can also be the result of food entering the respiratory tract, compression of the lungs by a tumor, inhalation of toxic gases, and a postoperative complication.

Who is at risk of getting sick

Anyone can get pneumonia. But there are groups of people who are especially vulnerable to this disease.

High risk groups include:

• Newborns and children under 3 years old;
• Children with congenital diseases of the respiratory system;
• Children with congenital or hereditary defects of the immune system (immunodeficiencies);
• The elderly over 65 years of age;
• People who already have lung conditions (such as asthma and bronchitis);
• HIV-infected;
• Suffering from heart disease and diabetes;
• Smokers.

What are the signs of damage

The main signs of the disease are:

1. Fever. An increase in body temperature to 37.5 - 39 degrees within 1-3 days. Accompanied by severe weakness, loss of appetite or complete refusal of food, sweating and chills, insomnia, pain in the calf muscles. Fever is a manifestation of the body's fight against inflammation. Therefore, at temperatures up to 37.5-38C, it is not recommended to take antipyretic drugs.
2. Cough. At the beginning of the disease, dry, frequent, hacking. As the pneumonia progresses, sputum appears. The sputum has a characteristic greenish-yellow color, sometimes streaked with blood.
3. Dyspnea. In adults with a severe course of the disease, there is a feeling of lack of air, frequent shallow breathing. Sometimes shortness of breath persists even at rest.
4. Pain in the chest. Worried when coughing or taking a deep breath. With pneumonia, pain appears on the side of the affected lung, often stabbing or pulling, disappears after coughing.

Features of symptoms in children

Due to the fact that the airways of children are short and do not yet have protective immune barriers, inflammation is sometimes lightning-fast. Bronchopneumonia is especially dangerous in newborns and infants.

Symptoms such as fever and cough may be mild or absent in children. Sometimes inflammation of the lungs can develop at normal or reduced body temperature. Loud wheezing and shortness of breath come to the fore.

To suspect pneumonia in children, parents should pay attention to prolonged bronchitis or SARS, child's lethargy and lack of appetite, shortness of breath, shortness of breath.

What diagnostic examination should be carried out

If the above symptoms appear, you should consult a doctor. At the appointment, the doctor will conduct an initial examination, which includes:

1. Measurement of body temperature.
2. Percussion (percussion) of the lungs. With the help of fingers, the doctor performs percussion over the surface of the lungs (above the collarbones, between the shoulder blades, in the lower chest). In the presence of pneumonia, a shortening of the sound over the affected area is characteristic.

At the moment, this method is considered uninformative and is almost never used in the diagnosis of pneumonia.

1. Listening (auscultation) of the lungs. This is done with a stethoscope or phonendoscope. The essence of the method is to listen in the affected area for wheezing, weakened breathing, pleural friction noise. The appearance of these sound phenomena depends on the period of the disease (onset, peak, recovery) and cannot always be heard.

On the basis of complaints, characteristic symptoms and examination, a diagnosis of pneumonia can be made.

For documentary confirmation of the disease, it is necessary to conduct an x-ray of the chest organs and a number of laboratory tests. In special cases, you will need computed tomography, sputum analysis, tests for the identification of the pathogen, bronchoscopy.

X-ray of the lungs is the "gold standard" in the diagnosis of pneumonia. This research method should be performed twice - at the time of diagnosis and after treatment. Using this method, it is possible to evaluate the effectiveness of the treatment and determine the further prognosis.

How to treat bronchial pneumonia

Treatment includes measures for the regimen, nutrition, as well as the appointment of medications and physiotherapy.

At the beginning of the disease, bed rest is recommended. Be sure to ventilate and clean the room. With the normalization of body temperature, walks in the fresh air are allowed. Resumption of hardening from 2-3 weeks after the completion of pneumonia. Resumption of physical activity from the 6th week of recovery.

There are no food restrictions. Nutrition should be balanced, high in protein and vitamins. Fractional and frequent meals are recommended. It is obligatory to use a large amount of liquid in the form of warm fruit drinks, herbal teas, warm mineral water.

Should be started after normalization of body temperature. Chest massages, inhalations with drugs that facilitate breathing and sputum discharge are useful.

Used types of drugs

The use of antibiotics is the main treatment for pneumonia. The choice of antibiotic is made individually for each patient. The type of pathogen, risk factors, severity of the disease are taken into account.

Treatment involves the appointment of antibiotics in the form of tablets or injections (intravenous or intramuscular).

Also in the treatment of bronchopneumonia, antipyretics, expectorants, antiallergic drugs, and vitamins are used. In some cases, oxygen is prescribed.

Therapy in childhood

Treatment of children is carried out only in a hospital. If necessary, the child can be placed in the intensive care unit.
When prescribing drugs, the dose is calculated relative to the weight of the patient. If pneumonia is caused by viruses, then in severe cases, antiviral agents may be prescribed.

Children are more at risk of dehydration. The threat is especially high against the background of elevated body temperature, so much attention is paid to maintaining water balance. Sometimes the missing liquid is administered using droppers. Oxygen inhalation is used to prevent shortness of breath.

Currently, due to the effective treatment of bronchitis and acute respiratory viral infections in the early stages, the number of children with severe forms of pneumonia is quite rare.

The consequences of inflammation and prevention

For most people, pneumonia goes away without a trace. Residual manifestations of the disease (weakness, shortness of breath when walking fast) disappear within 1 month.

To prevent relapse, you must follow simple rules:

• Wash your hands regularly;
• Avoid smoking;
• Avoid contact with sick people;
• Adhere to a healthy diet;
• Do sport;
• Get enough sleep, rest regularly.

Can asthma cause pneumonia?

To discuss these issues, we must first define these diseases. Asthma is a condition in which reversible airway obstruction occurs. It is often associated with inflammation. Pneumonia, on the other hand, is an infection of the lungs caused by viruses, bacteria, or fungi. (Chemical pneumonia is also possible).

Causes and risk factors

It is also important to distinguish between causes and risk factors. Unlike a cause, a risk factor increases the risk that something happens but is not the cause. For example, swimming in the ocean may increase the risk of drowning, but it does not cause drowning. A risk factor cannot cause a disease, but it can predispose you to developing a disease.

Asthma as a cause of pneumonia

First, a link was found between COPD treatment and pneumonia.

A review of studies has now confirmed that users of inhaled steroids along with long-acting beta-agonists (LABA) (the inhaled steroid combination LABA for COPD) are almost twice as likely to develop serious pneumonia, and those using LABA alone, Flovent (fluticasone) is associated with these complications are slightly more than Pulmicort (budesonide).

A 2017 study showed a similar scenario with asthma. People who were treated with inhaled steroids for asthma were 83% more likely to develop pneumonia than those who did not use these inhalers. The increased risk of pneumonia, in contrast to COPD, is similar to Flovent and Pulmicort.

It is not entirely clear why inhaled steroids increase the risk of pneumonia, but the effect of these inhalers on the immune system is likely the mechanism. It has long been known that people who use oral steroids (eg for rheumatoid conditions) are at greater risk of developing infections because the steroids "calm down" the immune response.

While you need to be aware of this potential risk, it doesn't mean you should stop taking your asthma medication. All asthma medications can have side effects, but inhaled steroids can greatly improve asthma symptoms. The risk of worsening asthma if inhaled steroids are stopped would be more dangerous than the risk of pneumonia seen here. The risk of illness and even death from severe asthma (asthmatic status is still a problem.

Can pneumonia cause asthma?

Scientists are beginning to understand the relationship between infections that cause pneumonia and worsen asthma symptoms or the development of asthma.

There is huge interest in an atypical bacterium called Mycoplasma pneumoniae, which is most commonly responsible for pneumonia. Generally, this infection is considered self-limiting, which means that the symptoms will clear up even if you are not treated with antibiotics. Scientists, however, have found that Mycoplasma pneumoniae infection causes the following in animals:

• Chronic infection: Scientists continue to detect signs of infection in the lungs of animals many months after infection.
• Chronic inflammation of the lungs: In studies of mice, a single infection with mycoplasma pneumonia resulted in pneumonia for up to 18 months.
• Abnormal lung function tests: Over the same time period, scientists found evidence of airway obstruction and hyperresponsiveness.

There is further evidence for a link between pneumonia and asthma in humans. Scientists have found evidence for Mycoplasma pneumoniae, which causes asthma to flare up, and for people who have this asthma. In particular, scientists have found:

• Mycoplasma pneumoniae is more common among people hospitalized for asthma than people hospitalized for other reasons.
• Mycoplasma pneumoniae is commonly found in children with asthma exacerbations.
• Up to 40% of children infected with Mycoplasma pneumoniae will experience wheezing and abnormal lung function tests.
• Children with asthma and mycoplasma pneumoniae infection may be more likely to have abnormal lung function tests at both 3 months and 3 years after infection.
• Children exposed to mycoplasma pneumoniae have higher levels of a certain marker that scientists use to study asthma called vascular endothelial growth factor (VEGF) compared to children without asthma. The relationship between VEGF and Mycoplasma pneumoniae suggests that they are related.

Asthma, influenza and pneumonia

You hear more about the flu and pneumonia, but pneumonia is a known side effect of a flu infection. While you do not have an increased risk of developing a flu infection because you have asthma, you are at an increased risk of developing a side effect such as pneumonia.

Your airways already have some degree of inflammation, swelling, and are more sensitive than those without asthma. Infection with the flu only increases swelling and inflammation.

Normally, your body filters out viruses and bacteria as they enter your body. Increased inflammation increases the chances that the flu virus will not be cured and cause problems. When the flu virus enters the alveoli, or breathing sacs in your lung, the alveoli can fill with fluid, which leads to pneumonia symptoms such as chills, cough, fever, and difficulty breathing.

If enough fluid builds up, it can also lead to hypoxia, or low oxygen levels in the blood. This usually requires hospitalization.

The flu virus can directly cause pneumonia, or you can develop bacterial pneumonia that requires antibiotic therapy. When you have the flu, you need to consider treatment. However, the best treatment is flu immunization and prevention together.

If you get the flu, your doctor may prescribe an antivirus. These drugs can reduce symptoms and may prevent more serious complications such as pneumonia. Antivirals require a prescription from your doctor.

Regarding antibiotics

With all this in mind, you might be wondering if people with asthma who have flare-ups should be treated regularly with antibiotics. Despite what we have previously discussed, there are no current recommendations for prescribing antibiotics for asthmatics. A 2006 study on antibiotic therapy for Mycoplasma pneumoniae compared with placebo found improvement in asthma symptoms but not lung function. There are no current recommendations in the study area for the treatment of chronic asthma or asthma exacerbations with antibiotics.

Conclusion on the association between asthma and pneumonia

There is obviously a link between asthma and pneumonia, although asthma does not appear to cause pneumonia. What has been found is one of the drugs (inhaled steroids) used to treat asthma is associated with a predisposition to develop pneumonia. Looking at the opposite scenario, there is ample evidence that the bacterium that causes community-acquired pneumonia can lead to the development of asthma. Either way, these two conditions can go hand in hand, and the flu, if you have asthma, can clearly increase your risk of developing pneumonia.

The danger of manifestations of pneumonia in asthmatics

Each disease is a serious threat to human health. Even a seemingly minor illness can lead to serious consequences in the future.

Emergence of one disease at the already diagnosed another deserves special attention.

In this case, one should not only carefully study all possible manifestations of the disease, but also pay special attention to the correct arrangement of all the applied methods of treatment recommended in the event of the simultaneous development of both ailments.

The most common in the parallel course of the two diseases is the inflammatory process in the pulmonary tract and the presence of asthma in varying degrees of complexity.

Inflammation of the lungs or pneumonia is an infectious disease that occurs as a result of exposure to one or more pathogens: staphylococci, pneumococci, mycoplasmas, chlamydia, viruses, etc.

Inflammation of this area has several specific features. It is not worth underestimating the risk of the phenomenon in this case, since every day the development of the disease increases the risk of development and complications.

Features of the course and principles of differential diagnosis

The manifestation in the human body of a disease is facilitated by several factors at a time. With regard to inflammation of the pulmonary tract, the following can be noted that there may be several causes of exacerbation, and the form of the disease itself is often different in each individual case.

The symptoms that appear depend primarily on factors such as:

• pathogen;
• the size of the lung tissues affected by the disease process;
• the likelihood of occurrence or already established complications that develop in parallel with the disease;
• the reactivity of the human body in a weakened state.

Often, the condition of the body and the development of inflammation are also affected by the living conditions of a person, timely medical care, the quality of the drugs used, and a well-chosen regimen.

In the case of differential diagnosis, pulmonary inflammation is most often differentiated from SARS. In this case, a viral infection is the background for the development of inflammatory processes in the lungs.

Also, in some cases, it is possible to differentiate pneumonia from bronchitis in an acute form or from bronchiolitis.

The diagnosis of pneumonia is determined on the basis of several data:

For inflammation of the pulmonary tract, developing against the background of SARS, catarrhal changes in the nasopharynx, a sharp increase in temperature are also characteristic, but there is no radiographic and local change.

Causes of the development of the disease in asthmatics

The occurrence of pneumonia in bronchial asthma often develops secondarily and is directly related to prolonged or frequent attacks of bronchial asthma. In this case, the bronchi are seriously affected, where an unfavorable accumulation of mucus dangerous for the respiratory tract occurs.

The age groups affected by the disease are as follows:

1. Patients from 1 to 5 years of age most often suffer from a viral type of pneumonia.
2. A group of patients from 5 to 30 years old is susceptible to mycoplasmal pneumonia.
3. Patients over the age of 30 suffer from pneumococcal (and other bacterial) pneumonia.

Patients suffering from bronchial asthma always have an increased risk of exacerbation of serious infections in the lungs. These infections are caused by a bacterium called Streptococcus Pneumoniae, which is the most common cause of the onset and spread of the disease.

In addition, this type of unfavorable bacterial background can provoke even potentially fatal ear and respiratory infections, brain blood flow infections.

Doctors noted that the manifestations of various infectious diseases in asthmatics, regardless of their age, are seven times higher than in other groups of patients. In addition, in 17% of case studies, this disease is directly related to asthma.

The results of research by scientists have proved that the scope of the scope of pneumococci can be significantly reduced if an early (preventive) vaccination of asthmatic patients is carried out.

Thanks to long-term laboratory studies conducted in a group of patients, including more than 4,000 people, it was possible to establish that asthmatics belonging to the older age group are at a sevenfold risk of developing and exacerbating pneumococcal lesions.

The susceptibility of asthma patients to microbial infections by immunologists is explained by the process of chronic inflammation, which affects the sharp weakening of the lungs, increasing the susceptibility to dangerous infections in the respiratory tract. Also, in bronchial asthma, a specific pathogenic mechanism of the immune system plays an unfavorable role.

The subtleties of the treatment of inflammation in the lungs with asthma

In asthmatics, in the treatment of this disease, a certain choice arises: the appointment of increased doses of antibiotics to eliminate inflammatory manifestations, but at the same time the risk of complicating existing asthma.

Prescribing low doses of antibiotics can affect the occurrence of complications in the period after pneumonia.

Therefore, you should look for a "golden mean", that is, prescribe the minimum dose of an antibiotic while taking anti-asthma drugs in parallel. As a result, asthma does not exacerbate, health complications are not observed, while the degree of resulting lesions of the pulmonary tract is reduced.

As a result, pharmacotherapy reduces the protection of the immune system. But on the other hand, asthmatic patients quite often use antibiotics as one of the components of the applied treatment regimen, where infectious agents deliberately adapt to antibiotic drugs.

This becomes the main reason for the phenomenon that pneumonia in asthma sufferers is much more difficult to treat therapeutically with antibiotics.

Since pneumonia belongs to the type of infectious diseases, it should be considered pathogenetically according to the type of pathogen identified, according to the characteristic mechanism of infections.

Non-infectious types of inflammation in the lungs, which are congestive pneumonia, are expressed in diseases such as asthma, alveolitis, but cannot be designated as a classic form of pneumonia.

Measures to treat complicated forms of pneumonia can be carried out by generalists, that is, general practitioners. In cases of particularly severe conditions of patients, immediate hospitalization is required. It is advisable to place the patient in a specialized hospital, in the pulmonology department.

The symptomatic approach to the treatment of pulmonary inflammation is aimed at:

• to effectively eliminate the causes of the disease;
• to alleviate the symptoms of the disease as soon as possible.

As treatment methods, it is effective to prescribe special complexes of procedures: inhalations, warming up. Additionally, it makes sense to regularly use mucolytic drugs that increase immunity.

The combination of asthma and pneumonia diagnoses is a fairly common combination.

In this case, the planning of the necessary treatment is based on the speedy disposal of the pulmonary tract from the detected inflammation.

1

Voskanyan A.G., Voskanyan A.A.

Pneumonia remains one of the most pressing problems in medicine today. And, if the issues of epidemiology, pathogenesis and pharmacotherapy find their solution in the research of evidence-based medicine, then the issues of healing are constantly experiencing rolls - either towards the substitution of “pneumonia”, almost all lung diseases, or the loss in the haze of another lung disease, banal pneumonia. And the reason for the discussion of this topic was the frequent cases of replacing allergic alveolitis with pneumonia and diligent treatment of bronchial asthma with pneumonia. Of course, ICD-10 (International Classification of Diseases 10th revision) drew a certain line under the fictitious definition of chronic pneumonia, drew a dividing line between pneumonia and pneumonitis, but so far it has not been possible to put an end to the i. On specific clinical cases, an attempt was made to isolate the physical features of pneumonia from those in pathoimmune inflammation: moist rales are necessarily heard over the focus of pneumonia, while with pneumonitis, there are no wet rales, but creaking rales appear, and with alveolitis, sooner or later, and “cellophane noise” is something like the sound of cellophane when you run your hand over it. There are clear differences and radiographic signs, not to mention the differences in the clinical analysis of peripheral blood. At first glance, “harmless” errors entail a loss of time to start etiopathogenetic treatment and, on the other hand, to even more blurring of the clinical signs of the underlying, one or the other, disease. Special skill of the clinician is required in the treatment of pneumonia in patients with asthma. The rationality of the treatment of such patients lies in the rejection of half-measures in favor of more aggressive approaches with the obligatory cover of possible reactions of the concomitant disease. Recreational methods of the recovery stage of treatment are important. However, it is necessary to treat the patient, both in the period of an acute onset and in the phase of the developed clinical course of pneumonia, and, which is very important for restoring the quality of life, a wise medical strategy for a health-improving program for the period of convalescence is needed - recreational, naturotherapeutic technologies.

Pneumonia(Greek pneumön - light) is acuteoe pneumonia caused by infectious agents: viral, bacterial or a combination of them - mixed: virus-viral, virus-bacterial, bacterio-bacterial. Considering that pneumonia is (mainly) a bacterial inflammation, the effectiveness of treatment directly depends on the rationality of antimicrobial pharmacotherapy, correct diagnosis, and verification of the infectious agent. But, as a rule, due to the difficulty of specifying the infectious agent, in a particular case, antimicrobial therapy is carried out to the extent of the doctor's experience. At the same time, the guidelines are the features of the clinical course of pneumonia, with one or another infection, according to the severity of the course and the prevalence of inflammation.

Unfortunately, the meaning of the term "pneumonia", as a nosological unit, in clinical practice is associated with an understanding of pneumonia in general. But!!! Not all pneumonia is pneumonia. Fundamentally different inflammation in burns, trauma, allergies or infection of microbes and / or viral bodies in the lung tissue. Although in all cases "inflammation"- a protective reaction of the body to the damaging effect of an exogenous or endogenous factor. An exhaustive definition of "Inflammation" is given by A.M. Chernukh in his book [Chernukh A.M. In: Inflammation. M. "Medicine", 1979, p.10]: "Inflammation is a reaction of living tissues to local damage that has arisen in the course of evolution; it consists of complex gradual changes in the microcirculatory bed, blood system and connective tissue, which are ultimately aimed at insulation and elimination of the damaging agent and repair (or replacement) of damaged tissues".

It follows from the definition that inflammation in any case is a protective reaction and is the physiological protection of the body from its damaged part, a kind of localizing function arising in the course of the evolution of protective reactions. In this context - the localizing function - there is a different view on the causal mechanism of the formation of clinical forms of pneumonia, croupous or focal. In our understanding, these are two options for "isolation" of the integrity of the body from the invading microbial agent, due to both the microbial factor and the immune-protective reaction. In one case, this is the gable isolation of the agent, at the site of its penetration, and in the other, it is the total isolation of the entire lobe, with demarcation along the perimeter of the functional unit of the lung. These are two variants of protection (inflammation) that have the right to life, undoubtedly due to the internal rationalism of the organism. In addition, there is the concept of "physiological inflammation" (Rössle, from the book Inflammation, A.M. Chernukh, 1979, "Medicine"); this inflammation is the cleansing of tissues from metabolic products and proceeds constantly due to the removal of endogenously occurring dead cells, which gradually resolve.

Erroneous substitution or combined into a single nosological concept - "pneumonia", various etiopathogenetic processes in the lungs with an inflammatory component, is the reason for discussing such an important and life-threatening lung disease as pneumonia. Overdiagnosis of pneumonia is just as dangerous for a person as underdiagnosis or not detecting it under the mantle of another disease, such as asthma or alveolitis.

Definition and classification

Pneumonia is an acute infectious disease of predominantly bacterial etiology, characterized by focal or lobar lesions of the respiratory sections of the lungs, the presence of intraalveolar exudation, fever and intoxication expressed to varying degrees.

As follows from the quote, the defining sign of pneumonia is the presence of intraalveolar exudate with mandatory clinically pronounced fever and intoxication due to bacterial and/or viral infection .

Afterword to the classification

First of all, the classification of the 10th revision drew a line under the fictitious definition of " pediatric pulmonology". Obviously, there should not be and, as follows from the classification definitions, there is no separately taken childhood pneumonia, as in other cases, and pneumonia of the elderly. Pulmonological definitions ( nosological forms) absorb all the age-related features of the clinical course of pneumonia from the intrauterine life of a little man ( congenital pneumonia) to a ripe old age hypostatic pneumonia), with its own nuances of formation. But! There is pneumonia in all age groups - pneumonia, this determines the nosological understanding of pneumonia.

The classification puts an end to the nosological definition of the disease: pneumonia, this is a bacterial or viral infection of agents with severe pneumotropism. That is, it is an infectious inflammatory disease of the lungs. And this means that congestion, eosinophilic tide and other immunogenic allergic and non-allergic pathomorphological processes, such as traumatic, toxic, burn inflammatory reactions, cannot be indicated by pneumonia, even if these lesions are infected. On the other hand, pneumonia and inflammatory processes in the lungs with other infectious diseases cannot be called, and those noted in the group J18 - bronchopneumonia, unspecified (J18.0) ; lobar pneumonia, unspecified (J18.1) ; congestive pneumonia, unspecified (J18.2) , appear as pneumonia - an infectious inflammation, unspecified, but pneumotropic infection, which is what the definition says - Pneumonia without specification of the causative agent (J18) .

Not included in the category "Pneumonia" and perifocal reactive inflammation in echinococosis, cancer and other formations in the lungs, lung abscess with pneumoniaJ85.1) , look exceptions from J18 . Unfortunately, the post-Soviet trace reaction of the definition - "Pneumonia is a disease that unites a group of inflammatory diseases that are different in etiology, pathogenesis and morphological characteristics, more infectious, processes in the lungs with a primary lesion of their respiratory departments"[N.V.Putov, G.B.Fedoseev Vkn.: Guide to pulmonology. L. "Medicine", 1984, p. 146.], remains to this day in the minds of doctors. Unfortunately for the patients and unfortunately for the doctors, as before, in lectures at universities, as a rule, the forms of the course of pneumonia are emphasized - "acute pneumonia" / "chronic pneumonia"- as nosological forms of pneumonia. The prevalence of inflammation is still stated as a nosology, "croupous pneumonia" / "focal pneumonia". Truly - " heavy hippocratic hat".

In clinical practice, this is not permissible, and the radiographic definition of pneumonia is also not acceptable, such as: with no pronounced interstitial shading, an x-ray conclusion is made - pneumonia, in the first or fourth phase of development, which happens with various interstitial pneumonitis, see Section "Lung Diseases Caused by External Agents" (J60-J70 ICD-10). At the very least, such an incorrect definition poses a difficult task for the doctor, especially the first link. The doctor consciously takes the conclusion of the radiologist as the basis for making the diagnosis, since there is no other way to verify the disease. And, quite naturally, it leads to quite predictable confusion in the diagnosis and treatment errors. On the one hand, the doctor (of the first link) understands pneumonia as an infection of the lungs and quite reasonably begins treatment with antibiotics, while the category of pneumonia also includes other, including non-infectious, pneumonia. And the insufficient effect of antibiotic therapy is interpreted by increased resistance or insensitivity of the microbial agent. The "race" of antibiotic treatment begins with an increase in doses in terms of strength and spectrum of antimicrobial effects. As a result, as in a joke: "They treated jaundice, and he, it turns out, is Chinese." Irreparable damage is done to the patient, time is lost, immunogenic pathological processes are formed - asthma, alveolitis, leukemoid reaction, etc.

In other cases, an incorrect diagnosis occurs - chronic pneumonia, but this is another, painful topic of practical medicine. This diagnosis is not uncommon in practice even today, although there is no such nosology in the classification. But! For some reason, she - "chronic pneumonia" is more alive than all the living. Why?

Critical essay in the context of chronic pneumonia: Back in 1810, Bayle introduced the term "Chronic pneumonia" into medical practice to designate a chronically ongoing disease process in the lungs. And, more than 100 years later, the leading clinicians - I.V. Davydovsky (1937), A.T. Khazanov (1947), S.S. Vaylya, and later A.I. ), I.K.Episov (1978) during a morphological study of lung preparations, came to the conclusion that clinically and etiopathogenetically different diseases have common morphological features, expressed as a stereotypical reaction of lung tissue elements to various damaging factors (inflammation, carnification, pneumosclerosis, emphysema and etc.). Later, Nikolai Vasilievich Putov, in our opinion very rightly, notes that "... chronic inflammation and its consequences, as a morphologically detectable phenomenon, began to be incorrectly identified with the term "chronic pneumonia", which is already given a clinical meaning, considering it the name of a special nosological form of pulmonary pathology". In doing so, special attention was paid to localization process. The localization of the process, according to judgment, emphasizes the difference between chronic pneumonia and diffuse lung diseases, such as chronic bronchitis, emphysema, diffuse pneumosclerosis. And the recurrent course of chronic pneumonia meant to exclude from the concept of chronic pneumonia asymptomatic localized pneumosclerosis, which is a purely radiological phenomenon, i.e. not a disease, but a form of cure for some forms of pneumonia [from the book: Nikolai Vasilievich Putov "Guide to Pulmonology"].

Soon, this invented false form of inflammation absorbed almost all of the chronic non-tuberculous pathology of the lungs. This concept of interpretation of chronic pneumonia turned out to be tempting for everyone, both theorists and practitioners, since it united virtually all chronic nonspecific lung pathology and was convenient in practical terms. For example, to make a diagnosis of COPD (chronic nonspecific lung disease), it was enough to exclude tuberculosis and lung cancer. Moreover, even asthma, by many authors who tend to think that asthma is an infectious disease, referred to COPD, i.e. to chronic pneumonia.

Despite such a theoretical alignment, which is also convenient for practicing doctors, even then, in those troubled times of confrontation between Western (bourgeois) and Eastern (socialist) medicine, chronic pneumonia seemed very doubtful to many doctors. The concept turned out to be painfully speculative, and long-term observations of these patients did not confirm the natural transition of chronic pneumonia to bronchiectasis or destruction of the parenchyma, the transformation of a local process (pneumonia is a local process), into a total lesion of bronchopulmonary tissue with the development of widespread bronchial obstruction, emphysema, etc. d. And, as Professor Putov N.V. in the same "Guide" to pulmonology - "... as experience has shown, the main and frequently occurring chronic non-specific lung disease, leading to progressive disability and death of patients and often causing determining influence on the development of acute processes in the lungs is Chronical bronchitis , not primarily associated with acute pneumonia. "But, as it seems to us, chronic inflammation of the bronchi, without the presence of congenital destructive changes, is not possible. This is confirmed by the practice of healing. All chronic, often recurrent inflammatory processes, in the end (as a result computed tomography) - are based on destructive lesions of the lungs.This is either primary bullous emphysema, or bronchiectasis, or cysts, etc.

However, the burden of the concept chronic nonspecific lung diseases, under a false mantle chronic pneumonia, haunted and, many leading clinicians-scientists, including Professor N.V. Putov, in the eighties of the last century, still cherished chronic pneumonia as an independent nosology. So, for example, Putov N.V., criticizing chronic pneumonia as a nosology, writes "... All of the above does not mean, however, that chronic pneumonia in a more specific and narrow sense of the term does not exist at all", and Dembo Alexander Grigorievich, at the plenum pulmonologists in Siauliai, 1983, put a bullet point - "Chronic pneumonia was, is and will be." But, following this assurance, at visiting seminars, including in Yerevan, he, Professor Dembo A.G., zealously criticized the magnitude of chronic pneumonia, and in lectures "On the legitimacy of the diagnosis of chronic pneumonia", he questioned the very concept of chronic pneumonia. pneumonia. That is, chronic lung disease - yes, this is a fact, but to pneumonia, as a nosologically defined group of diseases, has no pathogenetic relationship.

I consider it very important to draw the attention of doctors to the definition developed within the walls of the All-Russian Research Institute of Pulmonology: chronic pneumonia represents, as a rule, localized process, first - resulting from not completely resolved acute pneumonia; secondly, the morphological substrate is pneumosclerosis and/or carnification of the lung tissue, as well as irreversible changes in the bronchial tree by the type of local chronic bronchitis; and thirdly, clinically manifested in repeated outbreaks of the inflammatory process in the affected part of the lungs.

In the context of the academic definition of chronic pneumonia, all of the above components of this definition seem to be of fundamental importance. Mandatory connection of chronic pneumonia with acute, shows the main pathogenetic factor and delimits from primary chronic diseases. An indication of the morphological substrate - pneumosclerosis, draws a line between chronic pneumonia and chronic diseases, which are based on destruction resulting from the collapse of the lung parenchyma or bronchial expansion. The obligatory recurrence in the affected area of ​​the lungs excludes from the concept of "chronic pneumonia" asymptomatic localized pneumosclerosis.

Of course, the limitation of the concept of "chronic pneumonia" in the eighties led to a reduction in the statistical values ​​of the incidence of this disease, from 37% (Molchanov N.S., 1965) to 1-3% (Gubernskovoy A.N., Rakovoy E.A. ., 1984). And, if in the 60s it was believed that patients with chronic pneumonia accounted for more than half of all patients in pulmonology departments (Zalydnikov D.M., 1960), then in the 80s their number decreased to 3-4%, and according to foreign authors and even less - 1-2%.

It would seem, well, let it be, because it is so convenient, and who cares. But the clinical sadness is that under the diagnosis of chronic pneumonia, patients with non-infectious, chronically current diseases, in some cases, are secondarily infected, and the outcome of the disease, under a false mantle chronic pneumonia, very sad. Medical experience confirms this.

Example 1

Patient Anna, 9 years old, was delivered (on her arms) for a consultation, in a terminal state of progressive fibrosing alveolitis. From the mother's story: the girl was often sick, constant signs of a respiratory disease, occasional wheezing in her chest... (Based on the anamnesis, it can be argued that the girl suffered from bronchial asthma.) On the recommendation - from a television advertisement, my mother began to give panadol. But, after some time, panadol not only stopped helping, but the child became ill from it. With a sharp deterioration, the girl was taken to the children's hospital, where she was diagnosed with chronic bronchopneumonia. The diagnosis formula was derived on the basis of the X-ray report - "Confluent bronchopneumonia" and the fact of a long course (more than two years). As expected, strong antibiotics were prescribed, which made the girl even worse. They changed antibiotics, but!? ...It was too late, the child could not be saved. Only 9 months after hospitalization was diagnosed - "exogenous allergic alveolitis". In practice, the diagnosis of pneumonia and the subsequent antibacterial pharmacotherapy were not only inappropriate, but became an additional antigenic burden.

Example 2

Patient Gevorg, aged 22, was admitted to the Republican Antituberculosis Center with a diagnosis: "Infiltrative tuberculosis of the upper lobe of the left lung in the phase of decay and seeding. Chronic obstructive bronchitis." He was admitted to a tuberculosis hospital with a referral from a military hospital, and there he was treated for more than a year for pneumonia. Treated intensively, but alas!

In this case, already on the basis of the anamnesis, it was clear that the patient suffers from bronchial asthma, but the radiologist described pulmonary tuberculosis. The results of biochemical and clinical blood tests ruled out tuberculosis: Total antibodies for tuberculosis - negative test, ESR - 2 mm/h, leukoformula within the normal range with significant eosinophilia - Grn - 16 K/μ l. High Hematocrit - 52%(N - 36.0-48.0). Dramatically downgraded Cortisol - 0.7mcg/dl- at a rate of 7.0-25.0 mcg / dl, and the atopy test goes off scale - "Total immunoglobin "E"" - 1480.4 U / ml, at a rate of 1.31 to 165.3. The physical data of the objective examination fit into the diagnosis of asthma, these are diffuse dry wheezing, sharply prolonged exhalation, bloating of the lungs (emphysema), pneumotachometric coefficient = 0.3, and the peak expiratory flow rate (PEV) is 150 ml.

But!? There were obvious clinical and paraclinical signs of destructive pathology in the upper lobe of the left lung. These are local wet rales, and increased voice trembling, and an X-ray implied focus of tuberculosis, and earlier this focus was assumed to be pneumonia. Based on all studies, anamnesis and clinical course of the disease, a clinical diagnosis formula was derived: "Bronchial asthma, mixed form, severe course. Destructive pneumopathy, with perifocal inflammation in the upper lobe of the left lung." After computed tomography, the conclusion: "air cavities in the upper lobe of the left lung may metatuberculous character"(?).

Based on clinical and paraclinical data and the conclusion of a consultant thoracic surgeon, according to our recommendation, the patient Gevorg was operated on - "Left-sided upper lobectomy with pleurectomy". Histopathological conclusion of the removed organ: "Cysts of the upper lobe of the left lung, foci of pneumosclerosis, emphysema, atelectasis, foci of nonspecific inflammation" (from the epicrisis, 1479). Retrospectively, it can be argued that the sick Gevorg was saved by asthma. If it were not for asthma, chronic pneumonia or tuberculosis would be treated for a long time.

Of course, pneumonia is an infectious disease and pathogenetically should be considered as the type of pathogen - Pneumoniaklebsiela pneumoniae (J15.0) , and by the mechanism of infection - congestive pneumonia (J18.2) . Non-infectious lung inflammation or inflammatory reactions such as alveolitis, asthma, eosinophilic pneumonitis, etc. - can not be designated as pneumonia.

The clinician is obliged to isolate pneumonia according to etiopathogenesis: bacterial, viral, mycoplasmal, preferably with an indication of the pathogen, but it is inadmissible to put physical, chemical or other non-infectious signs in the etiopathogenesis series, i.e. factors that cause inflammation of the lungs.

Mixed pneumonia is a combination of two or more infections or a superinfection (lat. super - from above) of an already infected lung, but it is not an infection of a congestive lung or an infection of cysts, as, for example, in the case of Gevorg. See example 2.

Can viral pneumonia, with a specified virus (adenoviral), be complicated by another virus (parainfluenza infection) and this is a mixed virus-viral pneumonia. Or viral pneumonia, with a specified virus (adenoviral), complicated by a bacterial infection (Pseudomonas aeruginosa), then this is a virus-bacterial pneumonia, there may be a bacterio-bacterial pneumonia, etc., etc. - infection of mixed pneumotropic agents.

In clinical practice, it is often diagnosed pneumonia immunogenic pneumonitis. These are systemic inflammations or, more correctly, inflammatory reactions that manifest themselves in different ways - from rin ita , sinus ita , eustachians ita , laryng ita , trache ita before alveoli ita , pleura ita and the so-called interstitial pneumonitis ita . In our observations, almost all patients with asthma, at one stage or another of the formation of the disease, were diagnosed with one or another - ita - bronchitis, pharyngitis, rhinitis etc. and also - pneumonia, with all the ensuing treatment errors.

This kind of error is more common in pediatrics. At the same time, the pediatrician, for some reason, does not have a question, why pneumonia, bronchiolitis, pharyngitis, rhinitis are not amenable to antibiotic therapy and - incorrect, erroneous conclusions follow: chronic pneumonia, chronic bronchiolitis, chronic pharyngitis, chronic rhinitis. Yes Yes, chronic, although the child is "not a year old"!?

The real prospect (lat. perspectus - clearly seen) of effective therapy for pneumonia, of course, is due to the etiopathogenetic diagnosis. However, the isolation of certain microbes from the patient's sputum, and especially viruses, and even in the early stages of the disease, is a painstaking and, unfortunately, often impossible. However, the isolation of certain microbes does not mean that this particular microbe is the cause of pneumonia. But the definition of pneumonia as an infectious inflammation of the lungs is a matter of honor for the doctor and the first step towards recognizing the pathogenesis, the mechanics of the infection (Latin infectio - the penetration of pathogens into the body), and therefore, this is the right step towards prevention and effective treatment.

After the approval of pneumonia as an infectious inflammation of the lungs, it is necessary to exclude pneumonia that has arisen with independent infectious diseases, such as: psittacosis (A70); AIDS pneumonia (J18.9); congenital pneumonias (P23.-); pneumocystosis (B59). And only after the exclusion of independent nosological infectious diseases and the denial of non-infectious pneumonia (J60-J70) and (J-J), the doctor will stop acute pneumonia, in its etiopathogenetic variety and varieties of clinical course.

Back in the eighties of the last century, the stars of Soviet pulmonology - Gleb Borisovich Fedoseev and Nikolai Vasilyevich Putov, noticed: "If we exclude pneumonia that has arisen with independent infectious diseases (ornithosis, psittacosis, etc.), as well as pneumonia caused by non-infectious factors (radiation, drug, etc.), then an idea is created of pneumonia as a process associated mainly with bacterial and viral infection, characterized by severe pneumotropism. Quite understandably, in those years the "Minsk" (1964) classification of the so-called chronic pneumonia, adopted at the corresponding plenum of the board of the All-Union Scientific Society of Therapists, gravitated. By the way, this is the same fictitious "chronic pneumonia" that has swallowed up all chronic lung diseases, not of tuberculosis origin. And even asthma fell under chronic pneumonia, as Bulatov P.K., 1965 and Uglov F.G., 1976 write: "Some exaggeration of the role of infection in the origin of bronchial asthma has led to the fact that this disease is also associated with the concept of chronic pneumonia."

From the foregoing, it follows that an important fact for pulmonolia was that in the context of the ICD-10, a new understanding of pneumonia, the controversial, not correct form - "Chronic pneumonia" will disappear. If pneumonia is an obligatory effusion in the alveoli of the exudate, then it is difficult to imagine a chronic effusion. At the same time, pneumonia is quite real, often recurring in the same areas of the lungs, for one reason or another, favorable for the penetration of microbes, i.e. infections, as was the case with the sick Gevorg. It is more prudent to call this condition recurrent (Latin recidivus returning) pneumonia, but not chronic. All other inflammations without effusion into the alveoli should be called pneumonitis (gr. pneumön lung + it inflammation), including non-infectious pneumonias, such as alveolitis, bronchiolitis and various interstitial pneumonitis.

According to our data, the vast majority of patients with asthma, at one stage or another of the formation and course of asthma, develop pneumonitis in the form of uninfected bronchiolitis and alveolitis. Unfortunately, such patients are diagnosed with "pneumonia" with all the negatives that are brought into the clinical course of asthma, such as the prescription of antibiotics, vitamins, the use of biologically active substances and nutritional supplements. In fairness, it should be noted that this is not a criminal mistake and occurs not so much through the fault of the practitioner, but because of the incorrect (academic) definition of pneumonitis as pneumonia.

In a certain number of patients with asthma, as a result of a thorough examination, a destructive pathology of a congenital nature is revealed. For the most part, this is a congenital insufficiency in the structure of the bronchi or interstitium of the lungs. Asthma, as it were, brings this insufficiency into an obvious pathology, complicating a congenital defect.

Along with the overdiagnosis of pneumonia, in patients with asthma, cases of undiagnosed pneumonia are not uncommon, due to the prevalence of clinical symptoms, signs of bronchial asthma. Verification of pneumonia in patients with asthma is hampered not only and not so much by asthma itself, but by the non-typical course of pneumonia and, first of all, by an unresponsive onset and, like pneumonia, local immunogenic inflammatory reactions - eosinophilic hot flashes or pneumonitis.

All this entails, on the one hand, the loss of time to start antibiotic treatment, and on the other hand, even greater sensitization of the focus by immune inflammation. It should be noted that the physical signs of pneumonia and pneumonitis are completely different. Moist rales are sure to be heard over the focus of pneumonia. Above the focus of allergic pneumonitis, there are usually no moist rales, but creaking rales often appear, and with alveolitis, "cellophane noise" is something resembling the sound of cellophane when the wind blows or runs your hand over it. It is precisely because of the radiological diagnosis of immunogenic inflammation as "pneumonia" that in practice there is a discrepancy between clinical signs and the X-ray picture of the lungs.

Example 3

Patient Rustam, 56 years old, was admitted to the clinical department of the Bnabuzhutyun Medical Center on 02.02.2006. Habitus on admission: hypersthenic, swarthy, visible mucous membranes of a dark blue color, emaciated, shortness of breath at rest, heavy breathing, remote wheezing, exhalation is prolonged with a short intense inspiration. The general appearance is compassionate with a distrustful look of a seriously ill patient. Speech is interrupted, the tone is plaintively aggressive. Complaints on admission: General weakness and malaise. Perspiration and transient chill. Paroxysmal cough with scanty, viscous sputum; it can be purulent, liquid, especially - "... when it lets go of suffocation." Rattling in the chest and shortness of breath, aggravated by habitual physical activities, as well as sharp odors. Heaviness and feeling of congestion in the chest. Palpitation. physical examination: Palpation skin moist, sticky. Axillary, cervical lymphatic glands are not palpated. Voice trembling is asymmetric, increased in the lower section on the left and weakened over the middle fields of the right lung. Frenicus symptom - positive on the right. Percussion determined dull sound over the lower lobe of the left lung. Dullness and on the right, in the subscapular region. The tour of the lower percussion border is limited to the left. The Krening fields are expanded, the tops of the lungs are two to three transverse fingers above the clavicle. Percussion limits of absolute dullness of the heart are reduced. Diffusely widespread dry rales are heard over the lungs on auscultation in all fields, on the left in the lower section moist small bubbling and creaking rales are heard, locally. Above the other fields on the right, above the field of dull percussion sound, there are no moist rales (not detected). The heart sounds are deaf, the accent of the 2nd tone is determined above the mouth of the pulmonary artery. The abdomen is soft, palpation is painful. The percussion edge of the liver protrudes from under the costal arch by 2-3 transverse fingers, deep palpation is painful. Along the colon, tympanitis (gases) is determined, the descending section of the colon and sigma are palpated, in the form of a rigid cord, palpation is painful ...

Given that the patient was in an asthma attack, immediately after the examination, intensive infusion treatment was carried out, with the introduction of intravenous medium doses of glucocorticosteroids. After recovering from an asthma attack, the patient was sent home with a referral for X-ray examination, with a clinical diagnosis: bronchial asthma, left-sided lower lobe pneumonia. Radiographically (bilateral n/lobar pneumonia) the diagnosis was confirmed, but the category "pneumonia" also included right-sided shading, in the lower parts of the lung, which was not certain). The discrepancy between the physical signs of pneumonia and the X-ray picture of the lungs was obvious. The conclusion of the radiologist: "Bilateral bronchopneumonia." However, auscultatory moist rales were determined only on the left in the lower parts of the lungs.

Since the patient's temperature was only subfibrile, and the symptoms of intoxication were not pronounced, and, on the other hand, the patient was in an exacerbation of asthma, the infusion treatment of asthma was continued for another three days. Then a control x-ray was taken. And only after an additional examination, including a clinical analysis of peripheral blood, i.e. confirmation of infection by paraclinical methods, antibacterial treatment was carried out. X-ray control after 14 days of treatment. On a series of direct x-rays, we see the positive dynamics of the focus of inflammation, moreover, the complete resorption of inflammation in the left lower lobe. But on the right, the shadow not only did not disappear, but as a result of antibacterial pharmacotherapy, it became even more common, with some shade of the “ground glass” pattern. Which gives the right to think that there was no pneumonia on the right, but there was a focus of eosinophilic pneumonitis, which, against the background of additional sensitization to antibiotics, intensified somewhat. This is confirmed by the complete disappearance of shading as a result of desensitizing treatment, after stopping antibiotics. I should note that the physical signs of inflammation in the right lower lobe of the lung appeared on the 20th day of treatment, after desensitization treatment, and persisted for another month, in the form of a crescendo crepitation, on inspiration. Such dynamics of the physical signs of lung disease is quite clear to us from practice and is characteristic of alveolitis.

And, only two months later, on April 14, 2006, during the control examination, all signs of lung pathology completely disappeared from Rustam. Visicular breathing over all fields of the lungs, including over the right lung - presumed eosinophilic pneumonitis. Control X-ray examination and examination of peripheral blood confirmed the clinical cure. Medical control of asthma, including low doses of glucocorticosteroids, is ongoing.

In conclusion, before admission, Rustam suffered from infectious pneumonia for more than two months - recurrent acute pneumonia, but the doctors diagnosed him with already known asthma and received treatment only for asthma. Yes, and was sent for a consultation as a patient with severe asthma. Similar cases in our practice are countless, and the reason for this is not sufficient correctness during the derivation of the formula for the diagnosis of pneumonia.

Effective treatment of asthma, in the case of Rustam, with persistent pneumonia (relapses of pneumonia), confirms the incorrectness of the diagnosis of infectious-dependent (infectious-allergic) bronchial asthma. Of course, an infection (and not only of the lungs) can provoke an exacerbation or even contribute to the formation of asthma, but no infection can induce asthma, as they say, out of nothing. That is, for the formation of asthma, a necessary condition is hereditary diathesis - atopy, predisposition.

Features of the treatment of pneumonia in patients with asthma

In the practice of treating asthma patients, doctors face a dilemma - either prescribe loading doses of antibiotics and crush pneumonia, but the likelihood of aggravating the course of asthma is high, and in some cases it is possible to form alveolitis (see "Fibrosing alveolitis", or block the exacerbation of asthma, leaving pneumonia alone for one with the macro-organism, but then there is a high probability of complication of pneumonia.In this difficult situation, many solve the problem with a method similar to inaction - a few antibiotics and a limited amount of anti-asthma drugs.As a result, asthma smolders, pneumonia turns into chronic inflammation and the notorious chronic inflammation is formed. pneumonia, to be exact. Chronical bronchitis with relapses of peribronchial inflammation of the lungs - recurrent bronchopneumonia.

There is no doubt that etiotropic antibacterial pharmacotherapy is the most effective in the fight against pneumonia. At the same time, the choice of an antimicrobial drug, taking into account the causative agent of infection, is very important due to the presence of antibiotic-resistant strains, especially in cases of pneumonia in patients with bronchial asthma. On the one hand, anti-asthma pharmacotherapy suppresses immune defenses, and on the other hand, all asthma patients often and repeatedly take antibiotics, thereby adapting infectious agents to antibiotics. Exactly because of this reason pneumonia in asthmatic patients is more difficult to treat with antibiotics . This requires special skill of the clinician in the treatment of pneumonia in patients with asthma. So, how to be? Of course - to follow the path of etiotropic treatment! A rapid indicative bacteriological diagnosis based on microscopy of sputum smears and/or biochemical tests for the presence of antibodies in peripheral blood is needed. And if this is not possible, then an approximate etiotropic diagnosis can be made on the basis of the clinical features of the course of pneumonia, taking into account the characteristics of x-ray data of lung damage.

The clinical features of pneumonia are largely determined by the type of pathogen. For example, the causative agent of lobar pneumonia is the microflora of pneumococcal nature, and clinically lobar pneumonia begins suddenly, with a tremendous chill, pain in the side of the lesion, headache, shortness of breath, non-productive cough, fever, up to 40ºC. According to these signs of the disease - clinical deduction, from particular to general conclusions. If croupous pneumonia, then it is probably a pneumococcal infection, i.e. choice of antibiotics is clear. (See. Book: "Rational antibacterial pharmacotherapy").

According to the etiological significance, the leading among other pathogens of pneumonia are S. pneumoniae- 30-50% of cases and 10-20% - H. influenzae. From 8 to 20% are accounted for by the so-called atypical microorganisms: Chlamydophila pneumoniae, M. pneumoniae, L. pneumophilae. Typical, but rare - 3-5% - causative agents of pneumonia include S. auerus and K. Pneumoniae and other enterobacteria.

The most effective treatment for pneumonia, in the absence of an etiopathogenetic diagnosis, is a combined antimicrobial pharmacotherapy using two or three antibiotics with different mechanisms of action. At the same time, care must be taken to prevent exacerbation of asthma by using glucocorticosteroids.

Conclusions:

• Ø Often, in cases of pneumonia in asthmatic patients, the patient is treated under the diagnosis of bronchial asthma, with unsuccessful or even aggravating pneumonia, asthma treatment. In fairness, it should be noted that this is not a criminal mistake and occurs not so much through the fault of the practitioner, but because of the incorrect (academic) definition of pneumonitis as pneumonia in reference books and manuals.
• Ø Chronic inflammation in the bronchopulmonary tissue - for the most part, this is a congenital insufficiency of the self-regulation system of inflammatory reactions, in particular the lungs (the same can occur in the digestive tract, in the skin). Asthma, irritable bowel syndrome, allergic neurodermatitis, as it were, bring this insufficiency into a clear pathology.
• Ø Along with the overdiagnosis of pneumonia in patients with asthma, cases of undiagnosed pneumonia are not uncommon, due to the prevalence of clinical signs of bronchial asthma.
• Ø It is precisely because of the X-ray diagnosis of immunogenic inflammation as pneumonia, in practice, there is a discrepancy between clinical and X-ray signs of lung pathology.
• Ø All this entails, on the one hand, the loss of time to start antibiotic treatment, and, on the other hand, an even greater sensitization of the focus by immune inflammation.
• Ø Above the focus of allergic pneumonitis, as a rule, there are no moist rales, but crepitant rales often appear, and with alveolitis, “cellophane noise” is something reminiscent of the sound from cellophane when the wind blows or run over it with your hand.
• Ø Special skill of the clinician is required in the treatment of pneumonia in patients with asthma.
• Ø From the above, it follows that an important fact for pulmonology was that in the context of the ICD-10 (rational understanding of pneumonia), the incorrect form "Chronic pneumonia" will disappear. Chronic - pneumonia cannot be, and pneumonitis - always proceeds chronically.

P.S

No matter how much the disease is treated, the patient will not recover. . It is for this reason that the "Fathers of Medicine" recommend - "Treat the sick, not the disease" . This is a very important postulate. Internal energy capabilities determine how the disease will proceed. This means that it is necessary to create conditions more favorable for a particular individual, and the body itself will find ways to recover. As Nikolai Vasilyevich Putov describes in his book "Guide to Pulmonology" - "... along with the typical classical form of pneumococcal pneumonia, there are pneumonias (excellent) in terms of the extent of lung tissue damage ...". Further, he states - "Conditionally, it can be distinguished three groups of patients. AT some cases(30-35%) there is a distinct clinic of acute pneumonia: fever up to 38-39ºC, chest congestion, cough with sputum, pronounced signs of intoxication, distinct physical changes, and the severity of physical changes depends on the prevalence and localization of the inflammatory process. AT another case in the clinic of the disease, acute or exacerbation of chronic bronchitis predominates. The latter circumstance determines the common diagnosis - bronchopneumonia, when, along with fever and intoxication, there are signs of bronchitis and bronchial obstruction. In 1/3 of patients (meaning from the total number of patients with pneumonia), shortness of breath, persistent unproductive cough are observed. Correct diagnosis is facilitated by the detection of local asymmetry of physical data - a change in percussion tone, increased voice trembling, more pronounced auscultatory symptoms. "And finally, the author presents third group- "... the clinic of the disease is erased and manifested only by a persistent cough and signs of intoxication (subfebrile condition with temperature drops to febrile values, asthenia). Shortening of percussion sound, wet rales are detected in single patients, most have hard breathing with a bronchial tone and dry rales in a limited area, differing in constancy.

As well as possible, the author of the book described pneumonia in patients with asthma or the formation of allergic alveolitis, although he associates this with the age of the patient (over 40 years old), with chronic bronchopulmonary diseases (chronic bronchitis, pneumosclerosis, emphysema) and with cardiovascular diseases, which falls under the category of unspecified (late onset) asthma or asthmatic bronchitis. Perhaps with cardiac asthma.

It seems to us that this is reactive pneumonitis, against the background of chronic bronchitis, but not like pneumonia, as it is very appropriately noted in the book "Guide to Pulmonology" - changes in the interstitial tissue of the lung, identified in various pathological conditions, are a manifestation of a kind of immunomorphological reaction organism. So in the case of Rustam, we have two foci of inflammation, one on the left - lower lobe pneumonia and on the right - widespread pneumonitis with all clinical and paraclinical signs.

BIBLIOGRAPHY:

• 1. Inflammation. A.M. Chernykh. Moscow, "Medicine", 1979, - 448 p.
• 2. Exogenous allergic alveolitis / Ed. A.G. Khomenko, St. Muller, W. Schilling. - Moscow, "Medicine", 1987. - 272 p.
• 3. Mechanisms of bronchial obstruction. G.B. Fedoseev. St. Petersburg, Medical Information Agency, 1995. - 336 p.
• 4. Pathophysiology of the lungs. - 3rd ed., Rev. Moscow; St. Petersburg: "Publishing house BINOM" - "Nevsky Dialect", 2001. - 318 p.
• 5. Brief etymological dictionary of the Russian language. Ed. 2nd, rev. And extra. Ed. Corresponding Member USSR Academy of Sciences S.G. Barkhudarov. Moscow, Publishing House "Prosveshchenie", 1971. - 542 p.
• 6. Rational antimicrobial pharmacotherapy. Guidelines for practicing physicians; Under total ed. V.P. Yakovleva, S.V. Yakovleva - Moscow: "Litterra" publishing house, 2003. -1008 p.
• 7. Guide to pulmonology / Ed. N.V. Putova, G.B. Fedoseev. 2nd edition, revised. Oh add. - Leningrad: Medicine, 1984. - 456 p.
• 8. Practical approach to asthma: R. Powels, P.D. Sneshal. Translation from English; Scientific consultant and author of comments V.F. Zhdanov - St. Petersburg: Association "Asthma and Allergy", 1995. - 174 p.

The basis of any form of inflammation is the reaction of living tissues to irritation, A.M. Chernukh, in the book Inflammation. Moscow, "M", 1979.

infection [lat. ifectio] - infection, penetration into the body of pathogens.

Definition of inflammation from the book "Essays on Pathology and Experimental Therapy", A.M. Chernukh.

Fronton [fr. pediment< лат. frons (frontis) лоб, передняя сторона] - передняя сторона инфекции.

demarcation [fr. demarcation] - demarcation

Definition from the Book: "Rational antimicrobial pharmacotherapy". Moscow. 2003 p.252.

Quote [German] Zitat< лат. citare приводить, провозглашать] - дословная выдержка из текста.

Nuance [fr. nuance] - shade, barely noticeable transition in values.

Verification [fr. verification< лат. verus истинный + facere делать] - установление подлинности.

Reason [fr. raizon] - argument, reason, meaning.

Context [< лат. contextus сплетение, соединение] - законченный в смысловом отношении отрывок письменной или устной речи (текста), точно определяющий смысл отдельного входящего в него слова.

Postulate [lat. postulatum] - a statement accepted without evidence as a starting point.

Bibliographic link

Voskanyan A.G., Voskanyan A.A. PNEUMONIA. FEATURES OF THE COURSE AND TREATMENT OF PATIENTS WITH ASTHMA // Modern problems of science and education. - 2007. - No. 6-2 .;
URL: http://science-education.ru/ru/article/view?id=773 (date of access: 06/27/2019). We bring to your attention the journals published by the publishing house "Academy of Natural History"

Bronchial asthma is an inflammation of the bronchi of an allergic nature, which is accompanied by their increased reactivity and reversible bronchial obstruction, resulting in asthma attacks.

Frequency. Among adults, bronchial asthma occurs on average in 5% of the total population, in children - up to 10%.

Causes and pathogenesis of bronchial asthma

There are several reasons for the occurrence of the disease. This is a hereditary factor, bronchial hyperreactivity, and atopy, i.e., an unusual reaction to substances in the body, which usually does not cause any problems for most people.

Predisposing factors are substances-allergens. They can be household, food (some food), fungal. The cause of the development of the disease can be the pathological period of intrauterine development of the fetus, premature birth, unbalanced nutrition, atopic dermatitis, respiratory infections, passive and active smoking.

Allergies, viral respiratory diseases, physical and emotional overstrain, changes in climatic living conditions, adverse weather effects, etc. can provoke an attack of bronchial asthma.

Among the causes of asthma, attention has long been drawn to the role of external factors - contact with animals, plants (cat asthma, hay asthma), along with the importance of a special predisposition, often family, from the nervous system and metabolism (the so-called neuro-arthritic diathesis) .

With the development of the doctrine of anaphylaxis and allergies, in which bronchospasm, urticaria, eosinophilia are also observed, and in asthma they began to see a predominantly allergic reaction to certain allergens. From this point of view, the long-known forms of feline asthma, hay catarrh, asthma from primrose, ursola, down pillows, etc., as well as cases of so-called infectious asthma, i.e., special sensitivity of patients to metabolic products of even ordinary microbes, received a scientific explanation. respiratory tract.

However, the allergic theory of asthma does not exclude the leading role in the development of the disease of the neurogenic factor. Allergic manifestations are associated not only with an altered humoral environment, but mainly with altered nervous reactions, including changes in higher nervous activity. There are well-known cases of reflex asthma as a result of irritation of special asthmatic (i.e., asthma-causing) points of the mucosa in diseases of the nose (polyps, deviated septum), lungs (peribronchitis, pneumosclerosis), biliary tract, female genital and other organs distant from the lungs.

From the point of view of reflex reactions, asthma can be viewed as an inappropriate increase in such protective reflexes as sneezing, bronchospasm, larynx when inhaling caustic vapors, etc., which normally protect the deeper lungs in cases of irritation of the upper respiratory tract.

Attention is drawn to the frequent increase in sensitivity to cold in patients with asthma (as in cold urticaria) and to the usual constituents of food (milk, eggs), inhaled air, objects in contact with the skin due to an altered reactivity of the nervous system that affects the enzymatic - exchange processes. Violation of these processes should explain the possible decrease in the destruction of histamine in the tissues of patients with bronchial asthma, with which they associate reactions called allergic, urticaria, etc.

In patients with bronchial asthma, signs of the predominance of the parasympathetic autonomic nervous system are often found (as in similar intestinal diseases (mucosal colic) and a number of vascular neuroses).

Finally, it is necessary to emphasize very definitely the participation of the cerebral cortex in asthmatic attacks, which, as has long been known, even in cases of apparently typical allergic asthma, are caused only by mental influences. In the stubborn repetition of seizures in individual patients, rooted temporary conditioned reflex connections certainly matter. Cases are well known when a person suffering from "flower" asthma had an attack immediately even at the sight of an appropriate artificial plant, or when an asthma attack was interrupted by an injection of an indifferent solution (instead of adrenaline). Clinically, it was possible to trace the connection of disorders (“breaks”) of higher nervous activity, for example, with skull contusions, with vegetative shifts in the form of an increase in the tone of bronchial muscles during the development of bronchial asthma. Thus, asthma is a cortical-visceral disease accompanied by metabolic disorders, in addition to pronounced neurovegetative and allergic reactions. The high frequency of this disease among persons of sedentary professions and in some cases also suffering from other metabolic diseases (eczema) is explained by the influence of environmental conditions; nutrition, insufficiency of oxidative-enzymatic processes, a violation of the chemistry of tissues and a change in the reactivity of the nervous system. Asthma often develops as a purely central or reflex-nervous disease, with no apparent metabolic predisposition. Like other neuro-allergic diseases, asthma is widespread in the United States.

Bronchial asthma affects both sexes equally often, often for the first time during puberty. In some cases, asthma seems to have the character of an occupational disease, being associated with the action of certain irritants - in pharmacists (exposure to ipecac), furriers (exposure to ursola)? or it can be associated with household repeated exposure to allergens (primrose, rose), however, in these cases, neurogenic factors are no less important, which also underlie cases of asthma that begin after falling into cold water, and in cases of developing asthma after bronchitis, pneumonia , pneumosclerosis, etc.

Pathological anatomy. In rare cases of death from uncomplicated asthma, acute pulmonary distention is found, usually with obstruction of the bronchi by plugs of viscous mucus, distension of the right heart. In asthma associated with bronchopulmonary diseases, anatomical changes in the underlying disease predominate.

Recently, attention has been paid to the frequent combination with asthma of allergic lesions of the vessels of the lungs in the presence of interstitial inflammation.

Bronchoscopically during an attack, "urticaria" of the bronchi was found.

There is an opinion that the main in the development of bronchial asthma is the inflammatory process. It is persistent. If the disease proceeds for a long time, the structure of the respiratory tract changes: the epithelial layer is lost, fibrosis of the basement membrane of the bronchial tree mucosa occurs, angiogenesis increases, serous and goblet cells of the bronchial mucosa hypertrophy.

Classification

• atopic bronchial asthma;
• infectious-dependent bronchial asthma.

According to the etiological factor, they are divided into:

• exogenous;
• endogenous;
• mixed.

Symptoms and signs of bronchial asthma

The patient at the time of the attack assumes a position - sitting, leaning forward and resting his hands on the edge of the bed. Visually, you can see the bulging of the veins of the neck, the swollen wings of the nose, the skin in the area of ​​​​the nasolabial triangle and the nails on the hands turn blue. When listening to the lungs with a stethoscope against the background of uneven vesicular breathing, wheezing is heard. At the end of the attack, a little viscous vitreous sputum leaves. In young children, the onset of bronchial asthma can occur with signs of a respiratory viral disease with obstructive symptoms.

There are 3 degrees of severity of bronchial asthma:

• light;
• moderate;
• heavy.

Light degree characterized by infrequent occurrence of shortness of breath - 1 time per month, and only in the daytime. The course of attacks is mild, they quickly stop either on their own or after a single dose of bronchodilators (using an inhaler or orally). The disease does not lead to disruption of sleep and physical development of the child. The periods of remission last more than 3 months, while the function of external respiration is preserved.

Moderate degree. Attacks of shortness of breath - moderate. The function of breathing has been changed. It is possible to stop attacks with a single dose of bronchodilators, and also prescribe intravenous administration of glucocorticosteroid drugs). Remission is clinically and functionally incomplete.

Severe degree it is distinguished by frequent, also nocturnal, attacks of shortness of breath. They run hard. They can only be stopped by parenteral administration of agents that relax bronchospasm, in combination with glucocorticosteroid hormones. The disease greatly complicates physical activity and sleep. The period between attacks is 1-2 months. Remission for clinical and functional manifestations is not fully achievable.

The most typical for bronchial asthma are acute attacks of suffocation that occur either without apparent connection with any external influence, or during cooling, damp weather, colds of the respiratory tract, or in clear connection with the action of an allergen - through the air, food - at different hours of the day. often at night - from the action of special stimuli - a down pillow, etc., or from the predominance of parasympathetic influences with a physiological decrease in cortical influences at night), often after excitement.

An attack can begin with precursors (aura, as in gout, eclampsia, angina pectoris), which are different for different patients: mood changes, general weakness, itching in the nose, according to which the patient predicts the development of a major attack.

The attack occurs suddenly; the chest is not able to push out the air that inflates it, the patient feels suffocation, especially painful during the first attack in life. He sits in bed with his legs dangling, or jumps up, looking for a relief position, an arm rest, fresh air. Often the attack begins with the separation of watery secretion of the nasal mucosa, persistent sneezing, coughing. The patient himself and those around him hear a whistle in the chest. The face is cyanotic, the veins swell. Finally, scanty vitreous or pearly sputum begins to stand out with difficulty; then breathing becomes easier, the cough becomes wet, there is more sputum, it leaves more easily; the patient can lie down, fall asleep; asthma attack is over. Employability is soon restored.

Much more severe is the "asthmatic condition" (status asthmaticus - indomitable protracted asthma). An hour or two passes, the resolution of the expected attack but comes; there is a feeling of heavy tension, whistling in the chest; sputum, if any, does not bring the desired relief. The patient does not sleep all night, the day finds him in the same position, exhausted, having lost hope of relief; various remedies that usually helped do not work at all or bring a short-term slight improvement; the chest does not breathe completely; there comes an even more painful night, the second day. An attack may last up to a week, or attacks may follow each other only at short intervals.

An erased attack may be limited to dry wheezing or a feeling of immobility of the chest - when the legs are cooled, in a smoky room; after about half an hour, the attack passes.

When examining a person suffering from asthma for a long time, one can also distinguish by appearance, a pale cyanotic complexion, incomplete breathing even at rest, and other signs of emphysema. The chest during an attack, and later and constantly, is swollen, the ribs are raised, the sternum is pushed forward, the anterior-posterior diameter of the chest is increased. The intercostal spaces bulge due to increased intra-alveolar pressure. Respiratory mobility of the lungs is almost not determined by eye. During a severe attack, the patient has to be examined, usually sitting in bed or in an armchair. Rough whistling rales are often heard already at the entrance to the room where the patient is located, they are determined by the hand applied to the chest wall. Percussion gives the same airy sound throughout the entire region of the lungs, sonorous, pillow or box. Auscultation reveals an abundance of rales over the entire surface of the lungs, which does not happen in any other disease - musical, whistling, rough, scraping, making it difficult to listen to the heart, which is also covered by swollen lungs. Satisfactory filling pulse, with a tendency to decrease, which, like arterial hypotension, can be associated with parasympathetic predominance; tachycardia is observed in the most severe cases, occurring with vascular collapse. The liver is lowered due to swelling of the lungs; eosinophilia and erythrocytosis are noted.

A short-term increase in temperature is due to excessive muscle tension or irritation of the nerve centers; more often, fever depends on an infectious lesion of the respiratory tract.

Course, forms and complications of bronchial asthma

The course of asthma is highly variable. Two types can be distinguished.

In the first type, which usually begins in young years, asthma attacks recur for several years every month, week, even more often, or, conversely, with breaks for a whole summer or winter, even for a number of years. Asthmatic attacks can stop during acute febrile illnesses, with a change in the room, climate.

Over time, the disease can lose its correct character, manifesting itself only as asthmatic bronchitis with seasonal exacerbations or from other causes, without clear attacks, i.e. persistently recurrent bronchitis occurring with elements of asthma - an excessive amount of wheezing, their sudden appearance and disappearance, the presence of eosinophils in sputum, relieved by ephedrine.

Over the years, asthma, characterized by a regular course or expressed in the form of asthmatic bronchitis, leads to emphysema, usually with the development of pneumosclerosis of one degree or another. Such patients suffer from chronic pulmonary insufficiency. They die from heart failure, associated inflammatory damage to the lungs or atherosclerosis, cholelithiasis, etc.

In another group of patients, asthma joins an already existing chronic broncho-pulmonary lesion, post-measles, post-pertussis bronchiectasis, chronic pneumonia, pneumosclerosis of another etiology, syphilitic lung damage, chemical poisoning, even tuberculosis, manifesting itself for the first time with a typical attack or asthmatic bronchitis in adults. , and in the elderly. However, Rubel emphasized that the development of pulmonary emphysema even at a young age may indicate chronic hematogenous disseminated pulmonary tuberculosis or limited local bronchiectasis. An objective study is dominated by signs of the main pulmonary lesion, often determining the further prognosis - death from suppurative processes, amyloidosis, lung cancer, or, less often, from heart failure.

Diagnosis of bronchial asthma

You can determine the disease on the basis of anamnesis, patient complaints, examination. The methods of laboratory and instrumental diagnostics are as follows: blood test (eosinophilia is typical), urinalysis, biochemical blood test, allergological studies, general sputum analysis, x-ray, spirometry, bronchography and bronchoscopy, electrocardiography.

The main points of the diagnosis of bronchial asthma are:

• asthma attacks - wheezing, especially on exhalation, a feeling of lack of air, acute emphysema, forced posture with fixation of the shoulder girdle;
• paroxysmal cough, aggravated at night and in the early morning, disturbing sleep;
• the disappearance of shortness of breath and cough after taking bronchodilators;
• decrease in PSV or OFB1;
• blood eosinophilia, increased allergen-specific IgE in the blood;
• microscopic analysis of sputum.

Outside of seizures, early diagnosis is based on history alone. Pointing to urticaria, eczema, detection of nasal breathing defects, curvature of the nasal septum, hypertrophy of the shells, polyps are important. The development of emphysema already provides more support for the diagnosis.

The diagnosis of bronchial asthma is often mistaken for acute heart failure, cardiac asthma, myocardial infarction, acute nephritis, coronary sclerosis in hypertensive patients.

An asthma attack that occurs for the first time in old age, as a rule, depends on cardiac asthma, especially if it is accompanied by hypertension, enlargement of the heart, and pain in the region of the heart.

The young age of the patient speaks for bronchial asthma, as well as pneumonia, pleurisy, hemoptysis, urticaria in the past, family cases of asthma, interruption of an attack by adrenaline, duration of asthma attacks (cardiac asthma leads more often to death in the coming years). Sometimes bronchial asthma is combined with cardiac asthma (more often this combination occurs in elderly people with hypertension).

Differential Diagnosis

Bronchial asthma must be distinguished from cystic fibrosis, bronchoasthmatic syndrome with autoimmune pathology (collagenoses, etc.), infectious and inflammatory diseases (bronchitis, pneumonia, etc.), airway obstruction (tumors, foreign bodies, etc.), neurogenic disorders (hysteria and etc.), etc.

Forecast and work capacity

In atopic bronchial asthma, if the allergen is identified and eliminated, the prognosis is relatively favorable. In the infectious-allergic form of the disease, the course and severity of the underlying disease, the age of the patient, the presence or absence of complications affect the prognosis.

Asthma attacks do not usually die, although in the elderly and old people an attack can be dangerous. The disease disables and often requires a change in profession (pharmacist, furrier, etc.). Complications and concomitant diseases of the lungs further reduce the ability to work.

Prevention of bronchial asthma

Prevention of bronchial asthma is reasonable hardening, strengthening of the nervous system, a rational general regimen, systematically conducted physical education. It is necessary to treat diseases of the airways early and avoid professions associated with irritating substances.

Treatment of bronchial asthma

With an intermittent course, the first stage of therapy is carried out. Medications are prescribed only for the relief of seizures.

For this purpose, short-acting bronchodilators in inhalers or beta-agonists (beta-agonists), also inhaled, or beta-agonists inside are used.

With a mild persistent course, the second stage of therapy is prescribed: inhaled glucocorticosteroids for everyday use. Short-acting bronchodilators can be used to relieve an attack that has already begun.

A severe course requires the appointment of a daily intake of budesonide through a nebulizer, and inside - glucocorticosteroids in small dosages.

The treatment of bronchial asthma is reduced to general measures of calming the patient, regulating his higher nervous activity, to neuro-reflex therapy, as well as to the use of various pharmacological agents aimed primarily at influencing individual pathogenetic mechanisms and symptoms of the disease. Treatment should also be aimed at eliminating specific environmental stimuli (including special infectious, nutritional and other factors), as well as treating lesions of other organs that are the focus of irritation, the source of neuroreflex asthma.

In an acute attack of bronchial asthma, treatment is carried out in order to provide urgent assistance. Systematic treatment aims to prevent seizures and restore the patient's health and ability to work.

An attack of bronchial asthma is most reliably interrupted by adrenaline (0.5 ml of a 0.1% solution under the skin or intramuscularly for faster action), more mildly acting ephedrine (an alkaloid from Kuzmich's grass wild in the Urals, Siberia, Central Asia - Ephedra vulgaris) 0.025-0.05 by mouth or subcutaneously (5% solution), re-appointed if necessary, also with atropine injected under the skin or in an alcohol solution under the tongue. Smoking medicinal cigarettes or powder of asthmatol (Abyssinian powder) from the leaves of dope, henbane, belladonna containing atropine and related alkaloids and moistened with a 10% solution of potassium nitrate works well. In mild cases, dry cans, mustard plasters to the chest, hot foot baths, general calming of the nervous system are enough. In the prevention of seizures, an important role is played by the exclusion of individually various provoking moments well known to patients, for example, cooling of the legs.

Asthmatic condition (protracted recurrence of attacks of "indomitable asthma") requires more complex treatment, although already repeated injections of adrenaline in the indicated dose (up to 8-10 times a day) can bring relief. It is also recommended, especially when asthma is complicated by an infection or heart failure, efillin, which vigorously expands the bronchi by direct action on their muscles at a dose of 02.-0.7 in a suppository or 0.2-0.4 intravenously (slowly injected into a vein) or intramuscularly. Glucose also acts against bronchial edema, in addition, it is indicated due to the usual refusal of patients to eat and drink. Under the influence of eifillin, the action of adrenaline is also enhanced. It is also advisable to carry out a novocaine blockade according to Vishnevsky, prescribe hypnotics that prevent an anaphylactic reaction - large doses of paraldehyde, barbiturates (morphine is certainly contraindicated, especially if there is a risk of asphyxia, as it easily causes paralysis of the respiratory center and also increases bronchospasm), inhalation of oxygen (better in a mixture with helium - up to 30%), ionized air. With insufficient action, they resort to suction of the mucous plug with a bronchoscope. For respiratory tract infections, penicillin is used, especially in the form of an aerosol inhalation. In stubborn cases, other new and old anti-asthma drugs deserve to be tested: epinephrine subcutaneously in an oil solution (to prolong the action) or in combination with pituicrin (“asthmolysin”); antispastic agents - platifillin, papaverine, nitroglycerin; potassium iodide, which thins sputum and prevents blockage of the bronchi; antipyrine, aspirin, caffeine, calcium salts, pyryramidone, which alter the reactions of the nervous system. New antihistamines - diphenhydramine, piribenzamine, so effective in urticaria and serum sickness, do not bring definite benefit in asthma.

It is extremely important to carry out systematic treatment outside of attacks to prevent their return: regulation of the general regimen with sufficient sleep, use of fresh air, calming the nervous system, removing things from the room that contribute to the accumulation of dust and are rich in irritants-allergens dangerous for asthmatics (carpets, down bedding). , horse hair), flowers, domestic animals, the exclusion from food of eggs, milk, caviar, etc., sometimes causing asthma attacks.

Drugs that easily cause idiosyncrasy should be avoided, it is forbidden to administer intravenously quinine, serum, whole blood in order to avoid fatal shock; in case of emergency, their introduction is allowed only after preparing the patient with ephedrine, calcium chloride, aspirin, having an adrenaline solution on hand for quick use in case of a severe reaction. Special skin tests with extracts from suspected products can clarify the allergens responsible for the origin of attacks and desensitize the patient by subcutaneous injection of minimal, gradually increasing doses of these extracts. Patients with asthma who suffer attacks at work as a result of contact with ursol, ipecac, fish glue, etc., need to change their working conditions. Foci of irritation are eliminated by sanation of the nasopharynx, radical treatment of sinusitis, pulmonary diseases, cholelithiasis, adnexitis, etc. Long-term administration of antispastic and sedatives, such as ephedrine, luminal, bromides, regulates the nervous system of patients.

At last, reactivity of patients aspires to be normalized by the switching shock or irritating therapy; this is carried out, for example, by intramuscular administration of a suspension of sulfur in oil (1-2 ml of a 1% suspension), autohemotherapy, injection of a 5% solution of peptone into the muscle, Bogomolets antireticular cytotoxic serum (ACS), intravenous administration of hemolyzed or incompatible blood in small quantities, tissue therapy according to Filatov, for example, in the form of intramuscular injection of 1-5 ml of fish oil, pasteurized for 15 minutes for 3 days (gives painful infiltrates), or in the form of replanting pieces of organs under the abdomen according to Rumyantsev, X-ray therapy of the roots of the lungs, spleen, cervical sympathetic nodes. Physiotherapy in various forms is beneficial, such as: ionogalvanization with calcium and ultraviolet radiation, starting with small doses, which are believed to increase the tone of the sympathetic nerve; diathermy of the chest, spleen; climatotherapy in Kislovodsk, Teberda, on the southern coast of Crimea and other climatic stations (it is difficult to predict the effect in each individual case).

In rare cases, they resort to operations on the autonomic nervous system - cervical sympathectomy.

Each disease is a serious threat to human health. Even a seemingly minor illness can lead to serious consequences in the future.

Emergence of one disease at the already diagnosed another deserves special attention.

In this case, one should not only carefully study all possible manifestations of the disease, but also pay special attention to the correct arrangement of all the applied methods of treatment recommended in the event of the simultaneous development of both ailments.

The most common in the parallel course of the two diseases is the inflammatory process in the pulmonary tract and the presence of asthma in varying degrees of complexity.

Inflammation of the lungs or pneumonia is an infectious disease that occurs as a result of exposure to one or more pathogens: staphylococci, pneumococci, mycoplasmas, chlamydia, viruses, etc.

Inflammation of this area has several specific features. It is not worth underestimating the risk of the phenomenon in this case, since every day the development of the disease increases the risk of development and complications.

Features of the course and principles of differential diagnosis

The manifestation in the human body of a disease is facilitated by several factors at a time. With regard to inflammation of the pulmonary tract, the following can be noted that there may be several causes of exacerbation, and the form of the disease itself is often different in each individual case.

The symptoms that appear depend primarily on factors such as:

• pathogen;
• the size of the lung tissues affected by the disease process;
• the likelihood of occurrence or already established complications that develop in parallel with the disease;
• the reactivity of the human body in a weakened state.

Often, the condition of the body and the development of inflammation are also affected by the living conditions of a person, timely medical care, the quality of the drugs used, and a well-chosen regimen.

In the case of differential diagnosis, pulmonary inflammation is most often differentiated from SARS. In this case, a viral infection is the background for the development of inflammatory processes in the lungs.

Also, in some cases, it is possible to differentiate pneumonia from bronchitis in an acute form or from bronchiolitis.

The diagnosis of pneumonia is determined on the basis of several data:

For inflammation of the pulmonary tract, developing against the background of SARS, catarrhal changes in the nasopharynx, a sharp increase in temperature are also characteristic, but there is no radiographic and local change.

Causes of the development of the disease in asthmatics

The occurrence of pneumonia in bronchial asthma often develops secondarily and is directly related to prolonged or frequent attacks of bronchial asthma. In this case, the bronchi are seriously affected, where an unfavorable accumulation of mucus dangerous for the respiratory tract occurs.

The age groups affected by the disease are as follows:

1. Patients from 1 to 5 years of age most often suffer from a viral type of pneumonia.
2. A group of patients from 5 to 30 years old is susceptible.
3. Patients over the age of 30 suffer from pneumococcal (and other bacterial) pneumonia.

Patients suffering from bronchial asthma always have an increased risk of exacerbation of serious infections in the lungs. These infections are caused by a bacterium called Streptococcus Pneumoniae, which is the most common cause of the onset and spread of the disease.

In addition, this type of unfavorable bacterial background can provoke even potentially fatal ear and respiratory infections, brain blood flow infections.

Doctors noted that the manifestations of various infectious diseases in asthmatics, regardless of their age, are seven times higher than in other groups of patients. In addition, in 17% of case studies, this disease is directly related to asthma.

The results of research by scientists have proved that the scope of the scope of pneumococci can be significantly reduced if an early (preventive) vaccination of asthmatic patients is carried out.

Thanks to long-term laboratory studies conducted in a group of patients, including more than 4,000 people, it was possible to establish that asthmatics belonging to the older age group are at a sevenfold risk of developing and exacerbating pneumococcal lesions.

The susceptibility of asthma patients to microbial infections by immunologists is explained by the process of chronic inflammation, which affects the sharp weakening of the lungs, increasing the susceptibility to dangerous infections in the respiratory tract. Also, in bronchial asthma, a specific pathogenic mechanism of the immune system plays an unfavorable role.

The subtleties of the treatment of inflammation in the lungs with asthma

In asthmatics, in the treatment of this disease, a certain choice arises: the appointment of increased doses of antibiotics to eliminate inflammatory manifestations, but at the same time the risk of complicating existing asthma.

Prescribing low doses of antibiotics can affect the occurrence of complications in the period after pneumonia.

Therefore, you should look for a "golden mean", that is, prescribe the minimum dose of an antibiotic with parallel administration. As a result, asthma does not exacerbate, health complications are not observed, while the degree of resulting lesions of the pulmonary tract is reduced.

As a result, pharmacotherapy reduces the protection of the immune system. But on the other hand, asthmatic patients quite often use antibiotics as one of the components of the applied treatment regimen, where infectious agents deliberately adapt to antibiotic drugs.

This becomes the main reason for the phenomenon that pneumonia in asthma sufferers is much more difficult to treat therapeutically with antibiotics.

Since pneumonia belongs to the type of infectious diseases, it should be considered pathogenetically according to the type of pathogen identified, according to the characteristic mechanism of infections.