asthma
Introduction
Introduction Commonly known as "asthma", asthma is a type of sports injury. Asthma is a sudden onset without any warning, especially since many people are sick from late at night to dawn. I initially felt that my throat was tight and my chest was stuffy and my eyes were uncomfortable. Soon, the throat had asthma, asthma, and difficulty breathing. When breathing is severe, you may not be able to breathe, cough, or cough if you are not sitting after getting up. When the symptoms are alleviated, the cough will become lighter and the viscosity of the tendon will be less. Symptoms of difficulty breathing can also be improved.
Cause
Cause
Bronchial allergies in tracheal patients, as long as they are stimulated a little. When the bronchus is stimulated, it causes contraction, swelling of the bronchial mucosa, mucous membranes and mucus secretion. After a series of actions, the inner diameter of the bronchus becomes narrow. As a result, only a small amount of air can pass, causing wheezing and difficulty breathing.
The cause of asthma (the chance of stimulating an episode) is due to a variety of reasons. In addition to foreign bodies such as dust and pollen, cold symptoms, and respiratory infections such as bronchitis, changes in temperature and various stresses are also causes of the disease. The causes of bronchial allergies include allergic theory, the theory of viral and bacterial infections, autonomic nervous disorders, and endocrinology.
Examine
an examination
Related inspection
Sputum routine examination of blood routine Schistosoma cercariae reaction cerebrospinal fluid chloride
Airway inflammation measurement
Not routinely used in the clinic, and the significance of diagnosis and treatment needs to be accumulated more information.
(1) sputum eosinophils, neutrophil counts.
(2) Exhaled nitric oxide concentration (FeNO).
(3) Exhaled carbon monoxide concentration (FeCO).
Measurement of allergic conditions
(1) Skin acupuncture test: simple, rapid, sensitive, and inexpensive, therefore, is the main method for determining allergens. However, operators should receive specialized training to ensure correct practices.
(2) Specific IgE assay: It helps to identify allergens, and the sensitivity is similar to the skin acupuncture test, but the price is high.
(3) Skin acupuncture test and specific IgE test did not help to diagnose asthma. An allergen that is positive in both tests only indicates that the patient has an allergic reaction to the substance, and does not mean that the substance can cause asthma or other allergic diseases.
(4) The predisposing factors of occupational asthma can be obtained by self-monitoring PEF, or can be further confirmed by the bronchial provocation test of the predisposing factor in the specialist center.
Chest film
(1) There is no abnormality. In severe cases, the lungs can be seen to be over-inflated.
(2) patients with severe asthma should be routinely chest X-ray examination in order to find complications such as pneumothorax, mediastinal emphysema, atelectasis, pneumonia or complications. The shadow on the chest radiograph, in addition to considering the lung infection, should also be noted that it may be allergic lung infiltration.
(3) chest X-ray also helps differential diagnosis, such as cough variant asthma, chronic cough should be differentiated from tuberculosis, lung cancer and so on.
Arterial blood gas analysis
The degree of exhaustion used to assess respiratory function in the presence of dyspnea:
(1) Arterial blood gas analysis of mild patients can be completely normal.
(2) The typical performance is PaO2 60mmHg, while PaCO2 is low, and may have respiratory alkalosis.
(3) PaO2<60mmHg in severe cases, PaCO2 is normal or even high, and decompensated acidosis (the nature of metabolic acidosis, respiratory acidosis, metabolic + respiratory acidosis) may occur.
Diagnosis
Differential diagnosis
(1) Inhaled (exogenous) asthma :
The occurrence of this type of asthma is related to the inhalation of certain external allergens. It is characterized by obvious seasonality of the disease, which is usually seen in spring and autumn. It often has itchy nose, itchy throat and itchy eyes and eyes. Snoring, flow of watery nose and continuous cough and other respiratory and facial features. However, during the onset season, this type of patient often has no special symptoms, such as normal people, and some even have no cough or cough.
Most patients with this type of asthma have a significant history of family allergies (asylum or other allergic diseases in relatives). The patient also often has eczema, drug allergy, neurodermatitis or allergic rhinitis. Various wind pollen, dust, and mites are the most common inhaled allergens in inhaled patients. According to our research in the past ten years, the main inhalation allergies in Shanghai are the pollen of valerian, ramie and some dust mites and their metabolites. With the corresponding allergen extracts for inhalation or skin tests, the patient can have a local reaction in a short time. Therefore, this type of asthma is also called "rapid asthma" in medicine. This type of asthma is most common in children and young people, and most of the effects after appropriate treatment are satisfactory. However, if left unchecked, many patients will be converted into mixed asthma.
(2) Infectious (endogenous) asthma:
Infectious asthma is characterized by repeated infections; the initial cause is often a respiratory or pulmonary infection. There are obvious respiratory and inflammatory manifestations such as colds and fever before recurrent episodes. This type of patient occurs in the autumn and winter or before and after the cold. There was obvious wheezing at the time of onset, accompanied by increased sputum volume, yellowing of sputum and low fever, and elevated white blood cell counts. Adding antibacterial drugs during treatment can relieve symptoms early.
This type of patient has more onset of illness. The family and my family's allergy history is not as obvious as the inhalation type; the skin test with some common external allergens is usually a negative reaction. Because this disease has little to do with external allergens, this type of asthma is also known as "endogenous" asthma.
(3) Mixed asthma
Inhaled asthma patients with repeated asthma due to poor disease control after suffering from asthma, finally lead to further weakening of the body, and gradually appear clinical features of infectious asthma. The patient is initially susceptible to infection by various viruses and bacteria, prone to a persistent episode and often loses significant seasonality. This type of patient with both types of asthma is called "mixed asthma." The treatment of mixed patients is much more difficult than inhaled asthma.
(4) Occupational asthma :
For occupational reasons, asthma caused by inhalation or exposure to certain substances is called occupational asthma. This type of patient often has a certain family or patient's own history of allergies. Common allergens: cotton fine dust (discussed in the textile mill's former spinning section), yam powder, mushroom spores (mushroom plantation), silk moth dust (sericulture room), certain detergents and some factories' irritating gases , medicines, etc. These substances that induce asthma have the following characteristics:
1 The dust is small and easy to be inhaled.
2 itself has strong irritancy or antigenicity. In the early stages of illness, leaving the original work environment often eases the attack, and then entering the same environment can cause asthma attacks. The pathogenesis of this type is very complicated, and many problems are still under study.
(5) Others: According to some special manifestations or completely different pathogenesis, bronchial asthma also includes the following diseases or symptoms:
1 Chronic asthmatic bronchitis: This disease can be regarded as the combination of infectious asthma on the basis of chronic bronchitis. The patient is older, and the common wheezing is mild and the inflammation is obvious.
2 Sports asthma: Most of these patients are children or adolescents. Often have a strong genetic allergies. There is no history of asthma attacks on weekdays, but every time you exercise vigorously, such as running, you can have asthma attacks within about ten minutes. It was previously thought that the cause of the disease was related to excessive ventilation during exercise. Recent studies have suggested that some metabolic intermediates such as lactic acid produced in the body during exercise are associated with excessive accumulation in the body. This type of asthma can be prevented by taking theophylline or by spraying sodium cromolyn before exercise.
3 Chronic Asthma: Refers to some asthma patients whose asthma attacks are in a often chronic state. Although there is no particularly severe hypoxia or suffocation on weekdays, it brings great pain and inconvenience to life and work. Patients with chronic asthma are actually manifestations of these types of asthma in the later stages of development, and their stimulating factors (such as infection or inhalation of allergens) are often difficult to determine. Therefore, there is a chronic episode, and it is estimated that repeated or severe onset causes most bronchioles to have hypertrophy, scar, distortion and other pathological conditions, and the respiratory tract is highly sensitive to various stimuli. Unlike severe emphysema, patients with chronic asthma may still have a greater improvement in their condition and lung function under appropriate treatment.
4 Asthma, Aspirin Allergy and Nasal Polyp Syndrome: This is a rare but quite serious asthma. Asthma can be stimulated within half an hour of taking aspirin (acetylsalicylic acid); "non-steroidal anti-inflammatory agents" such as indomethacin can have similar stimulating effects. Asthma is also very common on weekdays, often in the end of the year, the peripheral blood eosinophils are often significantly elevated. A small number of patients may not have nasal polyps.
Asthma is a sudden onset without any warning, especially since many people are sick from late at night to dawn. I initially felt that my throat was tight and my chest was stuffy and my eyes were uncomfortable. Soon, the throat had asthma, asthma, and difficulty breathing. When breathing is severe, you may not be able to breathe, cough, or cough if you are not sitting after getting up. When the symptoms are alleviated, the cough will become lighter and the viscosity of the tendon will be less. Symptoms of difficulty breathing can also be improved.
