Today My Canadian Pharmacy decides to speak about bronchial asthma diagnostics. Let’s grapple with the question what is necessary to establish asthma diagnosis correctly.
Bronchial asthma (from Greek asthma – heavy breathing, choking) – human respiratory system chronic disease. The incidence of asthma is approximately 5% of the world’s population. In the United States there are nearly 470,000 hospitalizations and 5,000 deaths related to asthma. The incidence among women and men is about the same. The mechanism of disease is to establish bronchial hypersensitivity against chronic inflammation localized in respiratory tract level.
Asthma development can be caused by various factors:
- persistent respiratory tract infection;
- inhalation of allergens;
- genetic predisposition.
Long-lasting airway inflammation (such as chronic bronchitis) leads to structural and functional bronchial changes – muscular tunic thickening, increased activity of muciferous glands, etc. Allergens most often causing asthma, can be known as house dust accumulating in carpets and cushions, chitinous cells of micro-mites and cockroaches, pet dander (cats), pollen.
Genetic predisposition leads to increased sensitivity of bronchi to factors described above. Asthma attacks can be triggered by:
- inhalation of cold or hot air;
- physical effort;
- inhalation of allergens.
From viewpoint of Pathogenesis there may be distinguished two main types of asthma: infectious-allergic asthma;
It also describes some rare forms of asthma:
- exercise-induced asthma;
- aspirin – induced asthma, caused by constant aspirin use.
In case of allergic asthma, we distinguish between two types of response to inhaled allergen: immediate response (clinical picture of asthma develops after a few minutes after allergen penetration into bronchi) and late response, in which asthma symptoms develop after 4-6 hours after allergen inhalation.
Methods of Asthma Diagnostics
Asthma diagnostics is a complex and multi-step process. The initial diagnostic step is to collect anamnesis (patient survey) and clinical examination of patient, allowing in most cases, a preliminary asthma diagnosis establishment. Medical history involves clarifying patient’s complaints and revealing disease’s evolution over time.
Asthma symptoms are very diverse according to disease’s stage and individual characteristics of each patient. During initial development stages (pre-asthma), asthma symptoms are coughing seizures, which may be dry or with a small amount of sputum allocation. The cough occurs mostly at night or early in the morning, which is associated with physiological increase in muscle tone of bronchi in the morning (3 – 4 am). Cough may occur after prior respiratory tract infections.
Coughing seizures in the early disease’s stages are not accompanied by respiratory distress. Auscultation (patient’s examination) can be found scattered dry rales. Latent (hidden) bronchospasm is detected by means of special investigation methods: introduction of beta-agonists (drugs that cause relaxation of bronchial muscles) produces increase in fraction of exhaled air (spirometery).
In the later stages of development, the main asthma symptoms are breathlessness attacks. Development of suffocation attack precedes impact of one of precipitating factors, or attacks evolve spontaneously. In the beginning, patients may note some individual symptoms of coming attack:
- runny nose;
- sore throat;
- skin itching;
- progressive difficulties with breathing.
First, the patient observes difficulty when you exhale. It appears dry cough, and tension feeling in chest. Respiratory disorders make patient to sit resting his hands, in order to facilitate work of breathing by means of shoulder girdle muscles. The growth of suffocation is accompanied by wheezing appearance, which at first can only be detected on patient’s auscultation, but then become audible at a distance. Attacks of breathlessness in asthma are characterized by the so-called “musical wheezing” – consisting of sounds of different heights.
Further attack development is characterized by difficulty with inhaling when respiratory muscles position is in order to make deep breath (bronchospasm prevents air discharge from lungs during exhalation and leads to accumulation of large amounts of air in lungs).
Patient’s examination to diagnose pre-asthma stage did not reveal any specific features. Patients with allergic asthma, nasal polyps may be found, eczema, atopic dermatitis. The most characteristic symptoms are detected when inspecting a patient with breathlessness attack. As a rule, patient tends to take sitting position and rests his hands on chair. Breathing is long-lasting, tensed, significantly involved in act of breathing support muscles.
Jugular veins in neck swell when exhale and swelling disappears when inhale. When chest percussion revealed a high (boxed) sound, indicating accumulation in lungs of a large amount of air – plays an important role in diagnosis. The lower lungs’ boundary are down and inactive. When listening to lungs it is revealed a large number of wheezing of varying intensity and height. Seizure duration may be different – from several minutes to several hours. Resolution attack is accompanied by intense cough with release of a small amount of transparent sputum.
Particularly severe asthmatic condition is status asthmaticus – during which progressive dyspnea endangers patient’s life. In status asthmaticus, all clinical symptoms are more expressed than during normal asthma attack. In addition to them progressive breathlessness symptoms may appear:
- skin cyanosis (cyanosis);
- tachycardia (increased heart rate);
- heart rhythm disturbances (extrasystole);
- lethargy and drowsiness (central nervous system inhibition).
In status asthmaticus patient may die from respiratory failure or cardiac arrhythmia.
Additional Methods of Asthma Diagnostics
Establishing preliminary asthma diagnosis is possible based on clinical data collected by methods described above. Determination of particular asthma form, as well as disease pathogenic aspects establishment requires additional research methods use. Research and diagnosis of respiratory function (respiratory function, spirometry) in asthma help determine degree of bronchial obstruction, and their reaction to provocation of histamine, acetylcholine (substance causing bronchospasm), physical activity. If you come across with such a problem after consultation with doctor you are welcome to command My Canadian Pharmacy service able to offer you various medications directed to eliminate asthma symptoms.
In particular, determination is carried out by means of forced expiratory volume in one second (FEV1) and vital capacity (VC). The ratio of these values (Tiffeneau index) gives an indication of bronchial obstruction degree. There are special devices allowing patients to identify forced expiratory volume at home. To control of this parameter is important for adequate bronchial asthma treatment, as well as to prevent seizures development (attack development is preceded by progressive decrease in FEV). FEV determination is carried out in the morning before taking bronchodilator and in the afternoon after taking medicine. The difference of more than 20% between two values indicates bronchospasm presence, and need to modify treatment. Lowering FEV below 200 ml. reveals pronounced bronchospasm.
Chest radioluminography is an additional diagnostic method allowing to reveal symptoms of pulmonary emphysema (increased lung transparency) or pulmonary fibrosis (growth of connective tissue in lungs). The presence of fibrosis is more typical for infectious-dependent asthma. In allergic asthma, radiological changes in lungs may be disappearing for a long time.
Diagnostics of allergic asthma is to determine hypersensitivity in relation to certain allergens. Identification of appropriate allergen and its elimination from patient’s environment, in some cases, allow you to fully cure allergic asthma. To determine allergic status is performed procedure helping to define such IgE antibodies in blood. Antibodies of this type determine immediate allergic asthma symptoms development. Increase in level of these antibodies in blood is indicative for increased reactivity. Also for asthma it is characterized increase in eosinophils in blood and sputum in particular. Diagnosis of concomitant diseases of respiratory system (rhinitis, sinusitis, bronchitis) makes a general idea of patient’s condition and prescribe appropriate treatment. Drugs for treatment you may order via My Canadian Pharmacy Online – your choice for all intents and purposes.