Clinical features

The main complaints in patients with bronchial asthma are bronchial asthma attacks: dyspnea, asphyxia, episodic breathlessness and cough. In attacks development there are divide 3 periods: prodromal, manifestation, reverse.

/. The prodromal period: starts at several minutes, hours or sometimes days before asthma attack and characterized by sneezing, itchiness of the skin and eyes, hypersecretion from nose, paroxysmal coughing, breathlessness, headache, weakness and changes of mood.

//. The period of clinical manifestation (bronchial asthma attack): appears feeling of difficult breathing, significant dyspnea (expiratory type) with changes in respiratory rate (tachypnea), depth (shallow respiration) and noisy distant rales. General patients condition is from middle grave to extremely grave. Due to the acute hypoxia may be observed depressed or exited deranged consciousness. During asthma attack the patients take the forcedposture in form of orthopnea - sitting position fixing the shoulder girdle in order to reduce dyspnea. The color of the skin is pale with central or diffuse cyanosis. The form of the chest is emphysematous with accessory muscles participate in the breathing act, observed decreased excursion of the chest. The vocal fremitus is badly transmitted and generalized bandbox sound assessed over the lungs during percussion. Anscultative data are characterized by sibilant and sonorous dry rales over the pathologically decreased vesicular breathing.

III. The period of asthma attack reverse: the duration of attack is differing and its final may come quickly without any complications through sputum discharge; or may continue for several hours or days accompanied by permanent dyspnea, headache and weakness.

In severe causes bronchial asthma attacks may transform at asthmatic status -lingering bronchial asthma attack that characterized by shallow quick respiration (significant tachypnea), constant dyspnea and formation of "dumb lung". Severity of asthmatic status is characterized by degree of respiratory failure, acidosis, hypercapnia, level of hypoxemic coma and respiratory center paralysis.

In period of stable remission the general patients condition commonly satisfa­ctory or middle grave, however the clinical signs of emphysema are stay be present, particularly in causes of long disease duration and recurrently asthma attacks.

Additional methods of examination

Clinical blood analysis: secondary erythrocytosis; eosinophilia, accelerated ESR.

Sputum analysis: the character of the sputum is mucous, tenacious or tenacious thick consistency, glass-like color and odorless. In microscopic study are revealed columns ciliated epithelium, leucocytes, alveolar macrophages, eosinophils, Charcot-Leyden crystals and Kurshman spirals.

X-ray examination: in initial stages the specific data are absent. During asthma attack and according to the repeatedly periods of progression assess transparent lung tissue, horizontal position of the ribs, dilation of the intercostals spaces, low diaphragm position. In cause of inflammatory and allergic etiology of bronchial asthma observed augment and deformity of lung picture.

Test of ventilatory function (spirometric recording and pneumotachymetry): assess decreased respiratory reserve (75 % of maximum lung ventilation and lower), and decreased Votchal-Tiffeneau index.

Dynamic lung volumes and capacities are reduced but return toward normal after inhalation of an aerosolized bronchodilator. In patients with mild asymptomatic asthma, results may be normal. Because expiratory flow is determined by the diameter of the airways and by the elastic recoil forces of the lung, flow at large lung volumes exceeds flow at small lung volumes. Tests that measure flow at relatively large lung volumes (the forced expiratory volume during the first 1 sec (FEV¹) and peak expiratory flow) are largely effort-dependent and are less satisfactory than tests that measure flow over a range of lung volumes. Expiratory flow measurements at large lung volumes are insensitive to changes in peripheral airway resistance and reflect abnormalities principally in central airways. Early in an acute attack, forced expiratory flow between 25 and 75% of the vital capacity (FEF25-75%) may decrease only modestly. As the attack progresses, the FVC and FEV¹ progressively decrease; associated air trapping and increased residual volume result in hy­perinflation of the lungs.

Allergen identification: Inhalational bronchial provocation testing can be used with allergens to establish the clinical significance of positive skin tests or with methacholine or histamine to assess the degree of airway hyperresponsiveness in known asthmatics. It also aids in diagnosis when the symptoms are atypical (a persistent cough but no wheeze, as in cough-variant asthma).