Bronchial asthma atopic form

KARAGANDA STATE MEDICAL ACADEMY

Department of Children’s Diseases № 1

Case history No. 1163

Clinical diagnosis: Bronchial asthma, atopic form, moderate severity, persistent over, paroxysmal period (

Supervised: student 411 groups OM

Teacher: Shin

2. Date of birth

3. Age – 15 years

5. Mom – XXX, 35 years old,

place of work music school, secondary special education.

6. Dad – XXX, 46 years old,

8. The marriage of parents is registered, on the part of the mother first, the fathers second.

8. Organization – school № 9, class

9. Home Address – XXX

10. Date of receipt –

11. Diagnosis at admission – Atopic bronchial asthma, moderate severity, persistent course, exacerbation period

12. Directed – district children’s allergologist, the city of Saran.

Upon admission to the hospital

-asthma attacks that occur when changing meteorological conditions, inhalation of strong odors, flowering herbs;

-shortness of breath with difficulty exhaling with considerable physical exertion;

– deterioration of the general condition, fatigue;

Bronchial asthma atopic form

– pain, sore throat;

– feeling of nasal congestion, nasal discharge;

– redness of the eyes, feeling of pain, burning sensation in the eyes, lacrimation.

At the time of supervision noted complaints;

-shortness of breath, difficulty breathing out during exercise;

– eye redness, lacrimation;

He considers himself to be sick since the age of 12, for 3 years, since the spring of 2008, for the first time, an attack of suffocation arose on the way home from the store. The appearance of the first attack is associated with flowering herbs. At the same time, he began to notice shortness of breath on exertion, a cough that was not associated with acute respiratory infections, a deterioration in the general condition. The diagnosis was made: Bronchial asthma, the onset period, underwent inpatient treatment at the allergology department. Since 2008, taken to the D account. Repeatedly treated in the CSTO.

The present deterioration is noted from the end of March, for 2 weeks, when a suffocation attack appeared, shortness of breath, cough at night, worsening of the general condition, tearing, burning sensation in the eyes, redness of the eyes, congestion and nasal discharge appeared. Attacks occur 1-3 times a month, episodic, disappear spontaneously or after a single dose of short-acting bronchodilator, rare night attacks.

In connection with the listed complaints, he applied to the polyclinic at the place of residence and was sent for inpatient treatment.

The deterioration of the condition, the occurrence of an attack is associated with seasonal flowering of herbs, changing meteorological conditions.

Full name, 15 years old, born

Postponed diseases: chickenpox at age 13, follicular tonsillitis, often ARVI, bronchitis. Hepatitis, tuberculosis, sexually transmitted diseases denies. Hemotransfusions, operations were not. Allergic history: an allergic reaction to the flowering of herbs (wormwood and

Grew up a full-fledged child, in growth and development did not lag behind. Before the onset of the underlying disease was actively involved in sports. Now in the interictal period he is engaged in volleyball, basketball.

Parents are healthy, there are no chronic diseases, there is no record on “D”.

Place and living conditions, material security and social conditions are satisfactory. He lives in an apartment, the room is not raw. There is a pet – a cat.

Bad habits denies.

The state of moderate severity due to symptoms of the underlying disease. Consciousness saved, oriented in space and in time. Well-being – suffers moderately. The position is active. The mood is calm, good. Appetite saved.

HELL 90/60

The constitution of normostenichesky type, PZhK is developed poorly. Height is 166 cm., Weight 49 900 g. Patient of reduced nutrition.

Pale skin. There is periorbital cyanosis, the presence of edema under the eyes. Mucosal redness

Evaluation of physical development

Midline body: actual

Head height: actual

The ratio of the upper parts of the face + leg length to height:

Breast circumference: actual

Conclusion on physical development

1) The correspondence of the mass to the achieved height:

2) Correspondence of mass and height to age:

Emotional status without violations. Static and speech skills are developed according to age. Intellectual development corresponds to the age reached.

Conclusion on neuropsychic development: development corresponds to age, there are no deviations.

The skin, PZHK

Pale skin, marked periorbital cyanosis. Visible mucous membranes, marked hyperemia of the posterior pharyngeal wall, eye mucosa. Rashes, stains, traces of scratching there. The skin is dry. Elasticity reduced. Hair dry, brittle. Nails physiological in color, brittle.

Endothelial symptoms (symptom of a tourniquet, pinch, hammer) are normal.

The thickness of the subcutaneous caries (at the navel, scapula, on the inner surface of the thigh, on the inner surface of the shoulder, on the breast at the nipple, on the sides, on the face) is poorly developed, and it is evenly distributed.

There are constant swelling under the eyes, in other places there is no visible edema. Soft tissue turgor reduced.

Peripheral lymph nodes are not enlarged, not soldered to the skin, painless on palpation

Posture is correct, gait is correct, free. Muscle mass is underdeveloped. The tone of the skeletal muscles of the upper and lower extremities is preserved, with the palpation the muscular system is painless, the muscular strength is preserved.

Bone system without visible deformations and changes. Palpation painless. Head normal size, regular shape. Thorax normostenicheskogo form, without deformation, elasticity is normal.

There are no pathological curvatures of the spine, physiological curves have been preserved. No curvature of the limbs.

The shape and size of the joints is not changed, in norm. Movement free, painless, preserved in full. The skin over the joints of physiological color, hyperemia and edema no. Palpation painless. The dental formula corresponds to the age, the distance between the teeth is normal. Flatfoot no.

Breathing through the nose, difficult. Nasal discharge of serous character. The voice is not sonorous.

Thorax normostenicheskogo form, without deformation, elasticity is normal. The right and left halves of the chest are symmetrical, symmetrically involved in the act of breathing. Breathing smooth, NPV 24v minute. Type of breathing is mixed. Inflating the wings of the nose, attracting auxiliary muscles, perioral cyanosis. Voice tremor is not changed, it is felt in symmetrical parts of the chest with the same force.

Expiratory dyspnea, moderate.

With comparative percussion. Above both lungs, a boxed sound is defined symmetrically. Focal changes percussion sound is not marked.

With topographic

The boundaries of the lungs during percussion

Lower bounds: right to left

Fields Krenig 4 cm 4 cm

Tour of the lungs 5cm 4,5cm

Auscultation. Above the lungs hard breathing is heard. Marked lengthening exhalation. Wheezing dry, scattered, whistling. Bronchophony weakened.

Focal changes percussion sound is not marked. Symptoms Filatov, Philosopher Cup, Arkavina negative.

Osmor The region of the heart and large blood vessels is not visually altered. Thorax over the heart area is not deformed. Pathological pulsation of blood vessels in the neck and epigastrium is not observed. Venous network in the chest and abdomen is not detected.

Palpable. Apical impulse is determined in the V intercostal space on the mid-clavicular line. Localized, the area of ​​1 cm. Moderate strength, height and resistance.

Pulse. Symmetrical on both hands, rhythmic, moderate filling and voltage of 76 per minute.

Borders of relative cardiac dullness:

Right: right parasternal line.

Upper: III rib

Left: in the V intercostal space on the mid-clavicular line

The boundaries of absolute cardiac dullness:

Right: the left edge of the sternum

Left: the middle of the distance between the left midclavicular and parasternal lines

Heart diameter 9 cm.

Auscultation. Heart sounds are rhythmic, medium volume, noises and accents are not heard. Heart rate of 74 beats per minute.

Blood pressure 90/60 mm

Digestive system

Appetite saved. The act of swallowing is not broken. Oral mucous membranes are pale pink in color, moist, clean, there is hyperemia of the pharynx of the posterior pharyngeal wall. The tongue is not coated, moist, normal size and color, the gums are unchanged. Gums and teeth do not bleed, no inflammation, no kareo teeth. Zev clean. Tonsils for the palatine arch do not protrude. Pharyngeal mucosa is moist, pink, clean.

The belly of the correct configuration, symmetrical, the navel is retracted, the anterior abdominal wall is evenly involved in the act of breathing. There are no visible protrusions and depressions. Visible peristalsis is not observed.

Surface indicative palpation.

The abdomen is soft, painless. Symptom Shchetkina-Blumberg negative. Discrepancy of rectus abdominis and hernia of the white line of the abdomen was not detected.

Deep methodical sliding palpation according to the Obraztsov-Strazhesko method.

In the left iliac region, a sigmoid colon is palpated over a length of 15 cm in the form of a smooth, moderately dense cord; it is painless, easily dislodged, does not hurt, sluggish and rarely peristaltic.

In the right ileal region, the caecum is palpated in the form of a smooth, soft-peristaltic, slightly extended cylinder;

it is painless, moderately mobile, rumbling when pressed. The ascending and descending sections of the colon are palpable, respectively, in the right and left flanks of the abdomen in the form of mobile moderately dense, painless cylinders.

The transverse colon is defined in the umbilical region in the form of a transversely lying, arcuately bent downwards, moderately dense cylinder; it is painless, easily moves up and down.

At 2-4 cm above the navel, the greater curvature of the stomach is felt in the form of a smooth, soft, sedentary, painless cushion that runs transversely along the spine to both sides of it.

The liver is palpable at the edge of the costal arch, the edge of the liver is painless. Borders on Kurlov 10-9-7

Spleen palpation failed. With percussion: the upper pole – IX edge; lower pole – X edge.

The chair is regular, without pathological impurities.

Periorbital cyanosis and swelling under the eyes are noted. There are no visible edemas elsewhere. Visually, the area of ​​the kidneys and bladder is not changed. In the prone position and standing, the kidneys are not palpable. Symptom tapping is negative on both sides. Palpation of rib-vertebral points, along the ureter painless. Urination painless, free, regular.

Endocrine system.

Primary and secondary sexual characteristics correspond to sex and age. No growth impairment. Subcutaneously-fatty tissue is evenly distributed. Acne, roughness, thickening of the skin, stretch marks are absent. The thyroid gland is not visually detectable, not palpable, there is no pulsation.

Sexual development is age appropriate.

Nervous system.

No hyperkinesis. In the Romberg position is stable. Finger-nose and knee-heel tests are satisfactory. Symptoms Cherni, Gordon, Filatov negative.

The state of mind is not disturbed. The development of intelligence corresponds to the age.

Meningeal symptoms

Negative.

Sense organs

The state of the organs of sight, hearing, smell, touch, taste without features.

1. Clinical analysis of blood.

2. Biochemical blood test: Society. protein, glucose, Ig.

4. Sputum analysis.

6. Review radiograph of the chest cavity organs.

Data of laboratory and instrumental methods of research:

Urinalysis from

Relative density: 1018

Conclusion: performance is normal

General blood analysis (

Erythrocytes 4.3 * 1012 g / l

Leukocytes 4,6 * 109 g / l

Blood chemistry

Urea 2.7 mmol / l

Creatinine

Total protein 71 g / l

Bilirubin 12 mmol / l

Calcium: 2.3 mmol / l

Calcium Ionized: 1.14

Potassium 3.8 mmol / l

Sodium 135 mmol / l

Cholesterol 3.4 mmol / l

Conclusion: indicators in the normal range.

Blood test for glucose from

Blood glucose – 3.6 mmol / l

Conclusion: in the normal range.

ECG from

Increased electrical activity of the left ventricle. HR 76-63 beats / min.

Echo KS from

Spirography

In samples of inspiration – there is a violation of breathing of a mixed type of an extremely sharp degree of severity. Suspicion of extremely sharp generalized obstruction of the bronchial type, with more pronounced obstructive changes changes of the upper respiratory tract. Obstructive changes are observed against the background of restriction.

In expiration tests – respiratory failure of the mixed type of an extremely sharp degree of severity. Suspicion of extremely severe generalized obstruction of the bronchial type with more pronounced changes in the upper respiratory tract. Obstructive changes are observed against the background of restrictive restrictions extremely sharp severity. FEV reduction of 80%.

R-examination of the chest from

Feces on eggs worm from

Bronchial asthma atopic form

The main manifestation of the disease is the presence of lung syndrome. The differential diagnosis is carried out with the following diseases:

· Foreign body in the upper respiratory tract

· Exogenous allergic alveolitis

· Cardiac asthma

· Tracheobronchial Dyskinesia

· Bronchial asthma

Foreign body in the upper respiratory tract

With foreign X-ray and spirography, blood and sputum tests confirm the exclusion of this

Exogenous allergic alveolitis

Exogenous allergic alveolitis is a disease caused by inhalation of dust with various antigens and characterized by diffuse damage of the alveolar and interstitial lung tissue. A typical violation of the general condition and the occurrence of respiratory failure with expiratory dyspnea. The hereditary complication of an allergic history is rarely observed. Symptoms appear after 5-8 hours after contact with allergens, moist fine-bubbling wheezes are heard auscultatively. X-ray reveals a symptom of frosted glass. In the study of respiratory function is determined by the corrective type. Based on the inconsistency of anamnestic data, clinical manifestations, spirography, X-ray data, this disease can be excluded.

During an asthma attack, which is characteristic of cardiac asthma, the patient experiences pronounced suffocation, a feeling of lack of air and a strong sense of fear of death, behaves restlessly, gasping for breath, takes a forced semi-elevated or seated position with legs down. Breathing frequent, superficial, shortness of breath is mixed or mostly inspiratory in nature. Copious amounts of frothy sputum mixed with blood. The skin is covered with cold sweat. Pulse is thready, often arrhythmic. Hypotension (however, in patients with arterial hypertension, high blood pressure is possible). On auscultation, deafness of heart tones, the protodiastolic gallop rhythm, accent of the second tone on the pulmonary artery, fine bubbling rales and crepitus in the lower regions of the lungs;

The choking attack in my patient has the following symptoms. There is a feeling of lack of air, pressure in the chest, pronounced expiratory dyspnea. The inhale becomes short, the exhalation is slow, 2-4 times longer than the inhale, accompanied by loud, long, wheezing, heard from a distance.

The patient takes a forced position, sits, leaning forward, elbows on his knees, or leaning his hands on the edge of the table, bed, gasping for breath. Speech is almost impossible, the patient is worried, scared. The face is pale, with a bluish tinge, covered with cold sweat. The wings of the nose swell when inhaling. The chest in the position of maximum inhalation, muscles of the shoulder girdle, back, abdominal wall are involved in breathing. Intercostal spaces and supraclavicular pits are drawn in while inhaling. Cervical veins swollen. During an attack, there is a cough with a very difficult discharge of viscous, thick sputum. After sputum discharge, breathing becomes easier. Above the lungs, a percussion sound with a tympanic tinge, the lower borders of the lungs are lowered, the mobility of the pulmonary margins is limited, against the background of weakened breathing during inhalation, and especially on the exhale, a lot of dry wheezing is heard. Pulse is speeded up, weak filling, muffled heart sounds

On the basis of the inconsistency of the clinic, an x-ray of the chest organs that did not reveal the pathology of the lungs and the heart, and the ECG that excluded the cardiac pathology, I exclude this pathology.

Features of the clinical picture of tracheobronchial dyskinesia – paroxysmal cough, turning into asphyxiation, and expiratory dyspnea. Attacks are caused by physical exertion, laughter, sneezing, acute respiratory viral infection, sometimes abrupt transition from a horizontal to a vertical position. Cough has a bitonal character, sometimes a rattling, nasal shade. Coughing episodes cause short-term dizziness, blackening in the eyes, a short loss of consciousness is possible. During the attack, there is marked expiratory dyspnea. Auscultation: dry, wheezing in a small amount (may be absent).

The choking attack in my patient has the following symptoms. There is a feeling of lack of air, pressure in the chest, pronounced expiratory dyspnea. The inhale becomes short, the exhalation is slow, 2-4 times longer than the inhale, accompanied by loud, long, wheezing, heard from a distance.

The patient takes a forced position, sits, leaning forward, elbows on his knees, or leaning his hands on the edge of the table, bed, gasping for breath. Speech is almost impossible, the patient is worried, scared. The face is pale, with a bluish tinge, covered with cold sweat. The wings of the nose swell when inhaling. The chest in the position of maximum inhalation, muscles of the shoulder girdle, back, abdominal wall are involved in breathing. Intercostal spaces and supraclavicular pits are drawn in while inhaling. Cervical veins swollen. During an attack, there is a cough with a very difficult discharge of viscous, thick sputum. After sputum discharge, breathing becomes easier. Above the lungs, a percussion sound with a tympanic tinge, the lower borders of the lungs are lowered, the mobility of the pulmonary margins is limited, against the background of weakened breathing during inhalation, and especially on the exhale, a lot of dry wheezing is heard. Pulse is speeded up, weak filling, muffled heart sounds

On the basis of spirography and radiography of the chest organs that did not reveal pathology, I exclude this pathology.

The onset of bronchial asthma has the following symptoms. There is a feeling of lack of air, pressure in the chest, pronounced expiratory dyspnea. The inhale becomes short, the exhalation is slow, 2-4 times longer than the inhale, accompanied by loud, long, wheezing, heard from a distance.

The patient takes a forced position, sits, leaning forward, elbows on his knees, or leaning his hands on the edge of the table, bed, gasping for breath. Speech is almost impossible, the patient is worried, scared. The face is pale, with a bluish tinge, covered with cold sweat. The wings of the nose swell when inhaling. The chest in the position of maximum inhalation, muscles of the shoulder girdle, back, abdominal wall are involved in breathing. Intercostal spaces and supraclavicular pits are drawn in while inhaling. Cervical veins swollen. During an attack, there is a cough with a very difficult discharge of viscous, thick sputum. After sputum discharge, breathing becomes easier. Above the lungs, a percussion sound with a tympanic tinge, the lower borders of the lungs are lowered, the mobility of the pulmonary margins is limited, against the background of weakened breathing during inhalation, and especially on the exhale, a lot of dry wheezing is heard. Pulse is speeded up, weak filling, heart sounds are muffled.

The choking attack in my patient completely coincides with the above symptoms.

Allergic diseases in the family and in personal history are common.

The onset of attacks is acute. Develop quickly, short duration, the course of the attack is easy.

In general, blood tests are characteristic: eosinophilia

Skin tests with non-infectious allergens are positive.

In the analysis of sputum eosinophilia.

My patient:

There are allergic diseases in the family and in personal history.

The onset of attacks is acute. Develop fast, small

duration, course of attack easy

In general, blood tests are characteristic: eosinophilia

Skin tests with non-infectious allergens are positive.

In the analysis of sputum eosinophilia

The clinical and laboratory data of my patient is characteristic of this pathology.

Based on the above data, I diagnose bronchial asthma.

Clinical diagnosis and its rationale

Based on the patient’s complaints: asthma attacks that occur when changing meteorological conditions, inhalation of strong odors, grass blooms; shortness of breath with difficulty exhaling with considerable physical exertion; recurrent cough;

deterioration of the general condition, fatigue; pain, sore throat;

– feeling of nasal congestion, nasal discharge; redness of the eyes, feeling of pain, burning sensation in the eyes, lacrimation.

On the basis of the history of this disease: deterioration marks the end of March, for 2 weeks, when there was a choking attack, shortness of breath, cough at night, worsening of the general condition, tearing, burning sensation in the eyes, redness of the eyes, congestion and nasal discharge. Postponed seizure in 2011. Attacks occur 1-3 times a month, episodic, disappear spontaneously or after a single dose of short-acting bronchodilator, rare night attacks.

Based on the history of life: an allergic reaction to the flowering of herbs (wormwood and

Based on an objective examination: respiratory rate 24 respiratory movements per minute. Heart rate 110 per minute. Pale skin. There is periorbital cyanosis, the presence of edema under the eyes. Redness of the eyes.

Based on the inspection of organs and systems. (respiratory system): Breathing through the nose, difficult. Nasal discharge of serous character. The voice is not sonorous. Expiratory dyspnea, moderate. With comparative percussion: a boxed sound is defined symmetrically above both lungs. Auscultation: hard breathing is heard above the lungs. Marked lengthening exhalation. Wheezing dry, scattered, whistling. Bronchophony weakened.

Based on the data of laboratory and instrumental research methods:

Sputum analysis: mixed seeding.

Data spirography:In samples of inspiration – there is a violation of breathing of a mixed type of an extremely sharp degree of severity. Suspicion of extremely sharp generalized obstruction of the bronchial type, with more pronounced obstructive changes changes of the upper respiratory tract. Obstructive changes are observed against the background of restriction. In expiration tests – respiratory failure of the mixed type of an extremely sharp degree of severity.Suspicion of extremely severe generalized obstruction of the bronchial type with more pronounced changes in the upper respiratory tract. Obstructive changes are observed against the background of restrictive restrictions extremely sharp severity. FEV reduction to 80%

R-examination of the chest: limited pneumosclerosis of the lower lobe of the right lung.

You can put clinical diagnosis:

Bronchial asthma, atopic form, moderate severity, persistent course, paroxysmal period (

Bronchial asthma is exposed on the basis of: studies of respiratory function: obstructive breathing,

Atopic form based on the presence in the general analysis of blood eosinophilia, aggravated allergic history, positive skin tests with allergens (house dust) In the analysis of sputum eosinophilia

A persistent course of mild severity is set based on the frequency of attacks 1-3 times a month, a decrease in FEV of 80%, a remission of more than 3

Phase of exacerbation on the basis of the presence in the general analysis of blood signs of inflammation, the appearance of attacks, the characteristic seasonality.

Medium severity is set based on the presence of asphyxiation syndrome, which causes the severity of the condition.

Bronchial asthma is a chronic disease, the basis of which is an inflammatory process in the airways with the participation of various cellular elements – mast cells of eosinophins

Bronchial asthma atopic form

The disease is characterized by recurrent episodes of bronchial obstruction, partially or completely reversible, accompanied by paroxysmal cough, wheezing and pressure in the chest.

The prevalence of bronchial asthma among children in different countries varies from 1.5 to 8-10%. The discrepancies between official statistics on employment and the results of epidemiological studies are associated with the underdiagnosis of bronchial asthma in different age groups. The disease can begin at any age. In 50% of sick children, symptoms develop by 2 years, in 80% – by school age.

The currently reported increase in the prevalence of bronchial asthma in all age groups is explained by the following factors.

The impact of air pollutants inside dwellings associated with the characteristics of modern building materials and air recirculation (nitrogen dioxide, cigarette smoke, etc.), and the increase in it the number of different allergens (house dust mites, cockroaches, fungi, animal hair).

The incidence of SARS at an early age.

Nursing deeply premature babies with insufficient differentiation of the respiratory system, leading to the development of respiratory pathology (for example, syndrome of respiratory disorders, bronchopulmonary dysplasia, etc.).

Smoking in families, especially pregnant and nursing mothers, affecting the development of the lung of the child.

Etiology and pathogenesis

The development of bronchial asthma in children is due to genetic predisposition and environmental factors. There are three main groups of factors contributing to the development of the disease.

Predisposing (heredity, atopy, bronchial hyperreactivity, burdened by allergic diseases).

Causal or sensitizing (allergens, viral infections, drugs).

Causes exacerbation (so-called triggers), stimulating inflammation in the bronchi and / or provoking the development of acute bronchospasm (allergens, viral and bacterial infections, cold air, tobacco smoke, emotional stress, exercise, meteorological factors, etc.).

Respiratory sensitization is caused by inhaled allergens (household, epidermal, fungal, pollen). One of the sources of allergens is domestic animals (saliva, excretions, wool, horny scales, lowered epithelium). Pollen bronchial asthma is caused by allergens of flowering trees, shrubs, and cereals. In some children, asthma attacks can be caused by various drugs (for example, antibiotics, especially penicillins, sulfonamides, vitamins, acetylsalicylic acid). The role of sensitization to industrial allergens is undeniable. In addition to direct effects on the respiratory system, technogenic air pollution may enhance the immunogenicity of pollen and other allergens. Often the first factor provoking obstructive syndrome is ARVI (parainfluenza, respiratory syncytial and rhinovirus infections, influenza, etc.). In recent years, the role of chlamydial and mycoplasmal infections has been noted.

In children, asthma is a manifestation of atopy and is caused by a hereditary predisposition to excessive production of IgE. Chronic inflammatory process and dysregulation of bronchial tone develop under the influence of various mediators. Their release from mast cells activated by IgE leads to the development of immediate and delayed bronchospasm. A key role in the sensitization of the body is played by CD4 + T lymphocytes. Under the influence of allergenic stimuli, activation and proliferation of the Th2 subpopulation of CD4 + T-lymphocytes occurs with the subsequent release of cytokines (interleukin-4, interleukin-6, interleukin-10, interleukin-13), which induce general and specific IgE hyperproduction. The latter are formed under the influence of various inhaled allergens of the environment. Re-admission of the allergen leads to the release of preformed mediators by the cells and the development of an allergic response, manifested by impaired bronchial patency and an asthma attack. Bronchial obstruction that occurs during an asthma attack is the result of cumulation of the smooth muscle spasm of small and large bronchi, bronchial wall edema, accumulation of mucus in the lumen of the respiratory tract, cellular infiltration of the submucosa and thickening of the basement membrane. Due to the presence of bronchial hyperreactivity, exacerbations of asthma can occur under the influence of both allergic and non-allergic factors.

The clinical picture of asthma in children

The main symptoms of bronchial asthma attack are shortness of breath, feeling of lack of air, wheezing, paroxysmal cough with viscous transparent sputum (sputum is difficult), expiratory shortness of breath, swelling of the chest, in the most severe cases – suffocation. In young children, equivalents of a bronchial asthma attack may be coughing episodes at night or during the early morning hours, from which the child wakes up, as well as prolonged repeated obstructive syndrome with a positive effect of bronchodilators. Bronchial asthma in children is often combined with allergic rhinitis (seasonal or year-round) and atopic dermatitis.

It should be borne in mind that when examining a patient auscultatory changes may not be. Outside the attack with quiet breathing, wheezing is heard only in a small proportion of patients.

Severe attack is accompanied by severe shortness of breath (the child barely speaks, cannot eat) with NPV of more than 50 per minute (more than 40 per minute in children over 5 years old), heart rate more than 140 per minute (more than 120 per minute after 5 years), paradoxical pulse , the participation of auxiliary muscles in the act of breathing (in infants, the equivalent of participation of auxiliary muscles is the swelling of the wings of the nose during inhalation). The position of the child at the time of the asthma attack is forced (orthopnea, unwillingness to lie). Mark the swelling of the neck veins. Pale skin, possible cyanosis of the nasolabial triangle and acrocyanosis. Auscultatively detect wheezing dry wheezing in all fields of the lung, young children often have different sized wet wheezing (the so-called wet asthma). Peak expiratory flow rate (PIC) is less than 50% of the age norm. Signs that threaten life include cyanosis, diminished breathing, or “mute” lung, PIC less than 35%.

The severity of asthma (mild, moderate, severe) is assessed based on clinical symptoms, frequency of asthma attacks, the need for bronchodilator drugs and an objective assessment of airway patency.

Clinical classification of bronchial asthma

less often I once a month, 3-4 times a month several times a week

short attacks (hours-days) severe attacks, asthmatic from the state

Night symptoms occur

rarely or absent 2-3 times a week. Frequent night symptoms.

80% due 60% and 30%

POS variability 30%

General mode without significant physical and emotional stress. The diet is hypoallergenic.

Drug treatment of bronchial asthma according to GINA

To relieve an attack:

-V-adrenomimetics. Salbutamol single dose of 100 mg, up to 400 mg per day

-Methylxanthines. Eufellin 2.4% 5.0 mg 3 times a day.

-Anticholinergic drugs. Atrovent 1-2 inhalations 3 times a day.

Basic treatment:

Drug treatment of bronchial asthma according to GINA

2 step. Cromons are mainly used if they give a positive effect. Cromone therapy is carried out for 6 months. If Cromones do not give a positive effect, then glucocorticosteroids are applied in herd doses for 3 months.

Noosmin 0.01 1g x1 p.

Ambroxol

Ventamine.

Recommended: select factors provoking attacks of suffocation, sanatorium treatment

Curation Diary

BP – 90/60

BP – 95/65

The condition of the patient is moderate. Remains moderate weakness, shortness of breath. Unproductive cough

The skin is pale, dry. Periorbital cyanosis, swelling under the eyes. Breathing through the nose is difficult, serous discharge. Above the lungs hard breathing is heard, dry, wheezing, Tone boxed. The rhythm of the heart is correct. Tones of medium volume. Tongue moist, not coated. There is a hyperemia of the posterior pharyngeal wall. The abdomen is soft, painless on palpation. The liver is not enlarged. Urination free, regular stool

The general condition is relatively satisfactory. On the background of the treatment, the state of health has improved. The expiratory dyspnea during physical activity remains. Unproductive cough

The skin and visible mucous membranes are pale. Above the lungs hard breathing is heard, dry, wheezing, Tone boxed. The rhythm of the heart is correct. Tones of medium volume. Tongue moist, not coated. There is a hyperemia of the posterior pharyngeal wall. The abdomen is soft, painless on palpation. The liver is not enlarged. Urination free, regular stool

The patient’s condition is satisfactory, no complaints. The condition on the background of the treatment improved. Shortness of breath only with considerable physical exertion.

Objectively: pale skin, visible mucous membranes of normal color, clean. Above the lungs hard breathing is heard, dry, wheezing, Tone boxed. The rhythm of the heart is correct. Tones of medium volume. Tongue moist, not coated. There is a hyperemia of the posterior pharyngeal wall. The abdomen is soft, painless on palpation. The liver is not enlarged. Urination free, regular stool

1. The hypoallergenic diet

3. Drug treatment:

Salbutamol 100 mg to 400 mg / day

Eufellin 5,0×3 r

Ambroxol 0.03 1x 3p

Noasmin 0.01 1x1r.

1. The hypoallergenic diet

3. Drug treatment:

Salbutamol 100 mg to 400 mg / day

Eufellin 5,0×3 r

Ambroxol 0.03 1x 3p

Noasmin 0.01 1x1r.

1. The hypoallergenic diet

3. Drug treatment:

Salbutamol 100 mg to 400 mg / day

Eufellin 5,0×3 r

Ambroxol 0.03 1x 3p

Noasmin 0.01 1x1r.

Epicrisis

Patient XXX, 15 years old, was at the staged inpatient treatment in the allergy department with

Deterioration notes from the end of March, for 2 weeks, when there was a choking attack, shortness of breath, cough at night, worsening of general condition, tearing, burning sensation in the eyes, redness of the eyes, congestion and nasal discharge. Postponed seizure in 2011. Attacks occur 1-3 times a month, episodic, disappear spontaneously or after a single dose of short-acting bronchodilator, rare night attacks.

Allergic reaction to the flowering of herbs (wormwood and

Respiratory system: Breathing through the nose, difficult. Nasal discharge of serous character. The voice is not sonorous. Expiratory dyspnea, moderate. With comparative percussion: a boxed sound is defined symmetrically above both lungs. Auscultation: hard breathing is heard above the lungs. Marked lengthening exhalation. Wheezing dry, scattered, whistling. Bronchophony weakened.

Data of laboratory and instrumental methods of research:

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