Bronchial asthma is a fairly common and severe allergic disease, which affects about 6-7% of the population. Among children there are the most high performance morbidity reaching 20% ​​or more.

Atopic asthma is a chronic, inflammatory disease affecting the upper respiratory tract. Atopic form of bronchial asthma is most often diagnosed in people prone to allergic reactions.

What it is?

The provoking factor in the manifestation of atopic asthma are allergens, among which the most common are animal hair, plant pollen, household dust, mites, fungi, feathers.

When highlighting external factors that can also play an important role in the development of the disease, researchers give priority to:

• unfavorable environmental conditions;
• infectious diseases;
• smoking;
• long-term drug treatment;
• genetic predisposition;
• significant temperature fluctuations;
• strong chemical odors.

Pathogenesis

Most often, this disease is diagnosed in children under the age of ten. As medical practice shows, about 70% of patients experience the first manifestations of the disease before they reach the age of twenty.

The formation of asthmatic reactions occurs under the influence of immune and non-immune mechanisms provided by various cellular elements, represented by eosinophilic leukocytes, macrophages, and epithelial cells.

At the first contact with an allergen that has entered the human body, its sensitization begins to develop. The result of a negative impact is the formation of an early asthmatic reaction from the first minute of contact with the allergen and for the next 2 hours.

Attention! Pathological processes are accompanied by broncho-obstructive syndrome, swelling of the bronchial membrane, increased secretion of viscous mucus, muscle spasms.

With late asthmatic reactions, the bronchial walls undergo inflammatory processes, resulting in hyperplasia at the cellular level. The long course of atopic bronchial asthma is accompanied by the formation of irreversible changes.

Symptoms

The disease manifests itself specific features, the totality of which allows you to accurately determine the disease. This is about:

• the appearance of a cough;
• the occurrence of whistling during breathing;
• severe shortness of breath;
• itching in the nose;
• constant sneezing;
• inhalations and exhalations, which take on a rapid appearance;
• pain in the chest area;
• feeling of tightness in the chest.

The listed symptomatology worries after each contact with an allergen-irritant. For example, after scratching the skin, a person may experience itching and redness of the skin in this area.

You should not ignore the impact on the body of allergens, because the result of such contact may be anaphylactic shock, represented by a serious asthmatic attack.

Stages of the disease

Allocate four stages of development atopic bronchial asthma, each of which is characterized by a certain intensity of symptoms. So, the first stage is represented by a mild intermittent course, in which the manifestation of the listed symptoms is observed 1-2 times a month and predominantly at night.

The next stage, called the persistent course, is characterized by the manifestation of symptoms at least once a week. At the same time, the patient experiences asthmatic attacks both day and night.

Moderate stage is distinguished by the daily manifestation of symptoms, which does not have the best effect on the quality indicators of the patient's life. So, constant attacks prevent proper rest at night and an active lifestyle. At this stage, predominantly daytime attacks are observed, but at night the symptoms may disturb no more than once a week.

Fourth stage characterized by a constant manifestation of specific symptoms and frequent nocturnal attacks. At this stage, there is a high risk of developing status asthmaticus, characterized by the development of resistance to many drugs. Attacks are increasingly accompanied by severe suffocation, shortness of breath and loss of consciousness.

Types of disease

Depending on the allergens that provoke the development of atopic asthma, there are several varieties of this disease. Household asthma, also called dust asthma, is recognized as the most common today.

In most cases, the symptoms of the disease appear only with the onset of the heating period, but many patients suffer from asthma almost daily. Determining an allergy to house dust is quite simple, because asthma attacks occur only indoors, and the patient's condition improves dramatically after going outside.

Important! Fungal asthma is characterized by attacks mainly at night, and is also seasonal. The disease develops only during periods accompanied by spore formation of fungi.

A rather mild course is distinguished by pollen-type asthma. An increase in the concentration of dust in the air provokes the development of characteristic signs, represented by rhinitis and conjunctivitis, which smoothly turn into attacks of bronchial asthma.

If attacks of bronchial asthma are provoked by wool and derivatives of the skin of various animals, we are talking about the epidermal type of the disease. This type of asthma is diagnosed in extremely rare cases, because most often people suffer from the disease, professional activity which is inextricably linked with regular contact with animals.

Recently, the number of patients who developed atopic bronchial asthma as a result of keeping cats in the house, whose hair is considered the most allergenic, has also increased.

ICD-10 code

If patients are suspected of having bronchial asthma, for the correct diagnosis, specialists use the classification of diseases according to ICD-10, in the list of which this disease is indicated as: J45

There are several varieties of this disease, which are presented:

• asthma, predominantly of an allergic nature;
• non-allergic asthma;
• mixed form of the disease;
• asthma with unspecified etiology.

The atopic form of the disease in many cases disappears as the child grows older. Otherwise, complex treatment will be required, which, with a responsible approach of the patient, will certainly be crowned with success and obtaining sustainable results.

Features of treatment

Therapy used today for atopic asthma typically consists of non-pharmacological methods, drug treatment and immunotherapy. Only by providing an integrated approach to treatment and responsible fulfillment of all the requirements and recommendations of the attending physician will it be possible to permanently get rid of dangerous symptoms.

Speaking of non-drug methods, we are most often talking about the exclusion of allergens, for exact definition recommended for skin tests and blood tests.

So, when diagnosing an allergy to pollen, you can consider the option of changing your place of residence and moving to more favorable regions of the country. As practice shows, a change of residence is accompanied by the elimination of disturbing symptoms in 80% of cases.

If you have a food allergy, you should avoid eating foods that can cause such reactions. To significantly alleviate the condition of a patient who has been diagnosed with a household allergy, keeping the home clean and regularly removing dust through wet cleaning will help. If you are allergic to animal hair, you should avoid contact with pets, including staying in the same room together.

Important! Drug treatment is aimed not only at combating seizures, but also at the use of therapy in the interval between them.

In order to quickly relieve the symptoms of an asthmatic attack, patients are recommended to use special inhalation drugs, the effect of which is observed already 10 minutes after inhalation.

Among the drugs in this category, the most popular are Salbutamol, Terbutaline and Berotek.

The main treatment regimen for atopic asthma should be prescribed by the attending physician, guided by the type and severity of the disease. Carrying out basic therapy is impossible without the use of anti-inflammatory drugs and Beta-2-agonists and long-term drugs.

In the treatment of atopic bronchial asthma, the method of allergen-specific immunotherapy, which involves the introduction of a cause-significant allergen in small doses, is also very popular today, which helps to reduce sensitivity to it.

Atopic bronchial asthma in children

As already noted, atopic asthma is most often diagnosed in children. The manifestations of the disease have a lot in common with the symptoms of obstructive bronchitis, so complex diagnostics may be needed to accurately determine the disease. The main difference between atopic asthma is the frequency of attacks, which can be observed almost every month.

The main means of treating atopic asthma in children are inhalations aimed at alleviating the patient's condition, getting rid of allergens, reducing the intensity of attacks and activating protective reactions.

Asthma is not a death sentence!

Useful video

Watch a useful video about bronchial asthma to understand the etiology and pathogenesis of getting sick. This will help protect your child from the disease:

Atopic bronchial asthma can provoke many inconveniences and negatively affect the quality of life of a person. But when making an unpleasant diagnosis, one should not despair, because the correct definition of treatment methods, as well as compliance with all preventive recommendations, will provide significant relief from the condition.

Take care of your health and do not self-medicate!

This disease is considered an incurable disease that can occur in a person of any age. If such a pathology is suspected in a patient, then doctors use the International Classification of Diseases to make an accurate diagnosis, determine the disease code. It was proposed in 1983 by a doctor and scientist from France: J. Bertillon. It reflects all existing pathologies, their treatment, statistics of mortality and successful recovery are kept. All pathologies in this document are assigned a specific three-digit code. So, bronchial asthma code according to ICD 10: J45.

This classification is supplemented and changed once in 10 years. To date, when diagnosing pathology, medical professionals use the tenth revision of this document. In it, the diagnosis of bronchial asthma ICD 10 is relevant for patients who have fully reversible pulmonary obstruction. In the International Classification, this pathology is described as a disease of the respiratory tract, the triggering mechanism of which is inflammation of the bronchi. Its main symptom is suffocation. Asphyxiating attacks, coughing, a feeling of fullness in the chest, wheezing occur in the patient most often in the morning.

Bronchial asthma, classification

The division of this disease into types allows the doctor to accurately formulate the diagnosis. So, in accordance with the cause of the onset of the disease, there are several forms of this pathology:

Mostly allergic asthma:(J45.0). It is also called the atopic form of the disease. To confirm this particular diagnosis, it is necessary to identify the specific allergen that triggered the start of the pathological process.

Non-allergic asthma:(J45.1). This form also includes:

Mixed asthma:(J45.8). It is indicated as the main one in the diagnosis, when a person has both allergic and non-allergic signs of pathology.

Unspecified form of the disease:(J45.9). The reason for it remains unknown. It is often associated with late onset asthma. Similar case often noted against the background of a long developing chronic bronchitis. Distinguish:

asthmatic status:(J46). It is described in the classification as a serious complication of the disease that threatens health, which appears as a result of a prolonged intractable attack. It is characterized by the appearance of edema of the bronchi, a high concentration of viscous sputum in them, leading to a feeling of severe lack of air. In this group, acute severe asthma is distinguished, always threatening a person's life.

The ICD 10 code also allows the doctor to determine the nature of the course of the disease. So, each of the varieties of pathology, encrypted under a three-digit code, is divided into several degrees of severity of signs of suffocation. For a mild form of manifestations, signs that occur less than a single manifestation per week are characteristic. In between exacerbations, the natural functioning of the lungs is restored. If the disease is of moderate severity, its symptoms repeat from day to day, disrupting activity and sleep. A severe type of pathology is characterized by every minute symptoms, frequent worsening of the condition at night.

The information collected in the ICD-10 allows physicians to prescribe effective treatment based on world experience. And patients, respectively, significantly reduce the number and duration of attacks, which will allow them to as soon as possible return to normal life.

When formulating a diagnosis, it is necessary to take into account all classification signs (the form of the disease, the severity of the course, the phase). When diagnosing a form of the disease, its code according to ICD-10 should also be indicated.

In case of complications, the name and forms of pathology that complicate the course of the underlying disease should be indicated in the diagnosis.

Classifications of bronchial asthma

If treatment has already been carried out before, then it is necessary to indicate the drug and its dose that led to the achievement of remission. The same information is indicated in the selection of treatment, as well as the achievement of control over the manifestations of the disease.

Such detail is great value when prescribing and correcting therapy.

By etiology (with indication of ICD codes - 10)

1. Allergic origin, or with a predominance of the allergic component (exogenous variant) - J45.0.
2. Asthma of non-allergic genesis - J45.1.
3. Asthma of mixed etiology (cause - a combination of factors) - J45.8.
4. Asthma of unspecified etiology - J45.9.
5. Asthmatic status J46.

A number of experts point out into a separate, special group:

• bronchial asthma, the development of which is due to the influence of professional factors;
• bronchial asthma of physical exertion;
• so-called aspirin bronchial asthma.

By the presence of an infectious agent

1. Non-infectious-atopic.
2. Infectious-atopic.
3. Combined.

By severity

This type of classification, which takes into account, in addition to the main symptom complex, the entire set of clinical signs, distinguishes 4 degrees of severity of the course of the disease:

GINA (Global Initiative for Bronchial Asthma) classification

Takes into account, in addition to the frequency of clinical manifestations, and the degree of their controllability. According to this gradation, according to the possibility and level of control over the characteristic manifestations of the disease, bronchial asthma is divided into:

• controlled;
• partially controlled;
• uncontrollable.

The classification according to G.B. Fedoseev takes into account not only the etiology of the disease and the severity of its course, but also the stages of its development.

1. Bronchial defects in practically healthy patients.
2. The state of betrayal. Some of the modern researchers consider it irrational to single out preasthma as a separate item, since according to modern standards, bronchial asthma should be diagnosed in any form of bronchial hyperactivity.

Clinical Options

Gradation of phenotypic traits bronchial asthma

1. The severity of the pathology in this patient.
2. Patient's age.
3. The degree of pathological obstruction of the bronchial tree.
4. Influence of the physical stress factor.
5. Varieties of allergens.
6. Pathogenic impact of environmental factors.
7. Types of trigger mechanisms.

Phenotyping helps to implement an individual approach to the patient in the selection of treatment.

Phases of the disease:

• exacerbation;
• unstable remission;
• stable remission (in the case of a duration of more than two years).

Etiology

Currently set of factors, whose role in the development of bronchial asthma has been proven.

Pathogenesis

Features that matter most with the development of the disease:

• increased reactivity of the bronchi;
• release of inflammatory mediators;
• increased airway resistance;
• ventilation disorder;
• decrease in the level of oxygen in the blood.

Clinical picture

Cough

The most common symptom of bronchial asthma. Most often it is dry, unproductive. However, sometimes a small amount of sputum is produced.

In cases where cough is the only symptom that the patient complains about, a cough type of bronchial asthma is distinguished.

asthma attack

The main clinical manifestation bronchial asthma is an asthma attack.

Features of an asthmatic attack:

• frequent development at night;
• characteristic difficulty breathing;
• breathing during an attack is accompanied by wheezing and whistling;
• accompanied by expiratory dyspnea.

Attack duration- from several minutes; in some cases, an asthma attack can last up to several days; in this case, status asthmaticus is diagnosed.

Stages of an asthmatic attack

1. The gradual onset of symptoms against the background of a satisfactory condition of the patient; in the lungs - weakened breathing and noise; wheezing may not be;
2. The patient's condition is aggravated; in the absence of medical care, respiratory failure may develop; blood pressure drops, heart rate increases; with blockage of bronchioles by sputum fragments, the development of hypoxemic coma is possible;
3. The third stage of the attack is the most dangerous. In the absence of medical intervention, such an attack can be fatal.

asthmatic status

In the case of a long absence of care during an attack of bronchial asthma, there is a risk of developing status asthmaticus. This dangerous condition belongs to the category of urgent. The pathological substrate is edema of the alveoli, leading to severe hypoxemia. In 5 percent of cases, this complication ends in death.

Factors that can provoke status asthmaticus.

1. Allergic reactions to drugs.
2. Exacerbation of infectious lesions of the respiratory tract.
3. Frequent use of drugs of the group of adrenomimetics.

Stages of status asthmaticus

1. Compensated. Consciousness is preserved. The patient may take a forced position of the body ("orthopnea"). There is a cyanotic coloration of the nasolabial triangle. Severe suffocation.
2. Pronounced hypoxemia and hypercapnia. Ventilation is reduced. Reactions are slow. Blue fingers, increased heart rate, decreased blood pressure, increased volume of the chest.
3. The most dangerous stage. Confusion of consciousness, frequent, shallow breathing are diagnosed. Perhaps the development of collapse or coma. As a result of increasing cardiovascular insufficiency, a fatal outcome is possible.

Diagnostics

The main method used to diagnose bronchial asthma is the assessment of external respiration using spirometry and peak flowmetry. Spirometry measures the volume of air in the lungs and the rate of exhalation. Peakflowmetry allows you to determine the peak expiratory flow rate and blood gases.

In case of suspected bronchial asthma of physical effort, provocative tests with a load (eight-minute run) are carried out.

Spirography is used to determine the severity of an asthmatic attack.

To exclude other pathologies of the respiratory system (pneumonia, pulmonary tuberculosis), an X-ray examination is performed.

Among the diagnostic procedures, an important place is occupied by patient questioning, examination and auscultation.

Treatment

1. Mode. Treatment implies the absence of patient contact with potential allergens.
2. To stop an attack short-acting adrenomimetics (Salbutamol), xanthines (eufillin) are used. With the ineffectiveness of these groups of drugs, glucocorticoid hormones are used.
3. Basic therapy involves the use of inhaled forms of glucocorticoids; a combination of glucocorticoids with long-acting beta-agonists is possible.