Exogenous and endogenous bronchial asthma

Bronchial asthma is a recurrent disease, which is characterized by a predominant lesion of the bronchi. Late diagnosis and improper treatment lead to an aggravation of the course of asthma and the development of complications.

Therefore, it is necessary to know what the medical history may be, how exogenous and endogenous bronchial asthma manifests itself and is treated.

The reasons for the development of bronchial asthma

The development of this disease is based on persistent inflammation of the respiratory tract and bronchial hyperreactivity (the ability to react sharply to various stimuli). Such pathological processes lead to the development of bronchospasm, excessive production of mucus, edema of the epithelium and structural changes in the walls of the bronchi. As a result of these phenomena, the patency of the bronchi is sharply limited.

Bronchial asthma can occur for the following reasons:

• hereditary predisposition to bronchial hyperreactivity;
• tendency to develop allergic reactions;
• constant exposure to allergens;
• respiratory tract infections (especially viral);
• work associated with the inhalation of harmful substances (mineral dust, gases, vapors);
• active and passive smoking;
• unfavorable ecological situation.

It is worth noting that many people are affected by several adverse factors at once. However, the main role in damage to the bronchial epithelium and the development of inflammatory processes is assigned to eosinophils - cells of the immune system, the number of which increases with allergic reactions. Thus, allergic bronchial asthma (exogenous) is more common than non-allergic (endogenous) asthma.

Triggers of bronchial asthma

Depending on what factors provoke a deterioration in well-being, exogenous and endogenous asthma are isolated. In exogenous allergic asthma, attacks are triggered by the following triggers:

• household allergens (paper dust, dust mites, microscopic fungi, hair and dander of pets, feathers and down of birds, particles of human epidermis, cockroaches, bugs, food for aquarium fish);
• allergens common in the environment (plant pollen, fungal spores, insect allergens);

• food allergens (cow's milk, eggs, flour, red fish, caviar, brightly colored fruits and vegetables, additives);
• drug allergens.

Endogenous asthma manifests itself when exposed to non-immune provocateurs. These include the following irritants:

• physical activity;
• rapid deep breathing;
• cold air;
• meteorological factors;
• psycho-emotional stress;
• respiratory tract infections;
• gastroesophageal reflux (reflux of stomach contents into the esophagus);
• pregnancy.

The history of bronchial asthma is of great importance in diagnosis. With the exogenous form of the disease, it is sometimes possible to identify external allergens even without special skin tests. Symptoms of such asthma usually appear in childhood, and often there are concomitant allergic diseases - atopic dermatitis, conjunctivitis, or urticaria. Many people with exogenous bronchial asthma have close relatives with allergic diseases. This asthma is milder, the symptoms can almost completely disappear for a long time.

If bronchial asthma is endogenous, then external allergens cannot be determined even with the help of skin tests with alleged provocateurs. The disease manifests itself in old age and is rather difficult. Endogenous asthma is extremely rarely combined with allergic diseases and is usually not associated with heredity. The medical history may be irregular. There are atypical forms of bronchial asthma - "wet", "dry" and intermediate. Thus, the medical history told to the doctor helps to speed up the diagnosis.

Manifestation of bronchial asthma

The main symptom of bronchial asthma is an attack of expiratory dyspnea (suffocation), which is usually associated with exposure to provoking factors. In this case, a person experiences difficulties during exhalation. Participation in the respiratory process of auxiliary muscles - the shoulder girdle, chest, abdominal press - is noted. During a period of suffocation, a person seeks to take a typical posture - to lean forward, resting his hands on the bed, to raise and lower his shoulders.

The attack is also characterized by the following symptoms:

• dry obsessive cough;
• wheezing;
• rapid breathing (more than 20 breaths per minute);
• short inhalation and long exhalation;
• scanty, thick, vitreous sputum that comes out with difficulty (usually a sign of the end of the attack);
• a feeling of tightness in the chest;
• diffuse cyanosis ("cyanosis" of the skin);
• increased heart rate;
• increased blood pressure.

With exogenous allergic bronchial asthma, the prodromal period may indicate the imminent development of an attack. It is characterized by sore throat, nasal congestion, watery eyes, and sneezing. Thus, the history of the disease has significant differences, while the symptoms of an attack in endogenous and exogenous asthma are no different.

Diagnostics and prevention

The history of bronchial asthma and its manifestations are similar to signs of other pathologies - cardiac asthma, chronic obstructive bronchitis, bronchiectasis, tumors. To make an accurate diagnosis, determine the possible causes and severity of the pathological process, it is necessary to conduct a number of studies:

• blood and urine analysis (general);
• blood chemistry;
• chest x-ray;
• sputum analysis;
• spirometry;

• peak flowmetry;
• skin tests and the search for specific immunoglobulin E in the blood;
• provocative inhalation test;
• exercise test;
• test with aspirin.

Unfortunately, it is impossible to completely recover from bronchial asthma. The goal of therapy is to establish long-term control over the disease. This helps to relieve symptoms, maintain normal levels of physical activity, maintain adequate lung function, and prevent flare-ups.

It is worth noting that in most cases, exogenous asthma responds to treatment better than endogenous asthma.

Treatment and prevention involves the elimination of factors that provoke the development of an attack. Special measures are recommended to reduce the number of household allergens.

1. Get rid of carpets in your home.
2. Replace fabric upholstered furniture with leather or imitation leather upholstered furniture.
3. Get rid of stuffed toys and pets.
4. Ventilate rooms in the morning and evening.
5. Wipe the floor and other surfaces with a damp cloth daily.

1. Wear a mask or respirator when cleaning.
2. Wash your hair and take a shower every day.
3. Bedding with down and feathers should be replaced with pillows and duvets with artificial fillers.
4. Pack mattresses and pillows hermetically in cellophane.
5. Change bed linen and curtains weekly, wash or dry the blanket in the sun.
6. Maintain air humidity at a level not exceeding 50%.

If the deterioration in well-being is provoked by plant pollen, then it is advisable to leave for other regions during their flowering. When this is not possible, it is recommended to spend more time at home, especially in dry, hot and windy weather. Please note that you need to ventilate the rooms at night and after rains, using special nets that will trap pollen. Air conditioners and special vacuum cleaners with water filters also help to eliminate allergens. In case of an allergic reaction to food, it is required to adjust the diet.

Medications should be used with caution, as some of them cause asthma attacks. It is better not to use aspirin and other non-steroidal anti-inflammatory drugs without first consulting a doctor. Beta-blockers can cause bronchospasm, such drugs are usually prescribed for hypertension, angina pectoris (Anaprilin, Atenolol, Bisoprolol, Concor). Some doctors recommend getting a flu shot every year for people with moderate or severe bronchial asthma (especially if there is an endogenous form of the disease). This measure can significantly reduce the frequency of exacerbations.

Medicines to control bronchial asthma

Medications used to treat bronchial asthma include emergency medications and basic therapy medications. The first should be used only with a sharp deterioration in health. These medicines are short-acting bronchodilators, they quickly relieve bronchospasm and eliminate its symptoms. Basic therapy means are prescribed for a long time. These include bronchodilators and anti-inflammatory drugs, as well as glucocorticoids. Their use allows you to suspend pathological processes in the bronchi and prevent spasms in the future.

Almost all drugs for the treatment of bronchial asthma are available in the form of aerosols. The use of such a dosage form makes it possible to achieve a high concentration of active substances in the respiratory tract and minimize undesirable effects. Inhalation therapy requires the preparation of the patient, therefore, when prescribing aerosols, the doctor must tell you how to use them correctly.

The most effective medicines for controlling bronchial asthma are inhaled corticosteroids:

• Fluticasone;
• "Budesonide";
• Beklomed;
• Triamcinolone.

In severe asthma, the effectiveness of inhaled steroids is limited, so you have to prescribe tablet forms ("Prednisolone", "Cortisone", "Dexamethasone"). Typically, for home treatment, your doctor will prescribe a short course of oral corticosteroids for 10 to 14 days. Side effects of steroid drugs can be very serious, the risk of their development directly depends on the duration of use. Therefore, such funds are prescribed exclusively by a specialist.

Medicines that stabilize mast cell membranes (Intal, Cromolin) help reduce the release of inflammatory mediators. As an anti-inflammatory agent for bronchial asthma, "Tayled" and "Ketotifen" are prescribed. Bronchodilators actively dilate the bronchi. There are several groups of these drugs. To quickly relieve seizures, beta-2-adrenergic agonists of short action are used - "Fenoterol", "Salbutamol", "Terbutalin". In order to prevent exacerbations, long-acting beta-2-adrenergic agonists are prescribed - "Salmeterol", "Formoterol". It is impossible to abuse such medicines, they should be used no more than 3 - 4 times a day (6 - 8 inhalations).

The drug treatment regimen is selected individually for each patient, depending on what the medical history is and the nature of its course. The causes of asthma, the age of the patient, the presence of concomitant diseases and the need to take other drugs are of great importance.

Complementary treatments

As an auxiliary therapy in the absence of contraindications and with the permission of a doctor, the following methods can be used:

• acupuncture;
• breathing exercises;
• herbal medicine.

It is better to refrain from physiotherapy and the use of inhalation agents that thin phlegm, because they can intensify coughing and provoke bronchospasm. With exogenous allergic bronchial asthma, allergen-specific immunotherapy, especially if the medical history shows that the triggers are intravenous or pollen allergens. The maximum therapeutic effect can be achieved only in the early stages of the development of bronchial asthma.