Bronchial asthma: classification, types

The classification of asthmatic diseases divides the disease into categories, stages, phenotypes, forms and phases. The need for classification is explained by the multifactorial chronic course of the disease, the therapy of which should be carried out differentially.

The types of asthma have been studied by physicians for a long time, but the etiology of the disease has not been fully determined, despite the serious work done. For example, to date, almost all the reasons contributing to the onset of an asthmatic attack have been clarified, but there are cases when their symptoms are atypical and it is impossible to classify the disease according to the standard scheme.

Despite the fact that asthmatic disease is difficult to treat, the main focus in treatment is to prevent the occurrence of an exacerbation of an attack, as well as to stop the already appeared choking.

The disease is classified on the basis of the etiology, the severity of the symptoms and the characteristics of the course of bronchial obstruction. However, asthma is primarily classified by the severity of symptoms, since further therapy depends on this property.

Classification by stage of development

All diseases are classified according to the international classification (ICD). It is one for doctors all over the world. The classification of asthmatic diseases is quite difficult to determine, since it can be accompanied by various pathological processes.

The disease is classified according to the following factors:

• the severity of asthma at the beginning of therapy;
• asthma symptoms before starting treatment;
• flow phases;
• the presence of complications.

In accordance with this classification, it becomes possible to determine the patient's condition at the time of determining drug therapy, therefore, all these conditions should be considered together.

Classification of the disease by the nature of the course

The disease is divided into 4 degrees:

I - intermittent development of bronchial asthma, when an attack of suffocation occurs quite rarely and in the interval between attacks the patient's state of health does not change. At night, asthmatic symptoms may appear no more than 2 times a month;

II - persistent mild stage, characterized by the development of suffocation more often than once a week and more than 2 times a month at night;

III - the disease proceeds with moderate severity, and night attacks are observed several times a week. Daytime attacks occur almost daily;

IV - characterized by a severe course, which makes him take glucocorticosteroid drugs. This stage can lead to the development of status asthmaticus.

Symptom classification

In bronchial asthma, there are the following stages:

Precursors. This condition occurs several days or hours before the onset of the attack. This stage can be accompanied by vasomotor rhinitis, dry nasal cavity, difficult sputum discharge and periodic shortness of breath.

EXTENDED. At the height of the attack, the patient feels an acute shortage of air. In this case, the patient can take a forced position (sitting on a chair, resting his hands on the knee area). Additional muscles are included in the respiratory activity, and the retraction of the intercostal spaces during inhalation is observed. The exhalation is usually prolonged and performed with little effort. Depending on the severity of the condition, symptoms of hypoxia are possible.

REVERSE DEVELOPMENT. This form of the disease is characterized by the gradual disappearance of wheezing and shortness of breath, followed by the normalization of respiratory activity.

DEVELOPMENT OF THE ASTMATIC STATUS. In fact, this is a bronchial attack, but characterized by a longer and more severe development of the disease. In this case, the symptoms increase sharply, and oxygen deficiency is observed. If timely assistance is not provided, the patient may die.

Forms of asthmatic disease

According to the ICD, bronchial asthma is divided into several forms. These include:

ALLERGIC. In this case, the allergen is the provocateur of the disease. At the same time, an atopic form of asthma with increased sensitivity to household chemicals is released.

NON-ALLERGIC. This group includes aspirin asthma, manifested in intolerance to aspirin, NSAIDs and yellow medications.

MIXED. This group combines all the symptoms of bronchial disease.

In addition, persistent, moderate, mild and severe forms of the disease are distinguished. All these stages are characterized by common signs in the form of impaired respiratory activity, asthma attacks and decreased performance.

Allergic (atopic) form

This type of disease is one of the most common, the basis of which is an acute reaction to various types of allergens. Typically, allergens commonly associated with asthma attacks include:

dust mites found in house dust;

• animals (wool, saliva, excrement);
• stinging insect bite;
• pollen from flowering plants;
• Food;
• cosmetics, etc.

Treatment for this asthmatic form consists in stopping contact with the allergen and carrying out medication.

Aspirin bronchial asthma

This type of disease belongs to the allergic variety, and this form got its name due to the fact that among all anti-inflammatory drugs for its relief, most often an acute negative reaction provokes aspirin.

The classification of bronchial asthma in children is complicated by various complications, therefore, their compulsory drug treatment and restriction of the patient's access to the allergen are required. To expand the bronchial lumens and reduce the immune response to an irritant, adrenomimetics and glucocorticosteroids are prescribed.

Persistent form of the disease

This asthmatic form varies in severity. Persistent asthma can be severe, moderate, or mild. This type of disease is characterized by constant irritation of the bronchi, and the inflammatory process has characteristic symptoms and can take a long time (months or even years). The persistent form requires the use of complex therapeutic measures with the appointment of glucocorticosteroids and beta-2-adrenergic agonists.

Intermittent bronchial asthma

This type of disease is characterized by episodic development. Unlike persistent asthma, the disease of this form is much easier to treat without causing serious problems. Intermittent asthma attacks are episodic, therefore, therapeutic measures are aimed specifically at stopping their attack and achieving long-term remission, allowing the patient to maintain a familiar way life. In addition, it is recommended to comply with preventive measures aimed at preventing the development of stressful situations, adherence to a special hypoallergenic diet and a sleep and rest regimen. Quite often, these types of bronchial asthma require the prevention of all possible contacts with allergens, so that the disease sharply reduces its activity.

Uncontrolled bronchial asthma

This type of disease is considered the most dangerous, since the patient, as a rule, is not able to assess the severity of the development of symptoms. However, he does not receive specially prescribed treatment. Uncontrolled asthma develops suddenly and is accompanied by a sharp increase in symptoms. With untimely therapy, the disease can turn into a more severe chronic form. To prevent the development of uncontrolled asthma, constant monitoring of the patient's condition and timely consultation of specialists are required.

Occupational asthma

This type of bronchopulmonary disease accounts for 20% of all cases of bronchial asthma encountered. As a rule, it develops against the background of unfavorable factors associated with a person's professional activities (paint, varnishes, harmful products, chemicals, etc.). The disease occurs only in adult patients of working age.

To obtain positive results during treatment, a mandatory change in professional activity is required, excluding the penetration of harmful substances into the patient's respiratory system. In case of severe development of the disease, drug therapy is used in accordance with a special protocol.

The most understandable is the classification of bronchial asthma according to the severity of the condition (mild, moderate and severe). It should be borne in mind that sometimes it is rather difficult to make a conclusion about the severity of asthma, although it is necessary for making a decision on further therapy.

When determining the severity of the disease, all factors are taken into account (symptoms, duration of attacks, the effectiveness of the therapy, etc.). In addition, physical and instrumental diagnostics are carried out.

Disease classification according to severity

Classification of the disease according to the severity of the course is needed to prescribe adequate therapeutic measures that are necessary to neutralize the pathological process in the body.

The severity of the condition is assessed by the following indicators:

• how often daytime and nighttime attacks occur;
• the necessary time to relieve an asthmatic attack;
• the degree of negative impact of the disease on the general condition of the patient;
• indicator of external respiratory activity.

Clinical symptoms that characterize the severity of an asthmatic attack:

• breathing rate;
• the degree of participation of auxiliary muscles in respiratory activity;
• the presence of wheezing and wheezing;
• swelling in the chest area during breathing;
• the nature of pulmonary respiration, revealed during auscultatory examination;
• the frequency of contraction of the heart muscle (heart rate);
• gentle posture of the patient when an attack occurs;
• a change in the patient's behavior (excitement or, conversely, lethargy, lethargy);
• the required degree of restriction of physical activity;
• evaluation of the necessary therapeutic intervention and measures for the relief of an acute asthmatic attack.

The degree of gradation of an asthmatic attack

• light;
• medium heavy;
• heavy;
• very severe (characterized by the development of status asthmaticus).

Possible complications during an asthmatic attack

According to the assessment of probable complications, asthma is classified into uncomplicated form and complicated. Among the probable complications of a neglected asthma attack, the most common are:

• symptoms of pulmonary heart (acute, subacute and chronic stages);
• possible development of pulmonary emphysema (subcutaneous, interstitial and mediastinal);
• the occurrence of spontaneous pneumothorax;
• development of lung atelectasis (polysegmental and segmental);
• disturbances in the work of the hormonal system;
• damage to the nervous system.

As a rule, clinical practice determines the most difficult cases of asthma development, when their various manifestations are most striking. In this case, quite often patients have a low threshold for steroid treatment, therefore, they often have secondary development of asthma during complex treatment. Therefore, it is recommended for asthmatics to carry out intensive therapy, and in the most severe cases, resuscitation measures.

With the development of bronchopulmonary diseases, a period of remission and exacerbation is distinguished. During an exacerbation, an asthmatic attack is most pronounced, and obstruction may also develop. The acute development of asthma is accompanied by expiratory suffocation, wheezing and paroxysmal coughing, accompanied by a decrease in speed at the peak of expiration. This condition is noted both by the patient himself and by people around him. Symptoms of an attack can recur with varying degrees of complication.

Based on the syndrome of hyperreactivity and obstruction of the bronchi, 2 phases of the development of the disease are distinguished:

• aggravation;
• remission (in this phase, the disease is classified as persistent if there are no attacks for more than 2 years).

The remission period is complete or incomplete. This is determined based on the analysis of clinical and functional indications.

Phenotyping in bronchial asthma

Violation of the functionality of the bronchi in asthmatic disease can occur under the influence of many factors. In order to simplify the classification of the disease, as well as to determine the necessary therapeutic intervention, bronchial asthma is divided into phenotypes (a set of characteristic features in a living organism in certain forms of its development). This terminology can be applied to various diseases, for example, asthmatic.

The asthmatic phenotype includes:

• the severity of symptoms;
• age category of the patient;
• the degree of development of bronchial obstruction;
• the effect of physical activity on the body;
• influence of allergens and harmful environment;
• numerous physiological nuances;
• symptomatology of the clinical picture and triggers of the disease.

The classification of bronchopulmonary diseases by phenotyping is important in order to select individual treatment that will have the most effective result and will allow you to achieve prolonged remission.

It must be remembered that for any asthmatic manifestations at the initial stage of the disease, you must immediately seek advice from a highly qualified doctor who will prescribe a number of diagnostic and laboratory examinations to determine the classification of the disease and further effective therapy. You cannot take medications on your own, without a doctor's prescription. This can lead to the development of a prolonged asthmatic attack and the transition of the disease into a chronic form.