Therapy of pre-asthmatic conditions should be comprehensive, including medication, general regime and preventive measures. The main direction of treatment depends on the form of the pathology, in the case of the atopic type they try to reduce the allergic sensitivity of the organism, and in case of the infectious-allergic type, they eliminate the influence of the infectious agent. Monitoring by a pulmonologist or allergist is required to monitor the progression of the disease in order to prevent the development of bronchial asthma.
The treatment includes the following components:
- Nonspecific desensitization therapy. It is used in the acute phase of allergic manifestations to reduce the severity of symptoms or as a prophylactic measure before suspected contact with an allergen (for example, in seasonal pollinosis). In allergic rhinitis and conjunctivitis, local forms of antihistamines are used. Of the other desensitizing drugs, calcium preparations and quinoline derivatives are used.
- Mast cell membrane stabilizers. A common preventive agent prescribed to reduce the body’s allergic sensitivity, to prevent the development of reactions. Used in remission and as a seasonal prophylaxis.
- Expectorants. Herbal preparations or synthetic mucolytics are used. They reduce the viscosity of bronchial secretions, activate its removal from the bronchial tree, improve the function of external respiration.
- Bronchodilator drugs. Include alpha-adrenomimetiki, M-anticholinergics, glucocorticoids. These drugs relax the muscles of the bronchi, reduce the level of mucus secretion, providing airway patency. When predastmy appointed in case of increased bronchial obstruction to alleviate the patient’s condition, can be used by mouth or inhalation.
- Antibiotics. Used in infectious-allergic types of predastatic conditions in order to eliminate the infectious agent. Their use is possible only after a comprehensive survey and accurate determination of the nature of the pathogen.
- Specific immunotherapy. The introduction of small doses of the allergen contributes to the development of immunological tolerance. Properly performed immunotherapy can significantly improve the condition of the patient, reduce the risk of asthma.
In the treatment of predastmy also use a number of common-mode activities. These include limiting contact with the allergen – a thorough cleaning of the premises in case of intolerance to dust, correction of the diet in food allergies. Perhaps the use of respiratory gymnastics, sanatorium treatment, vitamin therapy and tonic.
If production factors become the cause of the predastatic state, the working conditions should be improved, and contact with allergens should be limited. Smoking and other bad habits that negatively affect the respiratory organs are subject to a clear ban.
The concept of “predastmy”actively used in domestic medical terminology. In 1969, Soviet researchers PK Bulatov and A.D. Ado included it in the list of clinical stages of asthma as a condition preceding the underlying disease. According to medical statistics, manifestations of the symptom complex are widespread, recorded in 5-10% of the adult population. The structure of the incidence has certain differences in different categories of patients – chronic obstructive bronchitis with a moderate allergic component prevails among men, recurrent bronchitis is more common in women against the background of urticaria episodes, pollinosis and food allergies. The criteria for distinguishing predastmas from bronchopulmonary and allergic disorders similar to it are not well defined, which creates difficulties in diagnosing this condition.
Causes of predmas
The preastatic state is polyetiological – many factors, both internal and external, are involved in its development. The significance of each factor has not been thoroughly studied, which makes it difficult to develop further etiotropic treatment. In addition, it is clinically very difficult to separate predastm, a variety of chronic lung pathologies, allergic diseases and syndromes.
For this reason, some researchers do not recognize the existence of a predastmatic state as a separate nosological unit.
The leading role in the occurrence of pathology, according to supporters of its existence, is played by the following groups of reasons:
- Hereditary and genetic factors. As with a number of allergic conditions, there is a hereditary correlation for predastm. Its substrate is the genetic features of the body’s reactivity and individual intolerance, susceptibility to certain infections.
- Infectious factors. Chronic infections of the respiratory tract (mainly the bronchi) are an integral part of the etiology of predastatic conditions. No clear correlation was found between the type of infection and the incidence rate.
- Allergic factors. Allergy is the second constant component of predastmy. Both conditions affecting the respiratory system (allergic bronchitis, rhinitis) and systemic reactions (urticaria) can occur.
- External factors. Working conditions and human life, climate, contact with infectious and allergic agents, harmful habits (smoking) have a significant impact on the development of pathological conditions preceding bronchial asthma.
- Endocrine disorders. In the majority of patients (55-70%), neuroendocrine disorders are observed against the background of the pathology of the respiratory system of this type. This circumstance reduces the adaptation abilities of the organism and changes the nature of its reactivity, which is one of the factors for the development of asthma in the future.
Pathogenesis of predastmas
Due to the considerable variety of forms of predastm, the pathogenesis of this condition is quite complex, it is very different in different cases, but there are also certain similar features. All patients have chronic inflammatory processes in the bronchi, the cause of which are allergic or infectious factors. According to the degree of the prevailing influence of a process, all cases of pathology are divided into atopic and infectious-allergic.
The main role is played by intolerance reactions of the first or anaphylactic type, when an organism is sensitized, hypersensitivity to certain substances (allergens) occurs. Contact with them activates the release of specific immunoglobulins E, the latter stimulates the degranulation of mast cells with the release of histamine and a number of other compounds, leading to reactions that are inflammatory.
Under the influence of inflammation, the nature of the secretion of mucous glands changes – the mucus becomes thick, harder is eliminated from the bronchi, clogs the respiratory tract of small caliber. In some cases, there is bronchospasm, which additionally enhances the obstruction of the bronchi. Continuing contact with the allergen or the preservation of the influence of the infectious agent leads to a gradual increase in pathological phenomena, causing a transition from a predastmatic state to severe bronchial asthma. In 11-18% of patients, the predastma turns into asthma even during treatment – the causes of this phenomenon are unknown.
Allergic manifestations are not limited to the lungs – the skin also suffers (urticaria, eczema), mucous membranes (rhinitis, conjunctivitis, pollinosis), other organs (food or drug allergies).
Classification of predastmas
Predastma is a complex pathology with a complex classification – in fact, it is a whole set of pathological conditions that dramatically increase the risk of asthma. Building a classification based on clinical manifestations is a very difficult task.
Currently, the systematization of predastatic conditions is carried out according to the etiological sign – the predominant influence of a specific (allergic or infectious) pathological process.
Based on this, there are several main groups of predastmy:
- Atopic type. Also called non-infectious-allergic type. The main role in the development of the state is played by intolerance to certain substances. More often registered with women, has a distinct hereditary character. Pulmonary manifestations are expressed softly, limited to recurrent bronchitis. Patients always show serious allergic disorders (polyallergy, pollinosis, drug intolerance), endocrine disorders are often found.
- Infectious-allergic type. Manifestations of allergy fade into the background, the main role is played by infection of the bronchial tree with the development of chronic obstructive bronchitis. This form is more often diagnosed in men, there is a clear correlation between the frequency of its development and the effects of adverse factors – smoking, poor working conditions, contact with dust. The allergic component may initially not be detected, then it is detected only by laboratory tests and partly determines the seasonal nature of exacerbations of bronchitis.
- Mixed type. The controversial form, with the allocation of which in a separate group, not all researchers agree. It is determined when there is a combination of a clearly expressed infectious variant of broncho-pulmonary disorders and strong manifestations of allergy (pollinosis, urticaria, reactive rhinitis).
Symptoms of predastmy
Manifestations of the disease are quite diverse, especially the course of pathology depends on its type. Atopic forms of predastmas are characterized by the prevailing development of allergic symptoms – initially patients complain of the presence of seasonal pollinosis (conjunctivitis, rhinitis), urticaria, intolerance to certain foods. As the disease progresses, there are signs of an allergic bronchus lesion, a bronchospastic syndrome under the influence of airborne allergens. It manifests a strong whooping cough with contact with household dust, animal hair, plant pollen.
The duration of an attack depends on the duration of contact with allergenic substances – it usually stops shortly after the completion of contacting, when taking agents that eliminate bronchospasm (bronchodilators) or the effect of histamine (antihistamines).
Infectious-allergic forms of predastmas begin with inflammatory lesions of the respiratory tract, which initially occur acutely and then become chronic. Symptomatology depends on the type of disease – as such may be bronchitis (including obstructive), recurrent polyposis, chronic pneumonia. Symptoms usually come down to repeated bouts of severe cough, dry rales in the lungs, and a small amount of purulent or mucous sputum. After the removal of the acute condition, the cough and a feeling of heaviness in the chest remain for a long time. With the progression of the disease, exacerbations become more and more severe, allergic disorders join (urticaria, pollinosis).
The duration of predastma from the onset of manifestations of the pathological condition to the development of obvious clinical signs of bronchial asthma ranges from 6-12 months to 10 years or more. For atopic forms, the dependence of the rate of asthma on the etiological factor of allergy is characteristic.
For example, in case of intolerance to household dust, asthma occurs within a short period of time, and an allergic reaction to pollen can persist for 10 years without a clear increase in asthmatic symptoms. The rate of progression of infectious-allergic forms is influenced by a huge number of factors (bad habits, living conditions, level of immunity). Because of this, it is difficult to determine the possible duration of a pre-asthmatic condition in a particular patient. In some cases, bronchial asthma does not develop – both under the influence of the treatment of manifestations of predastmia, and for a number of other reasons.
Complications of predastmy
In the scientific community, there are disagreements as to whether asthma should be considered a complication of pre-asthmatic diseases or the logical outcome of the development of predastma in the absence of treatment. A group of researchers who do not emit predastomy as a separate disease regularly views asthma as a complication of allergic or obstructive bronchitis, chronic pneumonia and other conditions.
Predastatic conditions can be complicated by anaphylactic shock, angioedema, secondary bacterial infection of the respiratory tract and mucous membranes. In the long run, serious disorders of the cardiovascular system are possible due to insufficient respiratory function of the lungs.
Diagnosis of predastmas
Determining predastmy requires the joint work of such specialists as a pulmonologist, allergist and immunologist. Diagnosis of pathology is quite complicated, especially in terms of its differentiation with other bronchopulmonary or allergic diseases.
Predastatic conditions are confirmed in the presence of four main factors – clinical symptoms, changes in laboratory tests, functional disorders of the lungs and anamnesis burdened by bronchial asthma.
Diagnostic methods aimed at identifying these four criteria include a large list of studies:
- Physical examination and anamnesis. During the interview, the patient finds out how long he has had complaints about the work of the respiratory system (coughing, shortness of breath, heaviness in the chest), whether there are allergic manifestations (pollinosis, rhinitis, urticaria). Particular attention is paid to the hereditary history – the presence or absence of cases of bronchial asthma, allergies, bronchitis in relatives. Produce auscultation of the lungs – often wheezing, hard breathing and other disorders are detected.
- X-ray examinations. Radiography of the chest with predastm reveals signs of irregularities on the part of the bronchial tree – increased pulmonary pattern, expansion of the borders of the lungs. In infectious-allergic forms, shadows associated with chronic pneumonia, thickening of the interlobar partitions, and an increase in the transparency of the lung tissues can be seen.
- Laboratory research. Complete blood count confirms a slight increase in the level of eosinophils and the presence of non-specific signs of inflammation (leukocytosis, increased ESR). In the case of sputum secretion, microscopy is performed – eosinophils and sometimes Charcot-Leiden crystals are found in it. Blood eosinophilia and the presence of cells in the sputum is an important differential criterion between predastomy and other lung diseases.
- Immunological diagnosis. If allergic disorders are detected, allergens are determined by means of skin allergy tests (scarification, application, PIRC-tests). It is important to develop further treatment in order to limit the patient’s contact with the allergen.
- Functional pulmonary tests. These include spirometry, pneumotachography and other tests. According to the research results, a decrease in tidal volume and other signs of pulmonary obstruction of varying severity are detected.
Cooperation between doctors of different specialties is the key to successful diagnosis of this pathological condition, allows you to take into account all the existing symptoms.
Insufficient examination of patients with predastomy prevents the development of a full-fledged treatment and significantly increases the chances of a full-blown bronchial asthma.
Forecast and prevention of predastmas
According to statistics, in about 10–15% of predastmic cases, full-blown bronchial asthma develops over several years against the background of non-specific therapy. Significantly improves the prognosis of a well-performed desensitizing immunotherapy or elimination of an infectious agent through antimicrobial treatment.
Regular observation by an immunologist with monitoring of lung function 1-2 times a year (X-ray radiography, spirography) allows to detect the progression of predastma in a timely manner and adjust the treatment to improve the patient’s condition.
The prognosis for survival is clearly favorable, and severe and dangerous complications are extremely rare. Prevention includes giving up bad habits, improving working conditions, timely treatment of allergic and infectious diseases.