Boundaries of the lungs in bronchial asthma. Diagnosis of bronchial asthma. Facial expression: calm

Carrying out auscultation of the patient's lungs during bronchial asthma, you can hear wheezing and whistling sounds of various origins. They are especially pronounced when holding the breath while inhaling, as well as when exhaling spontaneously.

What is meant by the term auscultation?

Auscultation is a diagnostic method for examining a patient with bronchial asthma, with the help of which the doctor listens to the patient and, according to the characteristics of the noise produced by the body, determines the disease. There are 2 auscultation technologies:

Direct auscultation. The patient who comes in can be listened to directly, simply by placing the ear to the person’s body. Indirect auscultation. This technology uses a special medical device– stethoscope.

Modern specialists have long abandoned the use of the first technology, because it is not so accurate and carries less information about bronchial asthma and other diseases, because human hearing cannot be compared with the sensitivity of the device used. During auscultation of the chest, an experienced pulmonologist will hear and analyze not only the sounds made during inhalation of air, but also the noises produced during exhalation. Only a comprehensive consideration of the results makes it possible to draw the right conclusions, which mandatory entered into the patient's medical record.

To determine which points need to be auscultated for bronchial asthma, the doctor may ask the patient to take different body positions (vertical or horizontal). In case of severe weakening of the patient with the disease, the listening process can be carried out lying down.

The doctor must listen to all zones of the patient’s chest: first of all, the anterior zone is listened, and then the lateral and only at the end the back. For the sole purpose reliable result The patient's breathing should be as deep as possible.

In some clinical cases Bronchophony is prescribed. This is another type of listening in which the pulmonologist asks the patient to quietly or even whisper words containing the letters “P” and “C.” If it is not difficult for the doctor to recognize the spoken words, then this indicates a compaction of the lung or hollow areas in it. If a person does not have pathologies, then only quiet sounds will be heard, which means the absence of bronchophony.

IMPORTANT! For a correct diagnosis of bronchial asthma modern medicine has at its disposal the most effective instruments for radiography, bronchography and other examinations. However, all examinations for bronchial asthma are prescribed by pulmonologists only after auscultation.

The noises that the doctor listens to during auscultation of bronchial asthma are of three types:

basic; side; noises generated by friction of the pleura.

Breath sounds in asthma

IN medical literature, and in practice breathing is divided into 2 types: bronchial and vesicular. To listen to the first, the doctor carefully listens to the areas located:

Above the larynx area. Above the trachea. Above the bronchi. In the area of the 7th cervical vertebra.

Bronchial breathing in asthma is characterized by a rough sound. It is necessary to listen to it at both stages of breathing - when inhaling and exhaling air. Unlike inhalation, exhalation can be described as rougher and longer. This type of breathing is formed in the area of the vocal cords in the larynx and is similar to pronouncing the letter “X” with an open mouth.

When a pulmonologist listens to other areas of the chest, the noise will be completely different, because it is inherent in the vesicular type of breathing, which originates in pulmonary alveoli. The air entering the lungs affects them, straightening the walls. The lung walls expand as you inhale and fall as you exhale. Because of this, a peculiar “F” sound is obtained. The vesicular type of breathing has a pronounced force and duration of inspiration.

Breath sounds and wheezing during auscultation (table)

By virtue of physical reasons or the presence of pathologies in the patient, this type of breathing is changeable. Physical overload in people with a thin chest definitely increases this breathing, and bronchitis and any ailments that narrow the lumen of the bronchi make it very rough, hard and uneven. In lobar pneumonia, vesicular breathing is loud, high-pitched and palpable right next to the ear. In bronchopneumonia, inflammation is so widespread that it is fused in nature. A bronchial type of breathing is formed, which differs from lobar pneumonia in a quiet and indistinct noise.

One of the reasons for a patient to experience bronchial breathing is the presence of voids in the lung. The sound of such breathing can be described as a sound into the void of medium volume with a low timbre.

IMPORTANT! If a patient has tuberculosis or bronchopneumonia, the doctor may encounter both types of noise.

All about side noises

Side noises include crepitus and wheezing, which in turn are divided into dry and wet, depending on the secretion. The root cause of dry wheezing is a narrowing of the lumen of the bronchi, which is found in patients with asthma, with various inflammations and bronchial edema, which is not typical for the wet variety.

The tonality distinguishes between high and low wheezing. High wheezes appear in small-caliber bronchi, and low wheezing in medium-caliber and large-caliber bronchi. Depending on the strength of inhalation and exhalation, wheezing can be heard nearby or not heard at all. For example, with asthma, a doctor can hear wheezing while being a few meters from the patient.

Sometimes wheezing can be local, for example with tuberculosis. In asthma, they have no location and are distributed everywhere. Dry wheezing is variable in nature. In a short time, dry wheezing may appear and then suddenly disappear. Dry wheezing can be heard both on inhalation and exhalation.

Moist rales occur when there is fluid in the lungs: the flow of air during breathing passes through the fluid and produces an audible wheezing, reminiscent of gurgling. Moist rales appear in the lung cavities. An experienced doctor can hear wet origins at any stage of breathing, but most doctors prefer to listen to them during inspiration.

Another type of noise is crepitus, which originates in the alveoli when there is a specific inflammatory fluid in them. For diagnosing the disease, the presence of crepitus is especially informative. Crepitation is clearly audible on inspiration and, compared to wheezing, does not disappear with coughing and is an immediate, rather than long-term, phenomenon. It is typical for patients diagnosed with lobar pneumonia. In addition, crepitus can occur without lung disease. For example, in elderly or non-ambulatory patients.

Noises generated from pleural friction

Pleural friction noise with pleurisy

The normal state of the pleura is a smooth surface. During uncomplicated breathing, the layers of the pleura easily slide over each other, but when inflammation occurs, fibrin and irregularities of various types appear on the walls of the pleura. In this case, the doctor, listening to the patient, will hear not wheezing, but a pleural noise, reminiscent of crust cracking or scratching.

Clinical variants of asthma with toxic damage to the pleura, its dryness, or the presence of leaf nodules are not uncommon. These phenomena also determine its noise, which can be heard at any stage of respiratory activity. The doctor will hear a dry cracking sound almost next to the ear. Such noises are not very common, but they cause pain to the patient.

Distinctive features of pleural friction from wheezing:

When the stethoscope is pressed closer to the patient’s body, the friction sound intensifies; frequent cough friction of the pleura does not change the strength and tonality of the sound, but wheezing does.

To distinguish between the movement of the lungs and pleura during breathing, doctors often resort to a special technique for asthma. The patient is asked to exhale as much as possible, not to inhale for a while, and during this time period to stick out his stomach. This technique imitates abdominal breathing, in which the diaphragm is set in motion, which promotes the sliding of the pleural layers. At this time, the doctor determines the type of noise in the lungs. With pleural inflammation, pericardial murmurs may occur, which experts associate with inhalation and exhalation. When the patient imitates suffocation, these noises disappear.

Bronchial asthma is a disease respiratory system chronic type, which is characterized high level reactivity of the bronchi to a number of certain stimuli environment. Diagnostics of this disease is an important component for each patient, since based on the data obtained, the attending physician prepares a treatment that can not only minimize, but also completely eliminate attacks of suffocation.

You can learn more about bronchial asthma at the link: http://lekhar.ru/bolesni/pulmonologija/bronchialnaja-astma/

Auscultation: main points

Auscultation - listening to sounds. It is a diagnostic examination that is necessary for bronchial asthma. This method allows the attending physician to listen to the patient’s lungs and, based on the sounds heard during breathing, determine the severity of the disease. Auscultation of the lungs is carried out in two main ways:

Direct method, characterized by the doctor listening to the patient by placing the ear to the body. Indirect method, in which a stethoscope is used for listening.

Modern medicine uses indirect method diagnostics, since it allows you to obtain more reliable data, on the basis of which you can get a complete picture of the ongoing disease. By auscultating the patient's chest area, the specialist analyzes all the noises that appear during breathing, both during inhalation and exhalation. All research results are reflected in the patient’s outpatient record.

For a more accurate examination, the doctor performs auscultation in a standing and sitting position. For weak patients, listening with a stethoscope can be done in a lying position, but the doctor must examine the breathing of all parts of the chest, so it is important that the patient takes deep breaths.

Carrying out the procedure for bronchial asthma

A number of cases require additional examination of the patient’s breathing and conducting bronchophony, which represents special type listening to the lungs. During the procedure, the patient must whisper words containing the letters “P” and “C”. If, with the help of a stethoscope, the doctor can easily distinguish the words that the patient speaks, then this indicates the presence of compaction in the lung area, as well as the presence of hollow spaces. These symptoms correspond to bronchial asthma in the patient. In the absence of any pathologies in the lung area, when listening, the doctor will hear only soft hissing sounds, but not words.

After listening to the chest, the doctor should examine the data obtained:

At two points of the lungs, located symmetrically, the noises are the same or not. What type of noise are they at each of the points listened to? Is there any extraneous noise that is not characteristic of bronchial asthma.

To diagnose this pathology of the respiratory system, auscultation is practiced for each patient, although today there are a number of more accurate diagnostic tests, such as radiography. The patient's breathing may be accompanied by three types of noises:

Main Side Noises arising from friction of the pleura.

Side noises

Adverse noises are divided into two main types: wheezing and crepitus. Depending on the nature of the secretion that predominates in the patient’s lungs, wheezing can be dry or wet. Dry wheezing occurs when the bronchial lumen is narrow. This symptom can be observed in patients with asthma and inflammatory processes, occurring in the tissues of the lungs.

Wheezes are divided into low and high. Depending on the force with which the patient breathes, wheezing can be heard at a certain distance. The impulsiveness of wheezing in asthma is so strong that it can be clearly heard even at a distance of several steps from the patient.

Bronchial asthma is characterized by the fact that wheezing is evenly distributed over the entire area of the lungs, and is not localized in small areas, which is typical for tuberculosis. Dry wheezing may disappear for a while, but then appear again. They are heard during the patient's breathing, both during inhalation and exhalation.

If there is any fluid (sputum, blood, etc.) in the lung area. then this is the cause of the formation of moist rales. When the patient breathes, the air flow, passing through the fluid in the lungs, forms wheezing of a “gurgling” nature. The place of their formation is the cavity of the lungs. They are heard when the patient breathes, but experts prefer to do this while inhaling.

If you listen to a patient with bronchial asthma during an attack, you will notice not only slow and heavy breathing, but also scattered dry wheezing. The reason for this phenomenon was the fact that during an attack different parts bronchial tree begin to narrow to varying degrees. In the intervals between asthma attacks, wheezing may not be heard at all.

Percussion

Percussion, which is performed for bronchial asthma, is diagnostic test, the essence of which is to tap areas of the lungs. The sounds that appear during this process make it possible to determine the hardness, elasticity and airiness of the lung tissue.

Percussion of the lungs is carried out by a specialist in the area where lung tissue should fit tightly to the walls of the lung. It is in these places that when tapped, a clear and distinct sound should appear. When a doctor examines a patient's breathing with asthma, these areas cannot always be accurately identified. In order to identify any pathological processes occurring in the lungs, the specialist conducts comparative percussion, after which topography allows one to determine the boundaries of the lungs and the mobility of the lower edge.

In asthma, tapping the chest produces a high-pitched sound, like an empty box. This is a sign of accumulation large quantity air in the lungs.

Bronchial asthma can be determined using several diagnostic procedures, each of which has characteristic features the presence of this disease.

What is auscultationRespiratory noisesAdditional type of noisesNoises arising from friction of the pleura

When performing auscultation for bronchial asthma, the doctor may hear whistling, hoarse sounds of a varied nature. They are heard especially well when the patient holds his breath while inhaling and when breathing weakens while exhaling.

What is auscultation

This is one of the methods diagnostic examination patient. With its help, the doctor listens to the patient, determining a possible disease by the nature of the noise coming from inside the body. There are two ways this study:

direct auscultation, in which the doctor listens to the person who comes to the appointment by putting his ear to his body (that is, directly); indirect, in which the doctor uses special device- stethoscope.

Modern doctors do not use the first method, since the second is more informative and accurate, due to the special sensitivity of the instrument used. Auscultation listening chest, the specialist analyzes the noises that appear during inhalation and those that occur during exhalation. Comparing both results, he draws the appropriate conclusions and enters them into outpatient card sick.

To determine the auscultated points and conduct the study itself, the doctor may ask the patient to sit down or stand up. If the patient is too weak, then you can listen to him in a lying position. Bugged anterior section chest, then lateral and posterior. To obtain a more accurate result, the patient's breathing should be deep.

In some cases, bronchophony is indicated. This is a separate type of listening. During the procedure, the doctor asks the patient to whisper words containing the letters “P” and “C”. If the doctor easily identifies the words spoken by the patient, then the conclusion is drawn that the lung is compacted or there are hollow spaces in it. Such signs correspond to bronchial asthma. If the body is healthy, then during this study only rustling or soft sounds are heard. This means that there is no bronchophony.

After carefully listening to the patient’s lungs, the doctor evaluates the results of auscultation:

whether the noise is the same at two points located symmetrically; what is the type of noise at all listened points; is there any side noise, not typical for the patient's condition.

Auscultation has important for the diagnosis of bronchial asthma. But modern doctors contain in their arsenal more modern devices for obtaining accurate results. Therefore, to make a diagnosis after this study, a number of others are carried out: radiography, tomography, bronchography and others. There are 3 types of noises heard in the respiratory organs: main (respiratory), secondary and those that arise from friction of the pleura.

Bronchial asthma is a chronic disease respiratory tract. Inflammatory processes occurring in the bronchi disrupt normal breathing and significantly worsen general state sick.

Auscultation is of great importance. The doctor, listening to the patient's chest, may hear wheezing or whistling sounds. They have a wide variety of origins and can be heard both during inhalation or exhalation, and when holding the breath.

Correct interpretation of what the physician hears during auscultation helps in the diagnosis and treatment of asthma.

Auscultation is one of the diagnostic methods used for bronchial asthma. With its help, the doctor listens to the patient, identifying and classifying noise in the lungs.

Two methods of auscultation are practiced:

Straight. Listening to the lungs is carried out without any instruments. Most often, the doctor simply puts his ear to the patient's chest.
Indirect. This method requires a special device - a stethoscope.

In modern medicine, only the second method is used, considering the first one to be insufficiently reliable.

By auscultation, the doctor is able not only to make a preliminary diagnosis, but also to determine the severity of the disease.

Features of auscultation

In modern medicine, the indirect method of auscultation is used. The attending physician carefully listens to the patient's breathing both during inhalation and exhalation and analyzes what he hears.

The results are necessarily entered into the patient’s outpatient record. To get a more complete picture, the procedure is performed standing and sitting.

In some cases, when the patient cannot stand or sit for health reasons, the procedure can be performed in a lying position. Since it is important to listen to all areas of the chest in any case, the patient should take deep, full breaths in and out.

In some cases, regular listening is not enough. For such situations, there is a special technique - bronchophony. The essence of this method is that the patient whispers words that contain the sounds “R” and “Ch”.

If the doctor clearly distinguishes the spoken words through a statoscope, it means that the patient has some kind of compaction in the lung area. This also suggests cavities in the lungs. These signs make it possible to diagnose bronchial asthma.

In the case of listening to a healthy patient, the doctor is not able to distinguish any words (only some hissing sounds).

After completing the procedure, the doctor systematizes what he heard and draws conclusions based on the following criteria:

compares the similarity of noise in both lungs at symmetrical points;
determines the type of noise, according to the accepted classification;
establishes the presence of extraneous noises uncharacteristic of asthma.

Despite the fact that modern medicine has such modern diagnostic methods as radiography, bronchography, etc., auscultation must be performed. And all other examinations are prescribed only based on its results.

Breath sounds and wheezing in bronchial asthma

Auscultatory data obtained by the doctor during the initial examination of the patient, as well as during the examination, have important diagnostic value.

There are three types of noise:

main ones:
side effects;
noise due to friction of the pleura.

Basic noises

These are noises produced by breathing. In medicine, there are 2 types of breathing:

bronchial;
vesicular.

In order to evaluate bronchial breathing, you should listen to the following zones:

above the larynx;
above the trachea;
above the bronchi;
in the area where the seventh cervical vertebra is located.

In the presence of bronchial asthma, rough sounds are heard during auscultation. For correct diagnosis It is important to listen to it both while inhaling and exhaling. In this case, exhalation is always rougher and takes longer.

If you listen to other areas, the sound has a different timbre. It corresponds to vesicular respiration. The air entering the alveoli straightens their walls with a characteristic sound.

For BA we can single out a single clinical picture. If there is a weakening of breathing sounds during an attack, this means that acute emphysema or pneumothorax has developed.

A “silent lung” (there is no breathing in any of the sections) indicates a large mucus plug or severe bronchospasm requiring urgent resuscitation.

If the wheezing is monotonous, equally distributed over the entire surface of the lungs, this indicates bronchospasm.

The combination of high and low wheezing indicates a prolonged exacerbation.

If the patient easy stage obstruction - noises are clearly audible only when exhaling. As the condition worsens, they begin to be heard when inhaling.

Side noises

Auscultation of bronchial asthma reveals crepitus and wheezing.

Wheezing, in turn, is also usually classified:

Dry. They arise due to a narrowing of the lumen of the bronchi. This occurs with bronchial asthma, pneumonia and other inflammatory diseases. Dry wheezing may appear or disappear. They are heard both on inhalation and exhalation.
Wet. Occurs when there is excessive accumulation of sputum. Moist rales are an indicator of the presence of fluid in the lungs. It occurs when air passes through it. That is why such noise resembles gurgling. These wheezes are best heard during inspiration, but an experienced doctor can hear them at any stage of breathing.

By tonality they distinguish:

Tall. They are characteristic of small bronchi.
Low. Occurs in large and medium bronchi.

Wheezing may be heard only when inhaling or only when exhaling. In some cases, they can be heard even without the help of any instruments. For example, during a bronchial attack, sounds can be heard at a distance of several meters from the patient.

Based on localization, they are divided into point (for example, with tuberculosis) and widespread throughout the cavity (bronchial asthma).

Separately, crepitation should be highlighted. It occurs in the alveoli when a specific fluid accumulates there, formed during inflammatory processes. Crepitation is clearly audible on inspiration. It doesn't go away after coughing.

Noises arising from friction of the pleura

The pleura in its normal state is a flat surface. If breathing is not complicated by any pathologies, the layers of the pleura slide easily and silently over each other.

In the presence of inflammation, a different picture arises. Irregularities form on the surface of the pleura. When auscultating the lungs, the doctor will hear a cracking sound that occurs due to the friction of these irregularities against each other.

Very often, bronchial asthma develops with toxic damage pleura. It becomes dry and leaf nodules form on the surface.

The noise they produce is easily audible both during inhalation and exhalation. With this type of pathology, the patient may experience pain.

There are several main differences between pleural friction and wheezing:

The more the statoscope is pressed against the patient’s body, the more clearly the crackling sound is heard.
If the patient coughs frequently, wheezing changes its strength and tone. In the case of friction, the sound remains unchanged.

For clear differentiation, doctors use a special technique: first they ask the patient to take a deep breath and hold the air, and then strongly protrude the stomach, simulating abdominal breathing. In this case, friction between the petals of the pleura occurs.

Difference between asthma and other pathologies by auscultation pattern

Thanks to auscultation, the doctor can distinguish bronchial asthma from other diseases associated with inflammation of the airways.

Bronchial asthma is characterized by uniform wheezing localized over the entire surface. And, for example, with tuberculosis, their localization is point-specific.

During the period of pneumonia, high-pitched noises are clearly audible. During bronchial breathing (which indicates the presence of voids in the lung), a noise of low timbre and low volume is possible.

In acute emphysema, a decrease in noise is noted. Moist wheezing, weakened breathing.

Bronchitis is characterized by vesicular breathing with dry wheezing and crepitus.

With pleurisy, the main distinguishing feature is the noise that occurs when the pleura rubs. If the disease is exudative in nature, vesicular breathing may be present.

Despite the fact that with the help of auscultation it is possible to determine the pathology affecting the respiratory tract, the final diagnosis is made only after other, more informative modern studies.

Finally

Auscultation for bronchial asthma is of great diagnostic importance. Any other study (x-ray, bronchography, etc.) is prescribed only after listening to the patient.

Characteristic wheezing and breathing patterns allow the doctor to make a preliminary diagnosis and begin timely treatment.

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Bronchial asthma- an allergic disease caused by reversible obstruction of the bronchial tree due to spasm of the smooth muscles of the bronchi, swelling of the mucous membrane of the bronchial tree and the accumulation of viscous secretions in the lumen of the bronchi. The attack of suffocation develops acutely. Pulmonary ventilation is impaired. The respiratory muscles of the upper shoulder girdle, chest, abdominals. The exhalation is prolonged, the shortness of breath is expiratory in nature.

Bronchial asthma: symptoms of the disease

In some patients with bronchial asthma, warning signs appear before an attack of suffocation - headache, vasomotor rhinitis, a feeling of tightness in the chest, itching, etc. More often, an attack of bronchial asthma is preceded by a dry, painful cough. At the beginning of the attack, the patient notices that difficulty in breathing begins to accompany the cough, and exhalation is made with difficulty. Gradually a feeling of suffocation arises. Breathing becomes hoarse and noisy. At a distance from the patient, you can hear wheezing in the chest (distance wheezing).

A patient with bronchial asthma fixes the upper shoulder girdle, taking characteristic poses and thereby facilitating the work of the respiratory muscles. The jugular and subclavian fossae are sunken. It gives the impression of a short and deep-set neck. The respiratory rate may not change, although sometimes there is both brady- and tachypnea. Profuse sweating sometimes makes it necessary to differentiate the condition with a carcinoid symptom. The attack ends with the resumption of coughing and the discharge of sputum, first viscous, then more liquid. Sometimes sputum is coughed up in the form of a cast of the bronchus. When examining a patient during an attack, signs of emphysema can be identified - a swollen chest, a boxy sound during percussion, the borders of the lungs are lowered, the excursion of the lungs is reduced. On auscultation, breathing is weakened vesicular, dry whistling and buzzing wheezing is detected mainly in the expiratory phase. An attack of bronchial asthma in some cases transforms into status asthmaticus - as an extreme degree of exacerbation of bronchial asthma. Status asthmaticus is characterized, on the one hand, by an attack of suffocation increasing in intensity, and on the other, by a decrease in the effectiveness of bronchodilators. An ineffective and unproductive cough appears. There are three stages of status asthmaticus. Stage I is a prolonged attack of bronchial asthma. Distinctive feature it is that the bronchodilator response to administered and inhaled sympathomimetics and xanthine group drugs is progressively reduced. When auscultating the lungs, scattered dry wheezing is heard, the intensity of which increases with exhalation and during coughing. At stage II, both wheezing and breathing sounds begin to disappear in the lungs, which occurs due to blockage by thick and viscous secretion lumen of the bronchial tree. During auscultation, a mosaic picture may be observed - some areas are better ventilated, others - worse, as a result of which breathing is carried out at different areas differently. This stage quickly develops into stage III - hypoxic and hypercapnic coma. The patient is inadequate, consciousness is confused, signs of hypoxic coma gradually increase, followed by cessation of breathing and cardiac activity.

Bronchial asthma: diagnosis

The diagnosis of bronchial asthma is based on anamnestic data: a family history, a history of allergic diseases (vasomotor rhinitis, dermatitis, urticaria, Quincke's edema), previous lung diseases ( chronic bronchitis, frequent pneumonia etc.) and characteristic clinical course attacks of bronchial asthma.

An attack of bronchial asthma must be differentiated from an attack of cardiac asthma. It is important to indicate a history of diseases of the cardiovascular system (hypertension, coronary heart disease, myocardial infarction in the past, the presence of heart defects) and kidney disease. The nature of the attack itself is great importance in the differential diagnosis. Often an attack of cardiac asthma occurs as a result of either acute disorder conditions in the cardiovascular system - hypertensive crisis, myocardial infarction. Dyspnea in cardiac asthma is of a mixed nature. Patients with an attack of cardiac asthma take sitting position, in a horizontal position, shortness of breath increases sharply and always occurs as tachypnea. Examination of the lungs showed no signs of pulmonary emphysema. More often, moist rales are heard, first in the lower parts, and then over the entire surface of the lungs. In cardiac asthma, dry wheezing may also be heard due to swelling of the bronchial mucosa and intersitial tissue, but they will be medium- and low-tonal in nature. When the patient turns from side to side, wheezing in cardiac asthma will shift to the underlying areas of the lungs. When auscultating the heart, the melody of the defect and arrhythmia can be heard. Cases of mixed asthma cause diagnostic difficulties when bronchial asthma develops in an elderly person or against the background of cardiovascular pathology. In a number of chronic lung diseases (diffuse pneumosclerosis, pulmonary emphysema, bronchiectasis, pneumoconiosis, especially silicosis, lung cancer) there is an increasing increase in shortness of breath, which is expiratory in nature, disturbing patients at rest; breathing in such patients is accompanied by wheezing. In advanced processes complicated by diffuse pneumosclerosis, shortness of breath becomes asthmatic in nature, accompanied by a painful cough with difficult to separate sputum. Differentiating asthmatic attacks, one should take into account medical history, the effectiveness of previous therapy, and the effect of sputum discharge on the severity of suffocation. In cardiac asthma, the discharge of sputum does not bring relief to the patient and has the most positive influence for bronchial asthma.

Bronchial asthma: emergency care

consists of providing the patient with the most comfortable conditions, creating a comfortable environment around him, and providing warm drinks. In mild cases, it is possible to use drugs that the patient usually previously used to relieve attacks of bronchial asthma. In cases of a mild attack of bronchial asthma, tableted anti-asthmatic drugs can be used. Humidified oxygen and vibration massage are prescribed.

In stage II of status asthmaticus, administration is continued hormonal drugs intravenously, as well as in tablets, increasing the dose by 1.5-2 times. The patient Stage III status asthmaticus - hypoxic coma - should be transferred to artificial ventilation lungs in conditions intensive care unit or departments intensive care. They continue to administer hormonal drugs, bronchodilators, and fight respiratory failure, acid-base balance disorders. The criteria for improving the patient's condition are the weakening of the feeling of suffocation, the beginning of sputum discharge, the patient becomes calmer. The number of dry wheezes in the lungs decreases, and in the “silent” lung stage, on the contrary, their appearance indicates an improvement in the patient’s condition.

Bronchial asthma: hospitalization

If there is no effect from treatment carried out in outpatient setting, urgent hospitalization is required. Transportation is preferable in a sitting position.

The purpose of the study is to determine the height of the apexes of the lungs in front and behind, the width of the Kroenig fields, the lower borders of the lungs and the mobility of the lower edge of the lungs. Rules for topographic percussion:

percussion is carried out from the organ giving loud noise, to the organ that produces a dull sound, that is, from clear to dull;

the pessimeter finger is located parallel to the defined boundary;

the border of the organ is marked along the side of the pessimeter finger facing the organ that produces a clear pulmonary sound.

Determination of the upper borders of the lungs is made by percussion of the pulmonary apexes in front above the collarbone or behind the spine of the scapula. In front, a finger-pessimeter is placed above the collarbone and percussed upward and medially until the sound becomes dull (the fingertip should follow the posterior edge of the sternocleidomastoid muscle). From the back, percussion is performed from the middle of the supraspinatus fossa towards the VII cervical vertebra. Normally, the height of the apex of the lungs is determined in front 3-4 cm above the collarbone, and in the back it is at the level of the spinous process of the VII cervical vertebra. The patient is in a standing or sitting position, and the doctor is standing. Percussion is performed with a weak blow (quiet percussion). Topographic percussion begins with determining the height of the apexes and the width of the Krenig fields.

Diagnosis of bronchial asthma: basic methods

Bronchial asthma - chronic illness respiratory system, associated with increased reactivity of the bronchi to certain factors external environment. Diagnosis of bronchial asthma is an important task in the daily practice of a general practitioner, since correct treatment can provide disease control and complete absence symptoms of suffocation in patients.

Physical examination

First of all, the doctor must interview the patient, collect anamnesis, and also use methods of auscultation and percussion of organs chest cavity make a preliminary diagnosis.

History taking

As a rule, the disease begins in young or childhood, you can trace the genetic prerequisites for the development of the disease. Others are observed in blood relatives allergic diseases or bronchial asthma.
The attack can be associated with the influence of a specific provoking factor (or factors), it develops acutely, shortness of breath with difficulty exhaling, and a feeling of congestion in the chest occur. Such a factor (trigger) can be physical effort, cold air, plant pollen, animal fur and skin, bird feathers, house dust, mold, certain foods and much more.
Patients take a forced position. which facilitates the participation of auxiliary muscles in the breathing process. Whistling, labored breathing can be heard from a distance. An attack can last from several minutes to several hours; after inhaling a bronchodilator, normal breathing is very quickly restored. The attack ends with the discharge of a large amount of light, glassy sputum, which brings relief to the patient.

Patient examination

On initial stages disease, examination of the patient does not provide any special findings in terms of confirming the diagnosis of bronchial asthma. However, with a long course of the disease and frequent attacks a symptom such as “barrel chest” develops. Indeed, due to difficulty in exhaling, emphysema of the lungs gradually develops, their volume increases, and the chest expands.

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Treatment for bronchial asthma should be selected individually, taking into account the course of the disease,

Bronchial asthma

Bronchial asthma is a chronic disease that occurs with relapses, with predominant damage to the respiratory tract, which is based on chronic allergic inflammation bronchi, accompanied by their hyperreactivity and periodic attacks of difficulty breathing and suffocation as a result of widespread bronchial obstruction, which is caused by bronchospasm, hypersecretion of mucus, and swelling of the bronchial wall.

There are two forms of bronchial asthma - immunological and non-immunological - and a number of clinical and pathogenetic variants: infectious-allergic, atopic, autoimmune, adrenergic imbalance, dyshormonal, neuropsychic, primary altered bronchial reactivity, cholinergic.

Etiology and risk factors for bronchial asthma in children: atopy, bronchial hyperreactivity, heredity. Causes (sensitizing): household allergens (house dust, house dust mites), epidermal allergens of animals, birds, and other insects, fungal allergens, pollen allergens, food allergens, medicines, viruses and vaccines, chemicals.

The general pathogenetic mechanism is the altered sensitivity and reactivity of the bronchi, determined by the reaction of bronchial patency in response to the influence of physical, chemical, and pharmacological factors.

Topographic percussion of the chest

Using topographic percussion of the lungs, the following is determined:

a) lower borders of the lungs;
b) the upper borders of the lungs, or the height of the apexes of the lungs, as well as their width (Kroenig fields);
c) mobility of the lower edge of the lungs.

The volume of one or both lungs may increase or decrease in various diseases. This is detected by percussion by a change in the position of the pulmonary edges compared to normal. The position of the edges of the lungs is determined during normal breathing.

Rice. 30. Determination of the boundaries of the lungs:
a, b, c – lower front and back and its diagram;
d, e, f - upper front, back, and its measurement.

The lower boundaries of the lungs are set as follows. They recut, moving the finger-pessimeter along the intercostal spaces from top to bottom (starting from the 2nd intercostal space) until the clear pulmonary sound is replaced by an absolutely dull sound. In this case, as noted, weak percussion is used. It is carried out along all identifying vertical lines on both sides, starting from the parasternal and ending with the paravertebral (Fig. 30, a, b). It is quite difficult to determine the lower edge of the lung along the left midclavicular and sometimes along the anterior axillary lines, since here it borders on the air-containing stomach. Having determined the position of the lower edge of the lung along all lines and marking this place with dots at the level of each of them, the latter are connected by a solid line, which will be the projection of the lower edge of the lung onto the chest (Fig. 30, c). The lower edge of the lung healthy person when percussed in a vertical position, it runs along the parasternal line on the right - along the upper edge of the VI rib, on the left - along the lower edge of the IV (here is located upper limit absolute dullness of the heart), as well as along the right and left midclavicular lines - along the lower edge of the VI rib, along the anterior axillary - on the VII rib, middle axillary - on the VIII, posterior axillary - on the IX, scapular - on the X rib and along the paravertebral lines at the level of the spinous process of the XI thoracic vertebra.

Textbook of medicine / Propaedeutics of internal diseases / Bronchial asthma

Expiratory shortness of breath, characterized by sharply difficult exhalation, while the inhalation is short and the exhalation is prolonged; attacks of suffocation that occur at any time of the day, especially in frosty weather, in strong winds, during the flowering period of certain flowers, etc. paroxysmal cough with the discharge of a scanty amount of viscous glassy sputum. Attacks of suffocation last from several hours to 2 or more days (status asthmaticus).

Anamnesis in a patient with an infectious-allergic form of bronchial asthma: instructions for past illnesses upper respiratory tract (rhinitis, sinusitis, laryngitis, etc.), bronchitis and pneumonia, the occurrence of the first attacks of suffocation after them. The frequency of occurrence of asthma attacks in subsequent years is determined, their connection with cold and damp weather, acute illnesses suffered respiratory diseases(flu, bronchitis, pneumonia). The duration of the attack and inter-attack periods of the disease, the effectiveness of treatment in outpatient and inpatient conditions, usage medications, corticosteroid drugs. Complications include the formation of pneumosclerosis, pulmonary emphysema, and the addition of respiratory and pulmonary-heart failure.

Patient's history atopic form bronchial asthma: exacerbations of the disease are seasonal, accompanied by rhinitis, conjunctivitis; patients have urticaria and angioedema, intolerance to some food products(eggs, chocolate, oranges, etc.), medicines, odorous substances, there is a hereditary predisposition to allergic diseases.

What is auscultation

This is one of the methods of diagnostic examination of a patient. With its help, the doctor listens to the patient, determining a possible disease by the nature of the noise coming from inside the body. There are two ways to do this research:

direct auscultation, in which the doctor listens to the person who comes to the appointment by putting his ear to his body (that is, directly);
indirect, in which the doctor uses a special device - a stethoscope.

Modern doctors do not use the first method, since the second is more informative and accurate, due to the special sensitivity of the instrument used. By auscultating the chest, the specialist analyzes the noises that appear during inhalation and those that occur during exhalation. Comparing both results, he draws appropriate conclusions and enters them into the patient’s outpatient record.

To determine the auscultated points and conduct the study itself, the doctor may ask the patient to sit down or stand up. If the patient is too weak, then you can listen to him in a lying position. The anterior part of the chest is heard, then the lateral and posterior parts. To obtain a more accurate result, the patient's breathing should be deep.

After carefully listening to the patient’s lungs, the doctor evaluates the results of auscultation:

whether the noise is the same at two points located symmetrically;
what is the type of noise at all listened points;
Is there any collateral noise that is not characteristic of the patient’s condition?

Auscultation is important for diagnosing bronchial asthma. But modern doctors have more modern devices in their arsenal to obtain accurate results. Therefore, to make a diagnosis after this study, a number of others are carried out: radiography, tomography, bronchography and others. There are 3 types of noises heard in the respiratory organs: main (respiratory), secondary and those that arise from friction of the pleura.

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Breathing sounds

In medicine, there are two types of breathing - bronchial and vesicular. To hear the former, the doctor listens to the following areas:

above the location of the larynx;
above the trachea;
in the front of the chest (above the bronchi);
behind in the area of the 7th vertebra cervical region spinal column.

This type of breathing has a rough sound. It is heard during both respiratory phases - exhalation and inhalation. When exhaling, it is longer and rougher than when inhaling. It is formed in the area of the vocal cords in the larynx. This breathing sounds like the sound “x” if you pronounce it with your mouth open.

If the doctor listens to the rest of the chest, the noise is not at all heard. This is another type of breathing - vesicular. It is born in the alveoli of the lungs. The air flow entering them affects their walls - they straighten out. This happens as you inhale. And as you exhale they fall off. Very similar to the sound "f". It differs from bronchial breathing greater strength and duration during inhalation.

This breathing is changeable. Physiological reasons or various pathologies are guilty of this. It intensifies when physical activity in people whose constitution has a thin chest. Bronchitis and various diseases, causing a narrowing of the bronchial lumen, make vesicular breathing too rough, rather uneven and excessively harsh. With pneumonia associated with croup, it is loud, felt directly under the ear, and has a high pitch. In diseases such as bronchopneumonia, the foci of inflammation are so widespread that they merge. Bronchial breathing occurs. But unlike lobar inflammation, it is quieter and lower in timbre.

Another reason that a patient experiences bronchial breathing is the formation of voids (cavities) in the lungs. The sound of such breathing is not too loud, reminiscent of emptiness, and has a low timbre. Breathing can be mixed, that is, one in which both types of respiratory sounds are observed. This condition is observed in patients with tuberculosis or bronchopneumonia.

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Side type of noise

Among such noises, two types are distinguished: wheezing (dry and wet, depending on the secretion present) and crepitus. Wheezing can be dry or wet depending on the secretion. The cause of dry wheezing is that the bronchial lumen narrows. This is observed in patients with bronchial asthma, swelling in the bronchi, and various types of inflammation in them.

There are high and low wheezes. High ones occur in smaller bronchi, and low ones in medium and large ones. Depending on how hard a person breathes, wheezing is barely audible or audible at a considerable distance. For example, in asthma, the intensity of wheezing is so great that it can be heard at a distance from the patient.

Sometimes wheezing is localized to a small area of the lungs, as with tuberculosis. Or they can disperse over its entire area, as in bronchial asthma. Dry wheezing is variable. Over a short period of time, they appear and then disappear. You can listen to them in both stages respiratory process- both on inhalation and exhalation. If there is fluid (exudate or blood) in the lungs, then wet wheezing occurs. The air flow passing through the liquid creates a gurgling wheeze. Moist rales form in the cavities of the lungs. They are heard during both phases of breathing, but doctors prefer to do this during inspiration.

There is another type of noise that differs in character from dry and moist wheezing.

This is crepitation. It is born in the alveoli when there is exudate in them. This is a very important sign for diagnosis. Crepitation is clearly audible when the patient inhales. Wheezing can disappear with coughing, and crepitus is unchanged. It appears like an explosion, at one moment, and wheezing is a longer-lasting phenomenon. Crepitation is typical for patients with lobar pneumonia. Sometimes it is observed without lung diseases. For example, in older people or in patients who are bedridden.