GINA strategy in the diagnosis, treatment and prevention of bronchial asthma. Bronchial asthma (2016). Russian Respiratory Society Federal Clinical Guidelines for the Diagnosis and Treatment of Bronchial Causes of the Development of Bronchial Asthma and


Bronchial asthma is a chronic respiratory disease. Inflammation is the root of the disease. resulting in hyperreactivity of the respiratory system.

The manifestations of bronchial asthma include a feeling of tightness in the chest both at night and in the morning.

There are special documents of scientific societies, which in a general and concise form contain recommendations for the detection and treatment of diseases. Such indicative materials are compiled to help practitioners who treat various diseases, including bronchial asthma.

Organization that solves the problem of bronchial asthma at the international level - this is GINA. The disease is incurable and occurs worldwide in people of all ages.

The organization has developed general rules for treatment and which are followed by physicians around the world. In 2016, an international structure presented a new report suggesting a way to get rid of the disease based on current best practice using clinical guidelines. The GINA plan is designed to be implemented in virtually any healthcare system

Latest GINA Updates

In 2016, the following were included in the GINA document:

  • hacking cough;
  • feeling of tightness in the chest;
  • wheezing;
  • sweating;
  • feeling of anxiety, panic;
  • dyspnea.

Also in 2016, the organization was created. The disease is divided into several phenotypes that differ according to the degree of manifestation and age of the patient. There are the following types:

  1. Allergic. This phenotype is the most common. Compared to other types, it is the easiest to both identify and treat. For treatment, ICS - corticosteroid inhalation drugs are used.
  2. Non-allergic. ICS drugs are not able to cure this type of asthma.
  3. Asthma with belated onset. It is found mainly in mature women.
  4. Bronchial asthma in obese patients.
  5. A phenotype that is characterized by a syndrome of obstruction of the respiratory tract. It occurs as a result of frequent and long-term treatment of bronchial asthma.

Treatment

The main treatment for asthma is. There are five degrees of severity of the disease, for each of which a special treatment is indicated. In this case, the severity of the disease is determined by the degree of therapy used.

Attention! The effectiveness of therapy should be evaluated every six months. If asthma symptoms persist and the risk of exacerbation increases, then it is recommended to increase therapy by moving on to the next step.

If the threat decreases, and the patient's well-being improves within 3 months, then the volume of therapy should be reduced. In this case, the number of ICS is reduced from 25% to 50% every 3 months. However, for such a step it is necessary to make sure that the patient has no respiratory dysfunctions and be sure that there is no danger to health. It is not recommended to completely exclude ICS in order to avoid the threat of exacerbations.

In accordance with the stepwise approach, GINA has developed a treatment for each step:

  1. At the first stage, beta-2 antagonists are used. These drugs are short-acting and are indicated for patients with mild disease. Asthma symptoms in such people appear less than twice a month and subside with appropriate treatment, but research on the safety of such treatment is still underway.
  2. At the second stage are patients with high risk of exacerbations. They are advised to take reduced doses of ICS (inhaled glucocorticosteroids) and SABAs (short-acting beta2-agonists), if necessary, supplementing them with drugs that relieve asthmatic symptoms.
  3. The third stage therapy involves taking low doses of ICS combined with LABA (long-acting beta2-agonists) and SABA. However, during exacerbation, this strategy is not effective.
  4. On the fourth step it is recommended to combine medium and high doses of ICS, LABA and SABA focusing on the needs of the patient.
  5. The fifth step requires the use of the anti-IgE drug Omalizumab. Such treatment is indicated for patients who have not been helped by therapy with maximum doses of inhaled drugs.

Thus, the main method of treatment is the use of ICS, in some cases in combination with LABA. Such therapy helps to quickly reduce inflammation.

Important! Currently, there are no drugs to completely get rid of bronchial asthma. However, there are medications that relieve symptoms and destroy the allergen.

There is also a scheme for the course of treatment in several stages. This scheme includes the following recommendations:

  • it is necessary to teach the patient basic self-help skills to apply them during the onset of symptoms of the disease;
  • required treatment of comorbidities and getting rid of bad habits;
  • attention should also be paid to non-drug therapy, for example, physical activity.

Bronchial asthma is the most common. At the same time, it is difficult to diagnose - asthma has symptoms similar to a cold.

Helps distinguish asthma from a cold temperature measurement- with asthma, its increase is not observed. Symptoms are preceded by:

  • discharge of watery mucus from the nose on waking in the morning, accompanied by sneezing;
  • severe dry cough a few hours after waking up;
  • the appearance of a wet and stronger cough during the day;
  • the manifestation of asthma symptoms after a day or several days, by this time the cough becomes paroxysmal.

The symptoms themselves include:

  • paroxysmal cough after sleep;
  • dyspnea;
  • intermittent breathing;
  • pressure in the chest;
  • difficult breathing;
  • dry cough when inhaling through the mouth;

Designed to prevent the development of allergies. For prevention, it is desirable to give preference to breastfeeding and isolate the child from exposure to tobacco smoke.

The Russian medical community has its own strategies for the treatment of bronchial asthma. The document in which main approaches to the diagnosis and treatment of pathology, are the "Federal Clinical Guidelines for the Diagnosis and Treatment of Bronchial Asthma". Basically, these recommendations coincide with the points of the GINA strategy.

Thus, the domestic document also notes a stepwise approach to the treatment of the disease. Determination of the scope of therapy depends on the severity of clinical manifestations of asthma. Attention is drawn to checking the correct inhalation technique, clarifying the diagnosis and eliminating concomitant diseases. All these conditions are necessary to advance to the next stage of treatment. It is also necessary to control environmental factors that have a significant impact on the effectiveness of therapy.

About diagnostics

Diagnosis of pathology in adults is based on the identification of relevant symptoms. Symptoms and degree of airway obstruction requires an accurate assessment. Thus, a complete and accurate clinical picture of the disease is obtained.

Those that increase the risk of asthma include:

  • choking, chest congestion and morning cough, wheezing;
  • symptoms during physical exertion, under the influence of allergens, low temperature;
  • the appearance of signs of illness after taking aspirin;
  • atopic diseases present in history;
  • hereditary factor.

There are also signs that reduce the risk of having the disease:

  • dizziness and darkening in the eyes;
  • regular normal chest examination results;
  • productive cough that is chronic;
  • voice change;
  • manifestation of symptoms as a result of a cold;
  • heart diseases.

Bronchial asthma is a chronic disease of a long-term nature, in the manifestation of which a hereditary factor and exposure to allergens play a significant role. The main goal of therapy is to control the disease. The correct drug treatment can only be prescribed by a specialist after a thorough diagnosis. However, in addition to drug treatment, it is important to pay attention to proper nutrition, moderate physical activity and environmental conditions.

Russian Respiratory Society
Federal Clinical Guidelines
for the diagnosis and treatment of bronchial
asthma
2016

2
Team of authors
Chuchalin Alexander Grigorievich
Director of the Research Institute of Pulmonology FMBA,
Chairman of the Board of the Russian
respiratory society, chief
freelance therapist
pulmonologist of the Ministry of Health of the Russian Federation, academician
RAS, professor, MD
Aisanov Zaurbek Ramazanovich
Head of the clinical department
physiology and clinical research
Research Institute of Pulmonology FMBA, Professor,
MD
Belevsky Andrey Stanislavovich
Professor of the Department of Pulmonology, FuV
Russian National Research Medical University named after N.I. Pirogov, Chief
freelance pulmonologist
Moscow Health Department,
professor, d.m.s.
Bushmanov Andrey Yurievich
Doctor of Medical Sciences, Professor, Chief Freelance
specialist
occupational pathologist
Ministry of Health
Russia, Head of the Department of Hygiene and
occupational pathology
Institute
postgraduate
professional
education FGBU SSC FMBC them. A.I.
Burnazyan FMBA of Russia
Vasilyeva Olga Sergeevna
MD,
manager
laboratory
environmentally conscious and professional
pulmonary diseases Federal State Budgetary Institution "Scientific
research
institute
pulmonology" FMBA of Russia
Volkov Igor Konstantinovich
Professor of the Department of Children's Diseases


Geppe Natalia Anatolievna
Head Department of Children's Diseases
Faculty of Medicine, 1st Moscow State Medical University.
I.M. Sechenova, professor, d.m.s.
Princely Nadezhda Pavlovna
Associate Professor of the Department of Pulmonology, FuV
RNIMU them. N.I. Pirogova, Associate Professor, Ph.D.

3
Kondyurina Elena Gennadievna
Head Department of Pediatrics, Faculty
advanced training and
professional retraining
doctors of NSMU, professor, d.m.s.
Kolosova Natalya Georgievna
Associate Professor of the Department of Children's Diseases of therapeutic
faculty 1 MSMU im. I.M. Sechenov
Mazitova Nailya Nailevna
Doctor of Medical Sciences, Professor of the Department of Medicine
labor,
hygiene
and
occupational pathology
Institute
postgraduate
vocational education FGBU
GNTs FMBTs im. A.I. Burnazyan FMBA
Russia
Malakhov Alexander Borisovich
Professor
children's cafe
diseases
Faculty of Medicine, 1st Moscow State Medical University.
I.M. Sechenov
Meshcheryakova Natalia Nikolaevna
Leading Researcher
rehabilitation laboratories research institutes
pulmonology FMBA, Ph.D.
Nenasheva Natalia Mikhailovna
Professor of the Department of Clinical
Allergology RMAPO, Professor, MD
Revyakina Vera Afanasievna
Head of the Department of Allergology
Research Institute of Nutrition of the Russian Academy of Medical Sciences, professor, MD
Shubin Igor Vladimirovich
Head of the clinical laboratory
Vaccinology Research Institute of Pulmonology
FMBA RF, Ph.D.
Fassahov Rustem Salakhovich
Professor FGAOU VO "Kazan
(
Volga) federal
university",
MD

4
The main changes made to the Federal clinical guidelines for the diagnosis and
treatment of bronchial asthma in 2016:
Chapter
Content of change
1. Team of authors:
Kondyurina Elena Gennadievna - head. Department of Pediatrics, Faculty of Advanced Training and Professional Retraining of Doctors, NSMU, Professor, MD
Kolosova Natalya Georgievna - Associate Professor of the Department of Children's Diseases, Faculty of Medicine, 1st Moscow State Medical University.
I.M. Sechenov
Malakhov Alexander Borisovich - Professor of the Department of Children's Diseases, Faculty of Medicine, 1st Moscow State Medical University. I.M. Sechenov
2. Diagnosis of asthma in children
In the section "Children 2-5 years old" added: "The most common triggers are respiratory viruses, as well as allergens (house dust mites, epidermal allergens, allergenic plant pollen, food)".
Added Table 4: "Characteristics to Suspect Asthma in Children 5 Years of Age and Under."
In the section "Additional diagnostic methods" added: "The reversibility of bronchial obstruction is assessed in the test with a bronchodilator
(200mcg salbutamol) in terms of FEV1 increase over
12%".
Added an algorithm for diagnosing bronchial asthma in children.
Added paragraph "Key indications for referring a child aged 5 years and under for further diagnostic testing"

5 3. Diagnosis of asthma in adults
Clinical signs that increase the likelihood of having asthma.
Clinical signs that reduce the likelihood of having asthma.
Added: "If treatment fails, reassess inhaler compliance and technique, rule out comorbidities that may aggravate symptoms
BA"
4. Treatment of stable asthma
The paragraph "Formulation of the diagnosis" has been added.
5. Stepwise therapy of bronchial asthma in children, adolescents and adults
In the Step 1 section, added: “In children under 5 years of age, regular therapy may be started at low doses.
IGCS, since 2 years - monotherapy with antigonists of leukotriene receptors, cromones.
Preference in the delivery of ICS is given to nebulizer therapy in children (from 6 months - budesonide suspension, from 6 years - also beclomethasone dipropionate), from 1 year - fluticasone propionate with a spacer.
In the "Step 3" section, the following has been corrected:
“Preferred choice (children over 5 years): low/medium dose ICS or in combination with
LABA or leukotriene receptor antagonists.
Added in Step 4: “For patients with severe allergic asthma uncontrolled by high-dose ICS in combination with LABA, starting at age 6, consider omalizumab.”
6. Exacerbations of bronchial asthma in adults
In the section "Causes of exacerbations of BA" added:
“respiratory tract infections (mainly viruses, most often rhinoviruses)”, “taking certain medications (beta-blockers, in patients with “aspirin asthma” - NSAIDs)”.
Added Table "The severity of exacerbations
BA".
In the subsection "Systemic steroids" added:
"unless the patient received systemic corticosteroids on an ongoing basis until the exacerbation."
In the section "Management of patients with exacerbation of asthma on

6 hospital stage", subsection "Inhalation
GCS” added: “If the patient received ICS before the exacerbation, ICS should be continued at an increased dose. Cancel assigned system
GCS is carried out ONLY against the background of the appointment of IGCS.
Table of contents
1. Methodology ............................................... ................................................. ................................... 7
2. Definition, principles of diagnosis in adults and children. ................................................. ...... 7
2.1. Diagnosis of asthma in children .............................................. ................................................. ............. ten
2.2. Diagnosis of AD in adults .............................................................. ................................................. ... 164
2.3. Differential diagnosis of AD in adults .............................................................. ............................... 175
2.4. Spirometry and reversibility tests .............................................................. .......................................... fifteen
3. Determining the severity of bronchial asthma .............................................. ...................... twenty
4. Treatment of stable asthma .............................................. ................................................. .......... 21
4.1. The concept of control over bronchial asthma .............................................. ...................................... 21
4.2. Stepwise therapy of bronchial asthma in children, adolescents and adults.................................................. 23
4.3. Inhalation devices .................................................................. ................................................. .... 29
5. Treatment of exacerbations of asthma .............................................. ................................................. ................ thirty
5.1. Treatment of asthma exacerbations in children and adolescents .............................................. .............................. thirty
5.2. .Treatment of asthma exacerbations in adults .............................................. ............................................. 32
6. Asthma in pregnancy .............................................. ................................................. ....................... 40
7. Difficult-to-control asthma .............................................. ................................................. .......... 41
8. Separate options ............................................... ................................................. ................... 43
9. Professional
asthma………………………………………………………………………………………………………………………………… …………………………….44
10. Prevention and rehabilitation of patients with asthma……………………………………………………………… .48
11. Education and training of patients with asthma…………………………………………………………………………………… 52
Application…………………………………..………………………………………………………………………………………… ………53

7
1. Methodology
Methods used to collect/select evidence:
search in electronic databases.
Description of the methods used to collect/select evidence:
the evidence base for recommendations are publications included in the Cochrane
library, EMBASE and MEDLINE databases. The search depth was 5 years.
Methods used to assess the quality and strength of evidence:

Expert consensus;

Significance assessment in accordance with the rating scheme (the scheme is attached).
Rating scheme for assessing the strength of recommendations (Table 1):
Levels
evidence
Description
1++
Meta-analyses
high
quality,
systematic
reviews
randomized controlled trials (RCTs) or RCTs with
very low risk of bias
1+
Well-conducted meta-analyses, systematic, or RCTs with
low risk of bias
1-
Meta-analyses, systematic, or high-risk RCTs
systematic errors
2++
High quality systematic reviews of case studies
control or cohort studies. High Quality Reviews
case-control or cohort studies with very
low risk of confounding effects or biases and
average probability of a causal relationship
2+
Well-conducted case-control or cohort studies
studies with an average risk of confounding effects or
systematic errors and the average probability of causal
interconnections
2-
Case-control or cohort studies with
high risk of confounding effects or biases
and the average probability of a causal relationship
3
Non-analytical studies (for example: descriptions of cases, series

8
cases)
4
Expert opinion
Methods used to analyze the evidence:

Reviews of published meta-analyses;

Systematic reviews with tables of evidence.
Description of the methods used to analyze the evidence:
When selecting publications as potential sources of evidence, the
in each study, the methodology is examined to ensure its validity.
The result of the study affects the level of evidence assigned to the publication, which, in turn,
turn, affects the strength of the recommendations that follow from it.
The evaluation process, of course, can be affected by the subjective factor. For
minimizing potential errors, each study was evaluated independently, i.e. on
at least two independent members of the working group. Any differences in scores
already discussed by the entire group. When consensus cannot be reached
an independent expert was involved.
Evidence tables:
Evidence tables were filled in by members of the working group.
Methods used to formulate recommendations:
Expert consensus.
Rating scheme for assessing the strength of recommendations (Table 2):
Strength
Description
BUT
At least one meta-analysis, systematic review, or RCT
rated as 1++ directly applicable to the target population and
demonstrating sustainability of results
or
body of evidence, including the results of studies evaluated
as 1+, directly applicable to the target population and demonstrating

AT

as 2++ directly applicable to the target population and demonstrating
overall sustainability of results
or
extrapolated evidence from studies rated 1++
or 1+
FROM
Evidence group including study results assessed
as 2+, directly applicable to the target population and demonstrating
overall sustainability of results;
or
extrapolated evidence from studies rated 2++
D
Level 3 or 4 evidence;

9
or
extrapolated evidence from studies rated 2+
Good Practice Points (GPPs):
The recommended benign practice is based on the clinical experience of members
working group to develop recommendations.
Economic analysis:
No cost analysis has been performed and publications on pharmacoeconomics are not available.
analyzed.
Recommendation validation method:

External peer review;

Internal peer review.
Description of the recommendation validation method:
These draft guidelines have been peer-reviewed
independent experts who were asked to comment primarily on the
the extent to which interpretation of the evidence underlying the recommendations is available to
understanding.
Comments received from primary care physicians and district physicians in
regarding the intelligibility of the presentation of recommendations and their assessment of the importance of recommendations as
working tool of daily practice.
A draft version was also sent to a reviewer who did not have
medical education, for comments from a perspective
patients.

GINA is an international structure designed to solve the problem of combating bronchial asthma on a global scale. Asthma is a heterogeneous disease with the localization of the inflammatory process in the respiratory tract, which is of a chronic nature. It is a global problem - people of all ages and social groups are affected by it. The disease requires constant monitoring due to its incurability.

What is the gina asthma program?

In 1993, a task force was established to study the worldwide problem of the development of bronchial asthma under the leadership of the World Health Organization and the US Heart, Lung and Blood Institute. The team's activities led to a report on the possibilities of treatment as well as prevention of bronchial asthma.

As a result, the GINA organization arose, which is a structure of interacting doctors, medical institutions and authorities. Later, this structure developed into an Assembly that brought together experts in this field from all over the world.

The purpose of the work of the association was to develop rules for the treatment of people suffering from asthma and to inform the population.

The organization is engaged in the implementation of the results of scientific research in the standards of treatment of asthma, their improvement. Until now, there is a low level of cure for bronchial asthma around the world. The organization makes every effort to ensure the availability of medicines, methods for implementing effective programs, and recording results. The latest GINA report is structured not just as a description, but as a strategy based on a strong new evidence base regarding the best way to apply clinical guidelines for asthma management.

Asthma definition according to GINA 2016

By 2012, information appeared that bronchial asthma is a heterogeneous disease. The association of gins brought out the exact definition of this disease: asthma is chronic, causes inflammation of the airways.

Early diagnosis and effective treatment of the disease is necessary, as it reduces the ability of a person to work, thereby indirectly affecting the economy. According to the GINA 2016 description, bronchial asthma is defined by such signs as:


These signs are manifested as a result of the reaction of the respiratory tract to irritants. There is their narrowing and active production of a large amount of mucus. These factors prevent the free passage of air into the lungs.

Inflamed bronchi become sensitive to allergens. Therefore, the disease has two varieties: allergic, accompanied by a runny nose and urticaria, as well as a non-allergic form of bronchial asthma.

The disease affects people of any age and social status. It occurs most often in children, who can, in most cases, get rid of it as they grow older. But the number of people suffering from bronchial asthma is steadily growing, crossing the border of three hundred million people.

Asthma classification according to GINA

According to the classification created by GINA 2016, bronchial asthma is divided into phenotypes. They differ depending on the clinical manifestations and age of the patient. There are five types of asthma:


Diagnosis of asthma at the initial stage, together with adequate therapy, can reduce the socio-economic damage caused by the disease, as well as significantly improve the lives of patients.

There are five levels of controllable signs and ways to reduce the risk of developing AD in the future:

It can be concluded that ICS, as well as their combination with LABA, becomes the basis for the treatment of bronchial asthma. This helps to relieve inflammation in a short time. The severity of the disease is measured only by the degree of treatment applied. Evaluation of the success of therapy should be carried out every three or six months. The intensity of treatment is reduced if a positive result is observed. In the absence of effect, treatment is applied at the next stage.

A scheme for conducting therapy in stages has been developed. According to this development, several recommendations must be followed:

  • it is necessary to teach the patient self-help during the active manifestation of symptoms of bronchial asthma;
  • be sure to treat comorbidities such as obesity and smoking;
  • attention should be paid to non-drug treatment: exclusion of sensitizers, weight loss, physical activity.

GINA (Global Initiative For Asthma) is an international organization whose goal is to combat asthma worldwide. AD is a chronic irreversible disease, under adverse conditions it progresses and endangers human life. The main task of the structure is to create conditions under which complete control over the disease will become possible. Bronchial asthma is diagnosed in people, regardless of age, gender, social status. Therefore, the problems that the GINA structure solves always remain relevant.

The history of the organization

Despite scientific achievements in the field of practical medicine, pharmaceuticals, the prevalence of bronchial asthma has increased every year. This trend was especially observed in children. The disease inevitably leads to disability. And expensive treatment does not always give positive results. Differences in the organization of health care in each individual country, limited medicines did not make it possible to bring the world statistics on the disease closer to real indicators. This made it difficult to determine the methods of productive treatment and quality control of the disease.

To solve this problem, in 1993. On the basis of the American Institute of Heart, Lung and Blood Pathology, with the support of WHO, a special working group was organized. Its goal is to develop a plan and strategy for the treatment of bronchial asthma, reduce the incidence of disability and early death, the ability of patients to remain able-bodied and vitally active.

A special program "Global Strategy for the Treatment and Prevention of Bronchial Asthma" has been developed. In 2001, GINA initiated World Asthma Day in order to draw public attention to an urgent problem.

In order to achieve control over bronchial asthma, Gina gives recommendations regarding the diagnosis, treatment, and prevention of the progression of the disease. The program involves international experts, specialists in the field of medicine, the world's largest pharmaceutical companies.

One of the objectives of the structure is to develop a strategy for early diagnosis and effective treatment with minimal financial costs. Since AD ​​therapy is an expensive measure, it is not always effective. Through new programs, the organization indirectly affects the economy of each geographic region.

Definition and interpretation of AD according to GINA 2016

According to the results of numerous studies, bronchial asthma was defined as a heterogeneous disease. This means that one symptom or sign of pathology is provoked by mutations in different genes or numerous changes in one.


Gina in 2016 gave the exact formulation of the disease: bronchial asthma is a chronic disease that causes inflammation of the respiratory mucosa, in which many cells and their elements are involved in the pathological process. The chronic course contributes to the development of bronchial hyperreactivity, which occurs with occasional exacerbations.

Clinical signs:

  • wheezing - they say that respiratory noises are formed in the bronchi with the smallest diameter of the lumen and bronchioles;
  • expiratory shortness of breath - exhalation is significantly difficult due to accumulated thick sputum, spasm and edema;
  • feeling of congestion in the chest;
  • cough at night and early in the morning, it is dry, persistent, heavy in character;
  • chest compression, suffocation - accompanied by panic attacks;
  • increased sweating.

Episodes of exacerbations are associated with the dynamics of severe obstruction of the bronchi and lungs. Under the influence of drugs, it is reversible, sometimes spontaneous, without objective reasons.

There is a close relationship between atopy (hereditary predisposition to the production of specific allergic antibodies) and the development of bronchial asthma. Also an important role is played by the predisposition of the bronchial tree to narrow the lumen in response to the action of a provoking agent, which normally should not cause any reactions.

With adequate therapy, bronchial asthma can be brought under control.. Therapy allows you to manage such symptoms:

  • violation of the duration and quality of sleep;
  • functional failures of the pulmonary system;
  • limitation of physical activity.

With the right selection of emergency drugs, the resumption of exacerbations is extremely rare, for random reasons.

Factors that determine the development and clinical manifestations of AD

According to GINA studies, bronchial asthma develops under the influence of provocative or conditioning factors.. Often these mechanisms are interrelated. They are internal and external.

Internal factors:

  • Genetic. In the development of bronchial asthma, heredity is involved. Scientists are looking for and studying genes in different classes of antibodies, studying how this can affect respiratory function.
  • The gender of the person. Among children under the age of 14, boys are at risk. The frequency of the disease is twice as high as among girls. In adulthood, the situation develops on the contrary, women get sick more often. This fact is related to the anatomical features. Boys have smaller lungs than girls, and women have larger lungs than men.
  • Obesity. Overweight people are more susceptible to AD. In this case, the disease is difficult to control. In overweight people, the process of lung pathology is complicated by concomitant diseases.

External factors:

  • Allergens. Agents suspected of causing AD include cat and dog dander, house dust mites, fungus, and cockroaches.
  • Infections. The disease in childhood can develop under the influence of viruses: RSV, parainfluenza. But at the same time, if a child encounters these pathogens in early childhood, he develops immunity and reduces the risk of asthma in the future.
  • professional sensitizers. These are allergens with which a person comes into contact at the workplace - substances of chemical, biological and animal origin. The professional factor is fixed in every 10 patients with asthma.
  • Effect of nicotine on smoking. The poisonous substance contributes to the progression of deterioration in the functioning of the lungs, makes them immune to inhalation treatment, and reduces control over the disease.
  • Polluted atmosphere and microclimate in a residential area. These conditions reduce the function of the respiratory system. A direct relationship with the development of asthma has not been established, but the fact that dusty air causes exacerbations has been confirmed.
  • Food. The risk group includes infants on artificial nutrition, as well as people who subject all products to thorough heat treatment before use, excluding the possibility of consuming a large amount of raw vegetables and fruits.

How is asthma classified?

Classification of bronchial asthma according to GINA 2015-2016 formed according to different criteria.

Etiology. Scientists are constantly trying to classify the disease according to etiological data. But this theory is ineffective, since in many cases it is not possible to accurately determine the true cause of bronchial asthma. Nevertheless, the collection of anamnesis plays an important role in the initial diagnosis of the disease.

Phenotype. Every year, information about the role of genetic changes in the body increases and is confirmed.. When assessing the patient's condition, a set of features that are characteristic of each individual patient and depend on the direct influence of the environment are taken into account. Using a multivariate statistical procedure, data are collected on possible phenotypes:

  • eosinophilic;
  • non-eosinophilic;
  • aspirin BA;
  • tendency to exacerbate.

Asthma control feasibility classification. This takes into account not only control over clinical manifestations, but also over possible risks in the future.

Characteristics by which the condition is assessed:

  • signs of pathology that occur during the day;
  • restrictions on physical activity;
  • the need for emergency medicines;
  • assessment of lung function.

Depending on the indicators, the disease is classified as follows:

  • controlled BA;
  • often controlled asthma;
  • uncontrolled AD.

According to GINA, all the data about the patient is collected first, and then the treatment that will give the best results is selected. The organization's strategy provides for the availability of therapy for patients.

@ 2022 wowway.ru - Diets and nutrition. Diagnostics and analyses. Medicines. Cholesterol. Atherosclerosis