Bronchial asthma in children: risk factors, symptoms and treatment

How does asthma develop

Asthma is defined by doctors as a disease characterized by episodes of bronchial obstruction (violation of the patency of the bronchi), fully or partially reversible. It is based on inflammation of the bronchial mucosa and bronchial hyperreactivity.

During an attack of bronchial obstruction, a narrowing of the lumen of both small and larger bronchi occurs.

All patients with asthma, when there is no attack, nevertheless, show signs of inflammation in the bronchial mucosa. This fact raises the question of the treatment of the inflammatory process - and not only during an asthma attack. There are such drugs, so persistent long-term treatment should be the basis for combating asthma.

No less important is the second position - on the presence of asthma patients with bronchial hyperresponsiveness, that is, increased irritability of the bronchi, responding with spasm to even insignificant amounts of irritating substances in the inhaled air. It forces to create a healthy air for these patients.

"Not all asthma that whistles"

Bronchial obstruction is observed not only in asthma, but also in a number of other diseases. In most of them, especially in adults, the disease does not have remission (light spaces), which distinguishes them from asthma.

But in childhood there is a group of diseases very similar to asthma associated with viral infection. They have no relation to asthma. Both a baby with asthma and a peer with no signs of allergy can give an episode of obstruction on the background of ARVI. The only difference is that asthma attacks of the disease will be repeated, not only with ARVI, but also in response to a non-infectious allergen, while a child without allergies will suffer from obstructive bronchitis and, most likely, "outgrow", so bronchial obstruction will stop after 1-2 such episodes. It is this fact that creates difficulties in the above-mentioned "relationships" with the diagnosis of asthma in many parents, as well as the incomplete adoption of the definition of asthma by pediatricians.

What is the difference between obstructive bronchitis on the background of acute respiratory viral infections and asthma? In some viral infections in infants, inflammation of the bronchial mucosa is observed, which thickens and the production of mucus increases. This leads to a narrowing of the very narrow children's bronchi, which is accompanied, as in asthma, by difficulty in exiting. This picture can be repeated 1-2 times, but with the growth of a child and an increase in the diameter of his bronchi, a new infection, although it causes bronchitis, does not cause a significant violation of bronchial patency.

The same thing happens in an allergic child, but over time, thanks to the preservation of bronchial hyperresponsiveness, almost every new infection will be accompanied by bronchospasm. Moreover, such a child can give bouts of obstruction in response to the inhalation of aeroallergens - and this is bronchial asthma.

Among children of the first three years who have obstructive diseases, the risk group for asthma are:

• children with an allergic predisposition (allergies in parents with allergic skin manifestations, positive skin allergy tests or high levels of immunoglobulin E);
• children whose obstructive disease develops without fever (indicating the role of a non-infectious allergen);
• children with more than 3 obstructive episodes.

After the age of 3 years, it is appropriate for almost all children with obstructive manifestations to make a diagnosis of bronchial asthma, however, many of them have stopped the disease in 1-3 years.

Forms of bronchial asthma

Above, we mentioned two forms of asthma - allergic and non-allergic. The division of asthma into forms is not limited to this.

Many children have asthma without severe attacks, during exacerbation they develop bronchitis with obvious signs of obstruction, which we commonly call asthmatic bronchitis, which should not reassure parents: asthmatic bronchitis is a form of bronchial asthma.

In some children, an asthma attack proceeds as a persistent night cough without severe shortness of breath - this is also a form of asthma, which can eventually turn into a typical form.

A number of children experience shortness of breath and difficulty breathing in response to physical exertion — this is asthma of physical exertion, and an attack develops as a result of bronchial hyperreactivity, stimulated by muscular efforts.

Many parents notice that an asthma attack occurs when the child is very excited, sometimes even talking about "mental asthma." There is hardly any reason to talk about the mental mechanism of asthma, but the fact that, in any form of this disease, excitement, especially related to the child's inability to cope with this or that problem, can cause an attack, is beyond doubt. Therefore, in a family where there is a child with asthma, a healthy psychological climate is very important.

How does asthma

A "normal" seizure develops suddenly, breathing becomes more frequent, exhalation becomes difficult, the child assumes a sitting posture and breathes superficially. Often, wheezing is heard from a distance, sometimes it is felt only when the ear is brought to the mouth of a child. The difficulty of exhalation leads to a retention of air in the chest, it usually swells, if you put your hands on it, then there is a tremor at the exit.

The attack can last from several minutes to many hours, often it ends spontaneously. However, it is unacceptable to wait for it to pass, or use dubious means (there are a lot of them thought up ): asphyxiation is a very painful phenomenon, so every minute of delay with effective treatment increases the child's suffering, scares him, which in itself can intensify bronchospasm. In more severe cases, intensive therapy is required.

Patients differ in the nature of the interictal period. In some patients, no changes can be identified, while others and in the interictal period there are significant limitations on the part of the respiratory function.

Asthma treatment

When I look at a child with asthma, the first thing I tell his parents is that asthma cannot be cured by any of the known remedies. It may be cruel, but why am I saying this? Because many parents, in search of miracle means, try a variety of methods, most of which not only do not bring benefits, but also harm the patient.

If you do not count on a cure, then what is the point of treatment? Its meaning is to reduce the severity of asthma, learn how to prevent attacks, at least make them rarer, quickly remove an attack if it occurs. In short, to make a child's life full - like a healthy child.

And with regard to the possibility of a cure, I always "relieve the soul" of my parents - in a very large percentage of cases, the child's asthma passes on its own.

Well, how to treat asthma? It is necessary to clearly distinguish between therapeutic measures to help get rid of an attack that has already occurred, and the means to soften the course of the disease.

How to prevent an attack? Preventing seizures is the primary goal of basic treatment. But to this should be added and measures for the possible prevention of contact with allergens, in the first place - with household dust. It is better to remove carpets and upholstered furniture, at least in the room where the child sleeps. I often joke - the ideal bedroom for a child is a prison cell, where, apart from the bed, table and stool, there is nothing. It is important to close the books in glass shelves, more often use a vacuum cleaner for cleaning, and it is better to moisturize. To reduce the patient's contact with the dermatophagoid mite, one should cover the child's mattress with plastic wrap and put 2 pillowcases on the pillows. Taking into account the allergenic properties of bird feathers, feather pillows should be replaced with cotton or foam rubber pillows.

It is very difficult to part with pets, but this is necessary if the child's sensitivity to their wool is revealed. In the room one should not have fresh flowers - not only their smells and pollen can be dangerous for the patient, but also the aspergilus fungus, which is often put in flower pots. In small patients with asthma, an attack can often be associated with food allergens.

It is hardly necessary to talk about the dangers of smoking in the apartment, where there is asthma. For him, first of all, it is necessary to create conditions ensuring maximum stay in the fresh air. Yes, and all other measures to prevent allergies should be fully observed.

It is very important to temper the child - this will reduce the purity of respiratory infections, which often cause an attack and contribute to increased bronchial hyperreactivity.

Very many children with asthma do not tolerate physical exertion - after 5-7 minutes from the start of running or outdoor games they develop bronchospasm, causing shortness of breath, or even an asthma attack. To prevent this, you should do 1-2 inhalations of beta- mietika or takeaminophylline powder, then the bronchospasm will not develop, and after 20-30 minutes the bronchi, on the contrary, will expand, under the influence of physical activity, which is very useful for the patient.

That is why physical education, increasing physical endurance is included in the arsenal of remedies for asthma. Moreover, physical training increases the self-esteem of the patient, contributes to his self-confidence and reduces dependence on adults. Breathing exercises are very useful, asthma patients learn proper breathing in the process.

Many parents ask if a child with asthma can go south to the sea. Experience shows that such a climate change usually provokes an asthma attack, so you need to be prepared for this. But then children usually feel good and get a lot of benefit from being at sea - because the sea air is very clean, breathing reduces bronchial hyperreactivity. Upon returning home, many patients again give asthma attacks, and this, too, must be prepared. In general, the benefits of such a trip will be palpable, if you spend a month or two in the south, no less.

Another frequent question is about climate change. In most cases, the climate cannot be "picked up," so I usually do not advise parents to embark on this very difficult enterprise. If asthma is clearly associated with the flowering of a certain plant, it is sometimes possible to take a child to another region for this period, but most often it is not possible to completely get rid of asthma in this way. The same applies to trips to the mountains, where at an altitude of 1500-2000 meters there are very few allergens: it is useful (including from the point of view of physical training), but it is still not possible to completely get rid of asthma.

Well, how to treat the treatment of asthma in salt mines? There are no allergens in the air, and this helps reduce bronchial hyperreactivity. But you can't spend your whole life in the mine, so you can't count on a cure. But staying in a halochamber (a room whose walls are covered with salt) seems to me at least doubtful.

Alternative treatments

Many have heard or read about miraculous means - acupuncture, special breathing techniques, miracle drugs, psychics, allegedly curing asthma. Yes, indeed, a mild seizure can be relieved by holding breath or acupuncture, but I could never understand how acupuncture is better than inhalation. Moreover, holding your breath even with moderate asthma can be quite dangerous.

I do not know of any solid research in which asthma cure using these methods would be proved, and the information such as "we were treated by a psychic - and asthma was gone" is absolutely unconvincing: after all, most children have asthma sooner or later!

And the harm from all these methods is the same - by resorting to them, parents are distracted from those measures that really help with asthma, in particular - they do not carry out basic treatment. Yes, and the use of other drugs during an attack (we hear from parents that they were recommended broncholitine, but shpu, papaverine, solutan, and even antibiotics) is unacceptable, as they, as a rule, do not alleviate the suffering of the child.

What awaits a future asthma patient? With proper treatment, as a rule, it is possible to stabilize the child's condition, and if the attacks do not stop at all, then their frequency and severity will decrease.

And do not forget that very often asthma passes.

Immediately make a reservation: the treatment of asthma is a big topic for another discussion, we will tell about it another time. Today on the agenda causes of asthma in children, its diagnosis and prevention measures.

Why do children suffer from bronchial asthma?

As a rule, due to allergies. That it causes the most common among children atopic or allergic asthma. Its main causes are dust, wool, pollen and other allergens. The child inhales them, the bronchi in his lungs are reflexively narrowed, and this leads to breathing problems.

In some cases, asthma attacks occur if the baby has not eaten something. This is due to the fact that allergies are often cross-sectional: to air and food allergens. For example, on birch and alder, and at the same time on apples, pears, peaches and plums. Avoid allergic products - reduce the likelihood of an attack of bronchial asthma in a child. More on prevention is just below.

Another type of asthma is infectious. Her seizures appear when infectious agents enter the child's airway: viruses, bacteria or fungi. For example, pathogens of bronchitis. However, an infectious-dependent form of the disease is rarely seen in children, so more often under the term "bronchial asthma in a child" is meant its allergic appearance.

Is there asthma: Symptoms in children

The younger the baby, the more difficult it is to understand whether he is sick with bronchial asthma. Even if he has any breathing problems, he cannot always describe it and sometimes just doesn't pay attention to it.

The difficulty is added by the fact that in babies under five years old the smooth muscles of the bronchi are not yet fully developed, and their lumen is still narrow. Therefore, the bronchi are not so clearly reacted to an asthmatic attack. As a result, bronchial asthma is often manifested in children not by respiratory spasm or intermittent sighs, but by swelling of the mucous membranes and the release of large amounts of sputum.

Because of this, the symptoms of childhood asthma are often confused with bronchitis or ARVI. And not only parents, but even doctors. What is the danger of such a delusion? The fact that asthma can develop in a child since birth, and parents learn about it only after a few years. And, of course, all this time the disease has not been treated.

A check list to help mom determine if a child has asthma or not:

• Coughs dry, with attacks, and coughing attacks occur and are aggravated by abrupt jumps, at night or in the morning immediately after sleep
• Breathes with a whistle
• From the side it is clear that it is difficult for the child to breathe for a long period of time
• Often complains that "crushes in the chest"
• Coughing and choking after stroking a cat or she just passed by
• Coughs and chokes when it gets to dusty books or dusty corners
• Does not cough outside in winter, but coughs and chokes in the period of flowering plants, from spring to autumn
• Coughs and chokes after active games and strong excitement

How does an attack of bronchial asthma in children?

First, the child begins to cough. He may leak from the nose, and on the skin pour out urticaria. Because of the narrowed bronchi, the baby breathes unevenly, inhales quickly, and exhales with difficulty. As if she was gasping for breath. Often during an attack, a rattle is heard and whistling when breathing. Sometimes the lips turn blue and the skin turns pale.

The first mother's actions if the attack began

1. Seat the child in a chair and tilt his body forward. So that the elbows rest on their knees.
2. Give the baby a breath of fresh and clean air. In winter, make sure that the room does not become a fridge, and in the flowering season, remember about allergens outside. Considering that a child has an attack of asthma, it makes sense to air the room through fresh air ventilation with good filters.
3. Remove the bronchial spasm with medicine using an inhaler. The first time is better to read the instructions for it. There are a lot of anti-asthma drugs, and which of them is "charged" into the inhaler is an open question. We will discuss it next time.
4. Get warm water (closer to hot) in a basin and make the baby baths for hands and feet. This will also help in the onset of bronchial asthma.
5. The attack does not stop? Call an ambulance.

Prevention of asthma in children

Preventive measures are divided into primary, secondary and tertiary. In accordance with the stage at which they are taken.

Primary prevention needs to prevent the development of the disease in the baby. The primary prevention measures are as elementary as they are important:

1. Mom is better to feed the baby with breast milk. Breastfeeding Infusion is an excellent prevention of wheezing and whistling when breathing.
2. Non-smoking moms - do not start, smokers - quit. Proved: from ta Smoke tank child often wheezes and whistles when breathing. Moreover, this effect is observed, even if the mother smoked during pregnancy.

Secondary prevention for children who do not have asthma yet, but the doctor has already identified asthma- like symptoms. These children are at risk if:

• In the family, someone is sick with asthma. The risk of asthma: up to 50%.
• Other allergic diseases have been identified in the baby: for example, atopic dermatitis or allergic rhinitis. Risk of asthma: 10-20%.
• The analysis showed a total level of IgE immunoglobulin more than 30 IU / ml and the presence of specific immunoglobulins (to milk, egg proteins and air allergens). Risk of asthma: up to 70% (especially if a child has dermatitis or rhinitis).

The purpose of secondary prevention is to eliminate the child from the risk group and prevent the development of asthma. Sheer prevention involves long (up to 18 months) preventive tera apy special drugs. It makes no sense to paint them, they are prescribed exclusively by a doctor. Therefore, in this case, the mother is better to refrain from self-treatment of the child. Practice shows that correct therapy reduces the frequency of attacks in half: from 40% to 20%.

Finally, tertiary prevention for children who already suffer from bronchial asthma. Her goal is for the child to drink less medicine. The essence of tertiary prevention is that the sick child contacts as little as possible with the dangerous factors that can trigger an asthma attack. Less contact with them - lower probability of seizures.

Some tips on tertiary prevention of bronchial asthma in children:

1. Get rid of dust in the apartment
2. To pickle cockroaches in the house: it is very important to reduce allergic sensitivity
3. Ideally, remove all animals from the house, at least not to let them into the nursery and main living room
4. Do not smoke near the child
5. Often ventilate the apartment, always cleaning the air from airborne allergens
6. Take the child out of the apartment for the period of repair and not return it while construction dust remains in it
7. To exclude allergic products from the diet: which ones, the allergist will tell
8. Fully exclude non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, diclofenac, nimesulide, etc.)
9. Children from 5 years old with wheezing or wheezing are required to register with a pulmonologist. He must appoint a preventive procedure (spirometry test with bronchodilator and physical on fire rate, peak flow).

Asthma in children: causes, symptoms, treatment

The diagnosis of bronchial asthma, made to a child, is no longer an event that complicates the life of a small person and his parents. Proper treatment allows him to develop normally, maintain an active lifestyle, and with age, the attacks usually go off easier, become rare, and often stop altogether.

In case of bronchial asthma, inflammation develops due to hypersensitivity of the bronchi to the action of certain substances. Coughing and choking attacks appear.

It is important to identify the factors that cause an attack (substances that the child has an allergy, or infections that trigger an exacerbation). Sometimes for the treatment of seizures, simply removing the "provocateur."

To prevent an attack from developing or interrupting it, the doctor prescribes anti-inflammatory drugs from different groups, including hormones.

How is asthma in children

The main symptom of asthma is chronic dry cough. In this case, the child does not increase the temperature and sputum is not separated.

The second common symptom is suffocation when in contact with certain substances that the child is allergic to (allergens), or due to the development of respiratory tract infections. During an attack, the bronchi are swollen and filled with viscous mucus.

Depending on the frequency and severity of asthma attacks in children, it is mild, moderate and severe. The attack begins with coughing, then shortness of breath (feeling of lack of air) develops.

The child's breathing is noisy, wheezing, and can be heard even from a distance. Often a runny nose, nasal congestion, and an itchy skin rash appear before an attack. Older children at such moments may complain of chest tightness and lack of air.

Causes of asthma

Bronchial asthma in children often develops against the background of a hereditary predisposition to allergies, but the disease itself cannot be considered hereditary. There are two main provocative factors for bronchial asthma: these are allergies (the propensity for it is called atopy , and this form of asthma is atopic) and inflammatory diseases of the respiratory tract (infectious-dependent asthma).

More common form of the disease, which is triggered by allergies. The "irritants" causing it can be any - foodstuffs, dust, pollen of plants, household chemicals, animal hair.

Sometimes asthma turns out to be the final link in the chain of allergic manifestations: first, the child's allergy is manifested by urticaria, eczema (itchy bubble rash), hay fever (runny nose), and only after some time the body begins to react to the allergen with an asthmatic attack.

Rarely, such attacks occur after a period of frequent inflammation of the airways, mainly bronchitis. And then, with each new episode of acute respiratory disease (ARI), asthma attacks occur.

How to diagnose asthma in children

The doctor collects detailed information about all the details of the child's life and how the seizure develops. Sometimes during a conversation, it is possible to guess which allergen causes asthma.

After this comes the next stage, when using a series of tests accurately determined the allergen that provokes the development of seizures.

The old method of determining allergies is a skin test, when solutions of various "irritants" are applied to the forearm, and the skin reddens at the point of contact with the allergen. Be careful - such a test can not be carried out on the day of the attack, you can cause deterioration, so it is better to take a blood test for allergens - it is safer and more informative.

The next step is to establish the degree of impairment of the respiratory system. For this, spirometry is performed (measurement of respiratory volumes).

The main indicators of spirometry - the volume of forced (that is, made with effort) expiration and the forced vital capacity of the lungs (the volume of the maximum inhalation plus the volume of the maximum expiration). The lower they are, the harder the asthma is.

Unfortunately, asthma is often diagnosed too late, many months after the onset of symptoms. Prior to this, the diagnosis may sound like "obstructive bronchitis" ("obstruction" means "blockage", in this case bronchial lumen with mucus).

This is partly due to the fact that parents perceive the diagnosis of "bronchial asthma" as a sentence, meaning a mandatory disability. This may encourage the doctor to the last not to make a traumatic diagnosis, while prescribing the same drugs that are usually given in case of bronchial asthma.

Treatment of bronchial asthma

For asthma, it is often enough to remove the allergen from the child's environment. If this does not help, the doctor prescribes anti-inflammatory treatment.

Preparations for the treatment of this disease are divided into two groups: some stop (stop) an attack, others prevent its development. In order for parents to consciously follow the recommendations of the doctor, you need to find out from him what each medicine is for. From this will depend on the mode of its reception.

In non-severe forms of asthma, as a rule, preparations are used from the group of stabilizers of immune cells (sodium cromoglycate). This drug does not help at the time of the attack, but it does not allow it to develop. Under the action of drugs, immune cells do not secrete substances that cause inflammation and narrow the bronchi.

In severe cases, to prevent seizures, the doctor prescribes hormones, corticosteroids (for example, budesonide, fluticasone). Do not be afraid of these drugs, because they act only on the mucous membrane of the bronchi. In severe asthma, the risk of side effects is much lower than the risk of the disease itself.

In order to urgently remove the attack in a child, use other drugs that quickly stop bronchospasm (salbutamol). Usually they are released in the form of a spray, and every adult who stays with the child should be able to properly inhale.

It is important that the parents of a child with asthma do not consider him seriously ill, if possible, give a lot of movement, reasonably quenched. When the child matures, the attacks will become rare, they will flow easier, and for many they will stop altogether.

It should be borne in mind that this perspective is not a reason to refuse treatment, including, if necessary, hormonal drugs. Each attack is a huge stress for the child, which must be eliminated by all means.

According to research scientists, asthma in a child often serves to care for parents from conflicts in the family, an important factor, a kind of stabilizer of relationships.

Six variants of the neuropsychic mechanism for the development of asthma in such situations, fixing asthma attacks, contributing to a protracted, chronic course of the disease that is not amenable to treatment with traditional means were identified:

• Ister-like
• Neurasthenoid
• Shunt
• Hypochondria
• Anosognosic
• Pseudoanozognosic

The first three mechanisms in the confrontation of an individual with a conflict situation cause an increase in psycho-emotional stress, directly resolved by the development of an attack of suffocation, and the next three find their manifestation of the patient's life position, which determines the behavior that makes it difficult to treat the disease (chronic factors).

Choking attacks, provoked by the ister - like mechanism, lead to the elimination from the field of attention of an unacceptable motive for the patient, the rejection of an independent solution of difficulties, and the avoidance of a real assessment of one's own role in a conflict situation. The preceding emotional stress decreases, conflict experiences are mitigated, and the attacks of suffocation that develop according to such a mechanism acquire the character of "conditional pleasantness", since they free the patient from the difficult situation for him, or rather, from the need to solve it. In this case, the tendency to escape into the disease.

Asthma serves the patient to attract attention, recognition, adaptation in the family

The disease is a powerful tool for managing family members. The activity of the family is subordinated to the interests of the patient, the interests of healthy family members are ignored or underestimated, which leads to an increase in bitterness in their particular position in the family. However, the bustle around the patient does not subside, due to moral and ethical ideas. At the same time, suppressed irritation, "sacrifice" does not escape the patient's attention, as it shows through the gestures, tone of speech, and expression of the family members. And then he "punishes" relatives for "insincerity" by another attack of suffocation.

The degree of awareness of this mechanism may be different. At the beginning of the disease (mainly in children) the patient almost consciously, wanting to get away from the demands of the environment, causes an attack in himself. "The main thing is to set yourself up for an attack, to lift yourself up, to be nervous, and the attack will develop by itself," some patients note.

Asthma often develops along the path of imitation, especially in families where one member is already sick with bronchial asthma (the phenomenon of pseudo-heredity). Sometimes bronchial asthma begins in a stressful situation when dealing with a sick family member against the background of complete well-being of the respiratory system.

In the case of a neurasthenoid way of fixing the disease, an intrapersonal conflict is important, similar to the conflict in patients with neurasthenia. However, it is not solved with the help of neurotic protection, but with the help of attacks of suffocation, which can be considered, the mechanism of protection. Sometimes he begins to provoke in all possible ways the development in the family of the so-called game "scandal" (E. Byrne) in order to cause emotional stress and a subsequent attack of suffocation. Thus, a sense of self-responsibility for the development of bronchospasm is being pushed out of the patient's mind ("relatives put me out"), the level of anxiety is reduced, and this stereotype of behavior is reinforced.

The shunt mechanism of psychogenic provocation of attacks of bronchial asthma can be understood from the position of "group psychosomatic protection". In the families of the patients, the existence of any problem was denied, except for the illness of its member, that is, in the family, although there is "smoldering", not always realized problems, open confrontation with them is avoided.

When a parent begins to quarrel, a child (or another family member) develops asphyxiation, which leads parents away from clarifying relationships by switching to a more "pressing" problem. Following this, the patient receives reinforcements in the form of attention and care of conflicting family members. The role of the "peacemaker" is firmly growing into family relations, then automates the onset of an attack of suffocation.

Patients with such a mechanism feel the need to attract and hold the attention of their family members; they are characterized by reactions accompanied by guilt feelings and auto-aggression.

Thus, in this case, the disease, on the one hand, is a peculiar stabilizer of a special kind of family relations, on the other hand, the symptoms of the disease themselves are supported and chronicled by the family climate.

Such a family system helps to fix the symptoms of the patient, as its members strive to preserve their rigid rigid stereotype of avoiding confrontation.

Patients with a hypochondriacal mechanism for fixing attacks of suffocation, as a rule, are brought up in childhood in families with an atmosphere of "cult of the disease." Increased attention to them contributes to the formation of anxiously-suspicious personality. The appearance of even mild respiratory disorders attracts the attention of the patient and his family members. In such patients, the "medical perspective" is easily lost, and they are more likely to be iatrogenic.

Anosognosic attitude to the disease is manifested in the conditions of high demands in education, encouraging the child's tendencies to independence, often untimely, develops a tendency to neglect the symptoms of the disease and treatment. This causes a later visit to the doctor, the development of severe asthmatic status.

With a false antifogging attitude to the disease, the patient, despite the fact that he adequately assesses the severity of his illness, hides it in every possible way from others. Most often this is due to the rejection of such a person in the family, in a social group.

Such patients are looking for non-traditional methods of treatment, which often leads to aggravation of the symptoms of the disease.

Bronchial asthma and emotions

It is known that asthma exacerbations are often associated with periods of increased emotionality. However, the causal relationship between asthma and emotions is not completely clear. As mentioned above, it has not yet been clarified whether high anxiety in asthma is a pathogenetic factor, or it develops as a result of constant fear of suffocation.

In each case, these components appear in different ratios depending on a variety of factors: the leading pathogenetic mechanism of asthma, the severity and duration of the disease, the personality characteristics of the patient.

1. An acute or prolonged (chronic) psychological trauma can be a "triggering" disease, both in the presence of a somatic predisposition (heredity, allergy, chronic respiratory tract infections), or in its absence. In these cases, bronchial asthma develops according to the principle close to the mechanism of stress violation, and the attacks can alternate with anxiety "influx". It is shown that life events themselves are not in themselves, however painful they are, namely, active avoidance of discussions of these events, the desire to force down to exert effort to suppress somatic conditions.

2. It has already become a byword in tongues, that for asthmatics one thought about an inhaler forgotten at home is a factor capable of triggering an attack of asphyxiation. Emotions of both the negative and positive spectrum are provocateurs of an attack. The number of emotional and stressful effects that reliably reduce bronchial patency and cause an asthma attack, according to different authors, included: mother's voice recorded on a tape recorder, listened to by an asthmatic child, discussion in a group of patients of various adverse life circumstances, memories of the most traumatic episodes of life.

Panic and other phobic reactions, so characteristic of patients with bronchial asthma, contribute to the worsening of the disease, directly affecting the patient's ability to make decisions in critical circumstances, the effectiveness of control of the attack.

The tendency to overdose of drugs: for some reason, doctors prescribed them more intensive steroid therapy, not focusing on objective indicators of the activity of the disease, but being under the influence of the patient's psychological reactions.

I do not want to urge to consider the psychosomatic approach to the development and course of asthma, as the only correct one. However, the same can be attributed to a number of other diseases, for example, gastritis, peptic ulcer, angina pectoris. Sometimes, I just really want the "traditional" medicine to approach each patient individually, taking into account not only the state of the body, but also the state of mind.