An anamnesis is of great importance in the diagnosis and treatment of bronchial asthma. Bronchial asthma is excluded in all cases of causeless shortness of breath or paroxysmal cough , as well as with frequent bronchitis and pneumonia , especially in children. In most cases, the diagnosis of bronchial asthma is easy to make.
The severity of the disease can be judged by the frequency, duration and severity of the attacks. When examining during an attack, they definitely specify when it started and how it could be caused (infection, contact with an allergen, etc.), does this attack differ from the previous ones, does the patient feel nausea , vomiting , chest pain , fever , what drugs the patient took before and during the attack, as well as the dose and time of their use.
Clarify the patient’s condition in the interictal period. It also allows you to assess the severity of the disease and choose a treatment regimen. They find out whether shortness of breath and cough are observed during this period, including at night and after physical exertion, what are the number and nature of macrotum, whether increased fatigue and decreased performance are noted. In addition, they specify which medicines and in what doses the patient uses, which side effects are noted. Find out what factors usually cause seizures, how the disease affects the patient’s study and work.
An assessment of the environmental condition and working and living conditions of the patient allows us to determine the factors that cause asthma attacks – contact with allergens and irritants, smoking , emotional or physical stress , infection , adverse climatic and weather conditions , occupational hazards, drugs, food additives (e.g. glutamate or sodium metabisulfite ).
Family history. Relatives of the patient often have bronchial asthma and an allergic disease of the respiratory tract.
Physical research. The severity of changes detected during physical examination depends on the frequency and severity of seizures. With uncomplicated bronchial asthma in the interictal period, physical examination is usually normal. Allergic rhinitis and sinusitis , as well as nasal polyps , are necessarily excluded . Determine the respiratory rate, pulse, blood pressure, as well as the height and weight of the patient, evaluate the appearance and posture. When examining the chest, pay attention to its shape, carry out percussion and auscultation of the lungs.
During an attack of bronchial asthma, breathing and pulse are quickened, and blood pressure is often increased. The auxiliary muscles participate in breathing, the retraction of the pliable areas of the chest, the exit through the compressed lips, the expansion of the wings of the nose, the increase in the anteroposterior size of the chest, the box percussion sound, the decrease in the mobility of the lower edge of the lungs and the excursion of the chest are characteristic. The auscultatory picture is heterogeneous, hard breathing, different-sized dry rales on inhalation and exhalation are distinguished.
During a severe attack of bronchial asthma , cyanosis, a paradoxical pulse, asterixis, miosis, swelling of the optic nerve disc, and sensitivity disorders are additionally noted. When examining the chest, its expansion and a sharp decrease in excursion are determined, with auscultation, breathing is not performed, there are no wheezing (dumb lung).
