Allergic (asthmatic) bronchitis

Etiology of asthmatic bronchitis

This disease is polyetiological and can occur both as a result of the action of household allergens (house dust, pillow fluff, animal hair, plant pollen, etc.), and viral and bacterial, especially pathogenic staphylococcus. The role of pathogenic staphylococcus in the etiology of allergic bronchitis and tracheitis is confirmed by its persistent inoculation from the secretion of the respiratory tract and an increased level of titers of anti-a-hypoxic in the blood serum (2 – 3 AE in 1 ml). Relapses of the disease are observed most often in the cold season, which may also indicate the importance of the infectious factor in the etiology of allergic bronchitis.

The pathogenesis of asthmatic bronchitis

The localization of the allergen-antibody immune conflict is large and medium bronchi, in contrast to bronchial asthma, in which small bronchi and bronchioles are affected. In allergic bronchitis, small bronchi and bronchioles remain intact. This can explain the absence of asthmatic attacks or a pronounced bronchospastic component in allergic bronchitis.

Pathomorphology of asthmatic bronchitis

When allergic bronchitis is bronchoscopic, a pale but edematous mucous membrane, narrowing of the lumen of the segmental bronchi due to edema, a large amount of mucous secretion in the bronchial lumen is detected. If a bacterial infection dominates in the development of the pathological process, then bronchoscopy determines the changes characteristic of viral-bacterial bronchitis (hyperemia of the mucous membrane, the presence of a mucopurulent secretion). In young children, due to the characteristics of the mucous membrane of the respiratory tract in an allergic reaction, edema and hypersecretion predominate, and bronchospasm is weak. This fact is one of the reasons that complicate the differential diagnosis of allergic bronchitis and bronchial asthma in young children. 

Clinic of asthmatic bronchitis

The disease occurs in children of any age, has a recurrent course. Relapses can be repeated 1 to 2 times a month. They appear and occur mainly at normal or subfebrile temperature. The duration of relapse can be different – from several days to 1.5 – 2 weeks or more. The main symptom of allergic bronchitis is a persistent, obsessive, often paroxysmal cough, mainly at night. In most cases, the cough is dry, later it can become wet. Cough is easily provoked by negative emotions, physical exertion, etc. In the lungs, different-caliber moist rales are heard, with a predominance of large and medium-sized ones. In young children, fine-bubbly wet rales are often determined. During relapse, along with wet rales, dry, often wheezing is heard. Unlike wheezing in bronchial asthma, they are heard mainly on inspiration.
Physical changes in the lungs are diffuse. A clinical feature is the variability of physical data several times during the day. In a short period, wheezing may completely disappear, then they reappear. An increase in the volume of the chest is not observed, however, a boxed shade of percussion sound over the lungs is also determined during relative remission.

Despite the stubborn recurrent course of the disease, there are no changes in the cardiovascular system, liver, kidneys, digestive system. The most common symptoms are those that indicate involvement in the central nervous system and the autonomic process. Children become moody, irritable, lethargic, and excessive sweating appears. When examining blood, moderate or severe eosinophilia is determined.

– ray – increasing the transparency of the lung tissue, perivascular infiltration and increased vascular pattern. The course of asthmatic bronchitis is long. S.V. Rachinsky et al. established (1978) that in 30% of children asthmatic bronchitis is transformed into bronchial asthma, in 35% – relapses continued even after five years of observation, in 20% – spontaneous cure occurred in 15% of children and relapses of bronchitis lost their asthmatic nature. Allergic bronchitis can be combined with allergic tracheitis, although the latter is often found as a manifestation of an independent respiratory allergosis. Allergic tracheitis occurs in children of all ages, but most often in preschool and school age. Similarly to asthmatic bronchitis, the main essence of the pathogenesis of allergic tracheitis is the antigen-antibody immune conflict. In this case, the released biologically active substances (histamine, histamine-like substances) cause swelling of the mucous membrane of the trachea and hypersecretion of its glandular apparatus. As a result of the attachment and activation of a bacterial infection, areas of hyperemia of the mucous membrane appear, the secret becomes mucopurulent. The cause of the development of allergic tracheitis is domestic and viral-bacterial allergens, the most often pathogenic staphylococcus, the primary and initial focus of localization of which are the affected ENT organs. Clinically, allergic tracheitis is manifested by repeated attacks of an obsessive cough. Coughing attacks appear mainly at night, accompanied by painful painful sensations that disrupt the child’s sleep. During an attack of coughing, redness of the face, vomiting is observed, which resembles a pertussis clinic. Allergic tracheitis, like other clinical forms of respiratory allergosis, is characterized by a persistent course. Exacerbations of the disease occur almost continuously. The condition of children is disturbed, although the disease occurs at normal body temperature. They become lethargic, moody, agitated. With isolated allergic tracheitis, physical changes in the lungs are not noted. A blood test also reveals moderate or severe eosinophilia. – ray – the reaction of the roots of the lungs in the form of their severity, strengthening the basal pattern mainly due to the thickening of vascular shadows. 

local_offerevent_note December 28, 2019

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