Diagnosis of infectious-allergic bronchial asthma is complex. It includes: identification (allergic history) of the frequency and severity of various inflammatory diseases of the respiratory tract before the onset of the disease, immediately before the first attack (resolving factor), before repeated exacerbations (provoking factor); data from the clinic and physical examination; determination of acute and chronic respiratory diseases, inflammation activity using clinical, radiological, bronchoscopic, biochemical. methods, as well as foci of infection outside the respiratory tract; establishing the etiology of the inflammatory process in the lungs (bacteriological examination of sputum and bronchial contents with a quantitative consideration of the number of microbial colonies, determination of the pathogenicity and virulence of an isolated microorganism, virus and mycological studies; determination of circulating antibacterial antibodies and antigens in dynamics); clarification of infectious allergies using allergological diagnostic methods (allergic diagnostic tests intracutaneous, allergic diagnostic tests provocative); immunological studies to determine the infectious allergy: RBTL, RTML, PPN with infectious allergens.
In a significant number of patients with infectious-allergic bronchial asthma. there is an increased skin sensitivity to the introduction of allergens of the neisseries, staphylococcus, hemolytic streptococcus, fungi of the genus Candida, etc. Skin reactions are of a different nature: immediate, delayed, combined (the latter prevails). There is no clear relationship between positive skin tests and the presence of relevant microorganisms in sputum, as well as in vitro immunological studies. This indicates certain limits of the diagnostic significance of the applied diagnostic methods, in particular, allergic diagnostic tests of intradermal with bacterial allergens. Allergological diagnostic tests provocative inhalation more specific; The reactions observed during these tests are of three types: early, occurring within 1 hour after inhalation (prevail in frequency); late arising after 8-12 hours, lasting up to 48 hours, with difficulty stopping by anti-asthma drugs; double, combining early and late reactions. In some patients with infectious-allergic bronchial asthma, microbial allergy can be observed without the presence of foci of infection in the lungs or nasopharynx.
Detailing of individual forms of infectious-allergic bronchial asthma according to various etiological factors is currently being developed. The neisserial form of infectious-allergic bronchial asthma, which has certain clinical and immunological features, has been isolated and studied.
Differential diagnosis of infectious-allergic bronchial asthma
It is carried out with other respiratory allergic diseases, other forms and variants of bronchial asthma, bronchospastic syndromes.
The similarity of the clinical manifestations of allergic inflammation in bronchial asthma and the infectious-inflammatory process complicates the differential diagnosis of bronchial asthma and infectious-allergic bronchial asthma, especially since their combination with the predominance of one of them is often observed.
Treatment of infectious allergic bronchial asthma
Therapy of infectious-allergic bronchial asthma depends on the course, the presence of complications, concomitant diseases. General principles of treatment are etiological, pathogenetic and symptomatic therapies. Etiological therapy includes treatment of an acute inflammatory process in the respiratory system or exacerbation of a chronic one (antibacterial agents, sanitation of the bronchi according to indications; sanitation of foci of infection in the oral cavity and adnexa of the nose (conservative and, if necessary, surgical treatment, carried out in the remission phase), as well as outside the respiratory . ways
Pathogenetic and symptomatic therapy consist in: specific hyposensitization when indicated (in phase or abating exacerbation remission); complex ten sensitizing non-specific therapy; elimination of bronchial obstruction with the help of bronchodilators, expectorants and mucolytic drugs; glucocorticosteroid therapy if indicated; increased nonspecific resistance of the body (massage, exercise therapy, physiotherapy, spa treatment; normalization of the functional state of the central nervous system.