Rehabilitation in bronchial asthma. Modern approach to the management of patients with bronchial asthma Asthma attack

The FVD study is a simple and informative way to evaluate performance respiratory system. If a person has a suspicion of a violation, then the doctor suggests that he undergo a functional diagnosis.

What is FVD? In what cases is it done to an adult and a child?

FVD is a set of studies that determine the ventilation capacity of the lungs. This concept includes the full, residual volume of air in the lungs, the speed of air movement in different departments. The obtained values ​​are compared with the average, on the basis of this, conclusions are drawn about the patient's health status.

The examination is carried out in order to obtain average statistical data on the health of the population in the region, to monitor the effectiveness of therapy, dynamic monitoring of the patient's condition and the progression of pathology.

FVD of the lungs, what it is, the patient can find out when a number of complaints appear:

  • asthma attacks;
  • chronic cough;
  • frequent incidence of respiratory diseases;
  • if shortness of breath appears, but cardiovascular pathologies are excluded;
  • cyanosis of the nasolabial triangle;
  • with the appearance of fetid sputum with pus or other inclusions;
  • if there are laboratory signs of excess carbon dioxide in the blood;
  • the appearance of pain in the chest.

The procedure is prescribed without complaints, in chronic smokers and athletes. The first category acquires a tendency to diseases of the respiratory system. The second resorts to spirometry to assess how much reserve the system has. This determines the maximum possible load.

Before surgical intervention FVD, evaluation of results, helps to get an idea of ​​localization pathological process degree of respiratory failure.

If the patient is being examined for disability, one of the stages is the study of the respiratory system.

What disorders of the respiratory system and lungs does the examination show?

Violation of respiratory function occurs in inflammatory, autoimmune, infectious lesions of the lungs. These include:

  • COPD and asthma, confirmed and suspected;
  • bronchitis, pneumonia;
  • silicosis, asbestosis;
  • fibrosis;
  • bronchiectasis;
  • alveolitis.

Features of the FVD method in a child

To check the functioning of the respiratory system, the respiratory system includes several types of samples. During the study, the patient must perform several actions. A child under 4-5 years old cannot fully fulfill all the requirements, therefore, FVD is prescribed after this age. The child is explained what he should do, resorting to a playful form of work. When deciphering the results, you may encounter inaccurate data. This will lead to a false declaration of lung or upper system dysfunction.

Conducting a study in children differs from adults because the pediatric population anatomical structure the respiratory system has its own characteristics.

The initial contact with the child comes to the fore. Among the methods, one should choose the options that are closest to physiological respiration, which do not require significant efforts from the child.

How to properly prepare for the procedure: action algorithm

If you need to prepare to explore the external character of breathing, you do not need to perform complex actions:

  • exclude alcohol, drinks, strong tea and coffee;
  • a few days before the procedure, limit the number of cigarettes;
  • eat before spirometry a maximum of 2 hours;
  • prevent active physical activity;
  • wear loose clothing for the procedure.

If the patient has bronchial asthma, then compliance with the requirements of medical personnel can lead to an attack. Therefore, preparation can also be considered a warning about a possible deterioration in well-being. An emergency pocket inhaler should be carried with him.

Can I eat food before the test?

Although directly digestive system is not related to the respiratory system, but overeating before the study of respiratory function can cause the stomach to compress the lungs. Digestion of food, its movement through the esophagus reflexively affects breathing, speeding it up. Given these factors, there is no need to refrain from food for 6-8 hours, but you should not eat before the examination itself. The optimal time is 2 hours before the procedure.

How to breathe correctly when doing the FVD?

In order for the results of the examination of the function of the respiratory system to be reliable, it is necessary to bring it back to normal. The patient is placed on the couch, where he lies for 15 minutes. Methods for the study of respiratory function include spirography, pneumotachography, body plethysmography, peak flowmetry. The use of only one of the methods does not allow to fully assess the state of the respiratory system. FVD - a set of measures. But most often the first methods of examination from the list are prescribed.

The person's breathing during the procedure depends on the type of examination. With spirometry, lung capacity is measured, for which a person must take a normal breath and exhale into the device, as with normal breathing.

With pneumotachography, the speed of air conduction through the respiratory tract is measured at rest and after exercise. To determine the vital capacity of the lungs, you need to take the deepest possible breath. The difference between this indicator and the volume of the lungs is the reserve capacity.

What sensations does the patient experience during the examination?

Due to the fact that during the diagnostics, the patient is required to use all the reserves respiratory tract may experience slight dizziness. Otherwise, the study does not cause discomfort.

Diagnosis of respiratory organs by spirography and spirometry

During spirometry, the patient sits with his hands in a special place (armrests). Registration of the result is carried out by a special apparatus. A hose is attached to the body, at the end having a disposable mouthpiece. The patient takes it in his mouth, the health worker closes his nose with a clamp.

For some time, the subject breathes, getting used to the changed conditions. Then, at the command of the health worker, he takes a normal breath and releases the air. The second study involves the measurement of expiratory volume after the end of the standard portion. The next measurement is the inspiratory reserve volume, for this you need to draw air as fully as possible.

Spirometry - spirometry with recording the result on a tape. In addition to the graphic image, the activity of the system is displayed in material form. To get a result with a minimum error, it is removed several times.

Other methods for the study of respiratory function

Other methods included in the complex are carried out less frequently and are prescribed in the case when spirometry fails to obtain a complete picture of the disease.

Pneumotachometry

This study allows you to determine the speed of air flow through different parts of the respiratory system. It is carried out on inhalation and exhalation. The patient is asked to inhale or exhale as much as possible into the machine. Modern spirographs simultaneously record spirometry and pneumotachometry readings. It allows you to establish diseases, accompanied by a deterioration in the conduction of air through the respiratory system.

Test with bronchodilators

Spirometry does not reveal latent respiratory failure. Therefore, in the case of an incomplete picture of the disease, a FVD with a test is prescribed. It involves the use of bronchodilators after measurements are taken without the drug. The interval between measurements depends on the medicinal substance applies. If it's salbutamol, then after 15 minutes, ipratropium - 30. Thanks to testing with bronchodilators
it is possible to determine the pathology at the earliest stage.

provocative lung test

This option of checking the respiratory system is performed if there are signs of asthma, but the test with a bronchodilator is negative. The provocation is that methacholine is inhaled into the patient. The concentration of the drug is constantly increasing, which provokes difficulty in the conduction of the respiratory tract. Symptoms appear bronchial asthma.

Bodyplethysmography

Body plethysmography is similar to previous methods, but it more fully reflects the picture of the processes occurring in the respiratory system. The essence of the study is that a person is placed in a sealed chamber. The actions that the patient must perform are the same, but in addition to the volumes, the pressure in the chamber is recorded.

Test with ventolin

This drug belongs to the selective agonists of β2-adrenergic receptors, the active substance is salbutamol. When administered after 15 minutes, it provokes the expansion of the bronchi. In the diagnosis of asthma, it is essential: the patient is given spirometry, measuring the parameters of air circulation before and after the drug. If the second test shows an improvement in ventilation by 15%, the test is considered positive, from 10% - doubtful, below - negative.

stress tests

They consist in measuring the performance of the respiratory system at rest and after exercise. Such a test allows you to determine the disease of effort, in which coughing begins after exercise. This is often seen in athletes.

Diffusion test

The main function of respiration is gas exchange, a person inhales oxygen necessary for cells and tissues, removes carbon dioxide. In some cases, the bronchi and lungs are healthy, but gas exchange, that is, the process of gas exchange, is disturbed. The test shows this: the patient closes the nose with a clamp, inhales the mixture of gases through the mask for 3 seconds, exhales for 4 seconds. The equipment immediately measures the composition of the exhaled air and interprets the data obtained.

Deciphering the results of the respiratory function: a table - the norms of indicators for a man, woman and child

Having received the conclusion of the apparatus, it is necessary to analyze the data obtained, to draw a conclusion about the presence or absence of pathology. They should be deciphered only by an experienced pulmonologist.
The run-up in terms of normal is much different, since each person has his own level physical training, daily activity.

The volume of the lungs depends on age: up to 25-28 years, the value of VC increases, by 50 it decreases.

To decipher the data, normal values ​​are compared with those obtained from the patient. For ease of calculation, inspiratory and expiratory volumes are expressed as a percentage of vital capacity.

A healthy person should have a volume of FVC (forced vital capacity), FVC, Tiffno index (FVC / FVC) and maximum voluntary lung ventilation (MVL) of at least 80% of the values ​​indicated as average. If the actual volumes are reduced to 70%, then this is recorded as a pathology.

When interpreting the results of a stress test, the difference in performance, expressed in %, is used. This allows you to visually see the difference between volume and velocity of air. The result can be positive when the patient's condition has improved after the introduction of a bronchodilator, or negative. In this case, the air conduction has not changed, the medicine can adversely affect the condition of the respiratory tract.

To determine the type of violation of air conduction through the respiratory tract, the doctor focuses on the ratio of FEV, VC and MVL. When it is established whether the ventilation capacity of the lungs is reduced, attention is paid to FEV and MVL.

What equipment and devices are used in medicine for testing?

Different devices are used to conduct different types of FVD studies:

  1. Spirometer portable with thermal printer SMP 21/01;
  2. Spirograph KM-AR-01 "Diamant" - pneumotachometer;
  3. Analyzer "Schiller AG", it is convenient to use for samples with bronchodilators;
  4. Spiroanalyzer "Microlab" has a touch screen, switching functions is carried out by touching the function icon;
  5. Portable spirograph "SpiroPro".

This is only a small part of the devices that record the functions of external respiration. Medical device companies offer portable and stationary devices to institutions. They differ in capabilities, each of the groups has its own advantages and disadvantages. For hospitals and clinics, it is more important to purchase a portable device that can be transferred to another office or building.

Will FVD show asthma in a child and how?

The patient is measured the main indicators, then determine the relationship to the norm. In a patient with obstructive diseases, there is a decrease in values ​​below 80% of the norm, and the ratio of FEV to FVC (Gensler index) is below 70%.

Asthma is characterized by reversible upper airway obstruction. This means that the ratio of FEV / VC after the introduction of salbutamol increases. In order to put asthma, in addition to the indicators of respiratory function, which speak of pathology, the patient must have clinical signs of a violation.

Research during pregnancy and during breastfeeding

When diagnosing diseases, the question always arises whether pregnant and lactating women can be examined. Violations in the functioning of external respiration and the system as a whole can be detected during gestation for the first time. The deterioration of the conductivity of the pathways leads to the fact that the fetus does not receive the required amount of oxygen.

For pregnant women, the rules prescribed in the tables do not apply. This is due to the fact that in order to provide the required volume of air to the fetus, the minute ventilation rate gradually increases, by 70% by the end of the gestational period. The volume of the lungs, the rate of expiration are reduced due to compression of the diaphragm by the fetus.

When examining the function of external respiration, it is important to improve the patient's condition, so if a bronchodilator load is required, then it is carried out. Tests allow you to establish the effectiveness of therapy, prevent the development of complications, start timely treatment. The method is carried out in the same way as in non-pregnant patients.

If the patient has not previously taken drugs for the treatment of asthma, then during lactation it is undesirable to use a test with a bronchodilator. If necessary, the child is transferred to artificial nutrition for the period of drug withdrawal.

What are the normal parameters of respiratory function in COPD and bronchial asthma?

2 violations differ in that the first refers to irreversible types of airway obstruction, the second - to reversible. When a breath test is performed, the specialist is faced with the following results for COPD: VC decreases slightly (up to 70%), but the FEV / 1 rate is up to 47%, that is, the violations are pronounced.

With bronchial asthma, the indicators may be the same, since both diseases are classified as an obstructive type of disorder. But after a test with salbutamol or another bronchodilator, the indicators increase, that is, the obstruction is recognized as reversible. With COPD, this is not observed, then FEV is measured in the first second of exhalation, which gives an idea of ​​the severity of the patient's condition.

Contraindications for the study

There is a list of conditions in which spirometry is not performed:

  • early postoperative period;
  • malnutrition of the heart muscle;
  • thinning of the artery with dissection;
  • age over 75;
  • convulsive syndrome;
  • hearing impairment;
  • mental disorder.

The study creates a load on the vessels, pectoral muscles, can increase pressure in different departments and cause a deterioration in well-being.

Are there possible side effects when PVD is performed?

Undesirable effects from the examination are due to the fact that it requires you to exhale quickly into the mouthpiece several times. Due to the excess influx of oxygen, a tingling sensation appears in the head, dizziness, which quickly passes.

If we examine the function with a bronchodilator, then its administration provokes several non-specific reactions: a slight tremor of the limbs, a burning sensation or tingling in the head or body. This is due to the complex action of the drug, which dilates blood vessels throughout the body.

The deterioration of the environmental situation leads to an increase in the proportion of acute and chronic bronchopulmonary diseases. At the beginning of development, they are secretive, therefore invisible. Medicine has improved the method of studying the respiratory function, so that all data is obtained automatically. Preparation does not take much time, and the patient receives the result almost immediately. Every person is interested in taking this study. This may be a guarantee that he is healthy.

An asthma attack is stopped with the help of drugs whose action is aimed at destroying the lipoprotein membrane of the resulting sputum clots (chemical exposure) or a significant decrease in the tone of the smooth muscles of the bronchial tree.

Attack relief methods are aimed at alleviating a person's condition during an exacerbation of bronchial asthma, preventing the development of asthmatic status and do not imply the resumption of the body's adaptive properties.

The main goal of a set of measures for rehabilitation, on the contrary, is to maintain and strengthen health, the body's ability to heal itself. These include diet food, physical education (therapeutic and breathing exercises), physiotherapy, massage. A complex of rehabilitation procedures for people with bronchial asthma is carried out at the base of sanatorium organizations. Services provided include health school visits (including asthma schools).

A complete examination of the respiratory organs of patients before the start of the rehabilitation course, registration of the main indicators of the state of the respiratory system (especially the function of external respiration or respiratory function), on the basis of which a conclusion is made about the degree of its damage, is mandatory.

Therapeutic exercise and bronchial asthma

Physiotherapy exercises in combination with the correct set breathing technique contribute to its normalization, strengthening the muscles of the respiratory system, restoring the mobility and flexibility of the chest, increasing the endurance of the body.

Physiotherapy exercises include light strength exercises (taking into account the individual characteristics of patients) and breathing exercises, the main tasks of which are:

  • decrease in the state of general tension;
  • elimination of congestion and pathological foci in the body;
  • strengthening the respiratory muscles;
  • stabilization of irreversible changes in the lungs;
  • decrease in the intensity of bronchial spasms;
  • mastering the techniques of voluntary muscle relaxation;
  • increasing the endurance of the body;
  • training in breathing control techniques;
  • increase in elasticity and mobility of the chest.

The effectiveness of physical therapy is assessed by comparing the general well-being, blood circulation and respiration of the patient measured before and after the course of gymnastics. One of the main evaluative research methods is to determine the value of respiratory function and other respiratory indicators using peak flowmetry, spirometry and spirography. They also practice the stress test method in combination with physical activity.

In addition to assessing the effectiveness of treatment, the determination of respiratory function is an objective indicator of the severity of bronchial asthma. The FVD values ​​obtained in the course of the study of patients are correlated with those in healthy people based on gender, age, height and weight. Therefore, the indicators of the norm are calculated in each case.

Physiotherapy

The methods of physical activity developed for people with bronchial asthma include hygienic morning and therapeutic exercises, long or short walks in park areas, sport games effortless, cross-country skiing, easy running.

The first stage lasts about two to three days and is carried out in order to familiarize yourself with the exercises and restore the correct breathing mechanisms. In the same period, the coach evaluates the capabilities of the ward's body and plans the course of the training stage.

The training period of therapeutic gymnastics for bronchial asthma is from two to three weeks, the proposed gymnastics is slow or medium. No one will set time records: the main thing is quality, not quantity. The training part includes general strengthening exercises (forward and side bends, upper and lower extremities) and various respiratory complexes, the purpose of which is:

  • improve gas exchange in the respiratory organs and body tissues;
  • activate metabolic processes;
  • eliminate the negative impact of asthma attacks as much as possible;
  • to establish full breathing during physical exertion;
  • increase the efficiency and endurance of the human body as a whole.

Gymnastic equipment (balls, sticks, hoops) can be used for training.
During physical exertion, adrenaline is actively produced in the patient's body (the work of the adrenal glands). Its amount directly depends on the activity of the sympathetic nervous system person. An important property of adrenaline is the antispasmodic effect, which prevents bronchial spasms or helps to reduce the tone of the smooth muscles of the respiratory system as a whole.

If the health of patients after physical activity does not worsen, then after training practice the use of circulation contrast shower(in a gentle mode, lasting no more than two minutes) or saunas. These procedures are carried out only in consultation with the doctor. Swimming in a cold outdoor pool at a temperature below 22-23 ° C is strictly unacceptable, as a sharp change in temperature can provoke an attack of bronchial asthma.

Breathing exercises

The effectiveness of breathing techniques is aimed at eliminating the pathology of the bronchi and the respiratory system as a whole. Regularity, consistency and quality of execution are important here. Systematic training leads to the ability to fully control your breathing, which is very important during an asthma attack (relief, full inhalation and exhalation, reduction in the amount of antispasmodic drugs).

Respiratory gymnastics has an irritating effect on the receptors of the respiratory organs of the upper sections, which actively contributes to the expansion of the lumen of the bronchial channels and, consequently, the elimination of shortness of breath and suffocation. Classes teach methods to reduce the respiratory rate (reducing over-ventilation of the lungs).

Breathing exercises include various techniques, including the pronunciation of consonants and vowels and sound combinations. This develops the ability to consciously control the breath, making it more even. At the same time, fluctuations in the airways during exercise contribute to a decrease in the intensity of bronchial spasms on exhalation.

In the process of breathing, attention is focused on a slow inhalation through the nose and a prolonged exhalation through the mouth, which contributes to more complete ventilation of the lungs, strengthening the abdominals and training the diaphragm.

Practice breathing exercises also includes the methods of Strelnikova and Buteyko. They have different approaches to the problem, but their effectiveness has been repeatedly proven in practice.

According to the teachings of Strelnikova, the “recovery reaction” is based on excessive saturation of tissues and organs with oxygen, which, in turn, displaces nitrogen from them. The technique consists in gently squeezing the chest during the deep inhalation phase without subsequent exhalation during exercise.

Buteyko breathing exercises for people with bronchial asthma are also based on the principle of nitrogen displacement. The difference is the breathing technique and the saturation of the body of patients not with oxygen, but with carbon dioxide. The diaphragm is involved in the respiratory act. The person takes a deep breath and holds the breath for as long as possible.

Feeling better comes only after the so-called reaction of the body. These include a decrease in appetite, a significant increase in body temperature, active sputum discharge in very large quantities (up to two liters), stool disorder. This technique is used both for people with bronchial asthma and in a number of diseases. lymphatic system, joints, urinary tract and many others.

Physiotherapy for bronchial asthma

Physiotherapy occupies a separate place in the rehabilitation complex. Its main tasks are to activate the drainage function of the respiratory system and eliminate disorders associated with lung obstruction.

Physiotherapy includes mud therapy (mud baths, applications and wraps), mineral baths, aerosols and electroaerosols with antispasmodic drugs, electrophoresis using potassium iodide (2%) or calcium chloride (5%), climatotherapy, artificial and natural salt mines and halochambers. For children with bronchial asthma, a hardening program is provided.

Bronchial asthma and massage

A good restorative result in rehabilitation is given by back massage (8-10 minutes) and thoracic(no more than 15 minutes). Massage technique for bronchial asthma consists in alternating stroking, kneading in the longitudinal direction and circular rubbing. The general course of treatment is 12-15 with daily procedures or their alternation in one day. Anchoring positive effect contributes to the systematic conduct of massage procedures and the number of courses (recommended up to 2-3 with breaks between them).

There is a relationship between the type of massage movements and the disease of patients: in obstructive pulmonary disorders, the rubbing and stroking technique is mainly used, and in inflammatory processes or impaired lung ventilation, stretching and rubbing techniques are used. At the end of the procedure, the masseur several times lightly and gently compresses the patient's chest during exhalation (promotes maximum exhalation).

Massage has a positive effect on the functionality of the respiratory organs and the body of patients as a whole, contributes to a more complete implementation of the therapeutic effect of gymnastics, therefore it is recommended to be carried out 1.5-2 hours before physical therapy.

Medical nutrition as a way of rehabilitation

Principle medical nutrition in bronchial asthma involves the complete or partial removal of potentially allergenic foods from the diet of patients (seafood, different kinds fish, eggs, legumes, whole cow's milk, cottage cheese and others).

The diet implies a complete diet, consisting of a balanced ratio of proteins, fats, carbohydrates, with a total calorie content of 2300-2400 kcal. Nutrition for patients is compiled on an individual basis, taking into account the type of allergy (food, pollen, medicinal and others), the severity of the disease and inflammatory processes, phase of the patient's condition (remission or exacerbation period).

Therapeutic nutrition for bronchial asthma of the "aspirin" type involves the removal of products from the diet:

  • canned type, which include aspirin, benzoic acid, monosodium glutamate, sulfate and sodium nitrite;
  • containing food coloring, which gives a yellow color to foods and dishes (tartrazine can provoke an attack);
  • including salicylates (reduce or selectively eliminate consumption);
  • with a high content of enzymes (cheeses, beef sausages, raw smoked sausages).

Also exclude alcoholic, alcoholic and carbonated drinks, spices, salty delicacies, coffee and cocoa.

Keeping track of the foods you eat will help you identify the food allergen. If this method is not effective, then such a diet is the most reliable method for identifying foods that provoke an attack. To achieve the result, you should adhere to a strict menu for two to three weeks, and then introduce a new product no more than once every three days.

The dietary menu for bronchial asthma includes:

  1. Meat of low-fat varieties (veal, rabbit meat).
  2. A large number of vegetables and fruits (apples, pears, cabbage, potatoes, cucumbers, squash).
  3. Dairy products.
  4. Various drinks made from permitted fruits, non-carbonated mineral water, various teas.

A fasting diet for bronchial asthma is indicated for people with severe form, overweight and obesity, eczema, psoriasis, multiple food and drug allergies. The course of treatment lasts no more than a week and depends mainly on the state of health of patients.

Health School or Asthma School

School of bronchial asthma is a systematic training on the basis of medical institutions, the purpose of which is to increase the education of patients in terms of self-help skills and asthma control, increase therapeutic effectiveness, psychological correction of the behavior of the patient and his environment.

The School of Health includes both theoretical and practical classes, the effectiveness of which is aimed at:

  • expanding horizons about the causes and first symptoms of asthma exacerbation;
  • training in self-analysis of the state and self-control in the event of an attack;
  • explaining the importance of proper and healthy nutrition;
  • providing psychological assistance;
  • rejection bad habits(alcohol, overeating);
  • training in working with a peak flowmeter and methods for assessing the state based on the results of measurements.

Spa treatment in combination with an asthma school contributes to a stable remission of bronchial asthma, the restoration and maintenance of patients' health, both physically and emotionally. If you have the opportunity to visit the resort, then do not miss it!

Spirometry is a safe, affordable and highly informative way to study the ventilation function of the lungs. This diagnostic method allows not only to detect violations in the respiratory system, but also to determine their nature.

Spirometry in bronchial asthma helps to confirm the presence and degree of bronchial obstruction.

How is the research done?

To carry out such a procedure, a special medical device is required. A conventional mechanical spirograph is represented by a movable cylinder, which is immersed in a vessel with water and is connected to a recording device. When a patient breathes into an empty cylinder, its volume changes - this is how the change in lung volume during breathing is recorded. Today, more often resort to computer spirometry. This diagnostic method allows not only to measure the main spirometric values, but also to determine additional values ​​in order to make a more complete picture of the disease and diagnose pathology in the early stages.

The environment affects the patient's well-being, and hence the result of the study. The procedure is carried out in an isolated, quiet, dimly lit room with an air temperature of 18 to 24 degrees and optimal humidity. Clothing (tight collar, tie, trouser belt, bra) should not interfere with the breathing process. It is extremely important to make respiratory movements exactly as the doctor asks.

If it is necessary to obtain the results of spirometry during the main exchange, then the following rules must be observed:

  • come early in the morning;
  • do not eat before the study;
  • do not take any medication during the day before the procedure (on the recommendation of a doctor).

An hour before the procedure, it is advisable to rest lying down. If there is enough data, with relative rest, spirometry is carried out in the afternoon, 2 to 3 hours after a light meal. Before the procedure, you need to sit for 15 - 30 minutes.

Standard spirometric values

Spirometry makes it possible to measure lung volumes during normal and very active motor movements. Using these results, it is possible to calculate lung capacities and other indicators, the size of which changes with bronchial obstruction.

Lung volume has several components.

  • tidal volume (TO);
  • reserve inspiratory or expiratory volume (ROVD or ROVID);
  • residual lung volume (ROL).

Vital capacity (VC) is one of the most important spirometric values. To measure it, after a series of normal inhalations and exhalations, you need to give the strongest breath and exhale just as deeply.

Lung capacity includes other values:

  • inspiratory capacity (EVD);
  • functional residual capacity (FRC);
  • total lung capacity (TLC).

In the course of the study, the forced vital capacity of the lungs (FVC) is also determined. In bronchial asthma, these data are especially important because they reflect the strength of bronchial obstruction. To determine FVC, the patient must take a deep breath and then exhale quickly. In addition, the forced test allows you to determine the following characteristics:

  • forced expiratory volume per second (FEVD1);
  • Tiffno index;
  • maximum expiratory flow rate at 25%, 50% and 70% of FVC;
  • the average volumetric expiratory flow at the level of 25-75% of FVC;
  • peak expiratory volume flow (PEV).

First of all, it is estimated general form spirograms. Outwardly, it is a curved line on graph paper, the various segments of which correspond to certain values. With any deviations, the graph greatly changes its appearance. Modern devices analyze the results themselves and build not only a standard spirogram, but also a flow-volume curve. On the graph, it has a teardrop shape with a beveled right side. In the case of bronchial asthma, this part of the loop ceases to be even and “sags”.

Decryption of received data

The interpretation of the results allows you to monitor the course of asthma, establish the stage of the disease, assess how effective the therapy is, and make a prognosis. Indicators of lung volumes and lung capacities can vary significantly in men, women, children and the elderly, patients with different types chest(normasthenic, hypersthenic and asthenic) and different levels of fitness. In addition, the result is influenced by atmospheric pressure and body position. With bronchial obstruction, the following changes are observed on the spirogram:

  • decrease in VC (often indicates a severe course);
  • decrease in ROvyd;
  • decrease in OFVD1;
  • decrease in the Tiffno index;
  • decrease in SOS25-75%;
  • decrease in POSvyd;
  • norm or increase in FRC;
  • increase in OOL.

The proper values ​​with which the obtained indicators are usually compared are as follows:

  • VC at least 90;
  • FEV1 not less than 85;
  • Tiffno index not less than 70;
  • OOL - from 90 to 110;
  • the ratio of OOL to OEL is not more than 105.

The earliest and reliable sign bronchial obstruction is a decrease in the calculated average volumetric velocity at the level of 25-75% of FVC. However, the calculation of this value requires very accurate measurements, so usually only computer spirometry makes it possible to find out this indicator. Thus, a decrease in the values ​​associated with exhalation and an increase in the values ​​associated with inhalation can be clearly seen. This is due to the difficulty of passing air through the narrowed lumen of the bronchi.

Often, doctors prescribe their patients to undergo a respiratory examination. What it is? What results are considered normal? What diseases and disorders can be diagnosed using this method? These questions are of interest to many.

FVD - what is it?

FVD is an abbreviation that stands for "function of external respiration." Such a study allows you to evaluate the work of the respiratory system. For example, with its help, the doctor determines how much air enters the patient's lungs and how much comes out. In addition, during the test, it is possible to analyze the change in the air flow rate in different parts respiratory system. Thus, the study helps to assess the ventilation capacity of the lungs.

Importance of FVD for modern medicine

In fact, the significance of this study can hardly be overestimated. Naturally, it is used to diagnose certain disorders of the respiratory system. But the range of application of the method is much wider. For example, spirometry is a mandatory, regular test for people working in hazardous environments. In addition, the results of this analysis are used for expert evaluation of a person's performance, determining his suitability for work in certain environmental conditions.

The study is used for dynamic monitoring, as it makes it possible to assess the rate of development of a particular disease, as well as the results of therapy. In some cases, the analysis of respiratory function is used to diagnose allergic diseases, because it allows you to trace the effect of a substance on the respiratory tract. In some cases, mass spirometry of the population is carried out in order to determine the health status of residents of certain geographical or ecological zones.

Indications for analysis

Indicators of analyzes in bronchial asthma

Bronchial asthma- refers to chronic diseases, a sign of which is an asthma attack resulting from swelling of the bronchial mucosa and spasm of smooth muscles.

non-infectious allergens (substances that cause allergic reactions):
. pollen
. medications
. insect bites
. food products, etc.

infectious allergens:
. viruses
. bacteria
. mushrooms

chemical substances:
. alkalis
. acids

physical factors:
. air temperature changes
. atmospheric pressure changes
. stressful influences

Hereditary genetic predisposition, certain working and living conditions, past viral respiratory and allergic diseases can also predispose to the development of bronchial asthma.

The main manifestation of bronchial asthma is an asthma attack (usually at night), which lasts from several minutes to several days.
The inhalation becomes short and the exhalation long.
Worrying cough, shortness of breath. During the period of suffocation, a cough with viscous sputum that is difficult to separate, the amount of sputum at the end of the attack increases, and it leaves more easily ("vitreous sputum").

Inflammation and obstruction of the airways in asthma

Indicators of laboratory research

General blood analysis. One of the signs of the disease is eosinophilia, which is more pronounced with frequent attacks; in some cases, eosinophilia can be observed immediately before an attack, and after an attack and in remission, eosinophilia may be absent.
Increased rates hemoglobin and erythrocytes appear with the development of insufficiency of external respiration. ESR is moderately increased.

Research in bronchial asthma. Examination of the function of external respiration (PVD)

For diagnosis of bronchial asthma. for dynamic monitoring of patients and evaluation of the effectiveness of therapy, indicators of the expiratory rate are recorded. Such studies are especially useful when the patient does not have asthma symptoms or signs of difficulty breathing.

Air flow rate and lung volumes are recorded by spirometry during forced exhalation. Airflow limitation in asthma causes smaller partial expiratory volumes of the lungs. Spirometric target values ​​for OOB1 have been developed for children of different heights, genders, and ethnicities. The decrease in FEV1, expressed as a percentage of the standard value, is one of the four criteria for the severity of bronchial asthma.

Since sick the lungs are usually swollen, and often very much, the ratio of FEV1 to FVC allows you to calculate their total expiratory volume. A FEV1/FVC ratio less than 0.8 usually indicates severe airflow limitation. However, it is impossible to diagnose bronchial asthma only on the basis of a decrease in airflow velocity, since this is also characteristic of many other diseases. pathological conditions. In bronchial asthma, inhalation of β-agonists (for example, salbutamol through a nebulizer) dilates the bronchi more than in the absence of asthma; asthma is characterized by an increase in FEV1 by more than 12%.

It is important to remember that diagnostic value spirometry data depends on the patient's ability to repeated full and forced expiration. Children over 6 years of age usually perform this procedure easily. Spirometry data are only relevant if they are reproducible over the course of the study. If, with three consecutive attempts, FEV1 differs by no more than 5%, then they are guided by the best of the three indicators.

Solopov V.N. Asthma. Evolution of the disease

Examination of the function of external respiration

a. Respiratory disorders in bronchial asthma are caused by reversible airway obstruction, which is manifested primarily by a decrease in FEV 1 and peak volumetric velocity. These indicators usually quickly normalize after the use of bronchodilators (see Fig. 7.3). An increase in FEV 1 after the use of bronchodilators by more than 20% indicates reversible bronchospasm. With blockage of the bronchi by mucous plugs and swelling of the mucous membrane, the action of bronchodilators is slower. It should be remembered that the absence of a significant increase in FEV 1 after the use of bronchodilators does not exclude the diagnosis of bronchial asthma. Lack of response may be due to the following reasons: 1) no obstruction or minor airway obstruction in the interictal period, 2) the action of bronchodilators used shortly before the study, 3) improper use of inhaled bronchodilators, 4) bronchospasm caused by irritants that make up the composition inhaled bronchodilators, 5) bronchospasm caused by diagnostic procedures, in particular spirometry.

1) In the interictal period, FEV 1 is usually normal. Indicators of FEV 1 and peak volumetric velocity reflect the state of the large bronchi. With narrowing of small (less than 2-3 mm in diameter) bronchi, FEV 1 and peak volumetric velocity are often normal (FEV 1 is reduced only with severe obstruction of small bronchi). To assess the state of small bronchi, another indicator is used - the average volumetric velocity of the middle of exhalation. To determine it, a graph of the dependence of the air flow on the forced expiratory volume is plotted - the flow-volume curve (see Fig. 7.3). It should be remembered that an isolated decrease in the average mid-expiratory volume velocity can also be observed in the interictal period.

Common dysfunctions of the respiratory system include a serious disease - bronchial asthma, the diagnosis of which is often associated with certain difficulties. This is due to the fact that the symptoms of asthma are similar to manifestations of other respiratory disorders: pneumonia, bronchitis, disorders in work. vocal cords, pulmonary thrombosis. They sometimes even resemble heart or allergic attacks. The development of the disease occurs as a result of inflammation of the bronchi, when their sensitivity to irritating stressors increases significantly.

Causes of asthma and its characteristic symptoms

There are many factors that contribute to the development of the disease. First of all, they include a group of external stimuli:

  • allergenic substances in the form of plant pollen, dust, wool;
  • atmospheric fluctuations in temperature, pressure and humidity;
  • viral and bacterial microorganisms;
  • drug and food intoxication.
Photo of common asthma allergens.

There is also a genetic predisposition to asthma. Then the probability of the disease increases many times after the transfer infectious inflammation(pneumonia or acute and chronic bronchitis).

Asthma is very diverse and can vary depending on the cause of the exacerbation (atopic and infectious) and the severity of the course (mild, moderate and severe). In a separate group is the hormonal and aspirin form. Asthma of the first type develops against the background of long-term use of steroid hormones. Bronchial disease of the second type is formed as a result of intolerance to aspirin, analgin and other anti-inflammatory drugs.

In the initial stages, cough occurs mainly in morning time but there is no difficulty in breathing. A typical symptom of bronchial asthma is suffocation, coughing fits, heard at a distance, wheezing when breathing. Heaviness in the chest forces the patient to sit down and rest with his hands to facilitate ventilation. Seizures are hallmark diseases and can become more frequent with exacerbation of respiratory ailments. After them, the patient may not feel unpleasant embarrassment, and difficulty breathing disappears.

A very dangerous moment for the patient's life can be the state of asthmatic status. Progressive choking has more pronounced symptoms than with ordinary attacks. Clinical signs status asthmaticus are as follows:

  • blue discoloration of the skin (cyanosis);
  • increased heart rate (tachycardia);
  • lethargy and drowsiness (dysfunction of the central nervous system);
  • violation heart rate(extrasystoles).

With a progressive attack of suffocation, the possibility of death from respiratory arrest or cardiac arrhythmias is not excluded.

Laboratory methods for testing bronchial asthma

Bronchial asthma, the diagnosis of which is a multi-stage procedure, is determined based on the collection of data through patient interviews and clinical examination. Complaints of the patient, the evolution of pathology throughout life are specified.

The doctor examines the patient, listens to him with a phonendoscope, taps the lungs for their pathological expansion. Thus, the doctor can make a preliminary conclusion.

The determination of a specific form of bronchial asthma with the fixation of pathogenetic factors forces one to resort to additional laboratory methods. With atopic bronchial asthma as a result of a malfunction immune system When foreign particles enter the respiratory system, there is an inadequate increase in the body's sensitivity to them. It can be plant pollen, medicinal and protein substances. In this case, skin and provocative tests are taken in special allergological laboratories, and food products that cause allergic reaction. A blood test shows an increase in eosinophils and lg E. Additional testing determines a change in basophils, an increase in microcytes and alteration of neutrophils.

Schematic representation of sputum types.

Infectious-toxic bronchial asthma is formed as a result of frequent respiratory diseases. In this case, a general biochemical analyzes blood to determine the presence of leukocytes and proteins. Sputum may also contain leukocytes, and nasal mucosa may contain viral antigens. The probability of developing bacterial hypersensitivity is determined.

Instrumental methods for verification of bronchial asthma

In order to install accurate diagnosis with a disease of the lower respiratory tract, various medical devices are used. X-ray and tomography of the lungs are indicated for difficulty in differentiating asthma and other pathologies, including oncological ones. X-ray on initial stage during exacerbation will not show differences from the norm. But over time, signs of emphysema (transparency of the lungs) or pneumosclerosis (proliferation of connective tissue) are noticeable in the lung picture. Computed tomography is indicated when there is doubt about the diagnosis of asthma, when there are prolonged cough and bouts of suffocation.

Schematic representation of the principle of assessing the function of external respiration.

The most reliable way to confirm bronchial asthma is to study the function of external respiration (RF). The essence of the examination is to measure the speed and volume parameters of exhalation. If other methods only assume the presence dangerous disease, then spirometry confirms the readings. The test allows you to set the value of forced expiratory volume per second (FEV) and vital capacity (VC). The quotient of these indicators (Tiffno index) makes it possible to fix the degree of patency and obstruction (narrowing) of the bronchial tract.

A special device has been developed - a peak flow meter, which can be used even at home. The patient should determine the peak value of the expiratory flow and further focus on it to assess the level of obstruction. The procedure is carried out in the morning before taking medication and in the afternoon. A difference in FEV readings of more than 20% indicates the development of asthma attacks. A decrease in FEV less than 200 ml indicates symptoms of severe bronchospasm.

Diagnosis of asthma using peak flowmetry allows you to constantly monitor the course of the disease, which contributes to a reasonable and dosed intake of medications.

The video talks about the main ways to diagnose bronchial asthma.

As a result, you can notice the impending crisis in time and avoid emergency medical examinations.

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