Bronchial asthma is one of the common chronic respiratory diseases, and its incidence is increasing worldwide, and it is listed by the World Health Organization as one of the “four persistent diseases” among chronic diseases. Many respiratory diseases can present with asthma-like dyspnea and are easily misdiagnosed as asthma, which is a major cause of treatment failure. Therefore, it is important to consider the presence of other diseases that cause wheezing in the diagnosis of asthma.
Bronchial asthma is classified by the World Health Organization as one of the “four persistent diseases” among chronic diseases.
(1) Exacerbation: exacerbation occurs when triggering factors are encountered. (2) Temporal rhythmicity: often attacks or aggravates at night and in the early morning. (3) Seasonality: often attacks or aggravates in spring and autumn. (4) Reversibility: Asthma medications usually relieve symptoms and can have a significant period of remission.
Many respiratory diseases can present with asthma-like dyspnea and can be easily misdiagnosed as asthma, so what are these diseases that can be easily confused with bronchial asthma?
Because many respiratory diseases can present with asthma-like dyspnea, including airway obstruction, acute left heart failure, and chronic obstructive pulmonary disease (COPD), these diseases are easily misdiagnosed as asthma and are often a major reason for their treatment failure. Therefore, consideration of the presence of other diseases causing wheezing is crucial in the diagnosis of asthma.
(1) COPD: COPD diagnosis includes all diseases that cause airflow obstruction, and the airway can be hyperreactive. The disease is very similar to bronchial asthma in terms of clinical symptoms, airway inflammation and structural changes, and pathophysiologic processes, and therefore a similar treatment approach can be used. Diffusion function and chest CT examinations can help distinguish COPD from asthma. Decreased CO diffusion (<70%) in patients with emphysema and chest CT reveals emphysema formation, which can be differentiated from bronchial asthma. In some patients, the two diseases may coexist.
(2) Cardiogenic asthma: Cardiogenic factors should be considered in elderly patients with asthma. Elderly patients with decompensated heart failure are often seen for dyspnea and wheezing. Cardiogenic asthma is commonly associated with left heart failure. The symptoms of the attack are similar to those of asthma, but the patient mostly has a history and signs of hypertension, coronary atherosclerotic heart disease, wind heart disease and mitral stenosis, etc. He often coughs up pink frothy sputum, extensive blistering and rales can be heard in both lungs, the left heart border is enlarged, the heart rate is increased, and a gallop rhythm can be heard in the apical part of the heart. On chest X-ray, heart enlargement and pulmonary stasis signs can be seen, and cardiac ultrasound and cardiac function tests can help to differentiate. If it is difficult to distinguish, nebulized inhalation of selective beta agonist or injection of small doses of aminophylline can be used to relieve the symptoms and then further examination.
(3) Narrow airway disease: including tumors, trauma and infection in the airway or mediastinum. The wheezing is characterized by progressive worsening of inspiratory dyspnea with no obvious relief period and ineffective treatment with bronchodilators. On examination, the “trigeminal sign” or inspiratory croup can be seen. CT scan and fibrinoscopy can determine the location, nature and extent of the lesion.
(4) Metaplastic pulmonary infiltrates: seen in tropical eosinophilia, pulmonary eosinophilic infiltrates, and polygenic metaplastic alveolitis. The cause is parasites, protozoa, pollen, chemicals, occupational dust, etc. Most have a history of exposure, symptoms are mild and may include fever and other systemic symptoms, and chest X-rays reveal multiple, fluctuating thin patches of infiltrative shadows that may disappear or recur on their own. Lung tissue biopsy can also help to differentiate.
(5) Recurrent polychondritis: due to softening of the tracheal stent and abnormal widening of the tracheal wall, the airway cannot maintain its normal shape. The patient’s intrathoracic pressure rises during breathing and coughing, causing narrowing and occlusion of the trachea and manifesting as expiratory asthma, which may be accompanied by erythema of the auricular and nasal cartilages. Chest CT and fiberoptic bronchoscopy can help in the diagnosis.
(6) Occlusive fine bronchitis: It is a deteriorating response of the airways to many intrapulmonary aggressive factors (including connective tissue disease, viruses, massive toxic gas inhalation and lung transplantation). On examination, characteristic inspiratory phase burst sounds are seen. The patient has wheezing and severe airway obstruction on pulmonary function tests. Definitive diagnosis is made by fiberoptic bronchoscopy or open-chest lung biopsy.
It is important to understand the causes and triggers of asthma to prevent attacks.
Some asthma patients tend to have attacks in spring and autumn, while others have attacks when they encounter cold air.
The causes of asthma are complex, but there are two main aspects, namely the physical condition of the patient and the environmental factors. The patient’s constitution includes subjective conditions such as genetic quality, immune status, mental and psychological status, endocrine and health status, which are important factors for the patient’s susceptibility to asthma.
Environmental factors including various allergens, irritant gases, viral infections, area of residence, conditions of the living room, occupational factors, climate, medications, exercise (hyperventilation), food and food additives, dietary habits, social factors and even economic conditions may all be important in the development of asthma.
Allergens are an important group of etiological factors that trigger asthma. Allergens are mainly divided into inhalant allergens and food allergens. Inhaled allergens mainly originate from particulate matter containing allergens in the living environment, and their allergenic components are mainly proteins and polysaccharides. The pathway of allergen invasion can determine the organism where the lesion occurs, and inhalation is usually the main route of respiratory sensitization and asthma attacks in children, as particles can be airborne and are present at all times in life.
There are many types of inhaled allergens, mainly indoor and outdoor allergens. Indoor allergens include room dust, dust mites, fungi and cockroaches, which are the main causes of asthma in children; outdoor allergens mainly include pollen and fungi, which are relatively less important because children are less active outdoors.
The causative factor is the factor that causes the first asthma attack, which is the “trigger” and the main cause of asthma, and plays an important role in both the occurrence and development of asthma; the triggering factor is the factor that induces the re-activity of occult asthma or acute asthma attack on the basis of the patient already having asthma, which is one of the comprehensive triggering factors in the process of asthma attack, and plays an important role in promoting the recurrence and further development of asthma. It plays an important role in the recurrence and further development of asthma.
Among these two categories of factors, some factors such as allergens, irritant and noxious gases, occupational factors, viruses, food and drugs have a dual role in both the development of asthma and in the development of asthma. However, it should be clear that all environmental factors are not the only determinants of the occurrence of asthma, but that the atopic qualities of the asthmatic patient himself are also very important. Understanding these has positive implications for enhancing patient self-prevention.
How can we prevent asthma attacks from a TCM perspective?
Chinese medicine has unique advantages in the field of preventing and treating asthma attacks, mainly focusing on the remission period of asthma, using methods to support and strengthen the root, adjust the qi, blood, yin and yang, and the function of the internal organs, especially the external treatment compress in the summer season and the paste recuperation method in the winter season have been widely used in the industry.
(1) Summer treatment for winter diseases
This therapy has a long history in China and is one of the wonders of traditional Chinese medicine in China, which originates from the medical theory of “the unity of heaven and man” and the treatment rule of “spring and summer nourishing the yang”. Chinese medicine believes that human beings and nature are one, and that the yang energy of the human body, like that of natural organisms, is born in spring, grows in summer, is collected in autumn, and is hidden in winter. If the body’s yang energy is insufficient, in the cold days of winter, because the respiratory tract is connected to the outside world through the nasal cavity, and Chinese medicine believes that “the lung is a delicate organ”, “the lung is the organ of Huagai”, “the lung is the master of the skin and hair “Therefore, the delicate lungs are very easy to feel the cold stimulation and cause the original disease attack or aggravation, asthma and other chronic lung diseases in the summer is mostly in remission less hair time, especially from Xia Xia to the beginning of autumn, people called the “summer”, “three volt days “This is the time of the year when the temperature is the highest and the yang energy is the most vigorous. At this time, the various functions of the body, the meridians and channels are open, it is a favorable time to support and nourish the Yang energy. According to the idea of “nourishing yang in spring and summer”, we should actively nourish the patient at this time, cultivate the essence and support the righteousness, so that the patient’s yang energy will be enriched, the righteousness will be strong, the resistance will be enhanced, and the immune function will be improved, so that the attack will be reduced or not occur in winter.
(2) Prevention of recurrence with poultices
Paste prescription, also known as poultice or poultice medicine, has the meaning of nourishment and connotation. It is a semi-fluid thick paste made by decocting, filtering, concentrating, adding excipients and collecting paste, which is one of the five major dosage forms (soup, pill, powder, paste and tincture) of traditional Chinese medicine, following the theory of diagnosis and treatment in Chinese medicine and selecting drugs according to the condition. Because of its ability to nourish qi and blood, harmonize yin and yang, nourish and strengthen the body, support the righteousness and consolidate the root, save the bias but not the disease, it fully embodies the preventive thought of “if the righteousness exists inside, the evil cannot dry up” and “treat the disease before it happens”. Because of its good taste, easy to take, stable medicinal properties, easy to carry, and can be taken for a long time, so the cream is very suitable for patients with chronic diseases, and favored by the majority of patients. Asthma is a kind of recurrent phlegm and asthma disorder with deficiency in the lung, spleen and kidney, with deficiency in lung qi, deficiency in external defense, deficiency in kidney yang, lack of power to steam, deficiency in spleen transportation, lack of biochemical source, brewing of dampness and phlegm, phlegm in the body, wind attacking and moving, then it is easy to have recurrent attacks. Ointment formula can benefit the lung qi, strengthen the body, defend against external attack, benefit the kidney and warm the yang, dispel phlegm and dissolve drinks, strengthen the spleen and stomach, biochemically nourish the source, etc. Therefore, ointment formula is especially unique in preventing and treating asthma.