[Pathogenetic variants of the obstructive syndrome in patients with bronchial asthma]

The study is made of the causes underlying a variety of obstruction syndrome presentation in bronchial asthma sufferers. Heterogenic pathogenesis of the disease is related to predominance of one of the three obstruction components: bronchospasm, inflammatory edema of the mucosa and sputum obturation of the airways as a result of defective expectoration. To quantify the components objectively, a special program of the patients' examination has been devised involving: 1) analysis of clinical symptoms, 2) pharmacological testing with selective and nonselective sympathomimetic agents and cholinolytics, 3) registration of the duration of the bronchial sputum evacuation (time of expectoration). Basing on relevant results, three variants of the obstruction are distinguished: bronchospastic, inflammatory-edematous++, obturation. The severity of bronchial obstruction progresses from the first to the third variant. Moreover, the efficacy of bronchospasmolytic drugs diminishes as shown by pharmacological tests: first of selective beta 2-agonists and cholinolytics followed by non-selective sympathomimetic agents which may be attributed to their additional alpha-stimulating action. In view of this the question of clinical significance of alpha-stimulated bronchial constriction is discussed with reference to original and literature data.