El factor alérgico y bacteriano en la clínica y terapéutica del asma bajo el control de la expectoración bronquial

Abstract

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A serie of cases of bronchial asthma is studied following the technic of watching the sputum to eliminate the cells and oropharingeal bacterias in order to study with more rigor its citobacteriology. Several evolutionary forms are considered: a) with sputum surely eosinophilic (more than 50% of leucocyte in all or in determinated sites of the preparation); b) with sputum really bacterial and predominance of the neutrophiles, being the Haemophilus the most often pathogenic germ; e) with sputum without bacteria nor eosinophiles, which are in their evolution the worse and sometimes they constitute the most malign asthmatic pictures. All the pattern of expectoration can be presented in a circumstantial manner transforming ones into anothers, but in general, one of them is predominant, which it is the one that gives the character to the asthma. The presence of eosinophiles in the sputums, about the 50%, that sometimes is accompanied by intense eosinophilia in the blood (examples of real eosinophilic diathesis in the osseous medulla) reveals the allergic character of the asthma. The presence of bacterias does not mean that the asthma is of this etiology, but that a superadded infection exists which besides favors the asthmatic response, because an antibacterial treatment transforms those sputums rich in neutrophiles and in germs, into a-bacterial and eosinophilic. A lot of asthmas called intrinsicals, of starting at ages superior at 40 years, and apparent bacterial symptomatology really they have a-bacterial sputum of permanent mode, and besides eosinophilic shoots, which remember the ones called extrinsicals asthmas. For this reason, the traditional classification of the asthma in intrinsical and extrinsical is emphasized. The valoration of the watched sputum allow to apply a more concrete therapeutic. When the bacterias dominate, it is advise the antibacterial treatment, principally if they are accompanied by purulated expectoration. Vaccines inespecific, antibiotics of ample especter (the tetracicline and cloranfenicol are associated, as we have studied in the preparated Tetrafenicol) can be useful. If exists an eosinophilia in the sputum, directly or through the anterior treatment, is advised to improve the conditions of the disreactive response: glucosed serum, eufiline, nicotic acid, corticals steroids, ACTH associated if it is necessary to antibiotics and digitalics. Aerosols, sedatives and oxygentherapy, will complete the treatment. Sometimes, it is usefull the association of the iodo and the antihistaminics. Bleedings and bronchiale aspirations in the cases of gravity. The Cutaneous tests to find out the alergic factors of the asthmatic picture, will be something important to take into account, never mind the age of the ill, specially, if eosinophiles are found in the sputum, well in a permanent mode or in plugs. It is wry possible that in the evolution of the bronchial asthma with its last structural consequences of fixation and conective-vascular organization of the pulmonar tissue, the study of the sputum allows more quantity of cytologic data. But this comunication is limited to the eosinophiles in its porcentual aspects, in view of its efficacy for the knowledge of the asthma with the adventage of its simplicity, which make easier the use as technic of routine. The systhematic study -nearly daily- of the expectoration of 40 ill with bronchial asthma, hospitalizatied, with whom the technic of the «watched» of sputum has been followed, to observe its citobacteriologic evolution, has been useful not only to know its evolutives characteristics, and etiopathogenies better, but also to help us in the most effective treatment.