Treatment of infection-dependent bronchial asthma. Bronchitis and infectious asthma Infectious-dependent bronchial asthma

The content of the article

Pathogenesis of infectious-allergic bronchial asthma

Diagnosis of infectious-allergic bronchial asthma

Differential diagnosis of infectious-allergic bronchial asthma

Treatment of infectious-allergic bronchial asthma

An allergy is a pathological reaction of the immune system to external influences. It is caused by food, pollen, and many other beneficial and harmful substances present in human life. When naming allergens that can lead to numerous reactions, we often forget about some of the most dangerous ones - infectious pathogens.

Many diseases, especially in children, caused by infection with microorganisms, are infectious-allergic in nature. Sensitization of the body occurs due to the action of toxins produced by pathogenic flora, as well as the allergic manifestations caused by them. This pathology is called infectious allergy.

Causes of infectious allergies

Provocateurs of such diseases can cause a response from the immune system in the form of allergies. They are:

Often, the cause of allergic manifestations is not the pathogens themselves, but the products of their life - sections of DNA, membrane molecules, enzymes and toxins that they secrete during the process of growth and reproduction.

The membranes of microorganisms store most of the substances perceived by the immune system as dangerous. It is to them that the immune system reacts more strongly than to internal components.

In this case, the influence of an allergenic substance on the course of an infectious disease can be different:

• The allergen plays a major role in the development of pathology (tuberculosis, syphilis, etc.). This group of diseases is called infectious-allergic.
• The irritant is not of leading importance, but is present during the disease in allergy tests (most acute infections).
• Allergies develop as a result of accompanying factors - intake, administration of serums, etc.

The course of such pathologies largely depends on the reactivity of the body, its ability to withstand external stimuli.

Factors and conditions of occurrence

The immune response accompanies a significant part of infectious diseases. This is facilitated by a combination of several conditions:

• most often, pronounced reactions appear during chronic infections;
• the penetration of microorganisms into cells enhances the body’s immune response;
• protracted course of the disease.

Not every person who has had an infectious disease becomes a victim of inadequate immune function. The formation of a response is facilitated by the special reactivity of the body, disturbances in the construction of immune complexes and mechanisms, and a predisposition, often genetically determined.

Provoking factors:

• heredity (main cause);
• disorders of the endocrine system, in particular diabetes mellitus;
• instability to stress associated with impaired synthesis of glucocorticoids by the adrenal glands.

The immune system fails to protect against infections; allergies can be triggered by:

• conducting tests, for example, the Mantoux test for tuberculosis or tests for dysentery, brucellosis;
• administration of vaccines;
• pathologies with infection by staphylococcus, E. coli, streptococcus, etc.

The most common allergenic component is present in the following pathologies:

Most often, allergies accompany infectious diseases in childhood. This is primarily due to the underdevelopment of the immune system. Moreover, any long-term and severe pathology can be accompanied by allergy symptoms. Coughing, sneezing and nasal congestion are often difficult to treat without taking into account the immune response to the allergen infection.

Symptoms

The signs of such an allergy are similar to its general manifestations.

Local manifestations may be accompanied by a general deterioration of the condition - lethargy, headache, slight low-grade fever, enlarged lymph nodes.

Due to the fact that the immune system has not yet been formed, and the body is depleted by infection, children also have the following common symptoms:

• delayed growth and weight gain;
• moodiness and bad mood, in babies – frequent crying;
• developmental delay;
• loss of interest in games and studies.

Respiratory pathologies due to malfunctioning immunity in children have a long and difficult course. Recovery does not occur for a long time; the following develop:

• shortness of breath and difficulty breathing;
• constant nasal congestion;
• prolonged cough.

After long-term respiratory infections, children often develop infectious-allergic bronchial asthma - a special form of bronchial disease that has a dual nature - bacterial and exogenous (allergic).

Other dangerous complications of infections with allergic components are significant damage to internal organs, which can lead to the following disorders:

• systemic vasculitis.

Severe allergies can cause and require emergency care due to the possibility of death from suffocation or paralysis of the heart muscle.

Infectious-allergic bronchial asthma

This type of disease is called mixed, since internal and external factors are involved in its formation. It affects more than 150 million people and is widespread throughout the world. The number of patients with infectious-dependent bronchial asthma is 60-85% of the total number of asthmatics.

It has become more widespread in developed countries, where the incidence of allergies is constantly growing. In Russia, the adult population has an indicator of 1 to 4%, in children it reaches 7%.

Causes and development factors

The main provocateurs of its development are:

• heredity (identified in a third of patients), atopic bronchial asthma is the name of a disease of an allergic nature and hereditary nature;
• infections;
• professional activities associated with staying in gas-polluted areas, dust, microparticles of various substances;
• bad ecology;
• unbalanced or unhealthy diet;
• overweight.

Pathogenic microflora contributes to the development of bronchial deformation, changes in tissue structure, and increased sensitivity to external influences. Swelling reduces the gaps in the bronchi, contributing to suffocation. The protective forces of the mucous membranes fall, local immunity weakens, it is no longer regulated by the body.

Symptoms

The main signs of the disease are attacks of suffocation, which usually begin after the end of the acute period of infection, and sometimes during it. Other manifestations:

• frequent cough with purulent discharge;
• wheezing in the lungs;
• attacks of suffocation – severe, short and prolonged, sometimes lasting for several days.

The pathology has a seasonal course, the frequency of exacerbations increases with the onset of the cold season. With progression, attacks occur at any time; seasonality is no longer traceable.

Complications and features

Serious complications are possible already in the first 3-4 years from the onset of the disease. A common exacerbation is emphysema- destruction of air sacs. Exacerbations of asthma always accompany respiratory diseases. Other provocateurs of deterioration of the condition are:

• stress and nervous disorders;
• hypothermia;
• exposure to non-infectious allergens;
• weather changes;
• in women - hormonal problems.

Asthma often coexists with chronic bronchitis and obstructive pulmonary disease.

During diagnosis and subsequent treatment, the infectious-allergic nature of the disease should be highlighted, allergens should be identified and separated from its other forms.

Diagnostics

The doctor conducts a survey of the patient to identify the nature of the reactions, as well as study the hereditary factor, that is, whether there are any allergies in the family. The presence of chronic inflammatory diseases is revealed.

Subsequently, laboratory measures are carried out to identify the causative agent of infection and allergy. When making a diagnosis, well-prepared allergens are crucial. They are isolated from infection proteins.

The following studies are being carried out:

• to identify the stimulus.
• . They help determine the immediate reaction (after 20 minutes) and the delayed response (after 24-48 hours). They are not always effective, since there are common allergens for different diseases. In addition, for example, staphylococcus is present in samples from healthy people. Skin tests are usually performed on children from the age of 6 years.
• Provocative tests. They consist of introducing an allergen extract and obtaining a “shock” reaction. For rhinitis, the allergen is applied to the mucous membrane, and the degree of sensitization is determined by the appearance of swelling. For asthma, inhalation is used to obtain bronchospasm. This method is considered dangerous; it is practiced in hospitals and is not performed on children.
• Determination of the type of pathogen by blood serum, in vitro (in vitro). This method is considered the best for babies because of safety, but the results are not very reliable.
• Carrying out tests developed for the corresponding pathology, for example, the Mantoux test for tuberculosis.
• General blood test and immunoglobulin E.

The doctor chooses the best method in each specific case, based on the course of the disease and the capabilities of the laboratories.

Bronchial asthma

During the examination, it is necessary to differentiate asthma of an allergenic nature from atopic, infectious asthma, and other diseases of the lungs and bronchi.

The disease is treated jointly by a pulmonologist and an allergist. Diagnostics includes the following set of studies:

Spirometry

• analysis of blood, sputum, material from the bronchi;
• prick skin tests;
• X-ray of the lungs;
• study of external respiration functions;
• bronchoscopy.

Children undergo a more expanded range of studies:

• spirometry (after 5 years);
• blood gas test;
• exercise tests;
• tests for helminths.

Treatment

Therapy primarily involves destroying the source of infection. For this purpose, courses of antiviral or antibacterial drugs that are effective against this pathogen are prescribed. Sometimes it is necessary to change antibiotics to completely remove the microorganism.

Symptomatic therapy

Allergy treatment:

• – Cetrin (syrup from 2 years), (from one year), (from 2 years), (from a month);
• sorbents for relieving intoxication - coal, Multisorb (from 1 year);
• local remedies for skin reactions - (from a month), Elidel (from 3 months), Desetin, Protopic (from a year);
• nasal sprays - (from 6 years), Nazol (from 3 months), Otrivin (from a month), Vibrocil (from 6 years);
• eye drops - Allergodil (over 4 years), Fenistil (from a month), Vizin, Zodak (from 6 months), Lecrolin (from 4 years);
• hormonal drugs in the form of tablets, injections, ointments, sprays - are prescribed to children only in extreme cases;
• immunostimulants and vitamins.

Physiotherapeutic procedures

Physiotherapy helps improve blood circulation and speed up metabolic processes in tissues exposed to allergens. The following procedures are shown:

• electrophoresis;
• magnetic therapy;
• ultraphonophoresis;
• DMV therapy;
• massage;
• exposure to air ions.

A good effect during the period of remission is provided by sanatorium-resort treatment using mud and hydrotherapy. These methods also help strengthen the immune system.

Diet

A well-thought-out diet with g helps to remove additional provoking factors, and also saturates the body with vitamins and microelements.

Asthma therapy

The following groups of drugs are prescribed for treatment:

• inhalation of glucocorticosteroids: Fluticasone, Budesonide;
• bronchodilators in the form of inhalation and orally: Salbutamol;
• mast cell membrane stabilizers: Nedocromil;
• mucolytics and expectorants: Carbocysteine, Bromhexine.

Treatment of children is carried out according to the same scheme with reduced dosages and caution in the choice of glucocorticoids. Infectious asthma also requires the use of antibiotics to remove the pathogen. Chest massage, salt caves and other methods of climatotherapy are widely used. To reduce the severity and frequency of attacks, they often resort to the help of psychotherapists.

Prevention and precautions

Strengthening the immune system is the best means of protection against such diseases and possible allergic reactions. To do this you need:

Taking care of your health and following preventive measures will ease the course of the disease and prevent new infections. To prevent the development of infectious allergies, you need to treat all diseases in a timely manner and follow the doctor’s instructions. An active lifestyle will increase your tone and become a barrier against infections.

When identifying diseases of the respiratory organs, doctors often diagnose asthma, but in half of the cases it is infectious-related bronchial asthma, which is easily confused with bronchial asthma. So, what are the differences and similarities between these diseases?

With bronchial asthma, the clinical picture is as follows. This disease is allergic and manifests itself only occasionally, in the form of attacks of suffocation. The cause of allergic bronchial asthma is a violation of patency in the bronchi due to swelling of the mucous membranes of the respiratory tract and bronchi, and the accumulation of secretions in them. Almost 70% of children who seek medical help for any manifestation of an allergic reaction are diagnosed with bronchial asthma in the future. Moreover, the course of the disease itself is more complex in a child than in an adult.

In the case of infectious asthma, the first attack occurs in a child only after an acute infection enters the body, namely the organs of the respiratory system. It is also possible that the infection is not the main cause, but only prepares the body to simplify the impact of external allergens on it. At the same time, the permeability of the mucous membranes of the bronchi increases in the child. There are cases when infection acts as an irritant. But modern research proves that those same bacteria and their metabolic products in the baby’s body become allergens.

Infection-related asthma and its symptoms

As with other types, infectious-related asthma is characterized by the presence of attacks of suffocation or difficulty breathing. If this happens, the person immediately seeks help. Or parents monitor the child’s condition, and in case of exacerbation of the disease, contact a doctor. However, in half of the cases you may not even be aware of the presence of asthma, because it sometimes occurs without pronounced attacks of suffocation. In such a situation, the main symptom is the frequency of acute respiratory diseases. A period of frequent illness is also considered a characteristic indicator of the presence of asthma. The patient may suffer from acute respiratory infections from summer to autumn, while winter and spring pass in the complete absence of the disease.

The main symptoms of asthma are cough and difficulty breathing, which do not appear just like that, but when the situation or environment changes (for example, a dusty room, contact with pets).

Sometimes the presence of asthma can only be signaled by a cough. This symptom is typical for young children or adolescents. In this case, the cough occurs most often at night.

There is a type of asthma called bronchial asthma of physical exertion. This means that the main symptoms (cough, suffocation) do not occur during the action of the allergen or physical activity, but after some time, during rest.

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Treatment of infectious bronchial asthma

A very important step during the diagnosis of bronchial asthma is the detection of an infectious focus. In most cases, it is located in the lungs, but can also be localized in the nasal cavity and gall bladder. Tuberculosis is considered one of the types of allergic infections. There are cases in medicine where, with surgical intervention or timely treatment of a disease, a patient was relieved of bronchial asthma.

Improvement of the child's condition and complete treatment are carried out using complex therapy. It includes taking bronchodilators and performing breathing exercises to maintain normal functioning of the respiratory organs and tracts between attacks. An important point of therapy is inhalation. They help ease breathing during physical activity and reduce the effect of bronchospasm on the general condition of the body.

In the treatment of infectious bronchial asthma, anti-inflammatory drugs are often prescribed. They fight infection very well, but the downside is that they don’t start working right away. Such medications noticeably improve the condition on the third to fifth day after starting treatment, so they are not suitable for quickly eliminating an attack. But bronchodilators instantly act on the muscle cells of the body, relieve spasms, which helps stop the attack. These drugs are well accepted by the patient’s body, but do not affect general allergic inflammation, so a set of procedures is necessary to eliminate the cause.

And even when doctors notice an improvement in the clinical picture, it is necessary to continue monitoring with functional studies.

The thing is that lung function in its recovery significantly lags behind the improvement in the general condition of the body. For example, often in a child who no longer feels regular attacks of suffocation, breathes freely and does not complain of difficulties during physical activity, functional studies still show obvious disturbances in the respiratory system. Even with the complete cessation of whistling and wheezing in the lungs, the patient cannot be considered completely healthy.

This clinical picture indicates that after a course of treatment it is necessary to undergo a course of recovery. Modern treatment methods offer herbal medicine to correct possible pulmonary dysfunctions, taking into account the patient’s age and the characteristics of the diagnosis. Those plants that are used to create anti-inflammatory drugs can cope with infectious bronchial asthma. These are St. John's wort, marshmallow, medicinal calendula, elecampane, large plantain, naked licorice and other herbs that can remove infections from the body.

However, there are some features that sometimes determine the clinical picture of the disease. They are often combined in different combinations. Studying pathogenetic variants will help to better understand the nature of this disease. The most common types of bronchial asthma are infectious-related. There are other, rarer forms, which we will discuss in our article.

The exogenous version of bronchial asthma is associated with exposure to allergens - pollen, dust and others. Endogenous asthma occurs under the influence of hormonal disorders and changes in the function of the nervous system. Often these pathogenetic variants occur simultaneously, causing mixed asthma. In particularly difficult cases, an atypical form of the disease develops, however, the mechanisms of development in all forms of the disease fit into those listed below, and are carried out depending on the severity of the symptoms.

Main allergens

This is the most common allergic form of bronchial asthma. Its main variant is pollen.

In the first phase (immunological), non-infectious allergens (dust, pollen, food and drugs, animal proteins) enter the bronchi, where they activate B-lymphocytes. These cells produce IgE, or reagins, which are deposited on mast cells.
Upon repeated contact with the allergen, the second phase of allergy develops - pathochemical. The allergen immediately binds to IgE attached to the mast cell membrane. As a result, the mast cell is activated and releases chemicals - mediators:

• histamine, leukotrienes, prostaglandins, thromboxane A2, causing bronchospasm;
• chemotactic factors that attract eosinophils and neutrophils into the bronchi;
• proteolytic enzymes that damage bronchial cells;
• platelet activating factor.

In the third phase (pathophysiological), under the influence of these mediators, bronchospasm, edema and increased secretion of viscous mucus occur, and an attack develops.
Subsequently, a conditioned reflex mechanism is formed, when even a memory or the sight of an allergen can cause symptoms of the disease.

Infection-dependent bronchial asthma

Most often, its development is associated with a delayed allergic reaction, which is why this option is called infectious-allergic. Under the influence of bacterial, viral, mycoplasma infection, T-lymphocytes are activated, releasing slow-acting mediators. They act on mast cells, macrophages and other cells, causing the release of leukotrienes and prostaglandins, causing bronchospasm.
In the infectious form, an inflammatory infiltration forms around the bronchi - “impregnation” with immune cells that secrete “fast” mediators, including histamine. Eosinophils present in the infiltrate secrete substances that damage the ciliated epithelium of the respiratory tract. As a result, it becomes difficult to cough up mucus.
Sometimes, more often with fungal asthma, the development mechanism is associated with an immediate allergic reaction, as with atopy.
The infection leads to toxic damage to the adrenal glands, resulting in a decrease in the production of its own glucocorticoids. The activity of β2-adrenergic receptors, “responsible” for the expansion of the bronchi, decreases.

Dishormonal option

When the functioning of the adrenal glands is disrupted due to infection or long-term intake of glucocorticoid hormones orally, the activity of mast cells increases, the level of histamine and prostaglandins in the blood increases, which leads to bronchospasm.
With an increase in the level of estrogen in the blood, which occurs in many gynecological diseases, the activity of the transcortin protein increases. Transcortin inactivates its own glucocorticoids and also reduces the activity of β2-adrenergic receptors. As a result, bronchospasm occurs. The same effect is observed with a lack of progesterone, another female sex hormone.

Variants of bronchial asthma: primary altered bronchial reactivity

An asthma attack may occur during exercise

Such forms are non-allergic. This variant is observed, in particular, with “aspirin asthma” and “exertional asthma.” There are no immune reactions with it. Primary hyperreactivity is a congenital condition accompanied by a genetically determined increased sensitivity of bronchial receptors to the effects of pollution, cold air and other factors.

Exercise asthma

“Asthma from exertion” is associated with increased sensitivity of mast cells and bronchial muscles. When stressed, breathing quickens, more moisture evaporates from the bronchial tree, and the epithelium dries out and cools. These conditions cause the release of inflammatory mediators from mast cells and trigger the mechanism of bronchospasm.

Aspirin asthma

With “aspirin asthma,” the metabolism of arachidonic acid is disrupted. Under the influence of aspirin taken, leukotrienes are formed from this acid, which is part of cell membranes, causing spasm of bronchial muscle fibers. At the same time, the balance of prostaglandins, also formed from arachidonic acid, changes, which increases the obstruction of the airways. In addition to aspirin, all non-steroidal anti-inflammatory drugs (diclofenac, indomethacin, ibuprofen), metamizole sodium (baralgin, analgin and many others), as well as products containing salicylic acid (cucumbers, berries, tomatoes, citrus fruits) or yellow dyes ( tartrazine). This option can be medicinal or professional (for example, among nurses).

Adrenergic receptor imbalance

In the walls of the bronchi there are α-adrenergic receptors, which are “responsible” for their narrowing, and β2-adrenergic receptors, which influence their expansion. An increase in the activity of the first type of receptor and inhibition of the second is called adrenergic imbalance. It may be congenital. It is also caused by viral infections and allergic reactions.
Adrenergic imbalance can increase with a lack of oxygen in the body, acidosis (“acidification” of the internal environment), and a constant release of adrenaline. As a result, bronchospasm begins to prevail over dilating influences.

Autoimmune reactions

With the progression of atopic and infection-dependent forms of asthma, the body begins to produce antibodies directed against its own tissues - cell nuclei, bronchial muscles, lung tissue, β2-adrenergic receptors. These antibodies combine with self-antigens to form immune complexes. The latter damage the bronchi and block β2-adrenergic receptors, causing constant bronchospasm.

Neuropsychic variant

Nervous or psychogenic asthma may predominate at some stages of the disease, then giving way to others. Under stress, the sensitivity of the bronchial walls to histamine increases, so nervous tension directly affects the tone of the airways, causing bronchospasm.
In addition, emotional stress leads to increased breathing, stimulation of sensitive nerve endings with sudden sighs, laughter, and crying. This leads to a reflex spasm of the airways.

Variants of bronchial asthma: video

Watch a video in which a pulmonologist talks about the forms, types and periods of bronchial asthma.

Infection-dependent bronchial asthma is a chronic disease of the respiratory tract with a characteristic infectious-allergic form of the inflammatory process and increased bronchial reactivity to external and internal influences.

The development of this form of the disease is facilitated by numerous predisposing factors, among which hereditary predisposition in children is of no small importance. The infection-dependent form of bronchial asthma, unlike allergic asthma, involves infectious pathways of development, and the influence of allergens is of secondary importance.

Features of the course of the disease

The disease is manifested by episodic bronchial obstruction with severe coughing, suffocation and difficulty breathing. The infection-dependent form of bronchial asthma in adult patients is provoked by bacterial and viral infections, which include chronic pneumonia, bronchitis, ARVI, chronic rhinitis, etc. This type of disease is quite rare in children.

This form of the disease usually occurs between the ages of 30 and 40. An acute attack develops against the background of an infectious process with a gradual increase in symptoms. Bronchospasm is determined by a protracted course and reaches its peak 2-3 weeks after the first manifestations.

Symptoms of suffocation are quite severe and can transform into status asthmaticus. A characteristic symptomatology is a decrease in the frequency or complete disappearance of an attack of suffocation during a febrile state. Therefore, when attacks of suffocation intensify against the background of hyperthermia, it is necessary to exclude allergic symptoms, as well as syndromic asthmatic genesis and respiratory viral lesions of the respiratory tract.

In addition, there are a number of allergic diseases, especially in children, who are hypersensitive to fungi, viruses and bacteria. Infectious allergic asthma is no exception.

This disease, compared to atopic forms, is much more severe and is accompanied by complications. Choking increases gradually, but lasts quite a long time. In addition, an asthmatic attack is difficult to stop with the help of sympathomimetics and aminophylline. The cause of the development of an attack of suffocation may be previous infections, poor ecology and genetic predisposition.

Symptoms of the disease

With the development of infection-dependent bronchial asthma, the main negative symptoms are associated with the development of respiratory infections.

The most common symptom is severe shortness of breath with difficulty in exhaling followed by suffocation. In addition, symptoms can be expressed by a strong paroxysmal cough, which most often disturbs the patient at night, disturbing sleep.

In this case, the patient may feel compression in the chest area and pain when inhaling. Typically, a minimal amount of sputum is produced.

Asthma symptoms are conventionally divided into several periods

An asthma attack may stop on its own or with the help of medication.

Diagnostics

The diagnostic definition of infection-dependent bronchial asthma is, as a rule, quite difficult. The first step is a visual examination by a pulmonologist. The history and symptoms of the disease are clarified.

The next step is an examination of the respiratory tract with the possible use of medications. As a result of the examination, the expiratory type of shortness of breath is revealed. In mild cases, exhalation is much longer than inhalation and is accompanied by wheezing. In addition, prolonged exhalation slows down the breathing rate. With severe asthma, breathing, on the contrary, becomes frequent and ineffective. In this case, patients are unable to pronounce some words.

To diagnose infection-dependent bronchial asthma, the peak flowmetry method is often used. Using this drug, the maximum expiratory breathing rate is measured.

The patient can take measurements independently in the morning and evening. It is recommended to keep a special diary to record the results. When examining a patient, the doctor conducts a thorough analysis of the measurements, which greatly facilitates the diagnosis of the disease. According to the results obtained, the most effective treatment tactics are selected.

In children, diagnosis is most often carried out using spirometry, which allows one to measure the volume of breathing and the degree of disturbances in the functioning of the respiratory system. With this type of diagnosis in children, the force of exhalation made with effort (forced) is assessed, as well as the total volume of air at maximum exhalation with forced vital capacity (VC). The lower these indicators are in children and adult patients, the more severe this form of the disease occurs.

Treatment tactics

Therapeutic treatment of infection-dependent bronchial asthma directly depends on the severity of symptoms and the addition of secondary infections. The principles of treatment are united by the etiology, pathogenesis and symptoms of the disease.

Depending on the severity of the process, treatment is divided into:

1. Etiological therapy

• Relieving inflammatory processes in the respiratory system and neutralizing exacerbations of chronic exacerbations;
• includes treatment of acute inflammatory process in the respiratory system, antibacterial agents, sanitation of the bronchi according to indications;

• sanitization of infectious foci of the oral cavity and nasal sinuses (it is especially important to carry out these measures in children, due to the special structure of the respiratory system);
• performing conservative treatment during remission, and, if impossible, surgical treatment.

2. Pathogenetic and symptomatic

• Carrying out specific methods of hyposensitization, regardless of remission or exacerbation;
• implementation of complex desensitizing nonspecific measures;
• relieving obstruction with bronchodilators and mucolytics;
• if necessary, prescribing glucocorticosteroid drugs (used with caution when treating children);
• strengthening the immune system with exercise therapy, spa treatment, massage, etc.

If the measures taken are ineffective, complications may occur in the form of status asthmaticus, characterized by acute respiratory failure and depression of consciousness (coma). In addition, if the disease progresses, emphysema and chronic respiratory failure are possible.