A case of bronchial asthma in a patient with long-term cough

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Abstract

BACKGROUND: The regulatory documents determining the phthisiatric care for population do not provide diagnostics and treatment of comorbid somatic pathology with tuberculosis in tuberculosis dispansery. If patients with diagnosed tuberculosis or suspected tuberculosis need therapeutic specialists’ consultation, they have to be referred to the district polyclinic working in the medical insurance system. So, timeliness of diagnostics and chronic diseases management decreases. The course of tuberculosis becomes more complicated and lengthened. At the same time tuberculosis specificities are not taken in to account complicating comorbid pathology. For effective diagnostics and treatment tuberculosis and comorbid pathology the special algorithms of patient management were develop in Tuberculosis Dispensary No. 5.

AIM: To describe the clinical case of bronchial asthma in a 35 year old female patient as an example of effective interdisciplinary communication between general practitioner, phthisiatrician and specialists of therapeutic profile.

MATERIALS AND METHODS: Patients with suspected tuberculosis are comprehensively examined by the phthisiatrician and therapeutic profile specialists according to special developed algorithms of diagnostic search at Tuberculosis Dispensary No. 5.

RESULTS: The patient with long-term cough was comprehensively examined. Within a short time tuberculosis was excluded, bronchial asthma was diagnosed. The effective treatment of asthma and a plan of further patient flow-up in the district polyclinic was recommended.

CONCLUSIONS: An experience of the interdisciplinary communication phthisiatricians and specialists of therapeutic profile who have entered the department of medical-social care and rehabilitation demonstrated the relevance and appropriateness in diagnostics of tuberculosis and concomitant chronic uninfection diseases, that let minimize risks of cross adverse effects and choose the optimal tactics of patient management.

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About the authors

Irina V. Yubrina

North-Western State Medical University named after I.I. Mechnikov; Tuberculosis Dispansary No. 5

Email: zav-monitoring@ptd5spb.ru
ORCID iD: 0000-0003-4442-3171
SPIN-code: 3387-5719

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

Igor A. Bozhkov

North-Western State Medical University named after I.I. Mechnikov; Tuberculosis Dispansary No. 5

Email: glvr@ptd5spb.ru
ORCID iD: 0000-0001-5586-9633
SPIN-code: 7240-8346

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg; Saint Petersburg

Ludmila N. Degtyareva

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: ludmila.degtyareva@szgmu.ru
ORCID iD: 0000-0001-8375-3363
SPIN-code: 5942-8540
ResearcherId: O-4144-2014

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Denis V. Karostik

Tuberculosis Dispansary No. 5

Email: d.karostik@gmail.com
ORCID iD: 0000-0003-3284-1421
SPIN-code: 8161-1338
Scopus Author ID: 57201056270
Russian Federation, Saint Petersburg

References

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  11. Prikaz MZ RF ot 15 noyabrya 2012 goda No. 932n “Ob utverzhdenii poryadka okazaniya meditsinskoi pomoshchi bol’nym tuberkulezom”. (In Russ.)
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  14. Bozhkov IA, Balasaniantc GS, Yubrina IV, et al. Temporary recommendations for the diagnosis, treatment of tuberculosis and dispensary observation in TB organizations during the COVID-2019 epidemic. Saint Petersburg; 2020. (In Russ.)

Supplementary files

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1. JATS XML
2. Fig. 1. The result of the test for anti-SARS-CoV-2, spike (S) protein, IgG

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3. Fig. 2. Chest x-ray of patient K.

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4. Fig. 3. Spirometry (left data) and bronchodilation test (right data) of patient K. The required values are used, R.F. Clement et al. in 1984. Conclusion: technical acceptability and reproducibility of respiratory maneuvers are satisfactory, vital capacity and forced vital capacity are within the normal range, airway flow abnormalities are not revealed. Bronchodilatation test with Salbutamol at a dose of 400 mkg is positive. Bronchial obstruction reversible (forced expiratory volume in the first second growth is 18.47 % — 530 ml)

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5. Fig. 4. Electrocardiogram of patient K. Р — 100 ms; РR — 130 ms; QRS — 97 ms; QT — 382 ms; QTс — 416 ms; RR — 840 ms; heart rate — 71 b/min; angle α: +67°. Transition point — V3. Cardiac axis is normal. Rhythm is sinus, regular. Repolarization processes are intact. Electrocardiogram is a normal variant

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Copyright (c) 2022 Yubrina I.V., Bozhkov I.A., Degtyareva L.N., Karostik D.V.

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