Bronchial asthma of moderate severity disability. Rules for obtaining disability with bronchial asthma

Bronchial asthma is one of the most common ailments. Approximately 10% of people worldwide suffer from it.

The disease is characterized by such manifestations as respiratory failure and cough syndrome, for this reason it is strictly forbidden to work in harmful conditions. Many people are interested in whether disability is given for bronchial asthma, and what is required to assign a group.

You can get a disability group, but it is worth considering that it is assigned depending on the degree of disorders that have developed in the patient's body since the discovery of the disease.

If minimal changes are detected, the patient is refused.

The Medical Commission, as a rule, draws attention to such points:

• frequency and duration of asthma attacks;
• the impact of the disease on the functions of the heart and lungs;
• the severity of the disease;
• whether the patient is dependent on hormonal medications.

Before becoming disabled with bronchial asthma, a person will have to prove that the disease is diagnosed correctly, as well as undergo an examination to establish the stage of the disease. A child, for example, is sent for a medical examination only 6 months after the diagnosis of this disease.

Criteria for establishing disability

Although the disease is serious, according to MSEC specialists, it is quite possible to fully live and work with it. In itself, this disease is not a reason for assigning a disability. A person diagnosed with asthma is not always completely or partially disabled. This happens due to some reasons:

• the development of bronchial asthma occurs at a slow pace;
• during the diagnosis of the disease, the well-being of an adult or a child is quite satisfactory. An asthma attack occurs in rare cases, and it can be easily stopped;
• there is no severe respiratory or cardiovascular insufficiency;
• the patient for many years is able to lead a fairly active life, study or work;
• the development of the disease is stopped.

With the right lifestyle, diet, rest in sanatoriums, as well as the use of medicines, the progression of the disease can be prevented, and health will not worsen.

Before starting to apply for disability for asthma in adults, you need to get advice from your doctor. Moreover, even if there are doubts, he should still refer you to the medical and social expert commission (MSEC).

How is disability group determined for asthma?

Asthma disability is prescribed only if there is a persistent, long-term severe or moderate disorder in the functioning of the respiratory organs, due to which the patient's life is significantly worsened.

The presence of asthma attacks, which are removed by the patient with the help of basic medicines prescribed by a doctor, does not constitute a reason for assigning a disability. Consider how the disability group is determined in asthma.

First group

The first group of disability in bronchial asthma is given to patients with a severe persistent form of the disease. It notes:

• status asthmaticus, daily asthma attacks at any time of the day;
• the occurrence of severe and moderate exacerbations, removed in the hospital, more than 5 times a year;
• FEV-1 (PSV) below 60%, differences in performance over 30%;
• every day, the use of corticosteroids is required, the daily dosage exceeds 1000 mcg (sometimes in combination with glucocorticosteroids);
• dependence on systemic corticosteroids. Due to a decrease in dosage, respiratory function may worsen;
• shortness of breath on the MRC scale 2 degrees (respiratory failure 2). Appears even at rest with a respiratory rate of 25-30 times per 1 minute. Or grade 3 (respiratory failure 3) - the presence of severe shortness of breath with a frequency of more than 30 times within a minute, even while sitting, leaning forward and with emphasis on the hands;
• An x-ray showed bronchial obstruction. The formation of respiratory and heart failure is observed.

There is a limitation of vital activity in relation to movement, self-service - 2 stages, working capacity - 2 or 3 stages. It is possible to control this type of ailment in part or not at all.

For recurrent extremely severe asthma, the following features are characteristic:

• systematic acute attacks of suffocation at any time of the day. It is impossible to control the disease;
• to stop the attack, you have to administer a large dose of medication. The daily dosage of inhaled corticosteroids is more than 1000 mcg;
• the dose of glucocorticosteroid drugs is more than 20 mcg;
• indicator on a scale of shortness of breath - 3-4 degree. There is no ability to endure even the smallest physical and emotional stress;
• DKhNZ;
• formation of pulmonary and extrapulmonary complications. The appearance of shortness of breath at rest;
• restriction regarding independent maintenance and work - 3-4 degrees.

Persistent severe asthma cannot be controlled. Against its background, respiratory and heart failure of 2-3 degrees develops.

Second group

The second group of disability is determined by persistent bronchial asthma of moderate severity, which is characterized by the presence of such signs:

• during the day, there is an occurrence of asthma attacks more than 3 times during the week or every day, and at night - more than 1 time during the week;
• the development of an exacerbation is observed a maximum of 5 times during the year, the attacks are removed by means of glucocorticosteroid drugs;
• the daily dosage of a glucocorticosteroid inhalation agent is a maximum of 1000 mcg;
• short-term 2-agonists are prescribed for everyday use;
• FEV-1 (PSV) ranges from 80-60%. The difference in FEV-1 is more than 30%;
• there is a possibility of insensitivity to 2-agonists, therefore, an increase in PSV is observed during testing. After exercise, there is a decrease in expiratory power (up to 20%);
• respiratory failure of the first degree is characterized by shortness of breath with a respiratory rate of 20-25 times per minute, which increases after minimal physical exertion;

Specialists establish violations of the respiratory function and restrictions on motor activity and disability of 2-3 degrees. This form of the disease can be partially controlled.

Third group

Patients with bronchial asthma are given disability of the third group if the functionality of the respiratory system is slightly impaired.

Intermittent asthma is characterized by the presence of the following symptoms:

• the frequency of asthma attacks in the daytime - no more than once every 7 days, at night - no more than 2 times in 30 days;
• there is a development of a short-term exacerbation of a maximum of 1 time in 12 months;
• there is no need for the use of glucocorticosteroid drugs.

Persistent asthma is characterized by the following symptoms:

• asthma attacks during the day a maximum of twice a day, no more than 1-2 episodes during the week, and at night more than 2 short-term cases in 30 days;
• the development of exacerbation is observed 1-2 times during the year;
• seizures are relieved with an inhalation aerosol;
• indicators of respiratory failure: the level of FEV-1 (or PSV) more than 80%. Change in FEV-1 during the day less than 20-30%;
• when conducting a test with salbutamol, an increase in FEV-1 by more than 20% is observed. On a sample of PSV using 2-agonists, an increase of more than 15% is observed.

No obstruction was found on x-ray. This form of the disease is well controlled and treatable.

When determining the level of disability, any serious change in well-being for the worse must be documented.

Respiratory disorders and deterioration in the quality of life are determined by the presence of serious exacerbations (status asthma), which are removed only with the help of medical professionals.

How to get disabled with bronchial asthma

Let's discuss which disability group is assigned to a person with asthma. The definition of disability is determined by how the disease proceeds, and by certain indicators, the decision is made by an expert commission. With such an ailment, both the third or second, and the first group are assigned.

In each case, based on how the disease proceeds, the appropriate disability group is assigned, regardless of the patient's gender and age. With appropriate symptoms, both an adult and a child are given the same disability group.

Disability of the first group

This disability group is determined in severe bronchial asthma, when special medications and hormonal agents do not bring an effect, and the disease continues to progress. Such a course of the disease is a serious reason for issuing a disability. MSEC focuses on the following points:

1. The patient's health continues to change for the worse despite treatment.
2. There is a significant difficulty in breathing during movement and at rest. Fixed shortness of breath.
3. There are heart problems.
4. Complications from other organs and systems of the body are fixed.
5. The person is completely disabled.
6. Due to the inability to move independently, the patient needs outside help all the time.

Disability of the second group

This disability group for asthma is assigned at 2-3 degrees of severity of the disease. In this case, the commission pays attention to the following nuances:

1. The functions of the respiratory organs are significantly impaired even with the least physical exertion.
2. Cardiac disorders develop.
3. Observed violations of the peripheral circulation.
4. The risk of developing diabetes mellitus increases due to the effects of hormonal drugs.
5. There is a sharp limitation in the ability to self-service.
6. The patient is unable to function properly.
7. The patient needs special conditions for work.

Disability of the third group

Patients with asthma are given disability of the third group if the disease occurs in mild and moderate form. In this case, ITU specialists are interested in the following features of the disease:

1. At the slightest physical exertion, respiratory failure occurs.
2. A person can not cope with the usual work.
3. There are some restrictions in independent movement and self-service.
4. There is a need to change the place of work or type of work activity.

When the disability expires, the patient should go through a second medical and social expert commission in order to obtain confirmation of his group.

With a significant improvement in the patient's health and the transition of the disease to a milder degree, the group may be reconsidered or the disability may be completely removed.

Consider how to get a disability for a person with asthma. To find out how to apply for disability with asthma, you need to consult a doctor. The patient can submit documents for recognition of incapacity for work independently or this is done by the official who represents him.

The attending physician does not prescribe disability. To make a decision on the assignment of a disability group, it is necessary to contact a group of experts of the medical and social expert commission.

The passage of the commission is prescribed if the patient has signs of persistent disorders of respiratory functions during the development of an attack of moderate or moderate severity. These include:

• frequent attacks in acute form at night - up to 3 times during the week, in the daytime - more than 4 times per month;
• dependence on taking hormonal drugs;
• short-term remission (less than 3 months) without seizures;
• bronchial patency is less than 80-60%, and lability is 20-30%;
• hyperreactivity of the bronchial system is not reduced by doses of an inhalation agent; in order to stop an attack, the help of doctors is needed;
• due to respiratory failure, it is impossible to work fully (and in childhood to be in kindergarten, school);
• moderate uncontrollable or diagnosed more than 6 months before the commission.

What is needed for registration

In order to be issued a disability group for bronchial asthma, it is necessary:

1. Visit the attending doctor to obtain a certificate of illness, in order to pass the MSEC and determine whether disability is due to this illness.
2. Pass a medical examination at the place of registration. In addition, an important requirement is to fill out the documentation in accordance with a special form.
3. When the medical commission is passed, the attending physician issues a referral for an expert assessment.
4. The patient is scheduled for an examination. For the examination, you will need a referral, passport, medical insurance and a certificate from the medical commission. A referral for a medical examination is issued by a pulmonologist.

If the patient is being treated in a hospital, then all the necessary examinations and examination of respiratory functions are carried out in a hospital setting.

When collecting documents during outpatient treatment, the patient should be examined by an otolaryngologist, neurologist, surgeon, cardiologist and endocrinologist to identify possible changes in the functioning of the body.

In addition, during the medical examination, the patient must:

• pass a general analysis of urine, sputum and blood;
• take blood and sputum for biochemical examination;
• undergo an X-ray examination of the organs of the chest cavity;
• make an ECG;
• pass peak flowmetry, spirography;
• do an allergen test;
• undergo other examinations (doplerechocardiography, rheography of the pulmonary artery, and others), if necessary.

The results obtained should be recorded in the patient's outpatient card. The doctor draws up a certificate and a referral to MSEC. If the doctor thinks that the patient is not entitled to a disability, and the disease is perfectly controllable, he still must refer the patient to the ITU with the note "at the individual request of the patient."

When a disability is issued, an asthmatic is entitled to the following privileges:

• free or with a 50% discount to receive medicines;
• preferential sanatorium treatment;
• preferential mortgage, waiting list for an apartment;
• improved working conditions for people with asthma;
• there is an opportunity to receive a free voucher for treatment every year.

Disability in bronchial asthma in a child

Consider how to get a disability if a child is diagnosed with asthma. Asthma disability is assigned to children if:

1. Due to illness, the child is not able to fully learn.
2. The kid is limited in self-service or free movement.
3. There are circulatory disorders, the work of the endocrine or respiratory system.
4. The development of irreversible complications is diagnosed, attacks occur quite often.
5. The child needs improved conditions for life, study and outside help.

The Medical Commission draws attention to the following points:

• the frequency of asthma attacks in a baby during the day and at night per day and week;
• daily dose of medicines;
• changes in the activity of the child in the daytime, whether he sleeps calmly at night;
• the presence of respiratory disorders before diagnosing the disease and after that.

If a disease is diagnosed in a child, this does not mean that there is no need to determine the disability group. Even if the child does not work, he needs treatment, and he also needs to receive benefits and benefits.

For the appointment of disability in the presence of asthma in children, it is also necessary to first consult with the attending physician. Otherwise, the actions are the same as for adults, the only difference is that the child needs to be accompanied by an official representative.

In order to issue a disability to a child, the ITU needs to provide the following documentation:

• birth certificate;
• child's outpatient card;
• referral from a pediatrician;
• medical insurance;
• an application for a disability, which is filled out by one of the parents or another representative of the child.

Even if the doctor does not consider that it is necessary to send a child with asthma to the disability group, he should do it. In such a case, the reasons should indicate: “according to the will of the guardian of the child”.

A child with asthma can also enjoy certain benefits. Among them:

• free use of public transport;
• before the age of 15, dairy products and medications are provided free of charge;
• parents are entitled to several additional days off, in addition, they are relieved of working overtime, working at night and traveling on business trips;
• mother with asthma is entitled to benefits in the form of early retirement.

Finally

A person with asthma is not always assigned a disability group, but there is a possibility of obtaining it, this chance should not be ignored.

Answering the question whether a person is given a disability when bronchial asthma is diagnosed, it should be said that there is such a possibility. It may not be easy, but it is possible to get a group, since an asthmatic is entitled to some benefits.

Is disability due to bronchial asthma is a question that is quite common among sick people. The emergence of such a question occurs for the simple reason that bronchial asthma is included in a group of diseases that are difficult to treat and for which relapses often occur. In addition, with bronchial asthma, serious complications are possible, which will only aggravate the severity of the disease. Bronchial asthma is a long-term and extremely dangerous disease, which is characterized by periodic attacks of moderate and severe severity. Over time, its manifestations only intensify, attacks become more frequent, and the state of health of a sick person worsens. Even without exacerbations, patients, especially children, complain of severe weakness and decreased vitality. People suffering from a similar illness, with moderate and severe severity of the disease, constantly experience lack of air and extremely poor health.

Rules for referral to ITU.

In what cases is the third group of disability given?

The third group of disability in bronchial asthma is assigned to those patients (both children and adults) who have a mild or moderate severity of the disease. In addition, the patient must undergo a hormonal treatment course. The main criteria for the appointment of this group are the following features:

The patient has respiratory failure.

Symptoms of bronchial asthma occur even with daily physical exertion.

Frequent seizures make it impossible to engage in normal work activities.

A person cannot independently serve and move around.

There is a need to change the type of work and reduce the amount of work performed.

If such signs and symptoms are observed in a patient, then he is given a third disability group for bronchial asthma. With deterioration, or vice versa, improvement, the group can be revised or completely canceled.

In what cases is the second group of disability given?

The second group of disability is already given to those patients whose disease has become moderate and severe. Within this group, there is a pronounced deterioration in the physical and emotional state of a person, as well as the following signs and symptoms:

Difficulty breathing and the manifestation of this symptom is constant, with minor physical work.

Heart failure and impaired peripheral circulation.

Limitation of vital activity during self-service and the implementation of work activities.

The presence of special conditions that will allow a sick person to work.

Inability to perform a number of professional tasks.

Such signs make it possible for a sick person to issue a disability of the second group, which can also be revised if the state of health worsens or improves. Children can also be given a disability, based on the signs listed.

When is the first group given?

Registration of the first group of disability occurs in relation to those patients (both children and adults) whose condition can be identified as an acute degree of severity. Also, patients experience a constant deterioration in health, despite the fact that various therapeutic measures are being taken against the patient. The main factors determining the appointment of the first group of disability can be considered the following:

Permanent treatment does not give the desired effect. Moreover, the condition of a person from this treatment is constantly deteriorating.

The patient has pronounced respiratory failure, constant shortness of breath, sometimes emphysema develops.

Heart failure becomes stable.

There are pathologies and difficulties in the work of the internal organs of a person.

The patient cannot independently serve and move around.

A person is not able to perform any work, including labor activity.

Only an improvement in the patient's well-being and the transition of the disease from a severe form to a moderate and mild severity will make it possible to revise the disability group and allow a person to carry out any kind of labor activity.

Conclusion

Bronchial asthma is a type of disease that can completely limit the life of both adults and children. The disease is very long and can quickly go from mild to moderate and even severe. The particular danger of the disease lies in the fact that therapeutic treatment does not always help, and sometimes even gives severe complications, especially with bronchial asthma in children.
In this case, the patient is no longer able to serve himself on his own and needs constant medical supervision. Disability can belong to one of three groups, each of which has its own clinical picture. For an easy degree, only a partial restriction of work duties is provided, but for an average and severe degree, a complete exemption from work and any physical exertion is required.
Consideration of such cases is carried out by a special commission, and each case is studied individually. Disability is appointed by the head physician of the medical institution, after which the patient begins to receive the appropriate allowance. This approach will help sick people get the necessary support without aggravating their situation with additional physical exertion.

Titles

Quite common are cases when patients are given disability with bronchial asthma. This disease can have a different form and severity of course, cause complications and concomitant diseases - all this draws the attention of the MSEC, each of the aspects can affect its decision.

Main characterizing points

For registration of disability in bronchial asthma, several conditions must be met, careful preparation is required.

Analysis of the changes that have occurred in the body since the diagnosis. In order to get a disability, it is not enough just to have a disease. Of great importance are the violations of the functioning of the body systems to which it has led. This is especially true of bronchial asthma, which is not an indication for disability and does not directly lead to it. Such disorders include frequent complications that accompany it: suffocation, the attacks of which can be frequent and prolonged; heart or lung failure; inflammation in the lungs, which has a chronic form; the patient's dependence on hormones.

The diagnosis is usually made in the clinic at the place of residence, while the development of the disease is quite slow, but a complete cure is rare.

In the initial stages, the patient is quite successfully helped by modern medicines that can stop asthma attacks, thanks to which a person gets the opportunity to maintain good health for quite a long time. From time to time, hospital examination and treatment is necessary. Years later, the patient, as a rule, feels a deterioration in well-being, a decrease in the ability to work and an active lifestyle.

After making a decision on obtaining a disability, the first thing to do is to contact your doctor. He must give a referral for the passage of an internal medical commission and a certificate intended for a medical and social examination, even if the doctor does not find grounds for registering a disability. In any case, he will be able to change the treatment strategy, if the current one is not effective enough, send him to consult additionally with related specialists.

The internal medical commission, which can be referred by a pulmonologist or therapist, includes a number of laboratory tests, radiography, electrocardiography and shorthand, examination of narrow specialists. Depending on the severity of the disease and existing complications, additional diagnostic measures may be required. For example, long-term use of hormonal drugs requires a conclusion about the functioning of the adrenal glands.

After completing the visits to all the specialists to whom there is a referral, passing all the tests and receiving their results, you should return to your doctor again. Based on the results obtained, they will enter the necessary data into the patient's card, after which he will be able to issue a referral for the ITU. If there are disagreements with the patient and the doctor sees no reason for the examination, he will make a note “At the request of the patient”.

Next, you need to make an appointment with the ITU Bureau at the place of residence for an appointment. On the day to be appointed, you will need to appear at the commission for a direct examination. With you, in addition to the received medical certificates and referrals, you need to have an identity document and a compulsory medical insurance policy.

During the examination, the experts will take an interest in well-being, living conditions, peculiarities of work activity and other details that, together with the medical information provided, will help to make a complete picture of the patient's condition and make the necessary decision. As a result of passing the ITU, a disability group will be assigned or denied. Each patient has the right to challenge the decision received at the Regional Head Office. If this result is not satisfactory, then further it is necessary to go to court.

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Groups of disability in bronchial asthma

If the patient has a disease of mild or moderate severity, which leads to a limitation of the person's ability to self-service, movement and work, then they usually give the third group of disability. At the same time, some restrictions are imposed on working conditions. Such people are forbidden to work in hazardous industries, in dusty, gassed rooms, where access to fresh air is limited. If an employee is forced to work in conditions that are contraindicated for him, then his qualifications should be reduced, and the volume of daily activities in production should be reduced.

Patients whose disease has an average and high severity of the course and is accompanied by pronounced disorders in the functioning of the respiratory, circulatory and endocrine systems can become disabled of the second group. Their main disease is often accompanied by diabetes, renal failure. It is difficult for such people to serve themselves on their own, learn something new and work. Workplaces should be specially equipped for such disabled people at the workplace. If professional skills allow, work at home is possible.

The severe course of the disease, which only progresses and has irreversible complications, gives grounds for assigning the first group of disability to the patient. At the same time, labor activity, if possible, is with significant restrictions.

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Statutory Benefits

Already at the time of diagnosis, a patient with bronchial asthma is entitled to free medicines.

It is usually much easier for children to get them: it is enough, being registered, to consult an allergist or pulmonologist. For adults, you will need a certificate from the Pension Fund stating that the right to receive free medicines has not been lost.

Patients with bronchial asthma require rehabilitation treatment. This is quite difficult to do in an urban environment, so such people are also entitled to vouchers for spa treatment. Such a rehabilitation program in pulmonology is aimed at ensuring control over the course of the disease in its non-acute phase using the least amount of medication.

People with this disease can count on receiving additional living space.

The current legislation provides for a number of benefits related to children and their guardians.

These include the following:

• free travel in public transport;
• benefits for payment of utility bills;
• children under the age of 15 are entitled to preventive products, which in this case include milk;
• a patient with a disability is entitled once a year to free travel to the place of treatment;
• children with bronchial asthma and their parents are given the opportunity to purchase treatment vouchers at a reduced price;
• mothers of children with disabilities are entitled to additional leave, as well as a work schedule that does not include night shifts and overtime work.

Bronchial asthma is an intractable and dangerous disease that occurs due to a very acute reaction of the airways to irritants. If a person with such a diagnosis can somehow adapt the domestic sphere of life to the limitations of the disease, then he has no power over working conditions. And they can be dangerous for him, given his illness.

Bronchial asthma and disability

A person with a similar diagnosis will have problems with working capacity:

• The workplace may not have the necessary conditions for safe work;
• A patient due to an illness may lose the possibility of employment in the field of his qualifications;
• Due to aggravating factors, the patient's condition may deteriorate sharply, which directly affects his professional abilities.

The disease every year is able to take more and more severe forms, a person can significantly or completely lose his ability to work.

Can. However, it must be remembered that disability is assigned depending on the degree of violations that have occurred in the patient's body since the moment the disease was discovered.

And if the violations are minor, the person will be refused.

The medical commission usually pays attention to:

• How often do the attacks of suffocation recur and how long do they last?
• The effect of asthma on the functioning of the heart and lungs;
• The development of a chronic inflammatory process in the lungs;
• The presence of hormonal dependence in the patient.

Before applying for a disability, you should consult with your doctor.

And even if he doubts, he will still be obliged to give a certificate for passing the ITU.

Children with such a diagnosis of disability are assigned on the following grounds:

1. Because of the illness, the child is limited in the ability to learn.
2. He cannot groom himself or move freely.
3. There are disturbances in the circulatory system, in the endocrine system and in the respiratory function.
4. Irreversible complications were diagnosed, health problems appear very often.
5. The child needs improved living conditions, education and outside help.

The Medical Commission will pay attention to:

• The number of asthma attacks in a child day and night during the day and week;
• The number of medications he needs throughout the day;
• Change due to illness of the rhythm of the child's activity during the day, the calmness of his sleep at night;
• The ease and freedom of his breathing before and after the diagnosis.

Depending on how severe the disease turned out to be for the body, a person can be assigned groups 1, 2 and 3.

Third group

Assigned to a mild form of bronchial asthma, however, the disease in such a case is diagnosed at an intermediate stage.

The symptoms on the basis of which the ITU gives the third group are:

• Difficulty breathing, insufficient oxygen supply, with physical exertion, it becomes more difficult for a person to breathe;
• Man cannot work at all;
• Due to the disease, problems arise with self-care, and freedom of movement is also limited.

In this case, the patient will be given:

• Reduction of the work load or restriction of labor activity;
• Half-holiday;
• Restriction on work with harmful substances.

Second group

Assigned upon detection of violations in the functioning of the lungs, with problems with the hormonal background and with the endocrine system.

The reasons for the second group are:

• Severe respiratory failure, obvious even with the most minimal physical exertion;
• Development of heart failure;
• Development of circulatory disorders;
• The presence of the consequences of hormone therapy: diabetes or problems with the work of the adrenal glands;
• Inability to take care of themselves and work independently.

First group

Assigned to the most severe form of bronchial asthma. In such cases, the consequences of the disease become irreversible, and deterioration occurs even after special therapy.

The grounds for assigning the first group are:

• Steady complication of the disease, regardless of the treatment;
• Persistent respiratory failure, shortness of breath at rest, often - emphysema;
• Serious problems in the work of the cardiovascular system;
• Severe disturbances in the activity of internal organs;
• The need for ongoing assistance with personal care and mobility;
• Inability to work at all.

What do you need to apply for disability status?

You will need to contact the doctor so that he gives a direction for the passage of the ITU.

You will need to collect the results of the following tests:

You must contact the bureau to set a date for the commission.

Come to the examination, taking with you:

• The passport;
• Compulsory health insurance policy;
• Referral for examination;
• Test results and other documents that confirm the severity of the disease.

The event is held by specialists who determine whether a person really needs social protection measures due to his health.

Such an examination can be carried out both in the office at the place of residence of the patient, and at home, if he is unable to come to the office due to health problems.

ITU runs as follows:

• After reviewing the submitted documents, experts can ask clarifying questions.
• Next, the patient is examined, in this case it is necessary to have a clean sheet with you, since the examination takes place when the patient lies on the couch.
• After examination by a majority of votes, the experts make a decision, however, if there are controversial points, they can ask to be examined.
• The decision will be announced in the presence of all the experts who carried out the procedure, and an act will be drawn up, which will subsequently be approved by the Ministry of Health.

The decision of the ITU is subject to appeal, the experts are obliged to explain the procedure for the necessary actions for this.

In the case when it comes to children, disability is assigned only in a severe or moderate form of the disease. With a mild child, over time, the disease can “outgrow”.

It is also worth remembering that if allergic asthma is indicated in the medical report, then the patient will be denied disability.

In such a situation, it is necessary to undergo a complete examination for allergies in order to exclude this possibility. And then you can appeal the decision of the ITU.

A doctor's call to a patient with an asthma attack should be officially registered, as this can be useful in obtaining a disability.

Bronchial asthma(BA) is a chronic inflammatory disease of the respiratory tract, which involves mast cells, eosinophils and T-lymphocytes. In susceptible individuals, this inflammation leads to repeated episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and/or early morning. These symptoms are accompanied by widespread but variable obstruction of the bronchial tree, which is at least partially reversible, spontaneously or under the influence of treatment. Inflammation also causes a friendly increase in airway response to various stimuli.
Epidemiology. According to studies, from 4 to 10% of the adult and 10-15% of the child population of the world suffer from asthma. Etiology and pathogenesis. In the etiology of the disease, 5 groups of factors are distinguished, which, under certain conditions, lead to the progression of congenital and / or acquired biological defects of the bronchi, lungs, immune, endocrine and nervous systems. These factors include infectious allergens (pollen, dust, industrial, medicinal, allergens of mites, insects, animals, etc.); infectious agents (viruses, bacteria, fungi, etc.); mechanical and chemical irritants (metal, wood, silicate, cotton dust, acid and alkali vapors, fumes, etc.); physical and meteorological factors (changes in temperature and air humidity, fluctuations in barometric pressure, etc.); neuropsychic stress effects.
The main role in the pathogenesis of asthma is played by chronic inflammatory processes. There is a clear relationship between inflammatory changes in the mucous membrane of the respiratory tract with bronchial hyperreactivity and the degree of bronchial obstruction. The implementation of hypersensitivity of the tracheobronchial tree is manifested by a characteristic triad - bronchospasm, mucosal edema and hypersecretion, and can be caused by both immunological and non-immunological mechanisms.

Risk factors for the onset and progression of the disease:

1. Heredity (if one of the parents is sick - the probability of the disease in children is 20-30%, if the parent is sick with asthma - 75%).
2. Prolonged contact with household and professional allergens
(house dust, allergens of indoor plants, animals, mushrooms, food products); Occupational asthma is characterized by the dependence of the onset of the disease on the duration and intensity of exposure to the causative factor (the absence of a previous respiratory symptom, the development of symptoms no later than 24 hours after contact with the causative factor at work, the elimination effect; the prevalence of cough, wheezing and shortness of breath in the clinical picture).
3. Chronic infection of the lungs.
4. The presence of prolonged or intense psycho-emotional stress.
5. Increased tone of the parasympathetic division of the autonomic nervous system.
6. Endocrine disorders (hyperthyroidism, fibromyoma, adrenal insufficiency).
7. Features of the development of children: high levels of immunoglobulins E, early artificial feeding, dysfunction of the gastrointestinal tract, food and drug allergies, frequent acute respiratory infections, passive smoking.

Classification.

According to the international nomenclature, the following forms of BA are distinguished:

1. Immunological (exogenous, atopic).

2. Non-immunological (endogenous).

3. Mixed.

In clinical practice, the classification of BA according to severity is used:
light, medium and heavy.

Clinical picture and diagnosis.

The main clinical manifestations of asthma are paroxysmal cough,
feeling of choking or difficulty breathing; hard breathing; wheezing and buzzing rales, the attack is completed by the separation of viscous sputum, after which breathing becomes freer and dry rales gradually disappear.

Laboratory data: eosinophilia in the blood, sputum changes (Curshman spirals, eosinophils, Charcot-Leiden crystals); positive results of allergological tests and an increased content of immunoglobulin E (with an immunological form); determination of indicators of the activity of the inflammatory process (with non-immunological asthma).

Current and forecast. With a mild intermittent (episodic) course of BA
exacerbations of the disease occur 1-2 times a year; asthma attacks are mild, short-term, less than 1 time per week, nighttime - less than 2 times a month, they are stopped on their own or using inhalers. In the interictal period, there are no signs of bronchospasm, the function of external respiration is within the normal range: FEV1, PSV> 80%, daily variability (daily fluctuations in PSV) -15-20%. In most cases, it is atopic asthma.
With BA of a mild persistent course, asthma attacks occur 1 time per week or more often, but less than 1 time per day, night attacks - more than 2 times a month; exacerbations of the disease can disrupt activity and sleep; PSV more than 80%, daily variability 20-30%.
With moderate asthma, asthma attacks can be daily, night attacks - more than 1 time per week; symptoms disrupt activity and sleep; daily intake of short-acting b2-agonists is required; FEV1 and PSV within 80-60%, daily fluctuations in PSV over 30%.
Severe asthma is characterized by persistent symptoms during the day, frequent exacerbations with severe asthma attacks, frequent nocturnal attacks; physical activity and quality of life are significantly reduced; FEV1 and PSV less than 60%, daily fluctuations in PSV more than 30%.

The prognosis of the disease, in addition to the severity of the course, is determined by the severity
complications: 1) pulmonary complications: status asthmaticus, pulmonary emphysema, respiratory failure, atelectasis, pneumothorax, thromboembolism of the pulmonary artery and its branches; 2) extrapulmonary complications: chronic cor pulmonale, heart failure, hypoxic ulcers, etc.; 3) complications of AD treatment: steroid diabetes, steroid ulcers, osteoporosis, steroid obesity, secondary adrenal insufficiency, etc.

Principles of treatment. In the treatment of AD currently used "stepped"
an approach in which the intensity of therapy increases (step up) if asthma worsens and decreases (step down) if asthma is well treated. The least severity of asthma is presented in stage 1, the greatest - in stage 4.
Prophylactic drugs for long-term use - basic therapy: inhaled corticosteroids (beclomethasone dipropionag, budesonide, fluticasone propionate, aldecine, beclocort, etc.); non-steroidal anti-inflammatory drugs (sodium cromoglycate and nedocromil are effective in preventing bronchospasm provoked by allergens, exercise and cold air); long-acting b2-adrenergic agonists (salmeterol, formoterol); theophyllines of prolonged action; leukotriene receptor antagonists (zafirlukast, montelukast - improve respiratory function, reduce the need for (short-acting b2-agonists, effective in preventing allergen-induced bronchospasm, exercise); systemic corticosteroids. actions (salbutamol, fenoterol, terbutaline, etc.); anticholinergics (ipratropium bromide, berodual); systemic corticosteroids (prednisolone, etc.); short-acting theophyllines (eufillin, aminophylline).

WUT criteria. During the exacerbation of BA, patients are temporarily unable to work. At
non-immunological, mixed forms of BA, the terms of treatment are determined by the nature and severity of the infectious exacerbation, the effectiveness of treatment, the severity of complications (DN, decompensation of chronic pulmonary heart): mild course - up to 3 weeks; moderate severity - 4-6 weeks; severe course - more than 6 weeks.
With immunological asthma of a mild course, the period of temporary disability is 5-7 days, of moderate severity - 10-18 days, of severe course - over 35 days. (depending on complications, effectiveness of therapy).

Criteria for mild asthma:
attacks no more than 1 time per month, mild, quickly stopped (with bronchodilators or on their own); there are no night attacks or they are rare, do not affect the child's sleep and his physical activity; outside the attack, there are no signs of bronchial obstruction, remission lasts up to 3 months or more, the physical development of the child does not suffer; forced expiratory volume and average daily bronchial patency - 80% and above, average daily bronchial lability - below 20%; basic treatment is either not carried out, or is carried out with drugs of the intala group.

Criteria for moderate asthma:
asthma attacks of moderate severity, with impaired function of external respiration, 3-4 times a month; night attacks up to 2-3 times a week; the child's physical activity is reduced, sleep is disturbed, physical development does not suffer; out of an attack, clinical and functional remission is incomplete, its duration is less than 3 months, relief of an attack is possible with the use of inhaled bronchodilators or parenteral corticosteroids, the average daily bronchial patency is 60-80%, the average daily bronchial lability is 20-30%; basic treatment is carried out with drugs of the intal group, and if they are ineffective
medium dose inhaled corticosteroids.

Criteria for severe bronchial asthma: asthma attacks almost daily and almost every night, which disrupts the physical activity, sleep and physical development of the child; in the interictal period, the phenomena of bronchial obstruction with signs of ARF persist, the duration of incomplete remission is no more than 1-2 months; for the relief of seizures, hospitalization is required (in a pulmonological hospital and an intensive care unit); average daily bronchial patency - less than 60%, average daily bronchial lability - more than 30%; basic treatment - high doses of inhaled corticosteroids.

Contraindicated types and working conditions: hard physical labor, work,
associated with severe mental stress, exposure to allergens that cause bronchospasm, adverse microclimatic factors (temperature changes, pressure, high humidity, etc.), in conditions of dustiness, gas contamination; types of labor activity, the sudden termination of which due to an asthma attack can harm the patient and others (air traffic controllers, drivers of vehicles, work related to staying at height, servicing moving mechanisms, on a conveyor, etc.); long business trips. With the development of DN II Art. work associated with physical stress of moderate severity, significant speech load during the working day is contraindicated.

Indications for referral to the ITU Bureau: the presence of contraindications in the conditions and nature of work and the impossibility of employment in an accessible profession without reducing qualifications or a significant decrease in the volume of production activities; unfavorable clinical and labor prognosis (severe, complicated course, treatment failure, etc.).

Required minimum surveys when sending to the ITU Bureau: clinical blood and urine tests; biochemical analysis of blood - the content of sialic acids, C-reactive protein, total protein and fractions, sugar, electrolytes; general sputum analysis (with non-immunological BA - culture for flora and sensitivity to antibiotics, for VC); KOS and blood gases; ECG; chest x-ray; spirography (if necessary, testing with anticholinergics, b2-adrenergic agonists); peak flowmetry; pulmonary artery rheography or Doppler echocardiography (to detect pulmonary hypertension).

Additional laboratory and instrumental research methods are carried out depending on the indications. For example, with constant intake of corticosteroids per os (more than 1 year), it is necessary to study the function of the adrenal cortex, exclude steroid ulcers and diabetes, osteoporosis (if there are relevant complaints and objective data), etc.

disability criteria. When evaluating life limitations, take into account
the form and severity of the course of asthma, the severity of complications, including those caused by the therapy, the effectiveness of treatment, the severity of concomitant diseases; education, profession, qualifications, nature and working conditions, labor orientation.

Disability III group installed in patients with mild to moderate asthma
currents, including hormone-dependent, DN I and II Art. with limited ability to work, self-service, movement - I st., working in contraindicated types and working conditions and in need of rational employment (decrease in qualifications or a decrease in the volume of production activities).

Disability II group installed in patients with moderate to severe BA
course with persistent severe disorders of respiratory and circulatory function (DN II-III stage and HF stage IIA), as well as endocrine system dysfunctions (diabetes mellitus, adrenal insufficiency) caused by steroid therapy, with limited ability to self-care, movement, learning II Art. In some cases, patients can work in specially created conditions, in particular, at home, taking into account professional skills.
Disability I groups are established in case of severe progressive course of BA,
refractoriness to treatment, the development of DN stage III, heart failure stage IIB-III, other irreversible complications, with limited ability to self-service, movement, work activity stage III.

Prevention and rehabilitation. Primary rehabilitation should be carried out in practically healthy people in the presence of biological defects that pose a threat to the development of asthma: exclusion of all trigger mechanisms (allergens; upper respiratory tract infections, including viral ones, especially in children; provoking drugs; psychotraumatic factors; physical overload; gastroesophageal reflux), as well as early and long-term anti-inflammatory therapy.

Secondary prevention of asthma should include elimination from the environment
adverse factors (allergens, irritants, etc.), the organization of the regime of life, physical education, rational employment arrangements, timely training and retraining, organization of the work of asthma schools and asthma clubs; preparation of printed, video, audio educational products, creation of an association of patients. It is necessary to conduct individual work with patients, including communication with psychologists.
The basis of secondary prevention is timely and adequate treatment at all stages (outpatient, inpatient, sanatorium-resort); drawing up and monitoring the completeness and quality, timeliness of the implementation of an individual rehabilitation program for a disabled person.
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