The period of exacerbation of bronchial asthma: how to help the patient? Manifestation of exacerbations of bronchial asthma Treatment of bronchial asthma in adults in exacerbation.

In fact, any patient entering the intensive care unit with an exacerbation of bronchial asthma (BA) is diagnosed with status asthma by specialists. Such norms are spelled out in ICD-10, but this does not allow to objectively judge the severity of the process. It is worth remembering that the diagnosis "status asthma" (AS) is a collective concept that combines different degrees of severity of asthma exacerbation. Some experts suggest that the term "AS" in the coming years will cease to be relevant. In the recommendations for the treatment of asthma of the GINA (Global Initiative for Asthma) association “asthmatic status! not mentioned.

But it was these documents that formed the basis for Russian recommendations for the treatment of asthma. The doctor's correct determination of the severity of an exacerbation of bronchial asthma makes it possible to optimize treatment, to find patients who require maximum attention.

According to the data cited by GINA experts, Russia ranks first in the world in mortality due to asthma. Some researchers say that this is due not only to the quality of care, but rather to the misdiagnosis of the disease. Doctors often mistake chronic obstructive pulmonary disease (COPD) for AD. As you know, long-term asthma is one of the main causes of chronic obstructive pulmonary disease. When a patient with asthma is 60 years or more years old, doctors will not make a mistake if they reflect COPD in the diagnosis.

If the patient's age is not more than 35-40 years old, the diagnosis of COPD can be excluded. The problem of differential diagnosis in people aged 40 and over is complicated by the fact that BA and COPD can be simultaneously observed. But often the manifestations of COPD, even if the patient has never had bronchial asthma, are mistaken for an exacerbation of asthma. This is the worst case, because the treatment for these diseases is very different.

Also, these diseases differ greatly in outcome. COPD is characterized by disease progression and lack of reversibility. For AD, reversibility is typical, good positive dynamics for correctly conducted treatment, undulating course. It should be borne in mind: if an exacerbation of asthma does not lend itself to the therapy, which will be discussed below, with a high probability the main pathology is COPD.

Causes of exacerbation of bronchial asthma

Most often, the triggering cause is viral, less often - bacterial infections, unfavorable environmental conditions, various allergens, errors in the treatment of diagnosed asthma.

Inspection and monitoring

All patients undergo lung x-rays. Blood pressure, heart rate, blood gases, ECG, peak expiratory flow (PSV), blood electrolytes, hematocrit, glucose, creatinine, blood saturation are monitored. A dynamic assessment of clinical symptoms is also carried out.

Doctors determine the severity of an exacerbation according to the table:

Treatment of exacerbation of bronchial asthma

For any severity of asthma exacerbation, corticosteroids and inhaled beta-2-agonists are prescribed. The treatment should be carried out in this order:

• Oxygen therapy

The patient takes a forced sitting or semi-sitting position. The attending physician should warn the nurses of the ward not to try to put the patient in the "lying" position.

Hypoxia is the leading cause of death in exacerbations of asthma. Therefore, if a person has hypoxemia, oxygen should be prescribed as soon as possible. Physicians adjust the oxygen delivery rate to ensure an SpO2 level of more than 92%. Even high oxygen concentrations (FiO2\u003e 0.7) in the respiratory mixture only insignificantly increase PaCO2 and do not lead to depression of the respiratory center.

• Inhaled bronchodilators

It is worth remembering that for inhalation administration of bronchodilators, both a nebulizer and metered-dose aerosol inhalers can be used with equal effectiveness. Inhaled bronchodilators are chosen for the treatment of exacerbations of bronchial asthma of any severity. In most cases, only beta-2 agonists can be given to the patient.

In severe cases, inhalation of beta-2-agonists together with anticholinergics is needed. It is recommended to use a combination of beta-2-agonist + anticholinergic (ipratropium bromide) in severe exacerbation of asthma; with insufficient effect of the ongoing treatment with beta-2-agonists; in patients over the age of 60, and at any age, if the doctor has noted signs of COPD in the patient.

If the patient before admission to the ICU did not take beta-2-agonists as prescribed by the doctor, or received them in usual doses, then it is best to continue inhalation of the beta-2-agonist that was previously most effective for treating this patient (ask him or relatives).

• Using a nebulizer

The procedure for inhaling drugs through a nebulizer takes a long time, and hypoxemia is common in patients, so it is recommended to use a pneumatic nebulizer from an oxygen line.

More often they take special solutions for inhalation:

Selective agonist of beta-2-adrenergic receptors. Method of application: using a nebulizer; nebula, 2.5 ml, which contains 2.5 mg of salbutamol in saline. 1-2 nebulas (2.5-5.0 mg) are prescribed for inhalation in undiluted form. If there is no improvement, doctors repeat 2.5 mg inhalations every 20 minutes for one hour. Thereafter, 2.5-10 mg every 1-4 hours as needed or 10-15 mg per hour continuously.

1 ml (20 drops) of solution for inhalation contains 500 μg of phenoterol hydrobromide and 250 μg of ipratropium bromide. You should inhale 1 ml (20 drops) of berodual in 3-4 ml of saline or 25% solution of magnesium sulfate for 5-10 minutes, until the solution is completely used. If there is no improvement, a second inhalation is needed after 20 minutes.

Doctors remember that magnesium sulfate demonstrates the properties of a bronchodilator, both when administered intravenously and when inhaled. Although the drug is somewhat inferior in effectiveness to both beta-2-agonists and anticholinergics. But if 5-8 ml of 25% magnesium sulfate is used instead of 0.9% sodium chloride as a solvent for beta-2-agonists, a more pronounced joint brocholytic effect can be observed.

Ipratropium bromide by nebulizer: 0.5 milligrams every 20 minutes for up to 3 doses, thereafter as needed. For this drug, when administered by inhalation, an extremely low absorption from the mucous membrane of the respiratory tract is typical, and therefore it does not have a systemic effect.

Metered-dose aerosol inhalers

For the effective use of metered-dose inhalers, it is important that they are equipped with a spacer, preferably a large volume (0.5-1 liter), because some people find it difficult to coordinate their inhalation with inhalation. If no spacer is available, it can be made fairly quickly from a regular plastic bottle or any other suitable container.

With an exacerbation of bronchial asthma, short-acting beta-2-agonists are prescribed - terbutaline sulfate (1 dose - 250 μg), salbutamol (1 dose - 100 μg), (1 dose - 200 μg), Berodual (one dose of berodual contains 0.05 mg fenoterol and 0.02 mg ipratropium bromide). Initially, the patient, with an interval of several seconds between inhalations, sequentially inhales four to eight doses of one of the above drugs. After - 1-2 doses in 10-20 minutes until the condition improves or the appearance of side effects - tachycardia, severe tremor. After that, if necessary - 1-2 doses in 1-4 hours.

Inhalation of ipratropium bromide through a metered-dose inhaler - 8 breaths every 20 minutes, if necessary, then repeat for 3 hours.

Complications

When using beta-2-agonists, contraindications to them should be taken into account: heart rhythm disturbances, severe hypertension, and others. You also need to control the concentration of potassium in the plasma - hypokalemia may develop. If the patient has signs of an overdose of beta-2-agonists, they should be stopped immediately. But after 4-5 hours it is necessary to start taking medications again. Patients with exacerbation of asthma should take these drugs until there is a lasting improvement in their condition.

Corticosteroids

It is important to consider: corticosteroids are prescribed to all patients with exacerbation of bronchial asthma, regardless of the severity, and immediately after admission, without delay. A significant role in the development of asthma exacerbation is played not only by bronchospasm, but also by inflammation, edema, dyskinesia of small airways and their clogging with viscous sputum. Therefore, corticosteroids, which have a strong anti-inflammatory effect, are important in the treatment of asthma. Corticosteroids can be administered both intravenously and enterally and the effect will be the same.

A clinically significant effect after their administration develops after 2-4 hours: on average, after 1-6 hours with intravenous administration. With enteral administration - a little later. Research suggests that relatively low doses of corticosteroids (40-80 mg / day) are as effective as relatively high doses of methylprednisolone - 200-300 mg / day. It has not been proven that the use of super high doses (pulse therapy) of prednisolone (1-2 g per day) can improve the results of therapy. That is, there is a kind of threshold effect.

For patients with mild to moderate exacerbation, enteral or inhalation can be assigned. The method of choice is methylprednisolone or prednisolone enterally at a dose of 60-80 mg per day for 1-3 doses. For severe or potentially fatal exacerbations of asthma, it is best to use the intravenous route of administration of corticosteroids.

Most experts choose a dose of 1.5-2 mg / kg per day of IV prednisolone, divided into 4 doses. The next day, the administration of the drug should be repeated - in the same dose and with the same frequency of administration. On the following days, the dosage of prednisolone should be reduced by 60-90 mg per day intravenously or enterally for 5-7 days or until the person's condition is stable.

Instead of prednisolone with virtually the same efficacy, dexamethasone 4 mg IV 3 times a day can be assigned, or hydrocortisone 125-250 mg IV 4 times a day. When compared with prednisone, dexamethasone has a longer biological effect. For this reason, the duration of the course can be as little as 4-5 days. The dose does not need to be gradually reduced. It is worth remembering: in severe exacerbation, inhaled corticosteroids are prescribed by doctors only after a steady improvement in the patient's condition.

Magnesium sulfate

Intravenous administration of magnesium sulfate was included in all recommendations as a secondary therapy, both in adult patients and in children. Magnesium sulfate is prescribed in case of insufficient effect from the use of beta-2-agonists; with severe exacerbation of bronchial asthma, in which there is severe bronchial obstruction.

Before the appointment of magnesium sulfate, hypovolemia must be eliminated, the systolic blood pressure should be above 100 mm Hg. Art. Important: if a person has a potentially lethal exacerbation, then magnesium sulfate is prescribed only after the person is transferred to controlled breathing and hemodynamic stabilization.

Most experts advise the introduction of 2 g of magnesium sulfate in 20 minutes. According to the subjective opinion of some researchers, such a technique for introducing magnesium sulfate is effective: 20 ml of a 25% solution (5 grams) is administered intravenously for 15-20 minutes, then intravenous infusion at a rate of 1-2 g per hour until the elimination of bronchospasm. At the same time, according to the researchers, they have never observed an increase in the level of magnesium in the blood above the therapeutic level - 2-4 mmol per liter. The appointment of magnesium sulfate should be careful if a person has symptoms of renal failure or hypotension.

Additional treatments for bronchospasm

The following drugs are not routinely prescribed. If there are no inhaled bronchodilators, a sufficient effect from inhalation therapy or the patient is unable to perform it effectively, doctors use intravenous administration of beta-2-agonists: salbutamol (loading and maintenance dose), epinephrine (Adrenaline). Today, physicians do not use (Euphyllin) for the treatment of exacerbation of asthma, because it causes a number of serious side effects, including tremors, tachycardia, and loose stools.

With severe exacerbation, aminophylline has the desired effect in such cases:

• If within 2 hours after the appointment of beta-2-agonists, intravenous administration of magnesium sulfate, a positive effect is not visible;
• If it is not possible to use inhaled bronchodilators.

Respiratory therapy

In addition to drug therapy, many patients require mechanical ventilation.

Non-invasive ventilation (NIV)

Some researchers have great doubts about the advisability of using NIV in patients with fatal exacerbation of bronchial asthma. But according to enthusiasts using this method in status asthmaticus, in many cases it was possible to avoid tracheal intubation and invasive mechanical ventilation.

Artificial (mechanical) ventilation of the lungs

Ventilation begins under the following conditions:

• The appearance of harbingers of coma (cyanosis, drowsiness, confusion);
• Lack of effect from the currently used treatment;
• Dumb chest, cyanosis, weak breathing;
• Increase in hypercapnia more than 60 mm Hg. Art. against the background of hypoxemia (PaO2 55-65 mm Hg, SpO2 less than 90%.)
• Bradycardia or arterial hypotension;
• Increasing fatigue and exhaustion of the patient;
• The peak expiratory flow rate is less than 30% of the patient's usual value.

Ventilation technology

It is best to infuse 400-800 ml of saline solutions just before the start of mechanical ventilation to reduce the risk of hypotension. After intubation and the beginning of mechanical ventilation, due to over-inflation of the alveoli, increased intrathoracic pressure and high auto-PEEP, there is a high probability of a sharp decrease in the filling of the right ventricle with blood. The consequence will be the development of hypotension. It is necessary to provide immediate first aid in advance to prepare a working solution of catecholamine (usually epinephrine (Adrenaline) - 1 mg of epinephrine diluted in 10.0 0.9% sodium chloride). In case of hypotension, it is recommended to inject 0.5-1 ml intravenously.

Preoxygenation. Tracheal intubation is best done with 100% oxygen inhalation. To reduce resistance to exhalation, doctors use an endotracheal tube of the largest diameter for a given person.

Induction is carried out - 1-2 mg per 1 kg of the patient's body or propofol - 1-3 mg / kg. For sedation in the first 2-4 hours, it is best to use a ketamine infusion of 2-4 mg / kg / hour, since it has a more pronounced brocholytic effect than other hypnotics. After some stabilization of the patient and reduction of bronchospasm, infusion of ketamine, propofol or their mixture (ketofol) is usually used for sedation. Succinylcholine 1.5 mg / kg is usually used as a muscle relaxant for intubation.

The duration of mechanical ventilation is 3-8 hours for most patients with a potentially fatal exacerbation and is usually not carried out longer than 2-3 days. The criteria for transferring the patient to spontaneous breathing are traditional: stable hemodynamics, clear consciousness of the patient, inspiratory pressure in the patient-respirator system of less than 25 mm of water. Art., PaO2 is more than 65 mm Hg. Art., SpO2 more than 90% with FiO2 30-40%., there is a person's spontaneous breathing.

Infusion therapy

This method is relevant if the patient cannot drink water on his own, or the doctor records signs of dehydration, hypotension. Patients often have right ventricular failure, so hypervolemia and large volumes of fluid are contraindicated.

Infusion using standard saline solutions is carried out: before the start of mechanical ventilation, in a volume of 2-3 liters per day intravenously during mechanical ventilation, if the tube introduction of food and liquid is not performed.

The warm summer, full of all sorts of usefulness and vitamins, is passing. Now is the time to start taking active care of your body, because in the fall, chronic diseases can begin to remind of themselves.

What condition in a patient with bronchial asthma is considered to be an exacerbation?

Bronchial asthma is a chronic respiratory disease. It affects about 300 million people worldwide. The main causes of the disease are hereditary predisposition to allergies, infectious diseases of the upper respiratory tract, including viral, tobacco smoke and others.

Usually, patients suffering from bronchial asthma receive basic therapy, that is, they take medications daily to avoid manifestations of the disease. However, if shortness of breath, cough, wheezing, wheezing or chest congestion or a combination of the above symptoms increase during treatment, this is an exacerbation of bronchial asthma.

Leptoprotect

Influ-stop

Balm "Sibiryachok"

Is it true that there is a classification of exacerbations of bronchial asthma?

Indeed, exacerbations can be mild, moderately severe, and severe. However, any severity of exacerbation requires immediate medical advice. It is important to evaluate not only the symptoms, but also the frequency of their occurrence, as well as the reaction to medications that a patient with bronchial asthma uses to relieve attacks as a kind of ambulance. The danger of exacerbation also lies in the fact that its severity can rapidly increase. It seems like a couple of days ago a person did not pay attention to a mild form of exacerbation, but it has already become moderately severe and continues to progress.

Why does the period of exacerbation of asthma occur in autumn?

Let's recall the risk factors that can provoke an exacerbation in patients with bronchial asthma: this is a viral infection, various allergens, house dust, house dust mites, plant pollen and others.
In autumn, human immunity is weakened. This is due to temperature changes, often a reluctance to dress warmer, as a result of which the susceptibility to viral infections increases. Against their background, asthmatic symptoms may appear in those who have had the disease latently, or existing ones may intensify.

What should be done when asthma worsens?

There is only one advice here: immediately consult a doctor. Even if you notice a slight deterioration in your condition, it doesn't hurt to consult a specialist.
In the event of an exacerbation, firstly, the basic therapy can be strengthened, that is, the doses of the drugs taken can be increased. Secondly, the doctor must understand the causes of the exacerbation. If it is a viral disease, he will prescribe antiviral drugs and drugs to increase immunity. If the cause is bacterial, antibiotics may be prescribed.

What are the consequences of exacerbation of bronchial asthma?

Today, in most cases, we can control the course of bronchial asthma. This means that the quality of life of our patients is not affected. However, this, of course, requires consultations with specialists. If people prefer to cope with the disease on their own or ignore the advice of a doctor, then the symptoms will only intensify over time. All this can lead to an uncontrolled form of bronchial asthma, when shortness of breath will be your constant companion, and asthma attacks will recur with unprecedented frequency. Remember that a viral infection can lead to bronchitis and even pneumonia, and against the background of bronchial asthma will cause a more severe course of the disease. Therefore, my advice is to monitor your health and consult a doctor for any deterioration. Indeed, ideally, with the right treatment, you can get rid of the manifestations of bronchial asthma.

Rimma Yakovlevna KATS, allergist-immunologist, highest category.

Exacerbation of bronchial asthma is episodes of a progressive increase in shortness of breath, cough, wheezing, shortness of breath, chest tightness, or a combination of these symptoms (GINA, 2006). Reasons for exacerbation: ARVI, intake of non-steroidal anti-inflammatory drugs, analgesics, ACE inhibitors, inhalation of tobacco smoke and pollutants, contact with an allergen, stress, gastroesophageal reflux disease, inadequate therapy for bronchial asthma. Before starting treatment, it is necessary to assess the severity of the exacerbation.

Table 7. Severity of exacerbation of bronchial asthma

An example of a diagnosis.

MainDs: Bronchial asthma, endogenous, uncontrolled, severe exacerbation, DNIIIst.

Figure 10. Treatment of patients with exacerbation of bronchial asthma (GINA, 2006).

Exacerbation of chronic obstructive pulmonary disease

When assessing clinical symptoms, attention is paid to the participation of auxiliary muscles in the act of breathing, paradoxical movements of the chest, the appearance or aggravation of central cyanosis, the appearance of peripheral edema, the state of hemodynamics (hemodynamic instability). Respiratory function assessment - decrease in PSV less than 100 liters per minute or FEV 1 less than 1 liter, pO 2<60 мм рт.ст., сатурация О 2 менее при дыхании комнатным воздухом говорит о тяжелом обострении ХОБЛ. ОФВ 1 на уровне 0,75 л или РаО 2 /FiО 2 32 кПа (240 мм рт. ст.) может хорошо переноситься лицами с тяжелой ХОБЛ, которые живут с этими показателями в стабильном состоянии, в то время как подобные параметры для тех, у кого в стабильном состоянии имеются чуть большие значения, например ОФВ 1 ~0,9 л или РаО 2 /FiО 2 ~ 38 кПа (282 мм рт. ст.), могут указывать на тяжелое обострение.

Arterial blood gases.In a hospital with severe exacerbation of COPD, the determination of the level of arterial blood gases is mandatory. If, when breathing room air, PaO 2<8 кПа (60 мм рт. ст.) и/или SaO 2 <90% (причем РаСО 2 может и превышать, и не превышать 6,7 кПа), то это указывает на дыхательную недостаточность. Кроме того, если РаО 2 < 6,7 кП (50 мм рт. ст.), РаСО 2 >9.3 kPa (70 mm Hg) and pH<7,3, то это указывает на угрожающее жизни состояние, которое требует оказания интенсивной терапии.

Other laboratory tests. Blood tests may show polycythemia (hematocrit\u003e 55%) or anemia. The white blood cell count is usually not very informative. The presence of purulent sputum during an exacerbation is a sufficient reason for starting antibiotic therapy. The most common pathogens in an exacerbation of COPD are Streptococcus pneumoniae, Haemophilisinfluenzae, and Moraxella catarrhalis. Biochemical studies can show whether electrolyte disturbances (hyponatremia, -kalemia, etc.), decompensation of diabetes mellitus or malnutrition (protein deficiency) are the cause of the exacerbation, and they can also speak of metabolic acidosis.

An example of a diagnosis

The main one is COPD, IIIst, severe exacerbation. Complication: Acute cor pulmonale, AHF. DNIIst.

Treatment

At home: exacerbation of COPD includes an increase in the dose and / or frequency of bronchodilator therapy. If anticholnergic drugs have not been used before, they are included in therapy until the condition improves. In more severe cases, high-dose nebulizer therapy may be prescribed on an as-needed basis for several days. However, after an acute episode has subsided, prolonged use of the nebulizer for routine therapy is not recommended. Systemic corticosteroids have been used successfully to treat exacerbations of COPD. They shorten the time to remission and help restore lung function more quickly. Their use should be considered in FEV 1<50% от должного. Рекомендуется преднизолон в дозе 40 мг в сутки в течение 10 дней. Антибиотики эффективны тогда, когда у больного с усилившейся одышкой и кашлем нарастает объем и гнойность отходящей мокроты.

Inpatient treatment

Indications for hospitalization

A significant increase in the intensity of symptoms, such as sudden onset of dyspnea at rest

Severe COPD pre-exacerbation

New clinical manifestations (eg, cyanosis, peripheral edema)

Inability to stop the exacerbation with the drugs originally used

Serious comorbidities

Newly manifested arrhythmias

Diagnostic uncertainty

Elderly age

Insufficient help at home

Indications for referral to the intensive care unit

Severe dyspnea with inadequate response to initial emergency therapy

Confused consciousness, lethargy, coma

Persistent or worsening hypoxemia (PaO 2<5,3 кПа, или 40 мм рт. ст.), и/или тяжелая/ухудшающаяся гиперкапния (PaCO 2 > 8 kPa, or 60 mm Hg. Art.), and / or severe / worsening respiratory acidosis (pH<7,25), несмотря на оксигенотерапию и неинвазивную вентиляцию легких

Treating severe but not life-threatening exacerbations

1. Prescribe guided oxygen therapy (2-5 L / min, at least 18 h / day) and repeat arterial blood gas measurements after 30 minutes

2. Bronchodilators: increase the dose or frequency of administration, combine beta2-agonists and anticholinergics, use spacers or compressor nebulizers (ipratropium bromide 0.25-0.5 mg (20-40 drops) through a nebulizer with O 2 in combination with p- rami of short-acting beta2-agonists: salbutamol 2.5-5 mg. or fenoterol 0.5-1.0 mg (10-20 drops) after 6 hours. The combination of beta2-agonists and anticholinergic drugs - solution of berodual 2 ml (40 drops ) through a nebulizer with O 2, then 1.5-2 ml after 6 hours during the day)

Consider ∕ in aminophylline (aminophylline 240 mg / h to 960 mg / day at a rate of 0.5 mg / kg / h under ECG guidance)

3. Add oral or intravenous GCS (40 mg / day for 10 days, if it is impossible to intravenously parenterally up to 3 mg / kg / day)

4. If there are signs of a bacterial infection, consider oral or intravenous antibiotics

5. Throughout therapy: monitor fluid and nutrient balance, consider subcutaneous heparin, identify and treat associated conditions (eg, heart failure, arrhythmias), carefully monitor the patient

People with bronchospasm can often develop an exacerbation of bronchial asthma. The disease is chronic, while the inflammatory process is accompanied by a sharp narrowing of the lumen of the bronchial tree, which leads to severe attacks, accompanied by suffocation. With proper treatment, this process is completely or partially reversible.

Depending on the severity of developing exacerbations, there is a classification of the patient's condition. The basis for determining the depth of development of the disease is the severity of the manifestation of suffocation and other symptoms. Moreover, to determine the severity of the patient, the presence of several signs is sufficient.

1. Easy degree. The symptoms of the disease are mild. The patient can move and talk normally, but shortness of breath appears when walking. Against the background of an increase in the heart rate and respiration, the muscles of the chest do not take any part in inhaling and exhaling. Auscultatory wheezing is determined at the expiratory height.
2. Moderate condition. In this case, the patient has limited physical mobility. Due to shortness of breath, the patient speaks in short phrases. The pulse accelerates to 120 beats per minute, breathing also quickens. The patient's condition is agitated. The intercostal muscles can take part in the act of breathing. Auscultatory wheezing is determined throughout the exhalation.
3. Severe degree. Shortness of breath in the patient is noted even at rest. The patient tries not to move so as not to worsen the condition. Talking is just as hard. The abdominal muscles and intercostal muscles are involved in breathing. Respiratory rate increases 1.5 times, heart rate is above 120 beats per minute. Auscultatory symptoms are manifested in loud wheezing during the entire respiratory act.
4. Threatening condition. Dyspnea at rest. There is no speech and movement. Various disorders of consciousness up to coma are noted. Breathing is shallow, it can be both rapid and slow. There is also a slowdown in heart rate. Breathing cannot be heard over the lungs.

The severity of the exacerbation of the disease often does not coincide with the severity of the course of bronchial asthma itself.

Exacerbation of bronchial asthma can pose a serious threat to the patient's life. To minimize the risk of such conditions, you should avoid the influence of various provoking factors.

1. Most often, the causes of an attack lie in the patient's contact with various allergens found in foods, drinks, air, clothes, etc., which trigger the disease mechanism.
2. Also, exacerbation of droppings often begin against the background of various respiratory viral infections, bronchitis and other respiratory diseases.
3. External factors such as changes in the weather, inhalation of tobacco smoke during secondhand smoke, unfavorable environmental conditions, etc. can also serve as a trigger mechanism.
4. Increased physical or psycho-emotional stress, as well as other factors leading to hyperventilation of the lungs.
5. Incorrect treatment tactics or incorrectly selected drug therapy.

Often the cause of an exacerbated disease is a violation by the patient of the prescriptions of the attending physician regarding the choice of drugs, as well as the prescribed medication treatment regimen.

Treatment of exacerbation of bronchial asthma depends on the severity of the patient's condition. It is also important to provide the first necessary aid even at the pre-hospital stage. It is best if the patient is able to help himself at the very beginning of the attack. Such therapy will not only reduce the symptoms of exacerbation, but also have a powerful psychological effect, instilling confidence in the patient and relieving dependence on other people.

To stop exacerbated asthma, the patient must always have a metered dose inhaler with a drug that has a bronchodilator effect, selected by the attending physician. The use of such inhalation at the beginning of an asthmatic attack most often stops the development of an exacerbation. Also, just in case, in the absence of a pronounced effect, there should be an aerosol with a medicine of the corticosteroid group selected by a doctor.

• development of severe exacerbation;
• the absence within an hour of the effect of the use of bronchodilators and corticosteroids;
• the threat of developing apnea;
• living conditions provoking an exacerbation of bronchial asthma.

Criteria for correctly provided care: reduction of shortness of breath, easier breathing, disappearance of wheezing in the lungs.

Given the fact that bronchial asthma often causes exacerbation, and also significantly impairs the quality of life, secondary prevention is given great attention.

1. Identify the allergen that provokes the onset of an exacerbation of the disease and eliminate the patient's contact with it as much as possible. The room in which the patient lives should have a minimal setting. Also, all objects that accumulate dust and insects (carpets, rugs, napkins, etc.) are removed from the room. Animals and houseplants should not be in the house either. Bedding should be made of easily washable hypoallergenic materials. Daily wet cleaning is also a prerequisite for maintaining the health of the patient.
2. If you live in an unfavorable ecological or climatic region, you should make a difficult decision to change your place of residence.
3. Review your daily diet with your doctor and eliminate foods that cause sensitization of the body.
4. Constantly work on hardening the body. You should also sleep with the window open all year round and take walks in the fresh air every day for at least two hours.
5. Master the techniques of self-massage and breathing exercises and carry out these procedures daily.
6. To refuse from bad habits. Take measures to eliminate secondhand smoke.
7. Use as a preventive measure under the supervision of a physician and methods such as zhen-chiu therapy, rest on the seashore in the cool season, speleotherapy (salt caves).
8. Pay due attention to prophylaxis medication selected by the attending physician. Take a full course of preventive therapy.
9. Visit a pulmonologist regularly and follow all his recommendations.

To avoid frequent exacerbations of bronchial asthma, all recommendations of the attending physician must be strictly followed.

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  Symptoms that bother you indicate that in your case, asthma may develop very soon, or this is already its initial stage. We recommend that you consult a specialist and undergo a medical examination in order to avoid complications and cure the disease at an early stage. We also recommend that you read the article about that.

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1. Question 1 of 11

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   Are you worried about a strong and excruciating cough?

2. Question 2 of 11

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   Do you have a cough when you are in cold air?

3. Question 3 of 11

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   Are you worried about shortness of breath in which it becomes difficult to exhale and breathing constraints?

4. Question 4 of 11

   4 .

   Have you noticed wheezing wheezing during breathing?

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   Do you have asthma attacks?

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   How often do you have an unproductive cough?

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   Do you often have high blood pressure?

Respiratory system pathologies are diagnosed by coughing, shortness of breath, sputum production. An exacerbation of asthma can be dangerous, as it entails severe asthma attacks in the patient, which can be relieved only by special inhalers. In order to prevent complications, you need to contact the clinic on time.

Main reasons

Exacerbation of bronchial asthma poses a direct threat to the patient's health and life. Asphyxiation leads to a critical lack of oxygen, if sprays from respiratory tract spasms are not applied in time.

Following the classification of exacerbations of bronchial asthma, the disease is divided into the following types:

• allergic;
• non-allergic;
• mixed;
• unspecified.

The reasons are the following:

• contact with irritants: dust, chemical compounds, pollen and other substances;
• respiratory viral infections that trigger bronchospasm;
• external factors: unfavorable urban air, changes in ambient temperature;
• smoking: tobacco smoke becomes a common cause of respiratory tract diseases, even with passive inhalation, which is especially dangerous for a child;
• psychoemotional load: stress, anxiety, depression;
• untimely or incorrect treatment of pathologies of the respiratory system.

In most cases, bronchial asthma is caused by infections and allergens that enter the respiratory system.

Infection

A patient who has already experienced an exacerbation may be exposed to it again, therefore health must be taken care of. A respiratory infection causes an increase in the symptoms of the disease. The risk is especially high during epidemics of influenza and SARS. It is also dangerous to be near someone with a cold, bronchitis or pneumonia, as you can catch an infection from him.

Pathogenic microorganisms cause inflammation of the bronchial mucosa. Subsequently, spasms cause severe suffocation, and it becomes difficult to do without special medicines.

Allergens

Bronchospasm in case of an allergic reaction is an expected immune response in humans. With increased sensitivity to stimuli, a person is at risk of developing asthma. Moreover, any change in the normal course of life can be a catalyst.

Symptoms

There are 3 stages in the development of the disease:

• Stage I: choking, paroxysmal dry cough, high blood pressure, rapid breathing.
• Stage II: shallow breaths, rapid pulse, low blood pressure, dullness of the skin, shortness of breath, the patient is in serious condition - urgent help is needed.
• Stage III: coma resulting from excess carbon dioxide.

At the first signs of illness, it is necessary to check in the clinic, because bronchial asthma can seriously affect health. At stages II and III, the patient needs to go to the hospital for round-the-clock monitoring.

Diagnosis

The criteria for making a diagnosis are:

• initial inspection;
• diagnostic procedures;
• breathing research;
• assessment of allergic risk.

The tactics of treatment are determined by a pulmonologist after a series of examinations and a general examination by a therapist. It is important for the doctor to establish the category, stage and severity of the disease in order to select the appropriate therapy.

The complex of studies includes a general and biochemical blood test. Sputum culture is also done to determine the causative agent of asthma in case of infection.

Spirometry is used when bronchial obstruction is suspected: with the help of it, the doctor evaluates the severity and reversibility of the pathology. Peak flowmetry is needed to monitor the patient's condition and trends during treatment.

Allergotest is used to determine specific irritants in an allergic form of the disease. The manifestation of a skin reaction to the applied substance indicates the non-infectious nature of the disease.

Therapies

Treatment is determined according to the diagnosis. In allergic asthma, the main principle is to guard against allergens and to take antihistamines. A special inhaler is the only pre-hospital care that a patient can provide himself. If the disease is the result of an infection in the respiratory tract, it is necessary to drink a course of antibiotics. In this case, the appropriate drug is determined during the diagnosis, since many pathogens quickly develop resistance to active substances.

As symptomatic therapy, your doctor may prescribe antitussives, expectorants, or pain relievers. To strengthen the immune system, vitamin complexes and immunomodulating pharmaceuticals are suitable.

Traditional medicine can be dangerous for bronchial asthma, since there is a risk of allergy to medicinal herbs in decoctions, infusions and compresses. Consult your doctor for home remedies.

Forecast

If treatment is started at the first sign of asthma, the prognosis is good. There is a direct relationship between the severity and the form of the disease: for example, suffocation due to the ingress of pollen has less pronounced symptoms than when irritated by dust. In addition, older patients are more severely asthma than younger patients.

If suffocation increases and symptoms are ignored, the risk of health deterioration increases. Tachypnea, cyanosis, hypoxia up to hypercapnic coma are diagnosed. However, the disease progresses very slowly, so it is not difficult to control the disease.

Prevention

Measures to prevent the disease have their own classification:

• Primary. The main goal is to prevent the development of the disease in the early stages.
• Secondary. The task is to prevent asthma attacks.
• Tertiary. The goal is to relieve asthma symptoms and alleviate the patient's condition.

To prevent asthma from exacerbating, you should lead a healthy lifestyle, eat right, observe the hygiene of the room, and avoid contact with irritants. In their recommendations, doctors advise to limit contact with people infected with a respiratory infection. To prevent asthma from appearing as a complication of any disease, any respiratory diseases must be treated in time.

Exacerbation of bronchial asthma brings many inconveniences to a person's life, while the disease can lead to serious suffocation and deterioration of health. To stop the symptoms, you need to make an appointment with a doctor, and not treat yourself.