Treatment of bronchial asthma in a hospital. Treatment of exacerbations of bronchial asthma

For citation: Nenasheva N.M. Exacerbation of bronchial asthma: treatment and prevention // BC. 2013. No. 29. S. 1490

Bronchial asthma(BA) is a disease characterized by a variable course. Exacerbations of asthma are a frequent occurrence in the life of patients suffering from this disease.

Concept definition
and severity of asthma exacerbations
According to the GINA definition, an exacerbation of asthma (acute asthma) is an episode of pronounced manifestations of asthma: increasing shortness of breath, cough, wheezing, chest congestion, or any combination of these symptoms. Respiratory distress and acute respiratory failure may develop. An exacerbation of asthma is characterized by a decrease in the volumetric flow rate of exhaled air, which can be determined by examining lung function by reducing peak expiratory flow (PEF) or forced expiratory volume in 1 s (FEV1). In a joint document of the European Respiratory Society (ERS) and the American Thoracic Society (ATS), dedicated to the definition of control and exacerbations of asthma in clinical trials and real clinical practice, it is proposed to allocate severe and moderate exacerbations of BA.
A severe exacerbation is defined as an event that requires immediate action from the physician in relation to the patient in order to prevent the development of an acute respiratory failure and death. A severe exacerbation involves the use of systemic glucocorticosteroids (GCS) (oral or parenteral forms), or an increase in the maintenance dose of GCS for at least 3 days, and / or hospitalization, or treatment for emergency care for the appointment of systemic GCS.
A moderate exacerbation of asthma is defined as an event that causes concern to the patient and requires a change in therapy, but is not severe. With a moderate exacerbation, an increase in symptoms is noted, incl. nocturnal, decreased lung function, increased need for short-acting β2-agonists. These changes should last at least 2 days or more, but not be so pronounced as to require the appointment of systemic corticosteroids and / or hospitalization.
The concept of "mild exacerbation" is not recommended to be used, because. it is difficult to separate it from the state of temporary loss of control of asthma, which is a common reflection of the variability in the course of asthma. Needless to say, these recommendations apply primarily to clinical research. In normal clinical practice, the severity of an exacerbation is determined by the severity of symptoms (dyspnea), physical examination data (respiratory rate (RR), pulse, auscultatory picture, the presence of a paradoxical pulse), the results of measuring PEF, oxygen tension in arterial blood(PaO2) and/or carbon dioxide tension in arterial blood (PaCO2), arterial blood hemoglobin saturation with oxygen, oxygen saturation (SpO2) (Table 1). Below are the criteria for severe and life threatening exacerbations of asthma, according to the British Convention for the Treatment of Asthma.
Criteria for severe asthma exacerbation:
. PSV 33-50% of the best or due;
. RR ≥25/min;
. HR (heart rate) ≥110/min;
. broken speech.
Criteria for a life-threatening exacerbation in a patient with severe asthma:
. PSV<33% от лучшего или должного;
. SpO2<92%;
. PaO2<8 kPa;
. PaCO2 norm (4.6-6.0 kPa);
. "silent" lung;
. cyanosis;
. weakness of the respiratory muscles;
. arrhythmia;
. exhaustion, disturbed consciousness.
The rate of development of an exacerbation of asthma can vary significantly in different patients - from several minutes or hours to 2 weeks, as well as the time for resolution of an exacerbation - from 5 to 14 days. Exacerbations of asthma can develop in any patient, regardless of the severity of the disease, but they are considered a common clinical manifestation in patients with difficult-to-control asthma. During the research program for the study of severe asthma in the United States, it was shown that patients with severe asthma are significantly more likely to develop exacerbations requiring hospitalization, incl. in the intensive care unit, as well as the appointment of mechanical ventilation, compared with patients with mild and moderate asthma (Fig. 1) . The annual frequency of severe exacerbations of BA in patients with mild, moderate and severe BA was 5, 13, 54%, and exacerbations close to fatal - 4, 6, 23%, respectively. At the same time, out of the total number of hospitalizations for exacerbation of BA, 30-40% are in patients with a mild form of the disease.
Respiratory viral infections occupy the first place among the causes of asthma exacerbations. It is known that 85% of asthma exacerbations in children and 60% in adults are caused by respiratory viruses, mainly rhinoviruses. In addition, exposure to an allergen, especially massive contact, also provokes an exacerbation of asthma, and the combination of these two triggers increases the risk of an exacerbation by several times (OR 8.4; 95% CI, 2.1-32.8) .
Treatment of asthma exacerbation in adults
Patients with a high risk of developing severe, fatal exacerbations of asthma should immediately seek medical help at the initial signs of a developing exacerbation. This group includes the following patients:
- having a history of life-threatening exacerbations of asthma, requiring intubation and mechanical ventilation;
- hospitalized or treated for emergency care for exacerbation of asthma during the last year;
- constantly receiving or recently canceled oral corticosteroids;
- not receiving inhaled corticosteroids (IGCS);
- with a high need for short-acting β-agonists (SABA) (> 1 inhaler / month);
- with mental illness or psychosocial problems (use of sedatives and narcotic drugs);
- with low adherence to treatment and not fulfilling doctor's prescriptions;
- smokers;
- with sensitization to Alternaria spp.
The severity of the exacerbation determines the strategy and scope of therapy. Patients with mild to moderate exacerbations can be treated on an outpatient basis. Patients with severe exacerbations should be treated in a hospital on an intensive care regimen. Table 2 presents the main therapeutic options and drugs for the treatment of asthma exacerbations, according to the recommendations of GINA and the British Thoracic Society.
High doses of inhaled β2-agonists are the first line of treatment for asthma exacerbations and should be started as early as possible! (Evidence level A.)
With an exacerbation of BA, in each case, a revision of the patient's basic anti-asthma therapy and an analysis of the causes of the developed exacerbation are required.
Indications for referring the patient to the intensive care unit and emergency therapy:
1) the need for ventilation support;
2) with severe or life-threatening exacerbation and lack of response to ongoing therapy, manifested by:
- deterioration of PSV;
- persistence or aggravation of hypoxia;
- hypercapnia;
- a study of blood gases showing pH or ↓H+;
- exhaustion, weak breathing;
- drowsiness, confusion, altered consciousness;
- cessation of breathing.
Therapy with high doses of inhaled corticosteroids administered by nebulizer, in particular budesonide 2 or 4 mg/day in 4 divided doses, was as effective as oral corticosteroids (prednisolone 40 mg/day). This exacerbation strategy has been studied primarily in children, but has also been shown to be effective in reversing asthma exacerbations of varying severity in adults. The use of a suspension of budesonide (2 mg 2 r./day) through a nebulizer for 5 days was compared with the traditional therapy of asthma exacerbation with prednisolone 15 mg 2 r./day in adult patients. The results showed that both strategies for the treatment of asthma exacerbation were effective in relieving exacerbation symptoms and restoring lung function. However, additional multicenter studies are certainly required to confirm the effectiveness of the strategy of using high doses of inhaled corticosteroids in the treatment of asthma exacerbations.
Prevention of asthma exacerbations
The goals of asthma therapy are to achieve and maintain disease control, defined by minimal (no more than 2 cases per week) daytime symptoms and the need for drugs to relieve them, the absence of nocturnal symptoms and limitation of the patient's activity, as well as normal lung function. Important components of the overall control of asthma include reducing the risk of exacerbations, preventing a decrease in lung function and the development of unwanted side effects of drugs (Fig. 2) .
Inhaled corticosteroids are the most effective group of pharmacological drugs in terms of achieving control and prevention of asthma exacerbations in both children and adults. They are particularly effective in eosinophilic inflammation, and titration of the ICS dose according to the level of eosinophils in induced sputum leads to stable control and a decrease in the number of asthma exacerbations compared with the traditional strategy based on monitoring symptoms and lung function. However, IGCS monotherapy is not effective in achieving BA control in all patients, because In normal clinical practice, there are many reasons for the reduced response to ICS (Table 3).
As can be seen from Table 3, in most cases, long-acting β2-agonists (LABA) help to optimize the response to ICS. IGCS and LABA show a complementary effect. IGCS increase the expression of the β2-adrenergic receptor gene, thereby activating the synthesis of these receptors and increasing their expression on the cell membrane, in addition, IGCS prevent the desensitization of β2-adrenergic receptors. At the same time, LABA activates inactive GCS receptors, making them more sensitive to steroid-dependent activation.
The clinical efficacy of combined IGCS/LABA preparations is manifested in achieving control in a larger number of patients and a significant decrease in the number of severe BA exacerbations, which was first noted in the FACET study. It showed that the addition of formoterol to both low and high doses of budesonide resulted in a significant reduction in the number of asthma exacerbations per patient per year (Figure 3).
This effect has been demonstrated in numerous studies investigating various combinations of ICS and LABA. The synergism of the action of ICS and LABA is manifested in relation to the reduction of eosinophilic inflammation, prevention of bronchospasm and inhibition of bronchial wall remodeling, which ultimately leads to effective control of BA and a decrease in the risk of exacerbations.
For the combined drug BUD / FOR (Symbicort®), a single inhaler treatment strategy is used, the essence of which is the use of the drug both for long-term control as basic therapy and for the relief of emerging symptoms of asthma, which is possible due to the rapid onset of the bronchodilator effect of formoterol (during 1-3 min.). In addition, formoterol has a dose-dependent bronchodilator effect, unlike salmeterol. The rationale for the single inhaler strategy, in addition to the effects of formoterol, is the additional anti-inflammatory effect of ICS inhaled simultaneously with formoterol to relieve symptoms, which, as expected, manifests itself in an additional clinical effect - a decrease in the incidence of asthma exacerbations.
This strategy has been studied in several large comparative randomized clinical trials, which have demonstrated that the use of BUD/POR in a single inhaler regimen reduces the frequency of severe asthma exacerbations requiring hospitalization and administration of systemic corticosteroids, reduces asthma symptoms and improves lung function when compared with 4-dose therapy. dose of budesonide or use of BUD/FOR for maintenance therapy and SABA for symptom relief. This effect was observed in patients with severe and moderate asthma, not controlled by moderate doses of ICS or their combination with LABA, who also had a history of severe exacerbations of asthma.
At present, the mechanism of the preventive action of the single inhaler strategy in relation to asthma exacerbations is not fully understood. Apparently, an increase in the dose of ICS at the same time as additional inhalations of LABA during the first signs of an exacerbation of asthma (the increase in asthma symptoms usually lasts 5-7 days) can prevent further development of an exacerbation, provided that the patient feels and adequately evaluates these symptoms. A retrospective analysis of 5 large randomized clinical trials (>12,000 patients) comparing the efficacy of BUD/POR used in the single inhaler regimen and various conventional therapy regimens showed the benefits of this strategy at all stages of therapy (according to GINA) in terms of reducing the number of severe asthma exacerbations (Fig. 4) .
As mentioned above, the most common cause of asthma exacerbations in adults and children is viral respiratory infections, often leading to loss of control and exacerbation even in patients with well-controlled asthma. A decrease in the risk of their development was shown against the background of IGCS/LABA therapy compared with IGCS monotherapy, which once again indicates a pronounced anti-inflammatory effect of combined drugs. The variable course of asthma often requires a rapid response to the onset of symptoms of an incipient exacerbation of the disease, and in this regard, the use of ICS on demand (when symptoms appear) after or simultaneously with SABA or LABA (formoterol) is a promising strategy.
An extensive retrospective analytic study examined the relationship between respiratory infections (colds) and severe asthma exacerbations in 12,507 patients participating in 5 large, randomized, double-blind clinical trials that evaluated the strategy of using AUD/POR in the single inhaler regimen compared with other regimens. therapy (IGCS / LABA at the same or higher fixed doses + SABA or formoterol as needed). Severe asthma exacerbations were considered exacerbations that required the administration of systemic corticosteroids for 3 or more days and/or hospitalization or emergency care. An exacerbation of asthma associated with an acute respiratory infection (ARI) was considered an exacerbation that developed within 14 days from the onset of a cold.
As expected, the results of the analysis showed that the incidence of ARI did not differ between patients receiving different regimens of anti-asthma therapy with ICS/LABA (20-22% of patients per year of follow-up). An increase in the frequency of ARI was noted in the autumn-winter period, the average duration of ARI was 7 days. The incidence of severe asthma exacerbations was significantly lower among patients treated with AUD/POR in the single inhaler regimen compared with other strategies + SABA (9-13 and 12-22%, respectively). During the ARI period, the advantage of BUD/POR in the single inhaler regimen in terms of reducing the risk of asthma exacerbations by 36% was also noted over the regimen of maintenance therapy with fixed doses of ICS/LABA + SABA on demand (Fig. 5). The maximum difference in the frequency of severe asthma exacerbations associated with ARI was found between single inhaler BUD/POR regimens (reduction of exacerbations by 52%) and equivalent fixed doses of ICS/LABA + SABA on demand, which may indicate the importance of a timely increase in anti-inflammatory anti-asthma therapy with the help of additional doses of ICS in combination with LABA in relation to the prevention of the development of an exacerbation of asthma.
Conclusion
Exacerbations of asthma can develop in any patient, regardless of the severity of the disease, but they are more common in patients with severe or difficult to control asthma. Prevention of asthma exacerbations is an important component of full and stable disease control. Inhaled corticosteroids are the most effective group of pharmacological drugs in terms of achieving control and prevention of asthma exacerbations in both children and adults. The combination of ICS and LABA is more effective when used regularly in patients with asthma symptoms not controlled by ICS alone. The use of BUD/FOR in the single inhaler regimen proved to be an effective strategy for reducing the frequency of severe asthma exacerbations, incl. as a result of ARI.

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Exacerbation of bronchial asthma in most cases occurs due to the interaction of a sick person with some kind of irritant, in other words, an allergen. This is the most important and most common cause of asthma.

The main symptoms of the disease that allow it to be recognized are: shortness of breath, paroxysmal dry cough with characteristic whistles and wheezing in the chest, a feeling of lack of air and increased sweating.

If the patient has an exacerbation of bronchial asthma, treatment and removal of the acute period should begin immediately. Asphyxiation attacks, which are characteristic of these periods, can carry a direct threat to life.

Treatment of exacerbation of bronchial asthma

One of the prerequisites for the implementation of effective therapy during exacerbations is careful monitoring of the patient's condition and how effective the prescribed treatment is.

An exacerbation of bronchial asthma can be treated at home, but you need to be able to assess the severity of the situation and, in the event of critical acute symptoms, immediately call a doctor.

• In case of exacerbation and the occurrence of an asthma attack, it is important first of all to supply the bronchi with a bronchodilator drug. To do this, a person suffering from asthma should always have an inhaler with a fast-acting drug (Atrovent, Berotek, Ventolin, Salamol, Astalin) at hand.
• Also, hormonal drugs, such as prednisone, are used to relieve seizures and stabilize the condition.
• Eufillin is a fairly effective tool for therapy during exacerbations. It can also be taken in tablet form by placing it under the tongue.

One of the most important elements of maintenance therapy is, as far as possible, the complete elimination of factors that cause an exacerbation of the disease. Most often these are allergens.

There is an excellent technique of breathing exercises that allows you to stabilize your breathing after stopping an asthma attack.

Salt air has a very favorable effect on the course of the disease. Therefore, if you stay in a maritime climate for a long time, you can reduce the number of attacks. Today, halotherapy and speleotherapy are successfully practiced - methods of treating the disease by being in an artificially created climate of salt caves.

With regard to care provided directly by medical professionals, there are some principles in the treatment of asthma exacerbations.

1. Initially, it is necessary to analyze the stage and severity. This is done to prescribe the right treatment and in order to prevent life-threatening consequences. If the condition is assessed by a doctor in a hospital, then most likely, first he evaluates the indicators of the function of external respiration and examines the blood for oxygen saturation.
2. The second important step is the exclusion of triggers, that is, irritants (allergens).
3. Further, the scope of treatment used in the previous exacerbation is specified, including questions regarding the dose of drugs that relieve bronchospasm, the time and method of the last use of the drug.
4. The scale of prescribed treatment depends on the severity of the exacerbation.

A huge number of people on our planet are sick. Ecology, chemical emissions, pollen and much more are provocateurs of this disease. This is a chronic disease that is difficult to treat, but possible. People need to know why it happens, how to deal with attacks and what to do so that they do not happen again.

This is a fairly common chronic respiratory disease, accompanied by severe coughing and shortness of breath, in more serious cases, an asthma attack may occur.

Under the influence of various allergens (dust, powder, cigarette smoke, etc.), a large amount of mucus is produced in the respiratory tract, which makes it difficult for normal air circulation. As a rule, doctors distinguish two main types of bronchial asthma: atopic and infectious-allergic.

The atopic form of the disease occurs due to the presence of some kind of irritant, or rather, an allergen, if it is not there, then there will be no asthma attacks. This form affects people who are genetically disposed to active reactions of the body to an allergen, or people who have some physiological characteristics. An allergen can be house dust, animal hair, pollen, and more.

The infectious-allergic form occurs against the background of any chronic infectious diseases of the respiratory tract. Over time, in addition, allergies can occur, as well as other pathologies of the lungs and bronchi.

Exacerbation of the disease

An asthma attack is an attack that is accompanied by a strong dry cough, wheezing, and chest pain. An asthma attack can come and go either gradually or instantly. Most often, such asthmatic outbreaks occur at night or in the early morning. If nothing is done, then in the most severe cases, suffocation may occur. It is the main cause of death among patients with bronchial asthma.

Causes that can cause an exacerbation of asthma:

• the presence of allergens (dust, pollen, cigarette smoke, etc.);
• SARS, acute respiratory infections;
• hostile working atmosphere (dust in production, toxins, chemicals);
• change in weather or climate;
• excessive physical activity;
• smoking;
• long pastime in a "damp" room, especially if there is mold and fungus;
• certain medications (such as beta-blockers);
• wrong treatment, etc.

Symptoms in adults

Signs according to severity

Doctors distinguish 4 degrees of the course of the disease:

• I degree, mild;
• II degree of moderate severity;
• III degree, severe;
• asthmatic status.

I degree: at this stage, symptoms occur quite rarely, approximately 1 time per week, the attack does not last long. Before the onset of symptoms, the person feels well, the lungs are in good condition and perform their functions well. Asthma can be caused by an allergen. There are some by which this disease can be identified: severe shortness of breath; whistling may be observed during exhalation; dry wheezing, determined by the doctor during the examination; cardiopalmus.

Grade II: Symptoms occur more than once a week. Signs of the disease: poor patency of the bronchi, which causes difficulty in exhalation and shortness of breath; dry wheezing; during a cough, mucus or even pus may periodically be released; shortness of breath that occurs during physical exertion. Symptoms in adults can appear even when there are no asthma attacks. II degree is also characterized by suffocation, which can be life-threatening.

III degree: at this stage, the symptoms of asthma accompany the patient all the time. They arise not depending on whether there is any stimulus, most often spontaneously and just like that. Signs of an attack of bronchial asthma: heavy and difficult breathing, which causes severe panic; cold sweat; a pronounced whistle that can be heard at a distance; pressure rises, there may be tachycardia (rapid heartbeat that causes pain); strong wheezing.

Asthmatic status: occurs when the patient does not respond to the treatment of an asthma attack; a dangerous condition that leads to death. The patient must be admitted to a hospital and connected to devices that support life processes. Causes of occurrence: many allergens act on the human body at the same time; the presence of SARS; drug overdose; a sharp change in treatment tactics, or its complete cancellation.

IMPORTANT! To prevent such a condition, it is best to seek help from doctors as soon as you notice that the treatment does not help and does not alleviate the attack.

The reasons

Contact with an allergen

With bronchial asthma, it is important to know what exactly provokes attacks, and if it is an allergy, then find out what exactly causes it. To do this, you must definitely visit a doctor, it is he who will take the necessary tests to determine the allergen. To reduce seizures to a minimum, or even get rid of them altogether, you should limit yourself from contact with the allergen as much as possible. If you can not limit yourself to 100%, then you need to take medications to avoid seizures.

IMPORTANT! For a consultation, you should go to the doctor, it is he who will conduct all the tests and prescribe the right medicines. You should not self-medicate.

House dust is the most common allergen. Everyone has her at home, we are in contact with her every day. If there is too much dust, then this provokes attacks of bronchial asthma.

• book;
• dust that collects in carpets and furniture;
• mold particles.

To prevent an attack caused by dust, you should:

• carry out daily wet cleaning in the apartment;
• get rid of carpets, they accumulate too much dust, which is difficult to clean;
• upholstered furniture collects a lot of dust, it is better to replace such furniture, for example, with leather;
• soft toys are best removed altogether;
• curtains should be replaced with blinds;
• books are best stored in a cabinet where there is glass, then they will “collect” less dust.

Taking medications with contraindications

Some patients are allergic to aspirin, which can cause seizures. Such people are prohibited from taking acetylsalicylic acid and non-steroidal anti-inflammatory drugs.

Treatment

At each stage, a certain type of treatment prescribed by doctors is used. An asthma attack is not cured, but only relieved. It is necessary to treat the disease itself in order to avoid these very attacks. An attack is a complication and exacerbation of bronchial asthma, which, with the progressive course of the disease and the absence of treatment, can intensify. More about the treatment is written in our article a little lower.

Preparations for the relief of shortness of breath

In a person suffering from bronchial asthma, Always carry an inhaler with you to relieve seizures., drugs of this kind dilate the bronchi and help a person breathe better.

IMPORTANT! A bronchodilator drug must be prescribed by a doctor.

If you have an inhaler with you, then during an attack you need to urgently use it, if a person cannot do it on his own, then he needs help. During an attack, it is very important that a person has something to breathe, so you should ensure that fresh air enters the room by opening a door or window. To rid the patient of clothes that interfere with him, for example, unbutton his shirt, take off his tie. Help to get into a comfortable position. If all of the above helps, then give the person warm tea or milk to drink.

What means are most effective

With a mild form of the disease, it will be enough to use an inhaler with a bronchodilator medicine. If an attack occurs, it will quickly help to stop it.

If the stage of the disease is II or III, then one inhaler is not enough. You need anti-inflammatory drugs.

Usually they are applied for a very long time, sometimes even for years, but thanks to they can completely control the disease, and minimize seizures, if not completely get rid of them. In such cases, inhalers with hormonal drugs are prescribed.

Drugs based on cromoglycic acid - are available in the form of powders and solutions for inhalation. They have anti-inflammatory and healing effects.

A person with asthma should always have an inhaler with a bronchodilator with him. He must be able to use it. What kind of inhaler the patient needs should be determined by the doctor. After all, they are all different and not everyone is suitable for this or that medicine.

How to use an inhaler correctly

Every asthmatic should know how to use an inhaler. After all, this is the only way he can help himself during an attack before the ambulance arrives. The inhaler contains a special cartridge, bronchodilator, it is he who, during an attack, will help the patient breathe freely, as far as possible.

How to use the can:

• place your index finger on top of the inhaler, and your thumb under it;
• remove the protective cap from the mouthpiece;
• shake the can slightly;
• inhale and place the mouthpiece in your mouth;
• while pressing the inhaler with your finger, take another breath;
• hold your breath for a few seconds and exhale.

How to treat at home

Ginger: take equal portions of ginger and pomegranate juice, add honey, mix thoroughly, take 2-3 teaspoons per day; 1 teaspoon of ginger and half a glass of water, mix, you need to take 1 tablespoon at bedtime.

Garlic: well cleans the bronchi from unnecessary mucus. You need to take 10 cloves and peel them, put a saucepan on a slow fire and pour half a glass of milk, add garlic and boil for 4 minutes, take before going to bed.

Eucalyptus oil: Add 5 drops of oil to a pot of hot water, lean over it, cover with a towel and inhale the steam deeply.

Honey: before bed to get rid of phlegm and breathe well all night, you can mix 1 tablespoon of honey with a teaspoon of cinnamon, eat everything with water.

IMPORTANT! Before starting treatment with home remedies, be sure to consult with your doctor.

In order for asthma attacks to disturb the patient less often, you need to follow some recommendations.

• Visit the doctor more often. Asthma requires constant monitoring by a doctor, it is he who will prescribe drugs that will help stop the disease. He must determine what exactly causes seizures and suggest how to cope with them.
• If the activator of seizures is an allergen, then as much as possible to protect yourself from contact with him.
• Try not to overcool and not to be where there is dampness.
• Eat right and lead a healthy lifestyle. Never smoke or be near people who smoke.
• If you do not live in a very ecologically clean area, then you should think about changing your place of residence.
• Do sport. But do not overload your body too much. It is best if you do some light exercise outdoors. Whether it is possible to play sports depends on the stage of bronchial asthma, so in this case it would be better to consult a doctor.
• Avoid stressful situations.
• If you are ill with ARVI or acute respiratory infections, you should consult a doctor as soon as possible and start treatment.
• You can go to rest in a sanatorium or resort. But it is very important that the climate of that place suits you, otherwise it will not give any result, and in some cases it may even provoke a new attack.
• Protect yourself from strong odors.
• Do it at home as often as possible wet cleaning and especially wipe the dust daily.
• Daily good ventilate the room in which the patient spends a large amount of time.

Useful video

Check out the visual signs of an exacerbation of bronchial asthma in the video below.

Asthma attacks account for approximately 5% of all patient calls in our country, according to the National EMS data. Moreover, about 12% of patients require immediate hospitalization. The period of exacerbation of bronchial asthma alternates with remission. During an attack, a person develops shortness of breath, wheezing, coughing, chest tightness. Obstruction leads to narrowing of the bronchial lumen and inhibition of normal respiratory rates.

The reason for the exacerbation of bronchial asthma may be inadequate treatment, ignoring the treatment regimen by the patient himself or frequent contact with a provocative trigger that causes suffocation (allergens, overload, respiratory infections, smoking, weather changes, stress, certain medications, etc.).

Degrees of exacerbation of bronchial asthma: classification

To assess the condition of the patient's respiratory system, a collection of clinical symptoms of the disease is carried out, as well as special testing. In particular, it is necessary to measure the pulse rate, peak expiratory flow (PSV), pressure (Pa), O 2 saturation (Sa).

There are 4 degrees of exacerbation of bronchial asthma:

• Lung;

The patient remains in a normal physical condition, but he becomes short of breath during walking. The seizure does not affect spoken language. Patients sometimes have an excited state with tachycardia, but not more than 100 beats per minute. PSV after using a bronchodilator is at around 80%. The pressure of oxygen and carbon dioxide is normal. Blood saturation 0 2 exceeds 95%.

• Moderate;

In this degree of exacerbation of asthma, physical activity is already limited. During a conversation, the patient has difficulty breathing, so he speaks in phrases rather than sentences. Patients have an almost constant excited state with a high pulse rate of up to 120 beats. Exhalations are accompanied by wheezing. PSV after using a bronchodilator drops to 60%. Reduced oxygen pressure and saturation.

• severe exacerbation;

Patients face severe physical limitations. They have shortness of breath even during a quiet rest. It becomes difficult to speak, the patient manages to pronounce only separate words. There is a strong emotional arousal, the pulse increases above 120 beats. Inhalations / exhalations are accompanied by loud whistling wheezing. PEF is below 60%, oxygen pressure is so low that signs of cyanosis may appear. Saturation is less than 90%.

• life-threatening exacerbation;

Patients have practically no physical activity, they cannot talk. Constantly worried about shortness of breath, shallow breathing is no longer accompanied by whistling. Patients have a disorder of consciousness, sometimes they even fall into a coma. Muscle fatigue is recognized by bradycardia and a "silent" lung. PSV is below 33%, there are signs of cyanosis.

A mild or severe exacerbation of bronchial asthma can be manifested by all of the listed or only some of the symptoms and indicators. But they allow us to give a general qualification of the degree of the disease. As a rule, the course of asthma and the severity of attacks correspond to each other. That is, with a mild illness, the aggravating symptoms will also be unexpressed, etc.

According to the degree of exacerbation of bronchial asthma, the treatment regimen is determined. It also depends on the manifestations of the disease where the patient's therapy will take place - at home, in a hospital or in an emergency department.

Treatment of bronchial asthma during exacerbation: basic principles

If we talk about the algorithms for the treatment of bronchus obstruction, they are classified according to the severity of the attack. At the initial stage of exacerbations, it is much easier to stop the symptoms than in severe cases. First, they resort to emergency drugs, if they do not give a quick result, then they use auxiliary physical procedures within the walls of the hospital.

• Treatment of mild exacerbation;

First of all, beta2-agonists are used in inhalers. The patient makes two injections of the medicinal substance. You can enter 3 doses per hour. If the drug helps, then the patient's PSV will rise to normal and the effect will last for four hours. After that, it is recommended to continue using the inhaler every 4 hours for two days and consult a specialist about the appointment of further therapy.

If the action of a short-term beta2-agonist ends after 60-120 minutes, then oral corticosteroids (usually Prednisolone) are added to the patient. Then you should enter the inhalation substance every four hours for 2 days.

When, after the introduction of bronchodilators, the effect persists for 60 minutes, and after that the symptoms intensify, the patient is hospitalized.

• Treatment of moderate exacerbation;

As with mild cases, beta2-agonists are prescribed in inhalers or by spraying the drug through a nebulizer. Within an hour, it is necessary to inject the drug 3 times. Salbutamol, Fenoterol, Berodual are used as nebulizer bronchodilators. Then they give Prednisolone tablets and observe the body's response. A good response to therapy is the continuation of the effect for 4 hours, PSV above 70%, almost complete blood oxygen saturation.

In such cases, the patient can stay at home and only see a specialist as needed. After an exacerbation, inhaled substances are administered for about two more days, they continue to take Prednisolone and adhere to the prescribed treatment regimen.

If the body's response is incomplete and the patient has signs of an asthma attack, he is recommended to do oxygen therapy. Corticosteroids are also additionally prescribed and the period between the introduction of a bronchodilator inhaler is reduced to an hour. You can add Eufillin and urgently hospitalize.

With a bad reaction of the body, the state of health becomes threatening, so the patient is taken to the hospital. There, intravenous or inhalation administration of all necessary drugs may be required. At the same time, the dose of corticosteroids is increased, beta2-agonists and anticholinergics are used in inhalations through a nebulizer. If the effect is weak, prescribe Theophylline, oxygen therapy, mechanical ventilation.

• Treatment of severe exacerbation;

In this degree of severity, continuous inhalation-nebulizer administration of beta2-agonists is required. Be sure to use corticosteroids and hospitalize the patient. A good response of the body is considered to be the removal of respiratory disorders and the preservation of the effect up to 4 hours. After that, continue to use the inhaler and anti-inflammatory drugs.

If the patient still has exacerbation symptoms, then the daily dose of Prednisolone is increased, and inhalations are administered every hour.

In a life-threatening situation, the patient is urgently hospitalized in intensive care, oxygen therapy is carried out. It is mandatory to use beta2-agonists with oxygen, administering the drug through a nebulizer. Additionally, anticholinergics, an increased dose of corticosteroids, possibly Theophylline are used. The patient is left in the inpatient department until the PSV rises to 75%. After that, the dosage of the drugs is adjusted.

Prevention of exacerbations of bronchial asthma is very important. The patient is still in the hospital taught how to eat right, engage in physical activity, rest, help yourself during an attack. Only in this case it is possible to avoid the next severe symptoms of asthma.

Bronchial asthma is a severe chronic disease characterized by a progressive nature. Under the exacerbation of asthma should be understood as an asthma attack, which can begin at any time. If timely and qualified assistance is not provided, such an attack can easily end in death. Severe exacerbations of bronchial asthma occur infrequently. They occur in less than 5% of cases, but their consequences can be sad.

In itself, an exacerbation of bronchial asthma is an episodic worsening of the patient's condition, in which there is severe shortness of breath, cough, wheezing with wheezing, a feeling of squeezing in the chest. This is explained by the fact that narrowing of the gaps occurs in the bronchi, which leads to the appearance of spasm and breathing problems. The main reasons that contribute to the occurrence of asthma attacks are incorrectly chosen methods of treatment, non-compliance with these methods and contact with a factor provoking an attack (trigger).

What provokes an exacerbation of the disease and how it happens

Factors that provoke a severe exacerbation include:

• allergic substances;
• pollutants;
• colds and flu;
• weather changes;
• medical preparations;
• stressful situations;
• smoking.

The severity of asthma exacerbations ranges from mild to deadly. In the first case, deterioration occurs gradually. The period during which the patient becomes worse can last from several hours to several days. At this time, there is a narrowing of the airways due to the formation of plugs in them. The cause of this phenomenon may be infections or lack of medical therapy.

Such an exacerbation is called a protracted progressive obstruction with the episodic appearance of spasms in the bronchi. This is the first type of exacerbation that occurs most often.

The second type of exacerbation is a sharp deterioration in the condition associated with a spasm of the smooth muscles of the walls of the respiratory organs. Such attacks are typical for young patients. They can be provoked by an increase in the emotional background (stress), taking medications from a number of pyrozolones in case of their intolerance, in contact with an allergen. Such attacks are very dangerous and often end in death. This is due to the fact that it is not always possible to get qualified medical care at the onset of an exacerbation. It can be negatively affected by its incorrect treatment and underestimation of the severity of the patient's condition.

There is a certain group of patients in whom the risk of dying during an acute attack is very high.

These are patients who take drugs from the group of corticosteroids, or those who stopped taking them less than six months ago.

The appointment of these drugs indicates a severe stage of the disease, and during this period, bronchial asthma is most dangerous. The second category of patients are people who have already had an attack. According to medical data, more than 60% of patients re-exacerbate asthma within a year. The risk group includes patients with mental and concomitant diseases (epilepsy, diabetes mellitus), low material, social and cultural standard of living.

Young people (from 15 to 25 years old) and representatives of the older generation are no exception. They are the most prone to panic and, due to their age, cannot control their emotions. An exacerbation of the disease often occurs in patients with a severe stage of the disease, in which several types of medications are required at once. This group also includes patients who systematically violate treatment regimens, skip taking medications, and ignore the prescriptions of the treating specialist.

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Treating an Exacerbation of Asthma

The tactics of providing medical care is based on the following principles:

• relieve airway obstruction as soon as possible;
• get rid of hypoxia;
• restore spontaneous breathing;
• determine methods of subsequent treatment;
• teach the patient how to act competently in case of a repeated attack.

Further treatment of exacerbation of bronchial asthma includes a set of measures that are aimed at preventing repeated exacerbations. To begin with, the doctor assesses the severity of the exacerbation and specifies at what stage the disease is. The second stage is the elimination of triggers that provoke seizures.

Be sure to evaluate the current treatment and its effectiveness. The dosage of bronchodilators and methods of their use are specified and regulated. An important point: whether corticosteroids were used, for how long and in what doses.

The symptoms of the disease can be traced in dynamics, if necessary, a procedure for saturating the blood with oxygen and gases is carried out. To alleviate the condition and prevent further attacks, the patient is taught the correct use of the inhaler, an individual plan for the provision of first aid is drawn up, which should always be at hand for the patient.

Usually this plan is drawn up in writing in two copies: one is at home, the second is always in the pocket of the patient's clothes. This is necessary so that in the event of an exacerbation in a public place, other people can help the patient stop the asthma attack. Such a plan is mandatory if asthma attacks occur in young children. The child's caregivers and teachers should be made aware of his illness.

Prevention of exacerbations also includes self-assessment of the patient's state of health. If there is a deterioration or the fact that the drugs do not have the desired therapeutic effect, you should immediately consult a doctor. The patient should be able to recognize the first signs of an exacerbation and be able to contact the attending doctor at any time of the day.

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Treating asthma attacks at home

To stop the exacerbation, measures to eliminate the attack should be started before the doctors arrive. If the patient is able to help himself on his own, this will not only contribute to the treatment, but also give strength, help him learn to control his illness. How well and competently the patient provides himself with help depends on the experience of the attending doctor and the skills of the patient, providing medicines and tools. The patient must necessarily know and be able to recognize both signs of deterioration, and understand the measures of medical care.

Of the drugs used at home, bronchodilators and corticosteroids can be distinguished. With bronchodilators we treat bronchial obstruction, and with corticosteroids we eliminate inflammation and reduce bronchial secretion.