Relevance of bronchial asthma in children. Introduction
One of the most pressing problems of modern world medicine is, in particular, bronchial asthma. It has been established that over the past 40 years there has been a dramatic increase in the number of patients with bronchial asthma.
The vast majority of these patients live in industrialized countries. On the contrary, in regions characterized by low socio-economic development of the population, a significantly lower prevalence of allergic pathology is recorded. Over the years of study, the clinical forms of allergies and variants of its course have been described in detail. Science has become aware of the molecular mechanisms of the development of this disease, and it has been proposed that it suppresses and prevents their occurrence. However, even in the case of successful treatment and a satisfactory response of patients to therapy, today we are talking only about the onset of remission of the allergic disease, but not about recovery.
Causes of development of bronchial asthma
Questions about the causes of the development of these diseases remain unclear. Traditionally, pollution of the external environment with industrial and household pollutants (chemical waste) is considered as the reason for the increase in the incidence of bronchial asthma. In recent years, considerable attention has also been paid to the study of the genetic predisposition of individuals to the development of this disease.
However, there are studies whose results cannot be explained only by these factors. In particular, one of them indicates that children born in the United States to immigrants from Mexico have bronchial asthma more often than children who were born in Mexico and emigrated to the United States at an older age. This indicates an additional influence in early childhood of a certain unknown factor that is not associated either with the harmful effects of pollutants or with the genetic predisposition of individuals.
Relevance of the topic. Bronchial asthma (BA) is an extremely pressing problem in pediatrics. Epidemiological studies of the latter.
Bronchial asthma in young children, presented at. which largely determines the relevance of the studies carried out.
Relevance. The prevalence of bronchial asthma in different countries ranges from 2 to 25.5% according to the European Community Respiratory.
Doctors do not have to remind doctors about the relevance of the problem of bronchial asthma; this disease is highly prevalent.
relevance of bronchial asthma Recipes with green beans Bronchial asthma in young children, presented on. which largely determines the relevance of the studies carried out.
Relevance. The prevalence of bronchial asthma in different countries ranges from 2 to 25.5% according to the European Community Respiratory. Doctors do not have to remind doctors about the relevance of the problem of bronchial asthma; this disease is highly prevalent.
relevance of bronchial asthma
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Every year on the first of May, International Asthma Day is celebrated on the initiative of WHO. It was first celebrated in 35 countries in 1998. within the framework of the first world meeting on asthma and every year the number of countries participating in the project increases. Its goal is to attract public attention around the world to the problem of bronchial asthma.
Almost every person has experienced breathing discomfort at least once in their life: coughing or feeling short of air, wheezing or discomfort in the chest, shortness of breath or wheezing. All these symptoms, different at first glance, may be a manifestation of bronchial asthma - chronic inflammation of the bronchi, predominantly of an allergic nature. Up to 80% of cases of the disease are accompanied by increased sensitivity to certain environmental factors. Skin testing, which is performed in an allergology office, helps clarify the spectrum of allergens and the strength of their effect on the body.
Asthmatic inflammation leads to bronchospasm, or narrowing of the lumen, to any influence, i.e. to the formation of so-called hyperreactivity. Bronchospasm can be caused by inhalation of cold air or dust, strong odors, strong emotions accompanied by crying or laughter, physical activity, as well as encounters with specific “provocateurs”-allergens: pollen, animals or insects and their waste products, mold fungi, some food products. products, medicines, etc. Mild bronchospasm can be manifested by a sore throat and paroxysmal cough, which in some cases go away on their own. At the onset of the disease, such conditions may occur only a few times a year and not cause concern. The inflammation slowly smolders, the disease waits for an opportunity to manifest itself in full force.
Such a case could be a common viral infection (URI), inhalation of irritating particles or gases, general cleaning of the house, or even visiting friends who have a cat in their house. The cause may be insignificant and remain unknown, but the consequences will not keep you waiting - a real attack of suffocation develops, that very condition when you cannot exhale or inhale, and there is heaviness and wheezing in the chest. The “gold standard” for diagnosing bronchial asthma is spirometry or a study of external respiratory function with special (bronchomotor) tests. A history of the disease, confirmed by a study of external respiratory function and supplemented by allergological tests, allows us to establish a diagnosis of bronchial asthma.
Bronchial asthma affects people of all ages, nationalities, and professions. Thus, it is the most common chronic disease among children. Half of the patients develop asthma before the age of 10 years, and another third before the age of 30-40 years.
Bronchial asthma is one of the most common diseases in the world. According to WHO, about ZOO 000 000 people in the world suffer from asthma. According to epidemiological studies conducted around the world, up to 10% of children and about 3-4% of adults suffer from asthma in the general population. Data for the Republic of Belarus among adults - 0.67%, among children -1.2%. According to WHO, every decade the number of asthma patients increases by 1.5 times. Three times in 15 years, the Global Initiative for Asthma (GINA) has provided guidance on the management of asthma to physicians around the world. In the Republic of Belarus we have an Agreed National Guidelines for the diagnosis, treatment, prevention and rehabilitation of bronchial asthma. It takes into account all GINA recommendations. The main indicator of the effectiveness of asthma treatment is achieving and maintaining disease control. Modern treatment methods, provided they are timely and correctly applied, can provide a person with asthma with a full, active life. A mandatory section of a comprehensive asthma treatment program is training. The purpose of education is to provide the patient and his family with the necessary information to successfully manage the course of the disease. Each patient must clearly know how to use an inhaler correctly, which drug to inhale daily to prevent exacerbation, and which one to relieve suffocation, know the factors that cause suffocation and monitor their condition using a special device peak flow meter - a device for assessing breathing - peak expiratory flow .
The Republic of Belarus has every opportunity to provide assistance to patients with asthma. These are modern means for basic therapy and emergency care, patient education and the widespread use of speleotherapy, as well as specific immunotherapy.
Success in the treatment of bronchial asthma can be called the ability to achieve confident control over the disease, which means a full life, physical activity, and preserved ability to work. Over 5 years, the number of patients requiring hospitalization has significantly decreased (from 25,599 to 15,319 - 40%), and the number of serious complications - status asthmaticus - has also decreased.
Relevance of the topic. Young people are more likely to get sick: most people develop asthma in childhood. 1/3 are under 40 years of age. At least 2% of the world suffers from asthma. In the USA, England, Germany, Sweden, France - 5%. Very high incidence in New Zealand and Australia. In Russia, epidemiological outbreaks in Kirishi, Angara, Volgograd, which are associated with the use of fungi of the genus Candida in the production of protein-vitamin concentrates.
There is a steady increase in cases of asthma and an increase in mortality. Every decade the number of patients increases by 1-2%. There are more severe cases of the disease ending in death. Morbidity is determined primarily by two factors: hereditary and environmental.
Bronchial asthma This is a chronic inflammatory process in the respiratory tract, which leads to the development of an attack of suffocation. The inflammatory process leads to: - Spasm of the smooth muscles of the respiratory tract - Formation of viscous bronchial secretion - Swelling of the mucous membrane - Irreversible sclerotic process in the respiratory tract.
Etiology and forms of asthma. Atopic. There are organic and inorganic allergens: plant pollen, dust (more than 30 types of mites were found in house dust), feathers, dander, animal hair, food allergies, medicinal substances, industrial chemicals.
Infectious-allergic. The cause is various microorganisms (influenza viruses, bacteria, etc.) Professional. Develops in patients working in woodworking, weaving and other industries. Physical exertion asthma. Cold asthma. Psychogenic asthma. The cause is neuropsychic overload. Dishormonal asthma. Develops as a result of endocrine disorders.
Pathogenesis: There are 3 stages: 1. Immunological: when an allergen enters the body, it causes the production of antibodies, which, when combined with the antigen, form an immune complex that is fixed on the mast cell membrane, damaging it. 2. Pathochemical: Mast cells begin to secrete BAS (histamine, serotonin, bradykinin, etc.) 3. Pathophysiological: BAS cause bronchospasm, increase the permeability of the vascular wall and mucus secretion.
According to the severity, BA is divided into: Mild - attacks 1-2 times a week, they are mild, short-term in nature, quickly relieved by bronchodilators. Nocturnal asthma attack no more than 1-2 times a month. During the interictal period there are no signs of illness. Moderate severity - attacks more than 2 times a week, accompanied by impaired physical activity, night attacks more than twice a month, stopped by parenteral administration of bronchodilators, signs of bronchospasm are observed in the interictal period. Severe – Attacks are frequent, prolonged, and difficult to stop. Exacerbations every night. Physical activity is reduced. Asthmatic conditions develop periodically.
Clinical picture: Precursor period: vasomotor rhinitis, lacrimation, itching, chest tightness, paroxysmal night cough. Lasts from several minutes, sometimes days.
An attack of suffocation begins with a persistent non-productive cough, there is a sharp difficulty in exhaling, tightness in the chest, and there is no sputum at the beginning. At the height of the attack, viscous sputum appears with a small amount. Upon examination, the patient takes a forced position “asthmatic pose”, sits leaning on his knees or the edge of the bed (to fix the shoulder girdle and activate the auxiliary respiratory muscles), the face is pale, puffy, with cyanosis, the skin is covered with perspiration. Respiratory rate is 10 -14 per minute, breathing is noisy, wheezing, wheezing can be heard in the distance. The chest is expanded. Percussion sound is boxed. Extension of the outlet is determined - expiratory shortness of breath. Hard or bronchial weakened breathing and scattered dry rales are heard. Tachycardia, blood pressure is normal or slightly increased.
Period of reverse development. Sputum begins to separate, becoming more and more liquid and abundant. Wheezing quickly disappears, exhalation shortens.
Status asthmaticus is a complication of asthma that threatens the patient’s life. This is a state of severe asphyxia, which cannot be relieved by conventional means for many hours or several days and can result in the development of hypoxic coma and death. An important role in its occurrence is played by a violation of the drainage function of the bronchi - blockage of bronchioles with mucus, swelling of the bronchial mucosa.
The condition is extremely serious. There is cyanosis, severe expiratory shortness of breath with very frequent and then rare shallow breathing. As a result of the formation of mucus plugs, the lumen of the bronchioles and bronchi is clogged and the conduction of sound to the surface of the chest is disrupted, the sonority and number of dry rales are reduced, until the “silent lung” disappears. Tachycardia and hypotension are noted. In the terminal stage, mental disorders appear: motor restlessness, fear, anxiety, loss of consciousness, bradypnea. Blood pressure is not determined. Death occurs from asphyxia.
Additional examination methods: Clinical blood test - eosinophilia. Sputum analysis - a large number of eosinophils, Courshman spirals (spiral-shaped casts of small bronchi), Charcot-Leyden crystals (decomposition products of eosinophils. Allergy tests Study of external respiration function. Peak flowmetry (forced expiratory flow rate) X-ray examination of the chest.
First aid for an attack of bronchial asthma. Choking, shortness of breath with difficulty in breathing, dry wheezing, audible at a distance and during auscultation of the lungs, participation of auxiliary muscles in breathing. Forced position - sitting or standing with support.
Nurse's tactics: Actions Rationale 1. Provide psychological support 2. Leave the sitting or standing position with support on your hands, unbutton tight clothing. 3. Conduct a nursing examination: skin color, pulse, respiratory rate. HELL. 4. Help the patient take 1-2 breaths from the pocket inhaler he usually uses (salbutamol, Berotec). Do not use the inhaler if the patient has already used it independently. 5. Call a doctor. Reduce emotional stress Reduce hypoxia Eliminate bronchospasm
Prepare medications for the doctor: Aminophylline solution 2.4% - 10 ml. Prednisolone solution 1 ml. Sodium chloride solution 0.9% 10 ml, 400 ml. Prepare tools.
Treatment of asthma Determination of the cause of the deterioration of the condition Elimination of the provoking factor. Diet therapy - exclude foods containing food allergens. Drink plenty of fluids.
Drug therapy: Basic anti-inflammatory. - Intal, Tailed (only in children) - Glucocorticoids: beclozone, becotide - used by inhalation. They have a local effect on the respiratory tract. Before using them, it is necessary to clear the airways of bronchial secretions with bronchodilator inhalers. They do not stop the attack. After using them, you need to rinse your mouth.
Bronchodilators - Sympathomimetics: salbutamol, berotec. Used to relieve seizures. Atimos – long-acting. - Xanthine preparations – aminophylline. - Anticholinergics – atrovent, berodual. Effect after 30 -90 minutes
Non-drug treatment Acupuncture Massage Exercise therapy Speleotherapy (in salt mines) Climatotherapy (sea and high mountain climates) Treatment with hunger.
Prevention of asthma: Timely treatment of acute respiratory infections; Fight against environmental pollution; Fight against smoking; Creation of “asthma schools”.
» Text of the work “Bronchial asthma”
Bronchial asthma
Introduction.
1 General characteristics of the disease.
1.2 General characteristics of bronchial asthma
2 Methods for diagnosing bronchial asthma.
2.1 Diagnosis of bronchial asthma
2.2 Additional methods for diagnosing bronchial asthma
3 Different ways to treat asthma
3.1 Drug treatment of bronchial asthma
3.2 Traditional treatment of bronchial asthma
3.3 Physical therapy as an element of therapy for asthma attacks
Conclusion
Bibliography.
INTRODUCTION
The most ancient era of the development of life - the Precambrian - lasted an incredibly long time - more than 3 billion years. The food for the first organisms was the “primordial broth” of the surrounding ocean or their less fortunate brethren. Gradually, however, over millions of years, this broth became increasingly dilute, and finally the supply of nutrients was exhausted. The development of life has reached a dead end. But evolution successfully found a way out of it. The first organisms (bacteria) appeared, capable of converting inorganic substances into organic ones with the help of sunlight. To build their organisms, all living things require, in particular, hydrogen. Green plants obtain it by splitting water and releasing oxygen. But bacteria do not yet know how to do this. They absorb not water, but hydrogen sulfide, which is much simpler. In this case, it is not oxygen that is released, but sulfur. (On the surface of some swamps you can find a film of sulfur). This is what ancient bacteria did. But the amount of hydrogen sulfide on Earth was quite limited. A new crisis has arrived in the development of life. Blue-green algae “found” a way out of it. They learned to split water. Water molecules are a difficult nut to crack; it is not so easy to separate hydrogen and oxygen. This is 7 times more difficult than breaking down hydrogen sulfide. We can say that blue-green algae accomplished a real feat. This happened 2 billion 300 million years ago. Now oxygen began to be released into the atmosphere as a byproduct. The accumulation of oxygen posed a serious threat to life. Beginning some time ago, a new spontaneous generation of life on Earth became impossible; the oxygen content reached 1% of modern levels. And living organisms faced a new problem - how to deal with the increasing amount of this aggressive substance. But evolution managed to overcome this test, winning a new brilliant victory.
1 General characteristics of the disease Bronchial asthma
1.1Structure of the respiratory system
Breathing is the most important source of life. A person can live without food and water for several days, but without air, at most, a few minutes. Breathing connects the human body with the biosphere and the living world of the earth. When there is insufficient air supply, the heart and immune system begin to work more actively, thereby preventing infection and lack of oxygen. The human respiratory system is designed in such a way that the body as a whole can adapt to any changes in the environment.
The respiratory muscles and diaphragm of a person work, obeying his will and consciousness, therefore, to master proper breathing, knowledge of the structure and mechanism of the respiratory organs is extremely important.
The respiratory apparatus consists of the upper respiratory tract (nasal cavity, nasopharynx, larynx), trachea, bronchi, lungs, pleura, chest with respiratory muscles, nervous, vascular and lymphatic systems.
The lungs are made up of tiny sacs (alveoli) surrounding the bronchioles. There are approximately 700 million of these bubbles, their total respiratory surface is more than 100 m2.
The main respiratory muscles consist of the intercostal muscles, scalene muscles and the diaphragm. When you inhale, the respiratory muscles raise the chest, the diaphragm contracts and thickens. As a result of this process, the volume of the lungs increases and air penetrates into the lungs as if through a pump. The maximum volume of air in a person's lungs at rest is 9 liters, including reserve.
Exhalation is a passive process in which the respiratory muscles relax, the diaphragm rises and air is freely expelled from the body.
Breathing can be abdominal, or diaphragmatic, and thoracic, or costal. Chest breathing, in turn, is divided into upper and lower costal breathing. All the blood in the body passes through the pulmonary alveoli, just like through the heart. The respiratory apparatus continuously receives blood: venous, which gives oxygen to the tissues and takes carbon dioxide from them, which is again saturated with oxygen in the lungs. Through inhalation and exhalation, pulmonary respiration occurs - a constant exchange of gases: oxygen and carbon dioxide. Thus, breathing ensures the interaction of the body with the environment. This connection is carried out, in addition to pulmonary respiration (exchange of gases between the air in the alveoli and the blood), tissue respiration. Tissue respiration is the exchange of gases between the blood and the tissues and cells of the body, as well as the exchange of alveolar air and air from the external environment.
Ventilation of the lungs is ensured by the respiratory act, which consists of the rhythmic movement of the chest and lungs. Impulses to breathing come from the respiratory center located in the medulla oblongata at the bottom of the fourth ventricle. Excitation of this center occurs through the nervous and humoral, that is, through the blood. The accumulation of carbon dioxide in the blood during exhalation leads to a concentration of hydrogen ions, which excites the respiratory center. Other mechanisms are also involved in the regulation of breathing: reflex - from the mucous membranes of the respiratory tract, from the skin and other sense organs.
Excitation of the nervous system, excitement, and food intake increase the number of respiratory acts. An increase in ambient temperature increases breathing speed; as it decreases, it becomes less intense. The breathing rate even depends on the position of the body: when a person stands, breathing quickens. On average, an adult takes 15 inhalations and exhalations per minute, thereby supplying the body with oxygen.
The amount of air that a person can inhale during maximum inhalation and exhale is the concept of vital capacity of the lungs. The vital capacity of the lungs in women is on average 3.5 liters, in men - 4-5 liters. Its value depends not only on gender, but also on age, height, degree of physical activity and the nature of work.
At birth, a person has the correct breathing mechanism, which is gradually lost, which leads to various disorders in the body. The primary causes of failure of the respiratory system are tobacco smoking, alcoholism, drug addiction and environmental pollution.
Each cell of the body requires a fairly large amount of oxygen. Brain cells are especially sensitive to a decrease in its intake.
Science has established a close relationship between breathing and the tone of the nervous system. Observations have shown that with frequent and shallow breathing, the excitability of the nerve centers increases, and with deep breathing, on the contrary, it decreases. People with a weakened nervous system breathe 14% more often than people with a strong nervous system.
After 40-50 years, the elastic elements of the lung tissue are penetrated by connective tissue formations. Ossification of the costal cartilages leads to a decrease in chest excursion. The expiratory phase is particularly susceptible to changes. To ensure full exhalation, especially when climbing stairs or a slope, older people try to breathe deeper. In the absence of training of the respiratory system, this desire to take in as much air as possible leads to the development of emphysema - inflation of the lungs and stretching of the lung tissue.
The percentage of oxygen absorption from the air in middle-aged and elderly people, both during physical activity and at rest, is lower than in young people. The reason for the age-related decrease in the need for oxygen is the reduced volume of blood circulating in 1 minute in the body, which, in turn, is due to a decrease in basal metabolism and sluggishness of oxidative metabolism, ultimately leading to a weakening of all vital functions of the human body.
When there is a functional discrepancy between the structure of the apparatus and the external environment, a decline in oxidative and synthetic processes occurs. A decrease in oxygen consumption by tissues leads to the accumulation of waste and a decrease in the intensity of renewal. The content of adenosine triphosphoric acid (ATP) decreases, and the most important carriers of genetic information - DNA and RNA - are lost. Atrophic processes and a decrease in the regenerative capacity of cells lead to changes in the respiratory system.
Violation of the rhythm, frequency, type, depth and level of breathing, as a rule, accompanies not only diseases of the respiratory organs themselves, but also diseases of the heart, gastrointestinal tract, nervous system, blood and metabolism.
Before you begin to heal your body with the help of breathing exercises, you should learn to breathe correctly, that is, to fully use the external respiration apparatus.
Breathing through the nose is natural because the nasal mucosa warms, filters and humidifies the air. This does not happen when breathing is done through the mouth.
In the mucous membrane, as well as on the outer surface of the nose and the skin located near it, there is a receptor zone, the influence of which by air flow, mechanical, electrical, chemical and temperature stimuli, as well as moisture, causes numerous reflexes, the most important of which is the vasomotor, from which depends on the level of blood supply to organs. Stimulation of the nasal cavity when breathing through the nose is in the vast majority of cases accompanied by vasoconstriction. When breathing through the nose, the central nervous system is constantly activated, which ensures normal sleep and optimization of reflex regulation of breathing and cardiac activity. In the treatment of certain diseases in medicine, various types of influence on the nasal mucosa are used (for example, breathing frosty air through the nose). At the same time, irritations, the intensity of which significantly deviates from the norm, have an adverse effect on a healthy body, and in sick people they aggravate the poor condition. Thus, long-term cessation of nasal breathing, for example, as a result of the growth of adenoid tissue in children, is accompanied by severe disturbances in the functioning of the body, including mental retardation and insufficient physical development.
The unfavorable condition of the mucous membrane of the nasal cavity and the lack of its optimal stimulation can cause a deterioration in the functional state of the body (eye diseases, dysmenorrhea, impaired sense of smell, appetite, secretory activity of the gastric glands, dental caries, tuberculosis, tissue metabolism disorders, changes in the acid-base composition of the blood, decrease in antitoxic liver function, decrease in leukocytes, etc.). There are known cases of fainting with subsequent death in people and animals who suddenly got water into their nasal cavity.
Mechanical particles that enter the nasal cavity with inhaled air are retained by the ciliary epithelium and mucus. Some of them are removed from the nasal cavity by sneezing, blowing your nose and brushing your nose. The particles move along with the mucus using the movement of cilia towards the nasopharynx, and are then either swallowed or spat out. The nasal mucosa neutralizes harmful gases, which have time to undergo the necessary processing, despite the short duration of contact with the small surface of the nasal cavity.
The oral cavity, like the entire mucous membrane of the airways, has filtering properties, but its function is much worse than that of the nasal cavity, especially during muscular work. Research shows that a large number of people, both children and adults, breathe through their mouths when talking and make no effort to breathe through their noses while sleeping. In children, such poor breathing leads to slower growth of the thyroid gland, delayed development and enlarged tonsils. Poor breathing in adults leads to earlier aging of the body, since it impairs lung function and reduces the production of the hormone prostacyclin, which inhibits the coagulation of blood cells, dissolves blood clots and dilates blood vessels, thereby preventing the development of atherosclerosis.
Holding your breath improves the ventilation function of the lungs, blood circulation, helps overcome the alveolar barrier and enhances gas exchange. When developing correct breathing, it is held for a short period of time at the final phase of a deep breath. Since oxygen saturation of the blood is much better when breathing through the nose, it is necessary to ensure that the mouth is closed both during exercise and during periods of rest. The therapeutic effect of holding your breath is that the accumulated carbon dioxide during a pause or slow breathing has a vasodilating effect, thus relatively simple breathing exercises can replace many specific medications that have side effects.
1.2 General characteristics of bronchial asthma
Asthma is chronic inflammatory disease of the respiratory tract. If there is a predisposition, this inflammation causes repeated bouts of coughing, wheezing, a feeling of constriction in the chest, and difficulty breathing. Inflammation makes the respiratory tract sensitive to allergens, chemical irritants, tobacco smoke, cold air or physical stress. When exposed to them, swelling and spasm of the airways occur, they produce increased amounts of mucus and they become hypersensitive to external influences. The bronchial obstruction that arises with all this is reversible (however, in some patients, not completely) both spontaneously and under the influence of treatment. If bronchial asthma is adequately treated, inflammation can decrease for a long time, and the frequency of symptoms of the disease can become minimal: concomitant problems associated with bronchial asthma also disappear.
Bronchial asthma is characterized by increased sensitivity of the bronchi to various allergens, as well as nonspecific irritants. According to the modern classification, there are 3 main forms of the disease: non-infectious-allergic (atopic), infectious-allergic and mixed. Based on the severity of the course, bronchial asthma is classified into mild, moderate and severe.
The disease often occurs in the classical form: in the form of attacks of suffocation, alternating with periods of remission. In this case, 4 periods can usually be distinguished: pre-attack, post-attack and inter-attack. In severe cases of bronchial asthma, not only individual attacks occur, but also asthmatic conditions. In some cases, bronchial asthma occurs in the form of asthmatic bronchitis.
People with a family history of asthma have a much higher risk of developing the disease. Allergies and asthma most often go hand in hand. Smoking with asthma is very dangerous, but many people continue to smoke.
Although asthma can develop at any age, asthma attacks are much more common in adults. If asthma symptoms appear, be sure to consult a doctor. The doctor will tell you how to use inhalers and other medications to prevent further development of the disease and breathing problems.
The cause of asthma is the accumulation of fluids in the breathing tube itself; at the beginning of inspiration, the patient experiences shortness of breath, which is accompanied by coughing, wheezing, a feeling of heaviness and expectoration of sputum. If fluid accumulates due to catarrh, asthma begins suddenly. If the cause of the disease is the accumulation of fluid in the vessels, then the patient experiences an uneven pulse and heart failure. When asthma occurs due to dryness, the patient complains of thirst and has no sputum.
Asthma patients should eat mainly dairy products, especially whey. Avoid excitement and great physical stress, do not smoke, do not drink alcohol. To thin out sticky sputum during an attack, take soda on the tip of a knife. You can also take 15 - 20 drops of valerian.
During an attack, you need to get rid of tight clothes, give an influx of fresh air, immerse your hands and feet in hot water or put mustard plasters on them, rub the heart area with a rag soaked in cold water with vinegar and salt (unless, of course, there is a pulmonary disease ), the patient's temples are rubbed with cologne.
A massage of the upper body from the head down to the top of the chest and back eases the severity of the attack. The massage should be done with something oily.
During an attack, you can use the following remedy: boil potatoes until soft, put them hot in a bowl, sit down, put the bowl in front of you, cover your head with a blanket and breathe in the steam. At the same time, drink very hot lingonberry teas (leaves and berries, fresh or dry) all the time. When it becomes easier to breathe, immediately go to bed and cover yourself well.
In case of a sudden (mostly at night) attack, swallow barley coffee with pieces of ice, sniff ammonia, apply mustard plasters to the calves, and rub the body with brushes. In the patient's room the air should always be fresh, smoking should not be allowed in the room, and if it is smoky and the window cannot be opened, then a saucer filled with ammonia should be placed very close to the head of the patient's bed.
There are two stages of this chronic disease. The initial stage of development of bronchial asthma can be identified by conducting tests for a specific purpose, the role of which is to determine the altered reactivity and sensitivity of the bronchi in relation to physical activity, vasoconstrictor substances, and cold air. Partial changes in the sensitivity and reactivity of the bronchi are associated with disturbances in the state of the endocrine, immune, and nervous systems, which in turn do not have clinical manifestations and are detected by laboratory methods, most often by performing stress tests.
The second stage is formative for bronchial asthma. It does not appear in all patients and precedes quite pronounced asthma in 20 to 40 percent of patients. The physical condition before the disease itself is not a nosological form, but a certain set of signs that indicate a potential threat of bronchial asthma. Also, the clear presence of recurrent, acute or chronic nonspecific diseases of the lungs and bronchi with manifested respiratory discomfort and inherent phenomena of reversible bronchial obstruction, which are combined with the following 1 or 2 signs: hereditary predisposition to diseases of an allergic nature and bronchial asthma, extrapulmonary manifestations of allergy altered body reactivity, sputum and/or blood eosinophilia. The obvious presence of all these signs can be directly considered as the presence of an asymptomatic course of the disease in the patient.
2 Methods for diagnosing bronchial asthma
2.1 Diagnosis of bronchial asthma
Diagnosis of bronchial asthma is a complex and multi-step process. The initial stage of diagnosis is the collection of anamnestic data (questioning the patient) and a clinical examination of the patient, which in most cases makes it possible to make a preliminary diagnosis of bronchial asthma. Taking an anamnesis involves clarifying the patient’s complaints and identifying the evolution of the disease over time. Symptoms of bronchial asthma are very diverse and vary depending on the stage of the disease and the individual characteristics of each patient.
In the initial stages of development, bronchial asthma is manifested by coughing attacks, which can be dry or with a small amount of sputum. Cough occurs mainly at night or in the morning, which is associated with a physiological increase in the tone of the bronchial muscles in the morning (3 - 4 am). A cough may appear after a respiratory tract infection. Coughing attacks in the initial stages of the disease are not accompanied by difficulty breathing. Auscultation (listening to the patient) may reveal scattered dry rales. Latent (hidden) bronchospasm is detected using special research methods: with the administration of beta-adrenergic agonists (drugs that cause relaxation of the bronchial muscles), an increase in the fraction of exhaled air is observed (sirometry).
At later stages of development, the main symptom of bronchial asthma is asthma attacks.
At first, patients may notice some individual symptoms of an upcoming attack: runny nose, sore throat, itchy skin, etc. Then progressive difficulty breathing occurs. At first, the patient notes only difficulty in exhaling. A dry cough and a feeling of tension in the chest appear. Breathing disorders force the patient to sit with his arms supported in order to facilitate breathing by working the auxiliary muscles of the shoulder girdle. The increase in suffocation is accompanied by the appearance of wheezing, which at first can only be detected by auscultation of the patient, but then becomes audible at a distance from the patient. An attack of suffocation in bronchial asthma is characterized by so-called “musical wheezing” - consisting of sounds of varying pitches. The further development of the attack is characterized by difficulty in inhaling due to the installation of the respiratory muscles in the position of deep inspiration (bronchospasm prevents the removal of air from the lungs during exhalation and leads to the accumulation of a large amount of air in the lungs).
Examination of the patient for diagnosis at the pre-asthma stage does not reveal any characteristic features. In patients with allergic asthma, nasal polyps, eczema, and atopic dermatitis may be detected.
The most characteristic signs are revealed when examining a patient with an attack of suffocation. As a rule, the patient strives to take a sitting position and rests his hands on a chair. Breathing is elongated, tense, and the participation of auxiliary muscles in the act of breathing is noticeable. The jugular veins in the neck swell as you exhale and collapse as you inhale.
When percussing (tapping) the chest, a high-pitched (boxed) sound is detected, indicating the accumulation of a large amount of air in the lungs - plays an important role in diagnosis. The lower borders of the lungs are lowered and inactive. When listening to the lungs, a large number of wheezes of varying intensity and height are revealed.
The duration of the attack can vary - from several minutes to several hours. Resolution of the attack is accompanied by a tense cough with the release of a small amount of clear sputum.
Status asthmaticus is the most severe condition in which progressive suffocation seriously endangers the patient's life. With status asthmaticus, all clinical symptoms are more pronounced than during a normal asthma attack. In addition to them, symptoms of progressive suffocation develop: cyanosis (blueness) of the skin, tachycardia (increased heart rate), heart rhythm disturbances (extrasystoles), apathy and drowsiness (inhibition of the function of the central nervous system). With status asthmaticus, the patient may die from respiratory arrest or cardiac arrhythmias.
2.2 Additional methods for diagnosing bronchial asthma
Based on clinical data collected using the methods described above, it becomes possible to conduct a preliminary diagnosis of bronchial asthma. Determining the specific form of bronchial asthma, as well as establishing the pathogenetic aspects of the disease requires the use of additional research methods.
Study and diagnosis of external respiration function in bronchial asthma help determine the degree of bronchial obstruction and their response to provocation by histamine, acetylcholine (substances that cause bronchospasm), and physical activity.
In particular, forced expiratory volume in one second (FEV1) and vital capacity of the lungs (VC) are determined. The ratio of these values (Tiffno index) allows one to judge the degree of bronchial patency.
There are special devices that allow patients to determine the volume of forced expiration at home. Monitoring this indicator is important for adequate treatment of bronchial asthma, as well as for preventing the development of attacks (the development of an attack is preceded by a progressive decrease in FEV). FEV is determined in the morning before taking a bronchodilator and in the afternoon after taking the medicine. A difference of more than 20% between the two values indicates the presence of bronchospasm and the need to modify treatment. A decrease in FEV below 200 ml reveals severe bronchospasm.
Chest radiography is an additional diagnostic method that can identify signs of emphysema (increased transparency of the lungs) or pneumosclerosis (growth of connective tissue in the lungs). The presence of pneumosclerosis is more typical for infection-dependent asthma. In allergic asthma, radiological changes in the lungs (outside of asthma attacks) may be absent for a long time.
bronchial asthma course work
Diagnosis of allergic asthma involves determining the body's increased sensitivity to certain allergens. Identification of the corresponding allergen and its exclusion from the patient’s environment, in some cases, makes it possible to completely cure allergic asthma. To determine the allergic status, IgE antibodies in the blood are determined. Antibodies of this type determine the development of immediate symptoms in allergic asthma. An increase in the level of these antibodies in the blood indicates increased reactivity of the body. Also, asthma is characterized by an increase in the number of eosinophils in the blood and in the sputum in particular.
Diagnosis of concomitant diseases of the respiratory system (rhinitis, sinusitis, bronchitis) helps to get a general idea of the patient’s condition and prescribe adequate treatment.
3 Methods of treating bronchial asthma
3.1 Drug treatment of bronchial asthma
Proper treatment of bronchial asthma should begin with basic therapy: first of all, there are non-hormonal drugs, which include Intal (sodium chromoglycate), Tailed (Nedocromil), Acolat (Zafirlukast), Ketotifen (Zaditen). These drugs do not work if an attack of suffocation has already developed. They are able to prevent it. Hormonal drugs (glucocorticoids of the adrenal cortex) have a rapid, effective anti-inflammatory effect and help prevent attacks of bronchial asthma. Inhalation forms (becotide, flixotide, ingacort, benacort) are used for long-term treatment of bronchial asthma. Drugs in the form of tablets are prescribed in courses only for severe exacerbation of bronchial asthma.
There are many more effective drugs for the treatment of bronchial asthma, but their use should be strictly under the supervision of a doctor. For medical reasons, efferent methods are used (hemosorption, plasmapheresis, plasmacytopheresis). They are based on passing blood through special devices to change its quality. Inpatient medical supervision is also required here when treating bronchial asthma. Other methods, such as reflexology, special breathing techniques, and psychotherapy can be widely used on an outpatient basis to treat bronchial asthma.
Prevention of asthma. First of all, it is necessary to protect the patient from contact with the “culprit” allergen or attack provocateur: dust, plant pollen, animal hair, certain products, cigarette smoke, dusty mattresses and pillows, strong odors, incl. the smells of perfumes, sprayed varnishes, tree and flower pollen, hypothermia and colds, everything that has a beneficial effect on the development of bronchial asthma.
The drug treatment regimen for bronchial asthma looks something like this:
Prescription of symptomatic medications. Their action is aimed at restoring bronchial patency and relieving bronchospasm - these are bronchodilators or bronchodilators. The drugs are used situationally for asthma attacks; the dosage is selected by a physician or pulmonologist individually, taking into account the severity and phase of bronchial asthma. Long-acting bronchodilators are used to prevent bronchospasm, that is, for long-term control of bronchial asthma.
Basic anti-inflammatory therapy drugs suppress allergic inflammation in the bronchi and reduce swelling of the bronchial walls. These include: glucocorticoid hormones, cromones and antileukotriene drugs.
Unlike emergency drugs, basic therapy drugs are prescribed for long-term prevention of asthma exacerbations.
Inhaled hormones. Among all drugs for long-term treatment and control of bronchial asthma, hormonal drugs are the most effective. Currently, inhaled glucocorticosteroids are the most popular. These drugs are used to treat moderate to severe forms of bronchial asthma.
Inhaled forms of cromones are considered the safest medications for long-term treatment of bronchial asthma, but are effective only in mild forms of the disease.
Antileukotriene drugs. New anti-asthma drugs for oral administration.
Systemic steroid hormones are used in severe cases and in cases of severe exacerbations.
3.2 Traditional treatment of bronchial asthma
Recipe: Every morning, half an hour before meals, take 30 drops of hydrogen peroxide, diluted in half a glass of water. And in the evenings, eat one teaspoon of badger lard with a teaspoon of honey.
Recipe: 3 liters of whey, add 100 grams of chopped elecampane roots and honey, mix everything and put in the oven. When the whey boils, set the oven to 100-150 degrees and keep it like that for 4 hours. Take one tablespoon, half an hour before meals, 3 times a day.
Recipe: to prepare the infusion, place washed green pine cones, a little pine resin with a diameter of 2 cm and half a liter of hot milk in a thermos. Stir and leave for 4 hours. Afterwards, the infusion is filtered through gauze folded 3 times. After washing the cones, they can be reused 2 more times. Take a glass of prepared milk in the morning and evening. The course of treatment is 4-8 weeks. After a break, it is advisable to repeat the course of asthma treatment.
Recipe: healing balm for asthma, prepared from 250 grams of aloe, half a liter of good wine and 350 grams of honey. The aloe plant is not watered for 2 weeks before cutting the leaves. After cutting, the leaves are not washed, but simply wiped with a damp cloth to remove dust. Place them in a jar, fill them with wine, add honey, and mix everything thoroughly. Leave for 10 days in the refrigerator. Afterwards, the infusion is filtered and the leaves are squeezed out. Take a teaspoon 3 times a day. For the first 2-3 days, take an increased dose, up to a tablespoon.
Recipe: Garlic oil is a very good mild and bactericidal folk remedy for the treatment of bronchial asthma. To make garlic butter, grind 5 large cloves of garlic, add salt to taste and mix with 100 grams of butter. That's all. You can eat this butter simply by spreading it on bread or adding it to purees.
During asthma attacks, it will be effective to massage the upper body, starting from the head and moving down to the chest. Massage can be done using oil, cream or talcum powder. To thin the mucus during an attack, you should take a little sour wine. If there is no wine, then you can drink a little soda, about a quarter of a teaspoon. Valerian tincture will also help. Add 15-20 drops of valerian to a glass of water. Nettle smoke is a particularly effective remedy. Nettle smoke can relieve an attack literally before your eyes, and with regular use it cures asthma.
3.3 Therapeutic exercise as an element of therapy for asthma attacks
Therapeutic exercise is important both as a means of secondary prevention and as an auxiliary element in the treatment of asthma attacks.
A) Self-massage
Self-massage and physical therapy improve blood and lymph circulation, pulmonary ventilation, bronchial patency, increase chest mobility, respiratory muscle tone, facilitate sputum discharge, promote the resorption of residual effects of the inflammatory process, and increase the performance of patients.
The use of therapeutic mud procedures in conjunction with exercise therapy (and massage) contributes to a more rapid improvement in the health of patients with nonspecific respiratory diseases.
Self-massage begins in the “sitting” position with stroking (alternating with rubbing) with the palm or back of the hand, with a fist of the shoulder girdle, back, neck, shoulder girdle and the front surface of the chest. When self-massaging the back and shoulder girdle, movements are made in the direction from the spine to the sternum, and when self-massaging the anterior surface of the chest and subclavian region - from the sternum to the shoulder joints and armpits. To massage the back and interscapular space, you can use a hard terry towel.
Then, stroking, rubbing and pushing with the 2nd, 3rd and 4th fingers, massage the intercostal spaces from the spine to the sternum.
After this, in the “sitting” position, massage the anterior and lateral surface of the chest in the direction from the sternum to the shoulder joint and the armpit. Women should bypass the mammary gland. Strokes are performed, alternating them with rubbing with the palm of the hand or fist, weakening the effect over the heart area. Then, light tapping of the front surface of the chest with your fingertips is recommended. And finally, stroking alternated with rubbing the back, neck, shoulder girdle and front surface of the chest for 2-3 minutes. The total duration of self-massage is 12-16 minutes. It should be done daily or every other day. After 15-20 procedures, a break of 10-15 days is required.
B) An approximate set of exercise therapy exercises:
Standing, feet shoulder-width apart.
1. Hands down. Raise your arms, stretch - inhale, return to the position. - exhale. Repeat 3-4 times.
2. The same, use your hands to imitate movements with poles when skiing. Breathing is voluntary. Repeat 7-8 times.
3. Hands on the belt. Move your straight arm to the side, up - inhale, place it on your belt - exhale. Repeat with each hand 3-4 times.
4. Same. Squat down, stretch your arms forward to shoulder level - exhale, return to standing position. - inhale. Repeat 4-5 times.
5. Arms extended forward, slightly wider than shoulder-width apart. With a straight right leg swing, reach the fingers of your left hand, then with your left foot reach the fingers of your right hand. Breathing is voluntary. Repeat with each leg 2-3 times.
6. Hands on the belt. Tilt your torso to the left, raise your right arm - exhale, return to IP. - inhale. Repeat in each direction 2-3 times.
Take a gymnastic stick.
7. Standing. Hands with a stick are raised above the head. Bend to the right - exhale, return to i.p. - inhale. Repeat 2-3 times in each direction
8. Standing, hands with a stick - in front of the chest, bent at the elbows. Quickly turn right, then left. Breathing is voluntary. Repeat 3-4 times in each direction.
9. Standing, hands with a stick below your back. Bend your elbows, reach your shoulder blades with a stick - inhale, return to the standing position. - exhale. Repeat 4-5 times.
10. Standing, leaning on a stick, slightly tilt your torso forward. Diaphragmatic breathing: stick your stomach out - inhale, pull it in - exhale. Repeat 5-6 times.
C) Sarvangasana (yogi gymnastics) - for those suffering from bronchial asthma.
Translated from Sanskrit, “Sarvangasana” means “pose for all parts of the body.” This health-improving gymnastics is available to both young and middle-aged people. Elderly people, especially those who have chronic diseases, need to consult a doctor and a specialist in physical therapy before practicing Sarvangasana.
Those suffering from hypertension, severe atherosclerosis, during acute and chronic infectious diseases (especially during the period of exacerbation of the latter) should not include this pose in their exercises.
Sarvangasana, according to yogis, improves blood circulation in the brain, helps in the treatment of varicose veins, hemorrhoids, and prolapse of internal organs. It is very useful for bronchial asthma.
The exercise is performed as follows.
Lie on your back, stretch your arms along your body with your palms facing the floor. Slowly raise your legs without bending your knees. Then place your palms on your lower back (thumbs facing out) and use them to lift your pelvis until your torso is vertical. The legs should be in line with the body. Exhale as you lift your legs.
In this position, you rest your shoulders, neck and back of your head on the floor. At the same time, the chin gently touches the jugular fossa.
Try to relax as much as possible.
Breathing is complete, without tension.
To return to the starting position, bend your legs slightly and bring them closer to your chest, gently lowering your pelvis and then your legs to the floor. Under no circumstances should your body fall to the floor!
After returning to the starting position, lie quietly for 15-20 seconds.
While performing the exercise, concentrate on the uniform and gradual movement of your legs and torso. While in a statistical pose, focus all your attention on the thyroid gland (located on the front surface of the neck between the Adam's apple and the manubrium of the sternum).
First, hold the pose for 1-2 seconds. If there are no unpleasant sensations, then within a month increase this time to 10 seconds.
Conclusion
Therapeutic exercise (physical therapy) is a system of using a wide variety of physical exercises - walking, skiing, swimming, running, games, morning exercises, etc. - that is, muscle movements that are a stimulator of human vital functions.
In medicine, it is a method of treatment that uses physical education for prevention, treatment, rehabilitation and supportive care. Exercise therapy develops strength, endurance, coordination of movements, instills hygiene skills, and hardening of the body with natural factors. Exercise therapy is based on modern scientific data in the field of medicine, biology, and physical education.
The main form of exercise therapy - therapeutic exercises - is a method of treatment and, therefore, should be used strictly individually, as prescribed and under the supervision of a doctor.
Indications for exercise therapy are very extensive. It can ensure the most effective treatment process and can help restore all body functions after treatment is completed. Moreover, in prevention, treatment, and rehabilitation, exercise therapy acts both directly and indirectly, while simultaneously having a positive effect on many other systems and functions of the body.
Exercise therapy exercises have a therapeutic effect only with proper, regular, long-term use of physical exercises. For these purposes, a methodology for conducting classes, indications and contraindications for their use, taking into account effectiveness, and hygienic requirements for training places have been developed. The load should be optimal and correspond to the patient's functional capabilities. To dose the load, you should take into account a number of factors that influence the amount of load, increasing or decreasing it.
Thus, even a brief overview of the possibilities of physical therapy allows us to draw conclusions about the enormous importance that it has in a person’s life:
1. By engaging in physical exercise, a person himself actively participates in the treatment and recovery process, which has a beneficial effect on his psycho-emotional sphere;
2. By influencing the nervous system, the functions of damaged organs are regulated;
3. As a result of systematic use of physical exercises, the body better adapts to gradually increasing loads;
4. Physical therapy exercises also have an educational value: a person gets used to systematically performing physical exercises, this becomes his daily habit, and contributes to maintaining a healthy lifestyle.
The process of studying asthma as one of the most important problems of medical science convincingly demonstrates the success of many branches of knowledge from fundamental (medical genetics) to applied (health care organization). At the same time, ongoing research constantly requires the revision of a number of concepts, the creation of new international consensuses on the problem of asthma, the development of new treatment methods and new standards of medical care, continuous education and self-education of medical workers.
1. Epifanov V. A. Therapeutic and physical culture: GEOTAR-Med //, No. 10, 2002
2. Ivanov S. M. Therapeutic gymnastics for children with bronchial asthma, Medicine, // Moscow State University, 1974
3. Isaev Yu., Moysyuk L. Bronchial asthma. Conventional and non-conventional methods of treatment. - M: "KUDITS-PRESS", 2008. - P. 168. ed. Chuchalina.//Global strategy for the treatment and prevention of bronchial asthma.. - M: "Atmosphere", 2017. - P. 104.
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