An attack of bronchial asthma is urgent. Diagnostic symptoms of an asthma attack

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KAZAKHSTAN-RUSSIAN MEDICAL UNIVERSITY

Department of Propaedeutics of Internal Medicine and Nursing

Essay

on the topic of:Algorithm for the action of a nurse during an attack of bronchial asthma

Completed by: Estaeva A.A.

Faculty: “General Medicine”

Group: 210 "B"

Checked by: Amanzholova T.K.

Almaty 2012

Introduction

1. Bronchial asthma. Etiology

3. Status asthmaticus

4. Treatment of bronchial asthma

Conclusion

Introduction

Bronchial asthma is a chronic nonspecific recurrent polyetiological lung disease, formed with the participation of immunological and non-immunological mechanisms, characterized by severe hyperreactivity respiratory tract to specific and nonspecific stimuli and the presence of the main clinical manifestation - attacks of expiratory suffocation with reversible bronchial obstruction due to spasm of smooth muscles, swelling of the mucous membrane and hypersecretion of the bronchial glands.

1. Bronchial asthma. Etiology

Bronchial asthma is conventionally divided into 2 forms: infectious-allergic and atonic.

b The infectious-allergic form usually occurs with inflammatory diseases of the nasal pharynx, bronchi and lungs.

b The atopic form develops when hypersensitivity to non-infectious allergens from the external environment.

Bronchial asthma is a disease based on chronic inflammation respiratory tract, accompanied by a change in the sensitivity and reactivity of the bronchi and manifested by an attack of suffocation, status asthmaticus, or, in the absence of these, symptoms of respiratory discomfort (paroxysmal cough, dictating wheezing and shortness of breath), accompanied by reversible bronchial obstruction against the background of a hereditary predisposition to allergic diseases, extrapulmonary signs allergies, eosinophilia of blood and (or) sputum.

Two important aspects of the problem can be noted:

· bronchial asthma occurs in waves, that is, periods of exacerbations are followed by remissions, during which the patient experiences virtually no discomfort. The conclusion naturally suggests itself about the need to carry out preventive treatment(to lengthen periods of remission);

· at the core pathological process chronic inflammation lies, therefore, the main therapy should be anti-inflammatory treatment.

The first stage of the development of the disease is identified by conducting provocative tests to determine the altered (usually increased) sensitivity and reactivity of the bronchi in relation to vasoconstrictor substances, physical activity, and cold air. Changes in the sensitivity and reactivity of the bronchi can be combined with disorders of the endocrine, immune and nervous systems, which also do not have clinical manifestations and are identified laboratory methods, more often by performing stress tests.

The second stage of the formation of bronchial asthma does not occur in all patients and precedes clinically pronounced bronchial asthma in 20 - 40% of patients. The state of preasthma is not a nosological form, but a complex of signs indicating real threat the occurrence of clinically significant bronchial asthma. Characterized by the presence of acute, recurrent or chronic nonspecific diseases of the bronchi and lungs with respiratory discomfort and phenomena of reversible bronchial obstruction in combination with one or two of the following: the following signs: hereditary predisposition to allergic diseases and bronchial asthma, extrapulmonary manifestations of allergically altered reactivity of the body, eosinophilia of blood and (or) sputum. The presence of all 4 signs can be considered as the patient having an asymptomatic course of bronchial asthma.

Broncho-obstructive syndrome in patients with pre-asthma manifests itself strongly, paroxysmal cough, aggravated by various odors, with a decrease in the temperature of inhaled air, at night and in the morning when getting out of bed, with influenza, acute catarrh of the upper respiratory tract, from physical activity, nervous tension and other reasons. The cough subsides or becomes less intense after ingestion or inhalation of bronchodilators. In some cases, the attack ends with the discharge of scanty, viscous sputum.

2. Main manifestation of the disease

The main manifestations of the disease are

· Attacks of suffocation (usually at night) lasting from several minutes to several hours, and in especially severe cases up to several days.

There are three periods in the development of an attack of bronchial asthma:

1. period of harbingers

2. high period

3. period of reverse development of the attack.

The period of precursors begins several minutes, hours, and sometimes even days before the attack. It may manifest itself various symptoms: burning sensation, itching, scratching in the throat, vasomotor rhinitis, sneezing, paroxysmal cough, etc.

The height of the period is accompanied by a painful dry cough and expiratory shortness of breath. Inhalation becomes short, exhalation is sharply difficult, usually slow, convulsive. The duration of exhalation is 4 times longer than inhalation. Exhalation is accompanied by loud whistling wheezes that can be heard from a distance. Trying to ease breathing, the patient takes a forced position. Often the patient sits with his torso tilted forward, resting his elbows on the back of the chair. Breathing involves auxiliary muscles: shoulder girdle, back, abdominal wall. The chest is in the position of maximum inspiration. The patient's face is puffy, pale, with a bluish tint, covered with cold sweat, and expresses a feeling of fear. The patient finds it difficult to talk.

With percussion over the lungs, a box sound is detected, the boundaries of relative cardiac dullness are reduced. The lower borders of the lungs are shifted downward, mobility pulmonary edges sharply limited. Above the lungs, against the background of weakened breathing, dry, whistling and buzzing rales are heard during inhalation and especially during exhalation. Breathing is slow, but in some cases it can be rapid. Heart sounds are almost inaudible; there is an accentuation of the second tone above pulmonary artery. Systolic blood pressure increases, the pulse is weak and accelerated. With prolonged attacks of suffocation, signs of insufficiency and overload of the right chambers of the heart may appear. After an attack, wheezing usually disappears very quickly. The cough intensifies, sputum appears, initially scanty, viscous, and then more liquid, which is easier to expectorate.

The period of reverse development can end quickly, without any visible consequences from the lungs and heart. In some patients, the reverse development of the attack continues for several hours or even days, accompanied by difficulty breathing, malaise, drowsiness, and depression. Sometimes attacks of bronchial asthma turn into an asthmatic state - the most common and dangerous complication of bronchial asthma.

3. Status asthmaticus

bronchial asthma help treatment

Status asthmaticus - acute progressive syndrome respiratory failure, developing in bronchial asthma due to airway obstruction with the patient’s complete resistance to therapy with bronchodilators - adrenergic drugs and methylxanthines.

There are two clinical forms status asthmaticus:

b anaphylactic

b allergic-metabolic.

The first is observed relatively rarely and is manifested by rapidly progressing (up to total) bronchial obstruction, mainly as a result of bronchospasm and acute respiratory failure. In practice, this form of status asthmaticus is anaphylactic shock, developing with sensitization to drugs (aspirin, non-steroidal anti-inflammatory drugs, serums, vaccines, proteolytic enzymes, antibiotics, etc.).

Much more common is the metabolic form of status asthmaticus, which develops gradually (over several days and weeks) against the background of exacerbation of bronchial asthma and progressive bronchial hyperreactivity. Bacterial and viral viruses play a certain role in the development of this form of status asthmaticus. inflammatory processes in the respiratory system, uncontrolled use of beta-agonists, sedatives and antihistamines, or unjustified reduction in the dose of glucocorticoids. Broncho-obstructive syndrome in this form of status is mainly determined by diffuse swelling of the bronchial mucosa and retention of viscous sputum. Spasm of bronchial smooth muscles is not main reason its occurrence.

There are three stages in the development of status asthmaticus.

Stage I is characterized by the absence of ventilation disorders (compensation stage). It is caused by severe bronchial obstruction, moderate arterial hypoxemia (PaO2 - 60-70 mm Hg) without hypercapnia (PaO2 - 35-45 mm Hg). Shortness of breath is moderate, there may be acrocyanosis and sweating. Characterized by a sharp decrease in the amount of sputum produced. On auscultation, hard breathing is detected in the lungs, lower sections in the lungs it may be weakened, with prolonged exhalation, while dry scattered wheezing can be heard. Moderate tachycardia is observed. Blood pressure is slightly increased.

Stage II - the stage of increasing ventilation disorders, or the stage of decompensation, is caused by total bronchial obstruction. It is characterized by more pronounced hypoxemia (PaO2 - 50-60 mm Hg) and hypercapnia (PaCO2 - 50-70 mm Hg).

The clinical picture is characterized by the appearance of qualitatively new signs. Patients are conscious; periods of excitement may be followed by periods of apathy. Skin pale gray, moist, with signs venous stagnation(swelling of the neck veins, puffiness of the face). Shortness of breath is pronounced, breathing is noisy with the participation of auxiliary muscles. There is often a discrepancy between noisy breathing and a decreasing amount of wheezing in the lungs. In the lungs, areas with sharply weakened breathing are revealed, up to the appearance of “silent lung” zones, which indicates an increasing bronchial obstruction. Tachycardia is noted (heart rate 140 or more per minute), blood pressure is normal or low.

Stage III is the stage of pronounced ventilation disturbances, or the stage of hypercapnic coma. It is characterized by severe arterial hypoxemia (Pa02 - 40-55 mm Hg) and pronounced hypercapnia (PaCO - 80-90 mm Hg or more).

The clinical picture is dominated by neuropsychiatric disorders: agitation, convulsions, psychosis syndrome, delirium, which quickly give way to deep retardation. The patient loses consciousness. Breathing is shallow and rare. On auscultation, sharply weakened breathing is heard. There are no breath sounds. Characteristic violations heart rate up to paroxysmal with a significant decrease in the pulse wave on inspiration, arterial hypotension. Hyperventilation and increased sweating, as well as limited fluid intake due to the severity of the patient's condition, lead to hypovolemia, extracellular dehydration and blood thickening. Among the complications of status asthmaticus are the development spontaneous pneumothorax, mediastinal and subcutaneous emphysema, DIC syndrome.

4. Treatment of bronchial asthma

Mild attacks of bronchial asthma are stopped by oral administration of theophedrine or ephedrine hydrochloride or inhalation of drugs from the group of beta-adrenergic agonists: fenoterol (Berotec, Partusisten) or salabutamol (Ventolin). At the same time, distracting means can be used: cups, mustard plasters, hot foot baths. If there is no effect of ephedrine hydrochloride or epinephrine hydrochloride, it can be administered subcutaneously. If there are contraindications to their use, 10 ml of 2.4% aminophylline solution is administered intravenously. isotonic solution sodium chloride. Humidified oxygen is also used.

In case of severe attacks and the presence of resistance to beta-adrenergic drugs, therapy consists of slow intravenous administration of aminophylline at the rate of 4 mg/kg of the patient’s body weight. In addition, they provide humidified oxygen.

In case of resistance to beta-adrenergic drugs and methylxanthines, glucocorticoid drugs are indicated, especially in patients who took these drugs in a maintenance dose. For patients who have not received glucocorticoids, 100-200 mg of hydrocortisone is initially administered, then the administration is repeated every six hours until the attack stops. Steroid-dependent patients are prescribed large doses at the rate of 1 mcg/ml, that is, 4 mg per 1 kg of body weight every 2 hours. Treatment of status asthmaticus is carried out taking into account its form and stage.

In case of anaphylactic form, emergency administration of adrenergic drugs is indicated, up to intravenous injection adrenaline hydrochloride (in the absence of contraindications). Elimination is mandatory medicines that caused status asthmaticus. Sufficient doses of glucocorticoids are administered intravenously (4-8 mg of hydrocortisone per 1 kg of body weight) at intervals of 3-6 hours. Oxygenation is carried out, and antihistamines are prescribed.

Treatment of the metabolic form of status asthmaticus depends on its stage and includes oxygen, infusion and drug therapy. In stage I, an oxygen-air mixture containing 30-40% oxygen is used. Oxygen is supplied through a nasal cannula at a rate of 4 l/min for no more than 15-20 minutes every hour. Infusion therapy replenishes fluid deficiency and eliminates hemoconcentration, dilutes sputum. In the first 1-2 hours, administration of 1 liter of liquid (5% glucose solution, rheopolyglucin, polyglucin) is indicated. The total volume of liquid for the first day is 3-4 liters, for every 500 ml of liquid 10,000 units of heparin are added, then its dose is increased to 20,000 units per day. In the presence of decompensated metabolic acidosis 200 ml of 2-4% sodium bicarbonate solution is administered intravenously. In case of respiratory failure, the use of sodium bicarbonate solution is limited. Drug therapy is carried out according to the following basic rules:

1. complete refusal to use beta-agonists;

2. use of large doses of glucocorticosteroids;

3. aminophylline or its analogues are used as bronchodilators.

Massive glucocorticosteroid therapy used for status asthmaticus has an anti-inflammatory effect, restores the sensitivity of beta receptors to catecholamines and potentiates their action. Corticosteroids are prescribed intravenously at the rate of 1 mg of hydrocortisone per 1 kg of body weight per 1 hour, i.e. 1 - 1.5 g per day (with a body weight of 60 kg). Prednisolone and dexazone are used in equivalent doses. In stage I, the initial dose of prednisolone is 60-90 mg. Then 30 mg of the drug is administered every 2-3 hours until recovery effective cough and the appearance of sputum, which indicates the restoration of bronchial patency. At the same time, oral glucocorticoid drugs are prescribed. After removing the patient from asthmatic status, the dose of parenteral glucocorticoids is reduced daily by 25% to the minimum (30-60 mg of prednisolone per day).

Eufillin is used as a bronchodilator, the initial dose of which is 5-6 mg/kg body weight. Subsequently, it is administered fractionally or dropwise at the rate of 0.9 mg/kg per 1 hour until the condition improves. After this, maintenance therapy is prescribed, aminophylline is administered at a dose of 0.9 mg/kg every 6-8 hours. Daily dose aminophylline should not exceed 1.5-2 g. Cardiac glycosides are not always advisable to use due to the hyperdynamic circulatory regime in status asthmaticus.

To dilute sputum, you can use simple, effective methods: percussion chest massage, drinking hot Borjomi (up to 1 l).

In stage II of status asthmaticus, the same set of measures is used as in stage I. However, higher doses of glucocorticoid drugs are used: 90-120 mg of prednisolone with an interval of 60-90 minutes (or 200-300 mg of hydrocortisone). It is recommended to inhale a helium-oxygen mixture (helium 75%, oxygen - 25%), lavage under careful bronchoscopy under anesthesia, long-term epidural blockade, inhalation anesthesia.

In stage III of status asthmaticus, patients are treated together with a resuscitator. Progressive impairment of pulmonary ventilation with transition to hypercapnic coma, which is not amenable to conservative therapy, is an indication for the use of mechanical ventilation. When it is carried out through an endotracheal tube, the tracheobronchial tract is washed every 20-30 minutes in order to restore their patency. Infusion and drug therapy are carried out according to the rules outlined above. Glucocorticosteroids are administered intravenously (150-300 mg of prednisolone with an interval of 3-5 hours).

It should be noted that drugs used in the treatment of uncomplicated bronchial asthma are not recommended for use in patients with status asthmaticus. These include beta-adrenergic agonists, drugs with a sedative effect (morphine hydrochloride, promedol, seduxen, pipolfen), cholinergic blockers (atropine sulfate, metacin), respiratory analeptics(corazol, cordiamine), mucolytics (acetylcysteine, trypsin), vitamins, antibiotics, sulfonamides, as well as alpha and beta stimulants.

Patients with status asthmaticus mandatory must be hospitalized in wards intensive care or intensive care unit.

5. Before medical assistance during an attack of bronchial asthma

Prepare for the doctor's arrival:

A system for intravenous infusion, syringes for intravenous, intramuscular and subcutaneous administration of drugs, a tourniquet, an Ambu bag (for possible mechanical ventilation);

Medicines: prednisolone tablets, 2.4% aminophylline solution, prednisolone solution, 0.9% sodium chloride solution, 4% sodium bicarbonate solution.

Conclusion

Young people get sick more often. Dust, various odorous substances, some food products. Bronchial asthma can also occur after a history of acute infection respiratory tract, acute bronchitis, pneumonia; sometimes it is preceded by sinusitis and rhinitis. Attacks more often develop in damp, cold weather. Neuropsychic factors may be of some importance.

When caring for patients with bronchial asthma, a nurse should not use creams with strong odor, perfumes, etc., as all this can provoke an attack.

List of used literature

1. Internal illnesses: Textbook / F.I. Komarov, V.G. Kukes, A.S. Smetnev et al.; edited by F.I. Komarova, M.: “Medicine”, 1990.

2. Mukhina S.A., Tarnovskaya I.I. General nursing care. Textbook allowance. - M.: Medicine, 1989.

3. Pautkin Yu.F. Elements general care for the sick. Textbook allowance. - M.: Publishing house UDN, 1988.

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To help the patient relieve an attack of suffocation, the following steps should be taken:

• You need to take several shallow breaths in and out, then hold your breath. This manipulation saturates the blood carbon dioxide, And his increased concentration relaxes the bronchi and restores breathing;
• Try to exhale all the air from your lungs, then take in small short breaths. Breathing gradually normalizes.
• Using the palms of your hands, press firmly on the patient's chest as you exhale. Frequency – 10 times. This technique dramatically reduces the attack of suffocation.
• Use a metered dose inhaler with a vasodilator medication. Salbutamol, Berotec, Bricanil, etc. are good options. If the condition has not improved, you can repeat inhalation after 20 minutes. Avoid overdose, as there may be side effects: rapid heartbeat, weakness, headache.
• Take a tablet of euphylline, ephedrine or any antihistamine (suprastin, claretin, tavegil, etc.). Good effect provide hormonal drugs(prednisolone, dexamethasone, hydrocortisone).

The condition will improve significantly if there is an influx of fresh air. In any case, the person begins to get nervous, his anxiety turns into panic. Help him relax and calm down.

First aid for an attack of suffocation

During an attack of suffocation nurse should act according to the following plan:

Upon arrival of the ambulance, the patient is hospitalized in the intensive care ward.

First aid for an attack of suffocation

If you become an involuntary witness to an attack of suffocation (asphyxia), you need to provide the patient with first aid, which consists of the following:

• call immediately ambulance, calmly and clearly explaining to the dispatcher information about the patient’s condition and the main symptoms of the attack;
• if the patient is conscious, calm him down, explain what measures you have taken to help him;
• create conditions for the circulation of fresh air, remove excess clothing from the throat and chest area;
• The cause of suffocation may be a foreign body in the larynx. Try to squeeze hard chest, mechanically displacing it into the respiratory tract. Then you need to give the person the opportunity to clear his throat;
• if it happened sudden attack suffocation and the person has lost consciousness, moreover, there is no breathing, no pulse, try to do a buried heart massage and artificial respiration;
• The consequence of an attack of suffocation may be a recessed tongue. The patient should be placed on his back with his head turned to the side. Pull out the tongue and attach (you can even prick it with a pin) to lower jaw;
• The cause of suffocation may be chronic diseases, such as asthma, bronchitis, tracheitis, heart failure, etc. The patient may have pills or an inhaler with medication. Help take medications before the ambulance arrives;
• if asphyxia occurred against the background allergic reaction, it is necessary, if possible, to identify the allergen and immediately take antihistamine(diphenhydramine, tavegil, loratadine, etc.). The patient needs to drink plenty of fluids, which will remove the allergen from the body.

A person’s life depends on how competently and skillfully first aid was provided.

Mild cases

It is necessary to provide access to fresh air and perform inhalation medicinal drug by using personal inhaler(with or without a spacer), give the patient something to drink hot water or tea.

Relief of severe asthma attacks

• Nebulizer administration of a bthea2-adrenergic agonist (preliminarily clarify the therapy already performed to exclude an overdose) or another bronchodilator drug for nebulizer therapy;
• Intravenous administration aminophylline (aminophylline) 2.4% solution in an amount of 10 ml (possibly with cardiac glycoside 0.5-1.0 ml);
• Intravenous administration of glucocorticoids (dexamethasone 8-12-16 mg);
• Oxygenotarpy.

Asthmatic status

With the development of status asthmaticus, affect from administered glucocorticoids, aminophylline, (aminophylline), sympathomimetics (incl. subcutaneous administration 0.5 ml of 0.1% solution of epinephrine (adrenaline), which is especially indicated for falls blood pressure) may not be sufficient. Then auxiliary ventilation of the lungs or transfer to artificial ventilation lungs. To resolve the issue of oxygen inhalation, as well as for subsequent monitoring of blood oxygenation and lung ventilation, the gas composition and pH of the blood are determined.

First aid for suffocation due to left ventricular failure

• Give to the patient sitting position(with hypotension, semi-sitting).
• Give nitroglycerin 2 3 tablets, or 5-10 drops under the tongue, or 5 mg per minute intravenously under blood pressure monitoring.
• *Carry out oxygen therapy with an antifoam agent (96% ethyl alcohol or antifomsilane) through a mask or nasal catheter.
• To deposit blood in the periphery, apply venous tourniquets or elastic bandages on three limbs, squeezing the veins (the pulse in the artery below the tourniquet should be preserved). Every 15 minutes, one of the tourniquets is transferred to the free limb.

Emergency assistance in case of foreign body penetration

Push-like standing of the abdomen (standing from the side of the victim’s back, grab him and with a sharp, jerk-like movement press inward and upward under the ribs). In this case, the foreign body is pushed out mechanically by the residual volume of air due to the pressure difference. After removal foreign body the patient should be allowed to cough, bending his torso forward.

If a foreign body enters the respiratory tract of a child aged 1-3 years, place the child on your lap face down and apply sharp short blows with your palm between the child’s shoulder blades several times. If the foreign body does not come out, use the Heimlich maneuver: lay the victim on his side, place the palm of his left hand on the epigastric area, with a fist right hand apply 5-7 short blows to the left hand at an angle towards the diaphragm.

If there is no effect, the patient is placed on the table, the head is bent back, the oral cavity and larynx area are examined (direct laryngoscopy is better) and the foreign body is removed with fingers, tweezers or another instrument. If breathing has not been restored after removal of the foreign body, then mouth-to-mouth artificial respiration is performed.

IN necessary cases- tracheotomy, conicotomy or tracheal intubation.

First aid for hysterical suffocation

In case of hysterical asthma, psychotropic drugs will be effective, and in severe cases, anesthesia. In case of hysteroid suffocation with spasm vocal cords In addition, inhalation of hot water vapor is required.

Suspicion of true croup requires all anti-epidemic measures, consultation with an ENT doctor and an infectious disease specialist.

An asthma attack is sharp deterioration health in patients with bronchial asthma. Manifested by shortness of breath, cough, suffocation. This is very dangerous condition, which indicates the ineffectiveness of the treatment.

Asthmatic attacks can develop without visible reasons. But most often they manifest themselves under the influence of the following factors:

• ineffectiveness of the treatment;
• acute respiratory tract diseases;
• contact with an allergen;
• stress.

As for cardiac asthma, in addition to the above factors, the occurrence of attacks can also be affected by:

• hypervolemia (increased blood volume);
• excessive eating before bed.

Seizure severity

Attacks of suffocation can be different. They are classified into several degrees:

• light;
• average;
• heavy;
• asthmatic status.

The mild form is characterized by slight shortness of breath and increased heart rate. Patients may experience mild psycho-emotional agitation. Possible increase in temperature. At the same time, physical activity and the ability to speak are completely preserved. Mild attacks usually go away on their own, without taking medications.

The average severity of bronchial asthma attacks is manifested by the following symptoms:

• patients can only speak in broken sentences because they lack air;
• physical activity is partially impaired;
• auxiliary muscles are involved in breathing;
• there is pronounced psycho-emotional stress;
• the number of heart contractions increases;
• shortness of breath and headache appear.

Symptoms of severe attacks

Severe attacks already require the use of medications. Manifested by the following symptoms:

• the ability to speak is practically lost, patients can only utter certain phrases;
• auxiliary muscles are actively involved in breathing;
• severe shortness of breath occurs;
• the number of heart contractions increases to 100–120 per minute;
• the patient leans forward with his whole body, trying to lean his hands on something;
• during an attack, patients are in severe fright;
• in some cases, a decreased body temperature is noted.

Severe attacks can lead to the development of status asthmaticus. This is a much more dangerous condition, which is characterized by the following symptoms:

• almost complete loss physical activity and conversational capabilities;
• confusion or coma;
• decreased contractions of the heart muscle;
• active participation of auxiliary muscles during breathing;
• uneven breathing or increasing shortness of breath;
• sinking of the costal spaces.

To eliminate status asthmaticus, high dosages of medications are required. This condition requires urgent hospitalization, since there is a great threat to the patient’s life.

In medicine, the severity of the disease is determined by the frequency of attacks. If they occur less than once a week, we're talking about O mild form diseases. Weekly one-time exacerbations, accompanied by slight shortness of breath, are characteristic of mild persistent bronchial asthma. If single exacerbations occur every day, we are talking about persistent bronchial asthma of moderate severity. A severe form of the disease is characterized by the occurrence of several attacks during the day.

The time of exacerbation of the disease is of no small importance. Nocturnal asthma attacks are considered more dangerous than daytime ones. With a mild intermittent form of the disease, attacks occur no more than twice a month.

Mild persistent asthma is characterized by deterioration of the condition no more than once a week. In the case of daily single deterioration, we are talking about persistent bronchial asthma of moderate severity. Several exacerbations per night indicate a severe form of the disease.

In the treatment of bronchial asthma, the frequency of attacks is of paramount importance. Based on this, the attending physician will prescribe competent treatment, which will completely relieve suffocation and significantly alleviate shortness of breath.

Bronchial asthma attack - first aid

First of all, the patient needs to take a sitting position and free himself from tight clothing on his chest. Fresh air must enter the room, so windows or doors should be opened. Further actions are:

• give to the patient medicine in the form of an inhaler to make breathing easier. This could be Metaproterenol, Terbutaline, etc.;
• until the attack is completely relieved, take 1–2 breaths every 15–20 minutes;
• if you don’t have a manual inhaler, you can use tablet drugs: Eufillin, Aminophylline, Diphenhydramine;
• try to calm and distract the patient.

If the exacerbation lasts more than 40 minutes, you must call an ambulance.

In case of severe persistent bronchial asthma, medical attention is needed immediately.

In case of cardiac asthma, you must call an ambulance and take the following actions:

• sit the patient down in such a way as to ease the work of the heart and prevent blood stagnation; you can put your feet in hot water;
• provide fresh air flow and loosen clothing that may slow blood circulation (belt, tie);
• measure blood pressure; at readings above 100 mmHg. Art. you can give the patient a Nitroglycerin tablet under the tongue;
• if blood pressure readings are below 100 mm Hg. Art., the use of Nitroglycerin is contraindicated.

To independently stop an attack of bronchial asthma, you need to learn how to use an inhaler correctly, following the following recommendations:

• it is necessary to inject the medicine while sitting or standing;
• so that the airways open up and the drug is in in full hit the bronchi, it is important to tilt your head back;
• shake the bottle of medicine vigorously before the procedure;
• after exhaling deeply, tightly hold the mouthpiece with your lips, and only at the beginning of the inhalation is it necessary to spray out the medicine;
• It is important to hold your breath for a few seconds at the end of the inhalation, this will allow the medicine to settle on the bronchial walls.

Usually an attack of bronchial asthma is stopped after 1-2 doses of the drug. The effect is observed after 5–15 minutes and remains for 6 hours. If the first two inhalations of the aerosol do not bring relief, inhalations should be repeated every 15–20 minutes (no more than three inhalations per hour are recommended) until the condition improves.

Qualified help

When the ambulance arrives, the first thing you need to do is inform the doctors about the procedures performed. It is also important to notify which drug was used to relieve an attack of bronchial asthma. The actions of doctors will depend on how difficult the patient’s breathing is, what kind of general state. In most cases, patients are given the following drugs:

• combination of Eufillin with or;
• Adrenalin;
• Atropine in combination with Ephedrine.

Usually the patient is offered hospitalization to relieve exacerbations of asthma. In the ambulance, a special mask is put on the patient's face, from where the increased amount oxygen. As a result, the patient's condition improves, and shortness of breath gradually disappears.

Seizure prevention

Today, approximately 5% of the world's population knows firsthand what bronchial asthma is. To prevent exacerbations of the disease, it is necessary to strictly follow medical recommendations. Preventive measures attacks of bronchial asthma include the following:

• strictly follow the doctor’s recommendations, take medications correctly in the indicated dosages;
• treat diseases in a timely manner respiratory system(pharyngitis, frontal sinusitis, laryngitis);
• avoid stress and emotional stress in every possible way;
• exclude intense physical activity;
• avoid factors that provoke attacks of bronchial asthma: tobacco smoke, dusty rooms, contact with an allergen, etc.

Asthmatics require strict hygienic conditions. It is necessary to remove from the patient’s room all things that can provoke an exacerbation of the disease: pillows, feather beds, flowers, perfumes, to prevent contact with tobacco smoke. The room should be ventilated daily, only cleaned wet method, change bedding more often. Breathing exercises are of particular importance in the prevention of bronchial asthma attacks.

It would be useful to remind you that patients should always carry an inhaler with them. Confidence and reduced fear of exacerbation significantly reduce the frequency of attacks.

Bronchial asthma: how to recognize an attack and provide first aid

A disease of the respiratory tract, which is accompanied by spasm of the bronchi and increased production of mucus in them, is called bronchial asthma. In this case, attacks of suffocation, severe coughing and shortness of breath occur. The reasons for this reaction are various irritants - allergens, stress, excessive cold air, infections, industrial substances. The attack itself and the condition preceding it are accompanied by symptoms, knowing which it is easy to stop at the very beginning.

Precursors of an attack and its features

An attack of bronchial asthma occurs acutely and develops rapidly, often at night. Its main manifestation is a strong dry cough that turns into suffocation. This condition can last several minutes, and in severe cases – days. 30–60 minutes before an attack, its precursors begin:

• cough and sneezing;
• sore throat, sore throat, wheezing;
• watery runny nose;
• headache;
• itching all over the body.

If the attack was caused not by the action of allergens, but by other reasons, it may be preceded by the following symptoms:

• prostration;
• anxiety;
• depression;
• insomnia at night;
• dizziness.

The attack itself is characterized by the following manifestations:

• cough, sometimes with thick sputum;
• expiratory shortness of breath - exhalation is difficult and lasts 2 times longer than inhalation;
• breathing rate increases to 60 cycles per minute;
• breathing is slow, wheezing, with wheezing, while additional groups muscles – abs, neck, shoulder girdle;
• heart rate increases;
• the patient takes a forced position - sitting, sometimes standing, resting his hands on his knees or other support (orthopnea);
• the skin turns pale and acquires a bluish tint;
• speech becomes difficult, anxiety increases.

Depending on the severity of the course, there are mild, moderate, severe degree attack and status asthmaticus. The latter is the most dangerous, as it can result in death from suffocation.

These symptoms make it easy to identify an attack of bronchial asthma before the patient enters the hospital. medical institution. During hospitalization, there is a need for differential diagnosis, because the different types asthma (cardiac, cerebral, uremic, hysterical) require the use of appropriate medications. Usually it is necessary to exclude cardiac asthma. To do this, we focus on the following indicators:

• age – the likelihood of cardiac asthma is higher in older people;
• previous pathologies - bronchitis, pneumonia or disruption of the cardiovascular system;
• type of shortness of breath – expiratory or inspiratory;
• a heart attack is accompanied by harsh breathing or congestive wheezing in the lower posterior regions.

An attack of bronchial asthma - emergency care

There are a number of things that can be done to help a person suffering from an attack before doctors arrive. But calling an ambulance is mandatory, since the patient needs to be examined and further drug treatment prescribed, even if he feels better.

First of all, you need to try to ease the person's breathing. To do this, you should ventilate the room or take the patient out into the air, free his neck from a collar, scarf, tightly buttoned shirt, etc. The person needs to be helped to assume the orthopneic position - lean with straight arms on his knees or the surface on which he is sitting. He may also stand with his hands on a table or chair. Elbows should be facing outward.

You can relieve an attack with an inhaler. You should put the nozzle on the bottle with the medicine, turn it over and inject the aerosol. There should be a break of 20 minutes between inhalations. The aerosol can be used up to 3 times. If the attack is mild, hot baths for the limbs or mustard plasters on the feet can help. All drugs used in first aid must be reported to the medical team, as this affects further treatment.

Emergency care for bronchial asthma medical workers carried out in accordance with the severity of the attack. If this light form, then you can limit yourself to tablets or inhalations of drugs such as: ephedrine, novodrine, alupent, aminophylline, theophedrine. Solutions of ephedrine or demidrol are also administered subcutaneously. This will lead to the removal of sputum and decrease shortness of breath. Improvement can be achieved within an hour.

In more difficult cases should resort to oxygen therapy through inhalation and administer the medicine by injection to achieve a quick effect. It could be:

• 2.4% aminophylline solution intravenously slowly, for tachycardia in combination with corglycone or strophanthin - dilates the bronchi and relieves spasm; used when the type of bronchial asthma attack is unknown;
• 0.1% adrenaline, 5% ephedrine, 0.05% alupent subcutaneously - reduce bronchospasm, reduce mucus secretion;
• antihistamines - suprastin, diphenhydramine, pipolfen - relieve spasms, reduce the secretory activity of the bronchial epithelium, and have a sedative effect;
• antispasmodics - 2% solutions of no-shpa and papaverine in equal proportions.

For more effective impact, adrenaline or ephedrine are combined with atropine. For cardiac asthma, adrenaline should not be used, and for bronchial asthma, morphine should not be used.
If the attack is severe, intravenous injections of prednisoline or hydrocortisone are used. When these drugs do not help, use a 2.5% solution of pipolfen intramuscularly and 0.5% novocaine intravenously. With severe suffocation, when the bronchi are full big amount sputum, the patient is intubated under anesthesia and a solution of trypsin or chymotrypsin is injected into the trachea. After a few minutes, the sputum is sucked out.

In some cases, the patient reacts poorly to medications and becomes increasingly worse. This is status asthmaticus, a dangerous condition that can lead to fatal outcome. The following drugs are used to help the patient: up to 90 mg of prednisolone, up to 200 mg of hydrocortisone, up to 4 mg of dexamethasone. If this does not lead to an improvement in the condition, the patient is transferred to controlled breathing and hospitalized in the intensive care unit.

Correct diagnosis of an attack of bronchial asthma and timely provision of assistance are necessary for a favorable outcome of the manifestations of this disease.