Emergency care for bronchial asthma. Medicines for bronchial asthma. An attack of bronchial asthma Helping a patient during an attack of bronchial asthma

Bronchial asthma is a disease characterized by periodic exacerbations or attacks. An attack of bronchial asthma is a condition when the symptoms of the disease appear suddenly or intensify so much that the patient experiences severe lack of air, even to the point of suffocation.

Bronchial asthma is a disease in which chronic, that is, constant, inflammation forms in the mucous membrane of the patient’s bronchi. The patient's airways become hyperreactive, that is, their reaction to any external irritation is significantly enhanced. Due to the latter, the patient periodically experiences episodes of wheezing, shortness of breath, coughing or chest tightness, especially at night or early in the morning. These symptoms should be attributed to common but variable airway obstruction. This means that the bronchi narrow in different sections to varying degrees, which is why symptoms of the disease arise. Symptoms characteristic of exacerbation of bronchial asthma may disappear spontaneously or after the use of medications.

There are a number of congenital and circumstantial characteristics that predispose a patient to the development of bronchial asthma. These include the following:

1. Atopy.
   Atopy is the increased production of immunoglobulin E in response to contact with an allergen in the patient’s body. Immunoglobulin E triggers and actively participates in allergic reactions. Atopy is an important predisposing factor to the development of allergic or atopic asthma.
2. Genetic predisposition to atopy or asthma itself.
   The fact is that if one of the parents or both has been diagnosed with bronchial asthma, then the likelihood of their child getting sick is very high. A predisposition to atopy can also be inherited.
3. Genetic predisposition to airway hyperresponsiveness.

How does an attack develop?

Pathogenesis is the main mechanism for the development of a disease or pathological process. The underlying pathogenesis of asthma is inflammation. It, in turn, begins in response to the influence of so-called triggers or specific irritants on the mucous membrane of the respiratory tract.

The most studied triggers are:

When triggers affect the lining of the respiratory tract, it becomes filled with blood. Specific cells accumulate in its microvessels, causing an inflammatory reaction.

The main ones among the latter should be considered the so-called mast cells. The granules of the mast cell contain mediator substances, such as histamine, leukotrienes, which act on the wall of the bronchi and cause the muscle cells in it to contract. This is the mechanism for the development of bronchospasm itself, that is, narrowing of the airway lumen.

In addition to mast cells, the inflammation mechanism is also carried out by other cells: white blood cells, macrophage cells and lymphocytes, which are called T-helpers.

Inflammation, in turn, further enhances the hyperreactivity of the bronchial mucosa. Thus, one mechanism for the development of an attack complements another mechanism: the vicious circle closes.

In addition, the pathogenesis of asthma can and usually does include an allergic component. In this case, in response to contact with the allergen, the level of immunoglobulin E in the patient’s blood sharply increases. Immunoglobulin E comes into contact with the mast cell and the antigenic, that is, foreign to the patient’s body, part of the allergen: a violent allergic inflammatory reaction begins.

The diagram shows granules with mediators in the mast cell, immunoglobulins E, which simultaneously come into contact with it and with an allergen site that is foreign to the patient’s body

An attack of the disease in its allergic form can develop very quickly.

Asthma symptoms are the final link that completes the pathogenesis of the disease. The mechanism for the development of wheezing is as follows: the small, terminal sections of the respiratory tract narrow to varying degrees and the air passing through them gives a characteristic whistling sound. The mechanism for the development of expiratory shortness of breath, that is, difficulty exhaling, is as follows: due to a lack of air, the force with which the patient tries to inhale increases, which leads to early closure of the respiratory sacs; their walls seem to touch, preventing the air stream from passing freely. The mechanism of cough development is as follows: the penetration of irritating substances into the respiratory tract and their effect on the bronchial mucosa leads to a protective reaction of pushing out these particles - a cough appears.

How to recognize an attack?

An attack of suffocation in bronchial asthma is a classic manifestation of the disease. Diagnosis of this attack, as a rule, does not cause difficulties. Usually the attack is preceded by symptoms of the disease, which manifest themselves quite mildly. The patient may have a cough, slight chest discomfort, or a general feeling that something is wrong. Also, a few days before an attack, an asthmatic may experience individual symptoms and signs indicating an imminent attack. These signs may include nasal congestion, frequent sneezing, and itchy eyes and nose. The patient may also become restless, irritable, depressed or scared: sudden changes in mood should also be noted.

The picture shows the difference between a healthy person and an asthmatic during an attack: grayish skin tone, barrel-shaped chest, frozen when inhaling, lungs full of air, additional breathing muscles are connected

When an exacerbation of the disease actually occurs, the patient experiences severe attacks of dry cough, which are difficult to interrupt.

His position is usually such that he rests his hands on the edge of a chair or bed: the patient uses this maneuver so that additional muscles begin to participate in breathing. The patient becomes agitated and has a frightened expression on his face. Speech is significantly difficult: a person can usually pronounce only individual words. The patient's condition is also characterized by pale skin. Sometimes the latter has a grayish tint. The wings of the nose swell, the chest seems to become frozen when inhaling, this position determines pathogenesis: the exhalation mechanism is disrupted.

Diagnosis by physical examination is as follows. If you percussion the chest, that is, tapping it, the sound over the entire surface will be similar to the sound of knocking on an empty box. That's what they call it - boxed. If you listen to the lungs, you can usually hear whistling wheezing both during inhalation and during exhalation.

After the attack stops, more detailed diagnostics can be carried out. In a conversation with the patient, you can determine whether he inhaled, for example, allergens before the symptoms of the disease significantly intensified or arose. As a rule, the attack can only go away after treatment is applied to it. When the attack is over, the symptoms of the disease become milder. Coughing attacks are transformed into productive ones and pass with the release of very thick, viscous, transparent sputum, called “vitreous.”

The state of suffocation can last up to several hours or even last a whole day.

Night attacks usually occupy the attention of doctors. These happen between 2 and 6 am. They are called paroxysms of respiratory discomfort. If the night symptoms of the disease bother the patient, then there is a high probability that his treatment is insufficient or inadequate.

What to do during an attack?

If an attack does occur, you can immediately apply specific treatment. Such treatment should consist of expanding the narrowed bronchi. For this purpose, short-acting drugs that cause relaxation of muscle cells in the wall of the bronchi, such as salbutamol or fenoterol, are usually used.

This treatment will quickly reduce the symptoms of the disease. The mechanism of action of these drugs is to stimulate receptors sensitive to the mediator norepinephrine. This causes the smooth muscle cells in the wall of the airways to relax.

In addition, sometimes treatment may be based on theophylline preparations. However, they are less effective. It is also important that their mechanism of action is such that serious cardiac conduction disturbances can be caused.

If drug treatment during an attack of bronchial asthma is unavailable for some reason, the patient can still be helped. Non-drug treatment should primarily focus on reassuring the patient. We need to teach him to breathe correctly. Explain that you need to form your lips into a tube and slowly blow through them, as if through a straw, while exhaling.

In this case, the pathological mechanism of rapid collapse of the walls of the respiratory sacs and small bronchi will be interrupted. This will allow you to exhale more completely, followed by a slower, more complete inhalation. Symptoms of the disease will immediately begin to decrease.

It is also necessary to carry out such basic measures as opening the window, unbuttoning the patient’s shirt so that he has greater access to fresh air. Treatment may also include stimulation of the chest through massage. You can also immerse the patient's feet in hot water. This will also help relieve symptoms of the disease.

Periodic short-term, 6-8 second, breath holdings by the patient will have a positive effect on the course of the attack. This promotes the accumulation of carbon dioxide in the patient’s blood and dilation of the bronchi. The mechanism is as follows: due to the increase in carbon dioxide, the patient’s body switches to inhalation.

How is the disease complicated?

Exacerbation of bronchial asthma can lead to serious complications. The most common complications that arise are:

The above complications are acute, that is, they usually occur during an attack. There are also chronic complications of asthma that require attention. Chronic complications are those that arise over time and develop gradually.

Chronic complications:

• emphysema, or enlargement of the air sacs in the lungs,
• pneumosclerosis, that is, replacement of part of the lung tissue with connective, non-respiratory tissue.

The figure shows the difference between the alveoli or respiratory sacs in a healthy lung and in emphysema

All this leads to disruption of gas exchange, and therefore the patient eventually develops signs of respiratory failure.

Status asthmaticus

Status asthmaticus requires closer attention, since it is this complication that can result in death. Status asthmaticus is a very prolonged attack of suffocation. Its diagnosis is simple: if the patient becomes resistant to treatment, then most likely he has already developed status asthmaticus.

Status asthmaticus often develops quite slowly, however, with allergic asthma, status asthmaticus can develop very quickly. Therefore, it is impossible to delay treating the patient during an attack.

When status asthmaticus has just begun, the patient develops resistance to short-acting adrenergic agonists, for example, salbutamol. In response to them, the expansion of the airways no longer occurs. Later, when status asthmaticus passes into the so-called “silent lung” stage, the patient experiences a rapid increase in respiratory failure, and gas exchange in the lungs is greatly impaired. In the third stage, advanced status asthmaticus without intensive care measures can result in coma and death.

Preventive actions

To prevent asthma attacks from happening as often as possible, they can be prevented. First of all, for effective prevention it is necessary to try to exclude from the patient’s life all kinds of allergens to which he reacts. These can be household allergens, such as dust, animal hair, household chemicals, or avoid exposure to work, for example, if industrial pollutants also cause or intensify the symptoms of the disease, that is, they have a great influence on its pathogenesis.

To prevent bronchial asthma, you can also use various breathing exercises, as well as general strengthening physical exercises from a course of physical therapy.

It is important to remember that during the prevention of exacerbation of the disease, its complications are also prevented. After all, the most dangerous, like status asthmaticus, acute complications of the disease usually occur during an attack of bronchial asthma.

In order for the treatment of asthma to be partially replaced by ordinary non-drug prevention of attacks, timely diagnosis of the disease is important. In order for such a diagnosis to be carried out, it is necessary to contact a medical institution if alarming signs and symptoms similar to those of bronchial asthma occur.

Video: Project “Tablet”, topic of discussion: “Bronchial asthma”

A debilitating cough and severe shortness of breath in asthma occur in response to the penetration of allergens into the body or under the influence of other harmful factors that irritate the mucous membranes of the respiratory system. If a person’s bronchial asthma suddenly worsens, then first aid, competently provided to him by relatives during a severe attack, is sometimes the only chance to quickly restore normal breathing, prevent blockage of bronchioles with thick mucus, and save him from pulmonary edema.

What actions need to be taken to prevent the development of bronchospasm?

Why does the disease occur?

The formation of inflammation of the bronchi of a non-infectious nature is most often caused by certain genetic problems and diseases: allergies, previous bronchitis, pneumonia.

What happens in the body during the development of bronchial asthma:

1. As a result of inhaling air with dust particles and various allergens, a person develops hyperreactive immune response to foreign agents.
2. Formed acute inflammation of the mucous membranes respiratory tract, accompanied by excessive mucus secretion.
3. Air gaps narrow due to swelling of the walls of the bronchioles, they become clogged with thick sputum, causing acute respiratory failure.
4. The supply of oxygen to cells decreases sharply, which leads to tissue hypoxia.

If first aid is not provided in a timely manner, the development of an attack of status asthmaticus can even lead to death.

Causes of attacks

The main condition for the life of patients with bronchial asthma is that patients should constantly take medications prescribed by an allergist-immunologist. Because without proper treatment, incredibly severe, dangerous asthmatic status can immediately occur - obstruction of the airways, which will lead to severe respiratory failure.

In addition, the following factors presented in the table can cause a severe asthma attack.

Table of contents

Bronchial asthma is a respiratory disease of an allergic nature, associated with increased sensitivity of the body to various substances of plant, animal, including microbial, or inorganic origin. An exacerbation of the disease is an attack of bronchial asthma. Symptoms and emergency care for this phenomenon are the topic of this article. What to do if you have an asthma attack and you can’t call a doctor?

An attack of bronchial asthma - symptoms of the phenomenon

An attack is an acute deterioration in the condition of a patient with asthma, manifested by shortness of breath, coughing, wheezing, requiring immediate drug therapy. An exacerbation of the disease is characterized by several sudden attacks or a gradual deterioration of the condition. During the interictal period, complaints usually do not arise; sometimes, auscultation reveals small wheezing rales of the respiratory organs.

As a rule, an attack of bronchial asthma occurs suddenly at any time of the day, more often at night: the patient wakes up with a feeling of tightness in the chest and acute lack of air. He is unable to push out the air filling his chest, and in order to enhance exhalation, he sits up in bed, resting his hands on it or on the knees of his lowered legs, or jumps up, opens the window and stands, leaning on the table, the back of a chair, thus turning on the act of breathing not only respiratory, but also the auxiliary muscles of the shoulder girdle and chest.

An attack of bronchial asthma is very difficult to confuse with anything; it occurs very quickly and violently. Literally within a few seconds shortness of breath occurs, clearly audible wheezing in the lungs, and dry coughing attacks appear. A patient with symptoms of an attack feels tightness in the chest and finds it extremely difficult to exhale. They instinctively rest their hands on something in search of support and so that the muscles help the lungs breathe. One of the most suitable positions during an asthma attack is astride a chair facing the back.

An attack of bronchial asthma is characterized by:

cough with a small amount of clear (“glassy”) sputum;

whistling exhalation (short inhalation and long exhalation);

feeling of difficulty in exhaling;

increased breathing (up to 50 per minute and more often);

pain in the lower chest (especially during a prolonged attack);

wheezing in the respiratory system, which can be heard from a distance;

forced position (sitting, holding hands on the table);

There may also be a feeling of fatigue, irritability, anxiety, headache, palpitations (heart rate - 140 beats per minute or more), itching, sore throat, sneezing and other nonspecific symptoms.

Cough is the main attack of bronchial asthma. It may be dry or moist, producing varying amounts of mucous or purulent sputum.

If emergency assistance is not provided in the early stages of the attack, then the symptoms continue to progress: shortness of breath and cough, whistling and wheezing intensify, voice, complexion, and behavior change.

Stages of an asthma attack and their symptoms

There are three stages of an attack of bronchial asthma, based on the following signs:

Stage I – prolonged attack of bronchial asthma with no effect from beta mimetics,

Stage II of a bronchial asthma attack – the appearance of “silent” zones during auscultation of the lungs,

Stage III of a bronchial asthma attack – hypercapnic coma, drop in blood pressure.

Mortality during an attack of bronchial asthma is a fraction of a percent. The immediate cause of death may be blockage of mucus or phlegm in the bronchi, leading to acute asphyxia; acute failure of the right heart and blood circulation in general; gradually increasing suffocation as a result of lack of oxygen, accumulation of carbon dioxide in the blood, causing overexcitation and decreased sensitivity of the respiratory center.

The development of these complications of an attack of bronchial asthma, the symptoms of which may include increasing cyanosis, the appearance of shallow breathing, weakening of breathing and a decrease in the amount of dry wheezing during auscultation, the appearance of a thread-like pulse, swelling of the neck veins, swelling and severe pain in the liver, is especially likely with prolonged (so-called intractable) attack, and even more so in an asthmatic state.

Diagnostic symptoms of an asthma attack

The clinical picture of an attack of bronchial asthma is very characteristic. The patient's face during an asthma attack is cyanotic, the veins are swollen. Already from a distance, whistling wheezing can be heard against the background of noisy, difficult exhalation. During an attack of bronchial asthma, the chest seems to freeze in the position of maximum inspiration, with raised ribs, an increased anteroposterior diameter, and bulging intercostal spaces.

When percussing the lungs during an attack of bronchial asthma, a box sound is determined, their boundaries are expanded, auscultation reveals a sharp prolongation of exhalation and extremely abundant varied (wheezing, rough and musical) wheezing. Listening to the heart is difficult due to emphysema and an abundance of wheezing. The pulse is of normal frequency or accelerated, full, usually relaxed, rhythmic. Blood pressure can be low or high. The apparent enlargement of the liver, sometimes revealed by palpation, can be explained (in the absence of congestion) by its being pushed down by the inflated right lung. Often patients are irritated, fear death, and groan; during severe attacks, the patient cannot utter several words in a row due to the need to take a breath. A short-term increase in temperature may occur. If the attack is accompanied by a cough, a small amount of viscous, mucous, glassy sputum is difficult to clear. Examination of blood and sputum during an attack of bronchial asthma reveals eosinophilia.

The course of attacks of bronchial asthma, even in the same patient, can be different: from “erased” (dry cough, wheezing with a relatively mild feeling of suffocation for the patient) and short-term (an attack lasts 10-15 minutes, after which it goes away on its own or after use dosed inhalations of beta-mimetics) to very severe and prolonged, turning into an asthmatic state.

The asthmatic condition lasts from several hours to many days. The attack does not stop, or the “light intervals”, when breathing becomes somewhat easier, are very short, and one attack follows another. The patient does not sleep, greets the new day sitting, exhausted, and without hope. Breathing remains noisy and whistling all the time, there is no sputum, and even if it is released, it does not bring relief. Beta-agonists, which previously quickly stopped the attack, do not work or provide a very short-term and insignificant improvement. Tachycardia (usually up to 150 beats per minute while maintaining the correct rhythm), red-bluish complexion, and skin covered with drops of sweat are noted.

Often during an attack of bronchial asthma there is an increase in blood pressure, which creates additional stress on the heart. The discrepancy between the obvious deterioration of the patient’s condition and auscultatory data is characteristic: when listening, a decrease or complete disappearance of wheezing is noted due to blockage of the small and medium bronchi with mucus plugs (“silent lungs”). Gradually, the patient weakens, breathing becomes shallow, less frequent, the feeling of suffocation becomes less painful, blood pressure decreases, and heart failure increases. There is a risk of developing a coma and respiratory arrest. Loss of consciousness may be preceded by the patient's agitation, stuporous state, and convulsions.

Clinical criteria for an asthmatic condition are, therefore, a rapid increase in bronchial obstruction, increasing respiratory failure and lack of effect from beta-mimetics.

The clinical picture of bronchial asthma with a characteristic triad of symptoms (breathing difficulties, cough, wheezing) usually does not create diagnostic difficulties.

Differential diagnosis of bronchial asthma

Differential diagnosis is carried out primarily with cardiac asthma. It is very important not to forget that the signs of bronchial asthma - wheezing against the background of noisy, difficult exhalation - can be a consequence of swelling and spasm of the bronchi that occurs against the background of acute coronary insufficiency, hypertensive crisis, etc., i.e. in cases where one can think about the occurrence of left ventricular failure and cardiac asthma, accompanied by spasm of the bronchi and swelling of their mucous membrane.

In chronic lung diseases, for example, chronic bronchitis, emphysema, pneumosclerosis and cor pulmonale, periods of sharp intensification of shortness of breath often occur; they can be distinguished from an attack of bronchial asthma by the absence of clear signs of the latter (sudden onset, vigorous participation of auxiliary muscles in the expiratory phase, whistling, “musical” wheezing against the background of sharply difficult exhalation). In these cases, there is no eosinophilia in the blood and sputum.

Sometimes it may be necessary to differentiate an attack of bronchial asthma and the so-called stenotic shortness of breath, which occurs when there is scar narrowing of the larynx or bronchi, narrowing of their lumen due to compression from the outside by a tumor, aneurysm, or entry of a foreign body into the trachea or bronchi: such shortness of breath is inspiratory in nature (prolonged noisy inhalation, accompanied by retraction of the intercostal spaces, suprasternal and supraclavicular fossae), there is no acute emphysema and other characteristic symptoms of bronchial asthma. Finally, attacks of suffocation in nervous patients (“hysterical shortness of breath”) occur without orthopnea (patients can lie down), frequent shallow breathing is not accompanied by wheezing and sharply prolonged exhalation, the general condition of patients remains satisfactory.

Bronchial asthma attack - emergency care

In case of shortness of breath, a patient with a disease of the respiratory system should be placed in a semi-sitting position, open a window or vent, and free the chest from tight clothing and heavy blankets. If possible, use an oxygen cushion.

Cough and difficulty breathing, as well as chest pain, are relieved by applying cupping or mustard plasters, the use of which should be alternated.

For thick, difficult to expectorate sputum, you can recommend drinking warm alkaline mineral water or hot milk with soda (0.5 teaspoon of soda per glass of milk) or honey.

If there is abundant liquid sputum, a patient with bronchial asthma or other respiratory disease should be given less fluid, and also put in a position for 20–30 minutes, 2–3 times a day, in which a cough occurs and accumulated sputum is removed. Minor hemoptysis usually does not require any - emergency measures, but you need to inform your doctor about it.

In case of excessive hemoptysis or sudden pulmonary hemorrhage, you should immediately call an ambulance. To prevent the patient from suffocating and the spilled blood from entering the neighboring bronchi and areas of the lungs, before the doctor arrives, the patient must be laid on his stomach, the foot end of the bed raised by 40–60 cm, while the patient’s legs should be tied to the back of the bed so that he does not slid down, you need to hold your head up.

With a significant increase in temperature, the patient may experience severe headache, anxiety, and even delirium. In this case, you should put an ice pack on your head and use cold compresses. In case of sudden chills, the patient should be covered and covered with heating pads. With a rapid decrease in temperature and increased sweating, it is necessary to change bed linen more often and give the patient strong, hot tea.

In children suffering from asthma, you can try to calm the attack by patting them on the back and reassuring them that everything is fine and that everything will pass soon - the main thing is not to panic.

How to provide emergency assistance to yourself during an attack of bronchial asthma?

If you or someone else is having an asthma attack, the first thing you need to do is try to calm down and normalize your breathing, trying to exhale as much air as possible from your lungs.

You need to provide yourself with a flow of fresh air.

After this, during an attack of bronchial asthma, immediately use a metered dose inhaler (it should always be at hand) with one of the bronchodilators, such as Salbutamol, Terbutaline. These medications help to quickly relieve an attack of suffocation by acting on the smooth muscles of the bronchi. Take two inhalations, wait, if the condition does not improve, repeat after 10 minutes. Increasing the dose may cause side effects due to overdose.

Also, intravenous aminophylline, an effective bronchodilator, is used to quickly relieve an attack of suffocation.

Emergency care for bronchial asthma can also be provided with home remedies. Dilute baking soda in hot water (2-3 small spoons per glass) and add a couple of drops of iodine. Breathe over this solution and then take a few sips. If this method does not immediately help, then you should not continue. If there is no improvement, call an ambulance.

Emergency medication during an attack

During an asthma attack, it is very important to take the medicine recommended by your doctor in a timely manner. When using inhaled medications, 1-2 inhalations are usually sufficient. Longer use of medication for bronchial asthma can be dangerous. If there is no effect, you should call a doctor.

If the attack does not occur for the first time and the patient is already receiving drug therapy against bronchial asthma, immediately take the drug (usually in the form of inhalations) in the dosage prescribed by the doctor to relieve the attack. After the condition improves, you can repeat taking the drug after 20 minutes. If such symptoms occur for the first time or the attack is severe, you must urgently go to the hospital or call an ambulance.

For mild attacks of bronchial asthma, drugs are prescribed in the form of tablets and inhalations of adrenergic agonists, such as Ephedrine, Euspiran, Alupent, Theophedrine and others. In the absence of such drugs, administer 0.5–1.0 ml of 5% ephedrine subcutaneously or 1 ml of 1% Diphenhydramine solution.

In case of a severe asthma attack, the drugs are administered parenterally. Adrenomimetic drugs are also indicated: Adrenaline - 0.2–0.5 ml of 0.1% solution subcutaneously with an interval of 40–50 minutes; Alupent – ​​1-2 ml of 0.05% solution subcutaneously or intramuscularly. Usually you cannot do without antihistamines intravenously or intramuscularly, such as Demidrol or Suprastin.

In addition, during emergency care during an asthma attack, humidified oxygen is inhaled, and for severe attacks, 50–100 mg of hydrocortisone is administered intravenously. The scope of emergency care for asthmatic patients outside an outpatient setting depends on the stage of asthma.

The pathogenesis of an attack of bronchial asthma determines the paramount importance of the use of emergency therapy to relieve bronchospasm. Graduality and consistency of this therapy are necessary. Often, patients themselves know which of the drugs, in what dose and with which method of administration help them and which do not, which makes the doctor’s task easier. In any case, while inhalation agents are effective, injections should not be resorted to.

Therapy during an attack of bronchial asthma begins with dosed inhalations of short-acting beta-agonists. The speed of action, relatively simple method of use and a small number of side effects make inhaled beta-agonists the drug of choice for relieving an attack of bronchial asthma. In emergency care for a patient with an attack of bronchial asthma, preference is given to selective beta-2-adrenergic agonists (the use of Berotek, Salbutamol is optimal, the use of non-selective drugs such as Ipradol and Astmopent is undesirable). The inhalation route of administration also increases the selectivity of the action of drugs on the bronchi, allowing for maximum therapeutic effect with a minimum of side effects. Tremor is the most common complication of metered dose aerosol therapy; agitation and tachycardia are rare. Rinsing the mouth after inhalation can further reduce the systemic effects of beta-agonists.

Emergency treatment for an asthma attack using an inhaler

In order for the patient to independently stop mild attacks of bronchial asthma, he must be taught the correct technique for using the inhaler. Inhalation is best done while sitting or standing, tilting your head back slightly so that the upper respiratory tract straightens and the drug reaches the bronchi. After vigorous shaking, the inhaler should be turned upside down. The patient exhales deeply, clasps the mouthpiece tightly with his lips and, at the very beginning of the inhalation, presses the canister, after which he continues to inhale as deeply as possible. At the height of inhalation, you need to hold your breath for a few seconds (so that the medicine settles on the wall of the bronchus), then calmly exhale.

The patient should carry an inhaler with him at all times (similar to nitroglycerin for angina pectoris); Just a feeling of confidence and a reduction in fear of a possible attack of suffocation can significantly reduce the frequency of asthma attacks. In most cases, 1-2 doses of the drug are enough to stop an attack; the effect is observed after 5-15 minutes and lasts about 6 hours. If the first 2 breaths of the aerosol are ineffective, it is possible to inhale 1-2 doses of the drug again every 20 minutes until the condition improves or until side effects appear effects (usually no more than 3 times within an hour). It should be emphasized that short-acting beta-agonists are the drug of choice for the relief, but not for the prevention, of attacks of bronchial asthma - their frequent use can worsen the course of asthma.

What to do if you have an asthma attack as a result of an anaphylactic reaction

If an asthmatic condition develops as part of an anaphylactic reaction (severe bronchospasm and asphyxia upon contact with an allergen), adrenaline becomes the drug of choice. Subcutaneous injection of a 0.1% solution of Adrenaline often stops an attack within a few minutes after the injection. At the same time, the use of adrenaline is fraught with the development of serious side effects, especially in elderly patients with atherosclerosis of the brain and heart vessels and organic myocardial damage, arterial hypertension, parkinsonism, hyperthyroidism, so only small doses should be administered with careful monitoring of the state of the cardiovascular system. Therapy begins with 0.2-0.3 ml of a 0.1% solution; if necessary, the injection is repeated after 15-20 minutes (up to three times). With repeated injections, it is important to change the injection site of the drug, since adrenaline causes local vascular contraction, which slows down its absorption.

It should be borne in mind that sometimes intradermal (lemon peel method) administration of Adrenaline as an emergency measure gives an effect in cases where the same dose of the drug administered subcutaneously did not bring relief. The possibility of a paradoxical increase in bronchospasm instead of the expected bronchodilator effect with frequent repeated administration of adrenaline limits its use in cases of prolonged intractable attack of bronchial asthma and asthmatic condition.

As an alternative to adrenergic agonists in case of their intolerance, especially in elderly patients, anticholinergic blockers - Ipratropium bromide (Atrovent) and Troventol - can be used in the form of metered aerosols. Their disadvantages are the later development of the therapeutic effect compared to beta-agonists and significantly lower bronchodilator activity; The advantage is the absence of side effects from the cardiovascular system. In addition, anticholinergic blockers and beta-agonists can be used in parallel; potentiation of the bronchodilator effect in this case is not accompanied by an increased risk of side effects. The combined drug Berodual contains 0.05 mg of Fenoterol and 0.02 mg of Ipratropium bromide in one dose.

The onset of action of the drug is in 30 seconds, duration is 6 hours. In terms of effectiveness, Berodual is not inferior to Berotek, but in comparison with it contains a 4 times smaller dose of Fenoterol.

In case of a severe attack of bronchial asthma (when the edematous and obstructive mechanisms of obstruction prevail over the bronchospastic component), with the development of status asthmaticus, as well as in the absence of inhalation agents or the impossibility of their use (for example, the patient cannot be trained in the inhalation technique), the standard “first aid” emergency medicine Eufillin remains a help. Typically, 10 ml of a 2.4% solution of the drug is diluted in 10-20 ml of isotonic sodium chloride solution and administered intravenously over 5 minutes.

During the administration of Eufillin, the patient's horizontal position is preferable. Rapid administration of the drug may be accompanied by side effects (palpitations, pain in the heart area, nausea, headache, dizziness, a sharp drop in blood pressure, convulsions), especially likely in elderly patients with severe atherosclerosis.

If there is an increased risk of side effects, Eufillin is administered intravenously - 10-20 ml of a 2.4% solution of the drug is diluted in 100-200 ml of isotonic sodium chloride solution; infusion rate – 30-50 drops per 1 minute. The average daily dose of aminophylline is 0.9 g, the maximum is 1.5-2 g. If the patient has previously received therapy with long-acting theophylline preparations (Retafil, Teopek, Theotard, etc.), the dose of aminophylline administered intravenously should be halved. The question of the advisability of using aminophylline after adequate therapy with inhaled beta-agonists (3 inhalations over 60 minutes) remains quite controversial; According to many researchers, the risk of developing side effects from such a combination of drugs exceeds the potential benefits of administering Eufillin.

What to do if an attack of bronchial asthma does not go away

In cases where the attack is prolonged, turns into an asthmatic state, and the above-described therapy is ineffective within 1 hour, further use of adrenergic agonists is contraindicated due to the possibility of paradoxical effects - “rebound” syndrome (increased bronchospasm due to functional blockade of beta-adrenergic receptors by metabolic products of adrenergic agonists) and “locking” syndrome (impaired drainage function of the lungs due to dilation of the vessels of the submucosal layer of the bronchi).

In such a situation, hormone therapy is necessary; The traditional regimen for relieving an attack of bronchial asthma is Prednisolone 90-120 mg intravenously in a stream or drip in 200 ml of isotonic sodium chloride solution or other corticosteroids (Hydrocortisone, Betamethasone) in an equivalent dose. Corticosteroids prevent or inhibit the activation and migration of inflammatory cells, reduce swelling of the bronchial wall, mucus production and increased vascular permeability, and increase the sensitivity of beta receptors of bronchial smooth muscle.

After the introduction of glucocorticoids, repeated use of aminophylline and beta-agonists can again become effective. The administration of corticosteroids is repeated, if necessary, every 4 hours; when treating status asthmaticus, there is no limit on the maximum dose for glucocorticosteroids. If there is no effect within 24 hours, oral hormones are added to the treatment of an attack of bronchial asthma at the rate of 30-45 mg of prednisolone in 1-2 doses (2/3 of the dose should be taken in the morning). After relief of status asthmaticus, the dose of corticosteroids can be reduced daily by 25%, the total duration of the course of hormone therapy is usually 3-7 days. If necessary, the patient is transferred to hormonal inhalers.

In order to combat hypoxemia, as well as to eliminate the patient's anxiety, oxygen therapy is performed. Humidified oxygen is supplied through nasal cannulas or through a mask at a rate of 2-6 l/min.

The issue of hospitalization is decided taking into account the general course of the disease and the patient’s condition during interictal periods. In case of an intractable attack and an asthmatic condition, the patient must be hospitalized immediately, since only in a hospital can the full scope of emergency care be applied, including, in especially severe cases, forced ventilation (transfer to mechanical breathing). The method of transportation (patient position, accompaniment) depends on the patient’s condition.

Causes and prevention of bronchial asthma attacks

An attack can be provoked by:

emotional stress;

tobacco smoke;

fur and epidermis of domestic animals;

respiratory diseases;

other allergens (plant pollen, food, specific odors, etc.).

Pathogenesis of the development of bronchial asthma attacks

In order to know how to properly stop an attack of bronchial asthma, you need to thoroughly study the information about this disease. Bronchial asthma is a chronic inflammatory disease of the airways, characterized by attacks of suffocation due to their obstruction. The pathogenesis of bronchial asthma is based on the complex interaction of inflammatory cells (eosinophils, mast cells), mediators and cells and tissues of the bronchi, caused by changes in the reactivity of the bronchi - primary (congenital or acquired under the influence of chemical, physical, mechanical factors and infection) or secondary (as a result of changes in the reactivity of the immune, endocrine and nervous systems). Today we will talk about what to do during an attack of bronchial asthma

In many patients, it is possible to identify heredity burdened by allergic diseases (atopy), a history of infectious or allergic pathology, and the presence of infectious-inflammatory processes during examination of the patient (i.e., the infectious-allergic nature of the disease is revealed). In cases where the allergic nature of the disease is not associated with an infectious process, aromatic compounds play a special role. Among this group of allergens are the odors of cosmetics, flowers, pollen, etc.

Often an attack of bronchial asthma is provoked by house dust (the main allergic component is house mites) and epidermal allergens (dander and animal hair). Cold, nervous stress, physical activity, and infection can also cause attacks of bronchial asthma. In patients with the “aspirin triad” (bronchial asthma, aspirin intolerance, nasal polyps), any non-steroidal anti-inflammatory drug (aspirin, analgin, indomethacin, voltaren, etc.) can cause a severe attack of suffocation.

An attack of suffocation in bronchial asthma is based on airway obstruction. Violation of their patency is caused by spasm of the smooth muscles of the bronchi, edema and swelling of the bronchial mucosa, blockage of small bronchi with secretions, which leads to impaired pulmonary ventilation and oxygen starvation. The immediate cause of an attack can be either direct exposure to allergens (contact with animals, inhalation of dust, exacerbation of the infectious process), or the influence of nonspecific factors - meteorological (cooling is a common cause), mental, etc.

Sometimes an attack is preceded by a bad mood, weakness, itching in the nose or along the front surface of the neck, congestion, soreness along the trachea, dry cough, sneezing, copious discharge of watery secretion from the nose, and a feeling of chest immobility. Sometimes an attack is provoked by emotional stress (crying, laughing, etc.).

How to prevent an attack of bronchial asthma?

To prevent attacks of bronchial asthma, the most important role is played by correct, systematic, ongoing treatment of the disease. The first-line drugs are inhaled forms of Cromolyn and Nedocromil sodium, beta-agonists and corticosteroids. Cromolyn sodium (Intal) and Nedocromil sodium (Tyled) suppress the activation of mast cells and the release of mediators from them. The drugs are used in the form of a dosed aerosol, 2 breaths 4 times a day.

Among inhaled beta-agonists during an attack of bronchial asthma, preference is given to long-acting drugs. Inhaled corticosteroids (Beclomethasone, Triamcinolone) are prescribed 2 puffs 4 times a day 5-10 minutes after the injection of beta-adrenergic agonists. After using inhaled corticosteroids, mouth rinse is necessary (prevention of oral candidiasis). Chronic oral corticosteroids are a “desperate therapy” and should only be used when frequent severe asthma attacks continue despite maximal therapy.

Long-term administration of hormones in tablets leads to osteoporosis, arterial hypertension, diabetes, cataracts, obesity and other complications. Long-acting theophylline preparations (Retafil, Teopek, etc.) are second-line drugs in the treatment and prevention of attacks of bronchial asthma.

These drugs are indicated in children and adults with severe manifestations of encephalopathy (when it is impossible to teach the patient how to use an inhaler), with severe shortness of breath (when it is impossible to take a deep breath), with severe exacerbation of the disease (when it is necessary to maintain a constant concentration of the drug in the blood).

At home, a patient with bronchial asthma needs particularly strict hygienic conditions. It is necessary to remove everything from his room that can cause allergies: pillows and featherbeds made of feathers and down, flowers, cologne, perfume, eliminate kitchen odors, stop smoking. The room where the patient is located must be well ventilated, cleaned only with wet methods, and bed linen must be changed frequently. Breathing exercises are of great importance in the prevention of bronchial asthma attacks.

Monitoring a patient with bronchial asthma or other respiratory disease includes measuring temperature and determining respiratory rate and pulse, collecting and monitoring the nature of sputum, and in the presence of edema, measuring the amount of fluid drunk and urine excreted (daily diuresis).

Patients prone to attacks of bronchial asthma and other respiratory diseases must observe a hygienic regime. Sleep should be sufficient, nutrition varied and nutritious. Hygienic exercises, including breathing, are necessary. The simplest breathing exercises are to lengthen and intensify your inhalation. It is important to stop smoking, as it contributes to the development and aggravates the course of chronic lung diseases.

Bronchial asthma is a disease characterized by periodic exacerbations or attacks. An attack of bronchial asthma is a condition when the symptoms of the disease appear suddenly or intensify so much that the patient experiences severe lack of air, even to the point of suffocation.

What is asthma?

Bronchial asthma is a disease in which chronic, that is, constant, inflammation forms in the mucous membrane of the patient’s bronchi. The patient's airways become hyperreactive, that is, their reaction to any external irritation is significantly enhanced. Due to the latter, the patient periodically experiences episodes of wheezing, shortness of breath, coughing or chest tightness, especially at night or early in the morning. These symptoms should be attributed to common but variable airway obstruction. This means that the bronchi narrow in different sections to varying degrees, which is why symptoms of the disease arise. Symptoms characteristic of exacerbation of bronchial asthma may disappear spontaneously or after the use of medications.

There are a number of congenital and circumstantial characteristics that predispose a patient to the development of bronchial asthma. These include the following:

Atopy.
Atopy is the increased production of immunoglobulin E in response to contact with an allergen in the patient’s body. Immunoglobulin E triggers and actively participates in allergic reactions. Atopy is an important predisposing factor to the development of allergic or atopic asthma. Genetic predisposition to atopy or asthma itself.
The fact is that if one of the parents or both has been diagnosed with bronchial asthma, then the likelihood of their child getting sick is very high. A predisposition to atopy can also be inherited. Genetic predisposition to airway hyperresponsiveness.

How does an attack develop?

Pathogenesis is the main mechanism for the development of a disease or pathological process. The underlying pathogenesis of asthma is inflammation. It, in turn, begins in response to the influence of so-called triggers or specific irritants on the mucous membrane of the respiratory tract.

The most studied triggers are:

Household allergens and occupational sensitizing agents.
They are also called external allergens - these are dust, pieces of skin from pet hair, those volatile mixtures and substances that an asthmatic can inhale while working at work.
Infections.
In this case, viruses are of primary importance. For example, the influenza virus. Medications.
The most common triggers for asthma are non-hormonal anti-inflammatory drugs, such as aspirin. Drugs such as non-selective beta blockers can also cause asthma symptoms. For example, propranolol. Aeropollutants.
This is the name for substances that, when inhaled, irritate the human respiratory tract. For example, household chemicals or odorous substances.

When triggers affect the lining of the respiratory tract, it becomes filled with blood. Specific cells accumulate in its microvessels, causing an inflammatory reaction.

The main ones among the latter should be considered the so-called mast cells. The granules of the mast cell contain mediator substances, such as histamine, leukotrienes, which act on the wall of the bronchi and cause the muscle cells in it to contract. This is the mechanism for the development of bronchospasm itself, that is, narrowing of the airway lumen.

In addition to mast cells, the inflammation mechanism is also carried out by other cells: white blood cells, macrophage cells and lymphocytes, which are called T-helpers.

Inflammation, in turn, further enhances the hyperreactivity of the bronchial mucosa. Thus, one mechanism for the development of an attack complements another mechanism: the vicious circle closes.

In addition, the pathogenesis of asthma can and usually does include an allergic component. In this case, in response to contact with the allergen, the level of immunoglobulin E in the patient’s blood sharply increases. Immunoglobulin E comes into contact with the mast cell and the antigenic, that is, foreign to the patient’s body, part of the allergen: a violent allergic inflammatory reaction begins.

The diagram shows granules with mediators in the mast cell, immunoglobulins E, which simultaneously come into contact with it and with an allergen site that is foreign to the patient’s body

An attack of the disease in its allergic form can develop very quickly.

Asthma symptoms are the final link that completes the pathogenesis of the disease. The mechanism for the development of wheezing is as follows: the small, terminal sections of the respiratory tract narrow to varying degrees and the air passing through them gives a characteristic whistling sound. The mechanism for the development of expiratory shortness of breath, that is, difficulty exhaling, is as follows: due to a lack of air, the force with which the patient tries to inhale increases, which leads to early closure of the respiratory sacs; their walls seem to touch, preventing the air stream from passing freely. The mechanism of cough development is as follows: the penetration of irritating substances into the respiratory tract and their effect on the bronchial mucosa leads to a protective reaction of pushing out these particles - a cough appears.

How to recognize an attack?

An attack of suffocation in bronchial asthma is a classic manifestation of the disease. Diagnosis of this attack, as a rule, does not cause difficulties. Usually the attack is preceded by symptoms of the disease, which manifest themselves quite mildly. The patient may have a cough, slight chest discomfort, or a general feeling that something is wrong. Also, a few days before an attack, an asthmatic may experience individual symptoms and signs indicating an imminent attack. These signs may include nasal congestion, frequent sneezing, and itchy eyes and nose. The patient may also become restless, irritable, depressed or scared: sudden changes in mood should also be noted.

The picture shows the difference between a healthy person and an asthmatic during an attack: grayish skin tone, barrel-shaped chest, frozen when inhaling, lungs full of air, additional breathing muscles are connected

When an exacerbation of the disease actually occurs, the patient experiences severe attacks of dry cough, which are difficult to interrupt.

His position is usually such that he rests his hands on the edge of a chair or bed: the patient uses this maneuver so that additional muscles begin to participate in breathing. The patient becomes agitated and has a frightened expression on his face. Speech is significantly difficult: a person can usually pronounce only individual words. The patient's condition is also characterized by pale skin. Sometimes the latter has a grayish tint. The wings of the nose swell, the chest seems to become frozen when inhaling, this position determines pathogenesis: the exhalation mechanism is disrupted.

Diagnosis by physical examination is as follows. If you percussion the chest, that is, tapping it, the sound over the entire surface will be similar to the sound of knocking on an empty box. That's what they call it - boxed. If you listen to the lungs, you can usually hear whistling wheezing both during inhalation and during exhalation.

After the attack stops, more detailed diagnostics can be carried out. In a conversation with the patient, you can determine whether he inhaled, for example, allergens before the symptoms of the disease significantly intensified or arose. As a rule, the attack can only go away after treatment is applied to it. When the attack is over, the symptoms of the disease become milder. Coughing attacks are transformed into productive ones and pass with the release of very thick, viscous, transparent sputum, called “vitreous.”

The state of suffocation can last up to several hours or even last a whole day.

Night attacks usually occupy the attention of doctors. These happen between 2 and 6 am. They are called paroxysms of respiratory discomfort. If the night symptoms of the disease bother the patient, then there is a high probability that his treatment is insufficient or inadequate.

What to do during an attack?

If an attack does occur, you can immediately apply specific treatment. Such treatment should consist of expanding the narrowed bronchi. For this purpose, short-acting drugs that cause relaxation of muscle cells in the wall of the bronchi, such as salbutamol or fenoterol, are usually used.

This treatment will quickly reduce the symptoms of the disease. The mechanism of action of these drugs is to stimulate receptors sensitive to the mediator norepinephrine. This causes the smooth muscle cells in the wall of the airways to relax.

In addition, sometimes treatment may be based on theophylline preparations. However, they are less effective. It is also important that their mechanism of action is such that serious cardiac conduction disturbances can be caused.

If drug treatment during an attack of bronchial asthma is unavailable for some reason, the patient can still be helped. Non-drug treatment should primarily focus on reassuring the patient. We need to teach him to breathe correctly. Explain that you need to form your lips into a tube and slowly blow through them, as if through a straw, while exhaling.

In this case, the pathological mechanism of rapid collapse of the walls of the respiratory sacs and small bronchi will be interrupted. This will allow you to exhale more completely, followed by a slower, more complete inhalation. Symptoms of the disease will immediately begin to decrease.

It is also necessary to carry out such basic measures as opening the window, unbuttoning the patient’s shirt so that he has greater access to fresh air. Treatment may also include stimulation of the chest through massage. You can also immerse the patient's feet in hot water. This will also help relieve symptoms of the disease.

Periodic short-term, 6-8 second, breath holdings by the patient will have a positive effect on the course of the attack. This promotes the accumulation of carbon dioxide in the patient’s blood and dilation of the bronchi. The mechanism is as follows: due to the increase in carbon dioxide, the patient’s body switches to inhalation.

How is the disease complicated?

Exacerbation of bronchial asthma can lead to serious complications. The most common complications that arise are:

Respiratory failure.
Occurs due to lack of oxygen. Since during an attack the efficiency of inhalation is greatly reduced, oxygen does not reach the patient’s organs and tissues in the required quantity. Spontaneous pneumothorax.
Due to severe coughing and overfilling of the lung tissue with air, ruptures may occur. In this case, air accumulates between the lung and its membrane. This is called pneumothorax. This complication should be feared, as it is life-threatening.

Air compresses the lung

It must be diagnosed immediately. Signs: severe chest pain, accelerated increase in shortness of breath. Treatment is surgical.

Asthmatic status.
This is the name for prolonged severe suffocation, which cannot be stopped until intensive treatment is carried out. Atelectasis.
Collapse of sections of lung tissue when the bronchi ventilating them are blocked by dense casts of sputum. There is a decrease in lung tissue involved in ventilation. In this regard, the increase in hypoxia, that is, lack of oxygen, and the onset of respiratory failure, respectively, accelerate.

The above complications are acute, that is, they usually occur during an attack. There are also chronic complications of asthma that require attention. Chronic complications are those that arise over time and develop gradually.

Chronic complications:

emphysema or expansion of the air sacs in the lungs, pneumosclerosis, that is, the replacement of part of the lung tissue with connective, non-respiratory tissue.

The figure shows the difference between the alveoli or respiratory sacs in a healthy lung and in emphysema

All this leads to disruption of gas exchange, and therefore the patient eventually develops signs of respiratory failure.

Status asthmaticus

Status asthmaticus requires closer attention, since it is this complication that can result in death. Status asthmaticus is a very prolonged attack of suffocation. Its diagnosis is simple: if the patient becomes resistant to treatment, then most likely he has already developed status asthmaticus.

Status asthmaticus often develops quite slowly, however, with allergic asthma, status asthmaticus can develop very quickly. Therefore, it is impossible to delay treating the patient during an attack.

When status asthmaticus has just begun, the patient develops resistance to short-acting adrenergic agonists, for example, salbutamol. In response to them, the expansion of the airways no longer occurs. Later, when status asthmaticus passes into the so-called “silent lung” stage, the patient experiences a rapid increase in respiratory failure, and gas exchange in the lungs is greatly impaired. In the third stage, advanced status asthmaticus without intensive care measures can result in coma and death.

Preventive actions

To prevent asthma attacks from happening as often as possible, they can be prevented. First of all, for effective prevention it is necessary to try to exclude from the patient’s life all kinds of allergens to which he reacts. These can be household allergens, such as dust, animal hair, household chemicals, or avoid exposure to work, for example, if industrial pollutants also cause or intensify the symptoms of the disease, that is, they have a great influence on its pathogenesis.

To prevent bronchial asthma, you can also use various breathing exercises, as well as general strengthening physical exercises from a course of physical therapy.

It is important to remember that during the prevention of exacerbation of the disease, its complications are also prevented. After all, the most dangerous, like status asthmaticus, acute complications of the disease usually occur during an attack of bronchial asthma.

In order for the treatment of asthma to be partially replaced by ordinary non-drug prevention of attacks, timely diagnosis of the disease is important. In order for such a diagnosis to be carried out, it is necessary to contact a medical institution if alarming signs and symptoms similar to those of bronchial asthma occur.

Video: Project “Tablet”, topic of discussion: “Bronchial asthma”

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The external manifestations of an attack of bronchial asthma are very similar to a heart attack: the patient experiences pain in the sternum, feels a lack of air, trying to swallow it convulsively.

Therefore, it is important to know how to recognize this disease and take the necessary algorithm of actions to provide first aid to the patient, since an attack characteristic of asthma develops rapidly and one cannot hesitate in such a situation.

Causes of asthma attacks

Depending on the factors that cause attacks of the disease, allergic and non-allergic asthma are distinguished.

The first occurs due to the sedimentation of allergens in the bronchi. Asthma of the second type occurs due to exposure of the bronchi to an irritant that provokes spasms, coughing and suffocation.

Factors that cause an asthma attack:

• allergens - perfumes, household chemicals, animal hair, plant pollen;
• traffic fumes;
• tobacco smoke;
• hypothermia, inhalation of cold air;
• ARVI;
• taking medications.

It is very difficult to identify a specific allergen that causes a spasm.

An attack of suffocation in bronchial asthma can develop as a result of stress and psycho-emotional stress.

Frequent respiratory diseases are another reason for the first signs of the disease to appear. An unfavorable environmental situation and air pollution from industrial waste can provoke an asthmatic attack in people predisposed to it.

Signs and symptoms of an attack

The duration of asthmatic attacks varies for each patient - from several minutes to several hours. During an attack, a lot of sputum is produced.

Some cope with the symptoms of the disease on their own, while other patients require medical intervention. A prolonged crisis can lead to the death of the patient.

Such conditions are preceded by the following symptoms, which appear half an hour before the onset:

• sneezing, runny nose with watery mucus;
• cough;
• sore throat;
• headache.

These manifestations occur if asthma is allergic in nature.

In the non-allergic form of the disease the following are observed:

• dizziness;
• lethargy, weakness;
• feeling of anxiety, restlessness;
• severe fatigue;
• sudden change of mood.

With asthma, before a night outbreak, the patient cannot fall asleep for a long time, he is tormented by a cough.

The main signs of an attack of bronchial asthma:

1. The onset is almost always sudden.
2. Many patients feel a deterioration in their condition, experience anxiety, and almost all have difficulty speaking.
3. The skin becomes pale.
4. Breathing becomes noisy and whistling. The occurrence of shortness of breath is associated with difficulty breathing.
5. The person wheezes, especially when exhaling.
6. The cough is paroxysmal in nature.
7. Copious sputum is produced, the person is forced to take a sitting position.
8. The patient's behavior during an attack sometimes resembles a person who has an epileptic seizure.

Depending on the severity of the asthmatic crisis, the following degrees of its course are distinguished:

♦ Lightweight. The patient experiences shortness of breath while walking. He may be lying down, slightly overexcited, and his speech is practically unimpaired. The breathing rate increases. Rattles on exhalation are weak. Heart rate is less than 100 beats per minute.

♦ Average. A person feels better when he sits, speaks in separate phrases, and is overly excited. The breathing rate is increased. The wheezing is very loud. The heart rate can reach 120 beats per minute.

♦ Severe degree. Respiration rate and heart rate increase. The patient is extremely agitated, severe wheezing is heard. Speaks in separate words.

A severe attack of bronchial asthma entails the occurrence of status asthmaticus, characterized by multiple attacks. A person can die from suffocation if help is not given to him.

Prevention

The main prevention of bronchial asthma attacks is strict hygiene:

• The room should be regularly ventilated and wet cleaned daily.
• Bed linen should be changed at least once a week.
• You cannot have down or feather pillows in the interior.
• Relatives are not recommended to use perfume or smoke in the presence of an asthmatic.

Special breathing exercises and adherence to a daily routine, alternating active activity and rest will help reduce the frequency of asthmatic attacks. Normal sleep and a balanced diet, as well as quitting smoking, help improve the condition of an asthmatic and prevent a crisis.

Preventing an asthma attack includes measuring body temperature, monitoring breathing rate, pulse, monitoring the state of sputum, measuring the amount of fluid drunk and urine excreted.

Relieving an attack of bronchial asthma

How to relieve an asthma attack at home? If there is an asthmatic in the house, his family members must follow a clear algorithm for action in the event of an attack. His life depends on how quickly emergency care is provided to a patient during an attack of bronchial asthma.

Emergency first aid for an attack of bronchial asthma includes the following:

1. you need to get rid of tight clothes: first of all, unbutton the shirt collar, take off the tie so that the person can breathe easier.
2. You should open a window in the room for fresh air.
3. give a comfortable position in which the patient can rest his hands on the surface.
4. it is necessary to calm the person so that he can breathe evenly.
5. hot baths for the upper or lower extremities help relieve a mild crisis.

What to do during an asthma attack if the patient cannot use the inhaler on his own - he should be helped, open the can and press the nebulizer. The active substance should reach the back wall of the larynx. Spray the medicine (salbutamol, fenoterol) 3 times with intervals of 20 minutes.

Important! If assistance does not bring relief and there is a threat of status asthmaticus, it is necessary to urgently call an ambulance.

First aid for an attack will help a person for a while, but will not cure the disease. If outbreaks occur regularly, you should urgently contact a medical facility, where the attending physician will prescribe adequate treatment.

Drugs

How to relieve an attack of bronchial asthma before the doctor arrives. To relieve an attack of bronchial asthma, special inhalers are most often used. The emergency physician needs to be told what medications were given to the patient during the crisis.

A medical professional injects a 0.1% solution of adrenaline to relieve spasm of the respiratory tract and reduce the amount of sputum. If after 10 minutes the expected effect has not occurred and the patient’s condition does not improve, the procedure is repeated.

The medicine has a number of side effects (increased heart rate, headache, chills), so it is not used for asthma caused by heart problems.

To stop an attack, a 1% ephedrine solution is also injected under the skin. It lasts longer than adrenaline, so to achieve maximum effect the medicine is used together with an atropine solution.

When it is not possible to accurately diagnose the type of attack (cardiac or bronchial), or there is a risk of status asthmaticus, intravenous aminophylline is used. These are the main drugs for stopping a crisis.

In the absence of positive dynamics from the administration of a bronchodilator, and also if the patient is in a highly agitated state, intramuscular administration of pipolfen and intravenous novocaine solution are recommended. Both medications are administered very slowly.

In cases where the patient requires the administration of antispasmodics, injections of a 2% solution of no-shpa and papaverine are used.

If relieving the symptoms of a crisis does not improve the condition of the asthmatic, he is subject to urgent hospitalization in a medical institution.

Asthma is an allergic disease, often of an atopic and hereditary nature, the attack of which develops as a result of chronic bronchial obstruction, and these attacks can be provoked by a number of reasons. Patients with asthma usually feel it coming and should have a special inhaler with them, since emergency care for bronchial asthma is not always available promptly. An attack can develop abruptly or gradually, depending on the situation, but the patient always has time to take action on his own or get help from loved ones. More than 6% of the Russian population suffers from bronchial asthma and this is a serious figure. Scientists are working very actively on this urgent problem, in particular, their work is aimed at preventive measures to prevent the development or complications of bronchial asthma in people. However, today the disease is recognized as chronic and practically incurable, but modern medicine is capable of stopping attacks and supplementing supportive treatment to significantly improve the quality of life of patients.

Stages of severity into which asthma is classified

As a rule, people suffering from asthma have concomitant diseases of the ENT organs, lung diseases or thyroid gland. Depending on the severity of the disease, the severity of asthmatic attacks may vary. There are three degrees of severity of asthma, which require immediate medical attention and consultation with further prescription of maintenance medications. And the fourth is status asthmaticus, which is regarded as a severe complication that threatens the life of the patient, and it develops if the first three stages of asthmatic attacks are ignored. In other words, if you don't help a person during an attack or its symptoms, they may die.

As a rule, people who have once experienced an attack of bronchial asthma already have an idea of ​​its onset, and also have a doctor’s recommendation to have the necessary inhalers on hand, suitable individually.

It is worth noting that with asthma, an attack of any stage can happen to a person at absolutely any time of the day, regardless of his activity, even in his sleep.

1. First mild degree. The person feels difficulty breathing, wheezes, and has a rapid pulse. You should definitely have two inhalers with different compositions on hand in case one of them turns out to be ineffective. The selection of inhalers is carried out after the results of tests to determine at least the approximate type of allergens.
2. Second degree. All the signs are the same as the first, with the only difference that attacks occur at least twice a month, and also in sleep. Shortness of breath occurs during physical activity. A person takes a characteristic sitting position, instinctively leaning on his hands to make it as easy as possible for air to enter the lungs. Blue lips and pale skin on the face are observed. These patients' inhalers should contain corticosteroids. In general, the second degree is already classified as dangerous.
3. Third degree. All signs of the first two degrees, but attacks occur abruptly, spontaneously, often and for a long time. The attack of suffocation is so aggressive that the person panics, which only makes the situation worse. The pulse quickens, tachycardia is observed, the face turns pale, and perspiration appears. The patient's breathing is complicated, with a loud whistle. These are very dangerous symptoms that require maximum prompt assistance. Corticosteroids and bronchodilators are prescribed to the patient in inhalers, and an additional course of corticosteroids is given in tablets. And treatment is carried out either on an ongoing basis or intermittently.
4. Asthmatic status can be called a conditional degree. This is the most extreme, uncontrollable degree of severity, when the patient can be treated exclusively in a medical institution with the help of both drugs and devices, since he will practically not be able to breathe on his own. If you do not transport the patient to the hospital in a timely manner, the risk of death is too great.

Common symptoms of an asthma attack

• weakness;
• tightness in the chest and difficulty breathing, especially when exhaling. Whistling when breathing;
• blueness of mucous membranes, as well as hands and face;
• barking dry cough;
• wheezing breathing. This breathing becomes very audible, and it is through it that people around them understand that an attack is occurring.

If the cough turns into a wet one and the sputum comes out, the attack may go away.

A lot of reasons can lead to bronchial asthma in humans. However, they should not be confused with the causes of asthma due to heart failure. For example, smokers have a high chance of acquiring persistent asthma with each year of smoking experience due to the bronchial tree affected by tobacco smoke. Hereditary predisposition also affects the chances of becoming asthmatic after age 20. But, nevertheless, the generally accepted cause of asthma is an allergy, or more precisely, a strong irritant.

In the presence of an irritant, 15 minutes pass from the onset of symptoms of an approaching attack to the immediate peak of the attack.

Attention! Bronchial asthma is allergic in nature and its hallmark is problematic exhalation. Cardiac asthma is a serious disease that makes it difficult for a person to breathe during an attack. And emergency care for an attack of bronchial asthma differs from a heart attack.

People living in countries with humid climates, workers in the chemical industry and people constantly exposed to large amounts of household or street/industrial dust are all at risk of developing bronchial asthma.

The symptoms of a worsening asthma attack are generally similar, but may vary depending on the severity of the disease. Patients usually know about their condition and have special equipment with them. But every person may experience an asthma attack for the first time. And then it is necessary to remain calm to others and the patient, and also to act competently and quickly. At the first suspicion of suffocation, you need to call an ambulance, but in the meantime, take some measures yourself.

Procedure for eliminating an attack

Algorithm of actions, if necessary, to provide first aid to a person with an asthmatic attack:

1. The first step is to isolate the person from the suspected irritant or allergen that triggered the attack. To do this, the patient is provided with access to fresh air and freed from a tight collar or thick outerwear.
2. An attack can also be triggered by anxiety and stress. It is better to sit the patient down so that he can lean on his hands - this will make breathing easier for him. Then eliminate the source that provoked the attack and ensure rest. The trigger for an attack can be any allergen - a chemical, a plant, an animal, even a toy that frightens and causes stress in the case of a child.
3. As first aid, you must have any bronchodilator such as Berodual or Salbutamol on hand. If within 20 minutes the drugs have not had the expected effect, i.e. did not increase the lumens of the bronchi due to their severe swelling, then to relieve an attack of bronchial asthma, you can repeat the inhalation (but no more than 3 times), and also give an intravenous injection of aminophylline 2.4% in a volume of 10 ml. If the injection is intramuscular, then 2 ml is enough. You can combine this with strophanthin if there are signs of tachycardia.
4. In parallel with the injections, we can take any antihistamine that is at hand. This should have a calming effect on the bronchi.
5. Since difficulty breathing, or more precisely, exhalation, is associated with bronchospasm, it is possible to stimulate the expansion of the lungs using a painful shock. Sometimes this is a very justified method when the attack drags on or becomes aggressive. Painful effect can be achieved in the area of ​​the elbow and knee joints.

If you don’t have any medications at hand, then first aid for an attack may consist of the following:

1. Place some salt on the patient's tongue. Salt helps relieve symptoms of bronchial spasms, and therefore can be used as a natural inhaler.
2. In case of a severe attack, you can add a little fresh ginger root juice to a pinch of salt. In this combination, relief from swollen bronchi should come even faster.
3. For mild attacks, steam inhalation will help. Place a spoonful of salt and a few drops of iodine in a glass of boiling water. It is enough to breathe in this steam a little to feel relief.

If we are talking about a child, then stopping an attack of bronchial asthma will be somewhat different from helping adults.

Helping a child during a seizure

It is extremely important to isolate the child from the allergen that triggered the attack. For example, this is household dust or a flowering plant, household chemical powder, bird feathers, book or fabric dust. Without panic, calmly and confidently, you need to take the child indoors and humidify the air with ordinary clean water, for example, from an ironing spray.

In case of food allergies, if the product was eaten within half an hour or an hour before the onset of the attack, the child should be given any available drug: Enterosgel or Activated Charcoal at the rate of a teaspoon of gel or 1 tablet per 10 kg of the child’s weight. The dose can be doubled if a food allergy occurs immediately after ingestion of the allergen product. And in some cases, a laxative drug makes sense.

It will be very good to put the child’s feet in a bowl of hot water and mustard. If the water cools quickly, add hot water on top without adding mustard.

Children's medications to relieve attacks are also available in conventional aerosol inhalers. But to make it easier for the child to inhale the active substance, a spacer is used. With the help of this tube attachment on the inhaler, the medicine will immediately enter the respiratory tract and work as effectively as possible. If the attack cannot be stopped, then after 5 minutes it is permissible to re-use the inhaler.

For mild asthma in children with infrequent attacks, drugs are prescribed in rare cases. Still, they are based on adrenaline. More often, the body receives the most effective help to defeat the disease on its own: walks in the fresh air, trips to the sea, climate change, an active lifestyle and activities that will be interesting to the child. Sometimes, as the baby grows and matures, these measures help to forget about asthma forever.