home Audience 6 What to do in case of exacerbation of bronchial asthma. Bronchial asthma. Autumn exacerbation of bronchial asthma. Principles of diagnosing bronchial asthma

What to do in case of exacerbation of bronchial asthma. Bronchial asthma. Autumn exacerbation of bronchial asthma. Principles of diagnosing bronchial asthma

Modern methods of treating bronchial asthma
Standards for the treatment of bronchial asthma
Protocols for the treatment of bronchial asthma

Bronchial asthma

Profile: therapeutic.
Treatment stage: hospital
Purpose of the stage:
1. Prevent deaths.
2. Restore respiratory function as quickly as possible and improve the patient’s condition.
3. Maintain optimal respiratory function and prevent relapse of the attack.
and the end of the stay at the stage.
Duration of treatment: 5-11 days.

ICD codes:
J45.0-Asthma with a predominance of an allergic component;
J45.1-Non-allergic asthma;
J45.8-Mixed asthma;
J45.9-Asthma, unspecified;
J46- Status asthmaticus

Definition: Bronchial asthma (BA) is a chronic inflammatory disease of the respiratory tract, the main pathogenetic mechanism of which is
bronchial hyperreactivity caused by inflammation, and the main clinical manifestation is attacks of suffocation (mainly expiratory in nature) due to bronchospasm, hypersecretion and swelling of the bronchial mucosa. Attacks of suffocation, as well as coughing, a feeling of “stuffiness” in the chest, and episodes of remote wheezing characteristic of asthma, occur mainly at night or in the morning and are accompanied by partially or completely reversible (spontaneously or as a result of treatment) bronchial obstruction.

Classification:
Asthma classification is based on a joint assessment of clinical symptoms and pulmonary function indicators:
1. By etiology: atopic (exogenous); non-atopic (endogenous); mixed.
2. According to the severity of the disease:
- grade I (mild episodic);
- grade II (mild persistent);
- degree III (persistent asthma, moderate severity);
- grade IV (severe persistent asthma).

3. According to the severity of the disease, they are distinguished:
- stage I(mild intermittent): number of symptoms during the day< 2 раз в неделю; отсутствие и нормальные показатели ПСВ (пиковая скорость выдоха) между обострениями, количество симптомов но чью < 2 раз в месяц; ОФВ1 или ПСВ >80% of the norm, the spread of PEF indicators is less than 20%.
- stage II(mild persistent); number of symptoms during the day > 1 time per week, but<1 раза в день; приступы нарушают активность; ночные симптомы >2 times a month; FEV1 or PEF > 80% of normal, PEF range 20%-30%.
- stage III(persistent, moderate severity); symptoms daily, attacks interfere with activity; night symptoms > once a week; FEV1 or PEF - 60 - 80% of normal, range of PEF values > 30%.
- stage IV(severe persistent): symptoms are constant, physical activity is limited; nocturnal symptoms are frequent; FEV1 or PEF< 60% нормы, разброс показателей ПСВ > 30%.

4. By phase of the course: exacerbation, unstable remission, remission, stable remission (more than 2 years).

Risk factors: aeropollutants, allergens from mites, house dust (so fine that they are invisible to the naked eye), tobacco smoking (whether the patient smokes or inhales smoke when others smoke), allergens from fur-covered animals, cockroach allergens, outdoor pollen and molds, indoor molds, physical activity, medications.

Admission: planned, emergency.

Indications for hospitalization:
1. Severe attack of bronchial asthma.
2. There is no rapid response to bronchodilators and the effect lasts less than 3 hours.
3. No improvement within 2-6 hours after starting oral corticosteroid therapy.
4. Further deterioration is observed - an increase in respiratory and pulmonary-cardiac failure, “silent lung”.
5. Patients at high risk of death:
- who had a history of conditions close to lethal;
- requiring intubation and artificial ventilation, which leads to an increased risk of intubation during subsequent exacerbations;
- who have already been hospitalized or sought emergency care for asthma in the past year;
- currently using or recently stopped using oral corticosteroids;
- excessive use of inhaled b2-agonists with rapid action, especially more than one package of salbutamol (or equivalent) per month;
- with mental illness, a history of psychological problems, including abuse of sedatives;
- with anamnestic indications of poor compliance with the asthma treatment plan.

The required scope of examinations before planned hospitalization:
General blood analysis
General urine analysis
Spirography
Peak flowmetry
X-ray of the chest organs
General sputum analysis and, if necessary, 3-fold examination for CD
Electrocardiography

Diagnostic criteria:
History of any of the following:
cough, especially at night; repeated wheezing; repeated difficulty breathing; repeated feeling of chest compression; symptoms occur or worsen at night; symptoms become more severe when exposed to triggers; symptoms relieved by bronchodilators, progressive worsening of shortness of breath, cough, wheezing, difficulty breathing, chest tightness, or a combination of these symptoms.

List of main diagnostic measures:
1. General blood test
2. General urine test
3. Microreaction
4. General sputum analysis,
5. Study of external respiration functions

List of additional diagnostic measures:
1. Analysis of the sensitivity of microbes to antibiotics
2. Chest X-ray
3. Consultation with a pulmonologist
4. Consultation with an otolaryngologist
5. Blood gas composition

Treatment tactics:
- Rapid-acting inhaled b2-agonists, usually via nebulizer, one dose every 20 minutes for 1 hour.
- Oxygen therapy for oxygen saturation > 90% (in children - 95%).
- Systemic corticosteroids if there is no immediate response to treatment or if the patient has recently taken oral steroids, or a severe attack (30-60 mg methylprednisolone or 250 mg hydrocortisone intravenously).
- In case of a severe attack, subcutaneous, intramuscular or intravenous administration of β2-agonists, IV methylxanthines, IV magnesium sulfate is possible.
- With a prolonged attack, rehydration may develop. Daily consumption may be 2-3 liters more than usual.

Stopping attacks: inhaled fast-acting b2-agonists (salbutamol, fenoterol); long-acting b2-agonists with a rapid onset of action (salmeterol, formoterol); combination drugs, including anticholinergics and b2-agonists; short-acting methylxanthines (aminophylline); systemic corticosteroids (prednisolone).
For long-term asthma management, a stepwise approach based on severity is recommended.

For all levels: in addition to regular daily therapy, if necessary, inhaled fast-acting b2-agonists should be used, but not more than 3-4 times a day, a fixed combination of fenoterol and iprotropium bromide.

Stage I- daily intake is not required to control the disease. It is recommended to prescribe short-acting bronchodilators as needed no more than 1-2 times a day.

Stage II- Inhaled GCS: fluticasone propionate 120 doses (100-200 mcg 2 times a day), Budesonide 100-250 mcg/day or Beclomethasone dipropionate 200-500 mcg in 1-2 doses.
Alternative treatment: prescription of long-acting theophylline preparations (theotard, teopek 200-400 mg/day), leukotriene receptor blockers (zafirlukast 20 mg 2 times a day). Short-acting bronchodilators (salbutamol, fenoterol) as needed no more than 3-4 times a day.

Stage III- Inhaled GCS: fluticasone propionate 120 doses (400-1000 mcg 3-4 times a day), Budesonide 800-1600 mcg/day or Beclomethasone dipropionate 800-1600 mcg in 3-4 doses). or ICS in a standard dose in combination with long-acting b2-adrenergic receptor agonists (salmeterol 50 mcg 2 times a day or formoterol 12 mcg 2 times a day), a fixed combination of fenoterol and iprotropium bromide or with a long-acting theophylline preparation. Short-acting bronchodilators (salbutamol, fenoterol) as needed, but no more than 3-4 times a day.

Alternative treatment: prescription of long-acting theophylline preparations (theotard, teopek 200-700 mg/day), cromones (intal 5 mg/dose), leukotriene receptor blockers (zafirlukast 20 mg 2 times a day).

Stage IV- Inhaled corticosteroid fluticasone propionate 100-200 mcg 3-4 times a day, Budesonide more than 800 mcg/day, Beclomethasone dipropionate 100 mcg - 10 doses (more than 1000 mcg) per day or equivalent plus an inhaled long-acting b2-agonist (salmeterol, formoterol), a fixed combination of fenoterol and iprotropium bromide; plus one or more of the following drugs as needed: sustained-release theophylline, antileukotriene drug, long-acting oral b2-agonist, oral corticosteroid.

Patients with viscous sputum are prescribed mucolytics (ambroxol, carbocisteine, acetylcysteine).
In the presence of purulent sputum, high leukocytosis, accelerated ESR, a course of antibacterial therapy is prescribed taking into account antibiograms (spiramycin 3,000,000 units x 2 times, 5-7 days, amoxicillin + clavulanic acid 625 mg x 2 times, 7 days, clarithromycin 250 mg x 2 times, 5 -7 days, ceftriaxone 1.0 x 1 time, 5 days, metronidazole 100 ml intravenously).

List of essential medications:
1. Beclamethasone aerosol 200 doses
2. Ipratropium bromide aerosol 100 doses
3. Cromoglicic acid aerosol dosed 5 mg; capsule 20 mg
4. Salbutamol aerosol 100 mcg/dose; capsule 2 mg, 8 mg; nebulizer solution 20 ml
5. Theophylline tablet 200 mg, 300 mg retard tablet 350 mg
6. Fenoterol aerosol 200 doses
7. Ipratropium bromide 21 mcg + fenoterol hydrobromide 50 mcg
8. Ambroxol tablet 30 mg; syrup 30 mg/5 ml
9. Amoxicillin + clavulanic acid 625 mg
10. Azithromycin 500 mg
11. Metronidazole 100 ml, bottle.

List of additional medications:
1. Aminophylline solution for injection 2.4% in ampoule 5 ml, 10 ml
2. Salmeterol aerosol for inhalation 25 mcg/dose
3. Fluticasone aerosol 120 doses
4. Clarithromycin 500 mg, tab.
5. Spiramycin granules for suspension 1.5 million units, 375 thousand units, 750 thousand units powder for infusion 1.5 million units.

Criteria for transfer to the next stage:
Ineffectiveness of bronchodilator therapy, intractable attacks of suffocation for 6-8 hours, increasing respiratory failure, “silent lung.”

Bronchial asthma is a chronic relapsing disease, which is based on an inflammatory process predominantly localized in the respiratory tract. A characteristic symptom of bronchial asthma is an attack of suffocation. We have already discussed this in the article of the same name. Here we will talk about the treatment of bronchial asthma, and also discuss the issues of diagnosis and differential diagnosis of this pathology. Let's begin.

Principles of diagnosing bronchial asthma

Spirometry will help verify the diagnosis.

If a doctor observes bronchial asthma directly at the time of an attack, it will not be difficult for him to make the correct diagnosis only on the basis of the clinical picture of the disease. Expiratory shortness of breath (it is very difficult for the patient to exhale), prolonged exhalation (3–4 times longer than inhalation), with effort and the participation of auxiliary respiratory muscles, forced position of the patient - sitting, leaning forward, leaning on outstretched arms, discharge after an attack of copious thick glassy sputum – all these symptoms are typical for bronchial asthma.

In difficult cases, when the doctor does not see the attack itself, but judges it solely from the patient’s words, and also to clarify the stage of the disease, it is recommended to use additional diagnostic methods - laboratory and instrumental studies.

So, taking into account the above, we should summarize the data. The criteria for diagnosing bronchial asthma are the following changes in the patient’s condition and tests:

Clinical and anamnestic data:

periodically occurring attacks of expiratory shortness of breath (suffocation), wheezing, audible at a distance;
one of the patient’s close relatives suffers from bronchial asthma;
the patient has a concomitant pathology such as drug, food or respiratory (breathing) allergies.

Data from instrumental research methods:

signs of reversible bronchial obstruction;
increased level of eosinophils in the blood;
in sputum - Charcot-Leyden crystals and Courshman spirals.

Differential diagnosis of bronchial asthma

Bronchial asthma is not the only disease characterized by periodic attacks of breathlessness. This symptomatology is also characteristic of a number of pathologies, and not necessarily related to the respiratory system. The main of these diseases are listed below.

Respiratory system diseases:

bronchial foreign body;
neoplasms of the bronchi;
abnormalities in the development of the respiratory tract;
spontaneous pneumothorax.

Cardiovascular pathology:

myocardial diseases (infarction, left ventricular aneurysm, cardiomyopathy, myocarditis, cardiosclerosis);
PE (pulmonary embolism);
tachyarrhythmias;
heart defects;
essential hypertension and hypertensive crises;
vasculitis, in particular periarteritis nodosa.

Diseases of other organs and systems:

Treatment of bronchial asthma

Unfortunately, it is impossible to completely get rid of this disease. The goal of the treatment is to prevent the progression of the pathological process and maintain the patient’s quality of life.

There is a concept of bronchial asthma control, with which the doctor evaluates the effectiveness of the prescribed treatment:

the course of the disease is controlled (daytime symptoms of the disease are absent or minimal - less than 2 times a week; no night symptoms; the patient’s activity is not limited; bronchodilators “on demand” are used less than 2 times a week; respiratory function indicators are within normal limits; exacerbations No);
Partial control of asthma has been achieved (any of the above signs are observed once a week);
the course of bronchial asthma is uncontrolled (3 or more signs of partial control are determined in any week).

Etiological treatment

The most important role in the treatment of bronchial asthma belongs to etiological treatment, namely, minimizing the patient’s contact with allergens that provoke the development of attacks. This type of therapy can be carried out only after identifying the type of allergen to which the body of a particular patient reacts. Complete cessation of contact with the allergen at an early stage of the disease can even lead to persistent remission.

If you are allergic to house dust, the patient should remove all “dust collectors” from the apartment - soft toys, woolen and cotton blankets, carpets; close open bookshelves; Cover the mattresses with washable plastic and wet clean them once a week; regularly carry out wet cleaning throughout the house, wash bed linen, wash wallpaper.
If you have a pollen allergy, it is necessary to reduce contact with pollen as much as possible during the flowering period; if necessary, you should even change your place of residence for a while.
If you are allergic to pet fur, do not have them in your home and do not go to visit places where there are animals.
If you have a food allergy, do not eat allergenic foods.
If you have an industrial allergy, change your place of work or its conditions.

Drug therapy

Drug treatment of bronchial asthma includes daily intake of anti-inflammatory drugs and periodic - according to indications - use of bronchodilators.

Drug therapy for bronchial asthma includes lifelong use of basic (control) drugs and periodic use of symptomatic drugs. The routes of administration of drugs into the body are as follows: injection or oral. The most effective route of administration for this pathology is inhalation.

Basic therapy

As mentioned above, basic therapy drugs should be used by patients constantly, daily, without interruption. Properly prescribed, they allow you to achieve disease control and maintain it for a long time.

For the purpose of basic therapy, drugs of the following pharmacological groups can be used:

inhaled glucocorticoids (GCS) are the first choice drugs;
systemic glucocorticoids;
leukotriene modifiers;
Cromons;
bronchodilators (β 2 -agonists and xanthines) of prolonged action;
systemic steroid sparing therapy.

Glucocorticoids (GCS)

Drugs in this group have powerful anti-inflammatory and antiallergic effects - they reduce swelling of the mucous membrane and reduce the production of secretions. The preferred route of administration is inhalation, since it helps to achieve maximum local effect with a minimum of side effects that develop when taking these drugs orally (literally “by mouth”, i.e. in the form of tablets) or parenterally (in the form of injections and infusions) . Among inhaled corticosteroids, it is worth noting budesonide and fluticasone.

Systemic corticosteroids (prednisolone, methylprednisolone) are prescribed if high doses of inhaled corticosteroids are ineffective. The duration of their use should be as short as possible, since with long-term treatment the risk of side effects increases significantly. Systemic corticosteroids should be taken in the minimum effective dose, and if the patient’s condition improves, reduce the dose or completely stop taking these drugs.

The main side effects of GCS are:

osteoporosis (even spinal fractures are possible for this reason);
Cushingoid syndrome (obesity in the abdomen, chest, neck, moon-shaped face, the appearance of skin rashes - acne, stretch marks on the skin - stretch marks, muscle atrophy);
steroid diabetes mellitus;
the appearance of ulcers on the mucous membrane of the stomach or duodenum;
increased blood pressure;
swelling;
psychoses;
activation of tuberculosis or other chronic infections;
decreased adrenal function;
cataract.

Cromony

Drugs in this group also effectively reduce inflammation, reduce the frequency of bronchospasms and their duration. The best known drug is sodium cromoglycate (Intal). It is administered by inhalation using a special inhaler device - a spinhaler. Effective for 5–6 hours, the course of treatment is at least a month. Other representatives of the cromon group are ketotifen (Zaditen), nedocromil sodium (Tyled) and a combination drug that includes berotec and intal - Ditek. Cromones are not used directly for treatment.

Leukotriene modifiers

These are new generation drugs that have been used in clinical practice relatively recently. The most prominent representatives of the group are 2 drugs – montelukast and zafirlukast. They reduce the activity of the inflammatory process in the bronchi and are used not during an asthma attack, but to prevent its development.

Long-acting B 2-agonists

Drugs in this group have a long-lasting – up to 12 hours or more – bronchodilator effect. In addition, they also have a weak anti-inflammatory effect. Formoterol and salmeterol are used more often than other drugs in this group. As a rule, they are prescribed in addition to therapy with inhaled GCS, which does not give the desired effect. To achieve maximum control over the disease, fixed combinations have been developed (salmeterol + fluticasone or formoterol + budesonide) - this is more convenient for the patient and most effective.

Systemic sparring therapy

In rare cases, when even systemic glucocorticosteroids are ineffective or side effects from taking these drugs are pronounced, immunosuppressants are used to treat bronchial asthma - gold drugs, cyclosporine A, methotrexate, cyclophosphamide. These drugs also have a number of serious side effects, so the issue of their use should be carefully considered, and treatment itself can only begin after the patient’s consent to it. Immunosuppressive therapy is selected in a hospital, under the supervision of experienced specialists and monitoring of the patient’s condition.

Stepped therapy for bronchial asthma

In order to achieve the maximum possible control over the disease, so-called step therapy was developed. There are 4 stages in total, corresponding to the stages of bronchial asthma. After the final diagnosis is made, the patient is prescribed treatment according to a certain stage. After some time, the examination is carried out again to determine the degree of control over the disease. If complete control is achieved, the therapy is reviewed and the patient is transferred to a higher level, i.e., to easier treatment. If even partial control is not achieved, the treatment is also reviewed and the patient is transferred to a lower level - more aggressive therapy is prescribed. We will not burden the reader with a table of drug correspondence to certain stages, since this may contribute to self-medication, which in this situation unacceptable. Your attending physician will most likely give an adequate answer to your questions regarding the steps.

You can read more about drug treatment of bronchial asthma, as well as symptomatic treatment in ours.

Principles of treatment of exacerbations of bronchial asthma

Even if the patient receives adequate basic therapy, exacerbations of the disease are sometimes possible. Mild to moderate severity, they are subject to outpatient treatment by increasing its intensity - the doctor simply increases the dose of drugs and, perhaps, temporarily adds something extra. Severe exacerbations are treated in a hospital setting, extremely severe exacerbations are treated in the intensive care unit. This is, in fact, an extremely severe exacerbation, which will be discussed in a separate article.

Generally speaking, the principles of treatment of exacerbations of bronchial asthma are as follows:

The patient must know what the first signs of exacerbation of his disease are, and be able to independently help himself in the early stages of exacerbation.
Drugs that dilate the bronchi should be administered by inhalation - this is most effective.
To eliminate the symptoms of expiratory suffocation, short-acting β 2 -agonists are used - usually salbutamol.
If short-acting β 2 -agonists are not effective enough, glucocorticoids should be used orally or intravenously-intramuscularly.
If there are signs of oxygen starvation in the patient’s body, oxygen therapy is used.
The effectiveness of the treatment is determined by the dynamics of FEV 1 and PEF indicators obtained during peak flowmetry or spirography, comparing the indicators after treatment and those when seeking medical help.

Other treatments

During the period of stable remission, a treatment method such as hyposensitization - specific and nonspecific - is effective.

When carrying out specific hyposensitization, only those antigens to which the increased sensitivity of a particular patient has been proven are used. The antigen solution is administered in a course starting with the minimum dose, gradually increasing it.

Nonspecific hyposensitization is carried out with histoglobulin, which includes the allergy mediator histamine and human blood gamma globulin. The drug is administered subcutaneously starting with 1 ml, gradually increasing the dose. For the purpose of nonspecific hyposensitization, enterosorbents (Enterosgel, Atoxil), adaptogens (Eleutherococcus extract, etc.), as well as an elimination hypoallergenic diet can also be used.

Antihistamines (Cetrin, Erius, Telfast, etc.) do not directly solve the problem of asthma, but can be used in its complex treatment.

According to the recommendations of the International Consensus, treatment of exacerbation of bronchial asthma is strictly regulated and consists of 2 stages - outpatient and inpatient.
In an outpatient setting, treatment involves adequate actions by a previously trained patient to assess his condition and self-medication methods (Fig. 5). To assess the state of his breathing, the patient uses individual peak flowmetry indicators. At the same time, the doctor and the patient need to be aware of the possible risks of such treatment. One of them is the high probability of death from bronchial asthma in a certain category of patients. The following factors indicate membership in this group:

the patient is taking or has recently taken corticosteroids by mouth;
the patient has been hospitalized or sought emergency care for asthma within the last year;
history of mental illness or psychosocial problems;
history of non-compliance with the treatment plan for bronchial asthma.

In accordance with the above scheme, patients with mild exacerbation of bronchial asthma can be treated at home using short-acting bronchodilators. A good help is the use of solutions for inhalation nebulizer therapy - nebuls - that have appeared on the Ukrainian market. In this case, it is necessary for the previously trained patient to have a treatment plan for the disease. To achieve a lasting reduction in the severity of symptoms and improvement in RESID scores, it may be necessary to continue the treatment for several days. The doctor should reconsider the basic treatment regimen in the direction of strengthening it.

Assessing the severity of an exacerbation Clinical picture: cough, difficulty breathing, wheezing, sensation of chest compression, participation of accessory respiratory muscles, jugular retraction and sleep disturbance. Dedication< 80% от лучших индивидуальных или должных значений		Initial stage of treatment Inhaled short-acting β2-agonists up to 3 times within 1 hour (note: patients at high risk of death should contact their physician immediately after starting treatment)
Response to treatment
good (mild exacerbation) Symptoms subside after initiation of β2-agonists and the therapeutic effect persists for 4 hours. POSV > 80% of best individual or expected values	Incomplete (moderate exacerbation) Symptoms improve after initiation of β2-agonists, but the therapeutic effect lasts less than 3 hours. POSV 60-80% of the best individual or proper values		Weak (severe exacerbation) Symptoms persist or worsen despite initial treatment with β2-agonists. POSvyd< 60% от лучших индивидуальных или должных значений
Your actions: You can continue using β2-agonists once every 3-4 hours for 48 hours. Consult your doctor for further advice	Your actions: Continue use of β2-agonists. Consult your doctor immediately for further advice.		Your actions: Take additional corticosteroids in tablet or syrup form. Immediately re-administer β2-agonist + anticholinergic. Go to hospital immediately for emergency treatment or call an ambulance

Rice. 62. Treatment of exacerbation of bronchial asthma at home - algorithm of actions for a previously trained patient

Patients with moderate to severe exacerbations require not only short-acting bronchodilators in adequate doses, but also the earliest possible use of systemic corticosteroids. An alternative is to use fluticasone in solution dosage form for nebulizer therapy. Patients with moderate exacerbation are treated in a general hospital - therapeutic, pulmonology or allergology departments. Patients with severe exacerbation of asthma - status asthmaticus - are hospitalized in the intensive care unit.
The algorithm of actions of medical personnel for the treatment of exacerbation of bronchial asthma in a hospital is shown in Fig. 5.
When treating an exacerbation of bronchial asthma in a hospital, short-acting inhaled β2-agonists are usually prescribed in high doses in the form of aerosol metered dose inhalers using a spacer. Ultrasonic nebulizer inhalers can also be used to administer these drugs.
GCS, administered orally or parenterally, are the most powerful treatments for severe exacerbations of bronchial asthma. They affect all types of metabolic processes in the body - protein, lipid, carbohydrate and water-electrolyte metabolism. These drugs have the strongest anti-inflammatory, antiallergic and immunosuppressive effects, as well as antitoxic and antishock effects. They restore the impaired sensitivity of bronchial adrenergic receptors to catecholamines.
In the treatment of bronchial asthma, various synthetic corticosteroids are used - hydrocortisone, prednisolone, methylprednisolone, dexamethasone, triamcinolone, betamethasone. They differ significantly in pharmacokinetic characteristics and have different efficacy.
The systemic effect of corticosteroids determines a large number of side effects - sodium and water retention in the body, potassium loss, osteoporosis, myopathy, the occurrence of ulcerative lesions of the stomach or duodenum, steroid-induced diabetes mellitus, arterial hypertension. Long-term use of these drugs leads to the development of Cushingoid syndrome, suppression of the function of the adrenal glands, decreased immunity to viral, bacterial and fungal infections, insomnia and other mental disorders. The frequency and severity of these complications are directly proportional to the duration of use and the dose.

Rice. 5. Algorithm of therapeutic and diagnostic measures for exacerbation of bronchial asthma in a hospital

Particularly dangerous are fungal infections of the skin and mucous membranes, which contribute to sensitization of the body to fungal antigens and exacerbation of bronchial asthma. According to the literature and our observations, in patients with bronchial asthma whose therapy includes systemic corticosteroids, fungi of the genus Candida are most often isolated from the sputum. Therefore, it is advisable in the complex treatment of such patients to use an infusion form of fluconazole 200 mg/day for 7-10 days, which leads to sanitization of the mucous membrane of the bronchial tree and a decrease in the body’s sensitization to fungal allergens.
Oral corticosteroids are preferable to intravenous corticosteroids for moderate exacerbations of asthma. Due to the significant risk of developing adverse reactions, systemic corticosteroids are used in the treatment of exacerbation of asthma in a short course of 5-10 days in average therapeutic doses of 20-40 mg/day. orally in terms of prednisolone. Then the drug is quickly discontinued, having previously prescribed an adequate dose of inhaled corticosteroids. In case of long-term administration of systemic corticosteroids orally, preference is given to prednisolone or methyl prednisolone. The drug is taken according to an intermittent regimen in the first half of the day after meals, preferably in a dose that does not exceed the Cushingoid threshold dose (10 mg of prednisolone or 8 mg of methylprednisolone per day).
The use of theophylline or aminophylline (aminophylline) together with β2-agonists does not provide an additional bronchodilator effect, but increases the risk of side effects and is usually not recommended within the first 4 hours after the start of treatment. However, theophylline or aminophylline can be used if β2-agonists are not available. If the patient is already receiving long-acting theophylline daily, it is necessary to determine the concentration of the drug in the blood serum before additionally taking short-acting theophylline. Aminophylline can be administered intravenously in a loading dose of 6 mg/kg of the patient’s body weight (25 ml of a 2.4% solution for a body weight of 100 kg), and then in a maintenance dose of 0.5-1 mg/kg for one hour for 24 hours .
Epinephrine can be used in the treatment of moderate exacerbation of bronchial asthma if short-acting β2-agonists are not available, but the risk of side effects increases. In case of status asthmaticus, the use of adrenaline is contraindicated .

Some medications are not recommended for use in the treatment of exacerbation of bronchial asthma - inhaled forms of mucolytic drugs (can increase cough), sedatives (must be excluded) and antihistamines (increase dryness of mucous membranes) drugs.
Excessive hydration with the introduction of large volumes of fluid (more than 2-3 l/day) is also contraindicated. However, controlled and properly administered infusion therapy for severe exacerbations of bronchial asthma is an important pathogenetic treatment method. Infusion therapy in the intensive care unit must be carried out under the control of central venous pressure. An effective drug that improves the rheological properties of blood is rheopolyglucin. The rheological effect of the drug, which is prescribed 200 ml per day for several days, is due to an increase in plasma colloidosmotic pressure, disaggregation of blood cells and hemodilution. In order to improve microcirculation, reduce intoxication, stabilize hemodynamics and correct the acid-base state, rheosorbilact, which contains sorbitol, sodium lactate and electrolytes in the form of an isotonic aqueous solution, is also prescribed. The drug is used 200-400 ml per day intravenously for 5-7 days.
The prescription of antibiotics is indicated only in the case of pneumonia or other verified bacterial infection, including purulent sinusitis.

Exacerbation of bronchial asthma is a gradual or sharp increase in symptoms that occurs due to several reasons. The patient faces deterioration in health and fear of death.

Attention! Typically, exacerbation occurs late in the evening and at night. The patient feels unwell around the clock. He is in danger. It is important to seek help as quickly as possible.

Types of asthma exacerbation

The onset of mild, moderate, severe, and threatening bronchial asthma can occur at any age. But most often it occurs at the age of 10-15 years.

There are several types of asthma exacerbation.

Bronchial obstruction increases gradually, over one or three to five days. This type is the most common. Choking occurs due to blockage of the bronchial tubes into which mucus enters.
Asphyxia occurs quickly. If the right measures are not taken, death will occur. This type usually occurs in young patients.

Attention! The severe condition may persist for 24 hours. Arises. Immediate hospitalization in the intensive care unit or intensive care unit is indicated.

According to the level of severity, asthmatic status of I, II and III degrees is distinguished. Typically, medical specialists perform the following manipulations:

elimination of hypoxia by supplying oxygen through a mask;
relieving swelling of the bronchi with the help of suitable medications;
restoration of bronchial patency through bronchoscopy;
in case of stage III, mechanical ventilation is prescribed.

Attention! A patient who has suffered this status is included in the risk group, because he may experience sudden death.

Symptoms of exacerbation

As the condition of a patient with asthma worsens, various symptoms are observed. First of all, this is expiratory shortness of breath, in which the exhalation is prolonged, but the inhalation remains the same, i.e. the patient has to make a lot of effort to exhale.

A cough occurs, usually it is dry. practically does not appear.

You can hear wheezing coming from the sternum. People around them can hear them clearly. The exhalation is very long.

The patient is forced to take a certain body position. When a person sits down, he feels better. It's almost impossible to lie down.

The patient turns pale, which is due to lack of air. Veins swell in the neck area. Signs of hypoxemia also develop.

Attention! It is difficult for the patient psychologically. His family should support him.

Exacerbation of bronchial asthma: therapy

Competent treatment of this pathological condition includes:

suppression of bronchial obstruction;
withdrawal from a hypoxic state;
restoration of respiratory functions;
development of a therapeutic regimen;
Explaining to the patient some of the nuances associated with lifestyle.

To achieve the desired effect in a relatively short time, you need to start treatment as early as possible. The basis is often taken as recommended by GINA. You can't panic. This will only make the situation worse. But what to do if asthma worsens?

At home

Treatment of an exacerbation in a well-controlled, partially controlled, at-home setting involves taking the following products:

garlic,
eucalyptus oil,
ginger.

You should not consume too much of these foods. If necessary, you should consult your doctor.

In the hospital

Treatment of exacerbation of allergic, infectious bronchial asthma in a hospital begins even before the examination begins. Using a mask, a healthcare worker saturates the lungs of an asthmatic with oxygen. Bronchodilators are administered through a nebulizer. If the bronchi are obstructed, the drug is administered parenterally or intravenously. The need for this usually arises due to the formation of mucus plugs.

If the patient's condition is very severe, then auxiliary bronchodilators are used. It is more often used when working with children. In such a situation, this medicine is most effective.

The doctor then assesses the severity level of the condition. He asks the patient certain questions and conducts an examination, which allows him to find out whether there are complications of the main disease. Next, the necessary laboratory and instrumental studies are carried out.

Systemic corticosteroids are the main medication that is administered in increased dosages, first parenterally and then orally. The doctor gradually reduces the dose. But this is done only after the patient begins to breathe better.

If necessary, other types of treatment are used. This doesn't happen often. A similar need may arise, for example, with a bacterial infection. Antibacterial treatment is carried out.

Attention! When the measures taken do not lead to an improvement in the condition, the person is sent to intensive care.

The patient is discharged only if his physical activity is considered normal and the results of studies and analyzes do not raise any questions. It is also important that attacks do not occur at night.

Preventing asthma exacerbations

If diagnosed with asthma, a person must be careful throughout his life. Your lifestyle needs to be adjusted. To minimize the number of relapses, you must strictly follow the doctor’s advice and visit him regularly. Also, to prevent exacerbation of bronchial asthma, you need to do the following:

predict in advance and prevent cases in which an attack may occur;
do not smoke or ;
strengthen the name system (this is especially important in the off-season);
do not have pets;
if necessary, change workplace;
promptly treat pneumonia, bronchitis and other similar pathologies (remember that asthma and a serious cold can irreversibly harm your health);
clean the apartment regularly;
remove mold and mildew from the walls (when such dirt is present);
ensure that the humidity in the home is about sixty percent and the temperature is up to twenty-two degrees;
be outside as often as possible, walk in the park;
Visit an allergist regularly.