Status asthmaticus: emergency care, causes, treatment, diagnosis

Status astmaticus refers to a severe complication of asthma that can sometimes pose a direct threat to the patient's life.

This condition, as a rule, occurs as a result of a prolonged attack of bronchial asthma, which is not controlled by drugs. The disease is characterized by an increase in edema in the bronchioles and the accumulation of viscous sputum in them. This leads to severe hypoxia and the progression of suffocation.

Signs of the development of status asthmaticus can be defined as an acute development of respiratory failure. It is triggered by oxygenation of the blood in the pulmonary system and the elimination of CO2. They are based on biochemical and pharmacological causes, as well as physical activity. The code (J46 status asthmaticus) of the international classification of diseases is ICD-10.

Urgent care

In case of an asthmatic attack, the patient should be provided with first aid. First of all, it is necessary to lay the patient down, raising his head and providing maximum air access. If an oxygen bag is available, it is recommended to give humidified oxygen.

First aid includes the use of aerosol inhalation with Berotek or Salbutamol. To reduce negative symptoms, you can give Prednisolone and Euphyllin (5-10 mg) to relax the bronchial muscles, but it should be remembered that Euphyllin and Prednisolone in any dosage (5 or 10) should not be given to children under 3 years of age, since these drugs, especially Euphyllin, have numerous side effects.

If the patient is worried, it is recommended to give him sedatives (Phenobarbital, Diazepam, etc.). It is important to use mucolytics to thin the phlegm. In this case, the patient should drink plenty of fluids.

If the measures are ineffective, you should contact a medical institution for further drug therapy. With an increase in status asthmaticus, correct and timely first aid is important. Sometimes the patient's life depends on it.

Reasons for the development of status asthmaticus

Status asthmaticus can only provoke an acute development of the disease. If prolonged use of medications does not contribute to improvement and negative symptoms, on the contrary, increase, then there is reason to consider this attack as status asthmaticus. Its pathogenesis is closely interrelated with various mechanisms of occurrence of different forms of the disease.

The main reasons for the appearance of status asthmaticus are:

• SARS and the presence of chronic foci of inflammation;

• incorrectly conducted basic therapy;
• an allergic reaction to drugs;
• uncontrolled intake of aspirin, sedatives and hypnotics;
• physical activity and stressful situations.

Sometimes even harsh climatic conditions can provoke the causes of an acute asthma attack. drops, therefore, asthmatics are recommended to rest and treatment in comfortable and familiar climatic conditions zones.

Stages and symptoms

The pathogenesis of status asthmaticus is characterized by severe hemodynamic disorder (hypovolemia and extracellular dehydration), which are caused by hematocrit (blood thickening), reaching 54%. Obstructive disturbances in the airways with an increase in the attack progress and deepen. In the final stage, the pathogenesis is complicated by hypercapnic coma.

With the development of the disease, the following stages of asthmatic status are distinguished:

• asthmatic status stage 1 - with this form of the disease, symptoms of relative compensation of asthma are possible. The skin is pale, cyanosis of the nasolabial triangle is possible. Breathing is noisy, the chest area is expanded. With this degree, an asthmatic attack is recommended to be removed by symptomatic therapy;

• Stage 2 - symptoms of decompensation appear. The second stage indicates an increase in the severity of the patient's condition. Examination of the patient does not determine respiratory activity in certain areas of the lung. There is practically no breathing. The skin acquires an earthy color, the patient is not able to make a full exhalation;
• status asthmaticus stage 3 - symptoms of hypercapnic acidotic coma appear. In the third stage, the patient's condition requires urgent care. The patient may have confusion, delirium, inadequate reactions to what is happening. The skin is hyperemic, with a bright red tint. This form of asthma can lead to the death of the patient.

Differential compensation may be due to the fact that the patient has intense expiratory dyspnea with difficulty exhaling. Therefore, the patient is forced to take a forced posture (in a half-sitting position, resting his hands on the knee area, which makes it possible to use additional respiratory muscles).

Diagnosis of status asthmaticus

Differential diagnosis, first of all, is based on clinical manifestations and a typical picture of bronchial asthma.

The criteria for laboratory and instrumental indicators are to obtain the following results:

• blood test analysis (asthmatic status is determined by polycythemia and hematocrit);
• determination of the gas composition of blood;
• identification of acid-base composition of blood;
• conducting electrocardiography.

Correctly formulated diagnostics allows you to differentiate the signs of bronchial asthma and identify the pathological process in the body. Depending on the degree of manifestation of bronchial asthma, presented in the International Classification, the necessary therapy is selected for the treatment of asthmatic status. The International Classification of Disease (ICD-10) is a standard assessment technique for determining the general health of a population. ICD-10 is used to ensure that the diagnosis of the disease is encoded in an alphanumeric code, which allows for more convenient processing and storage of information.

Depending on the diagnostics performed, based on the criteria for the test results, drug therapy is prescribed under the supervision of the attending physician.

Therapeutic activities

The algorithm for performing drug therapy provides for a kind of chain, when first emergency care is provided, and in case of ineffectiveness emergency therapy is performed, and then resuscitation measures are performed with the main drugs that are used to relieve asthmatic attack are:

Treatment of status asthma is primarily carried out with glucocorticosteroid hormones. Prednisolone is often prescribed (at a dosage of 5 mg per 1 kg of body weight). In case of complications, Prednisolone is administered intravenously, in a solution of sodium chloride (glucose). If necessary, Prednisolone can be administered every 4-6 hours. In some cases, therapeutic bronchoscopy is recommended. In this case, Prednisolone is administered endobronchially.

Quite often, Euphyllin (5-10 mg) is prescribed orally. Eufillin (10 mg.) Is recommended for use in case of moderate severity of an attack with possible repetitions after 4 hours. In addition, in emergency cases, to relieve acute bronchospasm and normalize respiratory activity, Euphyllin (5-10 mg) and Prednisolone can be administered intravenously. In this case, it is necessary to monitor the concentration of the drug in the blood plasma so that it does not go beyond 10-15 μg per 1 ml.

It is recommended to use B2-adrenomimetics with nebulizers. In their absence, the use of metered-dose Spencer inhalers is also recommended. In case of complication of the patient's condition, emergency therapy provides for oxygen intubation, subject to the provision of emergency care in hospitals.

In severe cases, Euphyllin (5-10 mg), Prednisolone and Salbutamol, as well as injections of Arubendol and Bricanil can be administered intravenously. Emergency care for status asthmaticus in an unconscious patient provides for artificial ventilation.

Complications in status asthmaticus

As a result of the inflammatory process in the bronchial system, complications of various degrees of development occur. An asthmatic attack with inadequate or untimely treatment can manifest itself with complications of varying severity.

These include:

• pneumothorax (pneumomediastinum) is one of the most common complications in status astatic which arise as a result of distal rupture of the alveoli, which promotes the penetration of air into the internal organs. The attack is manifested by a dull pain, which is quite intense, especially on the affected side. The first signs of pneumothorax are severe shortness of breath. With an increase in the severity of the condition, there is a likelihood of pleuropulmonary shock;

• with blockage of the bronchial passages with sputum, the development of atelectasis, which is most often formed in the middle lobe parts of the bronchi, is possible. This complication is most common in children;
• an attack of bronchial asthma with a strong and painful cough can lead to fractures of the costal-cartilaginous junction. In addition, "cough fainting" is possible with ruptures of the endobronchial vascular system and the release of blood when coughing;
• sometimes differential cardiac symptoms may occur, which are characterized by overloading of the right cardiac chamber and the appearance of "cor pulmonale".

Any complications require careful study by all specialists in order to provide comprehensive assistance. Subsequently, the patient, thanks to this interaction, will receive detailed recommendations for further treatment.

The cause of death of the patient may be insufficient intensive therapy in emergency care, as well as increased therapy with adrenomimetics (Theophylline, Eufillin). In addition, unrecognized complications can lead to death, the diagnosis of which is not performed professionally and the wrong first aid has been provided.

Preventive actions

Prevention of status asthmaticus in patients with bronchial asthma provides for the following conditions:

1. Asthmatics should remember all the recommendations and have an aerosol inhaler with bronchodilators with them in order to relieve an asthmatic attack as quickly as possible.

1. Inhalation drugs that relieve an acute attack cannot be used more than 8 times a day. As a result of frequent use, a decrease in susceptibility is possible and an acute attack of bronchial asthma can develop into an asthmatic status.
2. In no case should you self-medicate, since some medicines that used to relieve an asthmatic attack, have side effects and can cause negative consequences.
3. In the event that an asthmatic attack after self-administered therapy does not stop, you should immediately seek medical help.
4. Contact with various allergens is contraindicated, especially during the flowering period of plants. In addition, contact with pets is contraindicated, as this can provoke a severe asthmatic attack.
5. It is important to carry out timely treatment of bronchial asthma. This will avoid complications, including status asthmaticus.

Patients, as a rule, recover from an asthmatic state rather slowly. However, by strictly following all the recommendations of the attending physician, and observing preventive measures, it is quite possible to control the disease and avoid possible complications. In this case, the prognosis for recovery is quite favorable.