The asthmatic status is a heavy attack of bronchial asthma which proceeds much more intensively and is longer, than usually, and is not stopped by the raised dosages of bronchodilators which are accepted by the patient. It is shown by long suffocation, cyanosis of skin and mucous, tachycardia, increase in frequency of breath. At a decompensation the atsidotichesky coma can develop. It is diagnosed on the basis of clinical data, a research of gases of blood. The basis of knocking over of the asthmatic status is made by bronkhodilatiruyushchy therapy, hormonal therapy. The oksigenobaroterapiya, according to indications - IVL is in addition carried out.
The asthmatic status (status asthmaticus) - a zhizneugrozhayushchy state in pulmonology. Is a complication of bronchial asthma from the lethality among which young and able-bodied population reaches 17%, at the same time any of patients with bronchial asthma is not insured from the asthmatic status - according to different data, complications come in 17-79% of cases. Being both a medical, and social problem, the asthmatic status demands rational methods of prevention which has to be directed to treatment and the prevention of asthmatic, bronchopulmonary and allergic diseases.
Patients of bronchial asthma who constantly interact with allergens in life, at home or at work get into risk group. Quite often asthmatic status develops against the background of a SARS, an acute bronchitis, a stress. The wrong therapy of bronchial asthma can be the trigger of emergence of a long attack: sharp cancellation of glucocorticoids, inadequate selection of a dosage of bronchodilators, reception of aspirin and beta-blockers at the accompanying pathology. Physical activities and strong emotional experiences also quite often provoke the asthmatic status. But sometimes asthma debuts asthmatic status, then except weight of symptomatology panic and fear of death joins.
During an asthmatic attack there is a pronounced violation of passability of bronchial tubes because of hypostasis mucous, spasms of muscles of bronchial tubes and obstruction by slime. It leads to difficulty of a breath and to the active extended exhalation. During a short and short breath more air comes to lungs, than comes out during an exhalation because of obstruction and reduction of a gleam of airways, it leads to hyper lightness and to inflating of lungs. Because of the forced exhalation and tension small bronchial tubes become even more spazmirovanny. As a result of all these processes, air in lungs stands, and in arterial blood the amount of carbonic acid increases and the amount of oxygen decreases. Both at attacks, usual on weight, and at the asthmatic status, the syndrome of fatigue of respiratory muscles develops. Constant and ineffective loadings of respiratory muscles lead to a hypertrophy and to formation of a shape of a thorax, characteristic of asthmatics. The easy and hypertrophied muscles increased in volume give it similarity to a barrel.
The asthmatic status differs on the mechanism of emergence, severity and other paramentra. On pathogenesis differentiate three forms:
- metabolic - slowly developing asthmatic status, can accrue within several days and weeks.
- anaphylactic - immediately developing asthmatic status.
- anafilaktoidny - the asthmatic status developing within 1-2 hours, which is not connected with immunological mechanisms (is caused by inhalation of the irritating substances, cold air and so forth).
The asthmatic status passes the following stages in the development:
- The stage of relative compensation - is characterized by the syndromes which are moderately expressed bronkhoobturatsionny and respiratory.
- Decompensation stage - to it there correspond initial symptoms of asphyxia, a bronkhoobturatsionny and respiratory syndrome joins haemo dynamic violations.
- Coma - a stage of deep asphyxia and hypoxia.
Symptoms of the asthmatic status
The symptomatology directly depends on a stage of the asthmatic status and if it does not manage to be stopped, the first stage can gradually turn into a state of shock, and then and in a coma.
- The I stage – relative compensation. The patient in consciousness, is available to communication, behaves adequately and tries to reach position in which to it the easiest to breathe. Usually sitting, standing less often, having slightly inclined the case forward and looking for a point of support for hands. The suffocation attack more intensive, than usually, is not stopped by habitual medicines. Short wind and pronounced cyanosis of a nasolabial triangle, is sometimes noted perspiration. Lack of a phlegm is a disturbing symptom and indicates that the condition of the patient can worsen even more.
- The II stage – decompensations, or a stage of a mute lung. If the attack does not manage to be stopped in time, then the amount of unproductive air in lungs increases, and bronchial tubes spazmirutsya even more therefore the movement of air in lungs is almost absent. Gipoksemiya and a giperkapniya in blood accrue, metabolic processes change, because of a lack of oxygen the metabolism goes with formation of products of a nedoraspad that comes to an end with acidosis (acidulation) of blood. The patient is in consciousness, but its reactions are slowed down, sharp cyanosis of fingers, sticking is noted over - and subclavial hollows, the thorax is inflated, and its excursion is almost not noticeable. Also violations from cardiovascular system are noted – pressure is reduced, pulse frequent, weak, arrhythmic, sometimes passes into threadlike.
- The III stage - a stage of a gipoksemichesky, giperkapnichesky coma. The condition of the patient extremely heavy, consciousness the confused, proper response to the events is absent. Breath is superficial, rare, the symptomatology of cerebral and neurologic frustration, pulse threadlike accrues, there is a falling of arterial pressure passing into a collapse.
Death is caused by the asthmatic status because of permanent violation of passability of air in airways, because of accession of sharp cardiovascular insufficiency or owing to cardiac arrest. Cases when the asthmatic status came to an end with pheumothorax because of a rupture of a thorax are described.
The diagnosis is made on the basis of clinical symptoms and anamnestichesky data. Most often diagnostic events are held by emergency doctors or therapists in a hospital (if the attack occurred when passing treatment in the conditions of hospital). After first-aid treatment the patient is subject to the emergency hospitalization in chamber of intensive therapy or in intensive care unit where at the same time carry out therapy and as soon as possible examine the patient. The general blood test, urine, biochemical blood test, a condition of gas composition of blood and coefficient of acid-base balance are changed as well as at an attack of bronchial asthma, only extent of changes is more expressed. On the ECG in 12 assignments signs of an overload of the right cameras of heart, EOS deviation are visible to the right. The asthmatic status is differentiated with TELA, a foreign matter of bronchial tubes, hysterical frustration.
Treatment of the asthmatic status
In a stage of relative compensation to the patient the moistened oxygen through a mask moves. As the usual pharmacotherapy does not render due effect, it is necessary to start intravenous administration of glucocorticosteroids at once. Drop infusions are carried out, intravenous and inhalation administration of bronkhorasshiryayushchy medicines is carried out. One of ways of treatment is the oksigenobaroterapiya - high concentration of oxygen allows to eliminate symptoms of the accruing acidosis quickly.
Medicamentous therapy in most cases renders positive effect. If the patient is brought in a hospital in time, then it is possible to stop an attack, but weight and precipitancy of manifestations not always it allows. IVL is carried out according to indications when medicamentous therapy is inefficient, the patient faints, activity of cardiovascular system is seriously broken, and also at inadequacy of patients and exhaustion of respiratory muscles. At the same time artificial ventilation of lungs allows to correct and choose the most effective method of knocking over of an attack.
Prevention and forecast
Even if the asthmatic status is possible to stop successfully, the forecast extremely adverse as it forms the basis for confirmation of deterioration in a course of bronchial asthma. Prevention of the asthmatic status consists in constant and regular surveys of patients with bronchial asthma. Such patients should avoid nerve and physical strains, to seek for decrease in the minimum effective dose of bronchodilator. The healthy lifestyle, desensitization to allergens also helps to avoid complications.