Bronchial asthma is a chronic disease characterized by an inflammatory process in the bronchi. Asthma flare-ups can happen at any time.

This is the insidiousness of the disease, when, against the background of the almost complete absence of symptoms, a state of suffocation arises again. In this case, it is very important not to delay the treatment of bronchial asthma and, at the slightest hint of an exacerbation, immediately consult your doctor.

Features of the course of bronchial asthma

The course of bronchial asthma is not stable. A long period of remission, when a person feels completely healthy, is suddenly replaced by a severe condition associated with a high risk of death.

A number of symptoms are characteristic of the exacerbation of this pathology:

• unpleasant, painful sensations in the chest;
• wheezing is clearly audible when listening to the bronchi;
• breathing problems (due to tissue swelling);
• possible discharge of clear sputum;
• constant fatigue, loss of strength;
• violation of the heart rhythm;
• feeling of lack of air for normal breathing.

If bronchial asthma is of an allergic nature, rhinitis, lacrimation and skin rashes are possible.

Causes of asthma exacerbation and risk factors

While asthma exacerbations are difficult to predict, there are a number of factors that affect the course of the disease.

The main reasons for the deterioration of the patient’s condition:

1. In the spring, when flowering begins, the content of allergens increases in the air. Also, household dust, discharge or animal hair, strong odors – all this can provoke an exacerbation of the disease.
2. The air is too cold.
3. Tobacco smoke is a very strong irritant.
4. Food allergy. Eating foods that cause allergies can trigger an attack.
5. Evaporation of chemicals (paint, varnish, acetone).
6. Various infectious diseases that cause inflammation of the respiratory tract.
7. Chronic lung disease.
8. Psychogenic factors such as stress, depression.
9. Too intense physical activity.

In a patient with a diagnosis of bronchial asthma, the bronchi react very sharply to any irritating factors. A harmful substance in a concentration that a healthy person can tolerate without problems can cause a severe attack in an asthmatic person.

Although it is advisable to avoid all provoking factors, this is not always possible. You cannot close yourself in the house for the entire flowering period, it is difficult to protect yourself from stress, it is impossible not to breathe frosty air in winter. But the asthma patient should try to the best of his ability and ability to minimize the impact of the factors causing the attack.

Types, severity and symptoms of exacerbations

There are several degrees of exacerbation of bronchial asthma. In order to accurately determine the severity of the condition, an examination is carried out.

The patient’s well-being is assessed, the anamnesis is studied, and a number of tests are prescribed. Particular attention is paid to heart rate, blood pressure and oxygen saturation .

Depending on the severity of signs, 4 degrees of severity of exacerbation of bronchial asthma are distinguished.

1. Lightweight form. At rest, as well as with light exertion, the patient feels normal. With long walks, shortness of breath occurs. This condition does not prevent the patient from speaking. Also, with this degree of exacerbation, slight agitation and tachycardia are possible. Heart rate does not exceed 100 beats / minute, PSV (peak expiratory flow rate) is about 80%, blood oxygen saturation is not lower than 95%.
2. Moderately heavy. In this condition, the patient’s physical activity decreases. It becomes difficult to pronounce long sentences, the patient tries to limit himself to individual short phrases. The state is excited, the pulse is speeded up (up to 120 beats per minute). When exhaling and coughing, wheezing rales are clearly heard. PSV after using the drug ( bronchodilator ) is approximately 60%. There is also a decrease in oxygen saturation and partial pressure of oxygen in the blood.
3. Severe exacerbation. To maintain a satisfactory state of health, the patient needs to seriously limit physical activity. Shortness of breath can occur even at rest. It is almost impossible to maintain a conversation. The patient is limited to individual words. The pulse increases significantly and exceeds 120 beats per minute. Strong excitement is observed. PSV falls below 60%. The oxygen pressure in the blood drops so much that cyanosis can appear. Saturation does not exceed 90%.
4. Life-threatening aggravation. The most severe degree of bronchial asthma attack. The patient’s condition is aggravated by incipient suffocation. The attack can begin in a state of complete rest. The patient is practically unable to speak. Shortness of breath and shallow breathing are constantly observed. No wheezing. Disorders of consciousness, as well as coma, are possible. PSV is below 33%. There are clear signs of cyanosis. Muscle fatigue can be recognized by bradycardia.

The first three stages of the disease are recognized by all or part of the signs. However, there are always enough of them for an accurate diagnosis.

If we classify the exacerbation of bronchial asthma according to the increase in symptoms, then two types can be distinguished:

1. In the first case, a gradual deterioration occurs. The process can take up to 5 days. The lumen of the bronchi is slowly reduced, and there is a blockage of the airways with sputum. The result is obstruction. Most often, such a development of an exacerbation occurs with a protracted infection or with improperly selected therapy.
2. Rapid increase in symptoms. In this case, immediate medical attention is required. Delay can lead to death of the patient. This is quite a rare occurrence, and almost always it is a reaction to an allergen.

If an exacerbation lasts more than a day, it is called status asthmaticus (it, in turn, is also divided into 3 degrees of severity). Patients with status asthmaticus should be hospitalized immediately.  

First aid for exacerbation

In order to quickly and efficiently relieve an exacerbation of bronchial asthma, it is important to know the reasons that provoked it.

If AD is of an allergic nature, then most often it is sufficient to isolate the patient from the allergen. After that, the negative feelings will gradually disappear by themselves.

There are also antihistamines that can successfully combat the effects of an allergen entering the body. Medicines are available in the form of tablets, drops, injection solutions.

If bronchial asthma is of a non-allergic nature, special drugs cannot be dispensed with. These drugs are available in inhalation form. Every asthmatic person should always carry an emergency medicine prescribed by a doctor. 

If there is no visible improvement, an ambulance should be called immediately.

Asthma exacerbation treatment

The treatment regimen for exacerbation of bronchial asthma both at home and in the hospital is based on the same principles. It consists of the following stages:

• elimination of obstruction;
• restoration of the function of external respiration;
• elimination of the consequences of oxygen starvation;
• prescribing drugs for further therapy;
• recommendations to the patient about further treatment and prevention of exacerbations.

The effectiveness of treatment for exacerbation of bronchial asthma is influenced by the quality of first aid. After the arrival of the ambulance team, the question is decided whether the patient can continue treatment at home or whether urgent hospitalization is required.

The indications for inpatient treatment are:

1. The severity of the exacerbation of bronchial asthma. In severe cases, the patient will need constant monitoring by qualified medical personnel.
2. No marked improvement in the condition within 60 minutes after taking corticosteroids and bronchodilators .
3. The threat of respiratory arrest.
4. If it is impossible to prevent the patient’s contact with the factors that provoke the disease.

If first aid is provided correctly and in a timely manner, there is a restoration of breathing, the disappearance of wheezing and a decrease in shortness of breath. In this case, the patient can be allowed home under the supervision of the attending physician.

Depending on the severity of the exacerbation, different treatment regimens are used:

1. Easy degree. Inhalers are the most commonly used. Beta2 agonists are ideal as active ingredients. Two injections can be made at a time. Within 60 minutes, the inhaler can be used no more than three times. If the selected drug is effective, the patient’s PSV begins to increase. The effect lasts up to four hours. In the future, the use of the inhaler is shown every four hours for two days. During this time, you need to contact a specialist who will prescribe further treatment. If the action of beta2-agonists is insufficient, additional administration of corticosteroids is possible.
2. Exacerbation of moderate severity. In this situation, beta2-agonists are also used, but their administration is possible with a nebulizer. Three procedures are required in 30 minutes. After that, glucocorticoids are prescribed in tablet form. The effectiveness of the treatment is evidenced by the PSV, which becomes above 70%. The effect should last for at least four hours. In this case, the patient does not need to be hospitalized. Full treatment can be done at home. If there is no response to treatment or it is weak, hospitalization is required. 
3. Severe exacerbation. In this case, continuous administration of beta2-agonists, as well as corticosteroids by inhalation, is used. Hospitalization is necessary. If the treatment is effective, the effect should last for at least 4 hours. Otherwise, inhalation with a nebulizer is repeated an hour later , and the dosage of corticosteroids is increased.
4. In a life-threatening condition, urgent hospitalization in intensive care is required. Oxygen therapy is performed there. The use of beta2-agonists and corticosteroids is mandatory.

At home

In some cases, with an exacerbation of bronchial asthma, treatment at home is possible. But that doesn’t mean self-medicating. The control of the attending physician and strict adherence to all prescriptions are very important for the speediest improvement in well-being.

For home use, a doctor may prescribe bronchodilators and corticosteroids. Bronchodilators help relieve obstruction, and corticosteroids relieve inflammation and reduce phlegm production.

If treatment does not help, hospitalization may be required.

In the hospital

In case of severe or difficult to treat exacerbation of asthma, hospitalization is necessary.

At the time of admission, the doctor assesses the severity of the patient’s condition, collects anamnesis, and conducts an examination. In this case, the risk of complications is assessed.

Treatment of exacerbation of bronchial asthma should be started even before the results of the examination are received. First of all, oxygen is supplied with the help of a special apparatus. Next, bronchodilators are administered using a nebulizer . It is important to free the bronchi from sputum stagnant there.

In a severe case, drugs from the methylxanthine group can be added to therapy .

Systemic corticosteroids are the main drug for the treatment of exacerbations of bronchial asthma. They are administered parenterally or orally at an increased dosage. After the improvement of the patient’s condition, the doses of the active substances are gradually reduced.

If all the measures taken did not alleviate the patient’s condition, he is transferred to intensive care.

The patient is discharged if:

• his physical activity is restored;
• there are no deviations from the norm in the test results;
• there are no attacks at night;
• inhalers are used no more than 4 times a day;
• basic therapy was prescribed.
• the patient understands the further treatment regimen and is ready to follow it.

Prevention of exacerbations

To prevent the development of an exacerbation of an asthmatic disease, it is very important to know what preventive measures will reduce the likelihood of attacks.

These include:

• identifying an allergen that provokes an exacerbation, and preventing contact with it;
• organize a hypoallergenic life;
• if the climate is not suitable, if possible, change the place of residence;
• agree on a diet with a doctor and strictly adhere to it;
• temper;
• to refuse from bad habits;
• take medications strictly according to the scheme prescribed by the doctor, do not forget or miss;
• regularly undergo examinations.

Bronchial asthma is a dangerous disease. And in order not to put your life at risk, it is important to try to prevent exacerbations.