The diagnosis of an attack of bronchial asthma in typical cases is straightforward. A typical attack of bronchial asthma was described more than 100 years ago by the French clinician Trousseau
: “A patient experiencing shortness of breath for the first time does not realize the true nature of his illness, immediately becomes very anxious, afraid to suffocate, jumps out of bed, opens windows and strains all his muscles so that air can freely pass into the respiratory the way. Then he sits down, leaning forward with his torso, resting his hands and elbows on his knees, and instinctively tries to activate the auxiliary muscles that expand the chest. His whole body from head to toe is covered with profuse sweat, his face turns red, sometimes it becomes cyanotic and even swells, nasal mucus pours in abundance and causes sneezing. The breathing becomes sonorous, wheezing and buzzing rales are heard already at a distance from the patient.
Thus, the case lasts about two hours , then the threat gradually subsides, shortness of breath becomes less disturbing. Until now, the patient did not cough, now he begins to cough and expectorates plentiful, thick, grayish, foamy mucus with small, round, opal, gelatinous masses floating in the middle of it, which were called “pearl sputum” from Laennec . The appearance of sputum generally indicates that the attack is near the end … In a few moments shortness of breath reaches its greatest intensity. The patient does not always realize that only breathing is difficult for him. But, examining from afar the shape of his chest and respiratory movements, we see that all his efforts are aimed at expelling air from the lungs. If he seems to make respiratory movements, it is only because there is a need for new air. The chest is enlarged precisely in all directions: the shoulders are raised, the intercostal spaces are stretched.
There is no abdominal breathing , the patient breathes only by the neck and shoulders … As for the stethoscopic signs, they can be heard already at a distance: these are abundant buzzing rales, which are also accompanied by wet rales at the end of the attack, but wheezing wheezing always prevails, even in the final stage when sputum is manifested. Elongated exhalation is indeed a stethoscopic symptom that, if not overlooked, best describes asthma. The patient puffs when exhaling … “( Trousseau ,” Hygiene and treatment of asthmatics “, St. Petersburg, 1886). The differential diagnosis of the first attack of bronchial asthma should be carried out primarily with cardiac asthma.
Differential diagnostic criteria for an attack of bronchial and cardiac asthma
|Clinical and anamnestic data||Bronchial asthma attack||Cardiac asthma attack|
|Previous diseases||Previous pathology from the bronchopulmonary system||There are indications of diseases of the cardiovascular system|
|Nature of the attack||Expiratory dyspnea||Mostly difficult to breathe, feeling of lack of air|
|Auscultatory data||Abundant, diffuse, dry, wheezing and buzzing wheezing, mostly on exhalation||Wet rales mainly in the lower lungs|
|Pulse||Frequent, irregular rhythm||Often arrhythmic|
|Swelling||Are absent||Often there are|
|Liver size||Not changed||Often enlarged|
|Sputum||Thick, viscous, it is difficult to separate in small quantities||Liquid, foamy, sometimes pink, easy to peel off|
|Therapeutic effect||From bronchodilators||From morphine, diuretics, cardiac glycosides|
Treatment of an attack of bronchial asthma to date has been developed quite clearly. At home for the first time a mild attack of bronchial asthma can be stopped with hot foot baths, mustard plasters on the chest. Bearing in mind that such attacks are usually not dangerous for the patient, the doctor should reassure him, instill confidence in him that the attack will be quickly stopped. In the presence of medications, aerosol inhalations of bronchodilators ( salbutamol , etc.) are preferred . The effect occurs in 10-15 minutes, lasts 3-4 hours. Often, asthma attacks stop on their own.
Adrenaline is currently practically not used. The greatest difficulties are encountered in the treatment of patients with asthmatic status . Asthmatic status is defined as a qualitatively new state in the clinical picture of bronchial asthma, in which resistance to stimulants of adrenergic receptors, which arises as a result of and against the background of a developed picture of expiratory dyspnea, is decisive.