Usually, during a severe attack, the patient is forced to sit in bed (due to severe shortness of breath while lying down). He takes a “coachman’s pose” – with the rest of his hands to include auxiliary muscles in the act of breathing (a sign of BA severity). It is difficult for him to speak (intermittent speech, only short phrases) and to breathe. Inhale quickly, and long exhale (2-4 times greater), difficult and painful. With severe obstruction, breathing is slowed (BH 10-12 in 1 min). There is an unproductive, debilitating cough (sometimes it appears early in the morning and is the only symptom of AD) with a small amount of thick, sticky sputum due to impaired bronchial drainage. Sometimes after coughing up sputum comes some relief. Objectively, tachypnea (more often), prolonged exhalation, suffocation, swelling of the cervical veins and face, participation in the act of breathing of the auxiliary muscles of the shoulder girdle, back and abdominal wall are objectively detected; pale cyanosis of lips, ears; fright in the eyes; the face and chest are covered with cold sweat, since the respiratory muscles (diaphragm, auxiliary muscles) do a great job (often unbearable) under significant adverse mechanical conditions. In a severe attack, signs of acute emphysema of the chest are determined: it “freezes” in the act of maximum inspiration, the ribs begin to take a horizontal position. You can also note the cushingoid face as a result of prolonged use of corticosteroids. Percussion over the lungs reveals a boxy sound, lowering of the diaphragm. During auscultation of the lungs against the background of often weakened breathing, a variety of dry, “musical” wheezes (or resembling “squeaking”) are detected (better at the end of exhalation), indicating damage to the bronchi of various calibers. They are heard simply by the ear, at a distance (distance). The absence of sight in a patient who has other symptoms of an attack is an ominous symptom indicating that the airways are sharply narrowed and there is not enough air turbulence to cause the sight. In many patients, all these symptoms disappear after the end of the attack (nothing is heard above the lungs outside it). But in a number of patients with frequent attacks of suffocation and in the interictal period, wheezing persists. If asthma attacks are rare, then in the phase of remission, upon examination of the patient, the chest is usually normal, the size of the heart is small. If they are enlarged, then echocardiography, a heart examination is necessary. Blood pressure during the attack may increase slightly (especially DBP). The pulse is quickened, usually more than 100 beats / min (often due to the intake of large doses of beta2-AG), sometimes poor filling. In half of asthma patients with FEV1 less than 1.0 L, a paradoxical pulse is determined: during inspiration (decreases) and expiration (increases), the difference in SBP is more than 10 mm Hg. Auscultation revealed tachycardia and muffling of heart sounds. In elderly patients, arrhythmias (usually AF) may occur. Bradycardia and the absence of a paradoxical pulse indicate fatigue of the respiratory muscles. The severity of the attack can also be judged by the severity of hypoxemia with hypercapnia. All of these symptoms in a patient may not be. The duration of an attack of bronchial asthma is also important, since the mechanisms of bronchial obstruction change as the attack is delayed. At first, its main reason is bronchospasm (it stops in a few minutes), and later – the formation of mucous plugs and edema. To stop the latter, it may take several days of intensive treatment.