According to the severity, mild, moderate and severe attacks, as well as status asthmaticus, are distinguished.

A mild attack is characterized by moderate difficulty in breathing. The child’s well-being practically does not suffer. Physical activity and spoken language are preserved. Breathing is quickened, exhalation is lengthened. The participation of auxiliary muscles in the act of breathing is not clearly expressed. At the end of exhalation, wheezing is heard. On auscultation of the lungs against the background of hard breathing, a moderate amount of dry wheezing is heard. With lung percussion, a boxed tone of sound is noted. The heart rate is increased. Forced expiratory volume and peak expiratory flow rate are 80% of normal. The oxygen partial pressure remains within the normal range. The partial pressure of carbon dioxide is less than 45 mm Hg. Art.

For an attack of moderate severity, a pronounced clinical picture is characteristic. The general condition is disturbed. Examination of the child reveals pallor of the skin, perioral cyanosis and cyanosis of the nasolabial triangle. A sick child takes a forced position. Physical activity is limited. The child is agitated. Severe expiratory dyspnea is recorded. The auxiliary muscles are involved in the act of breathing. On auscultation of the lungs, dry wheezing and moist mid-bubbling rales are heard in all pulmonary fields against the background of an elongated expiration. The heart rate is increased. Forced expiratory volume and peak expiratory flow rate are 60-80% of the norm. The oxygen partial pressure is more than 60 mm Hg. Art. The partial pressure of carbon dioxide is less than 45 mm Hg. Art.

A severe attack is characterized by the occurrence of severe respiratory disorders. A sick child takes a forced position, becomes restless, there is a feeling of fear, respiratory panic, cold sweat. Speech is difficult. Expiratory dyspnea is extremely pronounced. A wheezing breath is heard in the distance. On examination, acrocyanosis is revealed, the heart rate is sharply increased. There is an increase in blood pressure. The auxiliary muscles are involved in the act of breathing. During auscultation of the lungs, a large number of dry wheezing and various-sized wet rales are heard throughout the pulmonary fields against the background of an elongated exhalation. The heart rate is increased. Forced expiratory volume and peak expiratory flow rate are less than 60% of normal. The oxygen partial pressure is less than 60 mm Hg. Art. The partial pressure of carbon dioxide is more than 45 mm Hg. Art.

Status asthma is a prolonged attack of bronchial asthma, characterized by severe respiratory failure and resulting from a deep blockade of D-adrenergic receptors.

The causes of status asthmaticus can be:

simultaneous action of large doses of allergens;

– accession of an acute respiratory viral infection;

– exacerbation of bronchopulmonary infection;

– overdose / 3-2-agonists;

– unjustified or rapid withdrawal of glucocorticosteroids in children with hormone-dependent asthma.

The criteria for status asthmaticus are:

– the duration of an attack of bronchial asthma that cannot be corrected by drugs, at least 6 hours; violation of the drainage function of the bronchi;

– a decrease in the oxygen content and an increase in the carbon dioxide content in the blood;

– lack of effect from the use of simpa-tomimetics.

There are three stages of status asthmaticus. In stage I status asthmaticus, relative compensation is maintained. A typical clinical manifestation is a long-term non-relieving seizure. The sick child is conscious, answers the questions adequately. When examining a child, attention is drawn to difficult, rapid, noisy breathing. An unproductive cough is noted. A sick child takes a forced sitting position. With lung percussion, a boxed tone of sound is noted. During auscultation of the lungs, a large number of dry whistling and various-sized wet rales are heard throughout the pulmonary fields against the background of weakened breathing. The auxiliary muscles are involved in the act of breathing. Swelling of the chest is noted. The heart rate is increased. Blood pressure is increased. The signs of respiratory failure are pronounced. In the blood, a decrease in the partial pressure of oxygen and an increase in the partial pressure of carbon dioxide are detected, and respiratory acidosis is determined.  

In stage II status asthmaticus, decompensation already appears. Broncho-obstructive syndrome and respiratory failure are increasing. On examination, acrocyanosis is revealed. On auscultation of the lungs, a mosaic of sound conduction or a sharp weakening, and then the disappearance of respiratory noises (“silent lung”) is noted, but distant wheezing persists. The chest is sharply enlarged and swollen. The movement of the chest during breathing is almost imperceptible. The heart rate is dramatically increased. Blood pressure is lowered. The pulse is weak. In laboratory tests, metabolic acidosis is recorded. 

At stage III of status asthmaticus, a hypoxic hypercapnic coma occurs. The child’s condition is extremely serious. Consciousness is broken. The skin and visible mucous membranes are clean, pale with a bluish tinge. Deep respiratory failure develops. Breathing is rare, shallow. On auscultation of the lungs, there is a “silence” in all pulmonary fields. The heart rate is dramatically increased. Blood pressure is sharply reduced. The pulse becomes threadlike. When analyzing laboratory data, decompensated metabolic acidosis is recorded. 

Classification

I. Course of the disease:    

– intermittent (rare exacerbations);

– persistent (frequent exacerbations).

II. According to the severity of the disease:    

– lightweight;

– medium-heavy;

– heavy.

The severity is diagnosed according to the following parameters:

1. Number of nocturnal attacks per week.    

2. Number of daytime symptoms per day and week.    

3. Multiplicity of exacerbation.    

4. The presence and severity of physical activity and sleep disorders.    

With a mild course of bronchial asthma, no more than one attack occurs per month. The attacks are easy and quickly stop. Nocturnal attacks are rare or even absent. Physical activity was not observed. The child’s physical development is not impaired. During an exacerbation, the peak expiratory flow rate is 80% of the norm. Daily fluctuations in broncho-passage no more than 20%. During the period of remission, symptoms are completely absent. External respiration function is normal. The duration of the remission period is 3 months or more. The attacks are stopped independently or with a single dose of bronchodilator drugs. Basic anti-inflammatory therapy is carried out with sodium cromoglycate, sodium nedocromil.

With a moderate course of bronchial asthma, the number of attacks per month is 3-4. Seizures of moderate severity are noted, occurring with pronounced disturbances in the function of external respiration. Night attacks are observed 3-4 times a week. There is a decrease in exercise tolerance. The child’s physical development is not impaired. During the exacerbation period, the peak expiratory flow rate is 60-80% of the norm. Daily fluctuations in broncho-passability 20-30%. During the period of remission, clinical and functional changes persist. The duration of periods of remission is less than 3 months. Attacks of bronchial asthma are stopped by broncho-lytic agents (inhalation or parenteral), according to indications, parenteral glucocorticosteroids are prescribed. Basic anti-inflammatory therapy is carried out with sodium cromoglycate, sodium nedocromil and inhaled glucocorticosteroids.

In severe cases of bronchial asthma, attacks occur several times a week or even daily. The clinical picture is characterized by manifestations of severe attacks and asthmatic conditions. Nighttime attacks are almost daily. Exercise tolerance is reduced, there is a lag in physical development. During an exacerbation, the peak expiratory flow rate is less than 60% of the norm. Daily fluctuations in broncho-passability more than 30%. The duration of the periods of remission is less than 1-2 months. Even during the period of remission, signs of respiratory failure of varying severity persist.

Bronchial asthma attacks are stopped by the appointment of bronchospasmolytics in combination with glucocorticosteroids.

Inpatient treatment is required. Basic anti-inflammatory therapy is carried out with inhaled and systemic corticosteroids.