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Adherence to the recommended therapy is the key to achieving control of bronchial asthma. An individual written action plan facilitates understanding of the doctor’s prescriptions and details the actions of patients on self-management in case of exacerbations. A partnership approach and taking into account the characteristics and wishes of the patient when drawing up a written action plan greatly facilitates its practical implementation. In the article, as an example of a clinical case, recommendations are given on drawing up an action plan for a patient with bronchial asthma in accordance with modern clinical recommendations and individual patient data.

Action Plan for Asthma Exacerbation

Compliance with recommended therapy is the key to achieving asthma control. An indiv> exacerbations. Partnership approach and taking into account patient’s features and wishes for written action plan greatly facilitates their practical implementation. On example of generalized clinical case the author prov> asthma in accordance with modern clinical guidelines and individual requirements.

The text of the scientific work on the theme "Plan of action for exacerbation of bronchial asthma"

Inhalation therapy news

Plan of action for exacerbation of bronchial asthma

HE. Brodskaya, A.S. Belevsky

Adherence to the recommended therapy is the key to achieving control of bronchial asthma. An individual written action plan facilitates understanding of the doctor’s prescriptions and details the actions of patients on self-management in case of exacerbations. A partnership approach and taking into account the characteristics and wishes of the patient when drawing up a written action plan greatly facilitates its practical implementation. In the article, as an example of a clinical case, recommendations are given on drawing up an action plan for a patient with bronchial asthma in accordance with modern clinical recommendations and individual patient data.

Key words: bronchial asthma, control, written action plan, exacerbations, electronically-mesh nebulizers.

The patient, 61 years old, suffers from bronchial asthma (BA) for 10 years.

The diagnosis was made on the basis of typical signs: recurrent wheezing in the chest, shortness of breath, cough, the presence of reversible obstruction according to spirometry.

The patient suffers from persistent rhinitis, gastroesophageal reflux disease (GERD), arterial hypertension, and obesity (body mass index 32 kg / m2). Hypersensitivity to household, epidermal, pollen allergens has not been identified. I never smoked. She had no occupational hazards. Two years ago, the patient was recommended a combination of vilanterol 40 mcg / fluticasone furo-at 200 mcg 1 inhalation 1 time per day by inhalation. Against the background of this therapy, control of AD symptoms was achieved (the need for salbutamol no more than 2 times a week).

However, against the background of acute respiratory viral infection in the last year, there was 1 exacerbation with hospitalization and 2 exacerbations requiring the use of systemic glucocorticosteroids (GCS). The patient admits that

FSBEI of HE "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Moscow.

Olga Naumovna Brodskaya - Cand. honey. sciences, associate professor of the department of hospital therapy PF.

Andrey Stanislavovich Belevsky - Doctor. honey. sciences, professor, head. Department of Pulmonology FDPO. Contact information: Brodskaya Olga Naumovna, [email protected]

sometimes, against the background of an improvement in the condition, he misses taking medications, however, the latest exacerbations occurred against the background of regular therapy. An attempt to recommend a flexible dosing regimen was not successful due to insufficient compliance.

In the last 2 months, the patient underwent chest x-ray, no pathology was detected. Significant eosinophilia of blood and sputum was not observed. Exhaled nitric oxide is within normal limits. Spirometry data: forced expiratory volume in 1 second (FEV1) initially 78% of what was expected, FEV1 / FVC 67% (FVC - forced lung capacity), after inhalation of 400 μg of salbutamol, the values ​​increased by 300 ml and 14%, respectively. At the time of treatment, the patient was in a stable condition, the purpose of the treatment was to consult on the prevention of exacerbations of asthma and to discuss tactics of behavior taking into account periodic residence in the city (cottage) without the possibility of quick access to medical care and occasional power outages. In addition, the patient notes the difficulty of using a powder inhaler for exacerbation due to anxiety and severe coughing.

Thus, the patient has the following current problems:

• lack of adherence to therapy,

• lack of necessary knowledge about tactics of behavior and a written action plan in case of an exacerbation of AD,

• frequent exacerbations of AD against the background of symptom control,

• concomitant diseases with an effect on asthma control: persistent rhinitis, obesity, GERD.

Lack of adherence to therapy

Low adherence to AD treatment is a common situation that occurs in approximately 50% of pediatric and 30-70% of adult patients. Studies have been published confirming the relationship between adherence to treatment and the number of severe exacerbations of AD. In children, improved adherence to therapy reduces the risk of severe exacerbations by 21-68%, in adults - by 25%. Of course, it is necessary to try to understand the reasons for the low adherence to therapy in order to solve this problem. Low adherence can be unintentional (forgetfulness, misunderstanding of prescriptions, difficulties in using an inhaler) and intentional (fear of side effects, the idea that treatment is not so necessary, desire to save, etc.).

In the case under discussion, most likely, we are talking about the deliberate refusal of drugs due to underestimation of the severity of the disease and the importance of treatment. The way out of this situation is to educate the patient in order to gain an understanding of the essence of the disease and its treatment and, most importantly, involve her in deciding on the choice of specific drugs, inhalers and dosages. The patient should be given a choice of medically correct treatment options. Therapy should be adapted to the specific patient.

Despite the long history of asthma, one should check the technique of inhalation for all used devices and, if necessary, carry out error correction.

Frequent exacerbations in symptom control

In the presented clinical case, the patient receives stage 4 therapy (long-acting P2 agonists (DBA) and high doses of inhaled glucocorticosteroids (IHC)), but she does not have adequate asthma control because frequent exacerbations are noted (exacerbations that develop 2 times are considered frequent per year or more). The patient has the so-called discordant AD phenotype, in which the severity of symptoms does not correspond to the frequency of exacerbations, i.e. at satisfactory

By monitoring the symptoms, frequent exacerbations are recorded. Often this phenotype is accompanied by sputum eosinophilia and a significant increase in the level of nitric oxide in exhaled air, which allows us to adjust the volume of therapy in accordance with the level of markers 3, 4. Unfortunately, in this particular case, we do not have this possibility due to the lack of an initial increase in these indicators.

Prevention of exacerbations of asthma

Options for the prevention of exacerbations in accordance with current recommendations are the following 2, 5:

• improved adherence to therapy,

• correct inhalation technique,

• treatment of concomitant diseases, especially obesity, rhinitis and, possibly, GERD,

• vaccination against influenza and pneumococcus,

• change in maintenance therapy,

• a written action plan.

Since frequent exacerbations mean a lack of AD control, maintenance therapy should be enhanced. It is proved that the use of a single inhaler in the regimen of supportive and emergency therapy is one of the most effective methods of reducing the frequency of exacerbations 2, 6-8. Unfortunately, in the past, the patient in question showed a low commitment to this regimen. In addition, the presence of a discordant AD does not allow us to recommend this regimen, because the symptoms may be underestimated by the patient, therefore, an adequate increase in the volume of therapy in the onset of exacerbation cannot be expected.

A planned increase in the dose of IGCS is not a useful measure, since it has been established that large doses of IGCs in combination with DBA usually do not contribute to better control. A similar treatment regimen is acceptable as a trial course with the ineffectiveness of other regimens. A combination of three drugs is considered more preferable for the prevention of exacerbations of AD. Consideration may be given to the addition of a long-acting muscarinic receptor antagonist tiotropium bromide to IGCS / DDBA. Tiotropium contributes to some improvement in functional indices and increases the period to the next exacerbation 2, 9. An alternative option, given the presence of persistent rhinitis, is the addition of receptor antagonists to leukotrienes to IGCS / DDBA. In principle, in some cases, theophylline can be considered as the third drug.

BA written action plan

In the presented example, the patient received an active request to draw up an action plan in case of an exacerbation of AD. Despite the fact that for more than 20 years, the need to draw up written action plans for patients with AD has been discussed, they are still absent in most patients. Even in health systems where a written action plan is part of the standards for AD management, in reality only 1/4 of the patients have it. At the same time, many studies have demonstrated that having a written action plan contributes to better control of symptoms, improving the quality of life, reducing the risk of exacerbations and reducing the need for medical services at all levels. The positive impact of the action plan is maintained regardless of the severity of asthma and the age of the patient.

The written action plan consists of three conventional zones - green, yellow and red. In the green zone, the patient’s routine actions in a stable state are described: the names and doses of inhalers that are maintained and used as needed, indications for situational administration of the inhaler, the concept of asthma control, and the best peak flowmetry values. Monitoring and correct interpretation of peak flow metrics are the key to the successful application of a written action plan and achievement of BA control.

The yellow zone contains information on the patient's actions in case of deterioration, which does not require emergency treatment for medical help. The symptoms of deterioration are described, the threshold for decreasing the peak expiratory flow rate (PSV) is indicated, the medications that must be taken in case of deterioration, the situation when you should urgently seek medical help are indicated.

In the red zone are the symptoms and indicators of PSV, requiring urgent medical attention, medications that should be taken while waiting for a doctor.

A written action plan is developed by the doctor individually for each patient, taking into account the phenotype of asthma, social factors, drugs taken to control asthma, concomitant diseases, and patient preferences. A written action plan should be explained to the patient and agreed with him. In subsequent contacts with the patient, it is necessary to evaluate the implementation of the plan and adjust it in accordance with the changing realities of life. A written action plan has helped-

to overcome panic and forgetfulness in case of deterioration and should contain clear instructions taking into account possible scenarios.

It is well known that in the event of an exacerbation of asthma, the main controlling drug is considered GCS. However, more and more studies are published on the role of increasing the dose of IGCS in the debut of exacerbation.

Doubling the dose of IHC was ineffective in preventing exacerbations. At the same time, an increase in the dose of IGCS by 4 times, but not more than the equivalent of 2,000 μg of the beclomete zone, prevented the development of severe exacerbations requiring the appointment of SGCS. Acceptance of an increased dose of IGCS for 7-14 days is equivalent to a short course of SGCS.

Nebulizer therapy for exacerbation of AD

The inhaler used for maintenance therapy in the discussed example, vilantherol 40 μg / fluticasone furoate 200 μg, is not intended to increase the dose of IHC by 4 times. Thus, we are faced with the need to select an additional inhaler in advance in case of an exacerbation. The use of a new type of inhalation device is not always comfortable for the patient, especially against the background of a worsening condition. In addition, the patient previously noted difficulties in performing the maneuver during the development of exacerbation. The solution in such a situation could be the use of a nebulizer, which does not require special inhalation maneuver and coordination of inhalation and exhalation. However, the patient is embarrassed by the relatively long inhalation time, the need to transport a bulky device to the cottage, and, most importantly, she fears an unexpected outage.

Overcoming the existing shortcomings of nebulizer systems was made possible thanks to the development of technology of electronic mesh inhalers. The operating principle of these devices is based on a vibrating membrane that forms a medicinal aerosol without heating. The device has a small mass, almost comparable to that of conventional inhalers. It can operate both from an electric network and from batteries, which ensures independence from problems with the supply of electricity and, in principle, from the availability of a stationary place for inhalation. The patient can carry a nebulizer with him in the same way as a metered or powder inhaler. Despite the small size,

Example written action plan

Actions with a stable course of AD Actions with a deterioration in AD Actions in conditions requiring urgent medical attention

My inhalers for basic therapy 1. The combination of DDBA (not formoterol) / high doses of IHC (name, color) I should use the inhaler for maintenance therapy every day, even if I feel good. I take 1 breath in the morning 2. Thiotropia bromide (name, color) ) I have to use the inhaler for maintenance therapy every day, even if I feel good. I take 2 breaths in the evening. I have BA deterioration if I observe the following symptoms: - wheezing, chest pain, shortness of breath, cough, - I wake up at night, - symptoms disturb my daily routine active activity (for example, work, physical education), - PSV below 320 l / min I have an exacerbation of asthma, if I observe the following symptoms: - my inhaler does not help me to alleviate the symptoms, - it’s hard for me to walk and talk, - I it’s hard to breathe, - I have strong wheezing, coughing or heaviness in the chest, - PSV below 240 l / min

My inhaler for relief of symptoms (salbutamol) (color) I use my inhaler for relief of symptoms only when needed I take 1-2 inhalations of the inhaler to relieve symptoms if: - I have dry rales, - there is a feeling of compression of the chest, - I have difficulty breathing, - I cough What should I urgently do to improve AD? If I have not temporarily used an inhaler for maintenance therapy, I should resume using it if the deterioration has occurred outside of maintenance therapy disorders. I am an electron-mesh nebulizer, inhal 2000 μg / day budesonide (500 μg 4 times a day) or 2000 μg / day beclomethasone (1000 μg 2 times a day) until the symptoms go away and PSV is not normal. Use the inhaler for relieve symptoms every 4 hours for 1-2 breaths until the condition improves What should I do urgently Sit down and try to calm down Make inhalation of 2.5 micrograms of salbutamol through a nebulizer If it does not get better or the condition continues to worsen, urgently call an ambulance help lasts longer than 15 minutes, you can repeat the inhalation of 2.5 μg of salbutamol through a nebulizer. It is possible to do 3 inhalations of salbutamol 2.5 μg through a nebulizer with an interval of 20 minutes for 1 hour. If it becomes better, consult a doctor during the day and take 50 mg of prednisolone

It is expected that with the right therapy and controlled asthma, I will not have any symptoms. If symptoms have not been observed within the last 12 weeks, I should inform your doctor, possibly reducing the dose of the maintenance drug. If the condition does not improve within 48 hours, I should immediately contact for medical help

My best PSV score is 400 l / min. If you have previously been given prednisone tablets, take 50 mg of prednisone (or 10 tablets of 5 mg) and then take it every morning for 7 days or until resolution of the exacerbation is complete. Contact your doctor right away if you started taking prednisone tablets

electron-mesh inhalers create a high respirable fraction of aerosol particles (more than 70% of the particles are less than 5 microns in size). Such devices provide a short inhalation time (about 3 minutes) and minimal loss of the drug to the environment due to the spatial storage and valve system in the nebulizer, which makes the therapy more effective and at the same time economical 12, 13.

It is important to note that in addition to inhaled inhaled corticosteroids, the electron-mesh nebulizer allows inhalation of short-acting bronchodilators, for example, salbutamol, which is

It is a necessary component of therapy for exacerbations. Especially convenient and effective is the use of a nebulizer in the case of an exacerbation requiring medical attention. In anticipation of assistance, patients are advised to independently perform from 4 to 10 inhalations (100 mcg salbut-mol) from a metered-dose inhaler, which can be technically difficult and often psychologically rejected as too large a dose. The use of a single inhalation of 2.5 mg of salbutamol through a nebulizer is equivalent to repeated use of a metered-dose inhaler.

The use of an electronic mesh inhaler in case of exacerbation turned out to be the most preferable for our patient, as a result, an individual written action plan for her was prepared based on the use of this device (table).

In addition to the symptoms presented in the table, the criterion for increasing the dose of IGCS was a decrease in PSV to 80% of the best values. The criteria for initiating therapy for corticosteroids were clinical symptoms, the lack of improvement due to an increase in the dose of corticosteroids for 48 hours, and a decrease in PSV of less than 60% from the best. The multiplicity of the dosage of IGCS was determined by research data demonstrating the greater effectiveness of budesonide in dividing the daily dose into 4 doses.

The plan was studied in detail and approved by the patient. The availability and accessibility at any time of all these drugs and devices are confirmed. At the second meeting, after 2 weeks, it was clarified whether there were reasons for an increase in the volume of therapy or prerequisites for the need to change the plan: such events did not occur. The patient continues to adhere to the plan drawn up, she is monitored with a frequency of visits of 1 time per month, the mode of relatively frequent visits to the doctor is selected taking into account the phenotype with frequent exacerbations.

The most important guarantee of achieving AD control is the patient’s commitment to the recommended therapy. Implementation of the doctor’s recommendations depends on the patient’s understanding of the essence of the prescriptions, the practical feasibility of their implementation, the psychological readiness of the patient to follow the doctor’s advice. The partnership approach and the patient’s participation in the choice of therapy within the framework of generally accepted recommendations provide the best adherence to treatment, as they allow taking into account the characteristics, capabilities and wishes of the patient. A written plan prepared by a doctor and agreed with the patient details the patient’s self-study

BA also prevents errors caused by misunderstanding, forgetfulness, confusion, which leads to a decrease in the frequency and severity of exacerbations, and an improvement in the quality of life.

1. Engelkes M, Janssens HM, de Jongste JC, Sturkenboom MC, Verhamme KM. Medication adherence and the risk of severe asthma exacerbations: a systematic review. The European Respiratory Journal 2014 Feb, 45 (2): 396-407.

2. Global Initiative for Asthma. Global strategy for asthma management and prevention. Update 2018. Available from: https://ginasthma.org/ Accessed 2018 Oct 04.

3. Haldar P, Pavord ID, Shaw DE, Berry MA, Thomas M, Bright-ling CE, Wardlaw AJ, Green RH. Cluster analysis and clinical asthma phenotypes. American Journal of Respiratory and Critical Care Medicine 2008 Aug, 178 (3): 218-24.

4. Brisk R, Heaney LG. Asthma control and exacerbations: two different sides of the same coin. Current Opinion in Pulmonary Medicine 2016 Jan, 22 (1): 32-7.

5. The Ministry of Health of the Russian Federation. Bronchial asthma. Clinical recommendations. ICD 10: J.45, J.460. Year of approval (frequency of review): 2016 (review every 3 years). M., 2016. 76 c.

6. Papi A, Corradi M, Pigeon-Francisco C, Baronio R, Siergie-jko Z, Petruzzelli S, Fabbri LM, Rabe KF. Beclometasone-for-moterol as maintenance and reliever treatment in patients with asthma: a double-blind, randomized controlled trial. The Lancet Respiratory Medicine 2013 Mar, 1 (1): 23-31.

7. O'Byrne PM, Bisgaard H, Godard PP, Pistolesi M, Palm-qvist M, Zhu Y, Ekstrom T, Bateman ED. Budesonide / formo-terol combination therapy as both maintenance and reliever medication in asthma. American Journal of Respiratory and Critical Care Medicine 2005 Jan, 171 (2): 129-36.

8. Kew KM, Karner C, Mindus SM, Ferrara G. Combination for-moterol and budesonide as maintenance and reliever therapy versus combination inhaler maintenance for chronic asthma in adults and children. The Cochrane Database of Systematic Reviews 2013 Dec, (12): CD009019.

9. Kew KM, Dahri K. Long-acting muscarinic antagonists (LAMA) added to combination long-acting beta2-agonists and inhaled corticosteroids (LABA / ICS) versus LABA / ICS for adults with asthma. The Cochrane Database of Systematic Reviews 2016 Jan, (1): CD011721.

10. Pinnock H. Supported self-management for asthma. Breathe (Sheffield, England) 2015 Jun, 11 (2): 98-109.

11. Pinnock H, Taylor SC. Self management for a man with asthma. BMJ 2015 Jul, 351: h3970.

12. Pleasants RA, Hess DR. Aerosol delivery devices for obstructive lung diseases. Respiratory Care 2018.63 (6): 708-33.

13. Technical data of the PARI VELOX nebulizer. Available at: http://pari.com.ru/ingalyatory-pari-dlya-nizhnikh-dykhatelnykh-putej/ingalator-pari-velox.html Link active on 10/04/2018.

14. Asthma UK website. Your asthma action plan. Available from: www.asthma.org.uk/advice-asthma-action-plan Accessed 2018 Oct 04.

Action Plan for Asthma Exacerbation

O.N. Brodskaya and A.S. Belevskiy

Compliance with recommended therapy is the key to achieving asthma control. An individual written action plan facilitates an understanding of doctor's prescriptions and details the actions of patients in case of exacerbations. Partnership approach and taking into account patient's features and wishes for written action plan greatly facilitates their practical implementation. On example of generalized clinical case the author provides recommendations on making an action plan for patient with asthma in accordance with modern clinical guidelines and individual requirements. Key words: asthma, control, written plan of action, exacerbations, electronic nebulizers.

Briefly about the disease

On the right in the diagram, the narrowing of the bronchi is indicated by arrows.

Bronchial asthma is called a disease, which is based on a constant inflammatory process in the respiratory tract, which usually develops against the background of allergic diseases in people predisposed to the latter. In this case, bronchial sensitivity in patients is significantly increased. This is manifested by attacks of suffocation, as well as respiratory discomfort, which is manifested by dry cough, shortness of breath and the so-called wheezing, sometimes heard even from a distance. All these phenomena are caused to be transient, that is, temporary and reversible, narrowing of the respiratory tract in response to a provoking factor.

Such a factor can be physical activity, strong emotions, the use of non-hormonal anti-inflammatory drugs, inhalation of cold air, dust, animal hair and other allergens.

Along with an increase in the reactivity of the mucous membrane of the bronchi of different calibers to the irritating effect, patients often also experience changes associated with the functioning of the immune, nervous and endocrine systems. This means that such patients must be examined carefully, focusing attention not only on one breathing apparatus. In patients, a deficiency of adrenal cortex hormones, glucocorticoid hormones, which could inhibit the development of inflammation, is often detected. There may be a mismatch in the work of sex hormones or thyroid hormones.

The nervous system participates in the development of asthma as follows: the effects of its departments are amplified, in which the substance acetylcholine is used to transmit the impulse, which leads to bronchial obstruction - narrowing of the lumen of the respiratory tract.

In the inflammatory process in the mucous membrane of the respiratory tract, all types of immunological reactions play a role. Special cells migrate to the area of ​​inflammation and release special substances called inflammatory mediators. The latter and support the process permanently. These include:

On the diagram is a mast cell with granules in which inflammatory mediators are located.

This leads to increased secretion of mucus, swelling, thickening of the walls of the bronchi, the formation of connective tissue that is not physiological for these areas, impaired cleansing function of the bronchial tree, which is called mucociliary clearance and is carried out due to ciliary cells, as well as fatigue of the respiratory muscles, including the diaphragm.

Physical rehabilitation for asthma is mainly aimed at reducing inflammation in the walls of the bronchial tree, reducing the reactivity of the bronchi, which leads to a reduction in asthma attacks and its symptoms in patients with severe forms of the disease, when the latter worries them even in between periods.

Procedure for taking rehabilitation measures

In rehabilitation for bronchial asthma, certain stages can be distinguished, which are important to perform sequentially on the principle of complicating the load for patients. This is important, since each of these stages plays an important role, however, inconsistency and structureless effects on the body of an asthmatic can lead to a breakdown and only exacerbate the patient's condition. Rehabilitation measures for patients should be started with exclusion from the patient’s environment of allergens to which he is sensitive, if possible. Next, you need to prescribe and strictly adhere to a hypoallergenic diet. A little later, you can proceed to the use of the following methods: physiotherapy exercises, that is, physiotherapy and hiking, and skiing on flat terrain, physiotherapy treatment.

The plan of action for patients should be to move from simple to complex. No need to bring down on the patient all the options for non-drug rehabilitation measures at once. It is important to remember that the body of an asthmatic is not as resistant to stress as the body of a healthy person, and it takes more time to adapt to the load. Therefore, you need to start with the exclusion of allergic factors and with a diet for the patient, and then attach physical therapy and physical rehabilitation methods.

About eliminating harmful environmental factors

Typically, patients with asthma have factors that provoke symptoms of the disease that they are constantly confronted with. These usually allergic factors may include: house dust, animal dander, industrial volatile substances, and urban exhaust fumes. If there is such an opportunity, you need to try to place the patient in a different environment. For example, change the place of residence to the countryside, change the place of work from production to a place where harmful volatile mixtures do not have to be inhaled, remove dust-collecting surfaces from the house: carpets, soft toys, and also begin to store fur things in covers.

If the coat of a pet is a provoking factor, difficulties may arise with the exception of the contact of an asthmatic with him. However, you need to try to remove the pet from the patient's house.

If contacts cannot be completely eliminated, the patient will have to take anti-allergic drugs additionally. Antiallergic drugs are usually taken over a long course and, like any systemic drug, can cause a number of side effects. Therefore, it is better to simply remove the allergen, and not take additional treatment.

About diet

The role of the diet in allergic forms of bronchial asthma, which make up the statistical majority of the disease, is quite serious. The purpose of the diet is to eliminate foods that cause an allergic reaction in patients and exacerbate asthma symptoms.

The following are the most common allergens:

  1. The eggs.
  2. Milk.
  3. Peanut.
  4. Wheat.
  5. Food additives and dyes.
  6. Smoked fish.
  7. Soya.

Sometimes lemon juice, wine, beer, dried fruits, shrimp and pickled products play a role in the onset of an asthma attack.

Consider an example menu that you can recommend asthmatics for the whole day:

  • For breakfast - boiled meat, buckwheat porridge, tea,
  • For the second breakfast - a fresh apple,
  • For lunch - vegetable soup, boiled meat and rosehip broth,
  • For an afternoon snack - carrot juice,
  • For dinner - cottage cheese and stewed cabbage,
  • Before going to bed - a glass of kefir.

For the whole day you can eat 300 gr. white bread or 150 gr. white and black bread, as well as some sugar.

Of course, adhering to a diet in strict order is quite difficult, especially for patients of small age categories. However, in the case of severe asthma, restrictions must still be observed.

About physiotherapy

The role of physiotherapy exercises in adapting to life in asthmatic patients is quite large. Over time, the patient’s body will become accustomed to training, become stronger and more durable.

The patient’s breathing will become rarer and more resistant to various factors provoking seizures of the disease: physical and emotional stress, temperature fluctuations. The patient will have the opportunity to lead a fairly active lifestyle, without being distracted by discomfort in the chest, difficulty breathing and a dry cough.

You can end each lesson with a massage of the face, chest and forearms. The entire course of physiotherapy exercises includes a preparatory phase, the duration of which is usually 2-3 days, as well as a training phase. The role of the preparatory stage is to familiarize the patient with a special complex of breathing exercises that are used to restore the correct breathing mechanism. At the same time, the medical worker conducting physical therapy classes, during the preparatory period, must evaluate the functionality of a particular patient.

Actually breathing exercises are usually aimed at forming the correct diaphragmatic breathing and increasing the mobility of the chest asthmatic, which is significantly reduced with bronchial asthma.

Examples of exercise complexes:

  1. Full exhalation exercises should be used. They consist in lengthening and slowing down exhalation. This allows you to almost completely remove the air mass from the expanded air sacs, and also helps to train the abdominal muscles and diaphragm. These muscles are directly involved in the implementation of a full expiration.
  2. Applied exercises with the pronunciation of consonants and vowels. Such techniques contribute to the fact that the patient developed the ability of volitional control of exhalation. The goal is to exhale evenly, calmly, and not intermittently.
  3. Exercises are also used to reduce breathing, that is, reduce the number of breaths taken by the patient in one minute. This helps to switch to exhalation, which just suffers during an attack of bronchial asthma. The basis of this switch is the removal of excess oxygen, reducing excessive ventilation of the lungs.
  4. Exercises designed to improve the performance of external respiratory function. They consist in sequentially inflating various chambers, pear and rubber objects.

It is better not to do exercises associated with long breath holding and straining. In addition, breathing exercises do not need to be done in case of fever, exacerbations of bronchial asthma, frequent attacks of suffocation, as well as if the patient has developed severe cardiopulmonary failure.

Mucolytic therapy

In the photo is a vacuum massage of the chest.

The purpose of the exposure is the removal of excessive, produced by the bronchi, thick glassy mucus and facilitating the passage of air flow through the bronchial tree. Mucolytics are administered to the patient by inhalation, haloaerosol therapy is performed. Haloaerosol therapy consists in the use of dry aerosol of sodium chloride. Undertaken by courses. In addition, vacuum and vibration types of massage are mucolytic methods.

Anti-inflammatory physiotherapy

Includes inhalation of glucocorticosteroids. When the drug enters the respiratory tract, it immediately exerts its effect through the superficial microvessels of the bronchial mucosa. Vascular permeability decreases, the activity of cells that determine inflammation decreases, and the reproduction of fibroblasts, the cells that produce collagen, is inhibited. The most commonly used agents are triamcinolone acetonide, flunisolid, beclomethasone dipropionate or budesonide. It is convenient to carry out not inhalation, but the so-called nebulization using a nebulizer device. Nebulization is faster, available for use by pediatric patients, however, only one glucocorticosteroid is available for it: budesonide or pulmicort. Pulmicort can even sometimes serve as an alternative to systemic therapy.

This means that its effect is strong enough to be compared with the systemic, and there are no systemic side effects.

The procedure is carried out twice a day, a course of 10-15 procedures.

Bronchodilator physiotherapy

A good method that is used to relax muscle cells in the wall of the bronchus with its subsequent expansion is ventilation with continuous positive pressure. The essence of the method is to apply positive pressure to the patient’s respiratory tract throughout the entire respiratory maneuver. With the help of such ventilation, the volume of ventilation, normal gas exchange are restored, and the work of the respiratory muscles is facilitated.

The procedure lasts 30 minutes - 1.5 hours every day. The course is 10-15 procedures.

Hyposensitizing Therapy

Biocontrolled aeroionotherapy is often used. The essence of the method is to inhale the so-called aeroions. Due to the effects of these particles, the movement of the villi of the epithelium of the trachea and bronchi is enhanced, that is, the mucociliary clearance is enhanced - the function of purification. Special negative air ions are obtained using special devices.

For air ions to have a therapeutic effect, it is necessary to absorb 10 to 12 degrees of air ions.

Speleotherapy is also used - patients stay in the microclimatic conditions of natural caves, salt mines and mines.

The place of speleotherapy.

The role of this effect is to beneficially affect the reactivity of the bronchi, reducing it for a while.

It is advisable to affect the patient's body for 7 hours a day, for 24 days.

Colonhydrotherapy may be useful for patients with a foodborne allergy in asthma. The procedure consists in periodically irrigating the walls of the large intestine with liquid.

This helps to restore the normal ratio of intestinal microflora, leaching of toxins and toxins, adequate synthesis of vitamins of group B. The blood flow in the intestine wall increases. The absorption of minerals is restored. The absorption of allergens and toxins is reduced.

For the procedure, fresh water is used, in which drugs are dissolved at a temperature of 37 degrees, at a pressure of 12-14 kPa. The solution should be administered by increasing portions from half a liter to one and a half liters. Mineral water is sometimes used.

Cardiotonic therapy

It consists in taking carbon baths. Carbon dioxide increases the parasympathetic effect on the patient’s heart, increases blood flow, improves self-regulation of cardiac blood flow. The patient’s breathing is reduced and becomes deeper, an asthmatic can inhale 1-1.5 l more per minute than before the procedure.

In the photo - the carbon dioxide bath procedure.

In carbon baths, a carbon dioxide concentration of up to 1.2-1.4 g / l is used. The temperature decreases gradually from 35 degrees to 32. The procedure lasts 12-15 minutes. The course is 10-15 procedures.

Carbon dioxide baths should not be given to patients with severe asthma of an unstable course, with myocarditis, arterial hypertension, and chronic circulatory failure.

Spa treatment

Patients with infrequent and not too protracted episodes of the disease, with cardiopulmonary insufficiency not higher than I degree, can be sent to climatotherapy resorts, such as Kislovodsk, Nalchik, Odessa, Feodosia, Albena, the Dead Sea, as well as to local sanatoriums.

In the photo - the sanatorium "Solnechny" in the city of Kislovodsk.

Do not send patients with a severe course of the disease for sanatorium-resort treatment.

What is this disease

Bronchial asthma is a chronic inflammatory disease of the respiratory tract involving a variety of cellular elements, primarily eosinophils, mast cells and T-lymphocytes.

Hyperreactivity of the bronchi and bronchospasm is characteristic, airway obstruction is reversible, which is a hallmark of this disease.

The disease often develops against the background of other allergic diseases, so bronchial asthma is often accompanied by:

  • allergic rhinitis
  • hay fever
  • allergic dermatitis,
  • hives,
  • Quincke's edema.

The occurrence of asthma is also due to genetic inheritance from parents. Among the children's population, the disease is more common than among adults.

Contribute to the development of the disease:

  1. environmental degradation and an increase in airborne allergens,
  2. synthesis of new substances with high allergenicity,
  3. eating canned food,
  4. the spread of immunodeficiency among the population, contributing to the long-term preservation and propagation of viral infection within the human body.

In severe cases and untimely assistance to patients, fatal outcomes are possible due to closure of bronchial lumens during asthma attacks.

Why does it appear

Bronchial asthma, like other diseases, has certain causes and does not appear from scratch.

In this case, external and internal factors play an important role in the development of the disease, with the combination of which the pathological process is launched.

Internal factors:

  1. genetic predisposition of the body to atopic reactions, that is, to increased secretion of antibodies when exposed to allergens. In half of asthma patients, concomitant atopic diseases are detected,
  2. predisposition to bronchial hyperreactivity, manifested in increased spasm of smooth muscle cells in contact with allergens, is associated with the release of antibodies in the body,
  3. genetic predisposition to asthma, in almost half of patients it is determined,
  4. in boys, asthma is more common in childhood due to a narrow airway, and in adulthood women are more likely to suffer,
  5. violation of the exchange of arachidonic acid due to genetic changes.

External factors:

  1. the effect of household allergens:
  • house dust
  • dandruff and pet hair,
  • food for aquarium fish,
  • mold and yeast fungi,
  • ticks.
  1. the influence of external factors leading to hay fever:
  • tree pollen
  • pollen of flowers.
  1. professional antigens
  2. food allergens:
  • citrus,
  • chocolate,
  • egg white,
  • nuts, especially peanuts,
  • Fish and seafood,
  • honey,
  • mustard,
  • cow's milk and dairy products,
  • bright vegetables and fruits.
  1. atmospheric allergens:
  • dust,
  • smog on the street
  • the accumulation of metabolites of gas combustion in the kitchen and distribution around the house.
  1. viral and bacterial infection.
  2. medications:
  • antibiotics
  • aspirin, and NSAIDs,
  • serum
  • vaccines
  • enzyme preparations
  • preparations for diagnostic measures.

The development of the disease may be due to the combined influence of various factors on the body.

What includes rehabilitation for bronchial asthma

Rehabilitation is a complex of measures aimed at restoring all the functions of the patient.

With bronchial asthma, measures are prescribed that should reduce the frequency of bronchospasm and sputum synthesis, then the patient will feel good and feel like a healthy person.

Rehabilitation also includes rational employment.

Rehabilitation of children with bronchial asthma pays special attention to the prevention of seizures, so that seizures occur as little as possible.

Repeated inflammatory processes in the bronchial tree will lead to irreversible changes and the development of a more serious disease.

For children, they carry out the same activities as for adults.

Rehabilitation is carried out:

  • in a hospital with an exacerbation,
  • in the clinic for remission of the disease,
  • in sanatoriums and resorts,
  • at home.

To restore health, doctors and the patient himself must make an effort, otherwise there will be no effect from the treatment, therefore, how the patient follows the doctor’s instructions and does it on his own plays a big role!

Physical exercise

Physical rehabilitation for asthma includes a set of exercises that contribute to:

  • strengthening the muscles of the chest
  • normalization of the nervous system,
  • increase body stamina,
  • improving mental health by improving brain function,
  • improve blood circulation throughout the body,
  • lymph flow improvement
  • improving metabolic processes,
  • stimulation of the hormonal-humoral mechanism.

Exercises should be performed during remission, when there are no seizures. Classes should be supervised by an instructor.

At the beginning, light exercises are performed when the instructor determines the patient's stamina and physical fitness. Gradually, complication of classes occurs when exercises with a stick and ball are joined.

Increased blood circulation and lymph flow provides a faster absorption of the accumulated exudate in the bronchi.

Normalization of the nervous system leads to a decrease in the tone of smooth muscle cells in the bronchial tree. You can not carry out exercises and hold your breath so as not to provoke an attack of suffocation.

After class, you should take a shower, but the water temperature should not differ much from room temperature. Cold or hot water can trigger an attack.

Massage

A drainage massage is carried out, which helps to remove sputum from the bronchi.

Also, touching the skin stimulates the brain and respiratory center, which leads to reflex coughing attacks.

Massage must be combined with other activities, carried out as a fixing stage during rehabilitation. The duration of one session is up to 15 minutes.

A massage is performed from the back and chest:

  1. The movements should be from the ribs to the back of the head.
  2. It is necessary to stretch all the muscles of the back and shoulder girdle.
  3. On the chest, carefully work with the nipple region and the heart.
  4. It is necessary to carry out receptions:
  • stroking
  • kneading
  • vibration
  • trituration.
  1. In conclusion, conduct stroking.
  2. You can do a slap.
  3. Allocate to the back and chest area for 5-6 minutes.

Due to vibration and patting movements, sputum and mucus are separated from the bronchial tree. The criterion for the effectiveness of the massage is the patient’s cough and better expectoration.

Photo: Direction of movements during massage

The effect of massage on the body:

  1. improved blood circulation,
  2. improvement of lymph outflow,
  3. stimulation of the nervous system,
  4. body relaxation
  5. improvement of metabolic processes,
  6. strengthening the muscular system at the site of massage.

Breathing exercises

Breathing exercises will help the patient strengthen the diaphragm and clear the airways of accumulated harmful substances.

After the course of exercises, the walls of the vessels strengthen, which will provide less penetration of antigens and inflammatory mediators through them.

Exercises:

  1. "Awakening". Lying in bed, bend your knees and pull to your chest, while exhaling. Perform immediately after sleep.
  2. Take a vertical position and, taking a breath, inflate your stomach.
  3. Breathe by closing the right and left nostrils in turn.
  4. Inflate balloons.
  5. Exercises with sounds when on a slow exhale, you pronounce hissing or consonants. The exercise is performed while standing.
  6. Blow through a tube into a vessel of water, taking a deep and slow breath.

How is exercise therapy for bronchial asthma? Details here.

Immunity strengthening

Hardening the body helps to cope with any disease.

Only in this case, you need to remember that excessively cold or hot temperatures can trigger an asthma attack.

Immunostimulating drugs are best taken after a doctor’s recommendation; they do not need to be taken on their own.

Physiotherapy exercises and massage also help strengthen immunity.

Medication

Medicines are prescribed by a doctor to reduce and prevent seizures.

Patients with asthma are doomed to the continuous use of drugs until the seizures and symptoms disappear completely.

Preparations:

  1. Anti-inflammatory therapy:
  • membrane stabilizing drugs
  • antileukotriene preparations,
  • inhaled glucocorticosteroids, which are the basic drugs for the treatment and prevention of attacks,
  • systemic glucocorticosteroids when inhaled do not help.
  1. Bronchodilator therapy.
  2. Antibiotic therapy.
  3. Antihistamines.
  4. Enterosorbents.

Treatment is selected individually, which depends on the characteristics of the body and the severity of asthma.

How to make a plan and what it consists of

The rehabilitation plan is based on the received data:

  1. medical history of the patient
  2. patient examination data,
  3. clinical trial data
  4. data on the effectiveness of previous therapy.

The severity of the patient is determined, after which the doctor decides where and how the rehabilitation will take place:

  1. a severe degree and asthma attacks are treated in a hospital until the attacks are reduced,
  2. mild and moderate form - observation of the health status in the clinic.

The purpose of rehabilitation methods also depends on the severity of the patient. For example, physical exercises will be suspended during exacerbation, and after seizures will again begin with small loads.

Useful Tips

  1. follow a hypoallergenic diet, because allergens in foods have strong allergic properties, especially proteins,
  2. do not interrupt the prescribed therapy as you wish if the symptoms have decreased or disappeared. This may be the stage of calm, always consult with specialists,
  3. do not allow active and passive smoking!
  4. get rid of all bad habits, because he needs strength to fight the underlying disease,
  5. if your child has a sick family, then try to lead the same lifestyle with him and eat the same foods so that he does not feel different from others,
  6. do not forget your inhalers, they may be needed at the most necessary moment,
  7. Do not skip taking medications.

Features of restoring children's health

The children's body is characterized by a greater ability to repair damaged structures, so recovery in children is possible.

But do not forget about the instability of the immune system of babies, which can lead to the appearance of concomitant allergic diseases if treatment is not followed.

Parents should exercise and massage with their children in their free time, as this is much better than drinking medications.

Only a child should like the activities, so teach your kid about physical education.

With constant exercise, defeating the disease will be faster.

Children are prone to infectious diseases in kindergarten and school, which can aggravate the condition, so during illness, protect the child from unnecessary and provocative contacts.

What should be the diet for asthma in adults? Read on.

How to provide emergency care for an attack of bronchial asthma? Find out more.

Preventative measures

Prevention is the key to health, so you need to take care of yourself and your loved ones.

What to do:

  1. If possible, avoid contact with allergens:
  • leave during flowering plants
  • follow a hypoallergenic diet,
  • leave work if asthma has developed because of it,
  • be careful with medications, always remember about allergies.
  1. Strengthen the body through physical education.
  2. Take the drugs on time.
  3. More often take a walk in the fresh air, perhaps it is better to move to another place.
  4. Treat all diseases caused by viruses and bacteria so that there are no complications.
  5. Observe the temperature conditions of room temperature and water when taking a shower.
  6. Do not drink alcohol.
  7. Visit your doctor periodically.

Bronchial asthma can be treated if efforts are made for this. She is not a death sentence, therefore, after hearing this diagnosis, do not be alarmed, but tune in to recovery and take care of yourself! Be healthy!

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Watch the video: Asthma (March 2020).