Sharpening of bronchial asthma attachments. Treatment of acute bronchial asthma in the pre-hospital stage

The aggravation of bronchial asthma in a large number of cases is seen through the interaction of ailing people with being a kind of a teaser, more simply, it seems, an allergen. The most common cause of asthma.

The main symptoms of ailments, which allow one to develop, є: difficulty in mental illness, attack-like dry cough with characteristic whistles and wheezing in the chest, as if there was an instability and lack of symptoms.

Iakshcho at the sick person there was a flare-up of bronchial asthma, the liking and knowledge of the hospitable period, it is not safe to worry. Attack the scent, which is characteristic of cich periods, can carry a direct threat to life.

Likuvannya aggravated bronchial asthma

One of the obligatory minds for the development of effective therapy is given an hour of fire, є respectful monitoring of the camp of a sick person and for him, as effectively as a sign of love.

The aggravation of bronchial asthma can be detected in the home minds, it is necessary to assess the degree of seriousness of the situation in the event of critical symptoms of the accident.

• In case of aggravated and vicious attack of the breath, it is important to preserve the bronchi with a drug of bronchodilator. For many people, people who suffer from asthma are guilty of an inhaler with a shvidkodiyuch lykarsky drug (atrovent, berotek, ventolin, salamol, Astalin).
• Also, for the nobility of attacks and stabilization, I will start using hormonal drugs, for example, prednisolone.
• Euphilin є to finish with an effective method for carrying out therapy in case of aggravation. Yogo can be taken in the form of tablets by clicking on the language.

One of the most important elements of the adaptive therapy is that it is possible for the officials to pick up the stinging ailments. Most of the allergy.

To understand the development of the technique of dichotomous gymnastics, so that it allows the stabilization of the dichotomy, while the suppression of the poison will attack.

Salt povtrya pouring in even more pleasantly on the perebіg ailments. To that, as soon as you are in the sea climate, then you can change the number of attacks. On the current day, it is successful to practice halotherapy and speleotherapy - methods of treating ailments by a path of knowledge in a piece-shaped chamber of salt caves.

If you need help, as if you are fed up with medical experts, then there is a principle in dealing with acute asthma.

1. It is necessary to carry out an analysis of the stage and the degree of gravity. It’s worthwhile for the recognition of the correct liking and the mark of the inheritance for the inheritance, which is not unbeatable for life. As soon as the assessment will be carried out by the doctor in the minds of the stationary, then I will be better for everything, I will assess the indicators of the function of the outgoing dichotomy and the level of shelter for the purpose of making it sour.
2. Another important step is the activation of triggers, that is, drastic factors (allergens).
3. It is possible to clarify the treatment of the drug, as it becomes stagnant when the front is sharpened, which includes nutrition, it is necessary to take a dose of drugs, which is known for bronchospasm, and how it can be used for the rest of the drug.
4. The scale of the sign of the likeness to lie down at the stage of the severity of the sharpening.

Bronchial asthma is an important chronic illness, as it becomes progressive in character. From the aggravated asthma, there is a slight attack of breath, which can be seen at any moment. With no time and quality help, such an attack can easily end in death. Significant aggravation of bronchial asthma is infrequent. The stench is in less than 5% of vipadk_v, and a little bit of a trace of it can be sumny.

It goes without saying that bronchial asthma aggravated, I will become a patient who will die, if there is a vignette, there is a strong backwardness, cough, wheezing with a whistle, and seeing a feeling of pressure in the breasts. Explains the fact that in the bronchi there is a sound of enlightenment, before you have a spasm and problems with the symptoms. The main reasons for the appearance of attacks of poison are the wrong choice of methods of treatment, non-control of these methods and contact with a factor that provokes the attack (trigger).

When provoking ailments and ailments

Prior to the factors, which provoke the importance of sharpening, the following should be included:

• allergic speeches;
• pollutant;
• cold and flu;
• weather changes;
• medicinal preparations;
• stressful situations;
• kurnnya.

The severity of aggravated bronchial asthma varies from easy to fatally insecure. At the first vypadku pogirshennya insisted step by step. Period, for every child it will be better, maybe from some years to some days. It’s an hour to see the ringing of the dichny nobles for the rakhunok of setting the traffic jams in them. The reason for this phenomenon can be the status of infection or lack of drug therapy.

I will call it a lingering obstruction with episodic appearance of spasms in the bronchi. The first type of zagostrennya, which is most common.

Another type of zagostrennya is the growth of the stun, tied with a spasm of smooth muzzles of the walls of the organs of the environment. Such attacks are typical for young children. Provokuvati їх it is possible to improve the emotional background (stress), taking medications along with pyrozolone for їх intolerance, in case of contact with an allergen. Such attacks are not safe and often end up lethal. It is tied with a tse z tim, but it is not possible to preserve the qualified medical help with a cob of zagostrennya. Negatively, there can be a misjudgment and underestimation of the degree of severity of the patient.

A very sensible group of patients, for those who like to die, the hour of a quick attack is even great.

Ailments that take medications from a group of corticosteroids, for that matter, they have taken them in less time for that.

It is intended to talk about the important stage of ailments, and in the whole period bronchial asthma is most important. Another category of patients is people who have already suffered an attack. It is worth mentioning that there are medical tributes, about 60% of people with illnesses re-transfer acute asthma. It is up to a group of people to have children with psychotic and adolescent ailments (epilepsy, tsukroviy diabet), low material, social and cultural life.

Not just people of the young age (from 15 to 25 years) and representatives of the older generation. The stench is the most smart to the point of panic and due to the fact that you cannot control your emotions. Aggravated ailments often occur in patients with ailments of an important stage, with the necessary use of several types of medications. Until the whole group gets sick, systematically disrupt the treatment schemes, skip the intake of drugs, which ignore the sign of the drug.

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Likuvannya aggravated asthma

The tactics of improving the lykarskoy additional help to ground on the offensive principles:

• yakomoga shvidshe know the obstruction of the dichal nobles;
• get around the hypoxia;
• update self-awareness;
• viznachiti methods of falsified treatment;
• Navchit the patient competently for a second attack.

Farther away, the development of bronchial asthma includes a complex of visits, which are directed to the prevention of repeated fire attacks. For the cob, the doctor will estimate the steps of the severity of the stinging and will clarify, at the same stage, the ailment has been overwhelmed. Another stage is the use of triggers to provoke an attack.

It is obligatory to carry out an assessment of the flow treatment and its efficiency. To clarify and regulate the dosage of bronchodilator drugs and methods of prescribing. An important point: we got used to corticosteroids, as well as in some doses.

Symptoms of ailments are quilted in dynamism, which is necessary, the procedure for saturating blood with sour and gases is carried out. If you fall short of the camp and if you are ready to attack, the patient will start the correct cure with an inhaler, an individual plan will be put in place for the first dolikarskoy help, which is guilty of always interfering with a sick person.

Name the plan to be put in writing in two examples: one is used at home, the other is to start a sick man in the place. This is necessary for the fact that, once the fire is set in a huge city, people were able to help a sick person take an attack of breath. Obov'yazkovuyu such a plan є in times, if the attack of bronchial asthma is indicated in children of a young age. Witchers and witnesses of the little one were to blame for the problem.

Increased zagostrenya including and self-assessment, we will become healthy. If the destruction is noted, for the fact that if it does not give a proper product effect, it is necessary to inaccurately turn to the product. The ailment is guilty of knowing the first signs of the current fire and mother's power at any hour to get in touch with the doctor.

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Likuvannya attacks of poison in the minds of the home

Stop killing zagostrennya, come in now and then we will attack you, but you will be sent out before the trip. I will help a patient in the snake of nadati on his own, not only by accepting a sickness, but also to give strength, in addition to being able to help trimati to control his ailment. Those who know it and competently have ailments to fix their own additional help, to lay down all the information of a licensed user and a patient's navigator, secured with tags and tools. The ailment is obov'yazkovo blame the nobility and in the form of a sign of destruction I will become, so I get to go in for medication.

With the preparations, which can be used in the home, it is possible to see bronchodilators and corticosteroids. Bronchodilators reduce bronchial obstruction, and corticosteroids assimilate and reduce bronchial secretion.

pid aggravated bronchial asthmathe reason for the progressive growth of expiratory badness, cough, wheezing or wheezing in case of recurrent symptoms.

Zagostrennya is characterized by progressive build-ups of bronchial obstruction, which can be assessed according to the change of a forced vidih ​​in 1 sec. (FEV1) for any peak performance (PSV), as well as for the increase in PSV variability in case of additional monitoring of the indicator. These indicators more effectively represent the severity of aggravated asthma, less clinical symptoms.

Classification of severe aggravation of bronchial asthma: According to the severity, you can see the legends, moderate and important acute asthma.

Lighter sharpening: physical activity is saved, stuntedness when walking, rises in motion - symptoms, symptoms of sickness can be increased, frequency of dysfunction is abnormal, additional muscles in the act of dying, do not preserve, wheezing wheezing in serous auscultation , paradoxical heart rate is less than 10 mm Hg. Art., pіkova іsvіdkіst vidikhu (PSV) іs for a bronchodilator intake more than 80 vіditsіvіvіvіd nіvіdnіvіd nіvіdnіtkіvіon nіdіvіdnіlly for a sick value, Ra sourness - the norm, the test is not consumed by the test, Ra in carbon dioxide gas is less than 45 mm. Art. (According to the recommendations of the EPR-2 experts - 42 mm Hg. Art.)

Moderate zagostrennya: physical activity is bridged, backwardness when growing, growing backward - phrases, ailments get overwhelmed, frequency of dysfunctions, additional musculature in the act of dying, most often take care of one's fate, with auscultation of lungs - fast hearty, 1 chilin, maybe a paradoxical pulse of 10-25 mm Hg. Ra sour more than 60 mm Hg, Ra in carbon dioxide less than 45 mm Hg, Sa sour 91-95 vid.

Vazhke zagostrennya: physical activity is sharply reduced because of the daytime, sleepiness in calmness, rosy mova - okremi words, ailments of abnormalities, the frequency of movement is more than 30 in sickness, additional muscles in the act of energy take care of the fate of the child, in case of auscultation the heart rate is much more than 120 per chilin, the paradoxical pulse is more than 25 mm Hg. Art., pіkova vidkіst vidikhu (PSV) when taken to a bronchodilator less than 60 hours a day from the right ones, or individually painted for a sick value (according to the recommendations of the EPR-2 less than 50 hours) or up to 100 years in a few years Hg, mossy cyanosis, Ra in carbon dioxide more than 45 mm Hg, Sa acid less than 90 vidsotkiv.

Life-threatening zagostrennya: physical activity is lowered abruptly, for the daytime, for a dull moment, for a quiet time, for a daytime, for a nightmare, for a coma wheezing on the day, dyhannya on the surface, "no" lung, bradycardia, the appearance of a paradoxical pulse is to indicate about the muscular sensation, the appearance of the appearance of those who take a bronchodilator is less than 33 , cyanosis, Ra in carbon dioxide more than 45 mm Hg, Sa acid less than 90 vidsotkiv.

The presence of decile parameters (not necessarily all) allows you to give a reference characterization of sharpening. Bagato s cikh parameters boules are systematic, so that the stench is deprived of fun.

Slide to mean that the severity of the sharpening is not synonymous with the severity of the overbearing of bronchial asthma, I want a sound ringing between them. So, the easy form of the sharpening, as a rule, is the power of the easy sickness. With moderate and important asthma, light, moderate and important aggravating can be prevented.

The tactics of treating bronchial asthma are initiated by the stage, on which it is carried out: buinok, "shvidka dopoga", stationary.

The algorithm for the therapy of acute bronchial asthma, regardless of its severity, is based on the following principles:

1. At the first glance, it is necessary to assess the severity of the attack, to carry out a flow meter, if possible, a pulse oximeter (in the stationary - EKG, X-ray, to monitor the calories of a female, blood gas).
2. Carry out a physical adjustment for the assessment of the severity of the aggravation and the appearance of possible accelerations (pneumothorax, pneumomedicastinum, atelectasis, pneumonia, etc.).
3. Visually the nature of the earlier therapy (the number of doses of the bronchodilator, how much was administered, an hour, after the moment of the last intake of the bronchodilator, when glucocorticosteroids (GCS) were consumed, and the dose).
4. Clarify the triviality of the aggravated and the other possible reasons for overturning the hospitalization of the bronchial asthma drive, the manifestation of asthmatic statuses (or important asthma aggravations) in the anamnesis.
5. Vidaliti causally significant allergies or triggers zagostreni (like the stench vidomі).
6. Carrying out non-emergency therapy in the fallowness of the severity of the aggravation. In the process of therapy, that caution, the severity of the sharpened can be glanced over.
7. Keeping an eye on dynamism for clinical symptoms, monitoring of a high degree of infection (PSV), Sa acidity, blood gas.
8. Start of ailing koristuvannya nebulizer і dosed aerosol inhaler.

When I look at the animals, I respect for the visibility of the patient, I know about the development of an important and even life-threatening asthma disease - the destruction of the property, the development of the problem, through the ailments, some of the short phrases, the dical noise during auscultation, pediatric emphysema, paradoxical pulse greater than 25 mm Hg. Art. (In case of non-destructive camps, the paradoxical pulse starts behind the first Korotkov tone at the height of the breath and on the glybin of the vidih ​​- if the storage difference is more than 12 mm Hg, then the paradoxical pulse will be positive), when the frequency appears to be 50-60 or the most important for a sick person, or less than 100 liters per chilin.

At times, if the cob stump of a sick person is evaluated as slightly or moderately heavy, it is necessary to start the ingestion of beta 2-agonists, or through the dosage of an inhaler with spacers of a large volume (a cob dose of 400-800 mcg), perhaps through the nebula mg). After 15-20 hours of inflammation, there is a fear of the severity of aggravated bronchial asthma.

Algorithm for the therapy of lung aggravation of bronchial asthma at the stage "outpatient assistance - shvidka additional assistance"

If the criterion is for the sick person, it is easier to assess (the PSV is more than 80% of the proper or individually shortened value after 20 minutes of ingestion of 400 μg of beta 2-agonizing of short action through a non-spacer a , effective beta 2-agonist trivє 4 years).

In case of a slight stinging of ailments, you can carry out a course of stinging therapy independently, according to the plan folded in advance (it’s possible to visually draw the first two or three dibs).

In case of aggravated bronchial asthma of a light step, it is recommended to:

1. To continue the ingestion of beta 2-agonizing skin for 3-4 years and lasting 1-2 dib.
2. For the prevention of attacks of bad health, it is necessary to use a change in anti-apical dysfunction: in the case of corticosteroids in medium or high doses, since the patient did not take away the disease in the past, and for the glucose treatment.
3. The patient is guilty of perebuvati under the outpatient visualization of a pulmonologist or a therapist to control the effectiveness of therapy.

Algorithm for the therapy of medium-gravity zagostrenny at stages "outpatient assistance - shvidka additional assistance"

At times, according to the criteria, the sick person is evaluated as a medium-heavy one (PSV is more than 50%, ale less than 80% of the proper or individually shortened value of ingestion of 400 μg of beta 2-agonist through a short distance of air):

1. Producing beta 2-agonizing agents through a nebulizer (2.5 mg) or doses of a large volume inhaler with spacers (400 mcg) for three years.
2. Assign systemic steroids (30-60 mg single dose).

With positive dynamics in a year (PSV is more than 80% of the proper or individually shortened value), ailments can be abandoned at home.

The patient is guilty:

1. Prodovzhuvati іngalyatsіy beta 2-agonіstіv 2.5 mg through a nebulizer or 400 μg through a skin spacer for 4 years and a stretch of 2 dB.
2. Take systemic steroids in a dose of 40-60 mg in one or two doses for 3-10 days.

If the patient has previously removed the ingestion of corticosteroids, it is recommended to increase the dose 2 times. If the ailment has not taken the ingestion of corticosteroids, then it is necessary to take it in medium or high doses.

The patient is guilty of perebuvati for a visual stretch of 3-7 days, so as to ensure the development of re-sharpening.

If, for another one year, with a moderately acute effect of the therapy, it is inconceivable, either on the day of the day, then the ailment was blamed for medical aid and was guilty of the hospital's retaliation due to the disease

When transporting a sick person in a car of "good help", they continue the ingestion of beta 2-agonists, add the ingestion of the atrovent, which is to inject a nebulizer (0.5 mg) or a spacer (4-8 inhaled) skin 3 times, 2 times years for demand. You can use salbutamol and atrovent in one nebulizer. If you have an opportunity - Kisneva therapy.

Algorithm for the therapy of important zagostrenny at stages "outpatient assistance - shvidka additional assistance - inpatient care"

For more than one year in case of a moderately severe exacerbation, the effect of the therapy is incomplete, either on the day, or on the cob, for the first year of therapy, to be afraid of the presence of a sick personimportant(PSV is less than 50-60% of nalny, the frequency of the reaction is more than 25 per chv., The frequency of the hearts is very much more than 110 per chv., Problem with growths - the unwillingness of vimovit the phrase, the proposition on one vidih) abolife threatening (PSV is less than 33% of a healthy, "nime easy", cyanosis, weak pulmonary disease, bradycardia and hypotension, abnormal weakness, abnormalities of the disease or coma) ...

Indicated for hospitalization of ailments with bronchial asthma to serve:

1. aggravated bronchial asthma of moderate severity during the daytime effect for a long period of time.
2. Important and non-threatening aggravated bronchial asthma. 3. There are a lot of minds for the provision of quality help and care for ailments in the dynamism of the outpatient stage.
4. Ailments, how to become a group of people who are uncomfortable with the result.

When taking a patient's anamnesis of acute bronchial asthma, it is necessary to reliably analyze the manifestation of factors associated with the development of an aggravated aggravation (a group of risk of an uncomfortable result).

To them are admitted:

1. Evidence in history of non-threatening aggravation of bronchial asthma.
2. Evidence in the anamnesis of the SHVL epizode from the drive of aggravated bronchial asthma.
3. Evidence in anamnesis of pneumothorax or pneumo-mediastinum.
4. Gospitalizatsiyya for the brutalization of extra medical aid by stretching out the rest of the month.
5. More than two hospitalizations extending the rest of the rock.
6. More than three animals for extra medical aid for the last ric.
7. Vikoristannya more than 2 balloons of beta agonies of a short day for the last month.
8. Recent changes in any additional intake of GCS.
9. The appearance of a concomitant ailment (for example, an illness of the heart-vascular system and a chronic obstructive ailment of the disease).
10. Psychological problems (zaprechennya ailments).
11. Social and economic factors (low income, inaccessibility of medicines).
12. Lack of adaptability to therapy.

Likuvannya zagostrennya in the minds of the stationary.

With an important and life-threatening exaggeration of the ailment, the skin should be estimated at 15-30 hilines.

Monitoring the sick person includes:

1. Assessment of clinical symptoms
2. Viznachennya PSV or FEV1
3. The value of Sa acid and gas storage of arterial blood when Sa acid is less than 92%
4. Viznachennya acid-puddle mill
5. Viznachennya instead of cali in sirovattsi blood
6. EHC
7. X-ray of the organs of the thoracic cell (if appropriate).

The ear of love does not go through laboratory tests. Anamnesis and physical condition of a sick person for an hour when heightened may be more important for the choice of a falsified liking.

When looking at a sick person for the first time, it is necessary:

1. Assess the severity of the sharpening, carry out a peak flow measurement based on the PSV values.
2. Visually the nature of the conducted therapy: bronchodilators, glucocorticoids and doses.
3. Clarify the triviality of the aggravated and the other possible reasons for overturning the hospitalization of the bronchial asthma drive, the manifestation of asthmatic status (or TOA) in the anamnesis.
4. Carry out a physical conditioning for the assessment of the severity of the aggravation and detection of possible acceleration (pneumothorax, pneumomedicastinum, atelectasis and in.).

Obov'yazkova post-ingalation we use sourness behind the addition of nasal catheters or Ventura masks (40-60% Fi sourness) to saturation sour more than 90%.

Triva abo to repaired (even before tsyo patients not to be used) with the use of systemic GCS.

Indicated for the sign of GCS in case of aggravated asthma є:

1. Ineffectiveness of beta-agonizing in short films.
2. Moderately heavy, important or life threatening aggravated asthma.
3. Hormone-dependent patients.

1. Experts EPR-2 recommend the use of systemic corticosteroids (prednizolone, prednizolone, methylprednizolone) at 120-180 mg / add orally in three or even priyomi for 48 years, at least 60-80 mg / add to quiet pyr, while the PSV is not reached % of the proper or individually shortened indicator, for which 40-60 mg is consumed per oral dose in one or two doses. You can take hydrocortisone 200 mg intravenously.

2. The British Thoracic and Canadian Partnerships recommend the following doses: 30-60 mg / add prednisolone orally or hydrocortisone 200 mg intradermally for 6 years. I will prescribe an additional dose of the drug to be taken without lowering for 7-14 days, or until no symptoms of bronchial asthma are detected, normalization of physical activity, PSV adjustment to short for a patient, the maximum value (80% during the day) up to the whole systemic corticosteroids in the form of basic therapy). At the same time, it is especially obnoxious for the possibility of one-time administration of the drug during the trivial therapy of GCS 15 days or less.

As a bronchodilator therapy, a combination of beta 2-agonists and holinolytics, which can be administered through a nebulizer or a spacer for skin 20 chilin, is used for a long period of time.

Even after 20 minutes, after the last ingestion of PSV, more than 50% of the lasting or individually short patient value, after turning the patient's standard mill PSV is more than 60-70% of nasal, 2.5 mg of skin for 6 years (4 times for dobu).

Even after 20 minutes the last ingestion of Ventolin PSV becomes less than 50% of what is needed for the patient, then repeat the ingestion of Ventolin (you can use the combination of non-hollow grains). a stretch of years.

Even after 15-20 hilines, for the last ingestion of the PSV, it takes less than 50% of what is good, or what is most important for the sick, then the ailments are due to the hospitalization in the case of reanimation.

Shown for the transfer of a sick person at the notice of reanimation є:

1. Significant zagostrennya bronchial asthma (in case of absence of the effect of the conducted treatment lasting 2-3 years).
2. Life-threatening zagostrenia bronchial asthma with development is a sign of the approach of zupinka dikhannya or vtrati svidomostі.

Therapy in the form of reanimation:

1. Oxygen therapy.
2. The introduction of beta 2-agonist іngalyatsіyno (skin 4-6 years old).
3. Glucocorticosteroids orally (if you have ailments) or parenterally.
4. Aminophyllin intravenously 5-6 mg / kg skin 10-30 quiline (the dose is reduced, if the patient has taken theophylline before it is appropriate), in a given dose, the dose changes to 0.6-1.0 mg / kg (720 mg / dob, maximum Dobova dose 2 r).
5. Can be administered parenteral beta agonists.
6. In case of ineffectiveness of the conducted therapy, a respiratory tract is indicated.

Shown up to piece ventilation legends (SHVL):

1. Obov'yazkovі - loss of svidomostі, zupinka heart, fatal arrhythmias of the heart.
2. Non-laxity - an increase in hypercapacia and respiratory acidosis (pH less than 7.15), refractory hypoxemia, impaired dysfunction, anxiety, swelling of the respiratory muscles.

For a high number of accelerated and lethality of ailments from TOA on a plateau, it is recommended that the tactics of keratoven hypoventilation (permisive hypoventilation) be improved, to the bearers of the ineffectiveness of the disease. The cob parameters of the respiratory tract are responsible for the vibration-controlled mode with a quiet volume of 6-8 ml / kg, with a ventilation frequency of 6-10 per 1 hour, with an inspiratory flow of 80-100 l / min. 2 introduce bicarbonate internally.

Criteria for the transfer from the revision of the reanimation:

1. Outside of kupiruvannya asthmatic status (important or life threatening aggravation of bronchial asthma.
2. Reducing the severity of aggravated bronchial asthma (NPV less than 25 per chilin, heart rate less than 110 per chilin, PSV more than 250 liters per chilin or more than 50% of the proper value, rasys more than 92 mm Hg and more Sa.

Vipiska to the stationary.

The sick person should recognize the preparations recommended for the vipist, taken for 12 years (bazhano for 24 years) before the patient looks at the hospital.

At the same time, it is necessary to overturn, for the purpose of controlling control, overcoming the impairment:

1. The need for short-lived beta 2-agonists is not often, not through the skin for 4 years.
2. Normal physical activity of the patient.
3. Sickness does not occur at night, or in the early ranks of the year.
4. Dans of the clinical routine are normal or close to normal.
5. For receiving the ingestion of beta 2-agonists of a short period of PSV and FEV1 more than 70-80% of the most appropriate or the most beautiful for the patient value
6. Dobovy rozkid PSV less than 20%. At the same hour, it is necessary to realize that for people with ailments, the value of PSV can grow to a good level of growth (especially, it is worth noticing rank failures), at that time as all of the criterion of the situation.
7. Patient vmіє correctly koristuvatisya recommended for delivery of the drug.
8. The patient will accept oral and ingalatory steroids in bronchodilators.
9. Hvoriy rozumіє, yak yomu lіkuvatisya sіslya whiskey.
10. At the patient's peak flow meter, who is the patient in my mind, koristuvatisya.
11. The sick person has a written plan for aggravated asthma.

For a whiskey from the hospital, the patient is guilty of being overtaken by a visual therapist or a pulmonologist for 4-6 days.

Thus, the current diagnostics and therapy of acute bronchial asthma include an assessment of the severity of patients with acute bronchial symptoms, a sign of beta 2-agonizing injections of cold serum through the palate, the first line for the suppression of bronchial obstruction.

I would like to encourage a wider implementation of these methods in clinical practice to allow the improvement of the effectiveness of the treatment of bronchial asthma.

ASTMATIC STATUS.

An asthmatic stance is an asthmatic attack of severity that is resistant to the acute for ailing bronchodilator therapy. The formation of a chain of resistance is tied to a progressive functional blockade of b-adrenergic blockers. In the case of asthmatic status, there is a great importance in the presence of mucociliary transport disorders.

Asthmatic stagnation - bronchial asthma is protractedly aggravated, the basis of which is the bronchial obstruction process (mucobronchostasis) and the accumulation of clinical syndromes: respiratory, hemodynamic and hypoxic encephalopathy.

Ethiology asthmatic status

Among the main factors, which lead to the development of the AU, see: massively injecting allergens, bronchial and sinus infections, infectious ailments, pardons in sick people, psycho-social You may not be able to get into the cause of the AS in half of the problems. More than half of the AS types are diagnosed in patients with steroids for bronchial asthma.

Tactical measures for carrying out drug therapy in patients with bronchial asthma, and in 70% of cases, are the reasons for the development of AS. It is unjustified that any type of glucocorticosteroid drugs is the cause of AS in 17-24% of cases.

Likewise, in 16.5-52.3%, the development of the AS is uncontrolled in the uncontrolled storing of English sympathomimetics. With the help of a large and good vaccination, the "ricochet" syndrome is characterized by progressive attacks of poisonous attacks through the bronchoconstrictor process of accumulating metabolites of beta-adrenoceptors. Talking about sympathomimetics in order to develop the AU. However, it follows that it is necessary to eliminate the "ricochet" syndrome and the death of the sick through the ineffectiveness of the ingestion therapy with sympathomimetics in case of severe bronchial obstruction and malfunctioning of the disease. The development of asthmatic status can also be provoked by the intake of non-steroidal anti-inflammatory drugs, beta-blockers.

PATHOGENESIS asthmatic status

The main element of the pathophysiology of the AS is the bronchial obstruction is swollen, surrounded by bronchial obstruction, bronchospasm, impaired bronchial drainage and obstruction of the bronchial tubes with mucous plugs. Everything should be done to make it difficult to breathe, to activate and to increase the vidih, to reorganize at the viglyadia of the decrease in VC, FVC, OFV, and the peak performance of the vid (PSV).

In addition to excessive bronchial obstruction in the pathogenesis of AS, the role of the development of "over-inflation" of the lungs is significant. On inhalation, a deyake of enlarged bronchial tubes is seen, and the patient inhales more, now he sees through the sound, obstruct the high tracheobronchial with the secret of the quiet way. Try to see the sick person see all the dizzy obsyag to bring up the vise and development of the phenomenon of expiratory collapse of the bronchial tubes to a sharp intra-pleural movement, so that it can be brought to a superficial contemplation of the legends. With a whole progression of arterial hypoxemia, the legenevius of the judgment is advancing, there are signs of a right-handed lack, the heart index is sharply reduced. The most important development is the syndrome of intra-dyshnoy muscles through the majesty, ale-ineffective robotics of respiratory mutilation. Kisneva price of the reaction is increasing, metabolic acidosis develops.

Arterial hypoxemia, which supervises AS in 100% of cases, is also tied due to the inhomogeneity of the disease of legacy parenchymal diseases and to the severe deterioration of ventilation-perfusion diseases.
Hypercaponia also occurs with AS, altogether in a significantly smaller number of vapors, as a result of a decrease in alveolar ventilation due to bronchial obstruction and dysfunctional musculature. Respiratory acidosis, which can become hypercapacitive, is often superimposed on metabolic alkalosis, and sometimes promotes the development of metabolic acidosis as a result of trivial tissue hypoxia and respiratory disease.

AU often supravodzhutsya delivery of hemodynamics of patients. The price is tied to the significant changes in the intrathoracic grip, especially to the vidiha, and also to the "over-inflation" of the lungs, to bring the front of the heart and the right heart to the lowering, the collapse of the lower empty season. On the other hand, there is the phenomenon of the appearance of the mid-slit septum in both the heart and the decrease in the diastolic resemblance of the l-slunk. In addition, with AS, a negative intrapleural vise is seen swirling until an hour is inhaled, until the change in the lingual shuttle is increased and the development of the so-called "paradoxical" pulse of a significant amount of arterial systolic phase. A decrease in the "paradoxical" pulse can be reduced either about a decrease in bronchial obstruction, or about the manifestation of a swollen dichotomy of muscles and the unwillingness of a significant decrease in an internal pleural grip on inhalation. Hyperventilation of legends, in order to make it possible to see it, with AS, it is often possible to develop hypotension and thickening of blood.

KLINICHNA PICTURE

Klinichny transfer of the AS to three stages (Chuchalin, 1985).
Stage I (obvious compensation) is characterized by development until it is not stopped by the attack of breath. Ailments perebuvaut at svidosti, adequate. Zadishka, cyanosis, pithiness around the turn. Percussion - Legendary sound with a boxed vidtink, auscultatory - dichanna weakened, carried out in viddili, dry wheezing. At this stage, hyperventilation, hypoxemia, and hypoxemia are most often promoted. FEV decrease up to 30% of the proper value. The most troublesome symptom is the appearance of sputum.

Stage II (decompensation or "nime easy") is characterized by an important stump that has increased bronchial obstruction (FEV,< 20% от должной величины), гипервентиляция сменяется гиповентиляцией, усугуб­ляется гипоксемия, появляются гиперкапния и респираторный ацидоз. Аус­культативно выслушиваются зоны "немого" легкого при сохранении дис­танционных хрипов. Больной не может сказать ни одной фразы, не пере­водя дыхания. Грудная клетка эмфизематозно вздута, экскурсия ее почти незаметна. Пульс слабый, до 140 в мин, часто встречаются аритмии, гипо­тония.

Stage III (hypoxic hypercapnic coma) is characterized by an extremely important stanchion, cerebral and neurological changes. Dikhannya Ridke, Surface. Pulse nodular, hypotonia, collapse.

Auscultatory phenomenon of "no lung". Progression of respiratory or metabolic acidosis in the background of the disease. However, for ailments in an important country, the signs are not easy to assess in dynamism, that in this hour with AU it is the main method, which allows it to be easy and fast, є flow meter. About the extremal stanza of a sick person: the value of PSV is less than 120 l / hv, the unkindness of the flow meter maneuver, or the appearance of positive dynamics as a result of treatment.

A.G. Chuchalin (1985) Vidіlyaє dvі forma AS: anaphylactic and metabolic.
Anaphylactic form of AS is characterized by rapid appearance and growths of bronchial obstruction (importantly for bronchospasm), clinical symptoms of AS, progressing arterial hypoxemia. For its sutta, the form of AS is an allergic reaction of the reagin type at a different exogenous factor. As a rule, the form of AS develops as a result of the intake of drugs, up to which the patient has a sensitivity (antibiotics, sulfanilamides, bio drugs, non-steroidal anti-inflammatory drugs, dextran, enzymes.) In addition, the form is given for the AS wininikє in case of dyhanna witnesses with the smells of Farbi and perfumery, as well as in case of mental trauma. The metabolic form of AS is rapidly developing, as it is characterized by a step-by-step (stretching of decilkoh days) development of the clinical symptoms of AS, a decrease in the amount of physical pressure. Naybilsh often lead to the development of the AS formulation: uncontrolled implantation of drugs, especially glucocorticoids, sedatives and antihistamines, aggravated bronchial infections. For the formation of AS, resistance to bronchospasmolitics is characteristic.

The death of ailments in AS occurs as a result of progressive bronchial obstruction, in case of unsuccessful medical visits, as well as in cases of important hemodynamic lesions, heart disease, or as a result of pneumothorax. Krіm tsogo dosit often leading to fatal outcome taktichnі pomilki lіkarіv: pіznіshe i in nedostatnomu obsyazі priznachennya kortikosteroїdnih preparatіv, peredozuvannya teofіlіnu, glіkozidіv, agonists, sedatives preparatіv, nadlishkove Introduction rіdini, posilennya bronchospasm pid hour sanatsіynoї bronhoskopії, progresuvannya bronholegenevoї іnfektsії on tlі SHVL.

Causes of death in status asthmaticus:
1. Progressive asthmatic stagnation, which does not yield to therapy
2. Inadequate therapy: lack, for example, lack of steroid intake
zanadto massive, for example, overdosing izadrin, theofilin
3. Intrusion of sedative abo drug addiction
4. Tied with a leg Legeny pathology: pneumothorax infection, aspirate masses
5. Inadequate implementation of piece ventilation of the legends or breakdown of the ShVL apparatus
6. Hemodynamic damage:

• hypovolemia, shock
• bunch of legends
• hypervolemia
• negative grip in the pleural emptying

7. Raptova zupinka heart

ROSLADY, CONNECTED WITH asthmatic status

internal vascular volume

Hypovolemia due to changes in blood volume by 10%; The cost of supervising the increase in hematocrit and concentration of blood plasma. The reason for this apparent change in plasma production is unclear. Change of internal vascular volume can be screwed up to circulatory collapse.

It has been described that there is a diagnosis of hypervolemia, for those with ailments in asthmatic status, an antidiuretic hormone is approved. In such a rank, one can develop water intoxication and hypernatrium, which can be insured as the reason for the change will become ill.

NABRYAK LEGENIV

The increase in the number of births in the legends of the Veda before the further obstruction of the bronchial tubes in asthmatic status and gas exchange. For a supplement to the hypervolence, there are plenty of legends, you can also find shirts of the SHVL. The tendency until the close of the other bronchial tubes is increased by the FOE and the elastic traction of the fabric and the leg. The magnitude of the intra-pleural grip, in such a rank, is more negative with inhalation and more and more positive with the appearance of only an important obstruction of the bronchi. In one of the dosages it is shown that intrapleurally the vise with the pull of the inhalation and vidych in children in asthmatic status colivalis "from -7.7 to -25.5 cm of the water stop with a norm of -5 cm of the water stop. , how about the penetration of the old age in the legend.

NADNIRKOVA INSUFFICIENCY

All ailments for bronchial asthma, which in the past were eliminated by hormones, are responsible for the asthmatic status of the systemic elimination of corticosteroids, so as the function of these supernaturals can be rapidly changed, at least on the day.

CENTRAL NERVOUS SYSTEM

If the symptoms of asthmatic status progress, the ailments are fraught with frailty, and the symptoms are confused. Win can stavati baiduzhim, right up to the development of a comatose stun. The reason for this is unclear. Factors that infuse the central nervous system into the mill can be hypercapnia and hypoxemia, as well as maternal weakness, the effect of drinking and, possibly, water intoxication. The destruction of the sick person's witness є with a grave acquaintance, not only to see the severity of the sick person, but rather to oppress the unhappy kind of therapy.

METABOLIC SHEETS

Metabolic acidosis is susceptible to developing into asthmatic status due to the increase in blood in the place of lactic and pyrovic acids. An increase in the intensity of glycolysis and anaerobic glycolysis in the spinal muscles during the period of supra-mucous obstruction of the hypochondriacal pathways can also lead to a change in the acid-puddle rye in the sour side.

In patients with asthmatic status, the activity of aspartate aminotransferase, lactate dehydrogenase and creatine phosphokinase in the blood is increasing. The concentration of ions Mq and K + in syrovatz blood becomes normal. The main value that changes in syrovatz blood is 2,3-di-phosphoglycerate, the concentration of which changes up to 17.5 μmol / g Hb "at the upper inter-norm up to 16 μmol / g Hb; possibly, due to the compensatory mechanism for delivery I am souring to fabrics with a stretch of asthmatic status.

Differential diagnosis

A patient, who can get on a bad breath and wheeze, at the same time with the active symptoms of expiratory wheezing and intercourse, the diagnosis of a hostile attack of bronchial asthma, too,

Obstructions of the upper, WILD whores

Internal chest obstruction of the trachea is also important for respiratory wheezing, which does not appear as wheezing during bronchospasm. Such tracheal obstruction may be accompanied by tracheal stenosis, an aberrant Legendary artery, or a side effect. Diagnostic help to clarify the ear of the disease, but it can only be confirmed during bronchoscopy.

If you want extrathoracic obstruction of the trachea or the larynx of the wickle, it is difficult to breathe, the stench can simulate bronchial asthma. We spared obstruction, a great pill, shoved into the mouth of an infant patient, roztineni like "bronchospasm" and internal infusions of aminophylline.

EMBOLIA Legendary artery

Backside and expiratory wheezing can be spontaneous in case of embolism of the legacy. Differential diagnosis of the development of the angiography of the Legendary Sudins. Scanning will show a change, both for that and for other processes.

NABRYAK LEGENIV

Nabreak legen often supervises the swelling of peribronchial spaces and the appearance of expiratory wheezing. For the diagnosis, you can use a catheterization of the leg artery with the aid of a floating balloon catheter. An abnormal condition with a normal grip is important for diagnosis, however, it can be suspected in case of a clinical condition.

LEGENEVA INFECTION

Gostry bronchitis or bronchialitis can simulate bronchial asthma. To make a diagnosis, you can help to diagnose sputum from farbuvannya according to Gram. Before leukocytes are observed, leukocytosis is often promoted when there is a leukocyte infection.

RISE OF THE LUNGS

Got it in the interstitial legends or in the middle you can stifle alternate paths, simulating spasm of the smooth muscles of the bronchial tubes. Expiratory wheezing can also be spontaneous in pneumothorax.

Aspiracy of shlunk juice

Aspirate and expiratory wheezing may but also aspirate aspirate shlunkovy together. At the same time, characteristic changes and diagnosis are not visible on the roentgenogram of the breast cancer; set by the method of victories.

LIKARSKI ZASOBI

Likki can experience a classic picture, identical to the classic picture in bronchial asthma, in case of hypersensitivity to them, even without a mediocrity.

Principles and methods of treatment of AS

Lykuvannya AS, as a rule, medication. In case of failure of conservative therapy by the vibration method, mechanical ventilation of the legends. The severity and the severity of the development of the clinical symptoms of AS dictate the need to provide additional assistance to patients in the minds of intensive therapy units or reanimation.

The main principles of AS therapy are: carrying out of a tense bronchodilating therapy, an infallible ear of glucocorticosteroids, the speed of carrying out medical visits, the ease of procedures for a patient, a correction of the second blood pressure

Glucocorticosteroids are the number one drugs for AS. Smell of building usuvati functional blockade of beta-blockers. The introduction of these drugs is guilty but it is not secret, it is not necessary to consider the therapy with glucocorticosteroids as monotherapy, as well as the effect of these drugs when administered internally, after 1-2 years. The dose of hydrocortisone for AS is 600-1200 mg / day.

Therapy with glucocorticosteroids reg os is carried out with a dose of 0.5 mg / kg predisolone with further progressive dose changes. If hormonal drugs are administered in sufficient doses, the effect of sympathomimetics is eliminated.

In a very important country of patients, who are suffering from a rapidly growing generalized bronchial obstruction, with a low efficiency of medical visits, a course of pulse therapy with methylprednizolone (1000 mg) is shown. Dosvid of pulse therapy in AS is unambiguously indicative of the high efficiency of the method of dealing with this category of ailments.

Teofilin zalizhaєtsya zasob, often to be implanted with AS Pochatkov, the dose of Euphilin is 5-6 mg / kg, in general, it is reduced to 0.6-1.0 mg / kg. The maximum additional dose of euphilin is 2 g. Stagnation of drugs in theophilin in the form of continuous monitoring of the heart activity through frequent tachycardia and arrhythmias is observed. Described fatal vapors, tied from the intake of drugs in theophylline for AS.

With renewed sensitivity, beta-blockers can be switched on before beta-2-adrenergic drugs therapy. The stench is introduced, as a rule, in the first place. There are great prospects for the storage of beta 2-adrenergic agents in the vigilance of aerosol inhalation, obtained for additional nebulizers (rosters) of young modifications, such as the generation of aerosols in a fraction of 0.5-5 microns. At the same time, prolongation of the ingestion is attainable, in the event of the need for a ligamentous synchronicity in the air and aerosol, it is necessary to carry out the relaxation of the mental health of the patients, in order to achieve a great amount of armor.

With anaphylactic form of AS, the introduction of adrenaline is indicated. Name it, enter it in a pedagogical way. Deyaki dwarfs vvazhayut for more beautifully with AS, injecting adrenaline intravenously with a rosary of 0.1 mg / kg / min. However, tsya therapy is supervised by numerical side effects, and to carry out at a lack of efficiency of treatment, or if collapse is evident.

If there is evidence of bronchial infection and daily allergic reactions, antibacterial therapy is indicated.
Oxygen therapy is indicated for AS in times of arterial hypoxemia (PaO2 less than 60 mm. Hg. Art.). With її carried out with less than 30% souring, as a rule, the growth of hypercapacity is not discouraged. Acid therapy should be carried out behind an additional nasal cannula, or Venturi masks with shvidkistu 1-5 l / hv. The control of the arterial blood gas meter should be carried out after 20-30 minutes after the cob of oxygen therapy, as it is used efficiently as a result of the preparation of a level of RaO2 greater than 80 mm Hg. Art. і SatO2, more than 90%.

Additional ventilation of the legends (VVL) is shown in the context of preservation of arterial hypoxemia, progression of arterial hypercapnia in patients on aphids of oxygen therapy, as well as in case of swollen dychial muscles. Basically, IHL - play an hour to carry out massive drug therapy, direct on the elimination of bronchial obstruction, without the rotting of the spontaneous behavior of the patient. VVL is carried out both in triggered and in adaptive modes behind the addition of facial abnormal masks. For the prevention of expiratory collapse of other bronchial tubes, as well as for the reduction of overworldly energetic vitrates, the dichotomy in patients with a high level of spontaneous positive vise in the mind of the water is recommended for the vigilance of vigorous intercourse. Art. under the control of hemodynamic indicators.

Shown before the transfer of the patient to the piece ventilation of the legends (SHVL) with AS є:

obov'yazkov_:
1. Destruction of svidomostі;
2. Zupinka heart;
3. Fatal heart arrhythmias.

optional:
4. Progressive acidosis (pH< 7,2);
5. Progressive hypercapnia;
6. refractory hypoxemia;
7. Driving behavior;
8. Destruction;
9. Bends of the dichal muscles.

The main problem, as soon as an hour is spent on the HVL at the ailments of the AU, is the failure of the lungs to "over-inflate". At this point, it is recommended to follow the offensive tactics: carry out the SHL, do not allow the development of a high vise in the dichny way (less than 35 cm of water. Art.), The frequency of ventilation is not guilty of changing 6-10 per min, dichny obsyag - 6-8 ml / kg. It will inevitably lead to a decrease in alveolar ventilation and an increase in hypercapnia (permissive, or hypercapnia is permissible). Adequate level of PaO2 will be taken for an additional adjustment instead of sourness at the intake of more than 60%, lowering the pH of the arterial blood below 7.2 should be corrected to the introduced sodium bicarbonate. The strategy of controlled hypoventilation allows an adequate level of oxygenation of arterial blood to be ensured, which significantly decreases in case of a wide risk of barotrauma of legends and the frequency of development of hemodynamic accelerated ventilation, often occurs with ailments.

An analysis of the reasons and regularities of the development of the AU is allowed by the way, which, for a long time, is rich in what lies in the behavior of the car.
Early diagnostics, rapid rational therapy will not provide adequate prophylaxis for the progression of AS, in the lower stages of the effectiveness of treatment sumn_vnoyu.

Modern methods of treating bronchial asthma
Bronchial asthma treatment standards
Protocols for the treatment of bronchial asthma

Bronchial asthma

profile: therapeutic.
Likuvannya stage: stationary.
Meta etapu:
1. Get over the lethal attacks.
2. It is possible to quickly update the dysfunctional function and polish the sick person.
3. Pіdtrimati the optimal function of the dichotomy and overcome the recurrence of the attack.
and the end of the transfer to the stage.
The triviality of the trip: 5-11 days.

Cody MKB:
J45.0-Asthma with overload of the allergic component;
J45.1-Non-allergic asthma;
J45.8-Zmishana asthma;
J45.9-Asthma, unspecified;
J46 - Status asthmaticus

value: Bronchial asthma (BA) is a chronically fiery incineration of dichal nobles, the main pathogenetic mechanism of such a є
hyperreactivity of bronchial tubes, zumovlena inflamed, and the main clinical manifestation - attack of breath (especially expiratory character) in addition to bronchospasm, hypersecretion and the mucous membrane of the bronchi. Attack the breath, and also typical for BA cough, seeming "nagging" in the breasts, sometimes wheezing, distant wheezing occurs at all times in any of the ranks of the year and is often accompanied by a turnover (spontaneously).

Classification:
Classification of asthma.
1. For ethology: atopic (exogenous); non-atopic (endogenous); zm_shana.
2. By the severity of the disease:
- stage I (lighter episodic);
- Stage II (light persistent);
- Stage III (persistent asthma, moderate severity);
- Stage IV (important persistent asthma).

3. For the severity of the disease, the following are allowed:
- step I(Mildly intermittent): number of symptoms during the day< 2 раз в неделю; отсутствие и нормальные показатели ПСВ (пиковая скорость выдоха) между обострениями, количество симптомов но чью < 2 раз в месяц; ОФВ1 или ПСВ >80% norms, distribution of PSV indicators less than 20%.
- stage II(Light persistent); number of symptoms in the daytime> 1 time per day, ale<1 раза в день; приступы нарушают активность; ночные симптомы >2 times per month; FEV1 or PSV> 80% norms, the distribution of PSV indicators is 20% -30%.
- stage III(Persistent, average severity); symptoms of the day, attack to destroy the activity; no symptoms> 1 time per day; FEV1 or PSV - 60 - 80% norms, the distribution of PSV indicators is> 30%.
- stage IV(Persistently important): the symptoms are persistent, the physical activity is interrupted; some symptoms; FEV1 abo PSV< 60% нормы, разброс показателей ПСВ > 30%.

4. During the phase of the current: aggravated, unstable remission, remission, stable remission (more than 2 years).

Riziku factor: aeropolyutants, allergy cliffs, home saw (such as drіbnі, but invisible with an unbreakable eye), smoky tyutyunu (why burn the patient himself, if he smokes dim, if he smokes), allergeni shergiensti, color mushrooms are common, physical activity, leaks.

proper: plan, extrene.

Shown before hospitalization:
1. An important attack of bronchial asthma.
2. No evidence of bronchodilator drugs and the effect of taking less than 3 years.
3. No supplementation for 2-6 years for a cob of oral corticosteroid therapy.
4. Spaster farther away from death - the growth of dyshnoy and legacy-heart failure, "not easy."
5. Ailments from a group of high risk deaths:
- in those who have a history of boule, I will become close to lethal;
- vimagayut іntubatsії, piece ventilation, scho to grow up to the growth of іntubatsіy at the onset of aggravation;
- for those who are behind the last ric, there is already a hospitalization, for example, for an incomplete auxiliary aid from the BA drive;
- vikoristovuyut in syogodennі or have recently been punished for the consumption of oral corticosteroids;
- overwhelmingly live the English b2-agony of the shvidkoy diya, especially more than one package of salbutamol (or equivalent) per month;
- with mental illness, psychological problems in anamnesis, including sinister sedatives;
- with anamnestic vkaz_vkami on the rotten to the plan of the BA treatment.

Necessary obsyag obsyag before the planned hospitalization:
Zagalny blood analysis
Zagalny analysis of the sech
spirography
picflow meter
X-ray of the organs of the breast
Analysis of sputum gallbladder and, if necessary, 3 times as long as it is on the BC
Elektrokardіogafіya

Diagnostic criteria:
Anamnesis has one of these manifestations:
cough, especially at night; repeated wheezing; repeating the difficulty of dikhannya; repetition of the appearance of the pressure of the breast; symptoms are found or buried at night; Symptoms become important when triggers are in contact; Symptoms to lie down when bronchial infections are stagnant, progressing growth of backache, cough, wheezing, difficulty in dysfunction, feeling sick in the chest or after symptoms.

Switching of the main diagnostic entries:
1. Outbound blood analysis
2. Out-of-the-box analysis
3. Microreaction
4. Outbound analysis of harkotinnya,
5. Prescribed functions of the calling environment

Change of additional diagnostic entries:
1. Analysis of the sensitivity of microbes to antibiotics
2. X-ray of the organs of the breast
3. Consultation of a pulmonologist
4. Consultation of an otolaryngologist
5. Gas storage of blood

Likuvannya tactics:
- Inhalation b2-agony of shvidkoy deiya, call through a nebulizer, for one dose of skin 20 minutes for 1 year.
- Oxygen therapy for sour food> 90% (for children - 95%).
- Systemic corticosteroids, which are not negatively susceptible to treatment, or if the patient has recently taken steroids orally, or an important attack (30-60 mg methylprednizolone or 250 mg hydrocortisone internally).
- In case of an important attack, it is possible to inflate, internally or internally injected in 2-agonists, in / in methylxanthines, in / in magnesium sulfate.
- With a trivial attack, there is a strong development of rehydration. You can add 2-3 liters more to your life, but you can get better.

Suppression of attacks:іngalyatsіynі b2-agony of shvidkoї dії (salbutamol, fenoterol); b2-agony of trivial diy with a quick ear of diy (salmeterol, formoterol); combination of drugs, which include holinolitics and b2-agony; short diy methylxanthini (aminophilin); systemic corticosteroids (prednisolone).
For trivial asthma management, it is recommended to step down in the fallowness of the degree of severity.

For all ages: Even before regular therapy, if necessary, there is a combination of fenoterol and brominated prothropy.

step I- a well-known reception for the control of sickness is not required. It is recommended to sign bronchodilators for a short period of time at least 1-2 times per need.

stage II- Ingalyatsiniy GCS: fluticasone propionate 120 doses (100-200 mcg 2 times per dose), Budesonide 100-250 mcg / dobu or Beclomethasone dipropionate 200-500 mcg in 1-2 priyomi.
Alternative drug use: the appointment of prolonged drugs in theophiline (theotard, theopec 200-400 mg / dobu), blockers of leukotrenic receptors (zafirlukast 20 mg 2 times a day). Bronchodilators of short diy (salbutamol, fenoterol) for need not more than 3-4 times for dob.

stage III- Ingalyatsiniy GCS: fluticasone propionate 120 doses (400-1000 mcg 3-4 times per dose), Budesonid 800-1600 mcg / dobu or Beclomethasone dipropionate 800-1600 mcg in 3-4 priyomi). either IGCS in a standard dose in conjunction with b2-adrenoreceptor agonists of the trivial diet (salmeterol 50 mcg 2 times a day or formoterol 12 mcg 2 times a day), a combination of fenoterol and bipropyl alcohol Bronchodilators of short diy (salbutamol, fenoterol) for the need, but not more than 3-4 times for the need.

Alternative drug use: the appointment of prolonged drugs in theophilin (theotard, theopec 200-700 mg / dobu), cromones (intal 5 mg / dose), blockers of leukotrenic receptors (zafirlukast 20 mg 2 times a day).

stage IV- Ingalant corticosteroids fluticasone propionate 100-200 mcg 3-4 times per dob, Budesonide more than 800 mcg / day, Beclomethasone dipropionate 100 mcg - 10 doses (more than 1000 mcg) per dobu or equivalent plus long-lasting b2 formoterol), a combination of fenoterol and iprotropy bromide; plus one more or more of such drugs, if it is necessary: ​​theophilin spovinenny vivilnennya, antileukotrienic drug, oral b2-agonist of trivial drug, oral corticosteroids.

We are sick with viscous sputum, which is associated with mucolytics (ambroxol, carbocysteine, acetylcysteine).
In the presence of nasal sputum, high leukocytosis, accelerated SHOE, a course of antibacterial therapy is prescribed for antibiotics urahuvannya (spiramicin 3000 000 OD x 2 times, 5-7 days, amoxicilin + clavulanic acid 625 mg 5-7 days, ceftriaxone 1.0 x 1 time, 5 days, metronidazole 100 ml intravenously dropwise).

Transfer of basic medicines:
1.beclamethasone aerosol 200 doses
2.IPratropium bromide aerosol 100 doses
3. Kromoglitsic acid aerosol dosage 5 mg; capsule 20 mg
4. Salbutamol aerosol 100 mcg / dose; capsule 2 mg, 8 mg; nebulizer rosette 20 ml
5. Teofilin tablet 200 mg, 300 mg tablet retard 350 mg
6. Fenoterol aerosol 200 doses
7.IPratropium bromide 21 mcg + fenoterol hydrobromide 50 mcg
8. Ambroxol tablet 30 mg; syrup 30 mg / 5 ml
9. Amoxicilin + clavulanic acid 625 mg
10. Azithromicin 500 mg
11. Metronidazole 100 ml, bottle.

Transfer of supplementary medicines:
1. Aminophyllin roschin for ін'єкцій 2.4% in ampoules 5 ml, 10 ml
2. Salmeterol aerosol for inhalation 25 mcg / dose
3. Fluticasone aerosol 120 doses
4. Clarithromicin 500 mg, tab.
5. Spiramicin granules for suspension 1.5 mln OD, 375 ths OD, 750 ths OD powder for infusion 1.5 mln OD.

Criteria for shifting to the offensive stage:
Ineffectiveness of bronchodilator therapy, inability to stop the attack of breath for 6-8 years, an increase in mental deficiency, "not easy."