Status asthmaticus is an asthma complication, characterized by lack of sensitivity to drugs, used to relieve disease attack, progressive bronchial obstruction and severe respiratory disorders up to coma. of Status asthmaticus basis consists of: persistent bronchospasm, pronounced swelling of bronchial mucosa, presence viscous mucus in bronchi which blocks its lumen.
Status Asthmaticus Symptoms
Status asthmaticus course is characterized by staging:
1 stage (lack of sensitivity to beta2-agonists (bronchodilators), no ventilation disorders):
- patient is anxious, frightened, but conscious;
- increasing dyspnea;
- significant difficulties with exhaling;
- patients take posture to facilitate breathing – sitting or standing leaning on arms on the chair or bed, bending body forward;
- painful, non-productive cough (sputum is not discharged);
- rales in chest, sometimes audible at a distance (wheezing);
- blue nasolabial triangle;
- active participation of additional respiratory muscles in breathing (intercostal retraction);
- due to compensatory body capacities, blood gas composition is maintained within normal indicators.
2 stage (stage of “silent lung”, increasing ventilation disorders):
- dramatic first stage symptoms worsening;
- patient is conscious but lethargic;
- chest is swollen, in position of maximal inhalation, its movements are rare and almost invisible;
- supra- and infraclavicular fossa retraction;
- blue skin (especially lips, fingers);
- low blood pressure;
- frequent, weak, arrhythmic pulse;
- due to bronchi blockage with viscous sputum because of respiratory act some parts of lung “turn off” (“silent lung”), which leads to oxygen deficiency and increase in carbon dioxide in the body.
3 stage (strongly expressed ventilation violations, hypercapnic coma):
- loss of contact with medicals, convulsions, coma;
- breathing is rare, shallow or absent;
- weak pulse;
- low blood pressure;
- dramatic decrease in oxygen content, marked increase in carbon dioxide content in the body.
Types
Anaphylactic – characterized by sharp, sudden onset and rapid increase of all symptoms until severe respiratory insufficiency and complete breathing cessation.
Leading cause – bronchospasm. As a rule, developed as reaction to certain medications intake (e. g., non-steroidal anti-inflammatory drugs), introduction of vaccines and serums. In practice appears extremely rare.
Allergic-metabolic – develops slowly (for a few days or weeks) due to asthma exacerbation. Asthma attacks become more frequent, intervals between them – shorter, during attack-free interval breathing is not fully restored, insensitivity to drugs used to relieve attack is formed.
Leading cause – swelling of bronchial mucosa, blockage of bronchial lumen by viscous sputum.
Causes
- lack of basic therapy in bronchial asthma treatment (unjustified cancellation or patient’s refusal from continuous use of basic drugs, especially inhaled corticosteroids);
- uncontrolled beta2-agonists intake (drugs used to relieve attack). These drugs effectively relieve asthma attack by eliminating bronchospasm. However, they can be used not more than 6 – 8 times a day, because further sensitivity to them decreases, leading to prolonged asthma attack, status asthmaticus development;
- massive exposure to allergens (such as certain foods, home and library dust, pollen, animal hair, bird feathers, molds, vaccines and serums);
- receiving drugs (such as some medicines used to lower high blood pressure, non-steroidal anti-inflammatory drugs) that can cause asthma attack, which in absence of treatment or at excessive reception of these drugs can transfer into status asthmaticus;
- acute emotional stress;
- joining of acute or exacerbation of chronic inflammatory process.
Diagnostics
- Clinical symptoms: strongly pronounced dyspnea, audible at a distance rales – wheezing, painful non-productive (without sputum discharge) cough.
- General examination: forced patient’s posture (sitting or standing leaning on arms, bending body forward), with blue skin, intercostal and supra- and infraclavicular fossa retraction; listening to lungs using stethoscope (pronounced wheezing, increased exhale in the first stage, in future – emergence of “silent” lung areas, not involved in breathing procedure).
- Lack of beta-2-agonists effect (drugs, that dilate bronchi, used to relieve asthma attack).
- Changing arterial blood gases – increase in carbon dioxide, reducing oxygen content.
- Peakflowmetry – a sharp decline in air volume exhaled in special device – peak flow meter (this method has additional value).
- Also it is possible to consult pulmonologist, resuscitator.
Status Asthmaticus Treatment
- Glucocorticosteroid hormones – main agents in status asthmaticus treatment. Their action is aimed at improving bronchial obstruction by removing spasm, swelling and mucus production suppression. Administered intravenously and orally in pills at the same time.
- Short-acting methylxanthines – in addition to glucocorticosteroid hormones to improve bronchial patency.
- To improve liquid deficiency – glucose, plasma substituting solutions.
- To improve rheological blood properties – direct anticoagulants.
- Oxygen therapy.
- Mechanical ventilation – during 2 or 3 stages of status asthmaticus.
- On 2 and 3 stages status asthmaticus treatment should be carried out together with resuscitator.
- Antibiotics – to prevent joining secondary infection.
- After status asthmaticus elimination patient’s asthma therapy is reconsidered, selection of basic (inhaled steroids) and bronchodilator (beta2-agonists, M-cholinolytics) therapy is carried out.
Complications and Consequences
- coma;
- secondary infection (e. g., pneumonia development – lungs inflammation);
- in absence or untimely medical care – death.
Status Asthmaticus Prevention
- Regular intake of prescribed drugs. Bronchial asthma is characterized by chronic inflammation, so you should not limit yourself to preparations for bronchi expansion (except for mild bronchial asthma), you must regularly use basic anti-inflammatory drugs (inhaled corticosteroids).
- Always carry drug to relieve attack with you.
- Drugs used to relieve attack (beta2-agonist), can be used not more than 6 – 8 times per day. Subsequently, sensitivity to them is reduced, which can result in prolonged attack and status asthmaticus. If there is no effect from prescribed doses of these drugs, you should immediately seek medical care (call an ambulance).
- You can not engage in asthma and other related diseases self-medication, since drugs can provoke allergic reaction (especially antibiotics), some drugs used to reduce high blood pressure, may provoke bronchospasm and induce asthma attacks.
- Avoid contacts with allergens and other factors that provokeasthma attack:
- exclude significant allergens from the diet (most often they are citrus fruits, nuts, fish, chocolate, honey, milk);
- wet cleaning 2 times a week (preferably in wet gauze bandage);
- remove from the house basic items, which collect dust (carpets, wool and pile fabric, feather pillows, stuffed animals);
- put books in glass cabinets;
- changed bedclothes once a week. In winter, dry it in cold, in summer – in the sun;
- during plants flowering in dry windy weather limit access to the street, because at this time concentration of dust in the air is the highest; limit nature trips;
- in flowering period after coming from the street you need to change clothes, take a shower, rinse your throat;
- exclude animals from the house;
- limit contacts with household cleaning products.
In Addition
Prolonged asthma attack leads to compensation abilities activation that provide body with oxygen:
- breathing deepens;
- respiratory muscles actively works;
- perspiration is enhanced, which in its turn leads to body dehydration and further increase in sputum viscosity. Viscous mucus blocks already narrowed bronchial lumen, resulting in impaired gas exchange: decreased oxygen saturation, increased carbon dioxide level in blood.
Excess carbon dioxide content in the body leads to:
- reflectory brain vessels expansion;
- increased intracranial pressure with confusion, drowsiness, seizures, coma.