Exacerbation of asthma can be expressed in the rapid growth of progressive shortness of breath, coughing, wheezing - is asthmatic attack, attack. However, some children acute asthma attacks, lasting minutes or hours pass into the chronic shortness of breath, continuing in the absence of adequate treatment for days, weeks or even months. So long, of varying severity shortness of breath, persistent cough, wheezing, dry in the background of weak breathing, are manifestations of a severe exacerbation of asthma and is characterized by asthmatic condition. The pediatrician is often extremely experienced serious difficulties in the treatment of a sick child during a severe asthma attack or asthmatic condition is in, threatening his life when conventional therapy is ineffective.
The existence of a severe exacerbation indicates a significant severity of asthma. In addition, its development, as a rule, said that there was insufficient basic (core) therapy in these patients, or not enough active tactics in the treatment of acute asthma in the initial stage of its development.
Clinic of acute attacks of asthma symptomatic and bright, the manifestations of the same status asthmaticus have their clinical and functional features, records which are very important.
So, if status asthmaticus clinical signs of bronchial obstruction in children can be expressed in much less than with paroxysmal course of the disease, while the functional parameters of external respiration and is sharply reduced.
Severe exacerbation of asthma poses a real threat to life a sick child. It is fraught with the possibility of at any time of clinical catastrophes, development asfiksicheskogo syndrome, which is the main reason for the dramatic outcome of bronchial asthma in children. Therefore, treatment of severe exacerbation of asthma in children should be intense, given that the basis for his development of allergic inflammation is accompanied by airflow obstruction, mucus hypersecretion, edema of the bronchial mucosa.
The decisive factor in the successful treatment of children with severe exacerbation of asthma is close monitoring of the patient and his response to therapy with a periodic examination (if possible) of the functional parameters of external respiration. Indicators of severity of the condition - especially the performance of peak expiratory flow rate, respiratory rate should be continuously evaluated during treatment. Objective register a sharp decline in the functionality of the lung (peak expiratory flow, forced expiratory volume in 1 sec) are reliable indicators of the severity of airway obstruction (if possible to measure them). The children of preschool age estimation of these parameters is not possible. Determining the severity of exacerbation in young children is mainly based on the clinical picture.
Absolutely necessary in treating a patient in severe exacerbation of asthma is the use of corticosteroids.
Corticosteroid means an exacerbation of asthma have a powerful anti-inflammatory effect.
As shown by long experience, the use of corticosteroids in severe exacerbations of asthma exacerbation is reliably relieves and prevents its progression. Ignoring the appointment of corticosteroid drugs in adequate doses, the severity of the patient's condition is very dangerous. Bronchial asthma attack is a powerful stress-regulating point. Frequent repeated attacks, asthmatic condition leads to oppression, not to enhance the function of the adrenal cortex. In these clinical situations, there is an urgent need for corticosteroids.
Corticosteroids should be administered for the treatment of severe exacerbation as early as possible. Systemic Corticosteroids should be used in the majority of patients with acute exacerbation of bronchial asthma. Dose, route of administration of these funds are chosen individually according to the severity of the patient, and previous history of disease exacerbation.
In practice, preference is usually given prednisone, corticosteroid average duration of action.
Accomplish the total elimination of exacerbation without glyukokortikos-teroidnyh drugs inside is not always possible. Corticosteroids have appointed inside, compared with parenteral inputs, longer and pronounced therapeutic effect. Glyukokortikosteroi-dy appointed interior, well adsorbed from the gastrointestinal tract, and this route of administration for severe exacerbation of asthma is preferred. Beginning of the effect of corticosteroids can be expected through at least 4-8 hours after their appointment. This is due to the mechanism of action of corticosteroids on the cellular level.
Certainly should be the appointment of prednisolone into the development of severe exacerbation in patients with a dramatic history with reference to the situation, really life-threatening ill child (development asfiksicheskogo syndrome, clinical death, hospitalization in the ICU, mechanical ventilation). Appointment of pre-nizolona inside must also be patient, has been repeatedly taking corticosteroids by mouth, especially in the pre-exacerbation period. These patients are at risk for a catastrophic outcome of asthma. Patients who are at increased risk of death from asthma, require especially careful monitoring and providing rapid assistance in the development of acute illness.
In the treatment of exacerbation of asthma, along with corticosteroid-mi, it is obligatory to use drugs with broncho-lytic action.
Anti-inflammatory drugs and, above all, inhaled glyukokor-tikosteroidy are currently the most effective means by which to monitor for severe asthma. These medicines have powerful anti-inflammatory effect and practically do not cause significant side effects. They are appointed after the elimination of severe exacerbation of asthma, bronchial patency restoration.
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