Asthmatic status
Asthmatic status is a severe attack of bronchial asthma, which proceeds much more intensively and for a longer time than usual, and is not stopped by increased dosages of bronchodilators that the patient takes. It is manifested by prolonged suffocation, cyanosis of the skin and mucous membranes, tachycardia, increased respiratory rate. During decompensation, an acidotic coma may develop. It is diagnosed on the basis of clinical data, blood gas studies. The basis for the relief of asthmatic status is bronchodilating therapy, hormone therapy. Additionally, oxygenobarotherapy is carried out, according to the indications – a ventilator.
General information
Asthmatic status (status asthmaticus) is a life-threatening condition in clinical pulmonology. It is a complication of bronchial asthma, the mortality rate from which among the young and able-bodied population reaches 17%, while none of the patients with bronchial asthma is immune from asthmatic status – according to various data, complications occur in 17-79% of cases. Being both a medical and a social problem, asthmatic status requires rational methods of prevention, which should be aimed at the treatment and prevention of asthmatic, bronchopulmonary and allergic diseases.
Reasons
The risk group includes patients with bronchial asthma who constantly interact with allergens at home, at home or at work. Often, the asthmatic status develops against the background of acute respiratory viral infections, acute bronchitis, stress. The trigger for the occurrence of a prolonged attack may be improper therapy of bronchial asthma: abrupt withdrawal of glucocorticoids, inadequate selection of the dosage of bronchodilators, taking aspirin and beta-blockers with concomitant pathology. Physical exertion and strong emotional experiences also often provoke an asthmatic status. But sometimes asthma debuts with an asthmatic status, then in addition to the severity of symptoms, panic and fear of death join.
Pathogenesis
During an asthmatic attack, there is a pronounced violation of bronchial patency due to mucosal edema, bronchial muscle spasms and mucus obstruction. This leads to difficulty in inhaling and to an active elongated exhalation. During a short and short inhalation, more air enters the lungs than comes out during exhalation due to blockage and a decrease in the lumen of the airways, this leads to hyper-airiness and to inflating of the lungs. Due to forced exhalation and tension, the small bronchi become even more spasmodic. As a result of all these processes, the air in the lungs stagnates, and the amount of carbon dioxide in the arterial blood increases and the amount of oxygen decreases. As with the usual severity of seizures, and with asthmatic status, the syndrome of fatigue of the respiratory muscles develops. Constant and ineffective loads of the respiratory muscles lead to hypertrophy and to the formation of the chest shape characteristic of asthmatics. The enlarged lungs and hypertrophied muscles give it a resemblance to a barrel.
Classification
Asthmatic status differs in the mechanism of occurrence, severity and other parameters. According to the pathogenesis , three forms are differentiated:
metabolic – slowly developing asthmatic status, may increase over several days and weeks.
anaphylactic – immediately developing asthmatic status.
anaphylactoid is an asthmatic status that develops within 1-2 hours, not associated with immunological mechanisms (caused by inhalation of irritating substances, cold air, etc.).
In its development, the asthmatic status goes through the following stages:
The stage of relative compensation is characterized by moderately pronounced bronchoobturation and respiratory syndromes.
Decompensation stage – it corresponds to the initial signs of asphyxia, hemodynamic disorders are associated with bronchopturation and respiratory syndrome.
Coma is a stage of deep asphyxia and hypoxia.
Symptoms of asthmatic status
The symptoms directly depend on the stage of the asthmatic status and, if it cannot be stopped, the first stage can gradually go into a state of shock, and then into a coma.
Stage I – relative compensation. The patient is conscious, available for communication, behaves adequately and tries to take a position in which it is easiest for him to breathe. Usually sitting, less often standing, slightly tilting the body forward and looking for a foothold for the hands. The attack of suffocation is more intense than usual, the usual drugs are not stopped. Shortness of breath and pronounced cyanosis of the nasolabial triangle, sometimes sweating is noted. The absence of sputum is an alarming symptom and indicates that the patient’s condition may worsen even more.
Stage II – decompensation, or the stage of the silent lung. If the attack cannot be stopped in time, then the amount of unproductive air in the lungs increases, and the bronchi become even more spasmodic, as a result of which there is almost no air movement in the lungs. Hypoxemia and hypercapnia in the blood increase, metabolic processes change, due to lack of oxygen, metabolism proceeds with the formation of under-decomposition products, which ends with acidosis (acidification) of the blood. The patient is conscious, but his reactions are inhibited, there is a sharp cyanosis of the fingers, sinking of the supra- and subclavian cavities, the chest is swollen, and its excursion is practically not noticeable. There are also violations from the cardiovascular system – the pressure is reduced, the pulse is frequent, weak, arrhythmic, sometimes turns into a threadlike.
Stage III is the stage of hypoxemic, hypercapnic coma. The patient’s condition is extremely severe, consciousness is confused, there is no adequate reaction to what is happening. Breathing is shallow, rare, the symptoms of cerebral and neurological disorders are increasing, the pulse is thready, there is a drop in blood pressure, turning into a collapse.
Complications
Death as a result of asthmatic status occurs due to persistent violation of air permeability in the respiratory tract, due to the addition of acute cardiovascular insufficiency or due to cardiac arrest. Cases are described when the asthmatic status ended with a pneumothorax due to a chest rupture.
Diagnostics
The diagnosis is made on the basis of clinical symptoms and anamnestic data. Most often, diagnostic measures are carried out by emergency doctors or therapists in a hospital (if the attack occurred while undergoing treatment in a hospital). After first aid, the patient is subject to emergency hospitalization in the intensive care unit or in the intensive care unit, where therapy is carried out simultaneously and the patient is examined as soon as possible. The general analysis of blood, urine, biochemical analysis of blood, the state of the blood gas composition and the acid-base balance coefficient are changed, as well as during an attack of bronchial asthma, only the degree of changes is more pronounced. The ECG in 12 leads shows signs of overload of the right chambers of the heart, the deviation of the EOS to the right. Asthmatic status is differentiated with PE, bronchial foreign body, hysterical disorder.
