Asthmatic status
The content of the article:
- Causes and risk factors
- Forms
- Stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Status asthma is a severe life-threatening complication of bronchial asthma, which is protracted and is characterized by progressive respiratory failure and ineffectiveness of the therapy.
The asthmatic status is based on persistent spasm and pronounced edema of the bronchial mucosa
The mechanism of development of status asthmaticus can be different:
- exacerbation of bronchial asthma (massive spasm of all parts of the bronchial tree, suppression of the cough and respiratory centers, violation of the natural drainage function of the bronchi, restriction of exhalation);
- contact with an allergen;
- reflex spasm of the bronchi due to exposure to the receptors of the respiratory tract of mechanical, chemical or physical irritants (cold air, pungent odors).
One of the leading pathogenetic mechanisms is a deep blockade of beta-2-adrenergic receptors, which is manifested by persistent bronchospasm, not sensitive to the measures taken.
Due to an increase in pressure in the chest cavity and inside the alveoli, pulmonary hypertension develops, the pressure in the pulmonary artery and in the cavity of the right ventricle increases, and the mechanism of venous return of blood to the heart is damaged.
Violation of the respiratory function and the work of the cardiovascular system leads to a shift in acid-base balance and blood gas composition. A decrease in the concentration of oxygen in the blood in combination with respiratory alkalosis is replaced by a progressive increase in the level of carbon dioxide and acidification of the internal environment of the body.
Causes and risk factors
The main causes of status asthmaticus:
- acute or chronic (in the exacerbation phase) infectious and inflammatory diseases of the respiratory system;
- hyposensitizing therapy (aimed at reducing sensitivity to an allergen) during an exacerbation of bronchial asthma;
- withdrawal syndrome after a sharp, one-step cessation of glucocorticoid hormones taken for a long time;
- taking drugs that can provoke an allergic reaction (salicylates, vaccines, serums, antibacterial drugs, analgesics, etc.);
- massive exposure to allergens;
- incorrect or untimely therapy;
- incorrect assessment of the severity of the condition by the patient himself (at home) or by the attending physician (in a hospital setting);
- syndrome of "blockage of the lungs" due to an overdose of adrenergic agonists;
- overdose of sleeping pills and sedatives;
- neuropsychic stress, persistent stress.
Triggers for status asthma
Forms
According to the rate of development of the clinical picture (pathogenetic variants), there are:
- slowly developing status;
- anaphylactic (immediately developing) asthmatic status;
- anaphylactoid status - the rate of occurrence is similar to anaphylactic status, but, unlike it, is not associated with immune allergic reactions.
Stages
During status asthmaticus, three stages are distinguished:
- The stage of relative compensation.
- Stage of decompensation, or "silent lung".
- Hypoxic hypercapnic coma.
Symptoms
Each of the stages of status asthmaticus is characterized by specific symptoms.
Stage I:
- during the day, long-term attacks of suffocation that cannot be stopped by the usual drugs regularly occur, in the interictal period it is not possible to completely restore breathing;
- excruciating dry, hacking paroxysmal cough with scanty, viscous glassy sputum;
- forced position of the body, accompanied by shortness of breath (orthopnea) with fixation of the shoulder girdle (the patient sits, resting his hands on the armrests of the chair, or stands, leaning on the back of the bed, window sill);
- rapid breathing (up to 40 respiratory movements per minute), involvement of auxiliary muscles in the act of breathing;
- dry wheezing rales heard at a distance (distant);
- cyanotic staining of the skin and visible mucous membranes;
- listening during auscultation of the so-called mosaic breathing (breathing is not heard in the lower parts of the lungs, in the upper parts it is hard, with a moderate amount of dry wheezing);
- pulse is frequent (up to 120 beats per minute), arrhythmic, stitching, aching pains in the region of the heart;
- signs of dysfunction of the central nervous system (unmotivated irritability, emotional lability, fear of death, sometimes delirium, hallucinations).
A painful dry cough with scanty sputum indicates stage 1 status asthmaticus
Stage II is manifested by the following progressive ventilation disorders (extremely serious condition):
- shortness of breath is pronounced, shallow breathing;
- the skin is pale gray, moist;
- forced position of the body;
- swelling of the veins of the neck;
- enlarged liver;
- the patient's apathy, a state of indifference can periodically be replaced by agitation;
- auscultation determines the "dumb lung" (over the entire lung or in a large area of both lungs, breathing noises are not heard, a small amount of dry wheezing is determined in an isolated area);
- pulse up to 140 beats per minute, weak filling and tension, blood pressure (BP) is reduced, heart sounds are deaf, gallop rhythm is possible.
At stage III of status asthmaticus, a hypercapnic coma develops, its signs are:
- disorientation in time and space, the patient is stunned, then loses consciousness;
- the veins of the neck are swollen, the face is puffy;
- spilled red cyanosis, cold clammy sweat;
- shallow, rare arrhythmic breathing (possibly abnormal Cheyne-Stokes breathing);
- during auscultation, breathing sounds are not heard or are sharply weakened;
- the pulse is threadlike, arrhythmic, blood pressure is sharply reduced or not detected, heart sounds are muffled, ventricular fibrillation may develop.
Hypercapnic coma develops at 3 stages of status asthmaticus
Diagnostics
Diagnosis of status asthmaticus is based on the analysis of the history of the disease, clinical manifestations, characteristic auscultatory picture, results of laboratory and instrumental research methods:
- general blood test (for polycythemia, increased hematocrit);
- biochemical blood test (for total protein, protein fractions, seromucoid, fibrin, sialic acids - increased);
- ECG (signs of overload of the right heart are established);
- study of acid-base balance (metabolic acidosis is determined);
- study of the gas composition of blood (detection of a decrease in oxygen concentration in combination with an increased content of carbon dioxide of varying severity depending on the stage).
Treatment
The development of status asthmaticus is an urgent pathology and a direct indication for emergency hospitalization.
General principles of therapy:
- complete abolition of sympathomimetics with a slowly developing status;
- restoration of the sensitivity of beta-adrenergic receptors with the introduction of glucocorticosteroid drugs;
- elimination of the phenomena of bronchial obstruction, edema of the mucous membrane of the bronchial tree, dilution of bronchial secretions;
- correction of violations of the gas composition of the blood (mechanical ventilation, oxygen therapy);
- elimination of decompensated metabolic acidosis;
- infusion therapy to replenish the volume of circulating blood, extracellular fluid, eliminate hemoconcentration;
- correction of symptomatic changes in blood pressure (hypo- or hypertension);
- fight against acute right ventricular failure;
- improvement of blood rheology, prevention of the possible development of thromboembolic disorders;
- fight against foci of bronchopulmonary infection (if necessary).
Oxygen therapy corrects blood gas abnormalities in status asthmaticus
The main clinical sign of the effectiveness of the therapy is the appearance of a productive cough with the separation of a large amount of viscous vitreous, then replaced by liquid, sputum.
Possible complications and consequences
Due to the asthmatic status, you may experience:
- hypoxic damage to the central nervous system;
- myocardial infarction;
- heart rhythm disturbances incompatible with life;
- metabolic acidosis;
- hypoxic ulcer of the stomach and duodenum;
- collapse;
- pneumothorax;
- adrenal insufficiency;
- atelectasis;
- pulmonary edema;
- coma, death.
Forecast
With timely provision of emergency care, the prognosis is favorable. It worsens significantly as the respiratory distress progresses. Mortality from status asthmaticus in out-of-hospital conditions exceeds 70%, in a hospital setting - no more than 10%.
Prevention
In order to prevent status asthmaticus, you need:
- strict adherence to the recommendations of the attending physician, mandatory intake of basic drugs;
- avoiding contact with allergens, exposure to extreme environmental conditions;
- limiting excessive physical exertion;
- timely treatment of infectious and inflammatory diseases;
- regular dispensary observation;
- to give up smoking.
YouTube video related to the article:
Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
