Bronchospasm
The content of the article:
- Causes of bronchospasm and risk factors
- Forms of bronchospasm
- Symptoms of bronchospasm
- Diagnostics
- Treatment of bronchospasm
- Possible complications and consequences
- Forecast
- Prevention
Bronchospasm (bronchospastic syndrome) is a pathological condition that occurs when the smooth muscles of the bronchi contract and their lumen decreases. With bronchospasm, there is a difficulty in entering the body of oxygen, while carbon dioxide is practically not excreted. It is more difficult for a patient with bronchospasm to exhale air than to inhale it, although according to the patient's subjective sensations, his breath is also difficult.
Contraction of smooth muscles of the bronchi with bronchospasm
Causes of bronchospasm and risk factors
The main causes of bronchospasm are:
- bronchial asthma;
- bronchitis (especially in children under seven);
- exacerbation of chronic obstructive pulmonary disease (especially in active smokers and in the presence of industrial hazards);
- a pronounced allergic reaction to inhalation of an irritating substance (dust, cigarette smoke, fumes of chemical compounds, industrial pollution of the environment, etc.), anaphylactic shock;
- intoxication of the body against the background of a viral or bacterial disease of the respiratory tract;
- side effects of a number of drugs (including a reaction to anesthesia);
- excessive physical activity (especially in patients with bronchial asthma);
- ingress of a foreign body into the respiratory tract (especially in children under the age of three);
- stressful situations;
- adverse weather factors.
Bronchial asthma is a common cause of bronchospasm
Genetic predisposition also plays a role in the development of bronchospasm.
Forms of bronchospasm
The following forms of pathological condition are distinguished:
- bronchospasm with reversible airway obstruction (can be stopped with bronchodilator drugs);
- bronchospasm with irreversible blockage of the airways (not stopped by bronchodilators).
Depending on the prevalence of the pathological process and the degree of narrowing of the bronchi, bronchospasm is distinguished:
- partial - areas of normally functioning lung tissue are preserved;
- total - complete spasm of bronchioles and small bronchi.
Symptoms of bronchospasm
Spasm of the bronchi is a reflex protective reaction of the bronchi, a sharp narrowing of which occurs in response to the action of an irritant, which creates an obstacle to the penetration of the irritant into the patient's lungs. With the development of pathological bronchospasm, this process becomes protracted - the contracted bronchial muscles continue to squeeze the bronchi, and do not relax. Due to the increasing pressure from the outside, as well as due to the increased blood flow, the inner walls of the bronchi swell, the lumen narrows, which prevents air from passing normally through the respiratory tract. With the further development of the pathological process, oxygen starvation of the body may begin. To compensate for the acute shortage of air, a patient with bronchospasm begins to take convulsive breaths, however, due to the narrowing of the lumen of the bronchi, exhalation is difficult,air accumulates in the lower respiratory tract, and this creates an obstacle for oxygen to enter the body.
The first symptom of bronchospasm is a feeling of acute shortness of breath
The main symptoms of bronchospasm are:
- feeling of acute shortage of air, as well as heaviness in the chest, which causes the patient to have an attack of fear, panic;
- increasing shortness of breath (short inhalation and prolonged difficult exhalation), noisy wheezing;
- a painful cough, which in some cases may be accompanied by a slight discharge of viscous sputum, but more often it is unproductive;
- pallor of the skin, cyanotic skin tone around the mouth;
- tachycardia, muffled heart sounds;
- excessive sweating (cold sweat);
- forced tense posture with the body tilted forward and support on the arms, raised shoulders, head retracted.
There are a number of signs that may indicate an impending bronchospasm. These include:
- sneezing, accompanied by the appearance of profuse transparent discharge from the nose;
- itchy skin, eye irritation;
- severe paroxysmal cough;
- dyspnea;
- headache;
- increased frequency of urination and an increase in the volume of excreted urine;
- weakness, depression, or irritability.
Sneezing can signal an impending bronchospasm
Visually, in a patient with bronchospasm, breathing tension is noticeable, as well as movements of the respiratory muscles (intercostal spaces sink, blood vessels in the neck swell, nasal wings are drawn in).
With total bronchospasm, the patient's breathing is completely absent, which is accompanied by severe disturbances in gas exchange.
Diagnostics
Diagnosis of total bronchospasm is not difficult, in contrast to partial bronchospasm, which may have scant symptoms. In addition to the cyanotic shade of the skin, as well as moderate arterial hypertension with visual control under thoracotomy, patients have insufficient lung collapse on exhalation, as well as increased resistance to artificial inspiration. Stable respiratory acidosis with vigorous mechanical ventilation indicates the presence of a latent form of partial bronchospasm.
The study of the function of external respiration is of great importance for the diagnosis of bronchospasm. When carrying out hardware diagnostic methods, the minimum concentration or complete absence of carbon dioxide in the exhaled air is determined, while its concentration in the patient's blood increases.
Endoscopic picture of bronchospasm, on the left - before, on the right - after the attack
Differential diagnosis is carried out with mechanical obturation of the bronchi with a foreign body, bending of the endotracheal tube, acutely developed during anesthesia with atelectasis. It is often required to differentiate this pathological process with pulmonary edema, the latter may also be the terminal stage of bronchospasm. At the initial stage of the development of bronchospasm, the patient has bradycardia, arterial hypertension and low pulse pressure due to an increase in diastolic blood pressure, a small amount of viscous vitreous sputum is separated. With pulmonary edema against a background of high blood pressure, tachycardia develops, pulse pressure increases due to an increase in systolic blood pressure, then myocardial hypoxia occurs, followed by ventricular fibrillation and cardiac arrest. In patients with pulmonary edema, frothy sputum mixed with blood is separated.
Treatment of bronchospasm
A particular danger is the development of bronchospasm in children, so this condition should be stopped as soon as possible.
If bronchospasm occurs against the background of complete health, in the absence of bronchial asthma in the patient, and also in the case when the pathological condition cannot be stopped within an hour in patients whose history already has bronchospasm, an ambulance must be called.
If it is known that the cause of the development of the pathological process is the effect of an allergen, it must be eliminated, provide an influx of fresh air, rinse the nose with water and rinse the throat.
When bronchospasm occurs in patients with bronchial asthma, it is necessary to use one of the drugs that relieve bronchospasm and expand their lumen. After 15-20 minutes after using a bronchodilator, expectorant drugs are allowed. In the case of self-elimination of bronchospasm, the etiology of which is unknown, you should undergo an examination to determine the cause of the pathological condition.
Medical treatment of bronchospasm depends on the main pathological process, against the background of which this condition developed, and is selected for each patient individually. To stop the attack, they resort to bronchodilating and relaxing the muscles of the bronchi drugs, patients suffering from respiratory diseases, in which the risk of developing bronchospasm (for example, bronchial asthma) is increased, it is recommended to keep dosed aerosol pocket respirators in the quick access zone. Ultrasonic inhalations with solutions of antispasmodic drugs, anti-inflammatory hormonal agents are also effective.
If an attack of bronchospasm cannot be stopped within an hour, you need to call an ambulance
Drugs that help to eliminate spasm of smooth muscles of the bronchi include:
- glucocorticoids (have an anti-inflammatory effect, reduce the production of biologically active substances in the muscles of the bronchi);
- adrenomimetics (act directly on the smooth muscles of the bronchi, expanding them);
- M-anticholinergics (similar to adrenergic agonists, but somewhat less effective).
It is recommended to supplement the main treatment with plenty of drinking.
In some cases, patients with bronchospasm need oxygen therapy in a hospital setting.
Possible complications and consequences
Against the background of prolonged bronchospasm, hypoxemia may develop with the further development of hypercapnia, an increase in lung volume, congestion in the superior and inferior vena cava, as well as cardiac arrest and circulatory arrest.
Forecast
With timely relief of the pathological condition, the prognosis is usually favorable. With frequent relapses of bronchospasm in children (especially under six years of age), the prognosis worsens.
In the event of bronchospasm during surgery or in the postoperative period in the absence of emergency resuscitation measures, a lethal outcome is possible.
Prevention
In order to prevent the occurrence of bronchospasm, it is recommended:
- timely treatment of diseases that can serve as a background for the development of bronchospasm;
- avoiding excessive physical exertion;
- avoidance of stressful situations and mental overstrain;
- rejection of bad habits;
- avoiding exposure to the body of adverse environmental factors.
To prevent the development of bronchospasm during surgery in the perioperative period, a course of desensitizing therapy with antihistamines and corticosteroids is recommended, as well as aerosol therapy with bronchodilators. General anesthesia of sufficient depth with adequate ventilation of the lungs is required, due to which normal gas exchange is ensured.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
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!
