"Asthma" is a common disease, which is characterized by repeated attacks and prolonged healing. It is a chronic disease. Some asthma patients start from teenagers and still have frequent attacks after entering old age. Therefore, there is a saying that "internal medicine cannot cure asthma".
Bronchial asthma is a highly sensitive bronchial disease caused by some allergens (non-allergic factors can also be caused) from the outside or in the human body. Due to the over-sensitive reaction of bronchus to irritants (allergens), extensive reversible bronchospasm and stenosis occur. The clinical manifestation is paroxysmal expiratory dyspnea, accompanied by wheezing, which lasts for several minutes to several hours and gets better after treatment or self-improvement. In severe cases, it can last for several days to weeks or several times a day, and the patient is very painful. Asthma lasts for a long time, and people have various symptoms of hypoxia, such as angina pectoris, heart failure, pulmonary encephalopathy and other serious consequences caused by myocardial hypoxia and brain hypoxia. Long-term recurrent attacks are often complicated with chronic bronchitis, emphysema and pulmonary heart disease.
Bronchial asthma can occur at any age, but 50% of patients get sick at an early stage. 20% patients have a family history.
(1) Pathogenic factors:
(1) Some people with allergies inhale allergens, such as pollen, mites and fungal spores. Eat fish, shrimp, thorns, milk and eggs; Exposure to certain drugs such as penicillin.
(2) Respiratory infection, cold air, irritating gas and mental stress can all cause asthma attacks.
(3) Occupational contact with animals and plants or chemical dust, such as cotton wool, grains, mushroom dust, animal fur, pesticides, plastics, paints, chemical raw materials, etc.
(4) Asthma attacks caused by drugs can be found in aspirin, bacterial vaccine, antitoxic serum, propranolol, etc.
(5) Asthma after exercise is more common in children and adolescents. Asthma lasts for tens of minutes to 1 hour 2-5 minutes after strenuous exercise stops. The reason may be related to inhaling cold air, or it may be caused by excessive carbon dioxide exhalation and relatively insufficient oxygen after exercise.
(6) Some people's asthma attacks are related to emotions, and the conditioned reflex suddenly stops. Some patients can't find the cause of asthma.
(2) Clinical manifestations:
1? The premonitory symptoms are related to seasons and obvious contact with allergens. Before the attack, there are many itchy nose and eyelids, sneezing, runny nose or coughing. Some patients have cough and expectoration due to a cold, and asthma occurs with the aggravation of their illness.
2? Exhaled dyspnea accompanied by wheezing, chest tightness, difficulty in exhaling, forced to sit down for several minutes to several days. Patients with severe asthma have obvious cyanosis in complexion and lips. When the attack is about to stop, the cough is more intense. After coughing up more thin sputum, dyspnea was relieved, asthma stopped and returned to normal. But it can happen many times in one day.
3? When asthma lasts for more than 24 hours, it is called "asthma status quo", which is one of the critical diseases in internal medicine and needs active rescue. The patient's breathing is extremely difficult, and a lot of sweating leads to thick phlegm that is not easy to cough up, and then respiratory failure and unconsciousness occur, and in severe cases, breathing gradually stops.
(3) Differential diagnosis of bronchial asthma:
1? Cardiogenic asthma
Patients with heart disease have paroxysmal dyspnea and hemoptysis at night. X-ray examination of heart enlargement, pulmonary congestion and pulmonary edema. Sometimes it is difficult to distinguish it from bronchial asthma, and it is necessary to go to the hospital for detailed examination. There are similarities and differences in treatment.
2? asthmatic bronchitis
Mainly chronic cough with asthma. Asthma is often one of the manifestations of acute attack of chronic bronchitis. Cough is accompanied by jaundice and fever, which mostly occurs in middle-aged and elderly people. We must actively fight infection and treat asthma to prevent the attack.
(4) Rescue measures for asthma attack:
(1) First of all, try to calm the patient down, encourage him to drink more warm water and pat his back to help him cough up phlegm.
(2) To give the patient oxygen, it is best to humidify the oxygen with a humidifying bottle before inhaling. Because the patient breathes with his mouth open, the tracheal mucosa is easy to dry, making the sputum sticky and not suitable for coughing up. Can use a cup of hot water, let patients inhale hot steam, moist airway mucosa, make sputum diluted, easy to cough up.
(3) Use asthma aerosol. At present, there are many dosage forms, so you can choose drugs that suit you, such as Chuankangsu and Shuchuanling, and spray them into your mouth when you take a deep breath, which can make asthma better. But it should not be used too much in a short time, so as not to cause side effects such as tachycardia.
(4) Oral aminophylline or intramuscular injection to treat asthma. Aminophylline has an effect on all kinds of asthma, each time 1 ~ 2 tablets, three times a day. Use with caution in patients with coronary heart disease. If the oral effect is not good, it can be given intravenously, but it must be used in the hospital. Oral aminophylline can also be used to prevent seizures.
(5) Use expectorants, such as Bisuping, Chuanbei Kaipalu, Huatan Tablet, Yijing Huatan, etc. Cough drugs such as Kebiqing and codeine should not be used to avoid phlegm retention in the lungs and aggravate asthma.
(6) Asthma caused by allergic factors can be treated with antiallergic drugs, such as chlorpheniramine, phenamine and cisplatin. At the same time, actively look for allergens, avoid inhalation, contact or eating, and prevent asthma from recurring.
(7) If asthma attacks several times a day, you can take prednisone, 5 ~ 10 mg, three times a day, and stop taking medicine for one week.
(8) Asthma induced by respiratory infection should be treated with antibiotics, such as midecamycin, acetylspiramycin, erythromycin, cephalosporin IV or VI. If the effect is not good in 3 ~ 5 days, use strong antibiotics for intramuscular injection or intravenous injection.
(9) After the above treatment, asthma still does not improve, and should be sent to hospital for treatment in time. Always pay attention to keep the patient's respiratory tract unobstructed during transportation, and don't cover the patient's head too tightly, causing suffocation, especially when the patient is unconscious.
(5) Preventive measures:
Actively look for allergens and causes after the attack. Take preventive measures against allergens. At the same time, quit smoking and prevent colds. Strengthen physical exercise and enhance disease resistance. Appropriate vaccine treatment or nuclear cheese injection, as well as transfer factor therapy (if possible) can alleviate or reduce the onset of asthma.
Exercise can induce asthma (article source: journal of seeking medical advice and medicine) Yin Bing
Exercise asthma, also known as exercise-induced asthma, is a special type of bronchial asthma. Exercise can exist as a single cause or as one of many causes in specific asthma patients.
Exercise-induced asthma can occur in any age group, with more men than women. Most patients have chest tightness, shortness of breath, dyspnea, palpitation, wheezing and other symptoms 6 ~ 10 minutes after strenuous exercise starts or 2 ~ 10 minutes after exercise stops. The patient can hear obvious wheezing in both lungs. The above symptoms can be gradually relieved by themselves when it is about 0.5 ~ 1 hour. A few severe patients can last for 2 ~ 3 hours. There are also a few patients whose asthma symptoms can appear 4 ~ 13 hours after exercise. This kind of delayed asthma is clinically called "exercise-induced delayed asthma response".
What factors are related to the occurrence of exercise-induced asthma? Generally speaking, it has a certain relationship with the type, condition, intensity and duration of exercise. For example, running outdoors, climbing mountains or engaging in ball games in cold season are easy to induce exercise asthma; However, swimming, boating and other water sports in summer, as well as light sports in peacetime, such as weightlifting, Tai Ji Chuan, sword dancing and walking, are less likely to induce asthma.
How to prevent and treat exercise-induced asthma?
1. Use preventive drugs before exercise, often 15 minutes before exercise, and start inhaling short-acting β2 receptor agonists, such as Shuchuanling aerosol, 200 micrograms each time. Terbutaline aerosol, 250 ~ 500 micrograms each time, or sodium crotonate aerosol, 20 ~ 40 micrograms each time, can effectively prevent and treat asthma attacks.
2. Doing some warm-up activities and preventive preparations before exercise can avoid or alleviate asthma attacks.
3. Avoid inhaling dry cold air. Wearing a mask during outdoor exercise can help prevent asthma attacks.
4. When exercise-induced asthma attacks, you should stop exercising immediately and inhale β2 receptor agonist in time, which can effectively relieve asthma attacks.
5. Those who have a history of exercise-induced asthma should pay attention to the intensity, time and events of exercise, and take reasonable and correct preventive measures before exercise to avoid the sudden attack of asthma during exercise.
In almost all sports, many excellent athletes suffer from asthma to varying degrees. For example, on the American team that participated in the Los Angeles Olympic Games in 1984, 67 athletes suffered from asthma or exercise asthma. Through careful medical care and the use of drugs approved by the International Olympic Committee, 47 athletes won medals. Exercise-induced asthma can be completely avoided as long as preventive medication and effective treatment are done carefully.
Why does asthma attack at night?
It is common for asthma to attack or worsen at night. Some experts observed 7729 patients with asthma, and found that 64% of them had attacks twice a week at night, and 74% had attacks more than once a week at night. What is the reason?
It is generally believed that the increase of respiratory tract reactivity and vagus nerve excitability at night, sleep state and supine position affect respiratory function, while the change of circadian rhythm and fluctuation of hormone level in the body, extensive mucus obstruction in bronchioles, weakening cough reflex at night and stimulation of cold air are all inducing factors; Recently, it has been found that gastric reflux is another major cause of nocturnal attacks. The researchers found that most asthma patients have gastric juice reflux, and gastric juice frequently flows back to esophagus, which leads to reflux esophagitis, and its incidence rate is 45% ~ 65%, which is significantly higher than that of the general population. Continuous monitoring of esophageal acidity shows that even 82% asthma patients have abnormal gastric reflux. Lying on your back during sleep, weakening esophageal peristalsis at night and inhibiting epiglottic reflex during sleep all contribute to the occurrence of gastric reflux, which makes gastric juice easily inhaled into trachea by mistake. Obviously, the stimulation of reflux gastric acid to esophagus is the factor that induces asthma attack. Because of this, some scholars call asthma caused by gastric reflux "stomach asthma", and patients with "stomach asthma" are often severe or refractory asthma patients. Therefore, when asthma attacks repeatedly at night, which affects sleep and cannot be cured for a long time, we should also think of the possibility of "stomach asthma".
Why does asthma attack at night?
Patients with bronchial asthma often attack or worsen from night to early morning. At present, it is considered that the attack or aggravation of asthma at night is of great significance, and the frequency of asthma attack at night is one of the indexes to judge the severity of asthma. In addition, the results also show that people with significant fluctuations in the daily maximum expiratory flow rate (PEFR) are prone to sudden death.
The characteristics and laws of nocturnal asthma attacks are as follows:
(1) The typical onset time of nocturnal asthma is from midnight to early morning, and some patients have almost no symptoms during the day, and they only attack at night, or their asthma is aggravated at night.
(2) Dyspnea, chest tightness and cough are the symptoms during the attack. Patients often wake up because of wheezing and chest tightness, so their sleep is often disturbed and they are sleepy and weak during the day.
(3) Most nocturnal asthma occurs in the second stage of sleep, and most of them are in the rapid eye movement stage.
The mechanism of nocturnal asthma is very complicated. Professor Quan Ying from the Department of Respiratory Medicine, People's Hospital of Beijing Medical University believes that it may be related to the following mechanisms:
(1) Because the sympathetic nerve is inhibited and the parasympathetic nerve is excited at night, the circadian rhythm of catecholamine secretion level in blood and excretion level in urine of asthma patients is consistent with that of PEFR, and there is a significant positive correlation. On the contrary, the level of histamine in blood at night is significantly higher than that during the day, which is negatively correlated with PEFR. It is observed that asthma patients turn to work at night, rest and sleep during the day, and the PEFR decreases after waking up during the day. Therefore, nocturnal asthma may be mainly related to sleep and lying position.
(2) Normal human body temperature has a circadian rhythm, with a diurnal fluctuation range of 1. 1 degree Celsius, and the body temperature is the lowest at 2-4 am. The temperature drop of asthma patients in the morning is obviously greater than that of healthy people, and the bronchial contraction of asthma patients can be caused by cooling to 0.7 degrees Celsius. Therefore, it is considered that airway contraction may be one of the mechanisms of nocturnal asthma.
(3) The drug distribution is uneven within 24 hours, that is, the drug is used during the day and not used at night, which leads to the decrease of the blood concentration of antiasthmatic drugs at night.
(4) The airway ciliary system also has a circadian rhythm in clearing mucus. At night, the ciliary movement is weakened, and the clearance speed of mucus in the airway is slowed down, which makes more allergens and mucus accumulate in the airway and will also aggravate airway obstruction.
(5) Inhaling allergens indoors and in bed at night, or inhaling allergens during the day, resulting in delayed response, which can be manifested as asthma at night.
(6) The plasma adrenocortical hormone level of asthma patients also has obvious circadian rhythm, and it decreases at night, which is consistent with PEFR rhythm.
(7) Resting position at night is prone to gastric reflux, which is also an important factor that causes asthma at night.
(8) Recent research shows that the airway responsiveness of asthma patients also has obvious circadian rhythm, which is lower in the day and higher at night, so the responsiveness to various stimuli is enhanced.
In a word, the mechanism of asthma attack or aggravation at night is complex, which is probably the result of the comprehensive action of many factors.
How should night asthma be treated?
Asthma in the middle of the night is really a headache. The patient not only suffered, but also disturbed his family. According to statistics, more than 90% of patients have had this painful experience, especially children, and asthma attacks at night are more common. Some patients have mild symptoms during the day, but their symptoms are obviously aggravated in the middle of the night. Asthma attacks force patients and their families to go to the hospital for emergency treatment, thus becoming frequent visitors to the emergency room of the hospital at midnight. According to statistics, among 8000 asthma patients, 39% have an attack every night, 64% have an attack at least three times a week, and 74% have an attack 1 time. Moreover, 70% of deaths caused by asthma attacks occur at night. Therefore, active treatment of nocturnal asthma is an important part of asthma prevention and treatment. Professor Chen Ping from the Department of Respiratory Medicine of shenyang military area command General Hospital recently published an article in Health News, pointing out several key points in the treatment of nocturnal asthma attack.
(1) Prevent airway contraction at night. Using drugs to dilate airway and prevent contraction and spasm of airway smooth muscle is an effective means to control nocturnal asthma attack. I used to take aminophylline before going to bed to control it, but because of its short half-life, the effect was not ideal. Long-acting β in recent years? 2 receptor agonist and theophylline modified controlled release tablets (Youchuanping) solved this problem. The curative effect of these drugs can be maintained for more than 12 hours once administered. Clinical studies have shown that long-acting β2 receptor agonists and theophylline controlled-release tablets have similar effects in controlling the symptoms of nocturnal asthma. However, in recent years, many foreign studies have shown that the increase in asthma mortality is related to the increase in the use of β2 receptor agonists, and long-term use of β2 receptor agonists can lead to the deterioration of lung function. Therefore, it is more appropriate to use You Chuanping. The usual dosage of Youchuan is 200 ~ 600 mg, which is taken two hours before going to bed and drinking a cup of warm water at the same time.
② Alleviate airway inflammation and reduce airway reactivity. Chronic airway inflammation is the basic feature of asthma. Asthma patients get worse airway inflammation at night. Anti-inflammatory therapy can reduce airway inflammation, reduce airway hyperresponsiveness and prevent asthma attacks. Glucocorticoid is the most effective drug to eliminate airway inflammation, and inhalation therapy has good curative effect and few side effects. Inhalation of glucocorticoid is more effective than long-acting β2 receptor agonist in controlling nocturnal asthma. Generally, drugs such as ANDEXIN or BIKETON can be inhaled, and the specific dosage can be adjusted according to the condition.
(3) Inhibition of gastroesophageal reflux. Although the relationship between nocturnal asthma attack and gastroesophageal reflux is still controversial, at least some patients with nocturnal asthma attack are related to it Most of these patients have hiatal hernia. The use of theophylline drugs can also increase the possibility of gastroesophageal reflux by relaxing the lower esophageal ring Determination of esophageal pH and lung function is the best method for auxiliary diagnosis. Treatment measures mainly include eating less and eating more meals, avoiding drugs and drinks between meals, especially before going to bed, avoiding fatty foods, alcohol, theophylline drugs and β2 receptor agonists, using H2 receptor antagonists and drugs that increase the pressure at the lower end of esophagus, such as cimetidine and urethane, and raising the head position during sleep. Patients with severe nocturnal asthma who are ineffective in drug treatment can be treated surgically.
(4) Eliminate paranasal sinusitis. Studies have shown that about 70% of asthma patients are complicated with sinusitis, and the use of antibiotics is related to reducing the severity of asthma. The course of antibiotic treatment should be more than 3 weeks, combined with nasal irrigation, nasal swelling and local use of corticosteroids. Individual patients need surgery.
(5) Prevention and treatment of allergic factors. The nocturnal attacks of some asthma patients are related to exposure to indoor allergens. Common indoor allergens include dust mites, dust, animal fur and secretions, perfume, air freshener, hair gel and so on. Studies have shown that the incidence of delayed asthma reaction in asthma patients exposed to allergens at night is as high as 90%, and it is serious and lasts for a long time.
Prevention and control measures mainly include:
① Find allergens through allergen skin test, specific immunoglobulin detection and allergen screening.
② Improving living environment is a simple and easy way to reduce allergens. Remove confirmed or suspicious allergic factors, such as not laying carpets, keeping the room clean, using acaricide, etc.
③ Specific desensitization therapy can be used for patients with definite allergens and poor therapeutic effects.
It should be emphasized that both specific desensitization therapy and anti-inflammatory therapy have the problem of maintenance therapy, that is, long-term medication. If the treatment is terminated without authorization, all previous efforts may be in vain.
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