Asthma Need More Oxygen?

Bronchial Asthma Disease site chest Common symptoms Difficulty breathing, chest tightness, cough, cyanosis, etc. Check item Routine blood examination, sputum examination, respiratory function examination, blood gas analysis, chest X-ray examination, detection of specific allergens, etc. English name asthma Main cause Genetics, allergens, external factors table of Contents 1 cause of symptoms 2 diagnosis 3 Differential diagnosis 4 check 5 treatment 6 clinical manifestations 7 preventive measures 8 daily care Causes of folding symptoms (1) Genetic factors Asthma is related to polygenic inheritance. The prevalence of relatives of asthma patients is higher than the group prevalence, and the closer the relationship, the higher the prevalence; the more severe the patient’s condition, the higher the prevalence of their relatives. (2) Allergen 1. Indoor and outdoor allergens: Dust mites are the most common and most harmful indoor allergens, and they are also an important cause of asthma worldwide. Dust mites are found in secretions such as fur, saliva, urine and faeces. The fungus is also one of the allergens existing in indoor air, especially in dark, humid and poorly ventilated places. Pollen is the most common outdoor allergen that causes asthma attacks. 2. Occupational allergens: common allergens include grain flour, flour, wood, feed, tea, coffee beans, silkworms, pigeons, mushrooms, antibiotics (penicillins, cephalosporins), rosin, reactive dyes, persulfuric acid Salt, ethylenediamine, etc. 3. Drugs: Aspirin, propranolol (Propranolol) and some non-corticosteroid anti-inflammatory drugs are the main allergens of asthma caused by drugs. (3) Inducing factors Common predisposing factors include air pollution, smoking, respiratory virus infection, pregnancy, strenuous exercise, and climate change; a variety of non-specific stimuli, such as inhalation of cold air and distilled water droplets, can induce asthma. In addition, mental and psychological factors can also induce asthma. Folding diagnosis 1. For patients with typical symptoms and signs, a clinical diagnosis can be made after wheezing, shortness of breath, chest tightness and cough caused by other diseases are excluded. 2. For atypical cases, bronchodilation or provocation test should be done, and the positive can be diagnosed. [1] Folding differential diagnosis 1. Mainly consider chronic obstructive pulmonary disease and heart failure. Multiple small pulmonary emboli can occasionally cause wheezing. 2. Patients with allergic pneumonia appear to be clinically similar to asthma, but after exposure to sensitizers, they usually have more systemic symptoms without wheezing, unless it is allergic bronchopulmonary aspergillosis. 3. Patients with bronchial obstruction secondary to malignant tumours, aortic aneurysms, endobronchial tuberculosis or sarcoidosis may occasionally have wheezing. 4. Upper airway obstruction caused by vocal cord dysfunction can be diagnosed by fiberoptic bronchoscopy during the attack. 5. Other rare diseases that can resemble asthma include carcinoid syndrome, Churg-Stauss syndrome and eosinophilic pneumonia (including tropical eosinophilia and parasitic infections that affect the lungs during certain periods of the disease). 6. Strongyloides faecalis infection must receive treatment to avoid death, but if treated with corticosteroids, it can lead to disseminated parasitic infection and multiple infection syndrome of gram-negative bacteria. 7. Usually, the completely atypical history of asthma suggests that other diseases have caused airway obstruction. Fold check (1) Laboratory inspection 1. Routine blood test Increased serum IgE caused by allergies, increased the total number of white blood cells and neutrophils during co-infection. 2. Sputum examination Sputum smear showed increased eosinophilia. 3. Respiratory function check (1) Obstructive ventilatory dysfunction was present at the onset of ventilatory function detection, and the expiratory flow rate index decreased significantly. (2) Bronchial provocation test is used to measure airway responsiveness and confirm the existence of airway hyperresponsiveness. Commonly used inhalation stimulants are methacholine and histamine. After inhaling the stimulant, the ventilatory function decreases and the airway resistance increases. (3) The bronchial dilation test is used to determine the reversibility of airway airflow. Commonly used inhaled bronchodilators are salbutamol and terbutaline. (4) Determination of PEF and its variation rate PEF can reflect changes in airway ventilation function. PDF decreases during an asthma attack. Diurnal PEF variation rate of ≥20% is in line with the characteristics of reversible changes in airway airflow limitation. 4. Blood gas analysis There may be different degrees of hypoxemia during an asthma attack. If the airway is severely blocked, PaCO2 will rise at the same time as PaO2 drops, and respiratory acidosis will occur. Severe hypoxia can be combined with metabolic acidosis. (2) Other auxiliary examinations 1. Chest X-ray examination During an asthma attack, the brightness of both lungs increases, showing an over-inflated state, and there is no abnormality in the remission period. 2. Detection of specific allergens Avoid or reduce exposure to this allergen. Folding treatment Appropriate use of drugs can save most patients from emergency and hospitalization. The choice of drugs should be based on the severity of asthma. (1) Treatment of acute attacks Acute asthma attacks can be divided into mild (stage Ⅰ), moderate (stage Ⅱ), severe (stage Ⅲ) or respiratory failure (stage Ⅳ). 1. In stage I or stage II, an aerosol bronchodilator is usually inhaled by compressed air atomization. For adult patients with acute asthma, use a salbutamol metered-dose inhaler to connect the storage mist. 2. For adult patients with stage Ⅱ acute onset, corticosteroids can be given within 48 hours. Arterial blood gases should be measured, especially if the patient is ineffective against inhaled β2-agonists, has severe distress or worsening, or the extent of the attack is uncertain. 3. The arterial blood gas should be measured immediately for stage III patients. And should use an oxygen mask to continuously inhale the albuterol atomized solution. If the patient continues to be in severe distress, aminophylline should be instilled continuously, and serum theophylline levels must be monitored. Patients with heart failure or liver disease or elderly patients should pay special attention and reduce the dose. For patients who use drugs that reduce the serum theophylline clearance rate (such as cimetidine, erythromycin, ciprofloxacin), the dose should be reduced and the blood drug concentration should be monitored. Proper oxygen is given to correct hypoxemia, and oxygen can be inhaled through a nasal cannula or mask. Stage III patients should be given corticosteroids, and the most frequently used is intravenous methylprednisolone. There are many indications for hospitalization, but the clear indications are: no improvement in the condition, progressive fatigue, relapse after repeated β-agonist and aminophylline treatment, PaO2 significantly decreases, suggesting respiratory failure. Many patients with severe asthma attacks who should be hospitalized were sent home from the emergency room. 4. In addition to β-agonists and theophylline, patients in or near stage IV should also be given intravenous methylprednisolone immediately. Stage IV patients who are ineffective in the treatment of active β2-agonists and corticosteroids appear Fatigued and progressive deterioration of arterial blood gas and pH should consider tracheal intubation and assisted breathing. Such patients should be admitted to the intensive care unit. Due to hypoxia and suffocation, many stage IV patients can experience extreme anxiety. It is advisable to treat basic respiratory diseases, including proper 02 therapy. At this time, it is especially necessary to obtain calm, caring and supportive guidance from medical staff. (2) Education The importance of education must be emphasized. The more patients know about asthma, including the precipitating factors, when to use what medicine, and how to use the aerosol canister, the earlier the use of corticosteroids when asthma worsens, the better the asthma control. It is absolutely useful to monitor the peak expiratory flow in families with moderate to severe asthma combined with education. When asthma is stationary, the peak flow value is measured every morning. If the patient's peak flow value drops to a personal optimal value of <80%, the diurnal variation rate needs to be measured twice a day. Diurnal variation rate> 20% indicates airway instability, and the treatment plan needs to be re-evaluated. Every patient should record the treatment response every day, especially the treatment of acute attacks. [1] Clinical manifestations (1) Symptoms Typical manifestations are episodic expiratory dyspnea or episodic chest tightness and cough, accompanied by wheezing. In severe cases, it is forced to sit and breathe, or even cyanosis; dry cough or a large amount of white foamy sputum. Some patients only have a cough as their only symptom. Asthma can occur in a few minutes, and after a few hours to a few days, bronchodilators can relieve or relieve itself. It is one of the characteristics of frequent asthma attacks and exacerbations at night and early morning. Some patients may experience chest tightness, cough and difficulty breathing during exercise. (2) physical signs During an asthma attack, the chest is over-inflated, auscultation has extensive wheezing and prolonged exhalation sounds. In severe cases, rapid heart rate, odd pulses, abnormal chest and abdomen movements, and cyanosis may occur. But in mild asthma or very severe asthma attack, wheezing may not appear, which is called sedentary chest. Folding precautions 1. Primary prevention: aims to prevent asthma by removing risk factors. 2. Secondary prevention: early diagnosis and treatment when asymptomatic to prevent the development of asthma. 3. Three-level prevention: actively control the symptoms of asthma, prevent the disease from getting worse, and reduce complications. [1] Folding daily care (1) Keep the airway open 1. Medication care (1) Bronchodilators, among which inhalation therapy has the advantages of small dosage, quick onset, and small side effects, and is the preferred drug treatment method. (2) Adrenocortical hormones are currently the most effective drugs for the treatment of asthma. Long-term use can produce many side effects, such as double infections and obesity. When the child has a change in body image, psychological care should be taken. 2. Oxygen Most children with asthma have hypoxia, so oxygen should be given to reduce anaerobic metabolism, and 40% oxygen concentration is appropriate to prevent acidosis. Closely monitor the arterial blood gas analysis value as an evaluation of the treatment effect. 3. Posture Adopt a position that expands the lungs, which can be a semi-sitting or sitting position. In addition, postural drainage can also be used to assist children with expectoration. (2) Ensure rest and do psychological care Excessive breathing exercises and hypoxemia make the child feel extremely tired and provide a quiet and comfortable environment for the child to rest. Nursing operations should be carried out as concentrated as possible. Take measures to ease fear, ensure safety, and encourage children to relax. Understand the psychological problems of parents and children and provide corresponding psychological care according to individual conditions. (3) Improve activity endurance Assist children in their daily life, guide children's activities, try to avoid emotional and nervous activities. Before and after the child's activity, monitor his breathing and heart rate. If there is shortness of breath or heart rate during the activity, continue to inhale oxygen and give rest. Depending on the condition, gradually increase the amount of activity. (4) Closely monitor the condition Continue to observe the child’s asthma, observe whether the child has a large amount of white sticky sputum, expiratory dyspnea, rapid breathing, and wheezing, whether there is a lot of sweating, fatigue, cyanosis and vomiting, and whether the chest is full, It is inspiratory, whether there is excessive response during percussion, whether the whole lung is auscultated for wheezing, and whether breathing sounds and wheezing are weakened or disappeared, and heart rate increases when the dyspnea worsens. In addition, the children should be closely monitored for irritability, increased asthma, increased heart rate, rapid liver increase in a short period of time, and blood pressure. Be alert to the occurrence of comorbidities such as heart failure and respiratory arrest. At the same time, you should also be alert to the occurrence of persistent asthma. If persistent asthma occurs, you should immediately inhale oxygen and give a semi-sitting position to assist doctors in joint treatment. (5) Health education guidance Breathing exercise: Respiratory exercise can strengthen the diaphragmatic respiratory muscles. Before performing breathing exercises, the secretions from the children’s nasal passages should be removed