In 1997, the National Program “Bronchial Asthma in Children. Treatment Strategy and Prevention. ” The materials of this document were repeatedly discussed at numerous congresses, symposia, workshops, and were further developed in the practical and scientific activities of pediatric pulmonologists and allergists. In the Russian Union of Pediatricians, experts in the field of pediatric pulmonology, allergology, intensive care and resuscitation have summarized domestic and international experience in the treatment of emergency conditions in children with bronchial asthma and developed a form to help children with an attack of bronchial asthma. The Department of Maternal and Child Health Protection of the Ministry of Health of the Russian Federation considers this issue as one of the priorities in pediatric pulmonology. In modern therapy of bronchial asthma in children, aerosol therapy is widely used, which is associated with the ability to quickly deliver drugs to the respiratory tract, high local activity, and a decrease in side systemic effects.non-invasiveness . The disadvantages of the inhalation technique, often due to age-related characteristics, affect the dose entering the lungs and, consequently, the response. In this regard, in recent years, nebulizer therapy has become increasingly widespread in the treatment of exacerbation of bronchial asthma . Monitoring of the function of external respiration (peak expiratory flow, forced expiratory volume in 1 second) is included today in the standards for the management of children with bronchial asthma older than 5 years. The use of peak flow meters is aimed at improving the diagnosis of exacerbation. In addition, peak expiratory flow rate (PSV) is an important objective criterion for monitoring “the effectiveness of therapeutic measures. It is fundamentally important to recognize the early symptoms of exacerbation of bronchial asthma, the ability to test the function of external respiration using a peak flow meter , the earliest possible assistance, and the conditions for observing the child for at least 1-2 hours. Recently, there has been a tendency to reduce the length of stay of the patient in the hospital and to provide skilled care on an outpatient basis. To do this, clear recommendations and equipping emergency and emergency care with effective medicines and their delivery vehicles, including nebulizers, are needed. At the same time, it must be remembered that the treatment of a sick child should take into account both the features of the course of the disease preceding the exacerbation and the exacerbation itself. Alternative treatment options are presented that make it possible to choose drugs, routes of administration. The recommendations are aimed at providing practical assistance to district pediatricians, emergency doctors, and hospital doctors. Bronchial asthma in children is one of the most common chronic diseases. Bronchial asthma in children is a disease that develops on the basis of chronic allergic inflammation of the bronchi, their hyperreactivity and is characterized by periodic attacks of difficulty breathing or suffocation as a result of widespread bronchial obstruction. An exacerbation of the disease can occur in the form of an acute attack or a protracted state of bronchial obstruction. An attack of bronchial asthma is an acute and / or progressively worsening expiratory suffocation, difficulty and / or wheezing, spastic cough, or a combination of these symptoms, with a sharp decrease in the peak expiratory flow rate. An exacerbation in the form of a protracted state of bronchial obstruction is characterized by prolonged (days, weeks, months) breathing difficulties, with a clinically pronounced syndrome of bronchial obstruction, against which acute attacks of bronchial asthma of varying severity can be repeated. Exacerbations of bronchial asthma are a leading cause of emergency calls and hospitalization of children. Indications for the hospitalization of children with exacerbation of bronchial asthma
1 Severe attack
2 Ineffective bronchodilator therapy within 1-2 hours after the start of treatment
3 Long-term (more than 1-2 weeks) period of exacerbation of asthma
4 Inability to provide emergency care at home 5 Adverse living conditions 6 Territorial distance from healthcare facilities 7 Risk criteria for adverse outcome of the attack Medical errors in the management of patients with exacerbation of bronchial asthma 1 underestimation of the severity asthma 2 underestimation of the severity of the attack 3 overdose of inhaled beta-2 agonists 4 late administration of corticosteroid drugs
5 overdose of theophylline
6 lack or ineffective regimens of routine corticosteroid therapy
7 lack of written instructions for the patient and his family on actions and emergency treatment for an attack. Severity criteria for an attack of bronchial asthma. Acute attacks of bronchial asthma are classified as mild, moderate and severe on the basis of clinical symptoms, and a number of functional parameters. The severity of bronchial asthma and the severity of seizures are different concepts, although, of course, the severity levels have a positive correlation. With mild asthma, there are mild and moderate seizures, with moderate to severe and severe, mild, moderate, and severe. If there is at least one criterion of a more severe degree, the attack is regarded as more severe.