If a person is diagnosed with bronchial asthma, a protocol is drawn up according to which the disease is treated and the quality of medical care is determined. This document specifies the sequence of actions of the physician dealing with a particular patient.
The completed protocol can also be considered a legal document, it is allowed to use it if any medical examinations or analyzes are required.
Keeping a protocol for asthma patients is a guarantee of improving their quality of life, reducing the risk of serious diseases against the background of this pathology. Thanks to these documents, it is possible to compile statistics on the prevalence of respiratory diseases among adults and children. Such data are necessary for the development and implementation of state programs for patient care.
Content of the therapy protocol
The clinical protocol for bronchial asthma contains the following items:
- indications for diagnosis and treatment;
- the form and degree of the disease before and after therapy;
- how asthma is controlled;
- drugs used for basic therapy, results of use;
- alternative treatments;
- examination data, recommendations for diagnosis and treatment from other specialists. Sometimes patients have to go to an appointment with an allergist, cardiologist, dentist, resuscitation specialist, infectious disease specialist;
- if necessary, indicate the grounds for hospitalization of the patient.
In addition, the medical document outlines the measures that will help to exclude the exacerbation of the disease, and the timing of subsequent consultations. As a rule, the frequency of medical examinations directly depends on the severity of asthma and the person’s age.
Taking anamnesis and assessing symptoms
The most important point in making a diagnosis is collecting information about the first symptoms of the disease and its progression. The main signs of the disease, which are indicated in the clinical protocol in the presence of bronchial asthma, are:
- shortness of breath, accompanied by a cough;
- the presence of wheezing in the bronchi;
- a feeling of heaviness and compression in the chest, tachycardia;
- cyanosis of the nasolabial region, which often occurs in children.
Sometimes these symptoms alone are not enough to make an accurate diagnosis. It is important to clarify whether they disappear on their own or after using special preparations.
When interviewing, the doctor should pay attention to factors that indicate the severity of asthma:
- frequent exacerbations;
- sudden deterioration in well-being;
- asthmatic status;
- the need for intensive care;
- connection to the ventilator.
It also takes into account the hereditary predisposition to the disease, the presence of chronic inflammation of the respiratory tract.
Mandatory and additional research
Sometimes a clinical picture is enough to establish a diagnosis. But to confirm it, at the discretion of the doctor, additional laboratory tests and other diagnostic procedures may be prescribed , which are also noted in the clinical protocol of bronchial asthma:
- cytological examination of sputum;
- sowing bronchial secretions to identify pathogenic microflora and determine its sensitivity to antibiotics;
- assessment of external respiration;
- chest x-ray.
To obtain a clear clinical picture and to detect airway reactivity, provocative inhalation tests may be prescribed. Thanks to such a study, it is possible to understand how the smooth muscles of the bronchi react to the effects of certain stimuli.
Outpatient and inpatient asthma treatment
When drawing up a clinical protocol and prescribing individual treatment for a patient with a diagnosis of bronchial asthma, the following indicators are taken into account:
- the phase of the disease – during an exacerbation and asthma attacks, tactical therapy is used, if remission is observed – strategic;
- severity of the disease, symptomatic picture;
- age characteristics of the patient, the presence of concomitant diseases.
Outpatient treatment in a polyclinic is prescribed for BA patients if:
- the disease is in unstable remission;
- there is a stable remission, which allows for strategic therapy;
- diagnosed with mild asthma severity.
There are such indications for urgent hospitalization of the patient:
- severe form of the disease in the acute stage;
- moderate severity of asthma in the acute stage;
- initial detection of the disease;
- suffocation attack.
Disease therapy tactics
The compiled protocol for the treatment of bronchial asthma describes in detail the therapeutic tactics. It is based on the following principles:
- prevention of respiratory failure, stopping attacks of suffocation and frequent coughing;
- selection of the optimal treatment option. Depending on the case, medication and non-medication methods may be prescribed;
- normalization of the self-cleaning function of the bronchi and lungs.
In case of a serious inflammatory process, complex treatment is required with the use of drugs with enhanced action, for example, hormonal drugs, antibodies to Ig . If the individual program is not successful, the doctor decides to increase the dosage or change the medication. The doctor records the effectiveness of the treatment in the protocol.
Stepped therapy principles
The essence of the stepwise approach to AD drug treatment is to decrease or increase the amount, dosage, or frequency of drug administration. The decision is made based on the effectiveness of the tercapia and in the case of achieving control over the disease.
If after 3 months clinical-functional remission was achieved, then the intensity of therapy is reduced by one step. In the opposite situation, the doses of drugs are increased.
For children, effective, but at the same time, safe drugs are selected, used in a minimum dosage.
The principles of stepwise therapy:
- For the treatment of mild intermittent asthma, basic therapy is not prescribed. During an exacerbation, short courses of taking cromones and drugs that suppress the action of leukotriene receptors will be required .
- A mild persistent form of the disease is treated with basic monotherapy using the same drugs. Fast-acting beta2-agonists may be prescribed on demand.
- If a patient is diagnosed with moderate bronchial asthma for the first time, then inhalation corticosteroids, long-acting beta2-agonists and theophylline are preferred. When treating small children, drugs are administered through a nebulizer.
- Severe bronchial asthma is treated with ICS, while a large dosage is selected. At the beginning of therapy, long-term combined agents (GCS and beta2-agonists) are the best option.
Today, due to the application of the basic principles of therapy, a person with BA has every chance to live a full life.
After the diagnosis is made, the patient is immediately adjusted to the need for long-term treatment and regular visits to the doctor.
The choice of medicines depends on the following features:
- the cause of the development of the disease;
- clinical manifestations;
- form and phase.
The general strategy is as follows:
- with an exacerbation of the disease and the occurrence of asthma attacks, treatment is aimed at obtaining an unstable remission;
- if unstable remission is achieved, then the patient should undergo supportive therapy to consolidate the result and prevent progression of asthma.
All asthma medications fall into two main groups.
- Drugs for the control of the disease, the action of which is aimed at suppressing the pathological process. Thanks to these medicines, the sensitivity to allergens is reduced and inflammation is reduced. Such drugs are referred to as basic treatment, they must be used constantly. In this case, long-acting β2-agonists, as well as theophyllines and leukotriene receptor blockers can be an example .
- Drugs that relieve symptoms and bronchodilators are prescribed by doctors to relieve asthma attacks. These drugs should be used once in an emergency. This group includes inhaled glucocorticosteroids . Short-acting inhaled β2-agonists can also be used for emergency care during an attack.
Depending on the stage and severity of the disease, along with treatment with drugs, non-drug methods can also be used. The main goal of this therapy is to prevent exacerbation of the disease.
All non-drug methods are divided into three areas:
- traditional methods of treatment;
- Alternative medicine.
The complex of folk treatment includes various recipes for making products at home. They can be found on the Internet, on TV channels or in newspapers.
Components of animal or vegetable origin are used as ingredients. When deciding to be treated in this way, you should understand that it will be more effective in combination with the methods of traditional medicine.
The complex of physiotherapy includes such procedures: visiting salt caves, acupuncture, hardening, aeroionotherapy, gymnastics and physiotherapy exercises. Also, acupressure and chest massage are especially effective in bronchial asthma.
An effective way to normalize breathing is a set of exercises according to the Buteyko method. If you follow the recommendations, you can stop the asthma attack without the use of medication. An asthmatic must learn to breathe shallowly through the nose and relax at the same time.
Monitoring the effectiveness of treatment and patient education
During the period of bronchial asthma therapy, the attending physician maintains a protocol in which he clearly indicates the effectiveness of the use of certain techniques. The document also notes the degree of asthma control and attaches the results of periodic examinations and diagnostic procedures.
The doctor’s responsibilities include not only prescribing and monitoring the effectiveness of therapy, but also informing patients about behavior and care during an attack. If necessary, training in proper breathing and physical exercises is carried out to alleviate the patient’s condition.
Protocol for BA in children
The clinical protocol for the detection and treatment of bronchial asthma in children was prepared by leading pediatricians and allergists. It has significant differences and notes.
In children, AD symptoms usually appear before 5-6 years of age. In infants, symptoms of asthma are often confused with symptoms of respiratory infections.
The main problem lies in the peculiarities of diagnosis and treatment. In children, bronchial asthma is often found in the second or third stage. In such cases, you cannot do without a serious therapeutic approach.
Timely detection of the disease and the correct approach to the treatment of bronchial asthma greatly increase the effectiveness of its therapy.
Following the protocol, the doctor will be able to provide competent assistance and take measures to prevent the development of complications.