What to do if asthma attacks occur during breastfeeding

During the breastfeeding period, you must control it to prevent the occurrence of asthma. Because some patients have asthma, and some patients may have recurring asthma several times a year. In addition, the body's immunity is very low during the breastfeeding period, and the situation is special, so it is normal to have frequent asthma symptoms. This requires relevant examinations first, and a diagnosis should be made based on the results of the examination.

examine

1. Laboratory examination

1. Routine blood test

In cases caused by allergies, serum IgE increases, and the total white blood cell count and neutrophil granulocytes increase when combined with infection.

2. Sputum examination

Sputum smears may show eosinophilia.

3. Respiratory function test

(1) The ventilation function test showed obstructive ventilation dysfunction during the attack, 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 inhaled stimulants are acetylcholine and histamine. After inhalation of the irritant, the ventilation function decreases and the airway resistance increases.

(3) Bronchodilation test is used to measure the reversibility of airway airflow. Commonly used inhaled bronchodilators include salbutamol, terbutaline, etc.

(4) PEF and its variability measurement PEF can reflect changes in airway ventilation function. PEF decreases during an asthma attack. If the diurnal PEF variability is ≥20%, it is consistent with the characteristics of reversible changes in airway airflow limitation.

4. Blood gas analysis

During an asthma attack, there may be varying degrees of hypoxemia. If the airway obstruction is severe, PaO2 will decrease while PaCO2 will increase, resulting in respiratory acidosis. Severe hypoxia may be accompanied by metabolic acidosis.

2. Other auxiliary examinations

1. Chest X-ray

During an asthma attack, the translucency of both lungs increases and they appear hyperinflated. There are no abnormalities during the remission period.

2. Detection of specific allergens

Avoid or reduce contact with the allergen.

treat

Appropriate use of medications can prevent most patients from needing emergency room visits and hospitalization. The choice of medication should be based on the severity of the asthma.

Treatment of acute episodes

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 II, aerosol bronchodilators are usually used by inhalation of compressed air. For adult patients with acute asthma, use a salbutamol metered-dose inhaler connected to a mist reservoir.

2. For acute attacks in adult patients in stage II, corticosteroids can be given within 48 hours. Arterial blood gases should be obtained, particularly if the patient is refractory to inhaled beta-2-agonists, is in severe distress or deteriorates, or if the extent of the seizure is uncertain.

3. Arterial blood gas should be measured immediately for patients in stage III. And the patient should use an oxygen mask to continuously inhale the nebulized solution of salbutamol. If the patient continues to be in severe distress, aminophylline should be continued as an infusion, and serum aminophylline levels must be monitored. Patients with heart failure or liver disease, or elderly patients should pay special attention and reduce the dose. For patients using drugs that reduce serum theobromine clearance (such as cimetidine, erythromycin, ciprofloxacin), the dose should be reduced and the blood drug concentration should be monitored. Administer oxygen appropriately to correct hypoxemia, either via nasal cannula or mask.

Patients with stage III disease should be given corticosteroids, most often intravenous methylprednisolone. There are many indications for hospitalization, but the clear ones are: no improvement in condition, progressive fatigue, relapse after repeated treatment with beta-agonists and aminophylline, and a significant decrease in PaO2, indicating respiratory failure. Many people with severe asthma attacks who should be hospitalized are sent home from the emergency room.