Bronchospasm in children and adults

When the lumen of small branches of the bronchial tree is narrowed, it is said that bronchospasm has occurred, associated with prolonged reflex contraction of smooth muscle fibers present in the bronchi and bronchioles. Bronchospasm entails a disorder of pulmonary gas exchange, and in complex cases - respiratory arrest. Let's consider this problem in more detail. [1], [2]

Epidemiology

Bronchospasms in bronchial asthma are a common problem, occurring in about 6-7% of the general population. The number of people with asthma has now reached 300 million, and most of them have uncontrollable bronchospasm attacks.

The prevalence of the disease depends on a number of factors - in particular, on the intensity of allergen concentration, on the degree of environmental pollution, on the peculiarities of dietary intake, on the immune reactivity of the organism, and on genetic parameters.

In childhood, bronchial spasm most often occurs in children younger than 7 years of age who have acute bronchitis or when a foreign body is ingested (inhaled).

Causes of the bronchospasm

Bronchospasm is one of the components of bronchial obstruction, as well as inflammation, edema, viscous sputum secretion, etc. Smooth muscle spasm and mucosal hypersecretion occur as a consequence of the effect of irritants, allergens, infection, etc. On the mucosal tissue of the respiratory tract.

Among the main pathological conditions in which bronchospasm is noted, the following can be distinguished:

• asthma;
• chronic obstructive pulmonary disease, bronchitis with obstruction, bronchiolitis;
• allergic reaction medication hypersensitivity.

The development of spasm is due to reflex contraction of smooth muscle fibers, which occurs in response to some irritant, such as:

• food intoxication;
• hysteria, mental disorder, nervous breakdown;
• anaphylactic shock;
• allergic reaction to tobacco smoke, dust, chemicals; [3]
• excitation of prostaglandin receptors;
• taking medication;
• penetration of a foreign object into the bronchi;
• cystic fibrosis;
• tumor process;
• relapse of lung disease, obstructive bronchitis, chronic obstructive pulmonary disease, asthma;
• relapse of chronic occupational pathologies of the respiratory system;
• stress, physical overload. [4]

Laryngitis, adenoiditis, laryngotracheitis, etc. Can be the direct cause of spastic bronchial contraction. In some cases, the problem is provoked by sharp inhalation of strong odors, cold exposure, strong emotional stress, unrestrained laughter. In patients suffering from cardiovascular disorders, bronchospasm may be due to stasis of blood in the pulmonary circle, which is associated with compression of sensitive receptors of neurons in the bronchial walls.

Bronchospasm in asthma

Bronchial asthma is a chronic inflammatory respiratory pathology for which bronchospasm is one of the key symptoms. Bronchial constriction occurs periodically, which is due to the inflammatory process and increased sensitivity of the respiratory system to various kinds of stimuli. Bronchial asthma can be atopic (non-infectious) or infectious-allergic. Often asthma starts as an atopic pathology, but later transforms into infectious.

Bronchial spasm is considered a key feature of bronchial asthma, as is an attack-like cough. Bronchospasm and coughing, sputum is scanty and viscous or absent: these signs develop in an escalating trajectory and go through several stages.

1. Predasthmatic condition is accompanied by the appearance of dry cough (sometimes with scanty amount of sputum), mainly at night, in the form of attacks.
2. The attacks proper with typical asthmatic asphyxiation.
3. Asthmatic conditions (at first there is watery nasal discharge or stuffiness, sneezing, itching of the skin, etc., then there is a feeling of pressure in the chest, problems with exhalation, inability to cough).

Bronchospasm usually starts rapidly, wheezing appears, later they increase, the chest becomes wider, neck veins bulge, the patient sweats profusely. Such an attack requires immediate emergency care, followed by complex treatment in the interictal periods. For most patients, corticosteroid inhalers and bronchodilators are used simultaneously.

Drug-induced bronchospasm

The medication-induced form of bronchospasm is particularly common in patients with bronchial asthma. The problem can occur as a result of taking or administering a number of potentially active medications. The most common are beta-adrenoblockers, non-steroidal anti-inflammatory drugs, antibiotics, angiotensin-converting enzyme inhibitors.

The basic risk factor for the development of drug-induced bronchospasm is the presence of any pathology of the respiratory system, including bronchial asthma. Other factors can also be included:

• smoking;
• hereditary predisposition;
• bronchial hypersensitivity.

The clinical picture of drug-induced bronchospasm is not characterized by specificity, so differential diagnosis of the underlying cause of this disorder is quite difficult.

Therapeutic measures involve as quickly as possible withdrawal of the drug that provokes bronchospasm, and if this is impossible to do - reducing its dosage. In addition, general therapeutic principles are applied as for the treatment of bronchial asthma.

Nervous bronchospasm

Nervous stress is one of the factors that can provoke an attack of bronchospasm. The fact is that the body's reaction to a stressful situation activates the immune system, stimulating the release of certain hormones, which, in turn, provoke the development of an attack.

The symptomatology of nervous bronchospasm does not differ from other variants of this pathology:

• wheezing, coughing;
• shortness of breath;
• a tightness in his chest.

Stress bronchial spasm can be caused by any provoking event:

• conflicts and problems at school or work;
• financial difficulties;
• problems in my personal life;
• the loss of a loved one;
• forced moves, change of job, etc.

In some situations, it is not possible to identify the provoking factor.

In the treatment of nervous bronchospasm, treatment is directed, both on the violation itself, and on the correction of the nervous system. In addition, doctors give patients such recommendations:

• Try to control your breathing when stress is approaching, alternating between deep inhalations and exhalations, managing your reaction to the event;
• learn how to meditate, self-soothe, reduce stress levels;
• do regular physical exercise, take frequent walks in the fresh air;
• get a good night's sleep, get quality rest.

If necessary, the doctor may prescribe sedatives.

Bronchospasm at night

Nocturnal spastic attacks are characteristic of bronchial asthma and are an indicator of the severity of the disease. For diagnostic purposes, a dynamic study of the daily rhythm of attacks, the number of awakenings, and the quality of sleep is performed.

At nighttime, levels of such hormones decrease:

• cortisol is a glucocorticosteroid hormone with marked anti-inflammatory activity);
• Adrenaline is a hormone that is, among other things, a bronchodilator.

This provides insight into why the nocturnal decrease in hormone activity contributes to the occurrence of attacks in individuals with bronchial asthma.

Bronchospasm makes itself known at night or closer to morning. Repeated attacks negatively affect the general well-being of the patient, the quality of sleep and life in general. A person instead of a normal night's rest often wakes up, worries, takes medication. Subsequently, there is insomnia, replaced by daytime sleepiness, as well as increased irritability.

Additional triggering factors for nocturnal bronchospasm include:

• incorrect (uncomfortable) sleeping posture, improperly selected pillows and mattress;
• too stuffy or cold, dry air;
• inappropriate clothing for sleeping (tight, uncomfortable).

In some cases, the occurrence of nocturnal attacks of bronchospasm indicates inadequate (incorrect) treatment of bronchial asthma.

Allergic bronchospasm

Allergic bronchospasm occurs due to contact of the pulmonary system with an allergen, which provokes an inadequate immune response of the defense mechanism. Under the influence of the stimulus there is excitation of nerve endings, dilation of blood vessels, contraction of smooth muscles, there is a strong dry cough, lacrimation, general condition is disturbed.

Entry into the body of a foreign protein-allergen causes an immune reaction: if the irritating agent is not neutralized in time, the symptoms will progress, the reserve defense is activated, a typical manifestation of which is bronchial spasm and edema of the mucosa lining the internal respiratory tract. Due to regular irritation, thick mucus is produced, which accumulates in the alveoli and can subsequently create favorable conditions for the development of bacterial infection. As a result of stagnation and infection, allergic bronchitis develops. The following factors can contribute to this:

• bad habits;
• immunodeficiency;
• poor quality, monotonous, meager food;
• unfavorable environmental conditions;
• uncontrolled use of medications;
• Lack of treatment, or improper treatment of other allergic conditions;
• Regular contact with chemical, organic components, potential allergens.

Treatment for allergic bronchospasm is prescribed after a comprehensive diagnostic examination. Diagnosis is established based on the initial examination and detailed study of anamnesis, the results of laboratory and instrumental diagnostics. [5]

Risk factors

An attack of bronchospasm can be provoked by inflammation, tissue swelling, ingestion of food elements, vomit. In addition, spasm is a natural reaction to the methacholine test used for diagnostic purposes in bronchial asthma.

Among the factors that increase the risk of bronchial smooth muscle spasm:

• hereditary predisposition;
• frequent respiratory system pathologies, acute respiratory viral infections;
• frequent allergies;
• poor environmental conditions;
• therapy with certain medications (e.g., use of Anapriline or Propranolol in bronchial asthma, intravenous administration of Verapamil in angina pectoris may cause an attack of bronchospasm);
• physical overload;
• Smoking (any type of smoking, including passive smoke inhalation);
• congenital abnormalities of the respiratory system.

In most cases, the phenomenon of bronchospasm is associated with bronchial asthma, less often - with trauma (mainly thermal burns), direct irritation of the vagus nerve.

Pathogenesis

Bronchial walls contain smooth muscle fibers, which under the influence of certain provoking factors sharply contract. This occurs in order to prevent the subsequent entry of a potential pathogen (infectious agent) into the deeper parts of the respiratory tract. Pathogenesis, the mechanism of bronchospasm can be described step by step:

1. A pathogen or other pathogen irritates the mucosal tissue of the bronchus.
2. The muscles contract, creating an obstacle to the subsequent advancement of the "stranger".
3. Spasmed muscles put pressure on the bronchial vessels, blood circulation is impaired.
4. Blood stasis occurs and swelling develops.
5. As a result of increasing tissue edema, the bronchial lumen is further narrowed, the patient's condition worsens.

At the initial stage, the development of bronchospasm is due to the protective response of the body. However, in conditions of prolonged smooth muscle spasm, oxygen supply to pulmonary alveoli significantly deteriorates, which is further aggravated by the appearance of edema and the development of acute respiratory failure.

In an attempt to provide the body with an additional portion of oxygen, the person's breathing becomes more rapid, breaths become frequent and short, but the situation does not improve due to excessive accumulation of air in the lungs, as exhalation continues to be difficult. Oxygen deficiency and excess carbon dioxide lead to the development of acute tissue hypoxia. Without qualified medical support, an attack of bronchospasm can be fatal.

Symptoms of the bronchospasm

Bronchospasm can be allergic, paradoxical (when inhaled medication causes a reverse reaction in the form of smooth muscle spasm), post-load (caused by physical activity), etc.

The following are considered typical of its manifestations:

• breathing difficulties, shortness of breath;
• the exhalation is lengthening;
• cough appears - dry, or with the release of a small amount of thick, viscous secretion;
• there is a feeling of pressure, heaviness in the chest;
• you can hear the wheezing in the lungs;
• there's a sense of anxiety, fear.

Against the background of some respiratory diseases, bronchospasm can occur atypically or covertly. In such a situation, the symptoms are smoothed, they are non-intense, so they require a deeper diagnosis with the use of special tests.

If no action is taken to eliminate the bronchospastic attack, it will progress further:

• his breathing becomes intermittent, there's whistling;
• breathing becomes even more labored, worsening shortness of breath;
• skin becomes pale, the nasolabial triangle acquires a bluish tint;
• heart rate increases.

If bronchospasm develops in children, the symptoms should be monitored by parents and close people, since babies are not always able to talk about their sensations and problems. It is important to carefully observe the manifestations of the disease, and at the first suspicion of bronchospasm to call emergency medical assistance.

Dangerous first signs at which you should call your doctor immediately:

• Noisy inhalation or exhalation with visible effort;
• wheezing, wheezing breath;
• retraction and inflation of the nasal wings;
• A bouts of non-productive coughing (especially at night);
• increased anxiety, frightened;
• pale skin, blue lips.

In children, the lung volume is smaller and the bronchial lumen narrower than in adults. As a consequence, bronchospasm often accompanies pediatric bronchitis, allergic processes. In addition, it is more severe and can rapidly provoke the development of severe respiratory failure.

Complications and consequences

Prolonged, chronic bronchospasm can cause hypoxia (oxygen deprivation) and carbon dioxide intoxication. In addition to a marked deterioration of well-being, there is an increase in intrathoracic pressure, compression of blood vessels, which over time can cause the development of pulmonary heart disease and emphysema. Bronchospasm, if not treated, can lead to complete cessation of respiratory function and cardiac activity.

Emergency medical care usually comes from a medical team arriving on a call. Subsequently, the doctor refers the patient for further diagnostics. In particular, it may be necessary to consult an allergist, immunologist.

Prolonged attacks of coughing, choking, and wheezing should not be ignored. In such situations, it is important to take action and call an ambulance as soon as possible, or, if treatment has already been prescribed, quickly use the medication (inhaler) prescribed by the doctor. If the asthmatic status worsens, in most cases there is a fatal outcome.

Diagnostics of the bronchospasm

First of all, diagnosis is carried out to find out the causes of an attack of bronchospasm. The doctor listens to the patient's complaints, performs physical examination, evaluates the results of additional tests.

Important questions to find out:

• if you're allergic to anything;
• presence of atopic pathologies (bronchial asthma, atopic dermatitis), including those in the family line.

Blood pressure, heart rate, blood saturation level are necessarily evaluated.

Physical examination includes:

• Assessment of the involvement of accessory respiratory muscles in the respiratory process;
• determining the mobility of the rib cage;
• listening for dry and moist rales;
• an assessment of hemodynamic disturbances.

Spirometry is performed without load, with medication and physical load, hyperventilation.

Spirometry may be performed to detect:

• with a lowered PEF1 by more than 10% of normal;
• of decreased forced vital capacity;
• reversibility of obstruction under the influence of bronchodilators.

Additionally, these tests may be required:

• blood tests with determination of COE and leukocyte formula, blood biochemistry, lipidogram, coagulogram, acid-base balance and blood electrolytes;
• urinalysis;
• Allergy tests (skin scarification tests);
• measurements of oxygen and carbon dioxide partial pressures;
• electrocardiography;
• spirography, bronchial hyperactivity testing;
• determination of nitric oxide in exhaled air;
• microscopic and bacteriologic analysis of sputum;
• bronchoscopy with biopsy for subsequent pathohistologic and immunohistochemical examination;
• chest x-ray.

Other instrumental diagnostics may also be used, which is determined by individual indicators.

Differential diagnosis

Bronchospasm should be differentiated with the following pathologies:

• bronchial asthma;
• obstructive bronchitis;
• bronchiolitis (including obliterative form);
• aspiration syndrome;
• foreign bodies in the trachea, bronchi, esophagus;
• chronic bronchitis;
• localized pneumosclerosis;
• cystic fibrosis;
• ciliary dyskinesia syndrome;
• tumor processes affecting or compressing the bronchi, trachea;
• bronchopulmonary dysplasia;
• cardiovascular, immunodeficiency pathologies, disorders of the peripheral and central nervous systems.

Laryngospasm and bronchospasm differ, first of all, in that laryngospasm causes difficulty in inhalation, while breathing in bronchospasm is characterized by difficult exhalation. Laryngospasm is accompanied by involuntary contraction of the laryngeal muscles, and bronchospasm is a spastic narrowing of the lumen of bronchioles and small bronchi. Both the first and the second situation is a reason to consult a general practitioner, otorhinolaryngologist, pediatrician (if the problem is found in a child). [6]

Treatment of the bronchospasm

Treatment includes symptomatic measures to provide immediate relief, as well as preventive and baseline therapy, to control possible recurrences of bronchospasm.

Successful therapy of bronchospastic conditions involves eliminating or minimizing the causes of bronchospasm. The treatment course is usually long, complex, it is prescribed strictly individually.

Important components of successful treatment of bronchospasm:

• Providing emergency care during seizures;
• comprehensive interventions during the interictal periods;
• the use of both medication and non-medication interventions.

Medication interventions may include the use of such medications:

• bronchodilators (Salbutamol, Spirovent, Berotec);
• expectorants (Ambroxol, Bromhexin, Lasolvan);
• anti-allergic drugs (Suprastin, Claritin, etc.);
• combined bronchodilators (Ditek, Berodual).

A combination of inhaled corticosteroids and bronchodilators is recommended for most patients.

Non-medicamentous influences for bronchospasm include:

• breathing exercises to optimize the drainage pulmonary function, for which special drainage positions and training with forced prolonged exhalation are used;
• moderate physical activity;
• LFC with the practice of cyclic training, dosed walking, slow jogging, mixed motor activity (alternating walking with running):
• chiropractic care, chest massage, cervical-collar massage;
• tempering procedures (ultraviolet and air baths, dousing and rubbing, contrasting influences, walking barefoot on natural surfaces, etc.).

How to relieve bronchospasm quickly?

First aid for a patient with bronchospasm consists of the following measures:

• Provide fresh air (open a window, loosen clothes, unbutton buttons);
• use of one of the bronchodilators (inhaled administration of Ventolin, Berotek, Atrovent, and in complicated cases - Pulmicort, Beclazone, Dexamethasone);
• intravenous eufillin;
• Adrenaline is given by injection for anaphylactic shock.

The drugs of choice are often inhalers, which helps to expand the respiratory tract in a short time, reduce mucosal swelling, minimize the amount of mucous secretion.

If it is a case of bronchial asthma attack and nocturnal exacerbations of bronchospasm, patients are recommended before going to bed:

• make breath preparations Intal, Ditek or inhaled corticosteroid, can be combined with a sympathomimetic agent (eg, Salbutamol), or use Theotard, Retofil (exhibit efficacy for 12 hours;
• when sputum appears, you can inhale a bronchodilator (Berotek, Atrovent, Salbutamol), and after 15 minutes perform inhalation of expectorant (saline solution, soda solution 2%, alkaline mineral water).

Drugs that relieve bronchospasm

As part of emergency care for bronchospasm, inhaled bronchodilators of short activity (beta2-agonists, M-cholinolytics), eufylline (theophylline), corticosteroid drugs of systemic action are used.

Today, the main group of medications for emergency treatment of bronchospasm is short-acting beta2-agonists. They have the ability to quickly eliminate spasm and prepare favorable conditions for further action of anti-inflammatory drugs.

An important characteristic of beta2-agonists is their selectivity towards beta2-adrenoreceptors. Salbutamol, fenoterol, terbutaline are optimal in this regard. These drugs have fewer side effects, including minimizing the likelihood of tachycardia, heart rhythm disturbances, hypoxemia, and so on. Beta2-agonists are used as emergency drugs to eliminate bronchial asthma attacks, to prevent bronchospasm caused by physical overload or allergic process. The drugs are administered by one inhalation 1 to four times a day. In severe bronchospasm, up to 6 doses of salbutamol can be used.

In addition, beta2-agonists are suitable for the treatment of dyspnea and bronchospasm in elderly patients. In case of undesirable side effects (muscle tremor, palpitations), the dosage is changed by combining the drugs with anticholinergics.

The use of methylxanthines (e.g., Theophylline) is not as effective as the use of inhaled beta2-agonists, so they are prescribed only as additional agents. They are administered intravenously (5-10 ml of 2.4% Eufylline), orally (200-300 mg each).

Inhaled corticosteroids (beclomethasone dipropionate, mometasone furoate, flunisolide, etc.) are the drugs of choice for prevention of bronchospasm recurrences (in particular, in bronchial asthma), which are appropriate at any degree of severity of the disease. They have high anti-inflammatory activity, including in allergic (immune) inflammatory process. Inhaled corticosteroids are prescribed to all patients with bronchial asthma taking short-acting beta2-agonists more than once a day. For the purpose of clinical improvement, the average therapeutic dosage (800 to 1000 mcg per day) is used in the mornings and evenings, with subsequent reduction to the minimally effective dosage. If the effectiveness of the average dose is insufficient, it is increased to 2,000-2,500 mcg per day for an adult patient.

Mast cell membrane stabilizer drugs - Nedocromil, sodium cromoglycate - are inhaled anti-inflammatory drugs (non-steroids), which are often used to eliminate bronchospasm in patients with mild persistent form of bronchial asthma, as well as to prevent attacks of spasm caused by physical activity, inhalation of cold air, contact with allergens.

Antileukotrienes - Montelukast, Zafirlukast - are so-called leukotriene receptor antagonists. They are used for oral administration in patients with aspirin-induced bronchospasm, as well as attacks caused by allergic processes or physical overload.

Systemic administration of systemic corticosteroids is indicated in patients with severe spasticity, if high-dose inhaled corticosteroids combined with bronchodilators are not successful. Optimally take methylprednisolone or prednisolone, which have a short half-life. Usually start with medium therapeutic doses (prednisolone - from 20 to 40 mg per day), continuing treatment for a week to ensure a persistent effect. Then the dose is reduced to half a tablet once every three days.

Control of severe bronchospasm requires the use of a nebulizer, which can achieve a rapid clinical effect within five or ten minutes. Nebulizer allows you to inject directly into the bronchi large enough doses of bronchodilators. In this case, the drugs have virtually no systemic action and do not cause a large number of side effects, as it happens in the treatment of tablets or injectable drugs. Nebulizers - an optimal alternative to parenteral treatment of severe spastic attacks. Drugs for nebulizer administration are produced in special nebulizers, for example:

• Ventolin nebulas (one dose contains 2.5 mg of the active ingredient salbutamol);
• Flixotide nebulized (one dose contains 2 mg of fluticasone).

Recommended inhalation for bronchospasm:

• inhalers for bronchospasms during the first hour used three times, with the introduction of salbutamol (Ventolin) 2.5 mg every 20 minutes, then - hourly until a clear improvement in well-being;
• Flixotide is used after inhaler administration of a bronchodilator up to 2 times a day for a week.

The optimal selective adrenomimetic for bronchospasm relief is Salbutamol, which is an active bronchodilator. Formoterol and Albuterol also have a similar effect.

As for corticosteroids, they are used to stop the development of an inflammatory reaction in the airways, which in turn helps to reduce bronchospasm. Corticosteroids are usually used in the form of inhalations. For example, the popular Pulmicort (budesonide preparation) is actively prescribed for the treatment of obstructive respiratory diseases. After a single inhalation with a dry powder inhaler, improvement in pulmonary function is observed for several hours.

The drug Atropine is used before surgical intervention and, in particular, before anesthesia as a drug to prevent laryngitis and bronchospasm.

As part of a complex therapy, it is possible to use the well-known antispasmodic drug Nospa. Usually it is prescribed for dry spastic coughing attacks in the absence of sputum. Without a doctor's prescription, as well as with a mild cough and the absence of breathing difficulties No shpa is not used.

How to relieve bronchospasm in an adult without medication?

Doctors do not recommend self-medication for bronchospasm, because it is a serious problem that should be solved only in conjunction with the attending physician.

Before the emergency vehicle arrives, the patient should be seated, clothing loosened, and a bronchodilator inhaler given. Do not offer the patient cough suppressants or sedatives, apply mustard plasters or rub the body with anything.

In the interictal periods, you can use folk methods of bronchospasm prevention:

• prepare an infusion of an equal mixture of mother and stepmother, hawthorn fruit, oregano leaves, clover flowers, drink it by the glass about 5-6 times a day;
• prepare 1 liter of infusion on the basis of nettle and borage, drink a little throughout the day;
• brew medunica, drink three times a day 1 tbsp. L;
• use onions or garlic with honey;
• drink carrot juice and lingonberry juice.

Breathing exercises have a good effect during an attack of bronchospasm. It is necessary to take a slow shallow inhalation for 3 seconds and a slow exhalation for 4 seconds, after which the breath should be held (for 3-4 seconds).

In a standing position, you can put your feet together and inhale through your nose, stretching your arms upwards on the inhalation and lowering them on the exhalation. Then you should breathe frequently through your nose, waving your arms back and forth, as if embracing yourself. Repeat the exercise, combining it with walking on the spot.

Prevention

In order to reduce the risks of bronchospasm in childhood, you should pay attention to the following recommendations:

• Practice breastfeeding babies until at least age 1 year (this is especially true for those with a family history of bronchial spasm, allergies, or bronchial asthma).
• Complete elimination of bad habits, especially smoking (this applies both to a woman's smoking during pregnancy and passive inhalation of cigarette smoke).
• Introduction of a healthy complementary food, careful control of the slightest manifestations of pathological reactions of the body.
• Minimize children's contact with potential allergens (dust, pollen, etc.).

In adults, the prevention of bronchial spasms is reduced to observing these rules:

• Maximum possible elimination of the potential impact of factors that can provoke bronchospasm (psycho-emotional stress, dusty room, inhalation of too cold or hot air, insufficient or excessive humidity, physical overload, etc.).
• Systematic ventilation of the premises.
• Regular wet cleaning.
• Timely treatment of any respiratory, infectious and allergic diseases, and if allergies are present, regular check-ups and consultations with an allergist with appropriate recommendations.

It is easier to prevent a spastic attack than to correct a spasm that has already occurred. People at risk should listen to medical recommendations, if possible excluding factors that can provoke the problem. If bronchospasm has already occurred, it is necessary to be examined by a pulmonologist, allergist, otorhinolaryngologist, cardiologist to clarify the causes of the disorder.