Physiotherapy in the treatment of bronchial asthma

Physiotherapy in the period of exacerbation of bronchial asthma

In the period of exacerbation of bronchial asthma, the following procedures are used.

Aerosol therapy. In the treatment of bronchial asthma, medium-dispersed aerosols (5-25 microns) and highly disperse (1-5 microns) are used. The first settle in the bronchi, the second - in the alveoli. To increase the depth of inspiration and increase the amount of precipitated aerosol particles, the aerosol particles are recharged by unipolar electric charge by means of electro-aerosol devices. Medicinal electro-aerosols most often have a negative charge. Negatively charged aerosols do not inhibit the function of the ciliated epithelium of the bronchi, increase gas exchange in the alveolar-capillary zones, contribute to the reduction of hypoxia.

The most effective aerosols generated by ultrasound, as well as electro-aerosols.

VN Solopov recommends the following inhalation program

Location of Zakharina Geda

• 1 At the midline of the sternum at the level of attachment of the IV rib
• 2 Near-vertebral line at the level of attachment of IV rib to the spine on the right
• 3 Place of attachment of XII rib to the spine on the left
• 4 Midfold between the thumb and forefinger of the right hand
• 5 Place of clavicle attachment to the sternum on the left
• 6 Above the carotid sinus on the right
• 7 Middle of upper edge of sternum
• 8 Second intercostal space to the left of the edge of the sternum for 2-3 cm
• 9 Second intercostal space to the right outside of the sternum margin by 2-3 cm
• 10 Place of attachment of the right ulna to the shoulder laterally
• 11 Place of attachment of V ribs to the spine on the left
• 12 Bottom edge of the xiphoid process
• 13 Lateral region of the elbow of the left arm
• 14 Place of attachment of VI rib to the spine on the right
• 15 Above the angle of the lower jaw to the left
• 16 Middle of outer surface of right lower leg lateral
• 17 Above the left Achilles tendon medially
• 18 4 cm outward from the attachment point of the second rib to the spine on the right
• 19 Near-vertebral line at level III of the lumbar vertebra on the left
• 20 Head area of the ulna of the right wrist
• 21 Edge of the first lumbar vertebra to the right
• 22 Upper left carotid sinus
• 23 Right nasolabial fold
• 24 The left wing of the nose

Inductothermy (variable high-frequency magnetic field) on the lungs (reduces bronchospasm) and adrenal glands (stimulates the glucocorticoid function of the adrenal glands). The course of treatment 8-15 procedures for 10-30 minutes.

Microwave decimeter therapy (DMV therapy) with the "Volna-2" device has a pronounced anti-inflammatory and bronchodilator effects. When exposed to the adrenal glands, their glucocorticoid function is enhanced.

Magnetotherapy improves the function of external respiration and bronchial patency. A magnetic field with a voltage of 350 to 500 oersteds is particularly effective.

Aeroionotherapy with negatively charged ions increases pulmonary ventilation, improves bronchial patency.

Laser radiation has an anti-inflammatory effect, stimulates the glucocorticoid function of the adrenal glands, activates the antioxidant system, improves microcirculation. Low-intensity radiation with a power of 25 mW is used, generating light in the red part of the visible spectrum with a wavelength of 632.8 nm.

Two methods are used:

• corporeal (biological active points in the interblade area are irradiated, the exposure time is 15-20 min, the frequency is 1-2 times a day, the course is 10 procedures). The corporal method is used for mild to moderate bronchial asthma;
• extracorporeal (within 25-30 minutes the laser blood taken from the vein of the patient's blood with subsequent reinfusion, the course of 4-5 procedures). The extracorporeal method is used for moderate to severe bronchial asthma and for glucocorticoid dependence.

Contraindications to corporal laser therapy:

• exacerbation of bronchial asthma;
• acute forms of ischemic heart disease (unstable angina, acute period of myocardial infarction).

Contraindications to intravenous laser therapy: viral hepatitis B in the anamnesis or carriage of HBsAg; suspected malignant neoplasm; diseases of the blood system (except anemia).

Autotransfusion with ultraviolet irradiated blood (AUCA) is used in the complex therapy of bronchial asthma in the period of remission. The mechanism of action of AUCA:

• activation of lipid peroxidation of cell membranes lipids, which leads to a change in their permeability, cell receptor cell activity, membrane-bound enzymes;
• increasing the activity of the antioxidant system;
• increased bactericidal activity of blood;
• improvement of microcirculation of tissues and collateral circulation, reduction of adhesion and aggregation of platelets;
• immunomodulating and desensitizing action.

AUFOK is carried out with the help of the "Isolde" device, it is recommended to perform the procedures every other day, on the course - 3-5 procedures.

Treatment of AUFOK prolongs the period of remission, allows to reduce the dose of bronchodilators and glucocorticoids. The method is more effective in patients with infectious-dependent bronchial asthma.

Contraindications to AOFOK:

• age over 80 years;
• photodermatosis;
• hemorrhagic stroke;
• severe heart failure;
• hypocoagulation;
• menstrual period.

Physiotherapy during remission

In the interictal period, physiotherapy is aimed at preventing exacerbations of bronchial asthma, the treatment of chronic bronchitis. During this period you can recommend:

• electrophoresis of calcium ions by the method of general action;
• endonasal electrophoresis;
• phonophoresis of hydrocortisone on the segmental zones of the thorax;
• Electrosleep procedures;
• hydrotherapy;
• influence decimeter waves on the adrenal gland;
• aeroionotherapy with negatively charged ions;
• hardening procedures;
• air and sun baths, sleep in the open air;
• bathing in the pool and at sea;
• UFO.

Chest massage

Therapeutic massage is widely used both for relief of asthma attacks (acupressure), and for treatment in the interictal period and in the period of exacerbation. Complex massage is more effective.

The course of complex massage is 10-12 days. The most effective is the following sequence of massage:

1. Massage of the posterior wall of the thorax:
   • stroking;
   • receptions of segmental massage;
   • classical massage;
   • point massage of biologically active points.
2. Massage of the upper wall of the chest:
   • classical massage;
   • point massage of biologically active points.
3. Hand massage:
   • classical massage;
   • point massage of biologically active points.

The patient's position is lying.

Method of conducting

First, stroking the back wall of the chest. Stroking is performed in the direction from the lower edge of the ribs (XI, XII) to the occiput, shoulders and axillary hollows. In the transverse direction, stroking is performed from the spine along the intercostal spaces to the axillary lines and back.

After performing various types of stroking pass to the sequential execution of the techniques of segmental massage.

1. The cushions of the III-IV fingers of the hand, placed at an angle of 30-35 °, are carried (with burdening) along the spine, as if stretching the long back muscle. Movement is performed from the 8th to the 1st thoracic vertebra 2-3 times.
2. Thumbs are placed parallel to the spine, pressing them against the skin, and the remaining fingers, grasping the skin with subcutaneous fat, slowly roll it to the rear axillary line. This method is performed 4-5 times in the range from the 8 th to the 1 st thoracic vertebra.
3. The ends of the III-IV fingers, placed one after the other (at an angle of 85 °) into the indentations between the spinous processes of the thoracic vertebrae and the inner edge of the long muscle of the back, are pushed back by short movements to the side by 1-1.5 cm. The reception is repeated 2-3 times. Then the long back muscle is propelled to the spine. In this case, the thumb of the hand is located on the opposite side of the spine in relation to the rest of the fingers, almost touching the surface of the back. Reception is repeated 2-3 times from the bottom up.
4. The stretching of the intercostal muscles is performed from the sternum to the spine with burdening (6-8 times).

After performing the techniques of segmental massage continue to carry out massage according to the classical technique.

The methods of rubbing, kneading the muscles of the back, the shoulder belt in the longitudinal and transverse directions are used. Methods of intermittent and continuous vibration are applied. In patients with severe nonspecific hyperreactivity of the bronchi it is advisable to use the method of continuous vibration.

The massage of the anterior wall of the thorax is carried out in the position on the back. The direction of massage movements - from the lower edge of the costal arches to the clavicles, shoulders, axillary cavities with the bypass of the mammary glands in women. Massage of the sternum, supra- and subclavian zones is especially carefully performed. Use techniques of stroking, circular grinding, longitudinal kneading.

Methodical instructions

1. When performing the techniques of segmental massage, the muscles are affected by the stretching method.
2. All the methods of massage are performed in a gentle mode.
3. When performing the methods of segmental massage, one half of the back is first massaged, then the other half.
4. When performing a classical massage, you must pay due attention to the massaging of skin areas on which the biologically active points are located: massage them gently, without much effort, preparing for the subsequent special finger impact.
5. Important for the performance of a classical massage, which is at the same time preparatory to a point massage, is given to achieve maximum muscle relaxation, the maximum effectiveness of reflex changes depends on its level when exposed to BAT in the appropriate organs and body systems.
6. The methods of segmental and classical massage are performed 8-10 minutes.
7. If there is an attack of bronchial asthma, classical and segmental massage is not performed using this technique, except for soft, deep strokes along the sternomastoid muscle and along the attachment line to the sternum, and along the collarbone in order to obtain the relaxation effect of the strained muscles of the neck, shoulder girdle and the chest for subsequent acupressure.

Acupressure

Point massage is the most specialized form of massage, with proper use it is possible to achieve the greatest therapeutic effect. The proposed method uses the braking method of massaging BAP for 10-12 days.

The course of treatment effect is divided into three periods (by days), with the selection of different amounts of BAP:

1. Day 1-3 (schemes 1 and 2);
2. 4-6th day (schemes No. 3 and 4);
3. 7-10-12th day (schemes 5 and 6).

Methodical instructions

1. The room in which acupressure is carried out should be separate, noise-proof, without direct sunlight entering through window openings and, preferably, without artificial lighting.
2. When performing a point massage, the muscles of the patient's body should be as relaxed as possible, and the eyes are closed.
3. A specialist performing acupressure should concentrate all attention on the points of influence.
4. BAT is massaged from 50 seconds to 2 minutes. The most painful points are massaged longer.
5. When massage BAT use methods of finger kneading. At the point, press I with your finger and make a circular motion without shifting the skin (counter-clockwise). This method causes a feeling of raspryaniya, aches and acts on the patient soothing.
6. Pressing on the BAT must be done so that it is not weak and at the same time does not cause severe pain. Sensation should be moderate ("comfortable pain"). In some cases, the patient feels like an electric current, irradiating at a distance from the point of impact.
7. Massage of symmetrical points is performed simultaneously with two hands.
8. Before each exposure to BAP, it is necessary to relax the fingers as much as possible, shake the hands and vigorously rub the palms for 3-4 seconds.
9. Point 17 XIV is used as an additional at attacks of a dyspnea, a dyspnea or short wind, a cough, a pain in a thorax.
10. With bronchial asthma, acupressure is performed even in the period of acute bronchospastic manifestations for their cupping.

The use of complex massage with bronchial asthma has its own specific characteristics in comparison with its use in patients with chronic bronchitis.

Features of the acupressure

In the treatment of bronchial asthma, acupressure, like other therapeutic methods of action, contributes to the relief of the bronchospastic state, reduces allergic manifestations in the patient and ultimately contributes to his recovery.

The therapeutic effect of acupressure in case of bronchial asthma can be conditionally divided into two periods:

• relief of acute bronchospastic manifestations;
• conducting a course of complex massage.

To stop the attack of bronchial asthma use two options for acupressure:

1st option. If the attack occurs in the patient at night or in the morning, then to stop it, the points are successively massed: 14 XII; 13 VII; 15 VII; 22 XIV; 1 I; 5 I. Massage points in this sequence can be performed 2-3 times, depending on the degree of manifestation of bronchospasm.

Effects on the points are carried out by a soothing method. Calming (sedative) method - continuous action, soft, slow rotational movements without shifting the skin or pressing with a finger pad (screwing) with a gradual increase in the pressure force.

The second option. If the attack occurs in the first 2-3 hours of the second half of the day, massage the points: 21 XI; 7 I; 4 I; 1 I; 13 VII; 15 VII and additionally massage point 4 II by an exciting method. Exciting (tonic) method - short strong pressure and intermittent vibration. Running for 1 min.

BAP massage is carried out for 3-5 days. As a result, the bronchospastic state is completely or partially suppressed. In the case of a significant improvement in the patient's condition, one can proceed to an integrated therapeutic massage.

The clinical effect is due to a combination of different types of massage. The effect of classical massage causes pronounced relaxation, and segmental and acupressure BAT facilitates (through the reflex mechanisms) the normalization of self-regulation of the bronchopulmonary apparatus.

Therapeutic massage promotes better sputum discharge, bronchial expansion, has a positive effect on overall reactivity, resistance of the body.

You can use and types of massage, such as vibrating, percussion.

In 1979, O. Kuznetsov developed an intensive massage of asymmetric zones (IMAZ) for the treatment of patients with chronic pneumonia, chronic bronchitis and bronchial asthma. The IMAS is conducted in two ways. In the first variant, the effect is performed in the region of the projection of the upper lobe of the left lung, the middle and lower lobes of the right lung. The methods of grinding and kneading occupy 80-90% of the whole massage session, the techniques of intermittent and continuous vibration - 10-20%. In the second variant, the opposite areas are massaged. In patients with bronchial asthma, it is recommended to carry out IMAz in the second option, which reduces or reduces bronchospasm. The duration of the IMAZ session for the second option is 30-40 min. Procedures are carried out with an interval of 3-5 days, the course of treatment consists of 3-5 sessions of massage.

Contraindications to IMAZ:

• acute inflammatory process in the bronchopulmonary system;
• asthmatic status;
• pulmonary heart failure II-III;
• hypertensive disease IB-III st .;
• age over 55 years in women and 60 years in men.

Massage is advisable to spend 1.5-2 hours before therapeutic gymnastics, as it increases the functional capacity of the respiratory system and the cardiovascular system.

Electrophoresis should be performed 30-60 minutes after the massage or 2-3 hours before it, UFO - after the massage, but it is better to alternate it with the latter (by days).

Water procedures (wiping, dousing, swimming, etc.) can be used both before and after the massage, thermal procedures must precede the latter. IMAS can not be combined with hardware physiotherapy. The combined use of these procedures can worsen the condition of patients and raise body temperature.

Postural drainage

Postural drainage is a therapeutic procedure that facilitates the removal of bronchial secretions and increases the productivity of cough by giving the body special drainage positions.

In these positions, sputum is progressed by gravity toward the main bronchi and trachea, reaches the tracheal bifurcation region, where the sensitivity of the Cough receptors is greatest, and is removed by coughing.

Postural drainage is indicated for any clinico-pathogenetic variants of bronchial asthma during the period of hyperproduction of sputum.

Contraindications to postural drainage:

• pulmonary hemorrhage;
• acute period of myocardial infarction;
• severe respiratory and heart failure;
• pulmonary embolism;
• hypertensive crisis;
• hypertensive disease in the period of a sharp increase in blood pressure.

Postural drainage is expediently used as a therapeutic component in a four-stage scheme of normalizing the drainage function of the bronchi.

The first stage is the normalization of rheological properties of sputum:

• expectorants;
• aerosol therapy (vapor or ultrasound inhalation);
• hydration of the patient (warm drink - 300 ml per 70 kg of body weight, infusion therapy according to indications).

The duration of this stage is 10-15 min.

2 nd stage - separation of sputum from the bronchus wall:

• optimal drainage position for the middle and lower lobes of the lungs (lying on the stomach or back with the head down);
• Vibration massage using intermittent and continuous vibration. Intermittent vibration or therapeutic percussion is performed with the palms (position "boat") on the chest at a frequency of 40-60 per min for 1 min, followed by a pause. Perform 3-5 cycles. Continuous vibration (manual, hardware) is performed for 10-30 seconds with short pauses;
• sound exercises (the patient utters voiced and deaf vowels and consonants, hissing sounds);
• breathing through the vibrator "Inga" for 2-3 minutes 2-3 times.

The duration of the stage is 15-25 min.

Stage 3 - mobilization of sputum and its conduction into the zone of cough reflex:

• stay in drainage position;
• drainage gymnastics;
• breathing exercises (alternation of a full breath and a series of exhalations with a short jerky diaphragmatic breathing);
• breathing exercises with the help of an instructor exercising an external extra effort on the lower third of the chest.

The duration of the stage is 10 minutes. 4 th stage - excretion of sputum:

• the patient coughs;
• makes a smooth deep breath, and on exhalation - 2-4 cough thrust.

The duration of the stage is 5-10 minutes.

A fully described complex of measures is performed 2-3 times a day.

Barotherapy

Barotherapy - treatment in conditions of artificially created altered barometric pressure.

In bronchial asthma, two methods of barotherapy are used: under conditions of reduced and elevated barometric pressure.

Treatment in conditions of low barometric pressure

The treatment was developed by PK Bulatov. The course of treatment consists of 22-25 sessions, conducted 5 times a week. The degree of dilution of air increases in the first half of the course, and then the treatment regimen remains constant until the end of treatment. In the first 2 sessions, the pressure reduction in the chamber corresponds to a rise to an altitude of 2000 m above sea level (596 mm Hg). During the 3-5th sessions, the maximum "lifting height" is 2500 m (560 mm Hg), from the 6th to the 12th session - 3000 m above sea level (526 mm Hg) from the 13th session to the end of the course of treatment - "height" 3500 m (493 mm Hg). Each session lasts about 1 hour and consists of "lifting" (aeration of air in the pressure chamber for 8-10 minutes), stay "at altitude" (25-30 minutes at maximum maximum pressure) and "descent" (gradual increase of pressure in the chamber to normal atmospheric for 12-18 minutes).

The mechanism of a positive therapeutic effect is not fully understood. Reducing air pressure in the pressure chamber facilitates breathing, especially exhalation. Low partial pressure of oxygen leads to hypoxia, which causes a number of compensatory reactions of the body (stimulation of the cardiovascular and respiratory systems, adrenal cortex functions, an increase in the tone of the sympathetic nervous system). Against the background of treatment, the pathological dominant of bronchial asthma decays.

Indications:

• atopic and infectious-dependent bronchial asthma of mild and moderate severity in the phase of exacerbation in children and adults under the age of 45;
• bronchial asthma in the phase of remission with signs of possible exacerbation with a view to its prevention.

Contraindications:

• age older than 42-45 years;
• active infectious-inflammatory process of any localization;
• pronounced morphological changes in the lungs (diffuse pneumosclerosis, pleural adhesions) with significant pulmonary and pulmonary-cardiac insufficiency;
• arterial hypertension and ischemic heart disease;
• inflammation of the middle ear and violation of the patency of eustachian tubes;
• severe bronchial asthma with glucocorticoids for less than 6 months before the start of barotherapy;
• hernia of any localization;
• pregnancy of all terms;
• fibroids of the uterus with a tendency to bleeding;
• organic diseases of the nervous system.

Treatment in conditions of increased barometric pressure

During treatment sessions, the air pressure in the chamber rises from 0.2 excess atmosphere (at the first 2 sessions) to 0.3 atm. (at the 3rd and 4th sessions), and then to 0.4 atm. Up to the end of the course, consisting of 22-25 sessions. Each session lasts for more than 1 h (compression - 10-15 min, stay under maximum pressure - 40 min, decompression - 10-15 min).

The mechanism of a positive therapeutic effect is related to the fact that with increasing pressure, oxygen is absorbed better and easier.

In addition, increased air pressure facilitates inhalation and creates a slight resistance to exhalation, similar to the action of therapeutic gymnastics, it is also important to stimulate the function of the pituitary-adrenal system.

Indications for barotherapy using excess air pressure:

• patients with severe bronchial asthma up to age 55, incl. Receiving small doses of glucocorticoids;
• The remaining readings are the same as for treatment in conditions of low atmospheric pressure.

Both types of barotherapy can be combined with medical treatment, which was prescribed earlier (bronchodilators, intal, etc.). As the condition improves under the influence of barotherapy, the need for drug therapy, incl. In glucocorticoids is reduced.

Normobaric hypoxic therapy

The basis of normobaric hypoxia is the fractionated breathing gas hypoxic mixture (GGS-10) containing 10% oxygen and 90% nitrogen. The mixture is used under normal barometric pressure conditions.

The mechanism of positive action of normobaric hypoxic therapy:

• improvement of the function of external respiration in patients with bronchial asthma;
• improvement of myocardial contractility;
• increase oxygen capacity of tissues and their ability to utilize oxygen;
• increasing physical performance.

Before the course of normobaric hypoxic therapy, a hypoxic test is performed. If patients have pronounced dyspnoea, a feeling of lack of air, an increase in heart rate by 30-40 beats per minute, an increase in blood pressure by 25-30 mm. Gt; This indicates a hypersensitivity to hypoxia. In such a patient, normobaric hypoxia is contraindicated.

Breathing of the hypoxic gas mixture (GGS-10) is carried out with the aid of a hypoxicator apparatus in a cyclic-fractionated regime: breathing GGS-10 for 5 minutes, respiration by atmospheric air for 5 minutes, which is one cycle. After the first cycle, the second one is performed immediately. The number of cycles in one procedure can vary from 1 to 10.

The concentration of inhaled oxygen for 5 min progressively decreases from 21 to 10%. The total respiration time of GGS-10 within 1 procedure is 30-60 min, with a total duration of 60-120 min. It is recommended daily or daily breathing GGS-10, the total duration of the course - 12-24 procedures. The course of normobaric hypoxic therapy is performed against the background of the basic drug treatment. The positive clinical effect of the method lasts about 4 months.

Indications for normobaric hypoxic therapy: all clinical and pathogenetic variants of bronchial asthma of mild and moderate severity in the phase of remission in the absence of arterial hypoxemia.

Contraindications to normobaric hypoxic therapy:

• severe course of bronchial asthma;
• acute somatic and infectious diseases;
• pulmonary insufficiency;
• heart failure;
• cortico-dependent bronchial asthma;
• age over 70 years.

Rational breathing exercises

Strong elimination of deep breathing according to KP Buteyko

In bronchial asthma, the leading pathophysiological mechanism of insufficiency of external respiration is a violation of bronchial patency.

Patients in this regard are trying to increase the volume of ventilation by deeper and frequent breathing (hyperventilation), which leads to a higher oxygen tension in the alveolar air and low - carbon dioxide. This circumstance has, on the one hand, a positive value, since facilitates the diffusion of gases through the alveolar-capillary membrane. On the other hand, hyperventilation leads to negative consequences, as the turbulence of airflow in the bronchi and bronchial resistance increase. In addition, the functional dead space increases, there is an excess removal of carbon dioxide from the alveoli and the body, which reflexively increases the tone of the muscles of the bronchi, strengthening their obstruction. The increase in bronchial obstruction sharply increases the load on the respiratory musculature. Its work becomes redundant and inefficient. Forced breathing also contributes to the evaporation of moisture and cooling of the bronchi, hyperosmolarity of their contents, which causes degranulation of mast cells of bronchi and alveolar macrophages and the release of biologically active mediators, which form bronchial obstruction.

The method of strong-willed elimination of deep breathing (VGGD) or volitional control of breathing KP Buteyko eliminates hyperventilation, maintains the optimal level of carbon dioxide, eliminates bronchospasm.

KP Buteyko defines VBGD as "a method of willful elimination of deep breathing, consisting in a gradual decrease in the depth of breathing through the constant relaxation of the respiratory muscles, or breath holdings until a sensation of slight lack of air appears."

Training VBGD are made in conditions of rest and muscle relaxation. Breathe only through the nose.

The main stages of the VBGD methodology are as follows:

• comfortable to sit down, relax, focus on breathing;
• perform a calm, superficial breath for 3 seconds (air from the nose as if reaching only the clavicles);
• produce a quiet, restrained exhalation for 3-4 seconds;
• hold your breath after exhalation (at first for 3-4 seconds, then gradually, as you train, the duration of apnea increases). Holding the breath causes for a short time hypoxemia and hypercapnia;
• take a shallow shallow breath, etc.

The patient should record the time of maximum breathing delay in a diary, which the doctor monitors during repeated visits, first a week later, after improvement of the condition - once a month and then once a quarter. The duration of the patient's breathing delay is determined by the mental count of seconds.

The training of respiratory pauses is carried out as follows: in a state of rest with interruptions of 5 minutes, you need to retention breathing after a shallow expiration, trying to lengthen the pause. The number of such delays during the day is determined by the total time of respiratory pauses, which should be about 10 minutes per day. With a respiratory pause of 15 seconds, the number of repetitions should be about 40, and with an exhalation delay of 20 seconds - about 30.

With systematic training of breathing delay and with a favorable dynamics of the disease, the pauses gradually increase: within 1-2 weeks, the retention of breath on exhalation reaches 25-30 seconds, and after 1.5-2 months it reaches 40-50 seconds.

The duration of the first classes is 15-20 minutes 3-4 times a day, as the training period increases, the duration of sessions increases to 45-60 minutes 4-5 times a day.

The therapeutic effect of HDVD occurs in 2-3 weeks.

The method of VLDP can be used for any clinical and pathogenetic variant of bronchial asthma. The application of the method during the precursors sometimes helps to prevent an attack of bronchial asthma, in a number of cases, VBGD stops it.

During an asthma attack, the patient should sit down, put his hands on his knees or put them on the edge of the table, relax the muscles of the shoulder girdle, back, abdomen, breathe more calmly, less deeply, try to reduce the volume of inspiration. The doctor should patiently and persistently repeat the patient several times: "Watch the depth of breathing, make it calm, subtle, quiet, superficial, restrain the desire to take a deep breath, try to curb cough, do not talk, do not speak." After 15-20 minutes improvement is noted, breathing becomes less noisy, cough is eased, sputum departs, cyanosis and pallor disappear.

Asthma, in addition to the regulation of inspiratory depth, is facilitated by short breathing delays for 2-3 seconds.

Contraindications to VLPP:

• asthmatic status;
• circulatory insufficiency caused by decompensation of the chronic pulmonary heart or other causes;
• mental illness or psychopathy with a negative attitude towards VBPD;
• myocardial infarction.

In a number of cases, other methods of respiratory gymnastics may be effective (the technique of A-N. Strelnikova - short breaths in combination with a special set of physical exercises, this kind of gymnastics normalizes the production of carbon dioxide and promotes its retention in the body, prolonged exercises during therapeutic swimming in the basin, including an extended exhalation above and under the water, methods for training diaphragmatic breathing, etc.). Patients with bronchial asthma are also recommended sound gymnastics - pronouncing various vowels, hissing and other sounds and their rational combinations. At the same time, exercises are carried out for relaxation, training of diaphragmatic breathing, and delay in breathing during exhalation. As the condition improves, gymnastic exercises are added in the form of flexion and reduction of limbs, flexion of the trunk. Much attention is paid to training in coordinating breathing movements.

The technique of dosed walking by EV Streltsov (1978) deserves attention. It consists in alternating fast and slow walking. Each patient independently chooses an individual walking speed. The total distance that he must pass for 1 hour of training increases from 3-6 km at the beginning of the class to 4-10 km at the end of the class. Each occupation of dosed walking ends with a set of respiratory and general restorative exercises.

Stimulation of diaphragmatic breathing is carried out by certain gymnastics, electrostimulation of the diaphragm.

Artificial regulation of respiration (respiration with resistance)

Artificial regulation of breathing is widely used in the complex therapy of chronic obstructive bronchitis and bronchial asthma.

Resistance can be created in the phase of inspiration, exhalation or throughout the entire breathing cycle. The resistive (aerodynamic) resistance to air flow is most often used, which is achieved by using various devices and devices (diaphragms, narrow tubes, whistles, nebulators, breathing regulators).

The breathing regulator is a miniature device that resembles a whistle with an inhalation and expiration channel, a valve in the end part and a diaphragm with which you can change the exhalation resistance and create a positive pressure of 2-4 cm of water during the exhalation. Art. Respiratory exercises using the breathing regulator are performed in the patient's position sitting at the table for 1-1.5 h before meals. The nose is closed with a clamp, the exhalation is slow, visually controlled by the water manometer. The breath is shallow.

The course of treatment lasts from 3 weeks to 4 months.

Treatment is carried out in two stages.

• The first stage is the training of voluntary breathing regulation. Control exercise with a breathing regulator.
• 2nd stage (main) - daily exercises with a regulator for 40-60 minutes 3-4 times a day before meals and before bedtime.

Lesson plan: 30-40 minutes - breathing through the breath regulator; 20-25 min - voluntary regulation of the depth of breathing; 5 min - a fractional exhalation through the breathing regulator (drainage exercise).

Every 5 minutes the patient measures the duration of the breath delay at the depth of a quiet exhalation, writing down the indices in the diary.

Day classes are conducted with the methodologist, the rest - independently.

Artificial regulation of breathing is used against the background of the use of bronchodilators with a subsequent decrease in their dose.

Before the appointment of artificial regulation of breathing, a test is made: before and after the exercises with a breathing regulator lasting 20-30 min, the function of external respiration is examined. The indication for the purpose of the method is an increase in the VAS, FVC, the reserve volume of exhalation.

In patients with concomitant IHD during and after classes, it is recommended to perform ECG monitoring.

The mechanism of the positive therapeutic effect of artificial respiration regulation in bronchial asthma:

• reduction of the expiratory collapse of the bronchi;
• disclosure of atelectasized lung sites;
• reduction of ventilation-perfusion ratio;
• decrease in the speed of airflow in the bronchi due to the rarer breathing, which leads to less irritation of the irritative receptors and bronchodilation;
• increase in the strength of the respiratory muscles.

The best results were noted in patients with bronchial asthma with mild and moderate forms and in patients with bronchitis with moderate respiratory failure.

Breathing through the dead space being measured

Breathing through the dosed dead space (DSMP) is a variant of the training methodology for the altered (hypercapnic-hypoxic) gaseous medium. The mechanism of action DDMP is similar to that in training in the mountains, as well as "when climbing to a height" in the pressure chamber or breathing gas mixtures with a low oxygen content. When breathing through DDMP, it is possible to create a partial pressure of oxygen in the alveoli, corresponding to any "height" of the rise in the mountains with the optimal voltage of carbon dioxide in the blood.

As DDMP use breathing through non-corrugated hoses or cylindrical tanks with a diameter of 30 mm, connecting with each other. Each container can have a volume of 100, 150, 300, 600 ml, which makes it possible to create DDMP with a volume of 100 to 2000 ml. Breathing is carried out through the oral mouthpiece, with the nasal breathing turned off with the nasal clamp.

Begin training with a volume of 200-300 ml; the minimum duration of the procedure is 5 minutes, the maximum duration is from 20 to 30 minutes.

In the future, the volume is gradually increased and adjusted to 1200-1500 ml. DDMP is recommended for 20 minutes once a day for 3-4 weeks. In the process of treatment, it is necessary to monitor the function of external respiration and blood gases.

Under the influence of DDM, the overall well-being of patients improves, dyspnea decreases, breathing becomes more rare, light and free, attacks of suffocation occur less frequently and flow more easily, and external respiration rates improve.

Indications for DDM:

• all clinical and pathogenetic variants of bronchial asthma for mild disease;
• Respiratory insufficiency III degree in the presence of signs of a decrease in the sensitivity of the respiratory center to carbon dioxide.

Contraindications to DSMP:

• severe course of bronchial asthma;
• circulatory insufficiency;
• the level of partial oxygen tension in the blood is below 60 mm. Gt; p.
• chronic renal failure;
• neuromuscular diseases with diaphragm damage;
• condition after traumatic brain injury; high body temperature;
• activation of chronic foci of infection; acute respiratory infections;
• pronounced vegetative-vascular dystonia.

Acupuncture

The basis of acupuncture is the reflex mechanism of regulation of somatosviteral interactions. A good therapeutic effect was obtained in 50% of patients. The method is most effective in patients with bronchial asthma, in which neuropsychic mechanisms play a significant role in pathogenesis. However, Iglor reflexotherapy is effective in atopic bronchial asthma. The best treatment effect was noted in patients in the state of predastmy (100%), with mild (96.3%) and moderate (91.4%) bronchial asthma. In severe cases a good effect is achieved in 66.7% of patients.

It is possible to combine acupuncture with RDT (starting from 1-2 days of the recovery period for 8-12 days).

Contraindications: severe emphysema, pneumosclerosis, severe respiratory failure. Relative contraindication - corticostependence.

Su-Jok therapy

Su-Jok therapy (in Korean Su - brush, jok - stop) - acupuncture in the biologically active points of the foot and hand. The method is based on the correspondence of the hand and foot to the organs of the human body. The correspondence points are detected according to the rules of topographic anatomy with observance of the three-dimensionality principle. Treatment of patients with bronchial asthma in accordance with the principles of the Su-Jok therapy consists in the reflex action on the therapeutic correspondence systems of the lungs themselves, as well as the nasopharynx, adrenal glands, pituitary gland, spinal cord and brain.

The course of treatment is 10-15 sessions. Su-Jok therapy can not only prevent, but also stop the attacks of bronchial asthma.

Mountain-climatic treatment

Mountain climate has a beneficial effect on patients with bronchial asthma. In the mechanism of the positive effect of mountain climate have the meaning:

• special purity of mountain air;
• decrease in barometric pressure and oxygen tension, which contributes to the development of adaptive reactions of the body, increase its reserve capacity and resistance to unfavorable factors;
• stimulating effect of hypoxia on the glucocorticoid function of the adrenal glands.

With a therapeutic purpose for bronchial asthma, low mountains (a land with a height of 500 to 1200 m above sea level), a middle mountain range (from 1200 to 2500 m above sea level) and highlands (over 2500 m above sea level) are used. The method of stepwise acclimatization is recommended: first, with the purpose of adaptation, the patient is sent for several days to low-mountain conditions, and then to medium and high mountains.

The method of mountain speleotherapy, when along with mountain climatic treatment a microclimate of high-mountainous mines is used, is also applied. Mountain climatic treatment is carried out in the summer months, the duration of treatment is about a month.

Indications for mountain climatic treatment: atopic and infectious-dependent bronchial asthma with mild and moderate severity.

Contraindications to mountain climatic treatment:

• severe course of bronchial asthma;
• active inflammatory process in the bronchial system;
• decrease in the function of external respiration by more than 50% of the proper values;
• cardiovascular disease with persistent rhythm disturbances and circulatory failure;
• cortico-dependent forms of bronchial asthma with a daily dose of prednisolone of more than 30 mg.

Relative contraindications to mountain climatic treatment are age over 60-65 years, glycocorticoid dependence with a dose of prednisolone no more than 20-30 mg per day; arterial hypoxemia.

Speleotherapy

Speleotherapy is the treatment of patients with bronchial asthma in salt caves (mines), mines. The main therapeutic factor of the microclimate of salt caves is a natural dry aerosol of sodium chloride. The main therapeutic factors are comfortable temperature and humidity regime and hypoallergenic air environment. Aerosol sodium chloride, due to its small size, penetrates to the level of small bronchi and has a secretolytic, anti-inflammatory effect, activates mucociliary transport, normalizes the osmolarity of the bronchial secretion and the functional state of the cells of the bronchial mucosa, exhibits bageriorostatic effect.

Speleotherapy hospitals operate in Ukraine (Solotvino, Zakarpattya region), in Georgia (Tskhaltubo), in Nakhchivan (Duz-Dag), in Kyrgyzstan (Chon-Tuz), in Belarus (Soligorsk).

The main indications for speleotherapy are atonic and infectious-dependent bronchial asthma of the lung and middle course in the phase of complete and incomplete remission, as well as cortico-dependent bronchial asthma in the phase of remission.

Initially, 4 days acclimatization to the region of the location of the cave (mine), from the 5th day acclimatization to the microclimate of mines begins - 3 hours, the second day - 5 hours, the third day - a break, the 4th day - 5 hours, 5 th day - 12 h, 6 th day - break, 7 th day - 12 h and further 13-15 daily descents for 12 h stay in the mine, the last 2-3 sessions are reduced to 5 h.

Patients with cortico-dependent bronchial asthma are treated sparingly - speleotherapy is prescribed for 5 hours daily or 12 hours every other day.

Treatment in conditions of salt caves leads to a significant improvement in the course of bronchial asthma: in 80% of patients for a period of 6 months to 3 years, in 30% of patients it is possible to eliminate corticostependence. The results of treatment are improved when the course is repeated.

Contraindications to the course of speleotherapy:

• severe course of bronchial asthma with pronounced morphological changes in the bronchi and lungs (emphysema, pneumosclerosis, bronchiectasis, adhesions) with respiratory insufficiency III degree;
• acute infection in the respiratory tract;
• severe concomitant pathology of other organs and systems.

Aerophytotherapy

Aerophytotherapy is the artificial modeling of a natural phytophon over plants in a treatment room by air saturation with vapors of essential oils. The necessary concentration of essential oils is created in the room with the help of special devices of aerophytogenerators.

Essential oils contain a complex of natural volatile biologically active substances that determine the aroma of plants. Thus, aerophytotherapy is aromatherapy. Essential oils of mint, lavender, sage, fennel, fir, eucalyptus, rose, etc. Are used in medical practice. The increase in bronchial patency is most pronounced when using essential oils of mint, lavender and essential oil composition of mint, anise, fir. The essential oils of lavender, fir, lemon wormwood, fennel, sage exhibit antimicrobial activity.

Essential oils have an immunomodulatory effect, increase the activity of the local bronchopulmonary defense system, increase the secretion of immunoglobulin A in the bronchial secretion, the main factor of antimicrobial and antiviral protection.

Indications for aerophytotherapy are bronchial asthma of mild and moderate severity in the phase of remission.

The duration of the aerophytotherapy session is 30-40min, the course of treatment consists of 12-15 procedures.

Contraindications to aerophytotherapy:

• increased individual sensitivity to smells;
• exacerbation of bronchial asthma;
• acute feverish conditions;
• severe respiratory and heart failure.

EHF Therapy

EHF (extremely high frequency) therapy - treatment of electromagnetic radiation of mm-range of nonthermal intensity. A low, nonthermal power of electromagnetic radiation of 10 " ¹⁸ to 10" ³ W / cm ², a wavelength of 1-10 mm is used. EHF therapy has an effect mainly on pathologically changed organs and systems, without affecting the normally functioning ones. MM waves change the charge of cell membranes, affect the membrane-receptor complex, the functioning of ion channels, change the activity of enzymes.

MM waves promote the development of intercellular relationships, as their range coincides with the range of MM waves generated by the cell membranes themselves. In the reach of EHF therapy are erythrocytes and lymphocytes microcirculatory bed. With EHF therapy, the following main effects are observed:

• develops a general adaptation syndrome and normalizes the function of the hypothalamus-pituitary-adrenal cortex system;
• immunomodulating effect is manifested, resistance to viruses, bacteria, X-ray radiation, ionizing radiation, chemotherapy increases;
• accelerated regeneration of damaged tissues;
• the function of the central and autonomic nervous system is normalized;
• improves microcirculation, rheological properties of blood, corrects DIC-syndrome;
• the blood content of endogenous opiate compounds is normalized;
• the state of the protease system is normalized - protease inhibitors and trace element composition of the blood;
• decreased addiction to smoking and alcohol;
• the psychoemotional status improves.

EHF therapy contributes to the relief of bronchial obstructive syndrome, improves the function of external respiration, prolongs the period of remission of the disease. Treatment is performed at fixed frequencies with individual frequency selection (microwave resonance therapy) or using a wide range of frequencies (information-wave therapy).

EHF therapy is carried out with the help of devices "Yav", "Electronics EHF", "Polygon". The most effective effect on biologically active points, the Zakharyin-Ged zones and large joints. Selection of biologically active points is carried out according to the rules of traditional Chinese medicine. The course of treatment consists of 5-12 sessions, conducted daily or every other day.

Indications for EHF therapy:

• various clinico-pathogenetic forms of bronchial asthma of mild and moderate severity of the course in the phase of a ceasing exacerbation, especially in the presence of neuropsychic changes;
• a combination of bronchial asthma with peptic ulcer of stomach, duodenal ulcer and other diseases of the gastrointestinal tract;
• drug intolerance in bronchial asthma.

EHF therapy is highly effective and harmless, has no absolute contraindications. Relative contraindications are epilepsy, pregnancy, cardiopulmonary insufficiency of II-III degree.

Homeopathic Therapy

Homeopathic therapy is based on the following principles.

• the principle of similarity (the like is treated similarly);
• study of the mechanism of action of drugs on healthy people (homeopathic pharmacodynamics);
• treatment with small doses of drugs prepared using special technology.

Homeopathic therapy is performed by physicians who have received special training. It is most effective in patients with predma, with initial manifestations of bronchial asthma of mild and moderate severity. Homeopathic treatment can be used to prevent recurrence of the disease, and as an additional method with insufficient effectiveness of standard therapy. Inclusion of homeopathic therapy in a complex of therapeutic measures with corticosteroid bronchial asthma allows in a number of cases to reduce the dose of glucocorticoid drugs.

Thermotherapy

Thermotherapy increases nonspecific resistance, reduces vegetative lability and meteorology for bronchial asthma. The following types of thermotherapy are used:

• local douche;
• hand and foot baths;
• hot breast wrap.

Local dousing. The procedure is carried out using a rubber hose, put on a water tap, or a jug. Douse the area of the spine, hands, feet with water at a temperature of 30-32 ° C and then lower it during the course treatment to 20-22 ° C. The procedure lasts 2-3 minutes, the treatment consists of 15-20 procedures. More vigorous effect is provided by contrasting local douches, alternately with hot water (40-42 ° C) for 20 seconds, and then cold (18-20 ° C) for 15 seconds. The temperature change is repeated 4-5 times during the procedure lasting 1.5-3 minutes. In the morning, the procedure starts with hot water and ends cold, and in the evening on the contrary. After dousing, you need to rub the skin with a terry towel until the hyperemia and sensation of pleasant warmth.

Local douches are used only in the phase of remission.

Hand and foot baths. Warm and hot baths can be used as a means of symptomatic therapy during an attack of asthma, as well as in the phase of remission. The method of using hot hand or foot baths is as follows: in the pelvis, a bucket of water with a temperature of 37-38 ° C, put both hands on the elbow (legs - to the middle of the shin). The shoulders, back and chest of the patient should be covered with a large towel so that the water in the pelvis does not cool (the towel should cover the pelvis). Then within 10 minutes the temperature of water is brought to 44-45 ° C and the patient holds hands or feet in the bath for another 10-15 minutes. The total duration of the procedure is 20-25 min. Then the patient wipes his hands or feet dry, puts on warm clothes and goes to bed for 20-30 minutes. The procedures are carried out every other day or twice a week, the course of treatment is 10-12 procedures.

Contraindications to hand and foot baths:

• myocardial infarction;
• acute cardiovascular diseases;
• acute pleurisy;
• acute purulent inflammatory diseases of the abdominal cavity.

Hot breast wrap. Hot breast wrap is prescribed to patients with bronchial asthma to increase blood flow in the lungs, improve the drainage function of the bronchi and is most indicated in infectious-dependent bronchial asthma, as well as a distracting and bronchodilating procedure for night attacks of bronchial asthma. A. Zalmanov describes the technique of performing a thoracic wrapping as follows. A large terry towel 1.5 m long is folded 2-3 times so that it covers the patient's chest from the chin to the end of the ribs. One end of the folded towel when wrapping the patient's chest should cover another 30-40 cm. Then take a second terry towel 1.5 m long, but wider (folded in 2-3 layers it should cover the width of the first towel). Next, fold a length of three layers of thin woolen or flannel blanket, so that it folded over the width of the second towel. Then the patient undresses to the waist. A woolen or a flannelet blanket is placed across the bed, a dry terry towel is applied over it, a well-pressed terry towel, pre-wetted in hot water 65-70 ° C, is applied over it. The patient lies with his back on all three layers and quickly wraps on the chest first the ends of a damp towel, then a dry towel and blanket, covered with a cotton swab on top. The duration of the procedure is 20 minutes. After the procedure, you should rest in bed for about 1 hour. The course of treatment consists of 10-12 procedures.

Contraindications are the same as for hot hand and foot baths. Foreign physiotherapists recommend the following list of thermal therapy procedures for patients with bronchial asthma in the phase of remission:

1. Warm shared bath (37 ° C) 10 min every evening; after it hot wrapping of the breast;
2. A cool shower every morning immediately after awakening;
3. Clefts with warm water;
4. Hot foot bath (40-42 ° C) for 10 minutes, followed by dousing with cold water and vigorous grinding of the collar zone;
5. Sauna once in 2-3 days at a temperature of 60-95 ° C, for a course of 6 procedures.

Thus, at the present time there are a large number of methods and directions of treatment of patients with atopic bronchial asthma. When starting the treatment of a patient after stopping an acute attack of suffocation, one should take into account the features of the course of the disease, the results of previous methods of treatment, and choose the most effective and acceptable methods.

Spa treatment

Sanatorium treatment for bronchial asthma is carried out in the remission phase with satisfactory parameters of the function of external respiration during the warm and dry seasons in the sanatoriums of the Southern coast of Crimea, in Kislovodsk, Nalchik, Nagorny Altai, etc. It includes climatotherapy, aerotherapy, gel therapy, hydrotherapy, kinesitherapy , balneotherapy, physiotherapy. The main mechanisms of the positive effect of sanatorium treatment: polyfactor elimination, nonspecific hyposensitization, increased resistance of the organism.

Contraindications to sanatorium treatment:

• severe course of bronchial asthma;
• cortically dependent form of bronchial asthma.

[1], [2], [3], [4], [5],