Physiotherapy in the treatment of bronchial asthma

Physiotherapy during exacerbation of bronchial asthma

During periods of exacerbation of bronchial asthma, the following procedures are used.

Aerosol therapy. In the treatment of bronchial asthma, medium-dispersed (5-25 μm) and highly dispersed (1-5 μm) aerosols are used. The former settle in the bronchi, the latter - in the alveoli. To increase the depth of inspiration and increase the number of deposited aerosol particles, aerosol particles are recharged with a unipolar electric charge using electroaerosol devices. Medicinal electroaerosols 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, and help reduce hypoxia.

The most effective aerosols are those generated using ultrasound, as well as electroaerosols.

V.N. Solopov recommends the following inhalation program

Location of Zakharyin-Ged zones

• 1 Along the midline of the sternum at the level of attachment of the IV rib
• 2 Paravertebral line at the level of attachment of the IV rib to the spine on the right
• 3 The place of attachment of the XII rib to the spine on the left
• 4 The middle of the fold between the thumb and index finger of the right hand
• 5 Place of attachment of the clavicle to the sternum on the left
• 6 Above the carotid sinus on the right
• 7 Middle of the upper edge of the sternum
• 8 Second intercostal space on the left outward from the edge of the sternum by 2-3 cm
• 9 The second intercostal space on the right side outward from the edge of the sternum by 2-3 cm
• 10 The place of attachment of the right ulna to the shoulder laterally
• 11 The place of attachment of the 5th rib to the spine on the left
• 12 Lower edge of the xiphoid process
• 13 Lateral region of the elbow bend of the left arm
• 14 The place of attachment of the VI rib to the spine on the right
• 15 Above the angle of the lower jaw on the left
• 16 Middle of the outer surface of the right leg laterally
• 17 Above the left Achilles tendon medially
• 18 4 cm outward from the place of attachment of the 2nd rib to the spine on the right
• 19 Paravertebral line at the level of the III lumbar vertebra on the left
• 20 The area of the head of the ulna of the right wrist joint
• 21 Edge of the first lumbar vertebra on the right
• 22 Upper part of the left carotid sinus
• 23 Right nasolabial fold
• 24 Left wing of the nose

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

Microwave decimeter therapy (UHF therapy) with the "Volna-2" device has a pronounced anti-inflammatory and bronchodilatory effect. When applied to the adrenal glands, their glucocorticoid function is enhanced.

Magnetic therapy improves the function of external respiration and bronchial patency. A magnetic field with a voltage of 350 to 500 oersted is especially effective.

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

Laser radiation has an anti-inflammatory effect, stimulates the glucocorticoid function of the adrenal glands, activates the antioxidant system, and 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.

There are two methods used:

• corporal (biologically active points in the interscapular region are irradiated, exposure time is 15-20 minutes, frequency is 1-2 times a day, course - 10 procedures). The corporal method is used for mild and moderate forms of bronchial asthma;
• extracorporeal (blood taken from the patient's vein is irradiated with a laser for 25-30 minutes, followed by reinfusion, a course of 4-5 procedures). The extracorporeal method is used in moderate cases of bronchial asthma and in cases of glucocorticoid dependence.

Contraindications to corporal laser therapy:

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

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

Autotransfusion of ultraviolet-irradiated blood (AUIB) is used in the complex therapy of bronchial asthma during remission. The mechanism of action of AUIB:

• activation of lipid peroxidation of cell membranes, which leads to a change in their permeability, the activity of the cell receptor apparatus, and membrane-bound enzymes;
• increasing the activity of the antioxidant system;
• increasing the bactericidal activity of the blood;
• improvement of tissue microcirculation and collateral circulation, reduction of platelet adhesion and aggregation;
• immunomodulatory and desensitizing effect.

AUFOK is performed using the Izolda device. It is recommended to perform the procedures every other day, with a course of 3-5 procedures.

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

Contraindications to AUFOK:

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

Physiotherapy during remission

In the interictal period, physiotherapy is aimed at preventing exacerbations of bronchial asthma and treating chronic bronchitis. During this period, it is possible to recommend:

• electrophoresis of calcium ions using the general impact method;
• endonasal electrophoresis;
• phonophoresis of hydrocortisone on segmental zones of the chest;
• electrosleep procedures;
• hydrotherapy;
• exposure of the adrenal glands to decimeter waves;
• aeroionotherapy with negatively charged ions;
• hardening procedures;
• air and sun baths, sleeping in the fresh air;
• swimming in the pool and in the sea;
• UFO.

Chest massage

Therapeutic massage is widely used both to stop asthma attacks (point massage) and for treatment in the interictal period and during 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 back wall of the chest:
   • stroking;
   • segmental massage techniques;
   • classic massage;
   • acupressure massage of biologically active points.
2. Massage of the upper chest wall:
   • classic massage;
   • acupressure massage of biologically active points.
3. Hand massage:
   • classic massage;
   • acupressure massage of biologically active points.

The patient's position is lying down.

Methodology of implementation

First, the back wall of the chest is stroked. Stroking is performed in the direction from the lower edge of the ribs (XI, XII) to the back of the head, shoulders and armpits. 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, move on to the sequential execution of segmental massage techniques.

1. With the pads of the III-IV fingers, placed at an angle of 30-35°, move (with weight) along the spine, as if stretching the long muscle of the back. The movements are performed from the 8th to the 1st thoracic vertebra 2-3 times.
2. The thumbs are placed parallel to the spine, pressing on the skin, and the remaining fingers, grasping the skin with subcutaneous tissue, slowly roll it to the posterior axillary line. This technique is performed 4-5 times within the range from the 8th to the 1st thoracic vertebra.
3. With the tips of the III-IV fingers, placed one after the other (at an angle of 85°) in the depressions between the spinous processes of the thoracic vertebrae and the inner edge of the long muscle of the back, move it to the side by 1-1.5 cm with short movements. The maneuver is repeated 2-3 times. Then the long muscle of the back is moved toward the spine. In this case, the thumb is on the opposite side of the spine in relation to the other fingers, almost touching the surface of the back. The maneuver is repeated 2-3 times from the bottom up.
4. Stretching of the intercostal muscles is performed from the sternum to the spine with weights (6-8 times).

After performing segmental massage techniques, continue with massage using the classical method.

Rubbing and kneading techniques are used for the muscles of the back and shoulder girdle in the longitudinal and transverse directions. Intermittent and continuous vibration techniques are used. In patients with pronounced non-specific bronchial hyperreactivity, it is advisable to use the continuous vibration technique.

Massage of the anterior chest wall is performed in the supine position. The direction of massage movements is from the lower edge of the costal arches to the collarbones, shoulders, armpits, bypassing the mammary glands in women. Massage of the sternum, supra- and subclavian zones is performed especially carefully. Stroking, circular rubbing, and longitudinal kneading techniques are used.

Methodological instructions

1. When performing segmental massage techniques, the muscles are affected by stretching them.
2. All massage techniques are performed in a gentle manner.
3. When performing segmental massage techniques, first one half of the back is massaged, then the other.
4. When performing a classic massage, it is necessary to pay due attention to massaging the areas of the skin where biologically active points are located: massage them gently, without much effort, preparing them for subsequent special finger action.
5. When performing classical massage, which is also a kind of preparatory massage before acupressure, great importance is attached to achieving maximum muscle relaxation, since the greatest effectiveness of reflex changes when influencing the BAP in the corresponding organs and systems of the body depends on its level.
6. Segmental and classical massage techniques are performed for 8-10 minutes.
7. When an attack of bronchial asthma occurs, classical and segmental massage according to this method is not performed, with the exception of performing soft, deep stroking along the sternomastoid muscle and along the line of attachment to the sternum, as well as along the collarbone in order to achieve the effect of relaxing the tense muscles of the neck, shoulder girdle and chest for subsequent performance of acupressure.

Acupressure massage

Point massage is the most specialized form of massage, when used correctly, it can achieve the greatest therapeutic effect. The proposed method uses the inhibitory method of massaging the BAP for 10-12 days.

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

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

Methodological instructions

1. The room in which acupressure is performed should be separate, soundproof, without direct sunlight coming through the window openings and, preferably, without artificial lighting.
2. When performing acupressure, the patient's body muscles should be as relaxed as possible and the eyes should be closed.
3. The specialist performing acupressure must 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 massaging the BAP, finger kneading techniques are used. The point is pressed with the first finger and circular movements are made without shifting the skin (counterclockwise). This technique causes a feeling of distension, aching and has a calming effect on the patient.
6. The pressure on the BAP must be applied in such a way that it is not weak and at the same time does not cause severe pain. The sensation should be average ("comfortable pain"). In some cases, the patient feels as if an electric current radiating at a distance from the point of action.
7. Massage of symmetrical points is performed simultaneously with both hands.
8. Before each impact on the BAP, it is necessary to relax your fingers as much as possible, shake your hands and vigorously rub your palms for 3-4 seconds.
9. Point 17 XIV is used as an additional point for attacks of suffocation, shortness of breath, cough, and chest pain.
10. In case of bronchial asthma, acupressure is performed even during periods of acute bronchospastic manifestations to relieve them.

The use of complex massage for bronchial asthma has its own specific features compared to its use in patients with chronic bronchitis.

Features of acupressure massage

In the treatment of bronchial asthma, acupressure, like other therapeutic methods of influence, helps to relieve the bronchospastic condition, reduces allergic manifestations in the patient and ultimately contributes to his recovery.

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

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

To relieve an attack of bronchial asthma, two types of acupressure are used:

Option 1. If the attack occurs at night or in the morning, then to relieve it, massage the following points in sequence: 14 December; 13 July; 15 July; 22 December; 1 I; 5 I. The massage of the points in this sequence can be performed 2-3 times depending on the degree of bronchospasm.

The points are affected by a calming method. The calming (sedative) method is continuous action, soft, slow rotational movements without moving the skin or pressing with the pad of the finger (screwing) with a gradual increase in the pressure force.

Option 2. If the attack occurs in the first 2-3 hours of the second half of the day, massage the following points: 21 XI; 7 I; 4 I; 1 I; 13 VII; 15 VII and additionally massage point 4 II using the stimulating method. The stimulating (tonic) method is short strong pressure and intermittent vibration. It is performed for 1 minute.

BAT massage is performed for 3-5 days. As a result, the bronchospastic condition is completely or partially relieved. In case of significant improvement of the patient's condition, it is possible to proceed to complex therapeutic massage.

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

Therapeutic massage promotes better expectoration, expansion of the bronchi, and has a positive effect on the overall reactivity and resistance of the body.

You can also use such types of massage as vibration and percussion.

In 1979, O. F. Kuznetsov developed intensive massage of asymmetric zones (IMAZ) for the treatment of patients with chronic pneumonia, chronic bronchitis and bronchial asthma. IMAZ is performed in two versions. In the first version, the effect is carried out in the projection area of the upper lobe of the left lung, the middle and lower lobes of the right lung. Rubbing and kneading techniques take up 80-90% of the entire massage session, intermittent and continuous vibration techniques - 10-20%. In the second version, opposite areas are massaged. In patients with bronchial asthma, it is recommended to perform IMAZ according to the second version, which reduces or stops bronchospasm. The duration of an IMAZ session according to the second version is 30-40 minutes. The procedures are carried out at intervals of 3-5 days, the course of treatment consists of 3-5 massage sessions.

Contraindications to IMAZ:

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

It is advisable to perform massage 1.5-2 hours before therapeutic exercises, as it improves the functional capacity of the respiratory organs and cardiovascular system.

Electrophoresis should be carried out 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 (rubbing, dousing, swimming, etc.) can be used both before and after massage, thermal procedures should precede the latter. IMAZ cannot be combined with hardware physiotherapy. The combined use of these procedures can worsen the condition of patients and increase body temperature.

Postural drainage

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

In these positions, sputum moves under the action of gravity towards the main bronchi and trachea, reaches the bifurcation area of the trachea, where the sensitivity of the cough receptors is greatest, and is removed by coughing.

Postural drainage is indicated for any clinical and 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 cardiac failure;
• pulmonary embolism;
• hypertensive crisis;
• hypertension during a period of sharp increase in blood pressure.

Postural drainage is advisable to use as a therapeutic component in a four-stage scheme for normalizing the drainage function of the bronchi.

Stage 1 - normalization of the rheological properties of sputum:

• expectorants;
• aerosol therapy (steam or ultrasound inhalations);
• hydration of the patient (warm drinks - 300 ml per 70 kg of body weight, infusion therapy as indicated).

The duration of this stage is 10-15 minutes.

Stage 2 - separation of sputum from the bronchial 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 (the "boat" position) on the chest at a frequency of 40-60 per minute for 1 minute, 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 pronounces voiced and voiceless vowels and consonants, hissing sounds);
• breathing through the Inga vibrator for 2-3 minutes 2-3 times.

Duration of the stage is 15-25 minutes.

Stage 3 - mobilization of sputum and its delivery to the cough reflex zone:

• staying in the drainage position;
• drainage gymnastics;
• breathing exercises (alternating a full inhalation and a series of exhalations with short, jerky diaphragmatic breathing);
• breathing exercises with the help of an instructor who applies additional external force to the lower third of the chest.

Duration of the stage - 10 minutes. Stage 4 - removal of sputum:

• the patient coughs;
• takes a smooth deep breath, and on the exhale - 2-4 coughing thrusts.

Duration of the stage is 5-10 minutes.

The fully described set of measures is performed 2-3 times a day.

Barotherapy

Barotherapy is treatment under conditions of artificially created altered barometric pressure.

For bronchial asthma, two methods of barotherapy are used: under conditions of low and high barometric pressure.

Treatment in conditions of low barometric pressure

The treatment method was developed by P.K. Bulatov. The course of treatment consists of 22-25 sessions, conducted 5 times a week. The degree of air rarefaction increases in the first half of the course, and then the treatment regimen remains constant until the end of the treatment. During the first 2 sessions, the pressure reduction in the chamber corresponds to an ascent to a height of 2000 m above sea level (596 mm Hg). During the 3rd-5th sessions, the maximum "ascent 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 until the end of the treatment - the "height" is 3500 m (493 mm Hg). Each session lasts about 1 hour and consists of an “ascent” (lowering the air in the pressure chamber for 8-10 minutes), staying “at altitude” (25-30 minutes with the maximum low pressure achieved) and a “descent” (gradual increase in pressure in the chamber to normal atmospheric pressure over 12-18 minutes).

The mechanism of the positive therapeutic effect has not been fully elucidated. Reducing the 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, functions of the adrenal cortex, increased tone of the sympathetic nervous system). Against the background of treatment, the pathological dominant of bronchial asthma fades.

Indications:

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

Contraindications:

• age over 42-45 years;
• active infectious and 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 coronary heart disease;
• inflammation of the middle ear and obstruction of the Eustachian tubes;
• severe bronchial asthma with the use of glucocorticoids for a period of less than 6 months before the start of barotherapy;
• hernias of any localization;
• pregnancy of all stages;
• uterine fibroids with a tendency to bleeding;
• organic diseases of the nervous system.

Treatment in conditions of increased barometric pressure

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

The mechanism of positive therapeutic action is related to the fact that with increased pressure, oxygen is absorbed better and more easily.

In addition, increased air pressure makes it easier to inhale and creates a slight resistance to exhalation, similar to the effect of therapeutic exercises; stimulation of the pituitary-adrenal system is also important.

Indications for barotherapy using excess air pressure:

• patients with severe bronchial asthma under the age of 55, including those receiving small doses of glucocorticoids;
• other indications are the same as for treatment in conditions of low atmospheric pressure.

Both types of barotherapy can be combined with previously prescribed medication (bronchodilators, intal, etc.). As the condition improves under the influence of barotherapy, the need for medication, including glucocorticoids, decreases.

Normobaric hypoxic therapy

Normobaric hypoxic therapy is based on fractionated breathing with a hypoxic gas mixture (HGM-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:

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

Before conducting a course of normobaric hypoxic therapy, a hypoxic test is carried out. If patients experience severe dyspnea, a feeling of lack of air, an increase in pulse rate by 30-40 beats per minute, an increase in arterial pressure by 25-30 mm Hg, this indicates hypersensitivity to hypoxia. Normobaric hypoxic therapy is contraindicated for such patients.

Breathing with a hypoxic gas mixture (HGM-10) is carried out using a hypoxicator device in a cyclic-fractionated mode: breathing with HGM-10 - 5 min, breathing with atmospheric air - 5 min, which is one cycle. The second cycle is carried out immediately after the first one. The number of cycles in one procedure can vary from 1 to 10.

The concentration of inhaled oxygen in 5 minutes progressively decreases from 21 to 10%. The total time of GGS-10 breathing during 1 procedure is 30-60 minutes, with a total duration of 60-120 minutes. Daily or every other day GGS-10 breathing is recommended, the total duration of the course is 12-24 procedures. The course of normobaric hypoxytherapy is carried out against the background of 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 mild to moderate bronchial asthma in the remission phase in the absence of arterial hypoxemia.

Contraindications to normobaric hypoxic therapy:

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

Rational breathing exercises

Voluntary elimination of deep breathing according to K. P. Buteyko

In bronchial asthma, the leading pathophysiological mechanism of external respiratory failure is impaired bronchial patency.

In this connection, patients try to increase the volume of ventilation by deeper and more frequent breathing (hyperventilation), which leads to a higher oxygen tension in the alveolar air and a lower carbon dioxide tension. On the one hand, this circumstance has a positive value, since it facilitates the diffusion of gases through the alveolar-capillary membrane. On the other hand, hyperventilation leads to negative consequences, since the turbulence of the air flow in the bronchi and bronchial resistance increase. In addition, the functional dead space increases, there is an excessive removal of carbon dioxide from the alveoli and the body, which reflexively increases the tone of the bronchial muscles, increasing their obstruction. An increase in bronchial obstruction sharply increases the load on the respiratory muscles. Its work becomes excessive and ineffective. Forced breathing also promotes the evaporation of moisture and cooling of the bronchi, hyperosmolarity of their contents, which causes degranulation of bronchial mast cells and alveolar macrophages and the release of biologically active mediators that form bronchial obstruction.

The method of voluntary elimination of deep breathing (VEDB) or voluntary control of breathing by K. P. Buteyko eliminates hyperventilation, maintains the carbon dioxide content at an optimal level, and eliminates bronchospasm.

K. P. Buteyko defines VLGD as “a method of volitional elimination of deep breathing, consisting of a gradual decrease in the depth of breathing by constantly relaxing the respiratory muscles, or holding the breath until a feeling of a slight lack of air appears.”

VLGD training is performed in conditions of rest and muscle relaxation. Breathing should be done only through the nose.

The main stages of the VLGD technique are as follows:

• sit comfortably, relax, focus on your breathing;
• take a calm, shallow breath for 3 seconds (the air from the nose seems to reach only the collarbones);
• perform a calm, restrained exhalation for 3-4 seconds;
• hold your breath after exhaling (initially for 3-4 seconds, then gradually, as you become more trained, the duration of apnea increases). Holding your breath causes hypoxemia and hypercapnia for a short time;
• take a calm, shallow breath, etc.

The patient must record the time of maximum breath holding daily in a diary, which the doctor monitors during follow-up visits, initially after a week, once a month after the condition improves, and then once a quarter. The patient determines the duration of breath holding by mentally counting seconds.

Breathing pause training is carried out as follows: in a state of rest, with 5-minute breaks, you need to repeatedly hold your breath after a shallow exhalation, trying to lengthen the pause. The number of such breath-holds during the day is determined by the total time of breathing pauses, which should be about 10 minutes per day. With a breathing pause of 15 seconds, the number of repetitions should be about 40, and with a breath-hold on exhalation of 20 seconds - about 30.

With systematic breath-holding training and favorable dynamics of the disease, pauses gradually lengthen: within 1-2 weeks, holding the 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 you gain training the duration of the classes increases to 45-60 minutes 4-5 times a day.

The therapeutic effect of VLGD occurs within 2-3 weeks.

The VLGD method can be used for any clinical and pathogenetic variant of bronchial asthma. The use of the method during the precursor period sometimes allows preventing an attack of bronchial asthma, in some cases VLGD stops it.

During an asthma attack, the patient should sit down, put his hands on his knees or on the edge of the table, relax the muscles of the shoulder girdle, back, stomach, breathe more calmly, less deeply, try to reduce the volume of inhalation. The doctor should patiently and persistently repeat to the patient several times: "Monitor the depth of breathing, make it calm, barely noticeable, quiet, superficial, restrain the desire to take a deep breath, try to restrain the cough, do not talk, be silent." After 15-20 minutes, an improvement is noted, breathing becomes less noisy, coughing is relieved, phlegm goes away, cyanosis and pallor disappear.

In addition to regulating the depth of inhalation, short breath holds of 2-3 seconds help relieve asthma.

Contraindications to VLGD:

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

In some cases, other methods of breathing exercises may be effective (the method of A.N. Strelnikova - short breaths in combination with a special set of physical exercises, this type of gymnastics normalizes the production of carbon dioxide and promotes its retention in the body; long exercises during therapeutic swimming in the pool, including an extended exhalation above and under water; methods of 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, relaxation exercises, training diaphragmatic breathing, holding the breath on exhalation are performed. As the condition improves, gymnastic exercises are added in the form of bending and adducting the limbs, bending the body. Much attention is paid to learning to coordinate movements with breathing.

The method of dosed walking by E. V. Streltsov (1978) deserves attention. It consists of alternating fast and slow walking. Each patient independently chooses an individual walking speed. The total distance that he must walk in 1 hour of training increases from 3-6 km at the beginning of the training to 4-10 km at the end of the training. Each session of dosed walking ends with a set of breathing and general strengthening exercises.

Stimulation of diaphragmatic breathing is carried out through certain gymnastics and electrical stimulation of the diaphragm.

Artificial regulation of breathing (breathing 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 inhalation phase, exhalation phase or during the entire respiratory cycle. The most commonly used is resistive (aerodynamic) resistance to air flow, which is achieved by using various devices and equipment (diaphragms, narrow tubes, whistles, nebulizers, breathing regulators).

The breathing regulator is a miniature device, shaped like a whistle, with an inhalation and exhalation channel, a valve in the end part and a diaphragm, with which you can change the resistance on exhalation and create a positive pressure of 2-4 cm H2O during exhalation. Breathing exercises using the breathing regulator are performed with the patient sitting at the table 1-1.5 hours before eating. The nose is closed with a clamp, the exhalation is slow, visually controlled by the readings of the water manometer. Inhalation is shallow.

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

The treatment is carried out in two stages.

• Stage 1 - training in voluntary breathing regulation. Control lesson with a breathing regulator.
• Stage 2 (main) - daily exercises with the regulator for 40-60 minutes 3-4 times a day before meals and before bedtime.

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

Every 5 minutes the patient measures the duration of breath holding at the depth of a calm exhalation, recording the results in a diary.

Daytime classes are conducted with a methodologist, the rest are conducted independently.

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

Before prescribing artificial breathing regulation, a test is performed: before and after training with a breathing regulator lasting 20-30 minutes, the function of external respiration is examined. The indication for prescribing the method is an increase in VC, FVC, and expiratory reserve volume.

In patients with concomitant coronary heart disease, ECG monitoring is recommended during and after exercise.

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

• reduction of expiratory bronchial collapse;
• opening of atelectatic areas of the lungs;
• decrease in ventilation-perfusion ratio;
• a decrease in the air flow rate in the bronchi due to less frequent breathing, which leads to less irritation of irritant receptors and bronchodilation;
• increasing the strength of the respiratory muscles.

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

Breathing through a metered dead space

Breathing through a dosed dead space (DDS) is a variant of the method of training with a modified (hypercapnic-hypoxic) gas environment. The mechanism of action of DDS is similar to that during training in the mountains, as well as "when ascending to altitude" in a pressure chamber or when breathing gas mixtures with a low oxygen content. When breathing through DDS, it is possible to create a partial pressure of oxygen in the alveoli corresponding to any "altitude" of ascent in the mountains with an optimal tension of carbon dioxide in the blood.

As a DMPA, breathing is used through non-corrugated hoses or cylindrical containers with a diameter of 30 mm, connected to each other. Each container can have a volume of 100, 150, 300, 600 ml, which allows creating a DMPA with a volume of 100 to 2000 ml. Breathing is carried out through a mouthpiece, while nasal breathing is turned off using a nose clip.

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

Subsequently, the volume is gradually increased and brought to 1200-1500 ml. DDMP is recommended to be performed for 20 minutes once a day for 3-4 weeks. During the treatment, it is necessary to monitor the function of external respiration and blood gases.

Under the influence of DDMP, the general well-being of patients improves, shortness of breath decreases, breathing becomes less frequent, lighter and freer, attacks of suffocation occur less frequently and proceed more easily, and external respiration indicators improve.

Indications for DDMP:

• all clinical and pathogenetic variants of bronchial asthma with a mild course of the disease;
• stage III respiratory failure with signs of decreased sensitivity of the respiratory center to carbon dioxide.

Contraindications to DCM:

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

Acupuncture

Acupuncture is based on the reflex mechanism of regulation of somatovisceral interactions. A good therapeutic effect was obtained in 50% of patients. The method is most effective in patients with bronchial asthma, in whose pathogenesis neuropsychic mechanisms are of great importance. However, acupuncture is also effective in atopic bronchial asthma. The best therapeutic effect was noted in patients in a pre-asthma state (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 day 1-2 of the recovery period for 8-12 days).

Contraindications: severe pulmonary emphysema, pneumosclerosis, severe respiratory failure. Relative contraindication - corticosteroid dependence.

Су-Джок терапия

Su-Jok therapy (in Korean Su - hand, jok - foot) - acupuncture in 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, observing the principle of three-dimensionality. Treatment of patients with bronchial asthma in accordance with the principles of Su-Jok therapy consists of a reflex effect on the therapeutic corresponding systems of both the lungs themselves and 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 attacks of bronchial asthma.

Mountain climate treatment

Mountain climate has a beneficial effect on patients with bronchial asthma. The mechanism of the positive effect of mountain climate is important:

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

For therapeutic purposes in bronchial asthma, low mountains (areas with an altitude of 500 to 1200 m above sea level), mid mountains (from 1200 to 2500 m above sea level) and high mountains (over 2500 m above sea level) are used. The method of stepwise acclimatization is recommended: first, for the purpose of adaptation, the patient is sent to low mountains for several days, and then to mid and high mountains.

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

Indications for mountain climate treatment: atopic and infection-dependent bronchial asthma with mild to moderate severity.

Contraindications to mountain climate treatment:

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

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

Speleotherapy

Speleotherapy is the treatment of patients with bronchial asthma in salt caves (mines), pits. The main therapeutic factor of the microclimate of salt caves is the natural dry aerosol of sodium chloride. The main therapeutic factors are a comfortable temperature and humidity regime and a hypoallergenic air environment. Sodium chloride aerosol, 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 bronchial secretion and the functional state of the cells of the bronchial mucosa, and exhibits a bacteriostatic effect.

Speleotherapeutic hospitals operate in Ukraine (Solotvyno village, Zakarpattia region), Georgia (Tskhaltubo city), Nakhichevan (Duz-Dag), Kyrgyzstan (Chon-Tuz), Belarus (Soligorsk city).

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

At first, 4 days of acclimatization to the region where the cave (mine) is located are assigned, from the 5th day acclimatization to the microclimate of the mines begins - 3 hours, 2nd day - 5 hours, 3rd day - break, 4th day - 5 hours, 5th day - 12 hours, 6th day - break, 7th day - 12 hours and then 13-15 daily descents of 12 hours in the mine, the last 2-3 sessions are reduced to 5 hours.

For patients with corticosteroid-dependent bronchial asthma, a gentle regimen is used - speleotherapy is prescribed for 5 hours daily or 12 hours every other day.

Treatment in salt caves leads to 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 corticosteroid dependence. The results of treatment improve with repetition of the course.

Contraindications to a course of speleotherapy:

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

Aerophytotherapy

Aerophytotherapy is an artificial modeling of the natural phytophone above plants in the conditions of a treatment room by saturating the air with vapors of essential oils. The required concentration of essential oils is created in the room using special devices - aerophytogenerators.

Essential oils contain a complex of natural volatile biologically active substances that determine the aroma of plants. Thus, aerophytotherapy is aromatherapy. In medical practice, essential oils of mint, lavender, sage, fennel, fir, eucalyptus, rose, etc. are used. The increase in bronchial patency is most pronounced when using essential oils of mint, lavender and a composition of essential oil of mint, anise, fir. 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, and increase the content of secretory immunoglobulin A in bronchial secretions, the main factor in antimicrobial and antiviral defense.

The indication for aerophytotherapy is mild to moderate bronchial asthma in the remission phase.

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

Contraindications to aerophytotherapy:

• increased individual sensitivity to odors;
• exacerbation of bronchial asthma;
• acute febrile conditions;
• severe respiratory and cardiac failure.

UHF therapy

UHF (extremely high frequency) therapy is a treatment with electromagnetic radiation of the mm-range of non-thermal intensity. Low, non-thermal power of electromagnetic radiation from 10" ¹⁸ to 10" ³ W/cm2 ^is used, the wavelength is 1-10 mm. UHF therapy affects mainly pathologically changed organs and systems, without affecting normally functioning ones. MM waves change the charge of cell membranes, affect the membrane-receptor complex, the functioning of ion channels, and 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. Erythrocytes and lymphocytes of the microcirculatory bed are within the reach of UHF therapy. The following main effects are observed during UHF therapy:

• a general adaptation syndrome develops and the function of the hypothalamus-pituitary-adrenal cortex system is normalized;
• an immunomodulatory effect is manifested, resistance to the effects of viruses, bacteria, X-rays, ionizing radiation, and chemotherapy increases;
• accelerates the 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 content of endogenous opiate compounds in the blood is normalized;
• the state of the protease system is normalized - protease inhibitors and the microelement composition of the blood;
• addiction to smoking and alcohol is reduced;
• psycho-emotional status improves.

UHF therapy helps relieve broncho-obstructive syndrome, improves the function of external respiration, and prolongs the period of disease remission. Treatment is carried out at fixed frequencies with individual frequency selection (microwave resonance therapy) or using a wide range of frequencies (information-wave therapy).

UHF therapy is performed using the devices "Yav", "Electronics UHF", "Polygon". The most effective impact is on biologically active points, Zakharyin-Ged zones and large joints. The 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 UHF therapy:

• various clinical and pathogenetic forms of mild to moderate bronchial asthma in the phase of abating exacerbation, especially in the presence of neuropsychiatric changes;
• combination of bronchial asthma with gastric ulcer, duodenal ulcer and other diseases of the gastrointestinal tract;
• drug intolerance in bronchial asthma.

UHF 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 (like cures like);
• study of the mechanism of action of drugs on healthy people (homeopathic pharmacodynamics);
• treatment with small doses of drugs prepared using a special technology.

Homeopathic therapy is performed by doctors who have undergone special training. It is most effective in patients with pre-asthma, with initial manifestations of mild to moderate bronchial asthma. Homeopathic treatment can be used to prevent relapses of the disease, as well as an additional method when standard therapy is insufficiently effective. Inclusion of homeopathic therapy in a complex of therapeutic measures for corticosteroid-dependent bronchial asthma allows in some cases to reduce the dose of glucocorticoid drugs.

Thermotherapy

Thermotherapy increases non-specific resistance, reduces vegetative lability and meteosensitivity in bronchial asthma. The following types of thermotherapy are used:

• local dousing;
• hand and foot baths;
• hot chest wrap.

Local dousing. The procedure is performed using a rubber hose attached to a water tap or a jug. The spine, arms, and legs are doused with water at a temperature of 30-32 °C, with the temperature subsequently decreasing to 20-22 °C during the course of treatment. The duration of the procedure is 2-3 minutes, the course of treatment consists of 15-20 procedures. A more energetic effect is provided by contrast local dousings, performed 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, which lasts 1.5-3 minutes. In the morning, the procedure begins with hot water and ends with cold water, and vice versa in the evening. After dousing, it is necessary to rub the skin with a terry towel until hyperemia and a feeling of pleasant warmth.

Local dousing is used only during the remission phase.

Hand and foot baths. Warm and hot baths can be used as a means of symptomatic therapy during an asthma attack, as well as in the remission phase. The technique for using hot hand or foot baths is as follows: lower both arms up to the elbows (legs - up to the middle of the shin) into a basin or bucket of water at a temperature of 37-38 °C. The patient's shoulders, back and chest should be covered with a large towel so that the water in the basin does not cool down (the towel should also cover the basin). Then, over the course of 10 minutes, the water temperature is brought to 44-45 °C and the patient keeps his or her arms or legs in the bath for another 10-15 minutes. The total duration of the procedure is 20-25 minutes. Then the patient wipes his or her arms or legs dry, puts on warm underwear and goes to bed for 20-30 minutes. The procedures are carried out every other day or 2 times 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 organs.

Hot chest wrap. Hot chest 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 for infection-dependent bronchial asthma, as well as a distracting and bronchodilator procedure for night attacks of bronchial asthma. A. Zalmanov describes the technique for performing chest wrap 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 overlap the other by 30-40 cm. Then take a second terry towel 1.5 m long, but wider (folded in 2-3 layers, it should overlap the first towel in width). Next, fold a thin woolen or flannel blanket lengthwise in three layers so that when folded it covers the width of the second towel. Then the patient undresses to the waist. The woolen or flannel blanket is placed across the bed, a dry terry towel is placed on it, and on top of that - a well-wrung out terry towel, previously soaked in hot water at 65-70 ° C. The patient lies down with his back on all three layers and quickly wraps the ends of the wet towel on his chest, then the dry towel and blanket, and covers himself with a cotton blanket 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 thermotherapy procedures for patients with bronchial asthma in the remission phase:

1. Warm general bath (37°C) 10 minutes every evening; followed by hot chest wrap;
2. Cool shower every morning immediately after waking up;
3. Enemas with warm water;
4. Hot foot bath (40-42 °C) for 10 minutes, followed by dousing with cold water and vigorous rubbing of the collar area;
5. Sauna once every 2-3 days at a temperature of 60-95 °C, a course of 6 procedures.

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

Sanatorium and resort treatment

Sanatorium and spa treatment for bronchial asthma is carried out in the remission phase with satisfactory indicators of external respiration function in the warm and dry season in the sanatoriums of the Southern Coast of Crimea, in Kislovodsk, Nalchik, Nagorny Altai, etc. It includes climatotherapy, aerotherapy, heliotherapy, hydrotherapy, kinesitherapy, balneotherapy, physiotherapy. The main mechanisms of the positive effect of sanatorium and spa treatment: polyfactorial elimination, non-specific hyposensitization, increased resistance of the body.

Contraindications to spa treatment:

• severe bronchial asthma;
• corticosteroid-dependent form of bronchial asthma.

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