Medicated dyspnea treatment
If the cause of dyspnea is the pathology of the respiratory system, then an extended drinking regime( abundant alkaline drink) is recommended. With severe symptoms of intoxication, infusion therapy is performed - intravenous fluid administration. For this purpose, saline, haemodes, polyglucin, reopolyglucin and some other liquids are used. However, in patients with dyspnoea caused by pulmonary edema, the administration of fluid is strictly limited, and intravenous fluid administration is performed in conjunction with diuretic diuretics. Intravenous fluid administration is mandatory in the hemic mechanism of dyspnea, the cause of which was poisoning. The diet is prescribed rich in vitamins and microelements.
If the cause of dyspnoea is bronchospasm, then the drug treatment should be aimed at eliminating spasm of the bronchi, their expansion. To this end, the following groups of drugs are used.
1. Selective β2-adrenomimetics. According to the duration of the action, the drugs are divided into short-term and long-acting drugs. The first are used to relieve the symptoms of acute shortness of breath, for example, with exacerbation of bronchial asthma.
Short-acting drugs are:
• salbutamol( ventolin) - available in the form of tablets of 2 and 4 mg, prescribed in a dose to children under 2 years 100 μg / kg 4 times a day, over 2 years 1-2 mg, adults -but 2-4 mg 3-4 times a day. The most commonly used metered-dose inhalers, inhalation powders, as well as nebulizer solutions;
• fenoterol( berotek) - a metered aerosol, one dose( inhalation) of which contains 100 or 200 micrograms( but 1-2 doses 3-4 times a day), as well as a solution for inhalation through a nebulizer( 0.5-1 mlon inhalation);
• Terbutaline - available in tablets of 2.5 and 5 mg, solutions for injection( 0.1-0.3 ml intramuscularly), inhalation( 0.5-1 ml per inhalation) and in the form of metered-dose inhalers( 0,25 mg in a dose, 1-2 doses 3-4 times a day).
Long-acting drugs include:
• long-acting salbutamol( saltos, wolmax), available in the form of tablets of 8 mg, given by half or whole tablet 2 times a day;
• formoterol( foradyl, oxy) - the preparation has the form of capsules of 12 μg and a metered-dose inhaler( 4.5-9 μg 1-2 times a day);
• clenbuterol - available in tablets of 20 mg and in syrup but 5 mg in 1 ml, is prescribed for children under 2 years of 5 ml 2 times a day, 2-4 years - 5 ml 3 times a day, 4-6 years- 10 ml 2 times a day, 6-12 years - 15 ml 2 times a day, over 12 years and adults - 1 tablet 2 times a day;
• salmeterol( salmeter, sulfur) - dosed aerosol of 25 mcg per dose and powder for inhalation of 50 mcg in a dose, prescribed 1 dose 1 -2 times a day.
2. Medications that cause relaxation of the muscles of the bronchi( blockers of m-cholinergic receptors):
• npratropium bromide( atrovent) - a metered-dose inhaler of 20 mcg in dose, administered at 1 -2 doses 3-4 times a day, as well as in capsules200 mcg - 1 capsule 3-4 times a day and a solution for injections through a nebulizer.
3. Combined preparations.
• Berodual contains fenoterol and ipratropium bromide - it is available in the form of a dosed aerosol of 20 mcg in a dose, 1-2 doses 2-3 times a day, and also as a solution for inhalation through a nebulizer;
• Ditek - a combination of fenoterol and cromogli-kata - has the form of a metered-dose inhaler, which is used at 1 -2 doses 3-4 times a day.
4. Methylxanthines:
• short-acting: eufillin is available in tablets of 150 mg( applied at a dose of 7-10 mg / kg), 2.4% solution for intravenous injection in an ampoule of 10 ml( used in a dose of 4, 5-5 mg / kg);
• long-acting: theopek( tablets of 100, 200 and 300 mg), theotard( 200. 350 and 500 mg each), euphylong( 250 and 375 mg capsules) and others at a dose of 10-15 mg / kg.
If the main cause of shortness of breath is inflammatory changes in the airway wall, then anti-inflammatory therapy is used.
Anti-inflammatory( basic) therapy for bronchial asthma
1. Non-steroidal anti-inflammatory drugs inhibit the release of substances involved in the development of inflammation. Preference is given to the inhalation route of administration of drugs( aerosols, spacer, nebulizer).These include:
• sodium cromoglycate( nourished) - metered-dose inhaler( 1 mg in 1 dose), powder for inhalation in capsules( in 1 capsule 20 mg);
• nedocromil sodium( tileed) - metered-dose inhaler( 2 mg in 1 dose), apply 2 doses 4 times a day;
• naklrom - is presented by capsules of 100 mg. Children under 2 years of age are prescribed 20-40 mg / kg / day, from 2 to 14 years - 1 capsule 4 times a day.
2. Steroid( hormonal) anti-inflammatory drugs. At present, even with mild asthma, it is recommended that basic glucocorticosteroid therapy be used. Preference is given to the inhalation route of administration of drugs.
Inhaled glucocorticoids:
• beclomethasone dipropionate( aldecin, becotide, beclometh, beclenzone) - metered-dose inhalers( 1 dose of the drug contains 50, 100 and 250 μg).Apply 100 μg 2-4 times a day, depending on the severity of the disease;
• budesonide( in 1 dose of 100 and 200 μg).Apply 100-200 mcg twice a day;
• pulmicort - is a solution of 0.125, 0.25 and 0.5 mg / ml, is available in ampoules of 2 ml;
• fluticasone propionate( fliksotid)( in 1 dose of 50, 125 and 200 μg).Apply 2 times a day.
The advantage of the inhalation route of administration of the drugs is the absence of hormones influence on the whole organism, they act directly on the respiratory system.
With ineffective inhalation hormones, systemic steroids are used. These include hydrocortisone( 5 mg / kg per day), prednisolone( 1-2 mg / kg per day), dexamethasone( 0.1-0.2 mg / kg per day).These drugs are administered orally in the form of tablets, as well as intramuscularly and intravenously in the form of solutions. However, for the relief of acute shortness of breath, it is not uncommon for the treatment to begin with parenteral administration of glucocorticosteroids.
To improve the patency of the airways in inflammatory diseases of the respiratory tract, the therapy is supplemented with preparations that dilute sputum and improve its separation.
These include mucolytic and expectorant drugs:
• preparations of the acetylcysteine group( ACC, mucobene);
• drugs based on carbocisteine: bronkatar, carbocysteine, mucodin, mucoprote, etc.;
• Bromhexine preparations: bromhexine, bromoxin, bronchosan, solvine, etc.;
• Ambroxol-based products: ambroben, ambrohexal, ambroxol, ambrosan, lazolvan, chalixol and others;
If the cause of dyspnoea is an allergic inflammation of the respiratory tract, for example, with bronchial asthma, then antihistamines are added to the treatment:
• expectorant medicines: cough syrup "Doctor Mom", althea root, mucaltin, licorice root, sodium benzoate, infusionplantain, mother-and-stepmother, thyme, wild rosemary, tri-colored violets, pine buds, oregano, cyanosis, bluegrass, thermopsis and some others.
• Diazolinum - applied internally 1 capsule 2-3 times a day;
• Dimedrol - 2% solution is administered intramuscularly at the rate of 0.1 ml per year of life, in the form of tablets - at a rate of 0.5 mg / kg per day;
• Suprastin - available in tablets of 25 mg( applied at a rate of 1-2 mg / kg per day), 2% solution in an ampoule of 1 ml( at a rate of 0.1 ml per year of life);
• Tavegil - inside in the form of tablets at 1-2 mg / kg per day or intramuscularly - at 0.025 mg / kg per day;
• Fenistil - in the form of a solution, is prescribed for 10 drops for children from 1 to 3 years, 20 drops for children over 3 years, over 12 years and for adults - 1 tablet 2-3 times a day;
• claritin( loratodine, loragexal) - is available in tablets of 10 mg, for children weighing up to 30 kg - 1/2 tablets once a day, weighing more than 30 kg and an adult on the whole tablet 1 time per day;
• clarissens - in a syrup containing 5 mg in 5 ml;
• cetirizine( cetrine, zirtek) - drops for oral administration - for children from 6 to 12 months - 5 drops once a day, from 1 to 2 years - 5 drops 2 times a day, 2-6 years - 5drops 2 times a day or 10 drops once, over 6 years and adults - 10-20 drops or 1 tablet( 10 mg) once a day;
• erius( desloratodine) - available in the form of tablets and syrup. Children from 12 months to 5 years of age - 1.25 mg per day( 2.5 ml - 1/2 teaspoon), 6-11 years - 2.5 mg per day( 5 ml - 1 scoop),over 12 years and adults - 5 mg per day - 1 tablet or 10 ml of syrup 1 time per day.
If the cause of dyspnea is stenosing laryngotracheitis caused by a viral infection, then antiviral agents are connected to the treatment.
In case of severe disease, it is possible to use donor immunoglobulin. At the third degree of stenosing laryngotracheitis, laryngoscopy is performed, intubation with transfer to the artificial ventilation of the lungs.
Inhalation with saline is performed.
A good effect in dyspnea is having a distracting therapy: hot foot baths, mustard calves for calf muscles.
If the cause of dyspnea is the development of cardiac asthma, then the treatment is carried out by cardiac glycosides:
• digoxin - for children the drug is prescribed at the rate of 50-80 mg / kg, the calculated amount of medicine can be administered in 1-7 days. The drug is available in the form of tablets at 65, 100, 125 and 250 mg, as well as in ampoules with 0.025% solution for injections of 1 and 2 ml;
• strophanthin - for children under 2 years of age the drug is prescribed at the rate of 10 mg / kg, over 2 years - 7 mg / kg as a dose of saturation, divided by 1-7 days. The agent is released in the form of 0.025% and 0.05% solution for injection in 1 ml ampoules;
• korglikon - the drug is administered to children from 2 to 5 years by 0.2-0.5 ml, from 6 to 12 years - by 0.5-0.75 ml, over 12 years - by 0.75-1 ml. The agent is released in the form of 0.06% solution in 1 ml ampoules, before administration, the drug is injected into 10-20 ml of glucose solution.
If the cause of the occurrence of dyspnea is a profuse exudation in the pleural cavity, a pleural cavity puncture is performed.
The causes that can cause both angina pectoris and myocardial infarction( MI) are:
• physical overload;
• emotional stress;
• significant hypothermia;
• hypertensive crisis, especially in the background of atherosclerotic changes in blood vessels;
• sudden change of weather;
• hypoxia;
• Alcohol abuse;
• coronary thromboembolism( more often leads to a heart attack), which can develop after massive injuries, fractures of tubular bones, gynecological and surgical operations, in patients with thrombophlebitis.