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Wake up wheezing: What Is Nocturnal Asthma? | Everyday Health

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What Is Nocturnal Asthma? | Everyday Health

If you wake up at night coughing, wheezing, and feeling breathless, you could have nocturnal asthma. So, what is nocturnal asthma? Also called nighttime asthma, it is the type of asthma that gets worse at night.

It’s not unusual for asthma symptoms to worsen after dark. Even in healthy people, “your best lung function is between noon and 4 p.m.,” said Ileen Gilbert, MD, a pulmonary specialist at Froedtert & The Medical College of Wisconsin. “And it is at its worst between 3 and 4 in the morning.”

One reason for the decline in lung function is your body’s circadian rhythm, or natural clock, which causes hormone production to ebb and flow. During the wee hours of the morning, levels of the hormones that protect against asthma symptoms are at their lowest, Dr. Gilbert explained. If you have asthma, you’re more likely to wake up coughing and wheezing as these levels fall.

A sinus infection or postnasal drip could be another cause of nocturnal asthma. When you lie down, nasal secretions can accumulate in your airways and make it harder for you to breathe.

Also, if you have allergies to pet dander, sleeping in the same room as your cat or dog can make your asthma worse at night.

Dust mites lurking in your mattress or bedding could be yet another trigger, said Clifford Bassett, MD, medical director of Allergy & Asthma Care of New York.

Peak Flow Meter for Diagnosis

Peak flow meter measurements are used to diagnose asthma, including nighttime asthma. “A peak flow meter is a handheld device provided to asthma patients as part of their asthma care plan,” said Jameel F. Durrani, MD, of the Regional Lung and Sleep Clinic in Allentown, Pa. “These devices help to compare the severity of airway narrowing or spasm at different times of the day.”

Studies show that anywhere from 30 to 70 percent of patients with asthma tell their doctors about waking up with nighttime asthma symptoms at least once a month. You can have nocturnal asthma regardless of the type of asthma you have – including allergic, nonallergic, occupational, and exercise-induced asthma.

If you have nighttime asthma, chances are it’s because your asthma is poorly controlled. “All asthmatics can get nocturnal asthma if their asthma is out of control,” Gilbert said.

The best way to control nighttime asthma is to control your asthma in general. “If you wake up more than twice a month with asthma symptoms, then you need to be on [long-acting] controller therapy,” Gilbert said. “If you wake up in the middle of the night, you can take your rescue inhaler to ease your symptoms. But that won’t prevent it from happening again.”

“If you’re waking up more than twice a night with cough, wheezing, or chest tightness, then your asthma is poorly controlled and you need to review your asthma treatment plan with your health care provider,” Dr. Durrani added.

Asthma and Sleep

Having difficulty sleeping with asthma can be serious. When you are sleep-deprived, you can be extremely fatigued during the day. “In children this can lead to increased learning difficulties, reduced attention span, and mood swings,” Durrani said. “In adults it can lead to reduced performance at work.” Also, he said, when you’re overtired at work, you’re more prone to accidents.

According to the National Sleep Foundation, people who have nocturnal asthma tend to have more severe asthma, and the more severe your asthma, the greater your risk of death.

Try these tips for getting a good night’s sleep:

  • Use mattress and pillow covers that keep dust mites away.
  • Look for allergy-free pillows.
  • Keep animals (live and stuffed) out of the bedroom.
  • Use a humidifier to keep the air moist.
  • Time your medications and adjust doses so they will continue working throughout the night.

What Isn’t Nocturnal Asthma

Some people wake up coughing and wheezing but may not have nighttime asthma. Other conditions that can cause you to wake up coughing and wheezing include: heartburn, gastric reflux, untreated or undiagnosed sleep apnea, heart failure, and abnormalities of the vocal cords, Durrani said. See a sleep specialist to determine what’s causing your nighttime asthma and find the treatment that’s right for you.

Nocturnal Asthma (Nighttime Asthma) Prevention & Treatment

Nocturnal asthma, with symptoms like chest tightness, shortness of breath, cough, and wheezing at night, can make sleep impossible and leave you feeling tired and irritable during the day. These problems may affect your overall quality of life and make it more difficult to control your daytime asthma symptoms.

Nocturnal or nighttime asthma is very serious. It needs a proper asthma diagnosis and effective asthma treatment.

Nighttime Asthma and Sleep Disturbance

The chances of experiencing asthma symptoms are higher during sleep. Nocturnal wheezing, cough, and trouble breathing are common yet potentially dangerous. Many doctors often underestimate nocturnal asthma or nighttime asthma.

Studies show that most deaths related to asthma symptoms such as wheezing happen at night.

Nocturnal Asthma Causes

The exact reason that asthma is worse during sleep are not known, but there are explanations that include increased exposure to allergens; cooling of the airways; being in a reclining position; and hormone secretions that follow a circadian pattern. Sleep itself may even cause changes in bronchial function.

Increased Mucus or Sinusitis

During sleep, the airways tend to narrow, which may cause increased airflow resistance. This may trigger nighttime coughing, which can cause more tightening of the airways. Increased drainage from your sinuses can also trigger asthma in highly sensitive airways. Sinusitis with asthma is quite common.

Internal Triggers

Asthma problems may occur during sleep, despite when the sleep period is taking place. People with asthma who work on the night shift may have breathing attacks during the day when they are sleeping. Most research suggests that breathing tests are worse about four to six hours after you fall asleep. This suggests there may be some internal trigger for sleep-related asthma.

Reclining Position

Lying in a reclining position may also predispose you to nighttime asthma problems. Many factors may cause this, such as accumulation of secretions in the airways (drainage from sinuses or postnasal drip), increased blood volume in the lungs, decreased lung volumes, and increased airway resistance.

Air Conditioning

Breathing colder air at night or sleeping in an air‑conditioned bedroom may also cause loss of heat from the airways. Airway cooling and moisture loss are important triggers of exercise‑induced asthma. They are also implicated in nighttime asthma.

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GERD

Continued

If you are frequently bothered with heartburn, the reflux of stomach acid up through the esophagus to the larynx may stimulate a bronchial spasm. It’s worse when lying down or if you take medications for asthma that relax the valve between the stomach and esophagus. Sometimes, acid from the stomach will irritate the lower esophagus and lead to constriction of your airways. If stomach acid backs up to your throat, it may drip down to the trachea, airways and lungs, leading to a severe reaction. This can involve airway irritation, increased mucus production, and airway tightening. Taking care of GERD and asthma with appropriate medications can often stop nighttime asthma.

Late Phase Response

If you are exposed to an allergen or asthma trigger, the chances are great that airway obstruction or allergic asthma will occur shortly afterward. This acute asthma attack ends within one hour. About 50% of those who experience an immediate reaction also have a second phase of airway obstruction within three to eight hours of exposure to the allergen. This phase is called the late phase response, and it is characterized by an increase in airway responsiveness, development of bronchial inflammation, and a more prolonged period of airway obstruction.

Continued

Many studies report that when allergen exposure occurs in the evening instead of in the morning, you are more susceptible to having a late phase response and are more likely to have one of greater severity.

Hormones

Hormones that circulate in the blood have well‑characterized circadian rhythms that are seen in everybody. Epinephrine is one such hormone, which exerts important influences on the bronchial tubes. This hormone helps keep the muscle in the walls of bronchi relaxed so the airway remains wide. Epinephrine also suppresses the release of other substances, such as histamines, which cause mucus secretion and bronchospasm. Your epinephrine levels and peak expiratory flow rates are lowest at about 4:00 a.m., while histamine levels tend to peak at this same time. This decrease in epinephrine levels may predispose you to nocturnal asthma during sleep.

How Is Nocturnal Asthma Treated?

There is no cure for nighttime asthma, but daily asthma medications, such as inhaled steroids, are very effective at reducing inflammation and preventing nocturnal symptoms. Since nocturnal asthma or nighttime asthma may occur anytime during the sleep period, asthma treatment must be sufficient to cover these hours. A long-acting bronchodilator delivered in an asthma inhaler can be effective in preventing bronchospasm and symptoms of asthma. If you suffer from nocturnal asthma, you may also benefit from a long-acting inhaled corticosteroid. If you suffer with GERD and asthma, ask your doctor about medication that reduces acid production in the stomach. Avoidance of potential allergy triggers such as dust mites, animal dander, or feathers in a down comforter may also be very helpful in preventing allergies and asthma and nocturnal asthma attacks.

In addition, using your peak flow meter, you can monitor how your lung function is altered throughout the day and night. Once you notice this altered pattern of lung function, talk with your doctor about a plan to resolve your nighttime asthma symptoms. According to your type of asthma and asthma severity (mild, moderate, or severe), your doctor can prescribe treatment to help you resolve your nighttime asthma symptoms so you can sleep like a baby.

Sleep and asthma | Asthma UK

What to do when asthma stops you sleeping

Simple tips to stop asthma waking you at night

Why asthma can wake you up at night

Tips from other people with asthma

Who can I speak to if my sleep problems continue?

It’s quite common for people with asthma to find that asthma symptoms wake them up at night – but you shouldn’t have to put up with them.

If you’re coughing, wheezing, breathless, or have a tight chest at night, it’s a sign that your asthma is not well controlled and you might be at risk of an asthma attack.

Early morning asthma symptoms may also be a sign that your asthma has been difficult through the night, even if you weren’t aware of it. 

Here are some simple steps you can take to stop asthma getting in the way of a good night’s sleep.

What to do when asthma stops you sleeping

  • If you have asthma symptoms, sit up and take your reliever inhaler (usually blue) as prescribed.  
  • Always make sure your inhaler is beside your bed before you go to sleep, so you don’t have to search for it in the middle of the night.
  • “Give yourself a bit of time to check your reliever medicine has dealt with your symptoms before you go back to sleep,” says Dr Andy Whittamore. “This is better than falling asleep straight away only to wake up soon after with asthma symptoms because your reliever didn’t help enough.”
  • Some people find propping themselves up with extra pillows helps as it keeps the airways open.

Video: Asthma and your sleep






Dr. Andy Whittamore explains why you should book an appointment with your GP if your asthma is keeping you awake at night.



Transcript for Asthma and your sleep




0:04
We hear from a lot of people on our


0:07
helpline and on social media that asthma does


0:10
interrupt their sleep on a


0:11
regular basis. As a health care


0:13
professional I know that unfortunately,


0:14
this means that your asthma is not quite


0:16
as well controlled as it can be. And it’s


0:18
worth making appointment with your GP or


0:20
your practice nurse to see what we can


0:21
do to help relieve those symptoms and


0:24
actually improve your quality of sleep.


Simple tips to stop asthma waking you at night in the long-term

You don’t have to just accept your night-time asthma symptoms as normal.

  • Using your preventer inhaler every day, as prescribed, will build up protection in your airways and keep your asthma symptoms under control, so they’re less likely to wake you at night.
  • If you’re having asthma symptoms at night or noticing asthma symptoms when you first wake up, you should make a same day appointment to see your GP or asthma nurse. Symptoms that keep you awake at night are one of the signs you might be at risk of an asthma attack.

It’s also important to:

  • Use your written asthma action plan to help you understand how to manage your symptoms and what to do if they get worse.  
  • Go for regular asthma reviews with your GP or asthma nurse. They can check you’re using your inhalers correctly. It’s also a chance to talk about any triggers that might be affecting your sleep.  

Why asthma can wake you up at night

If your asthma isn’t under control, you might get more symptoms at night.

There are several reasons why this might happen:

  • At night, your body produces fewer natural steroid hormones, which can affect your symptoms and more of the cells that cause inflammation in your airways.
  • When you lie flat on your back, gravity places extra pressure on your chest and lungs, making it harder to breathe. This position can also trigger a cough, as mucus in your nose could drip down to the back of your throat.
  • Your bedroom might contain triggers that can make your asthma worse, such as dust mites in your mattress, pillows and blankets.
  • Pet hair is a common asthma trigger, so avoid letting your pet sleep on your bed, and ideally keep them out of your bedroom.  
  • Mould is another common asthma trigger, so check your bedroom for damp patches on walls and mould growing around windows.
  • Lots of people find pollen triggers their asthma symptoms. When pollen is high, try using a fan to keep your bedroom cool rather than opening a window.
  • Some people are triggered by cold air at night, or by sleeping in a cold room. If this is you, keep windows closed and keep the heating on low in the bedroom if you can. 

If your GP has prescribed steroid pills for your asthma, you’ll probably be advised to take them in the morning after food, as they might cause difficulty sleeping if you take them at night, but always take them exactly as prescribed.

Don’t be tempted to stop taking the tablets early. It’s important to finish the course to bring your asthma back under control, otherwise your symptoms might come back and keep you awake anyway.

Tips from other people with asthma

If your asthma is keeping you awake at night, you’re not alone.

In our recent sleep survey, 45% of people told us they have difficulty sleeping because of their asthma at least once a week, and nearly 50% said they’d had an asthma attack at night.

Here are some of the things that people tell us help them get a good night’s sleep, which our nurses agree might be helpful:

  • Ease a dry throat with a glass of water
  • Try a nasal saline rinse or use decongestants to unblock a stuffy nose (but test this out during the day first: some people find products like Olbas Oil or Vicks trigger their asthma symptoms)
  • Take regular exercise
  • Relax in the evening using mindfulness, meditation, breathing exercises or yoga
  • Avoid caffeine in the afternoon and evening.

If you find reading about other people’s experiences useful, or have some advice to share, join the conversations on our HealthUnlocked forum.

Is your child disturbed by symptoms at night? Read our advice on asthma and your child’s sleep.

Who can I speak to if my sleep problems continue? 

Need some more advice? Speak to your GP or asthma nurse.

You can also call our Helpline on 0300 222 5800 and talk to an expert asthma nurse (Monday-Friday, 9am-5pm), or message them on WhatsApp.


Last updated: September 2019

Next review due: September 2022





Nocturnal Asthma: Here’s Why Your Asthma Gets Worse at Night

Having your sleep interrupted is annoying at best and, especially if it happens often, meltdown-inducing at worst. But when you wake up in the middle of a coughing fit or because you feel like you’re breathing through a straw, the whole experience can take a terrifying turn.

Unfortunately, that’s what some people with asthma have to deal with. “It is very common for asthma to get worse at night,” pulmonologist Ryan Thomas, M.D., director of the Multidisciplinary Severe Asthma Team at Michigan State University, tells SELF. This phenomenon, which experts sometimes refer to as nocturnal asthma, can make it far too difficult to get the amount of rest you need. It can also be a sign that you need to take steps to subdue your asthma before it gets even worse.

It’s important to cover some asthma basics before we dive into the rude awakening portion.

Your airways, which extend between your nose and mouth and your lungs, carry air in and out of your body, according to the National Heart, Lung, and Blood Institute (NHLBI). Pretty key job, huh? But if you have asthma, those airways can get all puffy and inflamed when you’re exposed to triggers like animal dander (particles of skin and saliva that they’ve shed), pollen, mold, cold air, cigarette smoke, exercise, and respiratory infections like the flu, the NHLBI says. That swelling can then cause the muscles around your airways to tighten, and your airways may also expel more mucus than they usually do. The end result is the opposite of breathing easy: You might experience asthma symptoms like wheezing (a whistling sound when you breathe), coughing, shortness of breath, and chest pain or tightness.

It’s possible that your asthmatic reaction to a trigger will be mild and go away on its own, but if your symptoms get worse and don’t respond to treatment, you can have what’s known as an asthma attack or asthma exacerbation, which can be life-threatening.

Depending on its severity, your asthma can fall into one of four categories. Some of this classification hinges on how your asthma acts at night.

Mild intermittent asthma means you have minor symptoms up to two days a week and up to two nights a month, according to the Mayo Clinic. Mild persistent asthma takes it up a notch, so you have symptoms more than twice a week but not more frequently than once in a day. Moderate persistent asthma involves symptoms at least once a day, along with more than one night a week. Finally, severe persistent asthma means you’re having signs of asthma throughout the day on most days, along with frequently at night.

No matter your asthma classification, you might notice that when you experience symptoms, they’re more likely to strike at night, or that they seem to be worse after the sun has set than they are during the daytime. There are a few reasons this may happen.

Doctors aren’t 100 percent sure why asthma can flare up at night, but there are some theories, including how prevalent triggers may be in your bedroom, hormonal fluctuations, and more.

Certain asthma triggers are more likely to pop up where you sleep. For instance, dust mites, which are microscopic creatures that feed on your old skin cells, are a common asthma trigger, according to the Mayo Clinic. If these gross little dudes incite your asthma, spending hours in your bed as you sleep raises the risk that you’ll have symptoms, Timothy McGee, D.O., a pulmonologist at Northwestern Medicine Central DuPage Hospital, tells SELF. That’s because dust mites adore living in areas like your bed, as that’s the exact type of warm, humid environment in which they thrive. Plus, there’s a ton of food for them there. (Remember, that food is your old skin cells.)

Anxiety, sleep apnea, and other causes

While waking up gasping for air is not uncommon, it can be extremely frightening.

Some causes, such as post-nasal drip, are easily treated. Others may require medical attention and a long-term treatment plan.

In this article, we describe why a person may wake up gasping for air, tools and medicines that can help, and when to see a doctor.

An individual may wake up gasping for air for a variety of reasons, including:

Obstructive sleep apnea

Sleep apnea refers to involuntary pauses in breathing during sleep. The two main types are:

  • Central sleep apnea, which is caused by signaling problems in the brain.
  • Obstructive sleep apnea, which occurs when a blockage in the airway stops airflow.

According to the National Sleep Foundation, around 18 million adults in the United States have obstructive sleep apnea.

A person may be unaware that they have the condition until someone informs them that they snore and gasp for air while asleep. When the person gasping catches their breath, they may not fully awaken.

Additional symptoms of sleep apnea include:

Anxiety

Anxiety can lead to panic attacks, and when they occur at night, a person may wake up gasping for air. According to the Anxiety and Depression Association of America, around 70 percent of people with anxiety disorders report difficulty sleeping.

Other symptoms of anxiety include:

  • restlessness
  • feelings of dread or worry
  • a fast heart rate
  • panic
  • difficulty concentrating

Asthma

Asthma is a chronic condition that causes inflammation in the airways. Nocturnal asthma is the medical term for having symptoms while sleeping. When the condition is poorly controlled, nocturnal asthma is common.

Additional symptoms of asthma include:

  • coughing
  • wheezing
  • feeling unable to catch a breath
  • tightness in the chest

Chronic obstructive pulmonary disease (COPD)

COPD occurs when small air sacs in the lungs are damaged. These sacs, called alveoli, become floppy, making it difficult to push air out of the lungs.

Symptoms can occur while a person is sleeping. They may wake up gasping or feel as if they are suffocating.

Other symptoms of COPD include:

  • wheezing
  • excess mucus
  • coughing
  • fatigue
  • tightness in the chest

Heart failure

Share on PinterestThough waking up gasping for air is often due to respiratory problems, heart failure may also be a cause.

When the heart is not pumping blood as efficiently as it should, this is called heart failure.

Abnormal heart valves, a history of a heart attack, and coronary artery disease can all lead to heart failure.

Shortness of breath is one of the most common symptoms. At first, a person may only notice it during physical activity. As the condition progresses, a person may develop shortness of breath while resting or sleeping.

A person with heart failure may also experience:

  • fatigue
  • swelling of the feet and legs
  • chest pain
  • abdominal swelling

Post-nasal drip

Mucus and saliva produced throughout the day typically flow to the back of the nose and throat and are swallowed. A person may be unaware of this process.

Post-nasal drip occurs when this mucus accumulates and trickles down the back of the throat.

As the mucus builds up, a person may feel like they cannot breathe. If they are asleep, they may wake up gasping for air.

Gastric reflux disease, sinus infections, and allergies are all common causes of post-nasal drip.

Additional symptoms include:

A doctor will ask a person to talk about their symptoms and medical history. They may also perform a physical exam.

The following tests can help to determine why a person wakes up gasping:

  • blood tests
  • a sleep study, to determine whether the person has sleep apnea
  • an echocardiogram, to check for heart abnormalities
  • an electrocardiogram, to measure the heart rate and rhythm
  • a pulmonary function test, to diagnose respiratory conditions

Once a doctor has discovered the cause, they may recommend one of the following treatments:

Medication

Medications can treat heart failure, COPD, and anxiety.

Beta-blockers can improve the function of the heart and eventually reduce breathlessness.

Bronchodilators and corticosteroid inhalers can open the airways and improve airflow in people with COPD. This may result in reduced shortness of breath.

Antianxiety medication can lead to fewer panic attacks, and a person may stop waking up gasping for air.

Continuous positive airway pressure (CPAP)

When obstructive sleep apnea is the culprit, a doctor may recommend CPAP. This therapy involves a machine that delivers air to the lungs, preventing the airway from becoming blocked.

Dental devices

Obstructive sleep apnea may also be treated with a dental device that pushes the tongue and jaw forward, preventing the muscles of the throat from collapsing backward and blocking the flow of air.

Saline nasal sprays

These are often recommended to manage post-nasal drip. Using a neti pot to flush out the sinuses may also help.

Good sleep habits

The following tips can help to reduce anxiety-related gasping and decrease stress overall:

  • get enough sleep
  • go to bed and wake up at the same times each day
  • consume caffeine only in the morning
  • before going to sleep, do something relaxing, such as meditation, breathing exercises, or reading.

A person may not require treatment if they wake up gasping for air infrequently, show no other symptoms, and can get back to sleep quickly.

However, if a person experiences this symptom often, or if other symptoms are present, they should speak with a doctor.

If an individual also has chest pain or cannot catch their breath, they should seek immediate medical care.

Once the underlying cause is identified, a doctor will recommend treatment that can ensure uninterrupted sleep.

Anxiety, sleep apnea, and other causes

While waking up gasping for air is not uncommon, it can be extremely frightening.

Some causes, such as post-nasal drip, are easily treated. Others may require medical attention and a long-term treatment plan.

In this article, we describe why a person may wake up gasping for air, tools and medicines that can help, and when to see a doctor.

An individual may wake up gasping for air for a variety of reasons, including:

Obstructive sleep apnea

Sleep apnea refers to involuntary pauses in breathing during sleep. The two main types are:

  • Central sleep apnea, which is caused by signaling problems in the brain.
  • Obstructive sleep apnea, which occurs when a blockage in the airway stops airflow.

According to the National Sleep Foundation, around 18 million adults in the United States have obstructive sleep apnea.

A person may be unaware that they have the condition until someone informs them that they snore and gasp for air while asleep. When the person gasping catches their breath, they may not fully awaken.

Additional symptoms of sleep apnea include:

Anxiety

Anxiety can lead to panic attacks, and when they occur at night, a person may wake up gasping for air. According to the Anxiety and Depression Association of America, around 70 percent of people with anxiety disorders report difficulty sleeping.

Other symptoms of anxiety include:

  • restlessness
  • feelings of dread or worry
  • a fast heart rate
  • panic
  • difficulty concentrating

Asthma

Asthma is a chronic condition that causes inflammation in the airways. Nocturnal asthma is the medical term for having symptoms while sleeping. When the condition is poorly controlled, nocturnal asthma is common.

Additional symptoms of asthma include:

  • coughing
  • wheezing
  • feeling unable to catch a breath
  • tightness in the chest

Chronic obstructive pulmonary disease (COPD)

COPD occurs when small air sacs in the lungs are damaged. These sacs, called alveoli, become floppy, making it difficult to push air out of the lungs.

Symptoms can occur while a person is sleeping. They may wake up gasping or feel as if they are suffocating.

Other symptoms of COPD include:

  • wheezing
  • excess mucus
  • coughing
  • fatigue
  • tightness in the chest

Heart failure

Share on PinterestThough waking up gasping for air is often due to respiratory problems, heart failure may also be a cause.

When the heart is not pumping blood as efficiently as it should, this is called heart failure.

Abnormal heart valves, a history of a heart attack, and coronary artery disease can all lead to heart failure.

Shortness of breath is one of the most common symptoms. At first, a person may only notice it during physical activity. As the condition progresses, a person may develop shortness of breath while resting or sleeping.

A person with heart failure may also experience:

  • fatigue
  • swelling of the feet and legs
  • chest pain
  • abdominal swelling

Post-nasal drip

Mucus and saliva produced throughout the day typically flow to the back of the nose and throat and are swallowed. A person may be unaware of this process.

Post-nasal drip occurs when this mucus accumulates and trickles down the back of the throat.

As the mucus builds up, a person may feel like they cannot breathe. If they are asleep, they may wake up gasping for air.

Gastric reflux disease, sinus infections, and allergies are all common causes of post-nasal drip.

Additional symptoms include:

A doctor will ask a person to talk about their symptoms and medical history. They may also perform a physical exam.

The following tests can help to determine why a person wakes up gasping:

  • blood tests
  • a sleep study, to determine whether the person has sleep apnea
  • an echocardiogram, to check for heart abnormalities
  • an electrocardiogram, to measure the heart rate and rhythm
  • a pulmonary function test, to diagnose respiratory conditions

Once a doctor has discovered the cause, they may recommend one of the following treatments:

Medication

Medications can treat heart failure, COPD, and anxiety.

Beta-blockers can improve the function of the heart and eventually reduce breathlessness.

Bronchodilators and corticosteroid inhalers can open the airways and improve airflow in people with COPD. This may result in reduced shortness of breath.

Antianxiety medication can lead to fewer panic attacks, and a person may stop waking up gasping for air.

Continuous positive airway pressure (CPAP)

When obstructive sleep apnea is the culprit, a doctor may recommend CPAP. This therapy involves a machine that delivers air to the lungs, preventing the airway from becoming blocked.

Dental devices

Obstructive sleep apnea may also be treated with a dental device that pushes the tongue and jaw forward, preventing the muscles of the throat from collapsing backward and blocking the flow of air.

Saline nasal sprays

These are often recommended to manage post-nasal drip. Using a neti pot to flush out the sinuses may also help.

Good sleep habits

The following tips can help to reduce anxiety-related gasping and decrease stress overall:

  • get enough sleep
  • go to bed and wake up at the same times each day
  • consume caffeine only in the morning
  • before going to sleep, do something relaxing, such as meditation, breathing exercises, or reading.

A person may not require treatment if they wake up gasping for air infrequently, show no other symptoms, and can get back to sleep quickly.

However, if a person experiences this symptom often, or if other symptoms are present, they should speak with a doctor.

If an individual also has chest pain or cannot catch their breath, they should seek immediate medical care.

Once the underlying cause is identified, a doctor will recommend treatment that can ensure uninterrupted sleep.

Anxiety, sleep apnea, and other causes

While waking up gasping for air is not uncommon, it can be extremely frightening.

Some causes, such as post-nasal drip, are easily treated. Others may require medical attention and a long-term treatment plan.

In this article, we describe why a person may wake up gasping for air, tools and medicines that can help, and when to see a doctor.

An individual may wake up gasping for air for a variety of reasons, including:

Obstructive sleep apnea

Sleep apnea refers to involuntary pauses in breathing during sleep. The two main types are:

  • Central sleep apnea, which is caused by signaling problems in the brain.
  • Obstructive sleep apnea, which occurs when a blockage in the airway stops airflow.

According to the National Sleep Foundation, around 18 million adults in the United States have obstructive sleep apnea.

A person may be unaware that they have the condition until someone informs them that they snore and gasp for air while asleep. When the person gasping catches their breath, they may not fully awaken.

Additional symptoms of sleep apnea include:

Anxiety

Anxiety can lead to panic attacks, and when they occur at night, a person may wake up gasping for air. According to the Anxiety and Depression Association of America, around 70 percent of people with anxiety disorders report difficulty sleeping.

Other symptoms of anxiety include:

  • restlessness
  • feelings of dread or worry
  • a fast heart rate
  • panic
  • difficulty concentrating

Asthma

Asthma is a chronic condition that causes inflammation in the airways. Nocturnal asthma is the medical term for having symptoms while sleeping. When the condition is poorly controlled, nocturnal asthma is common.

Additional symptoms of asthma include:

  • coughing
  • wheezing
  • feeling unable to catch a breath
  • tightness in the chest

Chronic obstructive pulmonary disease (COPD)

COPD occurs when small air sacs in the lungs are damaged. These sacs, called alveoli, become floppy, making it difficult to push air out of the lungs.

Symptoms can occur while a person is sleeping. They may wake up gasping or feel as if they are suffocating.

Other symptoms of COPD include:

  • wheezing
  • excess mucus
  • coughing
  • fatigue
  • tightness in the chest

Heart failure

Share on PinterestThough waking up gasping for air is often due to respiratory problems, heart failure may also be a cause.

When the heart is not pumping blood as efficiently as it should, this is called heart failure.

Abnormal heart valves, a history of a heart attack, and coronary artery disease can all lead to heart failure.

Shortness of breath is one of the most common symptoms. At first, a person may only notice it during physical activity. As the condition progresses, a person may develop shortness of breath while resting or sleeping.

A person with heart failure may also experience:

  • fatigue
  • swelling of the feet and legs
  • chest pain
  • abdominal swelling

Post-nasal drip

Mucus and saliva produced throughout the day typically flow to the back of the nose and throat and are swallowed. A person may be unaware of this process.

Post-nasal drip occurs when this mucus accumulates and trickles down the back of the throat.

As the mucus builds up, a person may feel like they cannot breathe. If they are asleep, they may wake up gasping for air.

Gastric reflux disease, sinus infections, and allergies are all common causes of post-nasal drip.

Additional symptoms include:

A doctor will ask a person to talk about their symptoms and medical history. They may also perform a physical exam.

The following tests can help to determine why a person wakes up gasping:

  • blood tests
  • a sleep study, to determine whether the person has sleep apnea
  • an echocardiogram, to check for heart abnormalities
  • an electrocardiogram, to measure the heart rate and rhythm
  • a pulmonary function test, to diagnose respiratory conditions

Once a doctor has discovered the cause, they may recommend one of the following treatments:

Medication

Medications can treat heart failure, COPD, and anxiety.

Beta-blockers can improve the function of the heart and eventually reduce breathlessness.

Bronchodilators and corticosteroid inhalers can open the airways and improve airflow in people with COPD. This may result in reduced shortness of breath.

Antianxiety medication can lead to fewer panic attacks, and a person may stop waking up gasping for air.

Continuous positive airway pressure (CPAP)

When obstructive sleep apnea is the culprit, a doctor may recommend CPAP. This therapy involves a machine that delivers air to the lungs, preventing the airway from becoming blocked.

Dental devices

Obstructive sleep apnea may also be treated with a dental device that pushes the tongue and jaw forward, preventing the muscles of the throat from collapsing backward and blocking the flow of air.

Saline nasal sprays

These are often recommended to manage post-nasal drip. Using a neti pot to flush out the sinuses may also help.

Good sleep habits

The following tips can help to reduce anxiety-related gasping and decrease stress overall:

  • get enough sleep
  • go to bed and wake up at the same times each day
  • consume caffeine only in the morning
  • before going to sleep, do something relaxing, such as meditation, breathing exercises, or reading.

A person may not require treatment if they wake up gasping for air infrequently, show no other symptoms, and can get back to sleep quickly.

However, if a person experiences this symptom often, or if other symptoms are present, they should speak with a doctor.

If an individual also has chest pain or cannot catch their breath, they should seek immediate medical care.

Once the underlying cause is identified, a doctor will recommend treatment that can ensure uninterrupted sleep.

90,000

Wheezing / noisy, rough, heavy breathing in a child

ASK YOURSELF QUESTION

POSSIBLE CAUSE

WHAT TO DO

Does a baby have a rather loud wheezing sound only when he inhales? Does he eat and grow normally?

Norm

If the child eats, sleeps and grows normally, noisy breathing simply indicates that the tissues of the respiratory tract are still sufficiently elastic. Such noisy breathing should pass by 1.5 years, when the cartilage of the larynx (windpipe) becomes denser. Nevertheless pay to the child’s noisy breathing attention of the pediatrician at the next examination

Does the child also have a runny nose or cough?

Colds (ARVI)

Call the pediatrician .Drink plenty of fluids and make the child feel comfortable (see also Child’s runny nose)

A child under one year old? Does he have a cough that lasts 2 hours or more? Has he had a cold in the last day or two? Rapid and labored breathing? Does he refuse to eat? Irritable?

Bronchiolitis is a disease, usually viral, affecting the smallest bronchi

Call Emergency .If the diagnosis is confirmed, hospitalization may be required

Does the child often cough? Do you have bouts of breathing difficulties, especially at night or during exercise? Does anyone in the family have asthma or allergies?

Asthma

Make an appointment with Pediatrician . He will examine the child and prescribe the necessary examinations; depending on the results, he will advise the treatment (see.(See also If a child has asthma)

Does the child have difficulty breathing, choking? A hacking dry cough that resembles a dog’s barking; hoarseness of voice? Fever? Symptoms get worse at night?

Croup – shortness of breath caused by inflammation and narrowing of the upper airways

Although most seizures can be treated with home remedies (seeCroup help), if a seizure begins, call emergency . Before the doctor arrives, take the child to the bathroom, close the door, pour hot water into the tub to generate steam, let the child breathe humidified air. Place naphthyzine in your nose. If the condition does not improve, allow the child to breathe the cool night air

Does the child suddenly have difficulty breathing, wheezing?

Foreign body in the airways (most common in children from 6 months to 2 years)

This is a medical emergency. Call an ambulance ; first aid measures – see Respiratory arrest)

Rapid breathing, wheezing, severe cough? Is the temperature increased to 38.3 about C or more? Does the child feel bad? When inhaling, intercostal spaces are drawn in?

Pneumonia

Urgently call a pediatrician , he will diagnose and prescribe treatment.Hospitalization may be required (see Shortness of breath, Cough)

Does the child snore in a dream? Wake up annoyed every morning? Does he breathe frequently through his mouth because his nose is stuffy? Tired quickly? Speaks through the nose? Does he have frequent colds and otitis media?

Enlargement of the adenoids; allergy

Contact the pediatrician , he will examine the child for an increase in adenoids (see.also Runny nose in a child, or an allergic disease), prescribe treatment

five reasons – the topic of a scientific article on veterinary sciences read the text of the research work for free in the electronic library CyberLeninka

a BRODSKAYA

My tongue grows numb, fugitive in limbs A flame has started to flow, in the ears of those who have died out There is a ringing and noise, and my eyes are darkened by a double Night.

fold

G. t

s

T 1

Nocturnal asthma: five causes

Nocturnal shortness of breath, cough, wheezing are very characteristic of bronchial asthma. Three out of four asthmatics wake up from nighttime shortness of breath at least once a week.It is no coincidence that the frequency of nocturnal symptoms is one of the important criteria for determining the severity of asthma and the need for drug therapy.

In asthmatics, as in healthy people, the functional parameters of the lungs, which can be measured with spirometry or peak flowmetry, are subject to cyclical fluctuations during the day – circadian rhythms. The best indicators for all are observed around 4 pm, and the worst – at 4 in the morning. However, if in healthy people the peak expiratory flow rate changes by only a few percent, then in asthmatics these fluctuations can reach 50%.In addition, the reactivity of the airways increases at night, that is, the ability to respond with bronchospasm to various stimuli. In this article, we will try to disassemble the most common causes of nocturnal asthma attacks and provide solutions to this problem.

Reason # 1

The main reason is the already mentioned daily neuroendocrine changes in the body. At night, levels of important hormones such as cortisol (the body’s own glucocorticosteroid, which has an anti-inflammatory effect) and adrenaline (among its many effects, expand the bronchi) decrease.It is clear that such changes contribute to the onset of bronchospasm in asthmatics at night.

In addition, the activity of the parasympathetic nervous system increases at night, the “kingdom of the vagus” (vagus nerve) begins. Recall that the autonomic nervous system regulates the activity of

of all internal organs and consists of the sympathetic and parasympathetic divisions. In general, the sympathetic department is responsible for activating influences, ensuring the mobilization of the body’s forces for various activities: under its action, the pulse quickens, blood pressure rises, etc.e. The parasympathetic part of the nervous system provides rest and recuperation (including digestion). With regard to our topic, it is important to know that under the action of the sympathetic nervous system and its mediator norepinephrine, the bronchi expand, and the action of the parasympathetic nervous system (the mediator is acetylcholine) causes their narrowing. Thus, the nocturnal predominance of vagus nerve activity is one of the main causes of nocturnal asthma.

I What to do to prevent a nighttime attack?

The use of long-acting bronchodilators (these include spiriva, salmeterol, formoterol, theophyllines of slow release) reduces the degree of nighttime deterioration of bronchial patency, but does not completely prevent it.

Reason # 2

Features of the course of inflammation in the bronchi in asthma. This reason naturally follows from the first, since inflammation is also regulated by the nervous and endocrine systems – on each of the

new reasons

LV

currents involved in the inflammatory process are receptors for various hormones and mediators. At night, the severity of inflammation in the bronchi increases and at the same time the sensitivity of the receptors to glucocorticosteroids and bronchodilator drugs of the beta-agonist class decreases (they act on receptors for adrenaline).

I What to do to prevent nighttime | attack?

Improving the control of bronchial asthma with the help of optimal drug therapy reduces the severity of inflammation in the bronchi, including at night.However, changing the dosing regimen of anti-inflammatory drugs (using a hormonal inhaler just before bedtime) does not in itself affect the frequency of nighttime symptoms.

Reason No. 3

Contact with allergens. During sleep, a person is especially closely and for a long time in contact with household allergens (house dust mites, discharge from pets, etc. ), as they accumulate in bedding.Most asthmatics are allergic to these substances, which can worsen symptoms at night.

? What can I do to prevent a nighttime attack?

Minimize contact with the allergen. This can be achieved,

PSTMPi ALLERGY 2010/3

using hypoallergenic bedding (pillows, duvets, various covers, etc.)and other measures of a hypoallergenic regimen.

Reason No. 4

The duration of action of not all drugs overlaps the sleep period.

? What to do to prevent a nighttime attack?

In agreement with the doctor, use long-acting drugs (mentioned above).

Reason No. 5

“Concomitant” diseases, which, like bronchial asthma, can cause or worsen nocturnal symptoms. Often, this last reason is the first or even the only one in terms of importance, only imitating the actually absent bronchial asthma.

Obstructive sleep apnea is a serious medical condition with snoring.Against the background of snoring, the upper airways periodically overlap (obstruction occurs), and breathing stops (this is apnea). As a result, the level of oxygen in the blood falls, and the brain, heart and other organs suffer from its lack, and the risk of vascular catastrophes increases. Obstructive sleep apnea syndrome can be suspected by the presence of not only snoring, but also excessive daytime sleepiness (after all, you cannot rest properly at night).

Gastroesophageal reflux. Translating into an understandable language – throwing the acidic contents of the stomach into the esophagus. Further, the acid enters the pharynx and can be aspirated into the bronchial tree. This condition, in addition to heartburn (which confirms the presence of reflux, but is not always noted with it), can manifest itself as shortness of breath and coughing, which are associated with a horizontal position of the body and can be provoked by errors in the diet.

Allergic rhinitis and sinusitis: at night the process of self-cleaning of the paranasal sinuses worsens, which can cause mucus leakage into the lower respiratory tract with the development of nocturnal cough and shortness of breath.

with l- +.

Cardiac asthma: Attacks of nocturnal shortness of breath that occur after a few hours of sleep and resolve when moving from a lying position to a sitting position may be a manifestation of heart failure.

In What to do to prevent nighttime | attack?

It is necessary to pay attention to the features of nocturnal attacks and accompanying symptoms and to tell the attending physician about them.He will advise which specialist to contact for the diagnosis and treatment of each of these diseases.

How to deal with a night attack?

And now, finally, let’s answer one of the main questions: what to do if the nocturnal attack of shortness of breath has already developed? Of course, a fast acting bronchodilator must be inhaled. It is possible to use any short-acting beta-agonist (salbuta-mole, berotek), but it is better, keeping in mind the nocturnal “kingdom of the vagus”, to use a combined drug acting simultaneously on the receptors of the sympathetic and parasympathetic nervous systems. Such a combination of a beta-agonist and a holinoblocker, which allows maximum resistance to nocturnal changes in neuroendocrine regulation, is available in the form of a well-known drug – Berodual N.

Berodual N contains beta-agonist (fenoterol) and an anticholinergic (ipratropium). Thanks to fenoterol, relief from taking the drug occurs within a few minutes after inhalation, and then ipratropium enters the fight against suffocation, the maximum effect of which develops by the end of the first hour.Total

Short course

the duration of action of bero-dual is 6 hours, which is longer than that of single-component drugs. As a rule, this duration of drug action allows you to sleep peacefully until the morning without experiencing asthma symptoms. Palpitations, tremors and other undesirable effects when using Berodual N are less likely than when using other inhalers, since Berodual N contains a reduced dose of beta-agonist. It is advisable to discuss in advance with the attending physician the use of berodual N for nocturnal attacks of bronchial asthma.

Hopefully this article will help you minimize the risk of nocturnal attacks and achieve asthma control. However, maintaining control of asthma is not always possible, and this is due to various reasons, such as smoking and viral respiratory infections. These two factors also increase the tone of the parasympathetic nervous system, therefore, night attacks against the background of acute respiratory viral infections or (alas!) Continued smoking is another reason for using the combined inhaler Berodual N.Of course, in any case, nocturnal asthma attacks are a signal that you need to see a doctor. And we wish you good dreams and free breathing.

Reference

BERODUAL N is a bronchodilator drug used both in chronic obstructive pulmonary disease and in bronchial asthma. Bero-dual N is a combined drug consisting of two drugs – Berotek and Atrovent, and the broncholetic drug Berotek in one dose of Berodual N is less than the dose released from a can with pure Berotec.Instead of freon, the cartridge uses hydrofluoroalkane, a filler that is harmless to the environment and humans. It is used as directed by a doctor.

X

PSTMPi ALLERGY 2010/3

Wheezing – concept and meaning

Consider what the concept and meaning of the word wheeze means.

Wheeze is 1.Same as wheezing.
2. Husky sound.
3. Loss of clarity of voice with a sore throat. 2.Local Spina, ridge (1 * 4).

Wheezing is – 1. Wheezing, hoarse sound. Dying x. 2. plural Noises in the respiratory organs (special). Wheezing in the lungs. Dry, moist rales.

Wheezing is 1. Wheezing, 1. singular only Same as wheezing. Dying death case The death case is heard
2.Loss of full voice in throat ailments. The patient has a runny nose, wheezing, cough. 2. Husky sound. Partial wheezing.
3. Sound phenomenon in the lungs in some diseases. Listen to wheezing in the lungs.

-a, m.

A hoarse, unclean sound made by the throat when breathing is difficult.

The sleeping people began to wake up, voices were heard, someone coughed with a wheeze. Peregudov, In those early years.

A hoarse, unclean sound accompanied by noises of something

Steam with a wheeze rushed through the iron pipe, and the copper whistle was buzzing throughout the Pershinsky plant with its wolf howl.Mamin-Sibiryak, Breadwinner.

In the dining room, with wheezing and humming, the clock strikes three times. Nikulin, Moscow Dawns.

usually plural (wheezing, -ov).

Noises in the lungs in some diseases.

Wheezing in the lungs.

I feel really bad. Doze will fog the brain. And in the chest there is an incessant creepy death Bill-Belotserkovsky, In the jungle of Paris.

Part of speech

Verb (personal form)

Word forms

wheezing, wheezing, wheezing, wheezing, wheezing, wheezing, wheezing

Synonyms wiki

sound, noise, hoarse, hoarse, hoarse, wheezing, hoarseness, wheezing, wheezing, like a greasy wheel, hump, scruff, crepitus, back, back, wheezing

Cm.also

… I AM AFRAID – I am not one of the shy SNORTS – take on the throat, intimidate SNAPE – speak (do not wheeze – shut up!) CHRON – the political officer of the colony CRUSH – a ruble bill CRUNCH – money CRUNCHY … (Criminal psychology)

… Malfunctions and diagnostics of loudspeakers and speakers The main manifestations of coil malfunctions are no sound, wheezing at any volume, wheezing at low or only at high volume The reason is the operation of the speakers… … and cleaning the loudspeakers when the loudspeaker is moistened or wet, the suspension becomes soaked, which may cause wheezing, then it is necessary to replace the dynacmics. Features of diagnostics and testing with automatic universal testers …
… for loudspeaker loudspeakers and dynamic microphones – violation of the elasticity of the diaphragm can lead to wheezing and distortion of sounds To ensure moisture resistance of materials, there may be elements of the equipment… (Diagnostics, maintenance and repair of electronic and radio equipment)



“The doctor, having listened to the lungs, to his own horror, noticed the beginning wheezing”

Polyclinics as carriers of the “coronavirus infection”, the happiness of the pharmaceutical business and the “resurrection” after a dropper in the RCH

City Hospital No. 2, where Rustam Batyr was treated for covid, turned out to be a greeting from the “Soviet past” with torn linoleum on the floor. That, however, did not affect the quality of the work of doctors, to whom the famous Muslim and public figure is grateful for their professionalism and friendliness. About how Leskov reads “under the coronavirus” and why the patients lying in the corridor are not the worst in today’s world – in the material of the permanent author of “BUSINESS Online”.

Rustam Batyr: “Coronavirus is a shoddy disease. He stole a month of my life from me. And another month should be spent on a round dance around the pills during the recovery period ”

CAN ONLY BE SICK IN ONE SINGLE CASE

Coronavirus is a crappy disease.He stole a month of my life from me. And another month should be spent on a round dance around the pills during the recovery period. But the most offensive thing is that the covid significantly crippled my creative plans, which I was building with great hope for the last quarter of the outgoing year. This is the same bastard!

In general, I do not have colds. From the word “absolutely”. I always looked with envy at my colleagues at work, who in the autumn-winter period one after another went on a short-term extraordinary “vacation”, and such a whim remained inaccessible to me.However, a couple of times I deceived my superiors by inventing a well-deserved flu for myself. There was a sin. But honestly, I can get sick only in one case: when, under the weight of deadlines, I turn myself into a driven horse. Then the body goes AWOL, they say, do whatever you want, master, go as long as you like, but I need rest.

All the more surprising was the temperature of 38.5 for me, which a thermometer suddenly showed one fine November day. What is this? Where did it come from, now there is no time trouble?

Perhaps the reason lay in a broken leg that I suffered two months before.The fracture was a complication. Therefore, the plaster was not removed for a long time. And when it was removed, it required surgical intervention. In general, for a long time I was actually immobilized. For me, this is a significant factor, since, to be honest, I don’t go in for sports, unless, of course, taking into account riding a monowheel (by the way, I ride the “Evil” – for those who are in the subject). All my sport is ten thousand steps in the fresh air, which every day I purposefully (on the counter) walked, as advised by doctors and all kinds of gurus on a healthy lifestyle.On crutches, you can’t hobble ten thousand steps. May God get to the bathroom. Here’s the immunity and sank. However, it is possible that COVID-19 hacks everyone, without exception, regardless of a person’s physical activity. However, lowered immunity still opens the gates wide open for the disease and complicates its course. So, if there were no fracture, perhaps I would have suffered asymptomatic or at least mild covid.

“Behind the doors is a tiny room where ordinary flu-sufferers, along with Kovidnikov, wait in line to see the doctor, pushing on a tiny patch like a herring in a barrel.

I SEE A STRANGE PRACTICE OF FORCING PEOPLE WITH TEMPERATURE DRAGGING TO THE POLYCLINIC

The next day after the onset of the ailment, as a law-abiding man in the street, having heard all kinds of fears about a pandemic, I went to the district clinic.Probably, in a normal situation, I would hardly do that. But with all that said, I began to be overcome with worrying fears. And, it turned out, not in vain: as a result, the temperature remained at 38.5 for two weeks, while no antiviral drugs helped, my back ached terribly, and three days after the illness, my taste and smell disappeared. Everything is like a manual. It was the coronavirus itself (analyzes later confirmed it).

In general, it seems to me a strange practice to force people with fever to trudge to the clinic.And the point is not only that it is physically difficult to do, but also that we become carriers of the infection at such a moment. Hello statistics.

As a resident of the Vakhitovsky district, I am attached to the polyclinic number 2 on Vishnevsky. For people with symptoms of colds, a separate entrance was organized there. It would seem that everything was done correctly. Only now there is a tiny room behind the doors, where ordinary flu-sufferers, along with Kovidniks, wait in line to see the doctor, pushing on a tiny patch, like a herring in a barrel.A terrible dream of an epidemiologist, not otherwise.

It was not possible to get to the doctor for the first time: it was the end of the working day and there were too many people who wanted to get medical advice. I had to go to the clinic again. Then two weeks of domestic ordeals began, or rather, a nightmare. Endless fever, weakness, headache. The pills were beneficial only to the pharmaceutical business, and my Covidik openly made fun of them. When the temperature rose to 39, a doctor was called at home. But he has exactly the same instructions as the doctor on duty at the clinic: to prescribe useless medications.Then again a visit to the clinic. Here the doctor, having listened to the lungs, to his own horror noticed the onset of wheezing and hastily wrote out a referral for hospitalization.

SYSTEM WORKS

Kovidnikov is first brought to the RCH. There is a diagnostic center, where patients undergo a comprehensive examination, after which they are distributed to hospitals in the city (at least that was the case in my case). I saw the beginning of the second wave: a small number of people were already lying in the corridors. They assigned me there too.In another situation, I would probably be indignant at such a circumstance. But, to be honest, being in the ward with other Kovidniks and breathing the same air with them seemed not the most tempting prospect.

Having diagnosed the moderate severity of the disease (35% of lung damage), two days later I was sent to the second clinical hospital. There was no shortage of beds here. True, the hospital itself turned out to be a portal to the Soviet past. We are already accustomed to the fact that in Tatarstan, medical institutions have been repaired to the highest European standards (in Kazan, for sure), and here is polyethylene nailed to the windows from a draft, and torn linoleum on the floors.

“The medical staff works in a well-coordinated, professional and, most surprisingly, friendly manner.”

However, this does not affect the quality of treatment. The medical staff works in a well-coordinated manner, professionally and, what is most surprising of all, friendly (with their salaries!). The cosmonauts’ camouflage is not removed from them (how can they generally work in this for days?), The sick are not allowed out of the wards into the corridors (to avoid mutual contamination), food from restaurants is categorically not allowed (these are the requirements for infectious diseases), all medicines ( there are no interruptions with them) and the procedure is on schedule.I don’t know where the spiteful critics get their horrible stories for the Internet, but this is definitely not about Tatarstan. The system works for us. Doctors are great fellows!

Back in the RCH, they put me on a drip with some kind of hormonal drug, and the temperature went away like a hand. I was resurrected at once. And already in the second hospital, for the first time in two weeks, I was even able to return to reading books. For three days of idleness, I swallowed another volume of works by Nikolai Leskov (before hospitalization I bought an 11-volume book, but did not manage to master it) in 600 pages, and over the next three days “Secret History” Donna Tartt (a friend infected me with the idea of ​​reading all Pulitzer Prize winners) with the same volume.On the internet, they often write that COVID-19 affects cognitive abilities. This is indeed the case. The first words read bounce off the walls inside the skull like dried peas in an empty jar. This is a very strange and hitherto unfamiliar sensation. But then everything is restored: the text begins to be absorbed in the usual way.

WE ARE IN THE FAMILY TRYING TO UNDERSTAND HOW CORONAVIRUS COULD LOSE US

After being discharged, the body overcomes a terrible weakness. It’s hard just to get up, let alone take a shower.After the hospital gruel, he is terribly drawn to protein foods, which, as you know, are the building blocks for cell repair. The meat is eaten up on both cheeks. However, perhaps this is a feature only of those who adhere to a carbohydrate-free type of diet, in which certain gastronomic habits are developed. I was also very attracted to the grenades. In a couple of weeks, without any exaggeration, I swept two boxes of this oriental fruit. Maybe it has something to do with blood (according to popular belief, pomegranate is useful for it), because it is the circulatory system that accounts for the main blow of the coronavirus, which actively provokes the formation of blood clots.However, perhaps the covid has nothing to do with it.

Looking back, we in the family are trying to figure out how the coronavirus was able to lasso us. We are not dissident, we try to follow all the sanitary recommendations of the authorities. In the summer, they saved themselves almost without getting out at the dacha, now – by ordering products through delivery services (they have almost forgotten what grocery stores look like from the inside). We work from home. True, we had two cultural and entertainment issues: one on the Horde at the Opera and Ballet Theater (the Tatar theme is sacred, we could not miss this) and the second – we went with friends to StandUp (of course not a sin, but I really wanted to get to know this genre of performing arts live).However, in terms of timing, both autumn outings do not correlate in any way with the moment of infection. Of the friends with whom we periodically meet, no one was sick with coronavirus.

Most likely, we got into the arms of covid through children who attend kindergarten. They endured the disease asymptomatically, and all the adults in our family collapsed. We do not find any other sources. Therefore, from their misadventures, they made the following conclusion: no matter how you insure yourself, you will not escape fate. We only assume, and the Lord disposes.So we’ll all be there. Sooner or later.

Treatment of asthma in adults at the primary level

This patient guide is based on the Estonian guidelines for the management of asthma in adults at the primary level, approved in 2014, and the topics covered there, together with recommendations. The recommendations for the management were drawn up on the basis of an analysis of the evidence-based medicine literature and taking into account the needs in Estonia and the possibilities of healthcare.

A patient guide helps to cope with the disease, to understand the nature of the anxiety disorder, different risk factors, possible causes of asthma exacerbation, gives recommendations on lifestyle and self-help that will help alleviate the disease, explains the peculiarities of asthma treatment, the effect of different groups of drugs, and the importance of continuous treatment … The aim is also to ensure that the asthma patient is aware of his illness and, if possible, productive cooperation with the attending physician.

The patient guide discusses the nature of asthma, the different risk factors, everyday problems associated with the disease, treatment options and treatments from the patient’s perspective. Both family and pulmonary doctors, who deal with asthma diagnostics, asthma counseling and treatment, and asthma patients, who amended the guidelines from the patient’s point of view, contributed to the development of the treatment guidelines.

The physician is advised to give the patient written prescriptions for the treatment of asthma, this will help to better remember the treatment regimen. These guidelines are well-suited to both personalized advice and a written source of patient information.

D Main Recommendations

  • Be physically active, as any movement helps to cope with the disease. Find the type of movement and load that suits you.
  • Keep track of your weight
  • Give up all types of tobacco products and also avoid secondhand smoke
  • Avoid inhalation of irritants and known allergens as much as possible, both indoors and outdoors.
  • Learn the names of the drugs you are prescribed or carry information about them with you.
  • Follow your doctor’s daily recommendations and treatment regimens.The doctor can be asked to write separately on paper the names of the drugs and the time of their administration.
  • Monitor inhalation techniques with your FHN / Asthma Nurse. Do this also if you have been using the inhaler for a long time.
  • Do not change the dose or frequency of medication yourself. Always consult your doctor on this topic.
  • Remember to rinse your mouth after each inhalation. Always inform your doctor about any side effects you experience.
  • Inform your doctor about all other medications you use and if you have any side effects with them.
  • Know the symptoms of an exacerbation of the disease. Ask your doctor for written guidance on flare-up symptoms and home first aid.
  • If you feel uncomfortable, follow your doctor’s recommendations for home first aid. When increasing the dose of medication, be sure to monitor the maximum allowed doses and the maximum allowed frequency of administration.
  • If you feel unwell, always contact your doctor to find out the tactics of further treatment. If you feel unwell quickly or if you have trouble breathing, call an ambulance or go to the hospital emergency department.
  • Monitor the content of the medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask your doctor for a new prescription before the inhaler is empty.
  • To assess your asthma at home, use an asthma control test, which you can get, for example, from your family nurse. You can always complete the same test at a visit to your family doctor or nurse. The test is included in Appendix 1 of this patient guide.

Asthma is a chronic inflammatory disease of the airways, the prevalence of which has increased dramatically throughout the world in recent years (Braman 2006), and in which there are occasional periods of difficulty breathing due to narrowing of the lower airways.The narrowing of the airways goes away partially or completely, either on its own or with treatment. It is believed that many people do not really know they have asthma and therefore do not receive proper treatment. At the same time, in the majority of patients with asthma, with the help of treatment, it is possible to achieve complete control over the disease, and thus maintain the quality of life and performance.

Air movement in the respiratory tract

The movement of air in the body begins through the nose or mouth.If you inhale, air travels to the lungs through the trachea and lung tubes (bronchi). The bronchi end in small bubble-like formations (alveoli), where oxygen and carbon dioxide are exchanged. Oxygen is absorbed from the alveoli into the blood, and the carbon dioxide generated in the body passes from the blood to the alveoli. When released, the air, along with carbon dioxide, is expelled from the lungs. Normally, when breathing, all airways are open and air moves through them freely and unimpeded.

What happens in the airways in asthma?

With asthma, the airways are inflamed, irritated and narrowed, and the movement of air in them is difficult. This is due to asthmatic inflammation, which creates edema in the mucous membrane and an increase in mucus secretion. Inflammation of the mucous membrane and the narrowing of the bronchi caused by it is a protective reaction against various external stimuli. In asthma, the airways are more sensitive than usual and react easily to various stimuli. Airway constriction can be caused, for example, by irritating odors, cold weather, severe stress, and contact with animals or pollen.

The main symptoms of asthma are:

  • choking feeling
  • lack of air (which can also occur at night)
  • wheezing and wheezing, especially on deep exhalation
  • cough that occurs more often during the night and / or early morning
  • tension or heaviness in the chest (Sistek et al, 2006).

Asthma symptoms can be milder or more severe, and last from several hours to several days if asthma is not diagnosed and the symptoms are not treated. An asthma attack is a condition in which all the symptoms of asthma – respiratory distress, wheezing, coughing, shortness of breath, and a feeling of heaviness in the chest – develop very quickly. The manifestation of symptoms (especially the first time) can cause feelings of fear, uncertainty, helplessness. There can be several reasons for triggering an asthma attack: excessive physical activity, various environmental factors, stress, or contact with allergens.

What are the causes of asthma?

In Estonia, 5-8% of the adult population or 70,000-112,000 people suffer from asthma (Merenet al 2005). Both genetic (non-modifiable) and environmental (modifiable) risk factors contribute to the incidence of asthma in adults. Asthma onset in adulthood is most common in women. The following factors influence asthma: 90 260

  • genetic predisposition, which is greater in those people whose relatives are already ill / have had asthma, allergic rhinitis and atopic dermatitis.
  • early childhood respiratory tract infections that may contribute to asthma at an older age
  • contact with environmental allergens and chemicals used in the home and at work (Tarlo et al 2008).
  • smoking and being overweight (Lim et al 2010).
Important to remember:

  • Genetic predisposition is an important risk factor if relatives have already had asthma.
  • Give up all types of tobacco products (cigarettes, electronic cigarette, cheek tobacco, hookah, cigarillo, pipe tobacco, cigars), as well as secondhand smoke.
  • If you have decided to quit smoking, ask your family doctor for advice, he will be able to refer you to an appointment with a support for ex-smokers. Drinking alcohol should be moderate.
  • Watch your weight. Talk to your doctor if you change your eating or dietary habits.
  • Don’t forget to move! Every day should include at least some physical activity.

If you have or have had episodes of wheezing and wheezing in the past, especially when you exhale deeply, as well as episodes of shortness of breath (shortness of breath), shortness of breath and heaviness in the chest, coughing attacks that start more often at night and / or early in the morning, then inform about them to your doctor.Tell about them even if these symptoms have already passed by the time of the visit to the doctor.

To diagnose asthma , your doctor must thoroughly familiarize yourself with your health data. The doctor should also clarify what diseases you have suffered and whether you have any allergies. If, based on the history, the diagnosis of asthma still remains in question, additional tests should be done.

There is no single and specific way to diagnose asthma, and it cannot be diagnosed only on the basis of a questionnaire.Usually, the doctor begins by listening to the lungs with a stethoscope, which helps determine if there is inflammation in the airways. In the case of asthma, whistling, wheezing and / or prolonged exhalations are heard in the lungs while listening. If the above symptoms were not found during listening, this does not mean that the diagnosis of asthma has been ruled out.

If your doctor suspects you have asthma, they may order you to have a spirographic examination. If the spirographic examination did not show signs of asthma, but you still have asthma symptoms that occur day or night for an unknown reason, then you will be prescribed a trial treatment or referred to a pulmonologist for a consultation.

Spirography

Spirography is an examination of the respiratory tract, during which the volume and speed of movement of inhaled and exhaled air, as well as the filling of the pulmonary tract, are assessed. Thus, we are dealing with the study of pulmonary function.

Spirography is painless and does not cause any significant harm to your well-being. In some cases, frequent, strong inhalation / exhalation can increase the pressure in the chest, abdomen and intraocular pressure and thus cause discomfort.There are contraindications for spirography, which the doctor or nurse will inform you about before the examination. The doctor and nurse will give you precise instructions on what to watch out for before coming for an examination:

  • If you are using an adjuvant with bronchodilators (bronchodilators), or the so-called inhalerpitcher, the doctor will advise you not to use it from 4 to 24 hours before the examination, depending on the duration of the medication.
  • Avoid physical activity
  • Do not smoke
  • Do not come to the examination with a full stomach, but you can have a little snack two hours before the examination.

Conducting spirographic examination

  1. Before the examination you will be weighed and measured, the data will be entered into the computer
  2. During the examination, your nose will be covered with a clothespin to prevent breathing through your nose and a special mouthpiece will be placed in your mouth. The mouthpiece is held in your mouth and you will breathe through it throughout the examination, with your back and neck straight (see Figures 1 and 2).
  3. First, the doctor or nurse will ask you to breathe in and out several times through the mouthpiece at a calm pace.
  4. Next, you will need to inhale as deeply as possible and then exhale as fast as as you can until the lungs are completely clear. This may take a few seconds. The nurse will tell you how long you will need to breathe at this rate.
  5. You may be asked to inhale as deeply as possible and then exhale as long as possible until the lungs clear.
  6. These breathing cycles are usually repeated several times — at least three times, but usually no more than eight times. If your lung function is impaired, you will need to take fast acting bronchodilators and after 15 minutes a new spirographic examination will be performed.

What do spirography results show?

Spirography measures the volume and / or speed of air that a person can inhale and exhale.Most often measured:

  1. The amount of air you can exhale forcefully for one second after maximum inhalation. This is called the forced expiratory volume in 1 second (FEV 1 ). If the airways are in order, a person can exhale most of the air in the lungs within one second.
  2. The maximum volume of air that you can exhale forcefully after a maximum inhalation. This volume is called forced vital capacity (FVC).

As a result of calculating the results of spirography, the above two indicators are compared with the control indicators. Your age, height and gender affect your lung capacity and are taken into account when calculating your results. Asthma may be signaled when the FEV 1 / FVC ratio is less than the reference. Low values ​​indicate that your airway is narrowed, which is a typical symptom of asthma. Typically, the spirography is repeated after you take a breath-relaxing medication.If you have asthma, your maximum expiratory volume will be increased during the post-medication examination. If the spirographic examination does not give results that would clearly indicate asthma, then the doctor may prescribe you a trial treatment with inhaled glucocorticoids. The physician will evaluate the effect of the trial treatment after four weeks: asthma will be indicated by an increase in FEV 1 of at least 200 ml or a significant improvement in clinical symptoms.

It may happen that spirography is contraindicated for you.In this case, PEF-metry or measurement of the peak expiratory (exhaled) air velocity is used exclusively for diagnostics, against the background of a trial treatment. Peak expiratory flow is measured using three measurements in a row with a PEF meter, of which the largest is taken (Quanjer et al 1997). During the measurement, the patient can stand or sit and the back and neck must be straight (McCoy et al 2010). The PEF meter is used to determine the maximum expiratory air velocity (see.(See also the chapter “Controlling asthma”).



If your complaints and clinical symptoms make it possible for the doctor to suspect you have asthma, but the results of spirography and trial treatment do not confirm the diagnosis, then the doctor will refer you to a pulmonologist.

If your cough lasts longer than eight weeks, an X-ray examination may also be done, although in general cases it is not done to diagnose asthma (Laboratory diagnosis and treatment of the most common community-acquired infectious diseases and diagnostic algorithms for family doctors 2015).

No allergens need to be identified for diagnosis (Primary Health Care for Asthma in Adults, Estonian Treatment Guidelines 2014). If the doctor still suspects that your asthma symptoms are caused by an allergy, that is, you have allergic asthma, then skin tests or a blood sample should be done to clarify possible allergens.

Important to remember:

  • Asthma is diagnosed based on symptoms and results of examination and treatment
  • Tell your doctor about the manifestations of breathing problems in different situations, as well as your options for the causes that may cause them.
  • Asthma symptoms:
  1. wheezing and wheezing in the chest, especially on deep exhalation
  2. occasional breathing difficulties
  3. shortness of breath and a feeling of heaviness in the chest
  4. coughing attacks, which occur more often at night and / or early in the morning
  • If asthma is suspected, a spirographic examination is carried out, if necessary, together with a test for bronchodilators
  • If asthma is not diagnosed based on spirogram but clinical symptoms remain suspicious, your doctor may prescribe you a trial with basic inhaled asthma medications or refer you to a pulmonary specialist.
  • For each patient, the doctor decides separately whether he needs additional examinations. Every patient does not need them.

Various options are used to treat asthma. It is important to know that there is no one best treatment that works for everyone. The disease progresses differently from patient to patient, and for the medication to work, asthma treatment depends on your personal needs.

The goal of treatment is to achieve and maintain good control of asthma and to improve the quality of life of an asthma sufferer. It is desirable to achieve this result with the lowest dose of drug / drugs and with the least side effects.

Asthma is well controlled if:

  • Symptoms do not appear during the daytime , or they appear only briefly and no more than two days a week
  • Symptoms do not appear at night , or they appear no more than two episodes per month
  • Asthma does not limit physical activity
  • The patient does not need seizure treatment (fast acting bronchodilators) or uses these drugs no more than twice a week.
  • Indicators of lung functions remain within normal limits (at least 80% of indicators for the last five years).
  • There are no more serious exacerbations or they do not appear more often than once a year.

If asthma is suspected or has already been diagnosed, it is very important that you tell your doctor about your well-being. Together with your doctor, you will find the treatment plan that best suits you.

Before visiting a doctor, track:

  • Your breath
  • Can certain activities trigger an asthma attack or respiratory distress
  • Do you have breathing problems at work while at home
  • You feel better

Record any occurrences noted as your doctor will need your exact descriptions.To track your asthma status, you can complete the asthma control test. This is a simple questionnaire that sums up asthma information (Jia et al 2013) and you can ask your FHN for a printed copy (see Appendix 1 of the Patient Guide).

Your doctor may ask you what symptoms you have, when they start, and how often they occur. You will be asked about other health data and may be asked if any of your relatives have asthma.Information about whether your relatives have had any breathing problems, lung diseases or allergies.

For your doctor, you can make a list of the medicines, supplements and vitamins you are taking.

Drug-free treatment

When treating asthma, lifestyle is important in addition to medication. Try to avoid upper respiratory irritants and known allergens.

The most important respiratory irritant is tobacco smoke.Smoking is one of the most important health risks. Quitting smoking will help you to significantly improve your asthma control.

Physical inactivity is an important risk factor (Lim et al 2012). Exercise that suits you is highly recommended for asthma. Regular exercise promotes better oxygen uptake and can improve quality of life and asthma control (Carson et al 2013; Heikkinen et al 2012).

Influenza vaccination is not contraindicated for patients with asthma (Primary Asthma Treatment in Adults, Estonian Treatment Guidelines 2014).

Important to remember:

  • Lead a healthy lifestyle – you need appropriate physical activity, achieving and maintaining a normal weight, quitting smoking.
  • Avoid upper respiratory irritants and known allergens.
  • Reducing the number of dust mites does not affect the course of asthma.
  • You can get the flu vaccine.
  • It is important for the patient to keep a diary of observation of their health, this is useful for both the patient and the doctor.

Drug treatment

The goal of pharmacological treatment of asthma is not only to relieve symptoms, but also to achieve the necessary asthma control with as few side effects as possible.

Asthma treatment is divided into basic treatment , which is used regularly to keep asthma under control, and seizure treatment , which is used as needed to quickly relieve asthma attacks. For patients with mild episodic asthma, doctors recommend the treatment of seizures β 2 short-acting agonists, for patients with persistent asthma, doctors prescribe constant baseline treatment and, if necessary, treat the seizures.

Basic treatment

The baseline treatment uses inhaled or inhaled drugs to both relieve symptoms and prevent exacerbations of asthma and preserve lung function. Typically, treatment is started with inhaled glucocorticosteroids or hormonal treatment. These medications have anti-inflammatory effects and reduce swelling and irritation in the walls of the lower airways, thus relieving breathing problems.

Basic treatment uses a phased approach, starting with the lowest dose of drugs, if possible with the drugs of the first choice. If the first-line drugs fail to control asthma, the doctor will prescribe a dose of the next level of baseline treatment. If asthma can be controlled for at least three months, the doctor may return the dose to the previous level. The doctor regularly monitors the effect of medications and may change the dose of medications if necessary.If one medication does not give the desired effect of controlling asthma, then the doctor may additionally recommend another medication. Usually β 2 long-acting agonists are used for this. You can use two different inhalers, but it is more convenient if the two medicines are combined in one inhaler.

β 2 – Long-acting agonists (bronchodilators) help open the airways, making breathing easier. Drugs that relax the bronchi can help prevent shortness of breath and wheezing.These medications do not help with exacerbated asthma.

There is also a group of less commonly used medicines that can be taken by mouth in pill form.

If within one month of using the basic treatment the desired result has not been achieved, then the doctor must first of all evaluate your inhalation technique and how much you adhere to the treatment plan and the recommended lifestyle. If necessary, the treatment regimen is changed – for example, the dose of the drug, the drugs themselves, or the frequency of their administration.If your asthma is properly controlled for at least three months, your doctor may recommend a reduction in baseline treatment. If control is not achieved by a combination of two drugs in increased doses, the family doctor will refer you to a pulmonologist for a consultation.

Seizure treatment

Seizure treatment bronchodilators are effective in relieving pre-existing asthma symptoms, but these seizure medications do not help prevent asthma flare-ups.

β 2 Short-acting agonists , also referred to as rapid-acting bronchodilators , help relieve asthma symptoms. They relax the muscles in the walls of the airways, help open the airways, and make breathing easier. This reduces chest tension associated with asthma, wheezing and coughing. Their action is short-lived and sometimes, if symptoms worsen, they need to be reused.Ask your doctor to write down for you what is the exact maximum number of doses for how long you can use without danger to health. In case of exacerbation of asthma, glucocorticosteroid tablets are used. Your doctor will prescribe the treatment regimen for you. In addition to the pills, you need to continue to take the inhaled drug from the basic treatment.

Before starting treatment for asthma, your doctor should assess the severity of your asthma. The dose of the drug and the frequency of its use depend on this. Next, you need to find a suitable inhaler with your doctor and nurse and learn the inhalation technique.The inhalers are convenient to use, easy to carry and easy to handle.

In the case of pharmacological treatment, the inhalation technique is very important, the attending physician or nurse will introduce you to it. Choosing the right inhaler for you is also very important.

There are several types of inhalers, so it is very important to learn a new technique when receiving the first medication or when changing it. The best way is a visual test, which can be done, for example, during a FHN appointment.

Teaches the correct inhalation technique by a family doctor or nurse

Both powder inhalers and metered dose inhalers are used. Medications used in both metered dose inhalers and powder inhalers work the same way. Examples of different inhalers are given in Appendix 2 of this patient guide.

NB! Unfortunately, many asthma patients use the inhaler incorrectly. In case of incorrect use of the inhaler, the medication will not be beneficial.

1. Inhalers with dispensers

From these inhalers, medication is released by pressing the canister and direct inhalation (see Appendix 2 of the patient manual).

Metered dose inhalers are used both to treat seizures and to take basic medications.

How to use a metered inhaler?

  1. Remove the cap from the inhaler.
  2. Shake the inhaler.
  3. Hold the inhaler upright, your ring finger will help you release the medication from the inhaler.
  4. Hold the mouthpiece of the inhaler near your mouth and exhale deeply.
  5. Place the mouthpiece in your mouth, gripping it firmly with your lips, and lift your chin up slightly. At the same time, when you inhale deeply and evenly, press the canister to release the dose of medication.
  6. Inhale long and deeply so that the medicine reaches deep into the lungs.
  7. Remove the mouthpiece from your mouth, close your mouth and hold your breath for 10 seconds.
  8. Exhale through the nose and repeat if necessary.
  9. After inhaling the medication, rinse your mouth.
  10. Avoid getting the medication in the eye.

If you’ve read the technique manual, try using the medicine yourself in front of a doctor or nurse. The first time using the medicine at home, do it in front of a mirror.

If you have any questions about the use of the medication, be sure to ask your doctor or nurse, as taking the medication correctly will help you keep your asthma under control.

If the use of the inhaler is complicated or you cannot use it due to your health condition, then be sure to inform your doctor about this, who will prescribe the type of treatment that suits you.

Cleaning the inhaler

The inhaler should be cleaned at least once a week. This is necessary so that the medicine does not clog the mesh of the inhaler mouthpiece.

Intermediate reservoir for drug use

An intermediate reservoir (or spacer) is a container that collects medicine and allows you to inhale the medicine slowly and deeply once or twice.The intermediate reservoir reduces the likelihood of the drug settling on the tongue or mouth, and helps more of the drug get into the lungs. The intermediate reservoir is suitable for those who find it difficult to inhale and inject at the same time.

Although the remainder of the medication remaining in the intermediate reservoir is harmless, it should still be flushed regularly after every 1 to 2 weeks. The easiest way is to rinse with warm water. After rinsing, the reservoir must be air-dried, never wiping it with a towel.

2. Powder inhalers

Powder inhalers contain doses of medicine in the form of a fine powder, which, when inhaled, enters the lungs. When using a powder inhaler, you do not need to inhale and release the medication at the same time, but the intake must be more intense. Therefore, a dry powder inhaler may not be suitable for elderly patients or people who have weakened nerves or muscles.

Powder inhalers (see.Appendix 2 of the treatment guidelines) are also used both in the treatment of seizures and as a basic treatment, depending on the medication they contain.

There are mainly 2 types of powder inhalers used:

  1. Multi-dose inhalers that include up to 200 doses.
  2. Single dose inhalers – If used, the medication capsule must be replaced before each use. It must be remembered that the capsules must not be swallowed! The medicine works only if inhaled!

The use of a powder inhaler depends on the specific type and brand of manufacture.The following are general principles for the use of such inhalers. When taking your prescribed medications, it is very important that you read the leaflet and consult with your doctor or nurse about the appointment.

How to use a powder inhaler?

  1. Remove the cap of the inhaler and release the dose of medication.If you have an inhaler to which you need to attach the capsule, follow the instructions
  2. Keeping the mouthpiece to one side, exhale deeply (not into the mouthpiece).
  3. Place your front teeth around the mouthpiece and close your lips tightly around it.
  4. Inhale quickly, intensely and deeply through your mouth for 2-3 seconds.
  5. Remove the inhaler mouthpiece from your mouth. Hold your breath for another 2-19 seconds.
  6. Exhale slowly and calmly through your nose.

Be careful when cleaning the powder inhaler. Most powder inhalers cannot be washed with water or soap. The mouthpiece can only be cleaned with a dry cloth.

Treatment of concomitant diseases

Be sure to inform your doctor about your other medical conditions (for example, high blood pressure, diabetes, etc.), as this may depend on the treatment you are prescribed.

In the case of cardiovascular diseases, medications are used that are not suitable for asthma patients. Be sure to tell your doctor about all medications you take, including pain relievers.On rare occasions, some patients may be allergic to aspirin. In this case, only paracetomol can be used as a pain reliever.

Important to remember:

  • The goal of asthma treatment is to control it.
  • It is very important to lead a healthy lifestyle – physical activity, weight management, smoking cessation and avoidance of respiratory irritants and known allergens.
  • Medication uses both basic and anti-seizure treatments, both of which are taken by inhalation.In the case of basic treatment, the first choice is glucocorticosteroids, to which long-acting bronchodilators are added. In this case, the doctor will usually write a prescription for the inhaler that contains both fixed-dose drugs.
  • In case of an asthma attack, use a short-acting bronchodilator, but do not exceed the prescribed dose.
  • Watch for symptoms of worsening asthma.
  • Tell your doctor about any other medicines you are taking and if there have been any side effects.
  • Monitor the dose of the medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask for a prescription for you before the inhaler is empty.
  • Information about all prescriptions issued and purchased by you can be checked in the prescription center of the state portal: www.eesti.ee → Services → For a citizen → Health and healthcare → Prescriptions.

With asthma, it is very important to self-monitor your well-being on a daily basis.One of the methods is the already mentioned asthma control test, as well as PEF-metry. The PEF meter is a device that measures the maximum expiratory flow rate. It can be used to assess the movement of air in the respiratory tract and the strength of the muscles that provide this action. Basically, the meter has a scale of liters / minute (l / min).

PEF is not a substitute for spirographic examinations by a physician. The PEF meter is a small, hand-held device that has the advantage of being fast and easy to interpret.Consult your doctor for information on the correct target values ​​for you.

How to use a PEF meter?

• the test should be performed while standing, while keeping the neck and back straight
• make sure that the device reads zero
• before starting the test, take a deep breath
• place the mouthpiece of the device in your mouth and close your lips tightly around it
• exhale into the mouthpiece with maximum speed and force.
• write down the obtained reading of the device (liter / per minute) 90 260
• repeat the test two more times 90 260
• as a result, write down the highest score of the three tests performed 90 260
• the highest value means a maximum air speed of
• Save your test results at different times so that you can show them to your doctor if necessary.

Keeping your asthma under control requires adherence to your treatment plan.Main symptoms of asthma not under control :

• You wake up at night due to asthma attacks 90 260
• You are using large quantities of bronchodilators
• physical activity decreased 90 260

The doctor assesses the state of asthma using a spirographic examination, which is carried out as needed, but in the case of persistent (persistent) asthma of moderate and severe severity at least twice a year.

Ask your doctor for a written treatment plan and discuss with him which treatment regimen is best for you.

Important to remember:

  • Constant monitoring of your well-being is very important. At home, you can use an asthma control test or a PEF meter for this. It is recommended that you record the test results and take them with you to your doctor’s appointment.
  • Asthma can only be controlled if you adhere to your treatment plan and doctor’s orders.
  • Learn the symptoms that indicate asthma is no longer under control. The question of the need and frequency of the spirogram is decided by the attending physician.

An asthma attack is a sudden worsening of a condition. The cause of an attack can be several: excessive physical activity, various environmental factors, stress and contact with allergens. During an asthma attack, the airways become inflamed, narrowed, and mucus production increases.All of these can cause breathing problems, wheezing, coughing, shortness of breath, and a feeling of heaviness in the chest. The manifestation of symptoms can provoke feelings of fear, uncertainty, helplessness.

Symptoms that may appear during an asthma attack:

  • heavy wheezing during both inspiration and expiration
  • persistent cough
  • rapid breathing
  • feeling of tension and chest pain
  • Contractions of the muscles of the neck and chest
  • difficulty speaking
  • the occurrence of feelings of anxiety or panic
  • pallor, sweating
  • blue lips

Mild asthma attacks occur with high frequency and usually last from several minutes to several hours.

When a severe asthma attack occurs, immediate medical attention is sometimes needed. Therefore, it is important to know which symptoms can be considered mild and which are not – such recognition at the right time will help you keep the situation under control. Ask your doctor for a written list of flare-up symptoms. Also ask him to write down the doses and the number of doses for you. If, despite home treatment of the attack, the situation still worsens, you need to call an ambulance within the next hour.

For advice, you can contact the round-the-clock information service of family doctors on the short phone number 1220 * or by phone (+372) 6346 630. In case of need for an ambulance, call the emergency number 112. If your condition worsens, go directly to the hospital emergency department.



If you do not immediately take anti-asthma medication when / during an asthma attack, your breathing will become difficult.If you use a PEF meter during an asthma attack to monitor your maximum expiratory flow rate, it is likely to be the lowest of your best results. This will also help confirm worsening of the condition.

If you do not receive sufficient treatment to relieve an asthma attack, it may be difficult or impossible for you to speak. The reason for this is a decrease in the level of oxygen in the blood, which causes discoloration of the skin and lips – they become blue.In such a situation, you must find help as soon as possible.

Important to remember:

  • Learn the symptoms that can appear in the event of an asthma attack.
  • Try to avoid triggering factors for asthma attacks.
  • It is important to recognize in time which symptoms are mild and which are not, in order to take medicine at home at the right time, or go to the hospital.
  • Ask your doctor to write down a description of the flare-up symptoms for you.
  • Keep close at hand phone numbers where you can turn around the clock – these are the family doctor’s advice line 1220 and the emergency number 112.
  • If worsening, go to the emergency room.
  • Learn the names of medicines used to treat asthma attacks at home and their safe dosages.
  • Try to remain calm at all times, panic makes breathing even more difficult.The person caring for you should be calm and know how to help.

The life of an asthma patient should not be different from the life of people without this disease. You feel your body better than anyone else, so you can do a lot on your own to improve your well-being. It is important to adhere strictly to your treatment plan and avoid factors that trigger an asthma attack. Every person is different, and the same rule applies to symptoms that manifest themselves differently from person to person.The most important thing is to observe the environment. Contact with allergens (allergy pathogens), chemicals, or other pathogens can cause asthma.

In addition, strong odors (such as paints or household chemicals) can irritate the respiratory tract. An asthma attack can also cause strong emotional experiences such as laughter, crying or, conversely, stress, some medications. You need to know what medications you have taken before and how they affected you.Watch what you eat. If some foods cause you allergies, then they should be discarded. The course of asthma can be influenced by other comorbidities. For example, backfilling of stomach contents into the esophagus (gastroesophageal reflux disease) can cause heartburn and asthma symptoms, especially at night.

It is recommended to keep a diary for observing your well-being, where you need to note information about everyday activities (for example, about the composition of food, how much you moved, whether there were changes in well-being due to a change in the environment, stressful situations, etc.).in order to track, in response to which factor exacerbates an asthma attack, and what helps keep the asthma attack under control.

Below are the main irritants and allergens to avoid. These irritants can cause a change in how you feel and trigger an asthma attack.

Cold air

In case of contact with very cold air, the airway can become irritated, which in turn can trigger an asthma attack.If you are outdoors in winter, cover your mouth and nose with a scarf.

Training

You should not avoid exercising if you are diagnosed with asthma. Discuss with your doctor and find the exercise plan that works best for you. It is important to warm up a little before training and cool down a little after training. Avoid exercising in cold air or during flowering. Also, avoid exercising if your asthma is out of control.

Infectious diseases

Lung infections – such as bronchitis or pneumonia – can be dangerous for someone with asthma. The increased amount of mucus and inflammation in the airways make breathing difficult.

If you have asthma, you can get yourself vaccinated against the flu – discuss this with your doctor.

Pollen

Most of the pollen is the main allergen that causes both allergic reactions and exacerbation of allergic asthma in many people.

Excess weight

Asthma is most common among overweight people, both adults and children. Children who come into contact with secondhand smoke are at greater risk of developing asthma. Teenagers who smoke also have an increased risk of developing asthma. Adults who have contact with tobacco smoke at work and at home have a 40-60% greater risk of developing asthma than those who do not come into contact with smoke. If you have been diagnosed with asthma, then smoking is contraindicated for you.Also, no one should smoke in the rooms where you are staying. On the street, try to avoid places where smoking is allowed and there may be a smell of tobacco.

Indoor molds

Mold usually occurs in damp rooms. Inhalation of fungal spores can cause allergic reactions. Keep your bathroom, kitchen and basement clean and dry



Cockroaches

Cockroaches and their secretions can cause allergic reactions in many people.Cockroaches are attracted to food leftovers, debris, and dry food. Do not keep trash open.

Pet dander

Pet dandruff comes from skin, hair, and feathers. Dandruff is excreted by most pets – dogs, cats, birds and rodents. If you have been diagnosed with asthma, it is not recommended to have pets. If you already have a pet, then it should not be kept in the bedroom. The pet needs to be washed regularly.

Important to remember:

  • Know as much as possible about your illness
  • Talk with your family doctor about the possible causes of the exacerbation of the disease and how to manage it.
  • Make sure you have seizure medication at home at all times, and always take them with you when you leave your home.
  • Know which pathogens and allergens are bad for your well-being.
  • Keep track of the doses of medication in the inhaler so that there is no situation when the inhaler is empty and you do not have a new prescription. Ask your doctor for a prescription before the inhaler runs out.
  • Keep a well-being diary to find situations and factors that contribute to an exacerbation. Try to avoid these situations and aggravating factors.
  • Try to live a fulfilling life. This is possible with the right treatment.

The Asthma Control Test (ACT) will help you assess how you are controlling your disease. Choose the appropriate answer for each question and write down the number (one to five) in the square box to the right.

Add up all the answer values ​​to get the result.

1 question

How often in the last 4 weeks has asthma interfered with your activities at work, school or at home?

All the time Very often Sometimes Rarely Never Points
1 2 3 4 5

Question 2

How often during the last 4 weeks have you experienced a lack of air?

More than once a day Once a day 3 to 6 times a week Once or twice a week Not once Points
1 2 3 4 5

3 question

How often in the past 4 weeks have you woken up at night or earlier than usual due to asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or chest pain)?

4 or more nights per week 2 or 3 nights per week Once a week Once or twice in the last 4 weeks Not once Points
1 2 3 4 5

4 question

How often in the last 4 weeks have you used your inhaler (eg with salbutamol)?

3 times a day or more often 1 or 2 times a day 2 or 3 times a week Once a week or less often Not once Points
1 2 3 4 5

5 question

How would you rate your asthma control over the last 4 weeks?

Failed to control at all Rarely managed to control We managed to control to some extent Good control over Completely managed to control Points
1 2 3 4 5

TOTAL:

……………………..

Explanation of results

25 points – Congratulations on an excellent result! from 20 to 24 – Satisfactory result less than 20 – Bad result
You have completely controlled your asthma in the last 4 weeks. You have not had asthma symptoms 90 260
and related restrictions.
If your condition worsens,
consult your doctor or nurse.
It is possible that in the last
4 weeks You are good
controlled asthma, but
not completely. Your doctor or
a nurse can help you achieve complete asthma control.
It is possible that in the last
4 weeks you failed
control asthma.
Your doctor and nurse can advise you on the action plan
must be taken to achieve better asthma control.

Review the test results with your family doctor or nurse.

Braman, S. S. 2006. The global burden of asthma. Chest, 130 , 4s – 12s.

Carson, K. V., Chandratilleke, M. G., Picot, J., Brinn, M. P., Esterman, A. J. & Smith, B. J. 2013. Physical training for asthma. Cochrane Database Syst Rev, 9 , Cd001116

Heikkinen, S.A., Quansah, R., Jaakkola, J. J. & Jaakkola, M. S. 2012. Effects of regular exercise on adult asthma. Eur J Epidemiol, 27 , 397-407.

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Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. 2012. A comparative risk assessment of burden of disease and injury at- tributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 380 , 2224-60.

Meren, M., Raukas-Kivioja, A., Jannus-Pruljan, L., Loit, H. M., Ronmark, E. & Lundback, B.2005. Low prevalence of asthma in westernizing countries-myth or reality? Prevalence of asthma in Estonia – a report from the “FinEsS” study. J Asthma, 42 , 357–65

McCoy, E. K., Thomas, J. L., Sowell, R. S., George, C., Finch, C. K., Tolley, E. A.
& SELF, T. H. 2010. An evaluation of peak expiratory flow monitoring: a compa- rison of sitting versus standing measurements. J Am Board Fam Med, 23 , 166–70.

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Sagedasemate haiglaväliste infektsioonhaiguste laboratoorse diagnostika ja ravi ja diagnostika algoritmid perearstidele 2005

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Täiskasvanute astma käsitlus esmatasandil RJ_J / 3.1–2014. Eesti ravijuhend.

Violation of breathing during sleep in children

Obstructive breathing disorders during sleep can be assumed when the child’s parents or relatives notice respiratory arrest during the period of night sleep. A shortened breathing period is usually caused by a blockage of the airway. Tonsillitis and adenoids can grow in children to a size larger than the lumen of the child’s airways. Inflammation and infection of the lymphoid tissue of the nasopharynx, located on the sides and back of the pharynx, leads to their growth and blockage of the airway lumen.

During episodes of blockage, the child may appear to be trying to inhale (the chest rises and falls during the breathing phases), but air does not enter the lungs. Often these episodes are accompanied by spontaneous premature awakening of the child in order to compensate for the lack of breathing. Such periods of blockage of breathing (obstructions) occur several times per night and are the cause of a violation of the physiology of the child’s sleep.

Sometimes, due to the inability to conduct air and oxygen into the lungs to ensure full breathing, there is a decrease in the level of blood oxygenation.If these situations are prolonged, there is a risk of severe dysfunction of the heart and lungs.

Obstruction of nocturnal breathing is most often detected in children aged 3 to 6 years. It is often observed in children with Down syndrome and with other congenital pathologies that cause impaired air movement in the respiratory tract (for example, with an increase in the size of the tongue or an abnormal decrease in the lower jaw).

What are the causes of obstructive sleep apnea in children?

In children, the most common cause of airway obstruction during sleep is enlarged tonsils and adenoids, which obstruct normal airflow in the upper airways.Infectious processes contribute to an increase in the size of these lymphoid formations. Large adenoids can even completely block the nasal passages and make it impossible to breathe freely through the nose.

There are many different muscles in the structure of the head and neck that help keep the airways open for air to breathe. When the child falls asleep, the muscle tone is physiologically reduced, thus allowing the tissues to collapse and disrupt breathing.If the respiratory flow is partially blocked (by enlarged tonsils) during wakefulness, then during sleep, the airways may be completely closed to air.

Obesity can also lead to airway obstruction during sleep. While this is the main cause in adults, obesity is less likely to cause sleep apnea in children.

A rare cause of obstructive sleep apnea in children is neoplastic processes or overgrowth of other tissues in the airways. Certain syndromes or birth defects, such as Down syndrome or Pierre Robin syndrome, can also cause obstructive sleep apnea.

What are the symptoms of obstructive sleep apnea in children?

You can point to the most common symptoms of obstructive sleep apnea, but each child may have these symptoms differently.

Sleep apnea symptoms include :

  • Periods of absence (stop) of breathing. In this case, the chest will make an inhale-exhale movement, but air and oxygen do not pass through the mouth and nose into the lungs. The duration of these periods is different and is measured in a few seconds or more.
  • Breathing through the mouth, snoring, just noisy breathing. Nasal breathing can be completely blocked by enlarged adenoids or tonsils. At the same time, the child may have a specific “nasal” voice.
  • Sleep does not give a child adequate rest. This can be both in the presence and in the absence of obvious periods of awakening during the period of night sleep.
  • Increased daytime sleepiness or anxiety. Due to the reduced quality of night sleep, the child has difficulty waking up in the morning, drowsy or heightened during the waking period.
  • Hyperactivity during daytime wakefulness. There may be behavioral problems, schooling problems, or social problems.

Obstructive sleep apnea symptoms may mimic other conditions or medical problems. You should always consult your doctor for an accurate diagnosis.

How is obstructive sleep apnea treated?

The treatment for obstructive sleep apnea will be selected by your physician based on some considerations:

  • child’s age, health status, medical history
  • Causes of airway obstruction
  • the possibility or impossibility of your child’s specific procedures, treatment and examination
  • prognosis of the course of the disease
  • will also take into account your opinion and preferences in the treatment

Treatment for obstructive sleep apnea is based on the underlying cause.Since the most common cause is enlargement of the adenoids and tonsils, treatment is surgical removal. Your otolaryngologist will talk with you about the treatment steps, risks, and need for a particular treatment.

If the cause of the disorder is obesity, the treatment will be less invasive, including weight loss and, in some cases, the use of CPAP therapy (a special mask during sleep to keep the airways open) may be required. This mask creates increased air pressure (CPAP) in the airways.The device for children is not completely adapted and can be difficult for a child to carry, since it is necessary to sleep in a mask.

How is obstructive sleep apnea diagnosed?

See a doctor for testing if your child has noisy breathing while sleeping or snoring becomes noticeable. You may be advised to consult an otolaryngologist.

In addition to the general clinical examination, diagnostic procedures may be recommended:

  • Completing a sleep questionnaire (by parents, possibly with the help of a doctor)
  • examination of the upper respiratory tract by an ENT doctor.
  • – Polysomnography sleep study. It is the best method for diagnosing obstructive sleep apnea, or the gold standard. This test can be performed on a large number of children, however, some of them, especially small ones, may have difficulties due to the lack of cooperation of the child during the study. Two types of studies are possible: polysomnography or cardiorespiratory monitoring (for small children – using a reduced number of electrodes). The child will sleep in a specialized laboratory.A number of parameters will be recorded during the examination:
  • brain activity
  • electrical activity of the heart
  • oxygen content in blood
  • chest and abdominal movements
  • muscle (motor) activity
  • number of respiratory flow through the nose and mouth

During sleep, all episodes of apnea or hypopnea will be recorded:

  • apnea – complete absence of respiratory flow
  • hypopnea – partial decrease in air flow through the upper respiratory tract with a significant decrease in oxygen in the blood

Based on laboratory testing, sleep apnea becomes significant in children if more than 10 episodes occur per night, or one or more episodes every hour.Some experts define problems as significant if a combination of one or more episodes of apnea and / or hypopnea are reported every hour.

Obstructive sleep apnea symptoms may reflect other conditions or medical problems. In any case, consultation with a pediatrician is necessary.

When You Stop Breathing: The Story of a Person with Sleep Apnea

  • Neil Steinberg
  • Mosaic / BBC Future

Photo Credit, Getty Images

Chances are high that you are not aware you have sleep apnea.However, if this happens very often during the night, then your life is in danger.

I thought I was dying. During the day I felt so tired that my knees were shaking. When I was driving, I sometimes caught myself nodding and falling asleep. Exhaustion was written on my face.

At night I slept in fits and starts, with difficulty finding a comfortable position for my legs, I often woke up with a pounding heart, gasping for breath.

My doctor was puzzled. He asked to donate blood and urine and sent me for an electrocardiogram.Perhaps, he suggested, the reason was heart disease, since I had such a rapid heartbeat at night.

But no, my heart was all right. And the blood showed nothing.

Then I was sent for a colonoscopy. All this happened in 2008, and I was then 47 years old – anyway, the right age to have a colonoscopy for the first time.

But the gastroenterologist did not find anything wrong with me either. No tumors. Not even polyps. However, he noticed something.

“When you were under anesthesia,” he said, “at some point you stopped breathing for a while. You need to check – it may be apnea.”

Apnea? I’ve never heard of that.

What is it and what is the threat

It turned out that apnea is an arrest of respiratory movements, in my case – during sleep. Specialists distinguish between obstructive (narrowing of the upper airways during sleep) and central apnea.

When the muscles in the larynx are too relaxed, they can block the airways.During sleep apnea, this can happen all the time, leading to a decrease in the level of oxygen in the blood.

Then you wake up gasping, gasping for air. During the night, this sometimes happens dozens, or even hundreds of times, and the consequences of this for your health can be dire.

Apnea increases the load on the heart, makes it work harder and faster, as it tries to compensate for the lack of oxygen.

Constantly changing oxygen levels in the blood lead to plaque in the arteries, increasing the risk of heart disease, hypertension and stroke.

In the mid-1990s, the US National Sleep Disorders Commission estimated that approximately 38,000 Americans die each year from heart disease aggravated by sleep apnea.

There is growing evidence that apnea affects glucose metabolism, leading to insulin resistance (type 2 diabetes) and weight gain.

Add to this the constant fatigue from lack of sleep, which causes memory problems, anxiety and depression.

A 2015 study of drivers in Sweden found that those with sleep apnea were 2.5 times more likely to have accidents.People with sleep apnea are more likely to skip work and are more likely to be fired.

Photo by Getty Images

Caption,

Sleep apnea means you never get enough sleep

summer period than those who do not have this syndrome.

However, as with smoking, people tend not to associate apnea with such serious health consequences, according to a report commissioned by the American Academy of Sleep Medicine.According to academy estimates, 12% of Americans suffer from sleep apnea, but 80% of them are undiagnosed with the syndrome.

Approximately the same percentage can be transferred to the whole world: as a result, it turns out that about a billion people on the planet suffer from moderate to severe sleep apnea (according to a 2019 study), while not realizing it and not receiving the necessary treatment.

How to deal with it?

I’ll tell you about myself, about my experience.

Risk factors for the development of apnea include obesity, specific body structure (large neck, large tonsils, etc.)or aging, but the problem is that the syndrome does not manifest itself in any way until a person falls asleep.

So the only way to diagnose it is by monitoring sleep. So in early 2009, on the advice of my doctor, I went to the sleep medicine laboratory in Northbrook, Illinois.

Sleep medicine specialist Lisa Shives examined my throat and advised me to undergo polysomnography, a study that monitors breathing, blood oxygen levels, heart rate, muscle and brain activity.

I came back to the laboratory a few weeks later at nine in the evening.

Photo by Getty Images

Caption,

The only way to diagnose sleep apnea is to watch a person sleeping

A lab technician led me into a small room with a bed. The equipment was housed in another room, with a window behind the headboard. I changed and the technician attached electrodes to my chest and head. At about 10 pm I turned off the light and fell asleep pretty quickly.

At half past five in the morning I woke up and was about to make an attempt to fall asleep again, but they told me that I had slept for six hours and the data was enough.

While I was getting dressed, the technician told me that I had severe apnea and that Dr. Shives would tell me the details. After such a message, I refused the planned breakfast and went home, rather frightened.

After a few more weeks, I returned to Northbrook, this time in the afternoon. Shives showed me a black and white video of me sleeping, and it was unpleasant – as if you see a crime scene and yourself killed.

As Shives told me, once my breathing stopped for 112 seconds – almost two minutes.

Normal level of blood oxygen saturation is from 95 to 100%. In patients with acute chronic pulmonary insufficiency, it is usually higher than 80%. I have 69% at the time of apnea.

How dangerous is it? According to the WHO’s handbook for surgeons, if the oxygen level in the patient’s blood drops to 94% or lower, it is necessary to immediately check whether the airways are blocked, whether the lung has failed, and whether there are problems with blood circulation.

I had few options. According to Scheives, I could have undergone uvulopalatopharyngoplasty, the essence of which was even more frightening than the name: it is an operation to remove tissue from the uvula, palate and pharynx – to widen my airways.

The operation is associated with blood loss, and recovery after it is difficult and long. As I understand it, Shives offered it to me only in order to go straight to the second option: the mask.

When sleep apnea was first discovered, the only option that was offered to patients was a tracheostomy – a tube removed through the opening in the windpipe.This brought relief – but also had serious consequences. It is now resorting to tracheostomy only as a last resort. And just ten years ago …

Photo author, Getty Images

Caption to photo,

A 2017 study found that almost 40% of German residents have sleep apnea

“I always snored loudly in my sleep, often woke up out of breath in the middle of the night, “says Angela Kakler of Hot Springs, Arkansas, who was diagnosed with sleep apnea in 2008.

In 2012, she was taken to the hospital with a heart attack and in the morning the doctor said: “We will do you a tracheostomy.”

More than seven years have passed since then – is she used to living with a tube in her throat?

“This is a serious story,” she says. “It requires regular cleaning, it’s like extra work. It’s unpleasant. You don’t breathe like a normal person. Your throat is constantly dry, you need to keep it moist. You are at risk of various infections.”

The main disadvantage for Angela is that she can no longer do her favorite swimming.And she hates it when people look at her with curiosity.

However, her apnea was gone. “I don’t snore, I can breathe normally in my sleep now, I sleep better.”

Photo author, Getty Images

Photo caption,

Although CPAP therapy is now recognized as the gold standard treatment for sleep apnea, many people who tried it were disappointed in it

Would she agree to such an operation again?

“If such a question arose again – yes, of course. It saved my life.”

And then Colin Sullivan, now a professor of medicine at the University of Sydney, invented the CPAP machine, CPAP therapy, which is now considered the gold standard in sleep apnea treatment. The device, which includes a special mask, can be used at home. Today it is used by millions.

But often it doesn’t work

However, it takes a lot of persistence to get a successful result. Although CPAP devices are becoming more and more advanced (for example, data from them can be directly uploaded to the cloud for subsequent analysis), doctors made one unpleasant discovery: this treatment often simply does not work.

Previously, the patient could simply deceive the doctor and say that the mask is great. But now, when the data is collected electronically, when it is immediately visible how long the patient slept in the mask, doctors have found that many simply do not use it or take it off soon after falling asleep, because it is uncomfortable and interferes with sleep, as noted in an article in New York Times in 2012.

Research shows that between a quarter and half of all users stop using CPAP in their first year.

As I did.

The first night I tried the device, I slept well – even with this mask on. This took place in the laboratory, under the supervision of doctors.

But the positive effect of the first night quickly dried up. At home I have not been able to experience the same. The fact is, the first letter “si” in the English abbreviation CPAP means “continuous”, “constant”. The device constantly delivers air, even when you exhale.

You have to deal with this opposite air flow.I woke up breathless.

In addition, I had to sleep in a mask that squeezes my face. Air seeped out from under the mask and dried the eyes, even when they were closed.

Most nights ended with me just pulling off my mask. In the morning I checked the statistics and saw how little I used the device.

Dr. Shives tried to help me by adjusting the supply air pressure, suggested trying other masks. I came to her laboratory several times, but everything was useless.

Finally, Shives said irritably: “You know, if you lose 15 kilograms, the problem will go away by itself.”

Indeed, obesity significantly increases the likelihood of developing sleep apnea. My height is 180 cm, and in 2009 I gained 95 kg (compared to 68, which I had when I graduated from university).

So, at the beginning of 2010, I decided to lose weight – as much as Shives advised. And I almost succeeded: by the end of the year I already weighed 80 kg. I got rid of apnea, and no mask was needed for this.

Photo author, Getty Images

Photo caption,

People with apnea risk going to surgery

However, it turned out that I won the battle, but did not win the war. Ten years later, the kilograms slowly returned to me. And with them the apnea syndrome returned.

I did not realize this until the summer of 2019, when I had a spinal operation. The preoperative questionnaire included questions about whether I snore during sleep, how often I get tired, and whether I have ever been diagnosed with sleep apnea.

As it turned out, sleep apnea poses risks for patients during surgery, can affect the well-being of the outcome and the likelihood of complications.

According to a 2017 German study, obstructive sleep apnea can be experienced by up to 40% of people in Germany, and only 1.8% of hospital patients have it.

The authors of the study believe that this is due to the low level of awareness about the problem – both among patients and medical staff.

After admitting that I was diagnosed with sleep apnea many years ago, I was subjected to extensive research trying to find out how severe I was.

Tests have shown that I have moderate apnea, possibly due to the fact that I still have not fully regained my previous weight.

“Weight loss is healthful,” says Phillip Smith, a professor of sleep apnea and lung disease at Johns Hopkins University School of Medicine. “The problem is that people usually can’t do it.”

And if we add to this that many patients cannot use CPAP therapy, then there are very few ways to get rid of apnea.

In the mid-1990s, for those who can’t stand a mask, they came up with a device that is inserted into the mouth and makes the lower jaw move forward, and with it the tongue [which can block the air flow during apnea] “.

Like CPAP, this device is not an ideal solution, it keeps the jaw in an unnatural position, a person may feel uncomfortable, prolonged use can change the bite … , used since the mid-1990s

However, most of Dr. David Turok’s patients are quite satisfied with the results of this device.According to him, it is suitable for patients with moderate apnea. In severe cases, CPAP therapy is preferable.

“I never offer freedom of choice,” he says. “I always say, try CPAP first.”

According to Turok, those who are intolerant of oral devices and CPAP masks can try surgery to improve the position of the jaw, which is much better than inserting a tube into the windpipe.

“Healing is easier and faster because it is bone,” says Turok.However, this is still an unpleasant operation, during which you have to break the lower jaw in two places.

Another treatment option for sleep apnea is electrical stimulation of the hypoglossal nerve, which causes the tongue to contract and stop falling backwards during sleep.

As stated by Laurence Epstein, Deputy Director of Medical Affairs for Sleep Assistance at Boston Women’s Hospital and recent chair of the American Academy of Sleep Medicine, CPAP therapy is still the gold standard, but in the end the treatment comes down to what is most appropriate for patient option.

“We have very effective methods, but each has its drawbacks,” he says. “What’s good for one patient isn’t necessarily as good for another.”

Photo author, Getty Images

Photo caption,

Researchers hope to create pills to treat sleep apnea – but this is unlikely to happen in the near future

Doctors are pinning their greatest hopes on pills that have not yet been created.

“The future is neurochemistry,” says Professor Smith.- Probably, in 10 years, or even five years, we will be able to treat apnea with medication – after all, this is actually a neurochemical problem, and not, say, a problem of obesity. Fats release certain hormones that cause the airways to close. “

And there are already some successes – for example, in the course of studies, dronabinol, containing a semi-synthetic cannabinoid, reduced the severity of sleep apnea compared to placebo.

According to experts, CPAP fights physical the problem, not the cause.The drug works on the brain and nerves that control the muscles in the upper respiratory tract.

There are other encouraging results: one small, placebo-controlled, international study of two drugs used in a specific combination (atomoxetine and oxybutynin) found that they dramatically reduced apnea by removing at least 50% of the obstructions in breathing during sleep – for all participants.

However, for people like me, those who suffer from apnea now, the wait may be too long.For me, all this means only one thing: a return to the diet and regular visits to a sleep specialist.

What is significant: when in July I tried to get an appointment with this very specialist, I was told that the nearest free window was the end of October.