What is Mars in ancient Rome? Mars, god of war (Rome)

Bronchial asthma (BA) is one of the most common diseases in the world. This pathology affects 5% of the world's population, and two thirds of patients with asthma have nocturnal bronchospasm attacks, which significantly worsens the quality of sleep and, as a result, aggravates the course of the disease. These nocturnal attacks are commonly called nocturnal asthma. It is characterized by a significant decrease in the daily rhythm of bronchial patency during the period of night sleep. Naturally, the provision effective assistance at night presents great difficulties.

The first mention of nocturnal asthma refers to XVII century. Back in 1698 year dr. John Floyer, himself an asthmatic, wrote: “I have noticed that the attack always comes at night... On first awakening, about one or two in the morning, the asthma attack becomes more pronounced, the breathing is slow..., the diaphragm seems stiff and constricted... She can go down with great difficulty.” Despite such a clear description, at least two and a half centuries passed before nocturnal asthma began to receive more attention. At one time there was a dispute between specialists about whether the number was increasing deaths among patients with asthma at night or not. Published combined results from four studies showed that 93 of the 219 deaths occurred between midnight and 8 a.m., which itself still indicates a significant (P< 0,01) учащение смертельных случаев именно в ночное время . Показатель смертности, конечно, выше именно ночью, а не днем и у всего остального населения, но здесь we're talking about only a 5% increase in deaths occurred between midnight and 8 a.m. - in contrast to a 28% increase in the same rate among asthmatic patients. Eight out of ten cases of respiratory arrest in asthmatic patients - already in a hospital setting - also occurred in the early morning.

The forced volume of exhaled air (forced expiratory volume) in 1 second (FEO) and peak flow measurements in patients with asthma drop sharply during the night, and in most patients by more than 50%. Among patients in remission, in approximately one third, bronchospasm occurs only at night, and in another third, it occurs before bedtime and continues throughout the night. Thus, two thirds of such patients have the most low performance bronchial obstruction occurs between 10 pm and 8 am.

Most healthy people There are also daily changes in the caliber of the bronchi with nocturnal bronchospasm. Significant amount studies that compared daily changes in bronchial patency in healthy subjects and in unstable asthmatic patients showed that, although changes in asthmatics and healthy subjects are indeed synchronous, the amplitude of the decrease in bronchial patency in patients suffering from bronchial asthma significantly higher (50%) compared to healthy subjects (8%).

Lack of sleep during the night reduces the degree of nocturnal constriction respiratory tract. The fact that some narrowing of the airways during the night persists, even if the patient is awake all night (for example, during shift work), may be a consequence of changes in the circadian rhythms of each individual person.

Thus, nocturnal bronchospasm in asthma appears to exceed normal level daily changes in the caliber of the bronchi. It is a consequence hypersensitivity to factors causing mild nocturnal bronchospasm in healthy subjects.

Possible, although less likely, causes of nocturnal narrowing of the airways include body position during sleep, interruption of treatment, and the presence of allergens in bedding. On the other hand, body position probably does not affect the width of the bronchial lumen, if only because patients who are in bed around the clock continue to experience bronchospasm attacks mainly in night period. The length of the intervals between taking medications is also not important; Regular use of bronchodilators throughout the day does not lead to the disappearance of nocturnal bronchospasm, and nighttime difficulty breathing is still the subject of complaints of many asthma patients who have not yet undergone treatment. It also seems unlikely that the presence of allergens in bedding is primary cause nocturnal asthma, since their removal, contrary to expectations, does not help get rid of nocturnal bronchospasm. However, it is likely that exposure to household allergens increases the degree of bronchial reactivity in patients with a corresponding predisposition and may thus lead to the onset of nocturnal bronchospasm.

In patients with asthma, bronchospasm can also be caused by cold and dry air. Nocturnal asthma is believed to be associated with inhalation of cooler air at night or with cooling of the bronchial wall as a result of a decrease in body surface temperature during the night. It is unlikely that the temperature and level of humidity of the inhaled air play a fundamental role in this case, since bronchospasm is persistent during the night even in healthy subjects - in cases where the temperature and humidity of the air are maintained at a constant level during the day. However, one study showed that inhaling warmer and more humid air (36-37°C, 100% humidity) during the night compared to room air (23°C, 17-24% humidity) led to the disappearance of nocturnal bronchospasm in six of the seven asthma patients who took part in the study. However, this study was, firstly, small in number, and secondly, it was conducted without polysomnographic control, so it remains unclear how well these patients slept.

The main complaint of patients with nocturnal asthma attacks is that their sleep is disturbed and daytime they often feel tired and sleepy. The fact of this kind of sleep disturbances was confirmed by studies conducted in the EEC countries. Nocturnal bronchospasm attacks are an indicator of the severity of asthma, so diagnosis of such conditions is necessary, for which it is recommended to clarify the daily rhythm of the occurrence of asthma attacks, the number of awakenings during the night, the nature and quality of sleep. For this purpose, patients with asthma, especially with signs of nocturnal asthma, undergo a polysomnographic study. During this study, in real time, during the patient’s night sleep, a simultaneous recording of EEG channels (leads C3/A2 and C4/A1) is carried out; EOG of the left and right eye; EMG from the mental muscles; breathing air flow sensor; thoracic and abdominal respiratory force sensors; taking readings from the microphone (registering snoring) and the body position sensor; ECG (precordial leads); recording pulse and saturation arterial blood oxygen (SaO2). In addition, during a polysomnographic study, patients can detect obstructive sleep apnea syndrome (breathing cessation with a complete cessation of air flow in the respiratory tract for at least 10 seconds), which further aggravates the course. bronchial asthma.

Several groups of researchers recorded the electroencephalogram (EEG) of asthma patients while they slept, paying attention to the stage of sleep during which the patients woke up with asthma attacks. The largest of these studies found that asthma attacks occur during all stages of sleep, with a frequency proportional to the amount of time spent in each stage of sleep. In this sleep laboratory study, patients with asthma were awakened during two nights during dreaming sleep (REM sleep) or slow wave sleep (NREM sleep), followed by peak flow measurements. The results showed that peak flow measurements were lower during awakening from REM sleep than from NREM sleep. However, the difference between these indicators was on average only 200 ml, while the drop in FEO throughout the night was about 800 ml. Expiratory time would increase during bronchospasm and was originally thought to increase during REM sleep in asthmatic patients. Further studies have shown that between the individual stages of sleep, in general, there are no changes in the average peak flow measurements, but at the same time, the duration of exhalation becomes noticeably more variable during REM sleep, which corresponds to the general irregularity of the frequency and depth of breathing at this stage . As in healthy subjects, asthma patients experience a reduction in ventilation as they progress from wakefulness to various stages of sleep; at the same time, the level of ventilation becomes lower during NREM sleep compared to the waking state, and the most low levels are recorded during REM sleep. In addition, recent studies have shown that nocturnal asthma leads to oxygen desaturation during sleep and, accordingly, to chronic hypoxemia.

Thus, nocturnal asthma is primarily a circadian rhythm of changes in the caliber of the bronchi synchronized with sleep.

A study of 30 young people suffering from clinically resistant bronchial asthma was conducted at the University of Delhi to determine the nature of sleep disturbances in this group of patients. The control group was formed from 30 healthy people. The study was conducted using a sleep diary, which subjects had to fill out over the course of a week. The results of the study showed that 90% of patients suffering from bronchial asthma, compared with 27% in the control group, have sleep disturbances. This difference is statistically significant. Another similar study conducted in the United States also showed that asthma attacks, especially at night, lead to sleep disturbances and negatively affect mental and mental health. physical performance.

Nocturnal asthma still presents serious problem for most patients and doctors. Nocturnal bronchospasm is a sign of inadequate asthma treatment; its development requires special monitoring and urgent treatment. Additional treatment nocturnal bronchospasm should be carried out only in cases where, with the help of optimally selected daytime therapy, it is not possible to achieve the disappearance of nocturnal symptoms. For the treatment and prevention of nocturnal asthma, the use of inhaled β-agonists is currently recommended. For example, the drug Serevent (salmeterol), the effect of which lasts more than 12 hours from the moment of inhalation. There is already evidence that salmeterol improves symptoms, nocturnal peak flow measurements, and sleep quality in nocturnal asthma. Formoterol is another long-acting inhalation agent has been shown to improve overnight lung function and the patient's subjective impression of sleep quality.

As for the treatment of sleep disorders that occur in patients with nocturnal asthma, most researchers are inclined to believe that adequate treatment of asthma itself in most cases leads to the disappearance of sleep disorders. In cases where this does not happen, that is, sleep disorders begin to be chronic, it is necessary to select adequate therapy for sleep disorders, which should not affect respiratory function. In particular, non-benzodiazepine drugs may be used during such therapy. sleeping pill Ivadal (zolpidem), the effectiveness and good compatibility with bronchodilators was shown in a study conducted recently in St. Petersburg.

In cases where nocturnal bronchial asthma is accompanied apnea syndrome during sleep, patients need special therapy with continuous positive pressure in the upper respiratory tract, the so-called CPAP therapy, carried out using special equipment.

Our study was carried out on the basis of City Clinical Hospital No. 50 and City Clinical Hospital No. 81 using a computer diagnostic system for polygraphic sleep research - the SAGURA sleep laboratory - SCHLAFLABOR-II.

The study involved 14 patients with asthma - 11 women and three men. middle age of which was 57.4 years. The vast majority of patients had concomitant pathology: 10 - chronic bronchitis, at 8 - arterial hypertension, 4 have IHD, 2 have diabetes mellitus. The severity of the condition was assessed according to clinical data, peak flow measurements, function external respiration and the results of a polysomnographic study. Exacerbation of asthma medium degree severity was detected in 3 patients, 11 patients had a severe exacerbation, and 6 of them were admitted to the intensive care unit upon admission to the hospital. 9 patients had frequent (more than once a week) nocturnal bronchospasm attacks, 3 patients - more than twice a month, 2 patients - less than twice a month. Among the main complaints, 9 patients noted a feeling of suffocation, 8 - coughing attacks, 7 - daytime sleepiness, 7 - a feeling of tension, 6 - frequent awakenings at night. All patients underwent a polysomnographic study in the first 7 days after admission to the hospital.

According to our data, in patients with AD, a decrease in sleep efficiency was revealed to 71.2% (with the norm being 93%), an increase in EEG activation reactions to 84.1 events per hour (with the norm being up to 21) and a decrease in the REM stage of sleep to 13. 24% (with the norm being 20%). In addition, data were obtained that the average SaO2 value in the subjects was equal to 90.6% (with the norm being at least 93%), and saturation decreased to a maximum of 45%, which confirms the data obtained in Western Europe on the presence of chronic hypoxia in this category of patients .

After the first polysomnographic study, conducted during an exacerbation of asthma, patients were prescribed adequate therapy for the underlying disease. Initially, they were administered prednisolone once, intravenously, in a bolus, then for one week the patients took Berodual 15-20 drops four times a day using a nebulizer. In most cases, when the patient's condition normalized, sleep disturbances disappeared. Under the influence of treatment, in 9 patients the feeling of tension disappeared, night awakenings became less frequent, and the daytime sleepiness. According to a polysomnographic study, the duration of the REM stage of sleep increased by an average of 18.5%. In addition, in 7 patients, nighttime O2 saturation increased to an average of 92.5%, that is, almost to the normal level. The remaining 5 patients who continued to have complaints of sleep disturbances upon normalization general condition, the drug Melaxen (melatonin), which is a synthetic analogue of the pineal gland hormone melatonin, was prescribed. The drug was prescribed at a dose of 3 mg once at night for 30 days. After a course of taking the drug, in all patients the period of falling asleep decreased to an average of 15.4 minutes, sleep efficiency increased to 78-85% and the presence of the REM stage of sleep increased to 17.9%. Thus, the drug Melaxen can be considered safe and sufficiently effective means combating sleep disorders in patients with bronchial asthma.

Nocturnal bronchial asthma is a fairly serious problem from both a medical and socio-economic point of view. The search for new methods of diagnosis and treatment of this condition should lead to an improvement in the prognosis of the disease and the quality of life of a large number of patients suffering from this pathology.

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There have been relatively few studies comparing the effectiveness of long-acting inhaled β-agonists with other nocturnal asthma control agents. One such study found no significant difference in effectiveness between salmeterol and oral theophylline, although there were some marginal benefits of salmeterol in terms of frequency of awakenings from sleep and improved quality of life. Another study found that salmeterol, compared with theophylline, caused less deterioration in nighttime lung function and improved subjective sleep quality. Salmeterol also has advantages over oral slow-release terbutaline in terms of the number of nights in which patients sleep well until the morning without awakening, as well as morning peak flow rates and degree determination. clinical effectiveness. Salmeterol at a dose of 50 mg twice a day daily was no less effective in improving the well-being of patients with nocturnal asthma than fluticasone, used at a dose of 250 mg twice a day daily. It seems likely that inhaled long-acting bronchodilators will gradually replace long-acting bronchodilators taken orally, which have more side effects.

* CPAP (short for continuous positive airway pressure) is continuous positive air pressure in the upper respiratory tract, preventing airway obstruction.

R06.0 Dyspnea

Causes of an attack of suffocation at night

In medicine, there are several causes of respiratory failure.

Doctors collected data looking for the relationship between sleep position, onset time and severity of nocturnal asthma attacks in patients with respiratory failure and found that suffocation occurs due to increased pressure in the venous vessels. This is easy to notice in the neck area: the veins in patients become greatly enlarged and swollen.

Symptoms of an attack of suffocation at night

The first signs of an attack of suffocation are pale skin, but the simultaneous presence of a noticeable blush on the face. The nasolabial triangle and fingers may acquire a bluish tint, and a feeling of heaviness appears in the chest area. The patient is frightened and tries to breathe through his mouth, the surface of the skin is covered with cold sweat, and the pulse may increase. A night attack of suffocation necessarily causes circulatory problems. If you listen to the lungs during an attack, it is easy to detect noises and wheezing. At the beginning of the attack, when auscultated, they are found exclusively in the area above the base of the lungs, but later they cover the entire lungs. The spaces between the ribs may noticeably retract as a result of efforts to inhale as much air as possible, and the veins in the neck swell. The consequences and complications of an attack can be very dangerous.

Nocturnal asthma attacks in children

A sudden and unexpected attack of suffocation in a child at night, when he was previously feeling normal, is the main sign stenosis caused by a foreign object that entered the respiratory system. In this case, the adult’s reaction should be immediate: it is necessary to squeeze the sternum to eliminate foreign object, and let the child cough. You can even lift the child by the legs and, by tapping on the back, help with coughing to remove a foreign object from the respiratory tract. An attack of suffocation, accompanied by stenosis of the larynx, also appears as a result of inflammation of various natures - cereal or allergic edema. A child with an inflammatory process usually experiences an attack at night, and with swelling due to allergies - more often during the day.

In addition, suffocation occurs as a result of increased excitability nervous system, due to a lack of calcium salts, birth trauma or infection. In addition, an attack can develop against the background of rickets, impaired functioning of the gastrointestinal tract or cardiovascular system.

Differential diagnosis

Since attacks of suffocation can have a different nature, in order to prevent relapses, it is necessary to contact medical institution, where specialists will conduct diagnostics to prescribe effective treatment. The specialist will conduct differential diagnosis pathologies with other diseases that have similar symptoms, will prescribe tests and instrumental examinations, which will allow you to make an accurate diagnosis.

During an attack of bronchial asthma, the patient experiences a very sharp compression of the bronchial tissues, and production begins large quantity secretion, as a result of which the necessary amount of oxygen does not enter the lungs.

That's why it is important to take such measures of assistance, which will help suppress the production of secretions, relieve strong tension in the bronchial muscles and remove inflammatory processes along with an allergic reaction.

Asthma attack: features

What to do if you don’t have an inhaler?

If for some reason you do not have an inhaler, you need to breathe over the steam and water in which jacket potatoes are boiled. To do this, you need to bend over the pan, after covering your head with a terry towel. This method will promote the opening of the bronchi and.

Helps very well cupping massage. To do this, you need to moisten a cotton wool wrapped around a pencil in alcohol and set it on fire. Burn the can with fire and secure it on your back. Do this until the cans cover the entire area between the shoulder blades. Before the massage, lubricate the back with Vaseline or any nourishing cream. Keep the jars for 1-2 minutes.

You can grate 2 onions on a fine grater and put this mixture on your back.

First aid

1. Be sure to free your neck and chest from tight clothing.
2. Open the window for fresh air.
3. Use an inhaler. If there is no effect, apply it again after 10 minutes.
4. To relieve suffocation, you can take a tablet called Eufillin.
5. It is also necessary to take any antihistamine.
6. Make a hot bath with mustard. For this purpose in hot water Dilute a tablespoon of powder and place your feet in the water. Keep them for 5-7 minutes.
7. You can also add a spoonful of soda to a glass of hot milk and drink this mixture. This will expand the bronchi and facilitate the release of sputum.

Algorithm for providing assistance

Anyone who witnesses a person suffocating on the street should call ambulance. But before her arrival, the person needs to provide first aid. It is divided into the following stages.

1. Be sure to sit the patient on a hard surface or hold him by tilting him forward. This will allow the asthmatic to breathe easier.
2. If the asthmatic has an inhaler with him, spray the medicine into the mouth.
3. If the effect does not occur after 10 minutes, repeat the steps again.
4. Rub the patient's back so that due to rubbing, a rush of blood to the bronchi begins.
5. It is recommended to give validol, corvalol or any other sedative.
6. Rub the asthmatic's hands vigorously so that proper blood flow begins.

The patient must study the symptoms of the onset of an attack in order to reduce suffocation. It is better to use the inhaler in advance to avoid complications. It is also necessary to remember important rule: Always carry all necessary medications with you.

Mars

Mars- one of ancient gods Italy and Rome, was part of the triad of gods who originally headed the Roman pantheon (, Mars and).

In Ancient Italy, Mars was the god of fertility; it was believed that he could either cause the destruction of crops or the death of livestock, or avert them. In his honor, the first month of the Roman year, in which the rite of expelling winter was performed, was named March. Mars was later identified with the Greek Ares and became the god of war. The temple of Mars, already as the god of war, was built on the Field of Mars outside the city walls, since the armed army was not supposed to enter the city territory.

From Mars, the Vestal Rhea Silvia gave birth to twins, and therefore, as the father of Romulus, Mars was considered the ancestor and guardian of Rome.

The symbol of Mars was a spear, which was kept in the home of the Roman king - the regia. There were also twelve shields, one of which, according to legend, fell from the sky during the reign of the king, and therefore was considered a guarantee of the invincibility of the Romans. The remaining eleven shields were made by order of the king as exact copies of the one that fell from the sky, so that enemies could not recognize and steal the original one. Going to war, the commander set his spear and shields in motion, calling on Mars; spontaneous movement was considered an omen of terrible troubles.

The wife of Mars was the insignificant goddess Nerio (Neriene), who was identified with and. They say that one day Mars fell in love with Minerva and turned to the elderly goddess Anna Perenna with a request to act as matchmaker. After some time, she informed him that Minerva agreed to become his wife. When Mars went for the bride and lifted the veil of the goddess presented to him, he discovered that in front of him was not Minerva, but the old woman Anna Perenna. The other gods laughed at this joke for a long time.

The wolf and woodpecker were considered sacred animals of Mars.