Basic treatment of bronchial asthma in adults. Bronchial asthma: differential diagnosis, complications, treatment

Bronchial asthma is a chronic pathology, the development of which can be provoked by various factors, both external and internal. People who have been diagnosed with this disease must undergo a comprehensive course of drug therapy, which will eliminate the accompanying symptoms. Any medicine for bronchial asthma should be prescribed only by a narrow-profile specialist who has undergone a comprehensive diagnosis and identified the cause of the development of this pathology.

The method of treatment of bronchial asthma

Each specialist in the treatment of bronchial asthma uses various drugs, in particular new generation drugs that do not have too serious side effects, are more effective and better tolerated by patients. For each patient, the allergist individually selects a treatment regimen that includes not only asthma pills, but also drugs intended for external use - inhalers.

Experts adhere to the following principles for drug therapy of bronchial asthma:

1. The fastest possible elimination of the accompanying pathological condition of symptoms.
2. Prevention of the development of asthma attacks.
3. Assistance to the patient in the normalization of respiratory functions.
4. Minimizing the number of drugs that need to be taken to normalize the condition.
5. Timely implementation of preventive measures aimed at preventing relapses.

Form of release of drugs

Most asthma medications are used in the form of:

• Aerosols given by inhaler. This method is considered the fastest and most effective, since the active substance is delivered directly to the trachea and bronchi in seconds. There is a local effect, therefore, the impact on other organs and the risk of side effects are significantly reduced. Smaller doses of the drug are used compared to other types. Inhalations are indispensable for stopping an attack of bronchial asthma.
• Tablets and capsules. They are mainly used for long-term systematic treatment of bronchial asthma.

List of medicines for the treatment of bronchial asthma

The entire list of drugs for bronchial asthma can be divided into two large groups:

1. For the relief of an attack of bronchial asthma. Bronchodilators are used. Asthmatic drugs of this group are useless for eliminating the disease, but are indispensable in an attack, instantly relieving life-threatening symptoms.
2. For the treatment of bronchial asthma. Systematic drug therapy of bronchial asthma involves taking medications not only during exacerbations, but also during calm periods. Medicines of this group are useless during an attack, because they act slowly, gradually reducing the sensitivity of the mucous membranes to the action of allergens and infections. Doctors prescribe the following remedies:

• long-acting bronchodilators;
• anti-inflammatory drugs: mast cell membrane stabilizers and hormone-containing (glucocorticosteroids) in difficult cases;
• antileukotriene;
• expectorants and mucolytics;
• new generation.

The names of all drugs are given for informational purposes only! Do not self-medicate.

Basic drugs for bronchial asthma

This group of drugs is used by patients for daily use in order to relieve the symptoms accompanying bronchial asthma and prevent new attacks. Thanks to basic therapy, patients experience significant relief.

Basic preparations that are able to stop inflammatory processes, eliminate puffiness and other allergic manifestations include:

1. Inhalers.
2. Antihistamines.
3. Bronchodilators.
4. Corticosteroids.
5. Antileukotriene drugs.
6. Theophyllines, which have a long therapeutic effect.
7. Cromons.

Medicines are used in combination for a permanent effect on the human body.

Non-hormonal antihistamines or cromones for asthma

Non-hormonal drugs are more harmless than glucocorticosteroid analogues, but their effect can be much weaker.

The cromon group includes:

• Tailed - the active substance is nedocromil sodium;
• Intal is the active substance sodium cromoglycate.

The drugs are used for intermittent and mild bronchial asthma. The reception mode consists in two breaths from 4 to 8 times a day; with significant improvements, the doctor can reduce the number of uses of drugs to two breaths 2 times a day.

Intal is contraindicated for use in cases of Ambroxol and Bromhexin, while Tailed should not be taken by children under 12 years of age.

Hormonal remedies for bronchial asthma

Corticosteroids are a broad group of drugs with anti-inflammatory properties.

According to the mechanism of action, two subgroups of medicines can be distinguished:

1. Drugs involved in the regulation of the processes of proteins, fats and carbohydrates, as well as nucleic acids. The active substances of this subgroup are considered to be cortisol and corticosterone.
2. Means having a mineral composition, which increases the effectiveness of the impact on the processes of water and salt balance. The active substance of the subgroup is considered to be aldosterone.

The active substances of corticosteroid drugs penetrate the membrane apparatus, after which they act on the nuclear structures of cells. One of the most important functions of this series of drugs is an anti-inflammatory effect, which leads to relaxation of smooth muscles in bronchial asthma. By participating in the formation of surfactants (structural components of the surface of the alveoli), corticosteroid drugs prevent the development of atelectasis and collapse.

There are the following forms of drugs:

• inhaled glucocorticosteroid hormones: a large form of drugs with a pronounced anti-inflammatory effect, leading to a decrease in the frequency of asthma attacks; differ in fewer side effects when used than analogues in tablets;
• glucocorticosteroid hormones in tablets: are prescribed if the inhalation form of drugs is ineffective.

Drugs in tablets are taken only in case of a serious condition of the patient.

Inhaled glucocorticosteroid hormones

The group used during bronchial asthma, basic inhaled glucocorticosteroid drugs include:

• Budesonide;
• Pulmicort;
• Benacort;
• beclomethasone dipropionate;
• Klenil;
• Nasobek;
• Backloget;
• Aldecin;
• Becotid;
• Beclazone Eco;
• Beclazone Eco Easy Breath;
• fluticasone propionate;
• Flixotide;
• Flunisolide;
• Ingacourt.

Each drug has an individual mode of use and dosage prescribed by the attending physician, taking into account the patient's condition.

Glucocorticosteroid hormones in tablets

The used glucocorticosteroid preparations, produced in the form of tablets, include:

• Prednisolone;
• Methylprednisolone;
• Metipred.

The use of drugs in the form of tablets does not preclude the continuation of therapy with previous high-dose basic drugs.

Before the appointment of potent glucocorticosteroids, an examination is carried out to identify the cause of the ineffectiveness of previous therapy with inhaled forms of drugs. If the reason for the low efficiency is non-compliance with the recommendations of the doctor and the instructions for the use of inhalations, the elimination of violations of inhalation therapy becomes a paramount task.

Unlike other drugs, hormones in the form of tablets are used in short courses during exacerbations to avoid the development of severe side effects.

Also, in addition to tablets in the systemic treatment of bronchial asthma, suspensions and injections (Hydrocortisone) of drugs are prescribed.

Antileukotriene drugs

With prolonged exposure to aspirin and non-hormonal anti-inflammatory drugs (NSAIDs), a violation of the synthesis of arachidonic acid is possible. Pathology can be acquired or hereditary, however, in both cases, it can lead to the appearance of severe bronchospasm and the aspirin form of bronchial asthma.

Each drug has a number of individual properties, depending on the composition of the drug, the mechanism of action and inhibited proteins.

• Zileuton - a remedy that inhibits the synthesis of oxygenases and sulfide peptides, prevents spasmodic attacks when consuming aspirin-containing drugs or inhaling cool air, eliminates shortness of breath, cough, signs of wheezing and pain in the chest area;
• Accolate - has a pronounced anti-edematous effect, reducing the risk of narrowing of the gaps in the bronchi;
• Montekulast - a selective receptor blocker, the main function of which is to stop spasms in the bronchi, is highly effective when combined with glucocorticosteroids and dilators;
• Accolate - a drug in tablets, the active substance of which is zafirlukast, improves the functions of external respiration and the general condition of the patient;
• Singulair is a drug that includes the active substance montelukast to provide anti-lecotriene action and reduce the frequency of seizures.

In most cases of modern treatment, leukotriene antagonists are used to improve the condition of aspirin-induced bronchial asthma.

Symptomatic drug treatment

In addition to the basic measures for the treatment of bronchial asthma in case of exacerbation, it is necessary to take medications to eliminate the accompanying symptoms of the pathology - bronchodilators. Bronchodilators - drugs that increase the gaps in the bronchi and alleviate the condition during attacks of bronchial asthma.

Long-acting bronchodilators or β-agonists

Drugs that have the ability to have a long-term effect when expanding the gaps in the bronchi are called β-agonists.

The group includes the following drugs:

• containing the active substance formoterol: Oxys, Atimos, Foradil;
• containing the active substance salmeterol: Serevent, Salmeter.

The drugs are used strictly according to the instructions.

Short-acting bronchodilators of the β2-agonist group

Beta-2-adrenergic agonists are aerosol preparations that begin to act against signs of suffocation 5 minutes after application. The drugs are available in the form of aerosols, however, for a more effective treatment of bronchial asthma, experts recommend using an inhalation device - a nebulizer to eliminate the shortcomings of the main technique associated with the deposition of up to 40% of the drug in the nasal cavity.

For bronchial asthma medications are used:

• containing the active substance fenoterol: Berotek, Berotek N;
• Salbutamol;
• Ventolin;
• containing the active substance terbutaline: Bricanil, Ironil SEDICO.

A group of medicines is used in case of insufficient action of basic therapy for the rapid elimination of seizures.

In case of intolerance to beta-2-agonists, it is possible to use anticholinergics, an example of which is Atrovent. Atrovent is also used in combination with the β2-agonist Berotek.

Bronchodilators of the xanthine group

A group of xanthines are asthma drugs that have been widely used since the beginning of the 20th century.

For the treatment of severe asthma attacks with the ineffectiveness of basic drugs, the following are used:

• Theophylline (Teopec, Theotard, Ventax);
• Eufillin;
• Theophylline and Ethylenediamine (Aminophylline);
• Bamifillin and Elixofellin.

Medicines containing xanthines act on the muscles that line the airways, leading to relaxation and stopping an asthma attack.

Anticholinergics

Anticholinergics are a group of drugs that help relax the structures of smooth muscle tissues during coughing attacks. Also, drugs relax the muscles of the intestines and other organ systems, which allows them to be used in the treatment of many serious diseases.

For the treatment of bronchial asthma are used:

• Atropine sulfate;
• Quaternary ammonium (non-adsorbable).

Medicines have a number of contraindications and side effects, which is why their appointment is determined only by the attending physician.

Antibiotics and mucolytics

To eliminate stagnation of sputum masses, restore breathing and reduce the severity of shortness of breath, mucolytic agents are used:

• Lazolvan;
• Ambrobene;
• Ambroxol;
• Mukolvan.

Means are issued in different forms, including for injection.

In case of exacerbation of bronchial asthma against the background of the development of a viral or bacterial infection, it is also necessary to use antiviral, antibacterial and antipyretic agents, however, the use of penicillins or sulfonamides is prohibited for asthmatics.

To combat infection, patients with bronchial asthma should use a number of antibiotics:

• cephalosporins;
• macrolides;
• fluoroquinolones.

The intake of any additional drug should be discussed with the attending physician in a timely manner.

Combination of several means

The correct combination of therapeutic agents during the treatment of bronchial asthma is one of the most important steps on the way to improving the condition. Medicines affect the complex biochemical processes of the body, which is why the combination of medicines must be treated very carefully.

Therapeutic schemes for improving the general condition in a stepwise manner:

1. First stage: the stage at which weak attacks of an irregular nature are observed. At this stage, systemic treatment will not be applied, but drugs of the base complex from the group of non-hormonal aerosols are used.
2. The second stage: the number of asthma attacks up to several per month, mild course of the disease. As a rule, the doctor prescribes the use of drugs of a number of cromones and short-acting adrenomimetics.
3. The third stage: the course of bronchial asthma is characterized as moderate. Comprehensive and preventive treatment includes the use of corticosteroid drugs and dilators with prolonged properties.
4. Fourth stage: due to severe manifestations of bronchial asthma, it is necessary to use a combination of several groups of drugs. Medications, regimen and dosage are prescribed by the attending physician.

Bronchial asthma can change its course, precisely because of this, during the period of treatment, it is required to regularly undergo an examination by a specialist to identify the effectiveness of the drugs used and changes in the condition. Subject to the recommendations of the doctor and instructions for taking medications, the prognosis of treatment is most often favorable.

Evaluation of the effectiveness of the use of drugs

It is important to remember that the use of basic drugs does not lead to a complete cure for bronchial asthma. The goals of the main course of drugs include:

• diagnosis and prevention of frequent seizures;
• improvement of external respiration;
• reducing the need to use a situational group of short-acting drugs.

The dosage and the list of necessary drugs may change during a person's life based on the general condition of the patient and the recommendations of the attending physician.

During the evaluation of the effectiveness of treatment, which is carried out every 3 months, changes are detected:

• patient complaints;
• frequency of visits to the doctor;
• frequency of emergency calls;
• daily activity;
• frequency of use of symptomatic drugs;
• state of external respiration;
• the severity of side effects after the use of drugs.

In case of insufficient effectiveness of drugs or severe side effects, the attending physician may prescribe other basic course medications or change the dosage. Also, the specialist reveals the compliance with the medication regimen, since if the recommendations are violated, the therapy may turn out to be ineffective.

Conclusion

Nowadays, drug treatment of bronchial asthma has acquired a certain structure. Rational pharmacotherapy of bronchial asthma consists in treating the disease depending on the stage of the disease, which is determined during the examination of the patient. The new standards of such treatment suggest fairly clear algorithms for prescribing asthmatics of various groups of drugs. Despite the fact that stage IV or even V asthma is often found among adult patients, it is usually possible to alleviate the patient's condition.

Almost all of the adult patients are eligible for sickness benefits. The composition of these benefits is determined by the relevant laws. It is important that patients can receive free medicines. What drugs you can get, you need to find out from your doctor, because usually medicines are issued on the basis of a medical institution.

Basic therapy of bronchial asthma is the beginning of all treatment for this disease. Pathology is characterized by the formation of chronic inflammation, which involves eosinophils and mast cells in the process.

If the patient is prone to negative symptoms, the formation of airway obstruction is acceptable, which is quite often reversible due to drug therapy or suddenly. This may be accompanied by hyperreactivity of the respiratory system in relation to internal and external manifestations. Clinical options for the basic therapy of bronchial asthma, the treatment of which can be carried out both at home and in a hospital, lie in compliance with the drug regimen.

What is the purpose of such therapy?

The control strategy and implementation of disease monitoring includes the following tasks, which make it possible to fairly assess the level of severity of asthma. Recommendations for the basic in adults will be as follows:

• assessment of the performance of the bronchopulmonary system;
• symptom control;
• elimination of possible secondary manifestations in the treatment of asthma;
• reduction and elimination of mortality from asthmatic attack;
• teaching the patient how to perform self-help in an emergency;
• control of initiating causes, as well as prevention of contacts, which are triggers for the formation of an asthmatic attack;
• the choice of the necessary medical therapy during the period of exacerbation of an asthmatic attack and during remission;
• in addition, a significant role is given to careful supervision of the patient's action and his response to drug therapy.

All of the problems listed above are considered the main ones in the treatment of asthmatic diseases. Each, except for the intermittent mild form, is controlled by pharmaceutical substances, which cannot be achieved with the acute development of the pathology that is associated with it.

Diagnostics

The diagnosis, as a rule, is established by a pulmonologist on the basis of complaints and the presence of characteristic symptoms. All other methods of examination are focused on establishing the level of severity and etiology of the disease.

Spirometry. Helps to assess the level of bronchial obstruction, to know the variability and convertibility of obstruction, and to assure the diagnosis. In BA, accelerated expiration after inhalation with a bronchodilator increases by 12% (200 ml) and more in one second. However, to obtain clearer data, spirometry must be done a couple of times.

peak flowmetry, or the determination of the maximum expiratory flow rate (PSV), makes it possible to monitor the patient's condition, comparing the characteristics with those acquired before. An increase in PSV already after inhalation by 20% or more from PSV before inhalation clearly indicates the presence of bronchial asthma.

Additional diagnostics include performing tests with allergens, assessment of blood gases, ECG, bronchoscopy and x-rays of the lungs.

Laboratory blood tests play a huge role in proving the allergic nature of asthma, as well as in predicting the effectiveness of a cure.

• Ordinary blood test. Eosinophilia and a slight increase in ESR during an exacerbation.
• Simple sputum analysis (sputum). With microscopy in sputum, it is possible to identify a huge number of eosinophils, Charcot-Leiden crystals (shining colorless crystals that appear after the destruction of eosinophils and have the shape of rhombuses or octahedrons), Kurshman's spirals (arise due to small convulsive contractions of the bronchi and look like casts of colorless mucus in spiral shape).

Intermediate leukocytes can be detected in patients in the stage of an intense inflammatory process.

It has also been established that Creole bodies are accentuated during an attack - these are rounded formations consisting of epithelial cells. A biochemical blood test is not considered the main diagnostic method, since the changes are of a general nature and similar examinations are prescribed to predict the patient's condition during an exacerbation. It is necessary to conduct a thorough diagnosis of the immune status. In this disease, the number and dynamism of T-suppressors rapidly decreases, and the number of immunoglobulins in the blood increases. The use of tests to determine the amount of immunoglobulins E is important if there are no opportunities to carry out allergological studies.

After all the manipulations, you can start therapy. Treatment in the basic therapy of bronchial asthma includes several groups of drugs. The most common of these are listed below.

Glucocorticosteroids

The main means of basic therapy for bronchial asthma are glucocorticosteroids. The therapeutic effect of pharmaceuticals is primarily due to the likelihood of increasing the production of adrenoreceptors with their help, which can stop the negative effect of allergens. In addition, corticosteroids remove all external manifestations of the disease, namely swelling. The difference between these substances and systemic ones is their anti-inflammatory result and the minimum number of secondary manifestations. The medication is dosed based on the severity of the disease and the general condition of the patient.

Systemic glucocorticosteroids

These substances are administered orally or by infusion in case of a complicated disease process in a small dose (according to a predetermined scheme), since they have impressive side effects. It is desirable to administer these pharmaceutical preparations intravenously. Such necessary drugs are prescribed when other methods of treatment are ineffective.

Mast cell stabilizers

These drugs have a special quality that prevents the degranulation progress of mast cells, release histamine elements. Stabilizers have the ability to restrain acute and prolonged bronchospastic responses to allergen attack. In addition, these substances reduce bronchial dynamism during inhalation and exhalation of air in the cold season, significantly reducing the frequency and duration of seizures. It should not be forgotten that therapy with these drugs should be short-lived, as they can provoke side effects.

Leukotriene antagonists

Such substances significantly reduce the need for the use of fast acting adrenomimetics. They belong to the newest generation of anti-asthma and anti-inflammatory substances used in the prevention of bronchospasm.

Basic therapy in the treatment of children

The main principle of the basic in children is the achievement of a lasting remission and an increase in the quality of life.

The use of basic therapy is determined by the relevant aspects:

• the frequency of bronchial symptoms (less than twice during the week);
• frequency of night attacks;
• limitation of daily energy;
• the need for emergency treatment;
• the possibility of exacerbations;
• normalization of respiratory activity.

Pharmacotherapy is considered an obligatory component in the treatment of bronchial diseases in a child. Significant progress in the treatment of asthmatic diseases in a child can be achieved with the use of basic substances designed to eliminate inflammation in the lungs and bronchi.

It should be noted that anti-inflammatory substances used as part of basic therapy should be used not only during an exacerbation of the disease, but also during remission as an exacerbation prophylaxis, which confirms the need for long-term treatment.

Mild medical treatment

When providing urgent assistance during a simple asthmatic attack, drugs are prescribed for inhalation in the basic therapy of bronchial asthma in children. These pharmaceutical products are best suited for a child older than three years who has not responded to other bronchodilators.

For the younger age group, the use of Atrovent or Berodual is recommended, but only under medical supervision. These aerosols have a significant degree of protection and can be used during a nocturnal asthma attack. For a young child, the use of metered-dose inhalers with a spacer or nebulizer is recommended. If the selected dose of the therapeutic drug is ineffective, it is recommended to combine bronchodilators with agonists, as well as increase the dose of ICS after consultation with the attending physician.

Depending on the severity of asthma for a child from a year old, Fluticasone Propionate can be prescribed in inhalations at least twice a day. With a mild course of the disease, basic treatment should be carried out every 4-7 hours for 1-2 days.

Medical treatment of moderate disease

With a given degree of asthma in a child, it is advisable to prescribe combined preparations for the basic therapy of bronchial asthma, bronchospasmolytics in the form of a spray ("Berodual"). If inhalation therapy is not feasible, intravenous administration of a 2.4% solution of "Euphyllin" is recommended, which is diluted with an isotonic sodium chloride solution (in the proportion proposed by the doctor).

Intramuscular, inhalation and anal (candles) administration of "Euphyllin" in a child at this stage of the disease is not used.

After assessing the condition of the children (after 20 minutes), permission is taken to start treatment with special preparations every 4 hours with a further transfer of the patient to fast-acting aerosols and long-acting bronchodilators.

Basic anti-inflammatory treatment in a child continues with the use of more serious drugs with a gradual increase in dose by 2 times during the week. In addition, it is recommended to use the anti-inflammatory drug "Ditek".

With a very serious degree of formation of bronchial asthma, emergency hospitalization of children in the intensive care unit with treatment in a hospital setting is necessary. At present, the generally accepted approach for treatment is a “stepwise” approach, when the reduction or increase in the size of the therapeutic intervention depends on the severity of the symptoms of the disease.

Working with patients with pathology

An important role is played by direct contact with an asthmatic. A positive effect is established if, in addition to a kind of therapy for this disease, the patient has additional data on the etiology of his own disease, the mechanism of its formation and possible complications.

For this, it is recommended to carry out small conversations with the patient, explaining the essence of the manipulations and the favorable result from their use. This makes it possible to emotionally set him up for a positive attitude towards the cure, which is important for obtaining a good result.

This aspect in the treatment of bronchopulmonary diseases is very significant for the parents of a child suffering from asthma, since children cannot make the necessary decisions without the help of others. Only an adult can help them, who must understand how to calm the baby and teach him how to use the inhaler on his own in case of emergency.

Prevention

There are three types of disease prevention:

1. Primary prevention focuses on groups of healthy people. Prevention is to prevent the transition of respiratory pathologies into chronic forms (for example, chronic bronchitis), as well as to prevent allergic reactions.
2. Secondary prevention includes measures to prevent the formation of the disease in sensitized individuals or in patients during pre-asthma, but not yet suffering from asthma. These are individuals who have allergic diseases, people with a tendency to asthma (for example, there are relatives with asthma) or people whose sensitivity has been proven using immunological methods of study.
3. Tertiary prevention is focused on reducing the severity of the course and preventing exacerbations of the disease in patients with this disease. The main method of prevention is to exclude the patient's contact with the allergen that causes an attack (elimination regimen).

An important role in the cure is given to visiting sanatoriums. Sanatorium-resort therapy has a favorable post-resort effect on patients. In international practice, significant experience has been accumulated in effective treatment at climatic resorts. The effectiveness of spa treatment depends on the correct selection of the resort. The attending doctor will undoubtedly help in selecting a suitable resort area for rehabilitation, who will find a sanatorium for the patient with the possibility of treating major and concomitant diseases.

Bronchial asthma is a disease that doctors are increasingly faced with in recent years. This is not surprising, because, according to international studies, in the developed countries of the world, about 5% of the adult population and almost 10% of children suffer from this disease. In addition, in recent decades there has been a clear upward trend in the incidence of allergic diseases, including bronchial asthma.

It is this circumstance that caused the appearance in recent years of a number of policy documents, guidelines on the diagnosis and treatment of bronchial asthma. Such fundamental documents are the Joint Report of the WHO and the National Heart, Lung, and Blood Institute (USA) “Bronchial Asthma. Global Strategy (GINA)”, 1996 and “Bronchial Asthma (Formulary System). A guide for doctors in Russia", 1999. These guidelines are intended for practitioners and serve one purpose - the formation of a unified concept of bronchial asthma, its diagnosis and treatment.

In turn, modern therapy of bronchial asthma is based on the above concept, on the basis of which the form and severity of the disease are determined.

According to modern concepts, bronchial asthma, regardless of the severity of its course, is a chronic inflammatory disease of the respiratory tract, in the formation of which many cells are involved: mast cells, eosinophils and T-lymphocytes. When predisposed, this inflammation leads to repeated episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and/or early morning. These symptoms are usually accompanied by widespread but variable bronchial obstruction that is at least partially reversible spontaneously or with treatment. Inflammation leads to the formation of increased sensitivity of the respiratory tract to a variety of stimuli, which do not cause any reaction in healthy individuals. This condition is bronchial hyperreactivity, which can be specific and nonspecific. Specific hyperreactivity is an increased sensitivity of the bronchi to certain, specific allergens that caused the development of asthma. Nonspecific hyperreactivity is understood as hypersensitivity to a variety of non-specific stimuli of a non-allergenic nature: cold air, physical activity, strong odors, stress, etc. One of the important signs of hyperreactivity used to assess the severity of bronchial asthma is the daily variability of peak expiratory flow component of 20% or more.

Allergic mechanisms cause the development of asthma in 80% of children and approximately 40-50% of adults, so the European Academy of Allergology and Clinical Immunology (EAACI) suggests using the term "allergic asthma" as the main definition of asthma due to an immunological mechanism, and in those cases when the involvement of immunoglobulin E class antibodies in this mechanism is proven, hence the term "IgE-mediated asthma". In our country, the term "atopic asthma" is used to refer to this variant. The definition fully reflects the essence of the process in which IgE antibodies take part. Other non-immunological types of asthma EAACI are proposed to be called non-allergic asthma. Apparently, this form can be attributed to asthma, which develops due to a violation of the metabolism of arachidonic acid, endocrine and neuropsychiatric disorders, disturbances in the receptor and electrolyte balances of the respiratory tract, exposure to non-allergenic aeropollutants and occupational factors.

Establishing the form of bronchial asthma is of fundamental importance for its therapy, because the treatment of any allergic disease begins with measures to eliminate the allergen (or allergens) responsible for the development of the disease. It is possible to completely remove the allergen, if it is a pet, food or drug, and only through this to achieve remission of bronchial asthma. But more often, the development of asthma is provoked by a house dust mite, which cannot be completely removed. However, the number of dust mites can be significantly reduced by using special allergenic bedding and acaricidal products, carrying out regular wet cleaning with a vacuum cleaner with a deep degree. All these measures, as well as measures to reduce the pollen content in indoor air during the flowering season and measures to minimize contact with spores of indoor and outdoor non-pathogenic mold fungi, lead to a significant reduction in asthma symptoms in patients sensitive to these allergens.

Pharmacotherapy is an integral and essential component of a comprehensive treatment program for bronchial asthma. There are several key provisions in the treatment of bronchial asthma:

• asthma can be effectively controlled in most patients but cannot be cured;
• the inhalation method of administering drugs for asthma is the most preferable and effective;
• basic asthma therapy involves the use of anti-inflammatory drugs, in particular inhaled glucocorticosteroids, which are currently the most effective drugs that control asthma;
• bronchodilators (β 2 -agonists, xanthines, anticholinergics) are emergency drugs that relieve bronchospasm.

So, all drugs that are used to treat bronchial asthma are usually divided into two groups: basic or therapeutic, that is, with an anti-inflammatory effect, and symptomatic, with predominantly rapid bronchodilator activity. However, in recent years, a new group of anti-asthma drugs has appeared on the pharmacological market, which are a combination of anti-inflammatory and bronchodilator drugs.

The basic anti-inflammatory drugs include glucocorticosteroids, mast cell stabilizers - cromones and leukotriene inhibitors.

Inhaled glucocorticosteroids (beclomethasone dipropionate, fluticasone propionate, budesonide, flunisolide) are currently the drugs of choice for the treatment of moderate to severe asthma. Moreover, according to international recommendations, inhaled glucocorticosteroids (IGCS) are indicated for all patients with persistent asthma, including those with mild course, because even with this form of asthma, all elements of chronic allergic inflammation are present in the respiratory mucosa. Unlike systemic steroids, which, in turn, are the drug of choice for acute severe asthma, ICS do not have severe systemic side effects that pose a threat to the patient. Only in high daily doses (above 1000 mcg) can they inhibit the function of the adrenal cortex. The multifactorial anti-inflammatory effect of inhaled glucocorticosteroids is manifested in their ability to reduce or even completely eliminate bronchial hyperreactivity, restore and increase the sensitivity of β 2 -adrenergic receptors to catecholamines, including β 2 -agonists. It has been proven that the anti-inflammatory efficacy of ICS is dose-dependent, so it is advisable to start treatment with medium and high doses (depending on the severity of asthma). Upon reaching a stable state of patients (but not earlier than 1-3 months from the start of IGCS therapy) and improvement in respiratory function, the dose of IGCS can be reduced, but not canceled! In the event of worsening asthma and a decrease in lung function, the dose of ICS should be increased. The occurrence of such harmless, but undesirable side effects of ICS, such as oral candidiasis, dysphonia, irritating cough, can be avoided through the use of spacers, as well as rinsing the mouth and throat with a weak solution of soda or just warm water after each inhalation of the drug.

Sodium cromoglycate and nedocromil sodium (cromones) inhibit the release of mediators from the mast cell by stabilizing its membrane. These drugs, given before exposure to an allergen, can suppress early and late allergic reactions. Their anti-inflammatory effect is significantly inferior to that of ICS. A decrease in bronchial hyperreactivity occurs only after long-term (at least 12 weeks) treatment with cromones. However, the advantage of cromons is their safety. These drugs have virtually no side effects and are therefore successfully used to treat childhood asthma and asthma in adolescents. Mild atopic asthma in adults is sometimes also well controlled with cromoglycate or nedocromil sodium.

Antileukotriene drugs, including cysteinyl (leukotriene) receptor antagonists and inhibitors of leukotriene synthesis, are a relatively new group of anti-inflammatory drugs used to treat asthma. Zafirlukast (acolate) and montelukast (singular) drugs, leukotriene receptor blockers, presented in a form for oral use, are currently registered and approved for use in Russia. The anti-inflammatory effect of these drugs is to block the action of leukotrienes - fatty acids, decay products of arachidonic acid involved in the formation of bronchial obstruction. In recent years, many works have appeared devoted to the study of the clinical efficacy of antileukotriene drugs in various forms and varying degrees of severity of bronchial asthma. These drugs are effective in the treatment of patients with the aspirin form of bronchial asthma, in which leukotrienes are the main mediators of inflammation and the formation of bronchial obstruction. They effectively control exercise and nocturnal asthma, as well as intermittent asthma caused by allergen exposure. Particular attention is paid to the study of antileukotriene drugs used in the treatment of childhood asthma, as they are convenient to use and cause a relatively low risk of serious side effects compared to ICS. In recent US guidelines for the diagnosis and treatment of asthma, leukotriene receptor antagonists are considered as an alternative to ICS for the control of mild, persistent asthma in children 6 years of age and older, as well as in adults. However, there are now many studies demonstrating the effectiveness of these drugs in people with moderate to severe asthma who are prescribed leukotriene receptor antagonists as an adjunct to ICS. This combination of drugs that potentiate the action of each other enhances anti-asthma therapy and avoids increasing the dose of ICS in some patients, and sometimes even reducing it.

Thus, new anti-asthma drugs - leukotriene receptor antagonists can be used for anti-inflammatory (basic) asthma therapy in the following situations:

• mild, persistent asthma;
• childhood asthma;
• exercise asthma;
• aspirin asthma;
• nocturnal asthma;
• acute allergen-induced asthma;
• moderate and severe asthma;
• GKS-phobia;
• asthma, which is poorly controlled by safe doses of corticosteroids;
• treating patients who have difficulty using an inhaler;
• treatment of patients diagnosed with asthma in combination with allergic rhinitis.

Bronchodilator drugs are used both for the relief of an acute asthma attack in its chronic course, and for the prevention of exercise-induced asthma, acute asthma induced by an allergen, and also for relieving severe bronchospasm during exacerbation of bronchial asthma.

Key points in bronchodilator therapy of bronchial asthma:

• Short-acting β 2 -agonists are the most effective bronchodilators;
• inhaled forms of bronchodilators are preferred over oral and parenteral forms.

Selective β 2 -agonists of the first generation: albuterol (salbutamol, ventolin), terbutaline (bricanil), fenoterol (berotek) and others are the most effective bronchodilators. They are able to quickly (within 3-5 minutes) and for a fairly long time (up to 4-5 hours) have a bronchodilator effect after inhalation in the form of a metered aerosol for mild and moderate asthma attacks, and when using solutions of these drugs through a nebulizer - and when severe attacks in case of exacerbation of asthma. However, short-acting β 2 -agonists should only be used to relieve an asthma attack. They are not recommended for permanent, basic therapy, as they are not able to reduce airway inflammation and bronchial hyperreactivity. Moreover, with their constant and long-term intake, the degree of bronchial hyperreactivity may increase, and indicators of respiratory function may worsen. These shortcomings are deprived of β 2 -agonists of the second generation, or β 2 -agonists of long action: salmeterol and formoterol. Due to the lipophilicity of their molecules, these drugs are very close to β 2 -adrenergic receptors, which primarily determines the duration of their bronchodilator action - up to 12 hours after inhalation of 50 μg or 100 μg of salmeterol and 6 μg, 12 μg or 24 μg of formoterol. At the same time, formoterol, in addition to a long-term effect, simultaneously has a rapid bronchodilatory effect, comparable to the time of onset of the action of salbutamol. All drugs β 2 -agonists have the ability to inhibit the release of mediators of allergic inflammation, such as histamine, prostaglandins and leukotrienes, from mast cells, eosinophils, and this property is most pronounced in long-acting β 2 -agonists. In addition, the latter have the ability to reduce the permeability of the capillaries of the mucous membrane of the bronchial tree. All this allows us to speak about the anti-inflammatory effect of long-acting β2-agonists. They are able to suppress both early and late asthmatic reactions that occur after inhalation of the allergen, and reduce bronchial reactivity. These drugs are the drug of choice for mild to moderate asthma and in patients with nocturnal asthma symptoms; they can also be used to prevent exercise-induced asthma. In patients with moderate to severe asthma, it is advisable to combine them with ICS.

Theophyllines are the main type of methylxanthines used in the treatment of asthma. Theophyllines have bronchodilator and anti-inflammatory effects. By blocking the enzyme phosphodiesterase, theophylline stabilizes cAMP and reduces the concentration of intracellular calcium in the smooth muscle cells of the bronchi (and other internal organs), mast cells, T-lymphocytes, eosinophils, neutrophils, macrophages, endothelial cells. As a result, relaxation of the smooth muscles of the bronchi, suppression of the release of mediators from inflammatory cells and a decrease in increased vascular permeability occur. Theophylline significantly suppresses both the early and late phases of the asthmatic response. Long-acting theophyllines have been successfully used to control nocturnal asthmatic manifestations. However, the effectiveness of theophylline in acute asthma attacks is inferior (both in terms of the onset of the effect and in its severity) to β 2 -agonists used by inhalation, especially through a nebulizer. Therefore, intravenous administration of aminophylline should be considered as a backup measure for those patients with acute severe asthma for whom the intake of β 2 -agonists through a nebulizer is not effective enough. This limitation is also due to the high risk of adverse reactions to theophylline (cardiovascular and gastrointestinal disorders, CNS excitation), developing, as a rule, when the concentration of 15 μg / ml in peripheral blood is exceeded. Therefore, long-term use of theophylline requires monitoring of its concentration in the blood.

Anticholinergic drugs (ipratropium bromide and oxitropium bromide) have a bronchodilator effect due to the blockade of M-cholinergic receptors and a decrease in the tone of the vagus nerve. In Russia, one of these drugs, ipratropium bromide (Atrovent), has long been registered and successfully used. Anticholinergic drugs are inferior to β 2 -agonists in strength and speed of onset of effect, their bronchodilator effect develops 30-40 minutes after inhalation. However, their combined use with β 2 -agonists, mutually reinforcing the effect of these drugs, has a pronounced bronchodilator effect, especially in moderate and severe asthma, as well as in patients with asthma and concomitant chronic obstructive bronchitis. Such combined preparations containing ipratropium bromide and a short-acting β 2 -agonist are berodual (contains fenoterol) and combivent (contains salbutamol).

A fundamentally new step in the modern pharmacotherapy of bronchial asthma is the creation of combined drugs with a pronounced anti-inflammatory and long-term bronchodilator effect. This is a combination of inhaled corticosteroids and long-acting β 2 -agonists. Today, on the pharmacological market in Europe, including Russia, there are two such drugs: seretide, containing fluticasone propionate and salmeterol, and symbicort, which contains budesonide and formoterol. It turned out that in such compounds, the corticosteroid and prolonged β 2 -agonist have a complementary effect and their clinical effect significantly exceeds that in the case of monotherapy with ICS or long-acting β 2 -agonist. The appointment of such a combination can serve as an alternative to increasing the dose of ICS in patients with moderate and severe asthma. Long-acting β 2 -agonists and corticosteroids interact at the molecular level. Corticosteroids increase the synthesis of β 2 -adrenergic receptors in the bronchial mucosa, reduce their desensitization and, on the contrary, increase the sensitivity of these receptors to the action of β 2 -agonists. On the other hand, prolonged β 2 -agonists stimulate the inactive glucocorticoid receptor, which as a result becomes more sensitive to the action of inhaled glucocorticosteroids. Simultaneous use of ICS and a prolonged β 2 -agonist not only alleviates the course of asthma, but also significantly improves functional performance, reduces the need for short-acting β 2 -agonists, and significantly more effectively prevents asthma exacerbations compared to ICS therapy alone.

The undoubted advantage of these drugs, which is especially attractive to asthmatic patients, is the combination of two active substances in one inhalation device: a metered-dose aerosol inhaler (Seretide PDI) or powder inhaler (Seretide Multidisk) and a turbuhaler containing drugs in the form of powder (Symbicort Turbuhaler) . The preparations have a convenient double dosing regimen; for Symbicort, a single dose is also possible. Seretide is available in forms containing various doses of ICS: 100, 250 or 500 micrograms of fluticasone propionate with a constant dose of salmeterol - 50 micrograms. Symbicort is available in a dosage of 160 micrograms of budesonide and 4.5 micrograms of formoterol. Symbicort can be administered 1 to 4 times a day, which allows you to control the variable course of asthma using the same inhaler, reducing the dose of the drug when adequate asthma control is achieved and increasing it when symptoms worsen. This circumstance allows you to choose adequate therapy, taking into account the severity of asthma for each individual patient. In addition, Symbicort, due to the fast-acting formoterol, quickly alleviates the symptoms of asthma. This leads to an increase in adherence to therapy: seeing that the treatment helps quickly and effectively, the patient is more willing to comply with the doctor's prescription. It should be remembered that combined drugs (IGCS + long-acting β 2 -agonists) should not be used to relieve an acute asthma attack. For this purpose, short-acting β 2 -agonists are recommended for patients.

Thus, the use of combined preparations of inhaled corticosteroids and long-acting β 2 -agonists is advisable in all cases of persistent asthma, when it is not possible to achieve good control over the disease only by prescribing inhaled corticosteroids. The criteria for well-controlled asthma are no nocturnal symptoms, good exercise tolerance, no need for emergency care, daily need for bronchodilators less than 2 doses, peak expiratory flow greater than 80% and its daily fluctuation less than 20%, and the absence of side effects from ongoing therapy.

Of course, it is advisable to start treatment with inhaled corticosteroids with a combination of them with salmeterol or formoterol, which will achieve a rapid clinical effect and make patients believe in the success of treatment.

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To date, many drugs have been created, thanks to which the quality of life of people suffering from bronchial asthma has improved significantly. Properly selected drug therapy allows you to control the disease, preventing the development of exacerbations and in a matter of minutes to cope with attacks, if they occur.

People suffering from bronchial asthma, especially moderate and severe, should get a peak flowmeter. With this device, you can independently measure the peak expiratory flow rate in the morning and evening. This knowledge will help the patient to navigate his condition and independently change the dosing regimen of the drugs that were prescribed by the doctor.

It has been established that self-correction of drug doses, depending on the state of health and the indications of the device, reduces the frequency of exacerbations and enables the patient to reduce the dose of basic drugs taken over time.

Drugs for the treatment of bronchial asthma are grouped into two broad categories:

1. Drugs that relieve the symptoms of the disease, relieving an asthma attack.

They can be used continuously to prevent an asthmatic attack, or they can be used situationally, as needed.

2. Basic preparations.

These drugs are taken more often for life, whether there is an exacerbation or whether the patient feels well. It is thanks to the constant intake of basic drugs (basic - basic, fundamental) that good results have been achieved in the treatment of bronchial asthma: exacerbations in most patients are not frequent, and in the period between attacks the quality of life of people is very good.

Often patients make the mistake of believing that they can stop taking basic drugs once the condition has improved. Unfortunately, with the abolition of this treatment, asthma again makes itself felt, and often in the form of severe attacks. According to statistics, every fourth status asthmaticus (a life-threatening attack of bronchial asthma) is caused precisely by the uncontrolled withdrawal of basic drugs.

Basic preparations

1. Nedocromil sodium (Thyled) and sodium cromoglycate (Intal). The drugs of this group are prescribed to patients with intermittent and mild forms of the disease.

Intal and Tailed are taken as inhalations, 2 breaths 4-8 times a day. When a long-term remission is achieved, it is sometimes possible to take the drug in 2 doses only 2 times a day.

Of the advantages of Intal: this is not a hormonal drug, it is actively used in children. Cons: not the highest efficiency of the drug, as well as a contraindication to using it simultaneously with Ambroxol and Bromhexine.

2. Inhaled glucocorticosteroid hormones. This group is perhaps the most extensive. And all because these drugs have a very good anti-inflammatory effect, and with regular use, they significantly improve the quality of life of patients, reducing the frequency and severity of exacerbations. At the same time, hormonal drugs taken in the form of inhalations rarely have a systemic effect. This means that most of the side effects (low resistance to infections, bone softening, thinning of the skin, fat deposition in the waist and face, etc.), characteristic of tableted and intravenous glucocorticosteroids, are absent or minimal in the inhaled form.

Below are the most popular inhalers in Russia with drugs in this group.

• Budesonide (Pulmicort, Benacort) - taken 1-2 breaths 2 times a day. One dose contains 50 mcg (Mite), or 200 mcg of the drug (forte). In children, only the mite form is used, 1-2 inhalations per day.
• beclomethasone dipropionate (Klenil, Nasobek, Beclodzhet, Aldecin, Becotide, Beclazone Eco, Beclazone Eco Easy Breathing) - as a rule, it is applied 2-4 times a day (200-1000 mcg / day). One dose of inhalate contains 50, 100 or 250 micrograms. In children, it is used at a dose of 50/100 mcg / day.
• fluticasone propionate (Flixotide) - usually prescribed 1-2 doses 2 times a day. 1 dose contains 50, 100 or 250 micrograms of the drug. In children, the daily dosage should not exceed 100 mcg (2 puffs).
• flunisolide (Ingacort) - in adults, it can be used up to 8 times a day, 1 breath at a time (250 mcg in 1 dose), in children - no more than 2 times a day, 1 breath (500 mcg / day)

3. Glucocorticosteroid hormones in tablets - such treatment is prescribed when glucocorticoids in the form of inhalation are ineffective. The doctor's decision to start using tablet forms of hormones indicates that the patient suffers from severe bronchial asthma.

As a rule, prednisolone or methylprednisolone (Metipred) is prescribed in minimal dosages (5 mg / day).

It should be noted that the appointment of this group of drugs does not eliminate the need to receive glucocorticoid hormones in the form of inhalations, and usually in high doses.

At the appointment, the doctor should try to establish the reason why inhaled hormones turned out to be ineffective in this patient. If the low effect of inhalers is associated with improper technique of their use or a violation of the drug regimen, it is worth eliminating these factors and trying to stop taking hormones in tablets.

Most often, however, hormones in the form of tablets and injections are used in short courses during exacerbations of the disease. After achieving remission, such treatment is canceled.

4. Leukotriene antagonists are currently used primarily in aspirin asthma, although according to recent medical data, they are very effective in other forms of the disease and can even compete with inhaled glucocorticosteroids (see point 2).

• zafirlukast (Acolat) is a tablet. Zafirlukast should be taken 20 mg twice a day two hours after a meal or two hours before it. Can be taken in children over the age of 7 years at a dosage of 10 mg 2 times a day.
• Montelukast (Singulair) is also available as tablets. For adults, a dose of 10 mg 1 time per day is recommended, for children from 6 years old - 5 mg 1 time per day. The medicine should be taken at bedtime by chewing the tablet.

Drugs that relieve the symptoms of the disease, relieving an asthma attack

The three main groups of drugs that relieve asthma symptoms are bronchodilators: their mechanism of action is to expand the lumen of the bronchi.

1. Long-acting bronchodilators (bronchodilators).

These include drugs from the group called β-agonists.

On the Russian market, you can most often find formoterol (Oxis, Atimos, Foradil) and salmeterol (Serevent, Salmeter). These drugs prevent the development of asthmatic attacks.

• Formoterol is used twice a day for 1 breath (12 mcg) in both adults and children over 5 years of age. Those who suffer from exercise-induced asthma should take one inhalation of the drug 15 minutes before the start of physical activity. Formoterol can be used for emergency help with an attack of bronchial asthma.
• Salmeterol can be used in both adults and children from 4 years of age. Adults are prescribed 2 breaths 2 times a day, children - 1-2 breaths 2 times a day.

In asthma of physical effort, salmeterol should be applied at least half an hour before the start of the load in order to prevent a possible attack.

2. Short-acting bronchodilators of the group of β2-agonists. These inhalers are the drugs of choice in the event of an asthma attack, since they begin to act after 4-5 minutes.

During attacks, it is preferable to inhale the aerosol with the help of special devices - nebulizers (there are also "pocket" options). The advantage of using this device is that it creates a "vapour" of liquid medicine with very small particles of medicine that penetrate the constricted bronchi much better than metered dose inhaler aerosols. In addition, up to 40% of the dose in "canned" inhalers settles in the nasal cavity, while the nebulizer eliminates this drawback.

• Fenoterol (Berotek, Berotek N) is used as inhalation in adults at a dosage of 100 mcg 2 breaths 1-3 times a day, in children 100 mcg 1 breath 1-3 times a day.
• Salbutamol (Ventolin) for continuous use is prescribed 1-2 inhalations (100-200 mcg) 2-4 times a day. The drug can be used to prevent bronchospasm, if it occurs upon contact with cold air. To do this, you need to make 1 breath of inhalate 15-20 minutes before going out into the cold.
• Terbutaline (Brikanil, Ironil SEDICO) is used as inhalation, 2 inhalations at intervals per minute, 4-6 times a day.

3. Bronchodilators of the xanthine group. This group includes a short-acting drug, eufillin, and a long-acting drug, theophylline. These are “second-line” drugs, and are prescribed when, for some reason, there is little effect or it is impossible to take drugs from the previous groups.

So, sometimes immunity to drugs of the β2-adrenergic agonist group develops. In this case, xanthines can be prescribed:

• Eufillin (Aminophylline) is used in tablets of 150 mg. At the beginning of treatment, ½ tablet is used 3-4 times a day. In the future, it is possible to slowly increase the dosage of the drug up to 6 tablets per day (divided into 3-4 doses).
• Theophylline (Teopec, Theotard, Ventax) is used at 100-200 mg 2-4 times a day. It is possible to take Theophylline in children from 2 years old (10-40 mg 2-4 times a day in children 2-4 years old, 40-60 mg per dose in children 5-6 years old, 50-75 mg - aged up to 9 years, and 50-100 mg 2-4 times a day at 10-14 years).

4. Combined preparations, including a basic agent and a bronchodilator.

These drugs include inhalers Seretide, Seretide multidisk, Symbicort Turbuhaler.

• Symbicort is applied 1 to 8 times a day,
• Seretide is used twice a day for 2 breaths at each dose.
• Seretide multidisk is inhaled 1 breath 2 times a day.

5. Drugs that improve sputum discharge

In bronchial asthma, the formation of very sticky, viscous sputum in the bronchi is increased. Such sputum is especially active during exacerbations or an attack. Therefore, often the appointment of drugs in this group improves the patient's condition: reduces shortness of breath, improves exercise tolerance, and eliminates a hacking cough.

Proven effect in bronchial asthma has:

• Ambroxol (Lazolvan, Ambrobene, Ambrohexal, Halixol) - liquefies sputum, improves its discharge. It can be used in the form of tablets, syrup, inhalation.

The syrup can be used in children and adults. In children aged 2.5-5 years, half a teaspoon 3 times a day, in children 6-12 years old, a teaspoon 3 times a day. For adults and children from 12 years old, the therapeutic dose is 2 teaspoons 3 times a day.

The solution can be used both inside and inhaled with a nebulizer. As inhalations, 2-3 ml of the solution is used once a day. Ambroxol can be used in the form of aerosols from 2 years of age. For inhalation, it is necessary to dilute the Ambroxol solution with saline in a ratio of 1 to 1, warm it up to body temperature before use, and then take normal (not deep) breaths using a nebulizer.

The method of allergen-specific immunotherapy stands apart, in which the allergen is administered in an increasing dose. The effectiveness of such treatment can be very high. So, with an allergy to insect venoms (bees, wasps and others), it is possible to achieve a lack of reaction when bitten in 95% of cases. Read more about this method of treatment in a separate article.

Drugs for bronchial asthma - an overview of the main groups of drugs for the effective treatment of the disease

Among chronic diseases of the respiratory system, bronchial asthma is often diagnosed. It significantly impairs the quality of life of the patient, and in the absence of adequate treatment can lead to complications and even death. The peculiarity of asthma is that it cannot be cured completely. The patient throughout his life must use certain groups of drugs that are prescribed by a doctor. Medicines help to stop the disease and enable a person to lead a normal life.

Treatment of bronchial asthma

Modern drugs for the treatment of bronchial asthma have different mechanisms of action and direct indications for use. Since the disease is completely incurable, the patient has to constantly follow the correct lifestyle and doctor's recommendations. This is the only way to reduce the number of asthma attacks. The main direction of treatment of the disease is the termination of contact with the allergen. Additionally, treatment should solve the following tasks:

• reduction of asthma symptoms;
• prevention of seizures during exacerbation of the disease;
• normalization of respiratory function;
• taking the minimum amount of medication without compromising the health of the patient.

A healthy lifestyle involves quitting smoking and weight loss. To eliminate the allergic factor, the patient may be advised to change the place of work or climatic zone, humidify the air in the sleeping room, etc. The patient must constantly monitor his well-being, do breathing exercises. The attending physician explains to the patient the rules for using the inhaler.

You can not do without medication in the treatment of bronchial asthma. The doctor chooses drugs depending on the severity of the disease. All drugs used are divided into 2 main groups:

• Basic. These include antihistamines, inhalers, bronchodilators, corticosteroids, antileukotrienes. In rare cases, cromones and theophyllines are used.
• Funds for emergency assistance. These medicines are needed to stop asthma attacks. Their effect appears immediately after use. Due to the bronchodilator action, such drugs facilitate the patient's well-being. For this purpose, Salbutamol, Atrovent, Berodual, Berotek are used. Bronchodilators are part of not only basic, but also emergency therapy.

The basic therapy scheme and certain medications are prescribed taking into account the severity of the course of bronchial asthma. There are four levels in total:

• First. Does not require basic therapy. Episodic seizures are stopped with the help of bronchodilators - Salbutamol, Fenoterol. Additionally, membrane cell stabilizers are used.
• Second. This severity of bronchial asthma is treated with inhaled hormones. If they do not bring results, then theophyllines and cromones are prescribed. Treatment necessarily includes one basic drug, which is taken constantly. They can be an antileukotriene or an inhaled glucocorticosteroid.
• Third. At this stage of the disease, a combination of hormonal and bronchodilator drugs is used. They already use 2 basic medications and Β-adrenergic agonists for the relief of seizures.
• Fourth. This is the most severe stage of asthma, in which theophylline is prescribed in combination with glucocorticosteroids and bronchodilators. The drugs are used in tablet and inhalation forms. The first aid kit for an asthmatic already consists of 3 basic drugs, for example, antileukotriene, inhaled glucocorticosteroid and long-acting beta-agonists.

Overview of the main groups of drugs for bronchial asthma

In general, all asthma medications are divided into those that are used regularly and those used to relieve acute attacks of the disease. The latter include:

• Sympathomimetics. These include Salbutamol, Terbutaline, Levalbuterol, Pirbuterol. These medicines are indicated for emergency treatment of choking.
• Blockers of M-cholinergic receptors (anticholinergics). They block the production of special enzymes, contribute to the relaxation of bronchial muscles. Theophylline, Atrovent, Aminophylline have this property.

Inhalers are the most effective treatment for asthma. They relieve acute attacks due to the fact that the medicinal substance instantly enters the respiratory system. Examples of inhalers:

Basic drugs for bronchial asthma are represented by a wider range of drug groups. All of them are necessary to alleviate the symptoms of the disease. For this purpose, apply:

• bronchodilators;
• hormonal and non-hormonal agents;
• cromones;
• antileukotrienes;
• anticholinergics;
• beta-agonists;
• expectorants (mucolytics);
• mast cell membrane stabilizers;
• antiallergic drugs;
• antibacterial drugs.

Bronchodilators for bronchial asthma

This group of drugs for their main action is also called bronchodilators. They are used both in inhalation and in tablet form. The main effect of all bronchodilators is the expansion of the lumen of the bronchi, due to which an asthma attack is removed. Bronchodilators are divided into 3 main groups:

• beta-agonists (Salbutamol, Fenoterol) - stimulate the receptors of mediators of adrenaline and noradrenaline, are administered by inhalation;
• anticholinergics (blockers of M-cholinergic receptors) - do not allow the acetylcholine mediator to interact with its receptors;
• xanthines (theophylline preparations) - inhibit phosphodiesterase, reducing the contractility of smooth muscles.

Bronchodilator drugs for asthma should not be used too often, as the sensitivity of the respiratory system to them decreases. As a result, the drug may not work, increasing the risk of death from suffocation. Examples of bronchodilator drugs:

• Salbutamol. The daily dose of tablets is 0.3-0.6 mg, divided into 3-4 doses. This drug for bronchial asthma is used in the form of a spray: 0.1–0.2 mg is administered to adults and 0.1 mg to children. Contraindications: ischemic heart disease, tachycardia, myocarditis, thyrotoxicosis, glaucoma, epileptic seizures, pregnancy, diabetes mellitus. If the dosage is observed, side effects do not develop. Price: aerosol - 100 rubles, tablets - 120 rubles.
• Spiriva (ipratropium bromide). The daily dose is 5 mcg (2 inhalations). The medicine is contraindicated under the age of 18, during the first trimester of pregnancy. Side effects may include urticaria, rash, dry mouth, dysphagia, dysphonia, itching, coughing, coughing, dizziness, bronchospasm, throat irritation. The price of 30 capsules 18 mcg is 2500 rubles.
• Theophylline. The initial daily dosage is 400 mg. With good tolerance, it is increased by 25%. Contraindications of the drug include epilepsy, severe tachyarrhythmias, hemorrhagic stroke, gastrointestinal bleeding, gastritis, retinal hemorrhage, age less than 12 years. Side effects are numerous, so they should be clarified in the detailed instructions for Theophylline. The price of 50 tablets of 100 mg is 70 rubles.

Mast cell membrane stabilizers

These are anti-inflammatory drugs for the treatment of asthma. Their action is the effect on mast cells, specialized cells of the human immune system. They take part in the development of an allergic reaction, which underlies bronchial asthma. Mast cell membrane stabilizers prevent the entry of calcium into them. It does this by blocking the opening of calcium channels. The following drugs produce such an effect on the body:

• Nedocromil. Used from 2 years of age. The initial dosage is 2 inhalations 2-4 times a day. For prevention - the same dose, but twice a day. Additionally, it is allowed to carry out 2 inhalations before contact with the allergen. The maximum dose is 16 mg (8 inhalations). Contraindications: first trimester of pregnancy, age less than 2 years. Of the adverse reactions, cough, nausea, vomiting, dyspepsia, abdominal pain, bronchospasm, and unpleasant taste are possible. Price - 1300 rubles.
• Cromoglycic acid. Inhalation of the contents of the capsule (powder for inhalation) using a spinhaler - 1 capsule (20 mg) 4 times a day: in the morning, at night, 2 times in the afternoon after 3-6 hours. Solution for inhalation - 20 mg 4 times a day. Possible side effects: dizziness, headache, dry mouth, cough, hoarseness. Contraindications: lactation, pregnancy, age up to 2 years. The cost of 20 mg is 398 rubles.

Glucocorticosteroids

This group of drugs for bronchial asthma is based on hormonal substances. They have a strong anti-inflammatory effect, removing the allergic swelling of the bronchial mucosa. Glucocorticosteroids are represented by inhaled drugs (Budesonide, Beclomethasone, Fluticasone) and tablets (Dexamethasone, Prednisolone). Good reviews are used by such tools:

• Beclomethasone. Dosage for adults - 100 micrograms 3-4 times a day, for children - 50-100 micrograms twice a day (for the release form, where 1 dose contains 50-100 micrograms of beclomethasone). With intranasal use - in each nasal passage, 50 mcg 2-4 times daily. Beclomethasone is contraindicated under the age of 6 years, with acute bronchospasm, non-asthmatic bronchitis. Among the negative reactions may be coughing, sneezing, sore throat, hoarseness, allergies. The cost of a bottle of 200 mcg is 300–400 rubles.
• Prednisolone. Since this drug is hormonal, it has many contraindications and side effects. They should be clarified in the detailed instructions for Prednisolone before starting treatment.

Antileukotriene

These new generation anti-asthma drugs have anti-inflammatory and antihistamine effects. In medicine, leukotrienes are biologically active substances that are mediators of allergic inflammation. They cause a sharp spasm of the bronchi, resulting in coughing and asthma attacks. For this reason, antileukotriene drugs for asthma are the first-line drugs of choice. The patient may be given:

• Zafirlukast. The initial dose for the age of 12 years is 40 mg, divided into 2 doses. Maximum per day can be taken 2 times 40 mg. The medicine can cause an increase in the activity of liver transaminases, urticaria, rash, headache. Zafirlukast is contraindicated in pregnancy, lactation and hypersensitivity to the composition of the drug. The cost of the medicine is from 800 r.
• Montelukast (Singular). As a standard, you need to take 4-10 mg per day. Adults are prescribed 10 mg before going to bed, children - 5 mg. The most common negative reactions: dizziness, headaches, indigestion, swelling of the nasal mucosa. Montelukast is absolutely contraindicated in case of allergy to its composition and under the age of 2 years. A pack of 14 tablets costs 800–900 rubles.

Mucolytics

Bronchial asthma causes the accumulation of viscous thick mucus in the bronchi, which interferes with the normal breathing of a person. To remove sputum, you need to make it more liquid. For this purpose, mucolytics are used, i. expectorants. They dilute sputum and forcibly remove it by stimulating coughing. Popular expectorants:

• Acetylcysteine. It is taken 2-3 times a day for 200 mg. For aerosol application, 20 ml of a 10% solution is sprayed using ultrasonic devices. Inhalations are done daily 2-4 times for 15-20 minutes. Acetylcysteine ​​is prohibited for use in gastric and duodenal ulcers, hemoptysis, pulmonary hemorrhage, pregnancy. The cost of 20 sachets of medicine is 170–200 rubles.
• Ambroxol. Recommended to be taken at a dosage of 30 mg (1 tablet) twice a day. Children 6–12 years old are given 1.2–1.6 mg / kg / day, divided into 3 doses. If syrup is used, then the dose at the age of 5-12 years is 5 ml twice a day, 2-5 years - 2.5 ml 3 times every day, up to 2 years - 2.5 ml 2 times / day.

Antihistamines

Bronchial asthma provokes the decomposition of mast cells - mastocytes. They release a huge amount of histamine, which causes the symptoms of this disease. Antihistamines in bronchial asthma block this process. Examples of such medications:

• Claritin. The active ingredient is loratadine. Daily you need to take 10 mg of Claritin. It is forbidden to take this drug for bronchial asthma in lactating women and children under 2 years of age. Negative reactions may include headaches, dry mouth, gastrointestinal disorders, drowsiness, skin allergies, and fatigue. A package of 10 tablets of 10 mg costs 200–250 rubles. Semprex and Ketotifen can be cited as analogues of Claritin.
• Telfast. Every day you need to take 1 time for 120 mg of this medicine. Telfast is contraindicated in case of allergy to its composition, pregnancy, breastfeeding, children under 12 years of age. Often after taking the pill there are headaches, diarrhea, nervousness, drowsiness, insomnia, nausea. The price of 10 Telfast tablets is 500 rubles. The analogue of this drug is Seprakor.

Antibiotics

Medicines from the group of antibiotics are prescribed only when a bacterial infection is attached. In most patients it is caused by pneumococcal bacteria. Not all antibiotics can be used: for example, penicillins, tetracyclines and sulfonamides can cause allergies and not give the desired effect. For this reason, more often the doctor prescribes macrolides, cephalosporins and fluoroquinolones. The list of adverse reactions is best specified in the detailed instructions for these drugs, since they are numerous. Examples of antibiotics used for asthma:

• Sumamed. Medicine from the group of macrolides. It is prescribed for use 1 time per day, 500 mg. Treatment lasts 3 days. The dose of Sumamed for children is calculated from the condition of 10 mg / kg. At the age of six months to 3 years, the drug is used in the form of a syrup in the same dosage. Sumamed is prohibited for violations of kidney and liver function, while taking with ergotamine or dihydroergotamine. The price of 3 tablets of 500 mg is 480-550 rubles.
• Abaktal. An antibiotic from the group of fluoroquinolones. It is taken twice a day at 400 mg, observing a break between doses of 12 hours. You can not use Abaktal for hemolytic anemia, pregnancy, lactation, under the age of 18 years. The cost of 10 tablets of this antibiotic is 250 rubles.
• Cefaclor. Representative of cephalosporin antibiotics. The average dose of the drug is 750 mg. It is divided into 3 doses per day. The only limitation to treatment with Cefaclor is an allergy to its composition. A package of 10 tablets of 125 mg costs about 200-300 rubles.

Preparations for basic therapy of bronchial asthma

Therapy of bronchial asthma is unthinkable without the use of drugs. With their help, it is possible to achieve control over the disease, but it is impossible to cure it completely. Inhalers for asthma are the best way to administer medication into the body.
All asthma medicines are divided into basic therapy drugs and emergency medicines. With complete control over the disease, basic therapy for bronchial asthma is used, the need for emergency drugs is minimal.
Means of basic therapy are aimed at suppressing the chronic inflammatory process in the bronchi. These include:

• glucocorticoids;
• mast cell stabilizers (cromones);
• leukotriene inhibitors;
• combined funds.

Consider these groups of drugs and the most popular drugs.

Inhaled glucocorticosteroid hormones (iGCS)

Inhaled corticosteroids are indicated for all patients with persistent asthma, since chronic inflammation is present in the bronchial mucosa regardless of the severity of the disease. These drugs do not have pronounced side effects associated with the systemic action of hormones. They can suppress the activity of the adrenal glands only when used in high doses (more than 1000 mcg per day).
Pharmacological effects of iGCS:

• inhibition of the synthesis of inflammatory mediators;
• suppression of bronchial hyperreactivity, that is, a decrease in their sensitivity to the allergen;
• restoration of sensitivity of β2-adrenergic receptors to β2-agonists (bronchodilators);
• reduction of edema and mucus production by bronchial glands.

The higher the dose of the drug, the more pronounced its anti-inflammatory effect. Therefore, treatment begins with medium and high doses. After the patient's condition improves and positive changes in the function of external respiration, the dose of ICS can be reduced, but these drugs are not completely canceled.
Such side effects of iGCS as candidal stomatitis, cough, voice change are not dangerous, but unpleasant for the patient. They can be avoided by using a spacer for inhalation and rinsing the mouth after each administration of the drug with clean water or a weak solution of baking soda.

beclomethasone

Beclomethasone is part of the following drugs, most of which are aerosol inhalers:

• Beclazone Eco;
• Beclazon Eco easy breathing;
• Beclomethasone;
• Beclomethasone DS;
• Beclomethasone Aeronative;
• Beclospir;
• Klenil;
• Klenil UDV - suspension for inhalation in ampoules.

Undesirable effects - hoarseness, oral candidiasis, sore throat, very rarely - bronchospasm. Allergic reactions (rash, itching, swelling of the face) are also noted. Extremely rarely, when used in high doses, systemic effects occur: suppression of adrenal activity, increased bone fragility, in children - growth retardation.
Beclomethasone is contraindicated in the following situations:

• severe asthma attack requiring treatment in the intensive care unit;
• tuberculosis;
• 1st trimester of pregnancy and lactation.

The only form intended for inhalation through a compressor nebulizer is Klenil UDV.

fluticasone propionate

Fluticasone propionate is the active ingredient in Flixotide. The drug is indicated for basic therapy starting from the age of patients 1 year. For these young children, medication is administered using a spacer with a face mask (eg, Babyhaler).
The drug is contraindicated in acute asthma attacks, intolerance, children under 1 year. There are no studies that have proven the safety of its use during pregnancy and lactation.

The World Health Organization recommended writing the name of this substance through the letter "z" - budesonide. It is part of the drug for the basic therapy of asthma Budesonide Easyhaler. A feature of this tool is a powder form. It is believed that it can be used in children and pregnant women if the risk of complications is less than the benefit of the drug. Contraindications are only hypersensitivity to budesonide and lactation.
The dosage is determined by the doctor depending on the age of the patient and the severity of the disease.
The advantages of a powder inhaler over an aerosol are the absence of gases in its composition, as well as easier application and, therefore, better delivery of the drug to the respiratory tract. After automatically measuring the required amount of powder, the patient only needs to place the mouthpiece of the inhaler in his mouth and inhale deeply. In this case, even if the respiratory function is impaired, the substance will reach the bronchi.

Flunisolide

Flunisolide is the active ingredient in Ingacort. Side effects, contraindications are the same as for other inhaled corticosteroids.

These drugs strengthen (stabilize) the membrane of mast cells - sources of inflammatory mediators. Mast cells release these substances into the surrounding tissues upon contact with allergens. The isolated inflammatory mediators increase the permeability of the vascular walls, cause other cells to migrate to the focus of inflammation, and damage the surrounding cells.
If cromones are prescribed before contact with the allergen, they prevent the release of inflammatory mediators and inhibit the allergic reaction. However, their anti-inflammatory effect is significantly lower than that of inhaled corticosteroids. On the other hand, they have practically no undesirable phenomena. Therefore, they are used in the treatment of bronchial asthma in children and adolescents. In adults, cromones are sometimes good at controlling mild atopic asthma. To achieve the effect, they must be taken for at least 3 months.

Of this group, the most common remedy is Tailed Mint, which contains nedocromil sodium. This is a metered dose aerosol for inhalation. It suppresses inflammation and allergic reactions in the bronchi, reduces the severity of nocturnal symptoms and the need for "emergency" drugs.
You can additionally take the medicine before contact with the allergen, exercise or going out into the cold. Adding Tailed to iGCS therapy in many cases helps to reduce the dosage of the latter.
The inconvenience when using Tailed is the need for regular care and cleaning of the mouthpiece, washing and drying it.
Side effects are rare:

• irritation of the pharynx and oral cavity;
• dry mouth;
• hoarseness of voice;
• cough and runny nose;
• paradoxical bronchospasm;
• headache and dizziness;
• nausea, vomiting, abdominal pain.

Contraindications - age under 2 years, 1st trimester of pregnancy, lactation.
The drug should be taken regularly, every day, even in the absence of symptoms of the disease. Cancellation is carried out gradually, within a week. If the drug causes a cough, you can use bronchodilators before inhalation, and drink water after it.

Leukotriene receptor antagonists

This is a fairly new group of drugs used to treat asthma. They block the action of leukotrienes, substances formed during the breakdown of arachidonic acid during the inflammatory reaction. Thus, they reduce inflammation, suppress bronchial hyperreactivity, and improve external respiration.
These drugs find their niche in asthma therapy because they are particularly effective in the following situations:

• asthma in children;
• aspirin asthma;
• asthma of physical effort;
• predominance of nocturnal attacks;
• refusal of the patient from the treatment of inhaled corticosteroids;
• insufficient control of the disease with the help of inhaled corticosteroids (in addition to them);
• difficulty using inhalers;
• combination of asthma and allergic rhinitis.

An advantage of leukotriene receptor antagonists is their tablet form. Zafirlukast (Acolat) is often used.

• nausea, vomiting, abdominal pain;
• liver damage (rare);
• muscle and joint pain (rare);
• allergic reactions (rarely);
• insomnia and headache;
• blood clotting disorder (rare);
• weakness.

The most common side effects - headache and nausea - are mild and do not require discontinuation of the drug.
Contraindications:

• age up to 7 years;
• liver disease;
• lactation.

The safety of using Accolate during pregnancy has not been proven.
Another active ingredient from the class of leukotriene receptor antagonists, montelukast, is part of both the original drug and generics: monax, moncast, monler, montelar, montelast, simpler, singlelon, singulex, singular, ectalust. These drugs are taken once a day in the evening. They can be used from 6 years old. There are not only regular, but also chewable tablets.
Contraindications: age up to 6 years, phenylketonuria, individual intolerance.

Combined drugs

A new step in the basic therapy of bronchial asthma is the creation and use of combinations with anti-inflammatory and long-term bronchodilating effects, namely, combinations of ICS and long-acting β2-agonists.

In these drugs, each of the components enhances the action of the other, as a result, the anti-inflammatory effect of iGCS becomes more pronounced than with hormone monotherapy at the same dose. Therefore, the use of combined agents is an alternative to increasing the dose of inhaled corticosteroids with their insufficient effectiveness. It facilitates the course of asthma, reduces the need for "emergency" drugs, and more effectively prevents disease exacerbations compared to iGCS monotherapy. These drugs are not intended to stop an attack, they must be taken daily, regardless of the presence of asthma symptoms. You can only cancel them gradually.
Two drugs are used: Seretide and Symbicort.
Seretide is available as a metered-dose inhalation aerosol and powder inhaler (Seretide Multidisk). It contains fluticasone and salmeterol.
Indications for use:

• starting therapy of bronchial asthma in the presence of indications for the appointment of inhaled corticosteroids;
• asthma well controlled with inhaled corticosteroids and long-acting β2-agonists given separately;
• asthma not well controlled with ICS alone.

Side effects that occur more often than one patient in 1000:

• candidiasis of the oral mucosa;
• skin allergic manifestations;
• cataract;
• increased blood sugar levels;
• sleep disturbance, headache, muscle tremors;
• heart palpitations;
• hoarseness, cough, throat irritation;
• the appearance of bruising on the skin;
• pain in muscles and joints.

Seretide is contraindicated in children under 4 years of age and in people who cannot tolerate the components of the drug. There are no clear data on the safety of the drug during pregnancy and lactation.
Seretide Multidisk is more convenient to use than a regular pocket inhaler for asthma.

Symbicort Turbuhaler is a metered powder for inhalation containing budesonide and formoterol. Unlike Seretide, the drug is not used as a starting therapy, but it can be used to stop seizures. The advantage of this drug is great opportunities in the selection of the optimal dosage that provides asthma control.
Adults are prescribed from 1 to 8 inhalations per day, choosing the smallest effective dose, up to a single dose per day. Children can use Symbicort Turbuhaler from 6 years of age. Side effects and contraindications are the same as those of Seretide.
The use of combined drugs is justified in all cases of asthma requiring the appointment of inhaled corticosteroids. Ease of use, fast and pronounced effect improve patient adherence to treatment, provide better control over the symptoms of the disease, give patients confidence in the possibility of a good quality of life with bronchial asthma.

Watch a video on how to use the inhalation spacer:

Basic therapy for bronchial asthma

Bronchial asthma is a chronic inflammatory process that is limited to the region of the respiratory tract, has an undulating course and, in most cases, is provoked by allergens. Modern pharmacology has created many drugs that improve the quality of life of individuals diagnosed with bronchial asthma. Correctly prescribed drug treatment allows you to clearly control the disease, prevent possible complications or exacerbations, and also stop attacks in a short period, if any.

For individuals who suffer from moderate to severe bronchial asthma, any specialist will recommend purchasing a peak flow meter. This special device is designed for self-measurement of peak expiratory flow at home. The measurement procedure should be carried out twice a day: in the morning and before bedtime. The results obtained show the patient his real condition, and also help to slightly independently adjust the dosage of the drugs prescribed by the doctor.

Medical practice shows that self-adjustment of the dosage of drugs, starting from the state of health and peak flow meter values, reduces the frequency of exacerbations, and also helps the patient to gradually reduce the dosage of constantly used prophylactic drugs.

Treatment program and tasks of basic therapy for bronchial asthma

The treatment program for bronchial asthma should consist of the following activities:

1. Educate patients to properly monitor and assess disease severity using objective peak flow measurements that reflect pulmonary dysfunction. This makes patients colleagues of doctors.
2. Eliminate allergens or risk factors provocateurs as much as possible (for example, physical activity in case of asthma of physical effort), which can trigger the development of suffocating asthma attacks.
3. Develop 2 treatment plans for the disease. The first plan is drug therapy for the permanent treatment of the disease, and the second - in case of its exacerbation.
4. Ensure regular visits to the doctor to monitor and adjust medication prescriptions.

IMPORTANT! The patient needs to pay special attention to the second point. After all, it is he who is more responsible for the effectiveness of the treatment of bronchial asthma and at the same time absolutely does not depend on the competence of the doctor.

In order for the treatment of bronchial asthma to be effective, it is necessary to adhere to a number of tasks of basic therapy:

• establish control over the symptoms of the disease;
• prevent exacerbations of bronchial asthma;
• strive to maintain a normal level of lung function;
• develop an individual possible physical activity;
• avoid harmful side effects from drugs used for treatment;
• prevent the development of irreversible obstruction.

All of the above objectives of preventive therapy not only bring the understanding of bronchial asthma to a new level, but also contribute to a deeper understanding of its treatment. If we take into account that this is a chronic disease, then treatment with a clear control over the disease, which is aimed at suppressing the inflammation itself, will be more effective. Such not symptomatic, but preventive, controlling and suppressive therapy is called basic.

Preparations of basic therapy and their significance in the treatment of bronchial asthma

Medications for the treatment of bronchial asthma are divided into 2 significant groups:

1. Drugs that alleviate the symptoms of the disease and eliminate suffocation. They can be used on an ongoing basis to prevent a new attack or taken by the patient according to the situation and health status.
2. Basic drugs, which are mainly taken by asthmatics for life and do not depend on periods of "calm" or exacerbation.

Medical practice shows that the importance of using basic drugs is quite large. It is thanks to their long-term or continuous use that the best results in the treatment of the disease are achieved: the frequency of exacerbations is almost zero, and the remission period can be described as a period with a fairly high-quality life.

Basic remedies not only prevent the further development of inflammation, but also reverse it, and also have a suppressive and preventive effect. Currently, to control the course and treat the disease, doctors are increasingly resorting to the use of inhaled glucocorticosteroids, which show the greatest effectiveness.

Often, patients are very mistaken about the fact that it is possible to stop taking prophylactic drugs when their health improves. However, medical practice suggests the opposite: the abolition of basic therapy returns the disease to its original indicators and symptoms. There are also a number of cases where refusal of it leads to severe attacks.

IMPORTANT! According to statistics, every fourth case with a severe suffocating attack, which gets status asthmaticus, is due to the rejection of basic drugs inconsistent with the doctor.

What drugs are used for basic therapy of bronchial asthma?

With bronchial asthma, the main goal of the patient should be to achieve complete control over the disease. This goal can be easily achieved with medications that eliminate inflammation and dilate the bronchi. These funds are grouped as follows:

1. Inhaled glucocorticosteroids.
2. Systemic glucocorticosteroids.
3. Beta2-agonists for inhalation.
4. Cromons.
5. Leukotriene modifiers.

Basic therapy drugs should be taken on a daily basis for a long time, and even for life. Due to the fact that asthma is characterized by constant inflammation of the mucous tract of the respiratory system, the most effective use is shown by agents that reduce inflammation and bronchial hyperreactivity.

Most modern pharmacological anti-asthma drugs have an anti-inflammatory effect (to varying degrees), but the greatest effectiveness is still observed after long-term use of inhaled glucocorticosteroids. To date, they are considered the basis for the treatment of asthma with moderate and severe course.

Inhaled glucocorticosteroid drugs in the basic treatment of bronchial asthma

Inhaled glucocorticosteroids are more effective due to the fact that they are introduced into the body by means of inhalation, which maximally brings the active substance to the goal. It is with the help of inhalation that a local effect is achieved, and side effects of systemic glucocorticosteroids are also limited. In this case, the dose of the drug is directly proportional to the severity of the course of the disease.

In addition, hormonal medicines that are used in inhaled form rarely have a systemic effect, which means that compared to the tablet or intravenous version, they have minimal or no side effects.

Glucocorticosteroids have a fairly wide spectrum of action and are therefore classified as preventive therapy drugs.

The clinical effectiveness of the use of glucocorticosteroids is:

• improvement in peak expiratory flow and spirometry;
• elimination of bronchial hyperreactivity;
• elimination of exacerbations.

Inhaled glucocorticosteroids differ in activity and pharmacokinetic features. According to experimental pharmacological assessments, Flixotide is the most active. Next in the activity rating are Pulmicort, Bekotid, Ingakort and Beclomet. "Dlixotide" is additionally good because it is as close as possible to receptors.

IMPORTANT! Inhaled glucocorticosteroids have a number of limitations in their use. They are not used for structural changes in the lung tissue, fungal lung infections, tuberculosis and immunodeficiency.

The most popular glucocorticosteroid inhaled drugs are:

1. "Budesonide" (analogues "Pulmicort" and "Benakort"). Their dosage is 1-2 breaths no more than 2 times in 24 hours. In the treatment of children, only the mite form is used.
2. "Bekotid", "Nasobek" and other preparations of beclomethasone dipropionate. The daily dosage of the drug in adults usually ranges from 200-100 mcg, and in children - 50-100 mcg. Inhalation is used 2-4 times in 24 hours.
3. "Flixotide". Doctors prescribe 1-2 doses twice a day. 1 dose is equal to 50, 100 or 250 mcg of the active substance. The maximum daily dosage for children is 100 mcg.
4. "Ingacourt". Adults are prescribed up to 7 times a day. 1 dose is 250 mcg, which is equal to 1 breath. The maximum daily dosage for children is 500 mcg, i.e. can be used no more than 2 times a day for one breath.

In clinical practice, there are cases when a doctor prescribes the use of glucocorticosteroid hormones in tablet form. This decision of the doctor indicates the transition of the disease into a severe form. Most often, Prednisolone or Methylprednisolone is prescribed. However, the appointment of a tablet type of drug does not cancel the use of inhalation. In this case, the inhalation type is prescribed in large doses. ⇒ Read about free medicines for asthmatics.

Beta2-agonists, cromones and leukotriene modifiers

Beta2-agonists in the form of inhalation have a prolonged effect (more than 12 hours) and good bronchodilator results. Doctors attribute them when therapy with small doses of inhaled glucocorticosteroids has not led to the desired control of bronchial asthma. In order not to increase the dosage of hormones to the maximum possible, bronchodilators with a prolonged effect are additionally attributed. Modern pharmacology has developed a number of combined medicines, using which you can take the disease under control.

Cromones are drugs that cause a chain of chemical reactions. The result is a reduction in the symptoms of the disease and inflammation in general. They are used mainly in the treatment of mild persistent asthma, because with a more severe course they become practically ineffective.

Leukotriene modifiers are a relatively unexplored branch of anti-inflammatory drugs that are used prophylactically. According to research, they improve lung function, reduce the symptoms of bronchial asthma, and also reduce the need for the use of inhaled beta2-agonists. Studies were mostly conducted in patients with mild or moderate disease, and the effect of the application was moderate.

IMPORTANT! Leukotriene modifiers may soon become an excellent replacement for low doses of inhaled glucocorticosteroids.

Fundamentals of stepwise therapy in the treatment of bronchial asthma

In order to successfully control the disease, doctors have long developed a stepwise therapy for treatment, a separate step of which involves the introduction of a certain combination of medications. If the combination contributed to the control of the disease, then a transition is made to the lower step. If control has not been achieved, then the transition will accordingly be carried out to a higher level, which means more severe healing.

The first stage implies a symptomatic approach. Use short-term inhaled beta2-agonists or cromones.

The second stage involves the combination of symptomatic substances and 1 prophylactic medication on a daily basis. Apply a low volume of inhaled glucocorticosteroids, cromones or leukotriene modifiers, as well as short-acting beta2-agonists in the form of inhalation (up to 4 times a day).

In the third step, symptomatic medications are used along with two controlling agents. One of the options is selected:

• high doses of inhaled glucocorticosteroids;
• low dose of inhaled glucocorticosteroids + long-acting beta2-agonist in the form of inhalations;
• low dose inhaled glucocorticosteroids + leukotriene modifier;
• short-term beta2-agonists in the form of inhalations, but not more than 4 times a day.

The fourth stage implies the addition of tableted hormones with a minimum dosage of 1 time in 2 days or daily to the selected means of the third stage.

Whatever drugs your doctor chooses for preventive purposes, remember that how quickly you get the disease under control depends only on you. After all, not a single medication is able to monitor your well-being and eliminate the allergen or provocateur factor from your life as much as possible. Visit your doctor in a timely manner, discuss with him the slightest nuances of well-being and be healthy!

The article was written based on materials from sites: terapewt.ru, vrachmedik.ru, ask-doctors.ru, bronhial.ru.

Bronchial asthma is a disease of the respiratory tract, steadily progressing and, as a rule, developing in childhood due to the influence of various factors of an allergic, infectious and genetic nature.

This determines the relevance of preventive methods and the need for the treatment of bronchial asthma in adults and.

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Basic step therapy in adults

Treatment of asthma is based on and depends on the level of control of the disease, and not on the severity of its severity, which may change over time due to ongoing therapy. Control of the disease consists of two components: control of symptoms and minimization of the risks of exacerbation. However, in patients with different levels of disease control, the degree of severity is a guideline in the appointment of basic therapy for bronchial asthma.

Basic therapy is necessary to reduce the number of exacerbations and hospitalization of patients due to the uncontrolled course of bronchial asthma.

The volume of basic therapy is determined individually and has a stepwise approach. There are 5 steps in the treatment of bronchial asthma. Each stage has a preferred therapy option and alternative methods.

How to treat at home

Treatment of asthma at home in adults is possible with full adherence to the therapy regimen. How to treat this disease in adults is determined by the doctor's prescription. The ineffectiveness of treatment in this case may be due to the lack of technology for using an asthma inhaler. This is due to the fact that the medicine for bronchial asthma does not enter the respiratory tract and is not able to provide the necessary therapeutic effect.

If the symptoms worsen and the condition of the patient treated at home worsens, a doctor's consultation is necessary to assess the course of the disease and prescribe effective therapy.

Drug Overview

A wide range of drugs are used to treat bronchial asthma. Their combinations and doses are selected by the doctor, taking into account the dynamics of the disease and the patient's condition.

The use of ICS in the form of inhalers (sprays)

Inhaled glucocorticosteroids (IGCS) are the most effective drugs in the basic therapy of bronchial asthma. Inhaled corticosteroids are able to reduce the severity of symptoms, improve external respiration and minimize the effects of bronchial hyperreactivity.

The following drugs are widely used in clinical practice:

• Budesonide;
• Flunisolide;
• beclomethasone dipropionate;
• Fluticasone propionate.

The mechanism of action of glucocorticoids in bronchial asthma is based on their anti-inflammatory effect. With the help of inhalers used in bronchial asthma, the molecules of glucocorticosteroids are on the epithelium of the respiratory tract. Then they penetrate the membrane and find themselves in the site where reactions occur that stimulate the release of anti-inflammatory molecules.

Names of some inhalers used for asthma:

• Budiare;
• Foster;
• Salmecort.

The clinical effect of glucocorticosteroids is achieved by prescribing different doses and depends on the degree of the disease. Low doses of inhaled corticosteroids reduce the frequency of exacerbations, improve external respiration, reduce inflammation and airway hyperreactivity. High doses of ICS are used to reduce bronchial hyperreactivity and better control the course of the disease.

Antileukotriene

Anti-leukotriene drugs for the treatment of bronchial asthma inhibit cysteinyl leukotriene receptors in eosinophils and neutrophils. This causes their anti-inflammatory effect. They also have a bronchodilatory effect. This group of drugs has found especially wide application in aspirin bronchial asthma, in polypous rhinosinusitis.

The use of antileukotriene drugs in bronchial asthma helps to reduce the prescribed doses of inhaled glucocorticosteroids.

Bronchodilators (Eufillin and others)

Bronchodilators in bronchial asthma are widely used to eliminate bronchospasm. Bronchodilators are available in the form of inhalers, sprays, syrups, solutions and tablets for bronchial asthma.

The pharmacological groups that have a bronchodilator effect include:

• beta-2 adrenoreceptor agonists, which are divided into short-acting and long-acting agonists (formoterol and salmeterol);
• antagonists of M-cholinergic receptors;
• adrenalin;
• myotropic antispasmodics;
• glaucine.

Eufillin, a phosphodiesterase inhibitor, is also actively used in this disease, it relaxes the muscles of the bronchi, relieves bronchospasm, and has a stimulating effect on the contraction of the diaphragm and the respiratory center. In addition, the use of aminophylline leads to the normalization of respiratory function and blood oxygen saturation.

It is impossible to single out the best pills for the treatment of bronchial asthma, the list of drugs is compiled by the doctor based on the current state of the sick person.

Glucocorticoids (Prednisolone and others)

In the group of glucocorticoids, prednisolone is actively used. It does not have a bronchodilatory effect, but has a strong anti-inflammatory effect. Glucocorticoids are prescribed for attacks in which treatment with bronchodilators is ineffective. The action of prednisolone does not occur immediately - it develops within 6 hours after taking the drug.

The dose of prednisolone is up to 40 mg per day. Its reduction should occur gradually, because otherwise the risk of exacerbations will be high.

Cromons

Cromones are drugs used in bronchial asthma and have an anti-inflammatory effect. This group of drugs has found wider use in pediatric practice due to their safety and minimal side effects. Cromona is used in the form of inhalations and spray for bronchial asthma. In broncho-obstructive syndrome, it is recommended to prescribe short-acting beta-2 agonists before use.

Cough in asthma occurs against the background of expiratory dyspnea and is stopped along with bronchial spasm by the drugs discussed above. Treat a cough that is not associated with an attack based on its nature with the use of antibiotics, mucolytic, antitussive and other means.

List of the most effective drugs

The list of the most effective drugs for bronchial asthma is presented below:

1. Omalizumab is a monoclonal antibody drug. It is able to provide hormone-free asthma treatment even in severe asthma in adults. The use of omalizumab can successfully control the symptoms of bronchial asthma.
2. Zafirlukast is an anti-inflammatory and bronchodilator drug. The mechanism of action of Zafirlukast is based on blocking leukotriene receptors and preventing bronchial contractions. Main indications for use: mild to moderate asthma.
3. Budesonide is a glucocorticosteroid with anti-inflammatory, anti-allergic effects. Budesonide for asthma is used in inhaled form.
4. Atrovent (ipratropium bromide) is an inhaled anticholinergic that has a bronchodilatory effect. The mechanism of action is based on the inhibition of musculature receptors of the tracheobronchial tree and the suppression of reflex bronchoconstriction.

Patients with bronchial asthma without a confirmed disability can count on free medicines. The conditions for their provision change over time, and also depend on the region of residence, so the question of obtaining them should be addressed to the doctor.

Non-drug methods

Non-drug treatment of bronchial asthma acts as an addition to the main treatment and is usually prescribed by the attending physician when indicated. Procedures are selected individually and according to the recommendations of a specialist.

Massage

Massage for bronchial asthma improves blood circulation, activates the work of the respiratory muscles and increases the saturation of tissues with oxygen. Massage also helps to eliminate congestion in the lungs and improve airway patency in obstructive syndrome.

Physiotherapy

Physiotherapy for bronchial asthma is represented by various methods, which vary depending on the period of the disease. So, for example, during an asthma exacerbation, aerosol therapy can be carried out using ultrasound. In addition, electroaerosol therapy is also used.

Aerosol inhalations are carried out with aminophylline, heparin, propolis, atropine.

In order to restore the patency of the bronchi, electrophoresis of bronchodilators is used on the interscapular region.

Non-specific methods include ultraviolet irradiation in order to increase the resistance of the body's immune system.

In the interictal period, calcium ion electrophoresis is used, as well as hydrocortisone phonophoresis on segmental zones of the chest.

To date, magnetotherapy and low-frequency ultrasound have proven their effectiveness in the treatment of bronchial asthma.

Spa treatment

Spa treatment for bronchial asthma is a combination of climatic therapy, thalasso and balneotherapy. Sanatoriums are located in the Crimea, Kislovodsk, Gorny Altai and are popular among patients with respiratory diseases. Only those patients who are in the phase of stable remission and those who have undergone a thorough examination undergo rehabilitation in such centers.

However, it is worth considering the fact that the patient needs time to adapt to climatic conditions, therefore, when choosing a sanatorium, the doctor should prefer resorts with a climate close to that in which the patient is used to living.

Folk remedies

The use of folk remedies is not particularly effective and has only a minimal impact. Phytotherapy is considered the most effective folk remedy for the treatment of bronchial asthma. It involves the use of medicinal plants in the form of inhalations and in tablet forms.

• garlic juice can be used for aerosol inhalation;
• tea from berries and lingonberry leaves;
• a decoction of viburnum berries and honey.

Phytotherapy has a number of side effects (allergic reactions) and contraindications, which requires a mandatory consultation with a specialist before use.

Respiratory gymnastics refers to physical therapy and includes performing exercises accompanied by holding the breath.

The purpose of this method is the relief and prevention of an attack of bronchial asthma.

The diet for bronchial asthma does not differ much from the diet of a healthy person. However, doctors recommend adhering to certain principles in compiling your diet:

1. Limiting daily salt intake.
2. Consumption per day of a sufficient amount of liquid (at least 1.5 liters).
3. Limiting the intake of fatty, fried and spicy foods.
4. Preference is given to steamed and boiled food.
5. It is recommended to eat small meals many times a day (5-6 times).
6. Nutrition should be balanced in proteins, fats and carbohydrates.
7. The diet should include both vegetables and fruits, as well as meat and fish.

Asthmatic status is a condition characterized by an attack of a protracted course of asthma, which is not stopped by bronchodilators for several hours. In order to treat bronchial asthma in this case, it is important to remember that the goal of assistance provided during an exacerbation of bronchial asthma is to limit the action of the trigger and stop the asthma attack.

Drugs used to treat an attack are preferably used in the form of inhalations or infusions.

Bronchodilator therapy for an attack is represented by fast-acting beta-2 agonists. Then, after an hour, the patient's condition is monitored and, when symptoms are relieved, the use of a beta-2 agonist is continued for every 3 hours during the day or 2 days.

With moderate severity, the doses of inhaled glucocorticosteroids are increased, their oral forms, an inhaled anticholinergic are added, and therapy with beta-2 agonists is also continued every 3 hours for 1-2 days.

In severe cases, oral and inhaled forms of glucocorticosteroids are also added at higher doses. Hospitalization in the inpatient department is indicated.

In case of asthmatic status, the patient is urgently hospitalized in the intensive care unit and immediate intensive care is started:

1. Systemic glucocorticosteroids (prednisolone) are urgently administered intravenously, and inhaled ones are administered through a nebulizer.
2. Epinephrine (adrenaline) is administered subcutaneously or intramuscularly when there is a threat of respiratory arrest.
3. Artificial ventilation of the lungs and resuscitation are carried out in the presence of clinical indications for these procedures.

Bronchial asthma is a disease of the respiratory tract that cannot be completely cured. Medications for bronchial asthma are used for relief.

The possibilities of modern medicine are limited by the ability to minimize risk factors, alleviate symptoms and improve the quality of health and life of the patient.

Of particular importance are preventive methods in both children and adults. In childhood, they are aimed at eliminating risk factors and the primary development of asthma.

Conclusion

- an inflammatory disease that has an allergic, infectious and non-infectious genesis, depending on the etiological factor.

Treatment of bronchial asthma involves the use of both drug and non-drug methods.

The severity of the course and the clinical picture of the disease determine the medical tactics and the required amount of therapy for the patient.

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