Basic drugs for bronchial asthma. Basic therapy and treatment of bronchial asthma

Principles for selecting basic therapy for bronchial asthma

N.P. Princely

In modern society, bronchial asthma (BA) is one of the most common diseases. The main goal of asthma treatment is to achieve disease control, i.e. the patient has no or minimal symptoms of the disease, the patient is not limited in daily activities, he has no (or minimal) need for emergency medications, and the frequency of exacerbations is extremely low. Thus, achieving control over asthma means eliminating the manifestations of the disease with the help of adequate and rational drug therapy. The high anti-inflammatory effect of the combined use of inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABAs) argues for the use of this therapeutic approach. Bronchial asthma -2 is a disease that is accompanied by inflammation of the bronchial mucosa, its swelling, plasma exudation (increased vascular permeability), hypertrophy of smooth muscle cells and desquamation of the epithelium. The GOAL (Gaining Optimal Asthma control) study, the results of which formed the basis for the asthma control strategy presented in GINA 2006 (The Global Initiative for Asthma), demonstrated the benefits of combination therapy with ICS and LABA in severe and moderate asthma. The first fixed-combination drug is Seretide, which is widely and successfully used to achieve control of asthma. Quantitative assessment of control is carried out using questionnaires, including AST (Asthma Control Test).

Key words: bronchial asthma, basic therapy, inhaled glucocorticosteroids, combination drugs, Seretide, AST.

Introduction

The last two decades have seen significant progress in the treatment of bronchial asthma (BA). This is due to the understanding of this pathology as a chronic inflammatory disease of the respiratory tract, requiring the use of anti-inflammatory anti-asthmatic drugs, primarily containing inhaled glucocorticosteroids (ICS). However, despite the progress achieved, the problem of asthma cannot be considered solved.

Basic principles of asthma therapy

The main goal of asthma therapy is to establish long-term control over the disease, and not just eliminate its symptoms. Treatment recommendations include four main aspects:

1) use of respiratory function indicators to objectively assess the severity of the disease and monitor the response to therapy;

2) identification and elimination of factors that aggravate symptoms, provoke exacerbation and maintain inflammation of the airways;

3) adequate pharmacological treatment to eliminate bronchoconstriction and prevent and eliminate airway inflammation;

4) achieving a partnership between patient and doctor.

Although a cure for asthma has not yet been found, disease control can and should be achieved and maintained in most patients. How to determine asthma control?

Criteria for the adequacy of BA therapy

The Executive Committee of GINA (The Global Initiative for Asthma) in 2006 recommended a more rational approach to asthma management based on level of control rather than severity. Based on these recommendations, the main goal of asthma treatment is to

Nadezhda Pavlovna Knyazheskaya - Associate Professor of the Department of Pulmonology, Federal University of Medicine, Russian National Research Medical University. N.I. Pirogo-va, Moscow.

achieving and maintaining control over the disease, which consists of the following: the patient has no or minimal symptoms of the disease, there are no restrictions in daily life activities, there is no (or minimal) need for emergency medications and the frequency of exacerbations is extremely low (Table 1).

The following factors increase the risk of future adverse events: poor control of clinical symptoms, frequent exacerbations during the previous year, any treatment of a patient with asthma in the emergency department, low forced expiratory volume in 1 second.

Is it possible to make it easier for physicians to assess asthma control in real practice? It should be remembered that for many chronic diseases for which treatment goals are defined, different parameters are used to achieve these goals. For example, the goal of treating hypertension is to achieve and maintain blood pressure at 140/90 mmHg. Art. or lower, for atherosclerosis - this is achieving a triglyceride level of 5.0 mmol/l and below, for diabetes mellitus - achieving a glycemic level of 5.6 mmol/l, etc. In the examples given, the goal of treatment and assessment of the effectiveness of therapy are specific and unambiguous. But for assessing asthma control there is no such clear criterion, so questionnaires that allow quantitative assessment of asthma control help in its implementation; of those adopted in Russia, these include ACQ-5 (Asthma Control Questionnaire) and AST (Asthma Control Test). Asthma Control Test - a test for asthma control - consists of 5 questions, the answers to which are presented in the form of a five-point rating scale. The result of the test is the sum of points for the answers: for example, a score of 25 points corresponds to complete control, a score of 20-24 points corresponds to good control, a score of less than 20 indicates an uncontrolled course of the disease, which requires medical intervention to control

Table 1. Classification of asthma according to the level of control С^А 2006

Characteristics Well-controlled asthma Partially controlled asthma Uncontrolled asthma

Daytime symptoms None (2 times or less per week) More than 2 times per week Three or more signs of partially controlled asthma weekly

Activity limitation No Minor

Nocturnal symptoms/awakenings None Minor

Need for situational medications No (2 times or less per week) More than 2 times per week

Respiratory function (PEV or FEV1) Normal<80% от должного или лучшего значения,если оно известно

Exacerbations No One or more per year Weekly

Designations here and in the table. 2: FEV1 - forced expiratory volume in 1 second, PEF - peak expiratory flow. Note. Any exacerbation is a reason to review maintenance therapy to ensure its adequacy.

Table 2. Classification of asthma according to the level of control С^А 2009

A. Assessment of the current level of control (preferably carried out within 4 weeks)

Characteristics I Controlled asthma (all of the following) Partially controlled asthma (any manifestation during any week) Uncontrolled asthma

Daytime symptoms None (or<2 эпизодов в неделю) >2 episodes per week Three or more signs of partially controlled asthma in any week

Activity restrictions None Any

Nocturnal symptoms/awakenings None Any

Need for emergency medications None (or<2 эпизодов в неделю) >2 episodes per week

Pulmonary function (PEF or FEV1) Normal<80% от должного значения или от наилучшего для данного пациента показателя (если таковой известен)

B. Assessment of subsequent risk (risk of exacerbations, unstable course of the disease, rapid decline in lung function, side effects)

Indicators associated with an increased risk of future adverse events include:

poor control of clinical symptoms, frequent exacerbations during the previous year, any treatment for asthma in the department

emergency care, low FEV1, exposure to cigarette smoke, high doses of therapy

Establishing or revising a treatment plan aimed at achieving good control of the disease.

The questionnaire corresponds to a set of asthma treatment goals and correlates with the above GINA criteria for asthma control. The use of questionnaires, including AST, is simple and convenient for use in outpatient and inpatient settings, and is also quite sensitive to changes in the patient’s condition. The test allows not only to quantitatively assess control, but also to clinically interpret the symptoms of the disease. No special knowledge is required to fill out the questionnaire, so it is easy to work with not only doctors, but also patients.

Despite the modern capabilities of basic therapy for asthma, the results of large-scale epidemiological studies conducted in Europe indicate a biased perception of their condition by patients themselves and, as a consequence, a low level of control of asthma. In this regard, it is very important that the patient is informed as fully as possible about his disease and can assess the level of control, which is possible using the specially developed AST questionnaire described above. Determination of the level of asthma control in real conditions (including

le outpatient clinics) is difficult due to a number of reasons, such as lack of time, lack of specialized expensive equipment, etc. However, using questionnaires, a doctor, including a primary care physician, can give a fairly complete assessment of the condition of a patient with asthma, assess the effectiveness of treatment at the current moment and over time. In addition, the patient himself actively participates in the control of his disease and, therefore, begins to understand the goal of asthma treatment. With the help of AST it is possible:

Screen patients and identify patients with uncontrolled asthma;

Make changes to treatment to achieve better control;

Increase the efficiency of implementation of clinical recommendations for the treatment of asthma;

Identify risk factors for uncontrolled asthma;

Assess the level of asthma control (for both clinicians and patients). The AST questionnaire is recommended for use by the main international guidelines for the diagnosis and treatment of asthma - GlNA. In Russia, AST is approved by the Russian Respiratory Society, the Union of Pediatricians of Russia and the Russian Association of Allergists and Clinical Immunologists.

One of the important control tasks is the absence of exacerbations of asthma. Therefore, in an outpatient setting during an exacerbation of the disease, it is necessary to assess the level of control, since an exacerbation is the most important sign of its loss. In addition, it is extremely important to assess control using tests in an outpatient setting, when the patient leads a normal lifestyle (work, study). Achieving control over asthma means eliminating the manifestations of the disease with the help of adequate and rational drug therapy aimed at suppressing inflammation in the bronchial tree.

Pharmacotherapy of asthma

Pharmacotherapy of asthma is carried out using two classes of drugs - fast-acting, which eliminate the symptoms of acute bronchoconstriction, and drugs for long-term disease control (basic), which, with regular use, improve the control of asthma in general. Even with very good asthma control, there is no guarantee of a complete absence of symptoms and exacerbations. Contact with an allergen, including unexpected contact, staying in a smoky room and other similar situations can cause difficulty breathing, coughing and the sudden development of an attack of suffocation. This can happen anywhere and at any time, which means you need to have an emergency aid with you and, of course, know how to use it.

To relieve asthma symptoms, inhalations can be carried out in various ways, but the most common is the use of a metered dose aerosol inhaler. Typically, when using it, the patient takes 1-2 breaths with an interval of 1-2 minutes. Which inhaler is the most effective and safe? Medical guidelines are unanimous that the first-line drugs for relieving an attack of asthma are selective P2-agonists with a rapid onset of action, which have a powerful bronchodilator effect, but have little effect on the functioning of the heart (P1-adrenergic receptors predominate in the cardiovascular system). In this case, preference is given to salbutamol drugs (Ventolin, etc.), the selectivity of which is maximum.

The main anti-inflammatory drugs for the treatment of asthma are ICS. Well-controlled, evidence-based studies have demonstrated their effectiveness in improving respiratory function, reducing airway hyperresponsiveness, reducing symptoms, and reducing the frequency and severity of exacerbations (Evidence Level A).

The anti-inflammatory effect of IGCs is associated with their inhibitory effect on inflammatory cells and their mediators, including the production of cytokines, interference with the metabolism of arachidonic acid and the synthesis of leukotrienes and prostaglandins, decreased permeability at the level of the microvasculature, prevention of direct migration and activation of inflammatory cells, increased sensitivity of P -smooth muscle receptors. Inhaled glucocorticosteroids increase the synthesis of anti-inflammatory proteins (lipo-cortin-1), increase apoptosis and reduce the number of eosinophils by inhibiting interleukin-5. Thus, ICS lead to the stabilization of cell membranes, reduce vascular permeability, improve the function of P-receptors (both through the synthesis of new P-receptors and by increasing their sensitivity to drug effects), and stimulate epithelial cells.

Fluticasone propionate (FP) is one of the most highly active anti-inflammatory drugs available today. The drug has low systemic bioavailability (-1%), and its absolute bioavailability is 10-30% depending on the type of inhaler. Fluticasone has a high affinity for glucocorticoid receptors and has a long-lasting relationship with the receptor. To prevent hoarseness and the development of candidiasis, when taking FP, you should follow the same rules as when taking other ICS, i.e. rinse your mouth and throat with water after inhalation. Due to the high anti-inflammatory effect, FP is also indicated for patients with severe asthma and dependence on systemic glucocorticosteroids.

Studies in the 1980s showed that patients who regularly took short-acting ß-agonists before taking ICS had significantly greater clinical effectiveness of therapy than those patients who used these drugs only on demand. This necessitated the creation of a class of selective long-acting β-agonists (LABAs). These drugs are represented by inhaled salmeterol and formoterol, which in combination with ICS are the basis of the basic therapy of BA, and in combination with ICS and bronchodilators of other classes - the basis of the basic therapy of chronic obstructive pulmonary disease. The inclusion of inhaled LABAs (salmeterol and formoterol) in the treatment regimen of patients whose asthma cannot be fully controlled with various doses of ICS allows for better disease control than simply increasing the dose of ICS by 2 times or more (Evidence Level A). Thus, the combination of ICS + LABA is currently the mainstay of therapy for BA in adults with moderate to severe disease and in children with severe disease. These classes of drugs (ICS and LABAs) should be considered as synergists, due to their complementary effects at the molecular and receptor levels. It is important to note that the anti-inflammatory effects of LABA cannot play a decisive role in patients with BA, since a decrease in the sensitivity of ß2-adrenergic receptors (desensitization) and down-regulation (decrease in the number of receptors) in inflammatory cells occur faster than in bronchial myocytes. Therefore, with systematic use of ß2-adrenergic receptor stimulants, tolerance to their anti-inflammatory effects develops quite quickly. However, due to the fact that ICS are able to increase the number and improve the function of ß2-adrenergic receptors, reducing their desensitization and down-regulation, when ICS and ß2-agonists are co-administered, the anti-inflammatory activity of LABAs can manifest itself clinically.

Salmeterol xinafoate (SAL) is an inhaled LABA. Clinical studies have shown that this class of drugs has a stabilizing effect on mast cells and inhibits their IgE-mediated release of histamine, which leads to a decrease in systemic and local histamine concentrations. Salmeterol is prescribed only as a drug for basic therapy and is not used as needed. Only recommended doses should be used, and short-acting ß2-agonists should be used to relieve symptoms. It should be noted that SAL also has a number of unexpected properties, in particular, this drug causes a decrease in the pathogenicity of P. aeruginosa and has a protective effect against H. influenzae in cultures of the respiratory tract epithelium.

Seretide is a combination of FP and SAL. In a study by S. Kirby et al. It was found that when using a combination of SAL and FP in healthy people, no systemic pharmacodynamic or pharmacokinetic interactions were observed. The GOAL (Gaining Optimal Asthma control) study, the results of which formed the basis for the asthma control strategy presented in GINA 2006, demonstrated the benefits of combination therapy with ICS + LABA for moderate to severe asthma. The results of the GOAL study have important practical significance, since it formulates criteria for the effectiveness of asthma treatment. In this study, 71% of asthma patients treated with a fixed combination of SAL/FP (Seretide) achieved good disease control (according to GlNA criteria) after 12 months of treatment. It is equally important that in the group that received a fixed combination as basic therapy, there were significantly more patients in whom complete BA control was achieved than in the AF monotherapy group. The important finding from the GOAL study is that treatment outcomes can be improved by setting more specific treatment goals, which in turn will require selecting the most effective primary therapy.

In a relatively recent study, N.C. Barnes et al. in patients with persistent asthma, initial therapy with SAL/AF compared with AF ensured faster achievement of control:

Patients with two signs of poor pre-treatment asthma control were 1.65 times more likely to achieve well-controlled asthma;

Patients with three signs of poor pre-treatment asthma control were 2.6 times more likely to achieve well-controlled asthma.

Thus, initial therapy with Seretide is justified when the patient is initially assessed as having moderate asthma (3rd stage of treatment).

If disease control is achieved and maintained for at least 3 months, an attempt should be made to reduce the amount of maintenance therapy stepwise to determine the minimum amount of therapy required to control asthma. It should be remembered that achieving and maintaining asthma control is a long process. Therefore, there is no need to take hasty actions in the form of quickly reducing the dose. At each stage of tapering, asthma control should be assessed. It is also necessary to take into account the fact that discontinuation of combination drugs and transfer to ICS monotherapy often leads to loss of BA control.

Conclusion

Seretide is an original combination drug, which includes a fixed combination of two active components - FP and SAL. The use of original drugs is possible only if there are reliably proven treatment results obtained in clinical studies to study the safety and effectiveness of the drug. Thus, absolutely all adverse reactions are recorded at all stages of clinical trials. This continues for a number of years after the drug is introduced to the market. And these conditions determine both the price and value of original drugs. As stated above, the main goal of asthma treatment is to achieve disease control. In numerous clinical studies

The high effectiveness of Seretide has been demonstrated in studies. The drug allows you to achieve symptom relief thanks to LABA (thereby increasing patient compliance) and at the same time receive a maintenance dose of ICS, which affects inflammation in the airways and improves disease control. In addition, the use of fixed combinations reduces direct and indirect costs of treatment compared to the use of the same drugs in individual inhalers. It should be remembered that this drug is not prescribed to relieve asthma symptoms. For this purpose, it is preferable to use short-acting P2-agonists. If it is necessary to increase the dose of ICS, the permissible dose of SAL should not be exceeded. In this case, the patient should be prescribed Seretide with a higher content of FP.

References

1. Global Initiative for Asthma. Workshop Report, 2006 // http://www.ginasthma.Org/documents/5/documents_variants/31

2. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Update 2009 // http://www.siaip.it/upload/879.pdf

3. Ogorodova L.M., Kobyakova O.S. // Allergology. 2005. No. 2. P. 50.

4. Bateman E.D. et al. // J. Allergy Clin. Immunol. 2010. V. 125. No. 3. P. 600.

5. Schatz M. et al. // J. Allergy Clin. Immunol. 2006. V. 117. No. 3. P. 549.

6. Thomas M. et al. // Prim. Care Respira. J. 2009. V. 18. No. 1. P. 41.

7. Ogorodova L.M. and others // Consilium Medicum. 2008. Extra edition. P. 6.

8. Tsoi A.N., Arkhipov V.V. // Rus. honey. magazine 2001. T. 9. No. 21. P. 930.

9. Dolovich M.B. et al.; American College of Chest Physicians; American College of Asthma, Allergy, and Immunology // Chest. 2005. V. 127. No. 1. P. 335.

10. Hall I.P. // Asthma and COPD Basic Mechanisms and Clinical Management. 1st ed. /Ed. by P.J. Barnes et al. London, 2002.

11. Barnes P.J. et al. //Am. J. Respira. Crit. Care Med. 1998. V. 157. No. 3. Pt. 2. P. S1.

12. Jeffery P.K. et al. //Am. Rev. Respira. Dis. 1992. V. 145. No. 4. Pt. 1. P. 890.

13. Djukanovic R. et al. //Am. Rev. Respira. Dis. 1992. V. 145. No. 3. P. 669.

14. Suissa S. et al. // N. Engl. J. Med. 2000. V. 343. No. 5. P. 332.

15. Mak J.C. et al. //Am. J. Physiol. 1995. V. 268. No. 1. Pt. 1. P. L41.

16. Pauwels R.A. et al. //Am. J. Respira. Crit. Care Med. 1998. V. 157. No. 3. Pt. 1. P. 827.

17. Barnes P.J. // J. Allergy Clin. Immunol. 1999. V. 104. No. 2. Pt. 2. P. S10.

18. Toogood J.H. et al. // J. Allergy Clin. Immunol. 1989. V. 84. No. 5. Pt. 1. P. 688.

19. Greening A.P. et al. // Lancet. 1994. V. 344. No. 8917. P. 219.

20. Woolcock A. et al. //Am. J. Respira. Crit. Care Med. 1996. V. 153. No. 5. P. 1481.

21. van Noord J.A. et al. // Thorax. 1999. V. 54. No. 3. P. 207.

22. Proud D. et al. // Clin. Exp. Allergy. 1998. V. 28. No. 7. P. 868.

23. Dowling R.B. et al. //Am. J. Respira. Crit. Care Med. 1997. V. 155. No. 1. P. 327.

24. Dowling R.B. et al. //Eur. Respira. J. 1998. V. 11. No. 1. P. 86.

25. Li X. et al. //Am. J. Respira. Crit. Care Med. 1999. V. 160. No. 5. Pt. 1. P. 1493.

26. Kirby S. et al. //Eur. J. Clin. Pharmacol. 2001. V. 56. No. 11. P. 781.

27. Bateman E.D. et al.; GOAL Investigators Group // Am. J. Respira. Crit. Care Med. 2004. V. 170. No. 8. P. 836.

28. Barnes N.C. et al. // Respira. Med. 2007. V. 101. No. 11. P. 2358.

29. Brozek J.L. etal.//http://jamanetwork.com/

This publication was financially supported by GlaxoSmithKline. The opinion of the author may not coincide with the position of the company. GlaxoSmithKline is not responsible for any possible violations of copyright or other rights of third parties resulting from the publication and distribution of this information. RU/SFC/0099/13 10/18/2013

Content

Among chronic diseases of the respiratory system, bronchial asthma is often diagnosed. It significantly worsens the patient’s quality of life, 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 must use certain groups of drugs prescribed by the doctor throughout his life. Medicines help stop the disease and enable a person to lead his 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 must 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 treating the disease is to stop contact with the allergen. Additionally, treatment should solve the following problems:

• reduction in asthma symptoms;
• prevention of attacks during exacerbation of the disease;
• normalization of respiratory function;
• taking a minimum amount of medication without harming the patient's health.

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

Treatment of bronchial asthma cannot be done without medications. The doctor chooses medications 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.
• Emergency supplies. These medications are needed to relieve asthma attacks. Their effect appears immediately after use. Due to the bronchodilator effect, such drugs make the patient feel better. For this purpose, Salbutamol, Atrovent, Berodual, Berotek are used. Bronchodilators are part of not only basic but also emergency therapy.

The basic therapy regimen and certain medications are prescribed taking into account the severity of bronchial asthma. There are four of these degrees in total:

• First. Does not require basic therapy. Episodic attacks are stopped with the help of bronchodilators - Salbutamol, Fenoterol. Additionally, membrane cell stabilizers are used.
• Second. This severity of 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. It 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 B-adrenergic agonists to stop attacks.
• Fourth. This is the most severe stage of asthma, for which theophylline is prescribed in combination with glucocorticosteroids and bronchodilators. The drugs are used in tablet and inhalation forms. An asthmatic's first aid kit already contains 3 basic medications, for example, antileukotriene, an inhaled glucocorticosteroid and long-acting beta-agonists.

Review of the main groups of drugs for bronchial asthma

In general, all medications for asthma 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 medications are indicated for emergency treatment of choking.
• M-cholinergic receptor blockers (anticholinergics). They block the production of special enzymes and promote relaxation of the bronchial muscles. Theophylline, Atrovent, Aminophylline have this property.

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

• Becotide;
• Budesonide;
• Flixotide;
• Flucatisone;
• Benacort;
• Ingacort;
• Flunisolide.

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, use:

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

Bronchodilators for bronchial asthma

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

• beta-adrenergic agonists (Salbutamol, Fenoterol) – stimulate receptors for the mediators adrenaline and norepinephrine, administered by inhalation;
• anticholinergics (M-cholinergic receptor blockers) – prevent the acetylcholine mediator from interacting with its receptors;
• xanthines (theophylline preparations) - inhibit phosphodiesterase, reducing the contractility of smooth muscles.

Bronchodilators for asthma should not be used too often, since 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 medications:

• 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: coronary heart disease, tachycardia, myocarditis, thyrotoxicosis, glaucoma, epileptic seizures, pregnancy, diabetes. If the dosage is observed, side effects do not develop. Price: aerosol – 100 rubles, tablets – 120 rubles.
• Spiriva (ipratropium bromide). Daily dose – 5 mcg (2 inhalations). The medicine is contraindicated under the age of 18, during the first trimester of pregnancy. Possible side effects include urticaria, rash, dry mouth, dysphagia, dysphonia, itching, coughing, dizziness, bronchospasm, and pharyngeal irritation. Price 30 capsules 18 mcg – 2500 rub.
• Theophylline. The initial daily dosage is 400 mg. If well tolerated, it is increased by 25%. Contraindications for 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. Price 50 tablets 100 mg – 70 rub.

Mast cell membrane stabilizers

These are anti-inflammatory drugs for the treatment of asthma. Their action is to influence mast cells, specialized cells of the human immune system. They take part in the development of an allergic reaction, which is the basis of bronchial asthma. Mast cell membrane stabilizers prevent calcium from entering them. This occurs by blocking the opening of calcium channels. The following drugs produce this effect on the body:

• Undercut. 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, 2 inhalations are allowed before contact with the allergen. The maximum dose is 16 mg (8 inhalations). Contraindications: first trimester of pregnancy, age less than 2 years. Adverse reactions may include cough, nausea, vomiting, dyspepsia, abdominal pain, bronchospasm, and unpleasant taste. Price – 1300 rub.
• Cromoglicic 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 under 2 years. Cost 20 mg – 398 rub.

Glucocorticosteroids

This group of drugs for bronchial asthma is based on hormonal substances. They have a strong anti-inflammatory effect, relieving allergic swelling of the bronchial mucosa. Glucocorticosteroids are represented by inhaled drugs (Budesonide, Beclomethasone, Fluticasone) and tablets (Dexamethasone, Prednisolone). The following products receive good reviews:

• Beclomethasone. Dosage for adults - 100 mcg 3-4 times a day, for children - 50-100 mcg twice a day (for a release form where 1 dose contains 50-100 mcg of beclomethasone). For intranasal use - 50 mcg in each nasal passage 2-4 times daily. Beclomethasone is contraindicated under the age of 6 years, with acute bronchospasm, non-asthmatic bronchitis. Negative reactions may include coughing, sneezing, sore throat, hoarseness, and 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, anti-leukotriene drugs for bronchial asthma are the first-line drugs of choice. The patient may be prescribed:

• Zafirlukast. The initial dose for ages 12 years and older is 40 mg, divided into 2 doses. You can take a maximum of 2 times 40 mg per day. The medicine may cause increased activity of liver transaminases, urticaria, rash, and headache. Zafirlukast is contraindicated during pregnancy, lactation and hypersensitivity to the composition of the drug. The cost of the medicine is from 800 rubles.
• Montelukast (Singular). Typically 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 if you are allergic 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 a person’s normal breathing. To remove phlegm, you need to make it more liquid. For this purpose, mucolytics are used, i.e. expectorants. They liquefy mucus and force it out by stimulating a cough. Popular expectorant medications:

• Acetylcysteine. Take 2-3 times a day, 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 for stomach and duodenal ulcers, hemoptysis, pulmonary hemorrhage, and pregnancy. The cost of 20 sachets of medicine is 170–200 rubles.
• Ambroxol. It is recommended to take 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 a day.

Antihistamines

Bronchial asthma is provoked by the decomposition of mast cells - mastocytes. They release huge amounts of histamine, which causes the symptoms of this disease. Antihistamines for bronchial asthma block this process. Examples of such medications:

• Claritin. The active ingredient is loratadine. You need to take 10 mg of Claritin daily. It is prohibited to take this drug for bronchial asthma in nursing women and children under 2 years of age. Negative reactions may include headaches, dry mouth, gastrointestinal disorders, drowsiness, skin allergies, and fatigue. A pack of 10 tablets of 10 mg costs 200–250 rubles. Analogues of Claritin include Semprex and Ketotifen.
• Telfast. Every day you need to take 120 mg of this medicine once. Telfast is contraindicated in case of allergies to its composition, pregnancy, breastfeeding, and children under 12 years of age. Often, after taking the pill, headaches, diarrhea, nervousness, drowsiness, insomnia, and nausea occur. Price 10 tablets Telfast – 500 rub. An analogue of this drug is Seprakor.

Antibiotics

Antibiotic medications are prescribed only when a bacterial infection occurs. 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, doctors often prescribe macrolides, cephalosporins and fluoroquinolones. It is better to check the list of adverse reactions in the detailed instructions for these medications, since they are numerous. Examples of antibiotics used for asthma:

• Sumamed. A drug from the macrolide group. Prescribed for use once a day, 500 mg. Treatment lasts 3 days. The dose of Sumamed for children is calculated based on the condition 10 mg/kg. At the age of six months to 3 years, the drug is used in the form of syrup in the same dosage. Sumamed is prohibited in cases of impaired renal and hepatic function and when taken concomitantly with ergotamine or dihydroergotamine. Price 3 tablets of 500 mg – 480-550 rub.

In addition to non-drug treatment, medications from various pharmacological groups are used in the treatment of bronchial asthma. The main goals of drug treatment are to relieve exacerbations and select adequate basic therapy that ensures a normal quality of life. It is important to inform patients about the essence of the disease, methods of preventing attacks and managing the course of bronchial asthma and training them in self-monitoring at home with a peak flow meter and the rules for using metered-dose inhalers.

Treatment of patients should begin with eliminating or limiting contact with allergens and irritating substances at home and at work. Complete smoking cessation should be mandatory. In the presence of focal infection, either conservative or surgical sanitation is necessary. Of great importance is the elimination of negative neuropsychic factors that traumatize patients and the conduct of psychotherapy.

Drug therapy should be aimed primarily at restoring bronchial patency. Of primary importance in regular anti-asthmatic therapy is the inhalation method of drug administration, which ensures its entry into the bronchial tree and a rapid clinical effect at lower doses of the drug compared to tablet forms.

Inhalation of aerosols is carried out using metered-dose inhalers after detailed instructions to the patient on the inhalation technique. The patient is recommended to take a slow breath at the moment of spraying the aerosol, followed by holding his breath for 5-10 seconds.

If patients (children, the elderly and those with diseases of the musculoskeletal system) find it difficult to synchronize their inhalation and administration of the aerosol, spacers are used - devices for volumetric spraying of a medicinal mixture under pressure. There are currently devices for inhalation of drugs in the form of powder or powder, activated by the patient’s own inhalation.

Nebulization (spraying) of salbutamol, Berotek and Berodual through a nebulizing device (nebulizer) is widely used to treat especially exacerbations of bronchial asthma. In stationary conditions, the working gas in the nebulizer is oxygen under pressure; in homes, it is air supplied to the nebulizer by an electric compressor. With nebulization, the required drug doses are significantly higher than those used in metered dose inhalers.

Medicines used as basic therapy: glucocorticoids, β 2 -agonists, anticholinergics, methylxanthines, mast cell degranulation inhibitors, antihistamines, leukotriene receptor antagonists, sedatives.

In the atopic form of bronchial asthma, pathogenetic treatment is carried out - allergen-specific immunotherapy.

Glucocorticoids

Glucocorticoids have an anti-inflammatory and desensitizing effect, reduce the secretory activity of the bronchial glands and improve mucociliary transport. Inhaled corticosteroids are used. These include beclamethasone dipropionate (aldecine, arumet, beclazone, beclocort, beclomet, becodisk, becotide), which is used in the form of microionized aerosols (100 mcg - 2 doses 3 - 4 times a day). In severe cases, the daily dose can be increased to 600 - 800 mcg, using dosage forms containing 200 or 250 mcg of the drug in one dose. The maximum dose in more severe patients may be 1500 - 2000 mcg / day in 3 - 4 doses.

Glucocorticoid drugs for inhalation use include pulmicort, the active substance of which is budesonide. One dose contains 50 or 100 mcg. The drug is used initially at 400 - 1600 mcg / day in 2 - 4 doses, then at 200 - 400 mcg 2 times a day. Pulmicort Turbohaller - Turbohaller (R) - is an inhaler in which the administration of the drug in powder form is activated by the patient's inhalation, and contains 200 doses of the drug with dose volumes of 100, 200 and 400 mcg. The powder is used in doses similar to those of pulmicort inhalations.

For inhalations, Ingacort (flunisolide) and fluticasone propionate 1 mg/day are also used (corresponds to two presses on the bottom of the reservoir in the morning and evening). The maximum dose is 2 mg/day (four presses 2 times a day).

Systemic glucocorticoids

Systemic glucocorticoids (prednisolone, methylprednisolone, dexamethasone, triamcinolone, betamethasone). Treatment should begin with small doses of prednisolone (15 - 20 mg/day) orally. This dose is prescribed for 3-5 days, and only if there is no effect, it is possible to increase the dose of prednisolone to 40-45 mg orally or administer prednisolone intravenously (60-120 mg). Severe exacerbation of bronchial asthma requires immediate intravenous administration of prednisolone or hydrocordisone.

Methylprednisolone is prescribed orally at a dose of 0.02 - 0.04 g / day, dexamethasone - at a dose of 0.012 - 0.08 g / day, triamcinolone - at a dose of 0.008 - 0.016 g / day. Betamethasone is a solution for injection in 1 ml ampoules, containing 0.002 g of betamethasone disodium phosphate and 0.005 g of betamethasone dipropionate. 1 ml is administered intramuscularly once every 2 to 4 weeks.

Glucocorticoids have numerous contraindications: hypertension stage II-III, coronary artery disease with angina pectoris III-IV functional classes, circulatory failure stages II-III, Itsenko-Cushing disease, gastric and duodenal ulcers, active pulmonary tuberculosis, generalized osteoporosis, poliomyelitis, thromboembolic process, endogenous psychoses, epilepsy, old age, condition after recent operations.

Complications of hormonal therapy include allergic reactions, edema and weight gain, Itsenko-Cushing syndrome, osteoporosis and spontaneous bone fractures during long-term treatment, steroid diabetes, thrombosis and embolism, vascular fragility, hemorrhages in the skin, activation of chronic infectious processes, development of acute purulent inflammatory diseases (boils, abscess, otitis, etc.), exacerbation of latent gastric and duodenal ulcers, development of peptic ulcers and phlegmonous gastritis, mental disorders, increased neuromuscular excitability, euphoria, insomnia. Long-term treatment with glucocorticosteroids causes suppression of the function of the adrenal cortex with possible atrophy of the adrenal glands, and in women - disruption of the menstrual cycle.

Taking into account possible complications, treatment with hormones should be carried out with mandatory monitoring of blood sugar levels, blood clotting, blood pressure, diuresis and the patient’s weight. To avoid increased secretion of hydrochloric acid and pepsin in the stomach and to prevent the development of peptic ulcers when taking corticosteroids, patients should be prescribed antacids. To reduce side effects during treatment with glucocorticoids, patients need a diet with sufficient protein, increase potassium intake to 1.5 - 2 g/day and reduce the administration of chlorides.

The end of treatment should be carried out by gradually reducing the dose, since sudden cessation may cause an exacerbation of bronchial asthma. Typically, the dose of prednisolone is reduced by 2.5 mg (1/2 tablet) every other day until the drug is completely discontinued. Within 3–4 days after discontinuation, small doses of corticotropin (10–20 IU/day) are prescribed to stimulate the function of the adrenal cortex.

β2-agonists

β 2 -agonists relax bronchial smooth muscle by binding to β-adrenergic receptors, which is accompanied by activation of G proteins and an increase in the intracellular concentration of cAMP. Short-acting (salbutamol, fenoterol, terbutaline) and long-acting (salmeterol, formoterol) β 2 agonists are used.

Salbutamol (albuterol, ventolin) is available in inhalers containing 200 doses of 0.001 mg, used in 2 doses 4-6 times a day. Fenoterol (Berotec) is a dosed aerosol, use 2 doses (200 mg) 3-4 times a day. Terbutaline (briquinil) is available in tablets of 2.5 mg and in ampoules with 1 ml of solution - 0.5 mg, prescribed orally at 2.5 - 5 mg 2 - 3 times a day, subcutaneously at 0.25 mg up to 3 times per day.

Long-acting β 2 -agonists act for 9-12 hours. Due to the long latent period (up to 30 minutes), they are not used to treat attacks of bronchial asthma. They are effective for maintenance therapy and prevention of nocturnal and exercise-induced attacks. Salmeterol is a metered aerosol for inhalation, 60 and 120 doses per bottle. It is recommended to take one (50 mcg) or two (100 mcg) inhalation doses per day. Formoterol is available in the form of a metered aerosol (inhalation dose 12 mcg) 1 - 2 doses 1-2 times a day or powder for inhalation (inhalation dose 4.5 - 9 mcg) 2 doses 2 times a day.

β 2 -Agonists have various side effects. Muscle cramps, tremor, headache, paradoxical bronchospasm, peripheral vasodilation and tachycardia are possible in patients with hypersensitivity to β 2 -agonists and when inhalation doses are exceeded. Allergic reactions (urticaria, angioedema, hypotension, collapse) develop less frequently.

Anticholinergic drugs

Anticholinergic drugs (atropine, platyphylline, metacin) reduce or stop spasms of the bronchial muscles during asthma attacks. They can be prescribed to patients with coronary heart disease, sinus bradycardia, atrioventricular blockade and patients who are intolerant to adrenergic agonists. Ipratropium bromide (Arutropide, Atrovent) and tiotropium bromide (Ventilate) have an M-anticholinergic effect.

Ipratropium bromide is used in the form of a metered aerosol of 1-2 doses (0.02 - 0.04 mcg of active substance) on average 3 times a day, it is possible to carry out additional inhalations of 2-3 doses of aerosol for medicinal purposes. Tiotropium bromide is a powder inhaler prescribed at 18 mcg/day.

Anticholinergics in overdose cause dry mouth, dilated pupils with impaired accommodation, thirst, difficulty swallowing and speaking, palpitations, etc. Contraindications for their use are increased intraocular pressure due to the danger of an acute attack of glaucoma and severe disorders of the cardiovascular system.

Combination drugs with bronchodilator effect

There are combination drugs with a bronchodilator effect: combinations of fenoterol and ipratropium bromide - Berodual, Berodual Forte; fenoterol and cromoglicic acid - ditek, which also has an antiallergic effect, drugs with salbutamol - redol - and ephedrine - broncholitin, solutan, theophedrine.

Berodual is a dosed aerosol for inhalation, containing 0.00002 g of ipratropium bromide and 0.00005 g of fenoterol in 1 dose (300 doses in a 15 ml inhaler). Berodual causes a pronounced bronchodilator effect due to the action of the components included in the drug, which have different mechanisms and localization of action. Fenoterol stimulates β2-adrenergic receptors of the bronchi, producing a bronchodilator effect, ipratropium bromide eliminates the cholinergic effect on bronchial smooth muscle. Berodual is prescribed 1 - 2 doses 3 times a day. If there is a threat of respiratory failure - 2 doses of aerosol, if necessary after 5 minutes - 2 more doses, subsequent inhalation is carried out no earlier than 2 hours later.

Berodual forte is a dosed aerosol for inhalation. The inhaler contains 100 and 40 mcg of active substances, respectively. The first dose is administered as early as possible in the morning, the last dose before bedtime. In an acute situation, a second dose may be administered if there is no effect from the first inhalation within 5 minutes.

Ditek is a metered aerosol containing 0.05 mg of fenoterol hydrobromide and 1 mg of disodium cromoglycate in 1 dose, in a 10 ml inhaler (200 doses). Fenoterol is a β2-adrenergic agonist. Disodium cromoglycate has a pronounced effect on mast cells, suppressing the release of allergy mediators, preventing an immediate bronchial immune response and delayed bronchial reactions. The combined use of these drugs makes it possible to increase the effectiveness of their action and use the components in small doses. Prescribe 2 doses of aerosol 4 times a day (morning, afternoon, evening and before bedtime). In case of bronchospasm, additional inhalation of 1-2 doses of aerosol is necessary. If there is no effect, inhale 2 more doses after 5 minutes. Subsequent inhalations are carried out no earlier than 2 hours later.

Methylxanthines

Xanthine derivatives and phosphodiesterase inhibitors: theophylline (diphylline, durophylline, retafil, teopek, theotard, euphyllong) and aminophylline (euphylline) increase the accumulation of cyclic adenosine monophosphate in tissues, which reduces the contractile activity of smooth muscles, and thereby has a relatively weakly expressed bronchodilator effect. Sometimes theophylline prevents respiratory muscle fatigue and respiratory failure.

Theophylline preparations are added to treatment if significant improvement cannot be achieved with inhalation agents. Long-acting theophylline preparations are usually prescribed at 200–400 mg orally 2 times a day. It is necessary to monitor the level of theophylline in the blood.

Aminophylline is a combination of theophylline with ethylenediamine, which facilitates its solubility and improves absorption. Aminophylline is available in tablets of 0.1 g and retard tablets of 0.35, ampoules for intravenous administration of 10 ml (0.24 g of active substance) and intramuscular administration of 1 ml (0.25 g of active substance) and rectal suppositories 0 ,36 g. The drug is prescribed orally at 100 - 200 mg 3 - 4 times a day, if necessary, the dose can be increased at intervals of 3 days. Treatment with retard tablets begins with 175 mg (0.5 tablets) every 12 hours, followed by increasing the dose every 3 days. In emergency situations, intravenous administration of the drug is used at an average dose of 240 mg up to 3 times a day.

When xanthine derivatives are taken orally, dyspeptic disorders (nausea, vomiting, diarrhea) and poor sleep when taken at night are possible. With rapid intravenous administration of aminophylline, dizziness, palpitations, headache, convulsions, decreased blood pressure, and rhythm disturbances are possible. Therefore, methylxanthines are contraindicated in patients with acute myocardial infarction, with a sharp decrease in blood pressure, with circulatory failure with hypotension, paroxysmal tachycardia and extrasystole.

Mast cell degranulation inhibitors

Widely used in the treatment, especially of atopic bronchial asthma, cromoglycic acid, intal (sodium cromoglycate), cromoglin (cromoglycic acid disodium salt) and nedocromil, which inhibit mast cell degranulation and the release of mediator substances that cause bronchospasm and inflammation.

Cromoglycic acid (metered aerosol dose 5 mg) is used for bronchospasm that occurs during physical activity, 5 - 10 mg 4 times a day. Cromoglin (metered-dose aerosol for intranasal use, dose 2.8 mg) is used in 1 - 2 doses 4 - 6 times a day to prevent attacks of bronchial asthma caused by stress. Nedocrolin (metered-dose aerosol, dose 4 mg) is used in 2 doses 2 - 4 times a day for attacks of bronchial asthma that occur during physical activity.

All drugs are used 15 - 60 minutes before physical activity or contact with other provoking factors (inhalation of cold air, contact with dust or chemical compounds). These drugs are not used to treat attacks of bronchial asthma. Inhalations of drugs are carried out daily. The clinical effect occurs within 2 - 3 weeks from the start of treatment. After the patients’ condition improves, the number of inhalations is gradually reduced and a maintenance dose is selected, which patients should use for a long time up to 1-1.5 months. Cromoglicic acid can be used in combination with bronchodilators and corticosteroids. In this case, the dose of corticosteroids can be significantly reduced, and in some patients their use can be completely stopped.

Antihistamines

Antihistamines have a stabilizing effect on mast cell membranes. Use ketotifen (zaditen) orally 1 mg 2 times a day, loratadine orally 10 mg once, chlororiramine orally 25 mg 2-3 times a day in the treatment of mild to moderate severity of bronchial asthma.

Leukotriene receptor antagonists

Leukotriene receptor antagonists (zafirluxate, monteluxate) are new anti-inflammatory and anti-asthma drugs that reduce the need for short-acting β2-adrenergic agonists. Zafirluxate is used 20 mg orally 2 times a day, monteluxate - 10 mg 1-2-4 times a day. The drug is used to prevent bronchospasm attacks mainly in persistent “aspirin-induced” asthma.

Mucus thinners

To improve bronchial patency, sputum thinners are prescribed: 3% solution of potassium iodide, infusions and decoctions of thermopsis and marshmallow, breast herbs, etc., plenty of hot drinks. Mucolytic drugs (acetylcysteine, trypsin, chymotrypsin) are contraindicated in patients with bronchial asthma due to the risk of increased bronchospasm. An effective way to liquefy sputum is steam oxygen inhalation.

Psychotropic and sedatives

The complex of measures in the treatment of bronchial asthma should include various types of individual and group psychotherapy (pathogenetic, rational, suggestion in the waking and hypnotic state, autogenic training, family psychotherapy), acupuncture, psychotropic and sedatives.

Psychotropic and sedatives have a calming effect on the central nervous system, cause muscle relaxation, have anticonvulsant activity, and have a moderate hypnotic effect.

• Among psychotropic drugs, it is advisable to use chlordiazepoxide (Elenium, Napoton), diazepam (Seduxen, Relanium), oxazepam (tazepam, nozepam) orally 5-10 mg once a day.
• Sedatives, by enhancing inhibition processes or reducing excitation processes in the cerebral cortex, help restore balance between the processes of excitation and inhibition. The group of sedatives includes bromcamphor, valerian root, motherwort herb, Corvalol, etc.

Treatment of exacerbation and basic therapy of bronchial asthma

Exacerbation of bronchial asthma is manifested by an increase in the frequency of asthma attacks, accompanied by an increase in respiratory failure, prolongation of bronchial obstruction, characterized by a feeling of lack of air and severe expiratory shortness of breath.

Relief of exacerbation

To relieve an exacerbation, it is preferable to use infusion forms of drugs - systemic glucocorticoids (prednisolone and dexamethasone) to achieve a quick effect. The initial dose of prednisolone intravenously is 60 - 90 mg. The dose is subsequently adjusted depending on the patient's condition until it stabilizes. When intravenous administration of glucocorticoids is discontinued, they are replaced with inhaled forms, the doses of which depend on the severity of bronchial obstruction.

To quickly relieve bronchial obstruction, inhaled forms of short-acting β2-agonists (fenoterol, salbutamol), anticholinergics (ipratropium bromide, tiotropium bromide) and tablet forms of short- and long-acting methylxanthines (aminophylline, theophylline) are also used. Mucolytic and antihistamine drugs are contraindicated in the acute period due to possible difficulty in drainage of bronchial secretions. To facilitate inhalation of bronchodilator drugs, the use of nebulizers is preferable.

In case of exacerbation of bronchial asthma against the background of activation of chronic foci of infection (purulent sinusitis, bronchitis, cholecystitis) or with the development of pneumonia, antibacterial therapy is indicated, taking into account the sensitivity of the flora and the possible adverse effect of antibiotics on the course of the disease. Macrolides (rosithromycin, rovamycin), aminoglycosides (gentamicin, kanamycin) and nitrofuran drugs are effective. Antibiotics should be prescribed in combination with antifungal drugs.

In the general complex of measures in stopping exacerbation of bronchial asthma, physical methods of treatment and physical therapy occupy an important place. They use inhalation of heated mineral waters, chest massage and breathing exercises, which improve the drainage function of the bronchial tree. It is possible to influence the microwave field (decimeter waves) on the area of ​​the adrenal glands in order to stimulate the release of endogenous glucocorticoids.

Basic therapy

Currently, in the treatment of bronchial asthma, a “stepped approach” is used, in which the intensity of therapy depends on the severity of bronchial asthma (stepped therapy). This approach allows you to monitor the effectiveness of the therapy. When the patient’s condition improves, the dose and frequency of medication taken are reduced (step down), and when the patient’s condition worsens, they are increased (step up). During remission, 1.5 - 3 months after the exacerbation subsides, prompt sanitation of foci of infection in the nasopharynx and oral cavity is recommended.

Stepped therapy for bronchial asthma

Stage 1. Irregular use of bronchodilators

• Therapy: Inhaled short-acting β2-agonists “on demand” (no more than 1 time per week). Prophylactic use of short-acting β2-agonists or sodium cromoglycate (or nedocromil) before exercise or upcoming antigen exposure. Short-acting oral β2-agonists or theophyllines or inhaled anticholinergics may be used as an alternative to inhaled β2-agonists, although their onset of action is delayed and/or they have a higher risk of side effects.
• Note: Go to step 2 if the need for bronchodilators is more than 1 time per week, but not more than 1 time per day; check compliance, inhalation equipment.

Stage 2. Regular (daily) use of inhaled anti-inflammatory drugs

• Therapy: Any inhaled corticosteroid at a standard dose (beclomethasone dipropionate or budesonide 100-400 mcg twice daily, fluticasone propionate 50-200 mcg twice daily or flunisolide 250-500 mcg twice daily) or regular use of cromoglycate or nedocromil (but if not achieved control, switching to inhaled corticosteroids) + inhalation of short-acting β2-agonists or alternative drugs “on demand”, but not more than 3-4 times a day.
• Note: High-dose inhaled corticosteroids may be used to treat mild exacerbations.

Stage 3. Use of high-dose inhaled corticosteroids or standard-dose inhaled corticosteroids in combination with inhaled long-acting β2-agonists

• Therapy: Inhaled short-acting β2-agonists or alternative drugs “on demand”, but not more than 3-4 times a day, + any high dose inhaled corticosteroid (beclomethasone dipropionate, budesonide or flunisolide up to 2.0 mg in divided doses; recommended use large spacer) or standard doses of inhaled corticosteroids in combination with inhaled long-acting β2-agonists (salmeterol 50 mcg twice daily or formoterol 12 mcg twice daily for those over 18 years of age).
• Note: In rare cases, if there are problems with the use of high doses of inhaled corticosteroids, standard doses can be used together with any inhaled prolongated β2-agonist or oral theophylline, or cromoglycate or nedocromil.

Stage 4. The use of high doses of inhaled corticosteroids in combination with regular bronchodilators

• Therapy: Inhaled short-acting β2-agonists "on demand", but not more than 3-4 times a day, + regular use of high doses of inhaled corticosteroids + sequential therapy with one or more of the following:
  • inhaled long-acting β2-agonists
  • oral extended-release theophylline
  • inhaled ipratropium bromide
  • oral long-acting β2-agonists
  • cromoglycate or nedocromil.
• Note: Review treatment every 3-6 months. If step-by-step tactics achieve a clinical effect, then a reduction in drug doses is possible; if treatment has recently been started from step 4 or 5 (or includes tablet corticosteroids), the reduction may occur in a shorter interval. In some patients, a reduction to the next level is possible 1-3 months after the condition has stabilized.

Bronchoobstruction is a sharp spasm of the respiratory system, which causes severe lack of air, shortness of breath and cough. To avoid or relieve signs of respiratory failure, basic therapy for bronchial asthma is used.

The treatment uses certain drugs that have proven themselves in relation to this pathology throughout many clinical trials.

These medications are mostly hormone-containing. Therefore, all medications to relieve an attack should be taken only with the prescription of a pulmonologist.

Treatment Goals

Drug treatment is prescribed to those patients who are bothered by an allergic cough, wheezing, shortness of breath and evening attacks of breathlessness. When a specialist prescribes drugs, several goals are pursued at once.

The tasks that basic therapy for bronchial asthma implies:

1. Control over emerging symptoms.
2. Maximum prevention of side effects from medications taken.
3. Reducing the incidence of seizures, as well as deaths from them.
4. Teaching an asthmatic to provide emergency care to himself during asthmatic manifestations.
5. Diagnosis of the body's reaction to the drug received, as well as dose adjustment as necessary.

The main goal of drug treatment, which combines all of the above stages, is to prevent the development of a severe stage of the disease, in which asthma is uncontrollable.

Only an experienced asthmatic who discusses all his actions with a doctor can select medications based on the main objectives of basic treatment. It is almost impossible to independently diagnose bronchial asthma and distinguish it from other pathologies of the bronchopulmonary system, so using medications on your own is not recommended. This rash step can subsequently affect the severity of the disease and its outcome.

What influences the selection of a treatment regimen?

Since medications for the treatment of asthma are strong and fast-acting, initial basic therapy involves the use of small dosages. A specialist can modify the original scheme depending on many factors.

Among which:

• frequency, intensity and duration of bronchial obstruction;
• severity of nocturnal suffocating attacks;
• general condition of the patient;
• the presence of accompanying symptoms (cough, shortness of breath, wheezing);
• test results;
• anamnesis aggravated by other pathologies of the respiratory system.

In all cases, a set of medications is prescribed to eliminate the patient’s main problems. The main goal of the treatment process is the relief of all signs of bronchial asthma and persistent relapse.

What medications are used

Basic treatment of bronchial asthma involves the use of a complex of medications, including glucocorticosteroids, as well as other groups of medications. Treatment should eliminate shortness of breath, prevent suffocation, relieve spasm and swelling of the bronchi, remove phlegm from the lungs and reduce the body's reaction to the allergen.

Inhaled glucocorticosteroids

This group of drugs is mandatory and basic in the treatment of bronchial asthma attacks. The main advantage of inhalation use of the drug is the administration of the drug directly to the destination site. Inhaled glucocorticosteroids relieve bronchial obstruction in the shortest possible time.

Additional benefits include:

1. Possibility of using minimal therapeutic doses.
2. Relieving inflammation in the bronchi.
3. Reducing the severity of all clinical manifestations.
4. Improving bronchial patency.
5. Due to low bioavailability, large amounts of the drug are not absorbed into the bloodstream.

However, this method of administering glucocorticosteroids has its side effects. The most commonly observed candidiasis of the oropharynx and hoarseness, which is diagnosed in 25% of patients or more.

If this happens, the dosage is reduced or the aerosol drug is replaced with a powder inhaler.

Medicines from this group that are most often used:

• Budesonide;
• Fluticasone;
• Mometasone;
• Beclomethasone.

Such glucocorticosteroids are used in dilution with saline using a pocket or mask inhaler.

Glucocorticosteroids for oral administration

If glucocorticosteroids for inhalation are designed to quickly eliminate respiratory failure (and successfully cope with this), then oral medications are prescribed in more serious situations.

Basic actions:

1. Relieving spasm in the bronchopulmonary system.
2. Elimination of bronchial inflammation.
3. Prevention of sputum hypersecretion.
4. Improving air permeability in the respiratory system.

Glucocorticosteroids in tablets are not prescribed to every patient diagnosed with bronchial asthma. There are several good reasons for this.

When is the use of this group of drugs indicated:

1. A sharp decrease in spirometry readings.
2. Ineffectiveness of previously prescribed therapy (inhalation agents).
3. Severe stages of asthma.
4. Disturbed night sleep due to respiratory failure.
5. Symptoms of asthma persist throughout the day.
6. The occurrence of bronchial obstruction more than once a week.

The tablets are taken in a course, regardless of the improvement in the patient’s condition. In severe stages, intravenous administration of fast-acting glucocorticosteroids is indicated.

The most commonly used drug in this group of drugs is Prednisolone.. The dosage varies based on the severity of asthmatic symptoms.

Mast cell stabilizers

Mast cell membrane stabilizers also take part in the formation of basic therapy for bronchial asthma. They involve the treatment of patients with mild disease, as well as moderate.

The main actions of this group of drugs:

1. Prevention and relief of allergic reactions.
2. Preventing the development of bronchospasm.
3. Relieving inflammation.
4. Reducing bronchial hyperactivity.

Sometimes mast cell stabilizers may cause mild weakness, drowsiness, and dry mouth. In very rare cases, an allergic reaction occurs.

Medicines used by the specialist:

• Ketotifen;
• Cromoglicic acid;
• Lodoxamide;
• Nedocromil sodium;
• Tranilast.

Mast cell membrane stabilizers help prevent bronchospasm, but they cannot stop it on their own. Therefore, they are suitable for use in combination with other drugs.

Leukotriene antagonists

Leukotriene receptor antagonists are designed to eliminate cysteinyl leukotrienes. They, in turn, are substances that are among the first to provoke an allergic reaction and bronchospasm to external irritants. Medicines help reduce the body's response, preventing the development of severe stages of asthma.

The main actions of this group of drugs:

1. Relieving bronchospasm.
2. Increased permeability of small vessels in the respiratory system.
3. Preventing hypersecretion of mucus produced.
4. Removing infiltration and inflammation from the mucous tissues of the bronchi.
5. Relaxation of the smooth muscles of the respiratory system.

The most commonly used leukotriene receptor antagonist is Montelukast.. Zafirlukast or Zileuton are prescribed less frequently, and the latter has high hepatotoxicity.

Treatment of asthma in children

Basic therapy for bronchial asthma in children also involves taking a complex of medications. The main goal of such treatment is to improve the child’s quality of life and promote stable remission.

The doctor evaluates the parents’ complaints about the manifestations of symptoms in the baby, including:

• presence and intensity of cough reflex;
• number of attacks per month, week;
• general well-being of the child;
• cyanosis of the skin;
• presence of wheezing in the chest.

Besides, Medical prescriptions directly depend on the severity of asthma in the baby, as well as the number of visits to a pulmonologist over the past year. After a thorough diagnosis, medications are prescribed to form asthma therapy.

Prevention

The use of medications to relieve suffocation is not a panacea. The basis of basic treatment of bronchial obstruction is its prevention and elimination of all predisposing factors from the patient’s life.

Otherwise, the condition of the asthmatic will worsen immediately after the completion of the next drug complex.

What else needs to be done:

• prevent inhalation of allergens (tobacco smoke, dust, dust mites, wool, mold, household chemicals, etc.);
• lead a healthy lifestyle;
• do not take medications for the treatment of asthma without prior consultation with a pulmonologist, do not change the dosage and duration of use on your own;
• refuse to keep pets;
• change your field of activity if it regularly exposes you to triggers;
• treat concomitant diseases of the bronchopulmonary system;
• be especially vigilant during the season of outbreaks of acute respiratory viral infections and influenza;
• purchase an air washer or consider using other gadgets to purify the air space in the room where an asthmatic lives.

Medicines are designed to control bronchial asthma and eliminate its manifestations. But without proper prevention, the disease will only progress, and the dosage will increase more and more. Therefore, the patient first of all needs to think about removing all factors that lead to illness from his own life.

Basic therapy for bronchial asthma allows you to suppress inflammation in the airways, reduce, and reduce bronchial hyperreactivity. Such treatment is suppressive, controlling and preventive in nature.

Attention! The course is developed for a specific patient. Age, severity of the pathology, general health, and other personal characteristics are taken into account.

Basic therapy for one of the most common diseases - bronchial asthma - involves the implementation of the following actions.

• Educating the patient on the features of monitoring and assessing the severity of the disease.
• Developing a treatment plan for the situation if an exacerbation occurs.
• Ensuring systematic visits to the doctor to monitor and adjust the developed plan, for example, when using.
• Maximum elimination of allergens and dangerous provoking factors (for example, avoidance of excessive physical activity, which can lead to asphyxia).

Attention! The fourth point is critical. Treatment time and results directly depend on it. The doctor’s competence is not important here; the determining factor is how accurately the allergen is identified, as well as how accurately the patient adheres to the recommendations to avoid contact with such an allergen.

During the treatment process, it is important to adhere to certain tasks:

• strict control of symptoms;
• support of lung functions at an appropriate level;
• development of a personal physical activity plan;
• eliminating side effects from medications used;
• preventing exacerbations;
• exclusion of progression of irreversible obstruction.

Attention! These tasks help to understand in more detail the features of asthma treatment.

Basic therapy for bronchial asthma: important nuances

Basic therapy for infectious and mixed bronchial asthma involves the prescription of basic medications (usually taken for life) and drugs that alleviate symptoms and help (can be used situationally or to prevent an attack).

Attention! You cannot refuse basic medications, even if the condition has improved. The disease will begin to appear again. Only control cancellation is allowed.

Physiotherapy is often prescribed for and other bronchial asthma. Various plants are also used (the most popular are thyme, wild rosemary, anise, plantain, coltsfoot, hyssop, violet, and marshmallow). Herbal medicine is recommended in the first three stages of the pathology. Further, the meaning in it disappears, because the plants cease to have even the slightest effect.

Attention! It is impossible to completely cure asthma. The main goal of the doctor is to improve the patient’s quality of life.

The principles of treatment of daytime and nighttime bronchial asthma are as follows.

• Controlled course: no nighttime symptoms, daytime symptoms occur two or less times a week, exacerbations go away, breathing remains normal.
• Weekly disease analysis.
• : 3 or more signs are observed every 7 days.

The tactics for subsequent actions are determined based on the above principles. The specifics of the treatment being carried out at a particular moment must be taken into account.

Basic treatment of asthma in children

Basic treatment of bronchial asthma in young patients is carried out comprehensively. It is important to achieve sustainability. The length of time the initial symptoms appeared, the presence of chronic diseases, and current health are of great importance.

In children, symptoms manifest themselves with markedly unequal intensity. There are:

• difficulty breathing;
• wheezing;
• dyspnea;
• asphyxia;
• deterioration of health;
• blue skin near the nose.

Young patients are prescribed inhaled glucocorticoids, drugs with an anti-inflammatory effect, and long-acting bronchodilators.

Basic treatment of asthma in adults

Basic drugs for the treatment of bronchial asthma help prevent the patient’s well-being from deteriorating. Prescribed:

• inhaled glucocorticosteroids,
• systemic glucocorticosteroids,
• mast cell stabilizers,
• leukotriene antagonists.

Inhaled glucocorticosteroids are indispensable for eliminating attacks. They have an anti-inflammatory effect and act in the shortest possible time. Such inhalations allow you to achieve the following:

• reduce the intensity of pathology symptoms;
• increase permeability in the bronchi;
• eliminate inflammation;
• minimize the entry of the active components of the drug into the general bloodstream.

You can take small doses of the medication. This is most relevant for patients who have chronic diseases.

Thanks to inhalation agents, it is possible to eliminate the attack. For the basic treatment of bronchial asthma, glucocorticosteroids in tablet form are required. They are prescribed for severe conditions. With their help it is possible to:

• get rid of spasms in the bronchi;
• reduce the volume of sputum produced;
• eliminate the inflammatory process;
• increase the patency of the respiratory tract.

Attention! You should not take these medications on your own. You should definitely consult your doctor.

Mast cell stabilizers reduce inflammation. Suitable for people with mild to moderate disease. Such medications can effectively:

• reduce bronchial hyperreactivity;
• eliminate and prevent allergies;
• prevent spasms from occurring.

Leukotriene antagonists block leukotriene receptors and inhibit the activity of 5-lipoxygenase enzymes. If you do not take such drugs, the body will inevitably react to allergens. They relieve even severe inflammation, eliminate spasms, reduce the volume of sputum, relax smooth muscles, and increase the permeability of small vessels of the respiratory system.

Please share this material on social networks so that even more people learn about methods of treating bronchial asthma. This will help them monitor the manifestations of the disease and take the necessary measures in time to block an attack.