Symptomatic drugs in the treatment of bronchial asthma are. What is the basic therapy of bronchial asthma

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 tendency towards an increase in the incidence of allergic diseases, including bronchial asthma.

It is this circumstance that has 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 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. If predisposed, this inflammation leads to repeated episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and / or in the 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 an increased sensitivity of the airways to a variety of stimuli, which do not cause any reaction in healthy individuals. This condition is bronchial hyperreactivity, which can be specific and non-specific. Specific hyperreactivity is an increased sensitivity of the bronchi to certain, specific allergens that cause asthma. Nonspecific hyperreactivity is understood as an increased sensitivity to various nonspecific stimuli of a non-allergenic nature: cold air, physical exertion, pungent odors, stress, etc. component of 20% or more.

Allergic mechanisms cause asthma in 80% of children and in about 40-50% of adults, therefore the European Academy of Allergology and Clinical Immunology (EAACI) suggests using the term "allergic asthma" as the main definition of asthma caused by an immunological mechanism, and in those cases, when the participation of antibodies of the immunoglobulin E class in this mechanism is proven, hence the term "IgE-mediated asthma". In our country, the term "atopic asthma" is used to refer to this option. The definition fully reflects the essence of the process in which IgE antibodies are involved. Other non-immunological types of asthma EAACI are proposed to call non-allergic asthma. Apparently, this form can be attributed to asthma, which develops due to impaired metabolism of arachidonic acid, endocrine and neuropsychiatric disorders, impaired 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) that is responsible for the development of the disease. It is possible to completely remove the allergen, if we are talking about a pet, food or medicine, and only thanks to this to achieve remission of bronchial asthma. But more often the development of asthma is provoked by a house dust mite, which cannot be removed completely. However, the number of dust mites can be significantly reduced by using special non-allergenic bedding and acaricidal products, and by regularly wet cleaning with a deep vacuum cleaner. All these measures, as well as measures to reduce the pollen content in the air of residential premises during the flowering season and measures to minimize contact with spores of non-domestic and intra-household non-pathogenic molds, lead to a significant reduction in the symptoms of bronchial asthma in patients sensitive to these allergens.

Pharmacotherapy is an integral and most important 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 it cannot be cured;
• inhalation method of administration of 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 for controlling 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 bronchodilators.

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 (ICS) are indicated for all patients with persistent asthma, including those with a mild course, because even with this form of asthma, all elements of chronic allergic inflammation are present in the respiratory tract mucosa. Unlike systemic steroids, which, in turn, are the agent of choice in 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) they can 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 -agonist drugs. It has been proven that the anti-inflammatory efficacy of ICS depends on the dose; therefore, it is advisable to start treatment with medium and high doses (depending on the severity of asthma). When a stable state of patients is reached (but not earlier than 1-3 months after the start of ICS therapy) and the FVD indicators improve, the dose of ICS can be reduced, but not canceled! In case of worsening asthma and a decrease in pulmonary functional parameters, 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 by using 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 sodium nedocromil (cromones) suppress the release of mediators from the mast cell by stabilizing its membrane. These drugs, prescribed before exposure to the allergen, can inhibit early and late allergic reactions. Their anti-inflammatory effect is significantly inferior to that of ICS. A decrease in bronchial hyperreactivity occurs only after prolonged (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 leukotriene synthesis inhibitors, represent a relatively new group of anti-inflammatory drugs used to treat asthma. In Russia, the drugs zafirlukast (acolat) and montelukast (singular), leukotriene receptor blockers, presented in a form for oral administration, are currently registered and approved for use. The anti-inflammatory effect of these drugs consists in blocking the action of leukotrienes - fatty acids, decomposition products of arachidonic acid, involved in the formation of bronchial obstruction. In recent years, there have been many works 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 asthma 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, since they are easy to use and cause a relatively low risk of serious side effects compared to ICS. In recent American 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 currently a lot of studies demonstrating the effectiveness of these drugs in persons suffering from moderate to severe asthma, to whom leukotriene receptor antagonists are prescribed as an adjunct to ICS. This combination of drugs, potentiating each other's action, 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) therapy of asthma in the following situations:

• mild, persistent asthma;
• childhood asthma;
• exercise asthma;
• aspirin asthma;
• nocturnal asthma;
• acute allergen-induced asthma;
• moderate to severe asthma;
• GCS phobia;
• asthma, which is not satisfactorily controlled by safe doses of GCS;
• treating patients who have difficulty using the inhaler;
• treatment of patients diagnosed with asthma in combination with allergic rhinitis.

Bronchodilator drugs are used both to relieve an acute asthma attack in its chronic course, and to prevent exercise asthma, acute allergen-induced asthma, as well as to relieve severe bronchospasm during exacerbation of bronchial asthma.

Key provisions 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 period (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 with severe attacks in case of exacerbation of asthma. However, short-acting β 2 -agonists should only be used to relieve asthma attacks. They are not recommended for continuous, basic therapy, since they are unable to reduce airway inflammation and bronchial hyperreactivity. Moreover, with their constant and long-term intake, the degree of bronchial hyperreactivity may increase, and the indicators of the function of external respiration may worsen. The second generation β 2 -agonists, or long-acting β 2 -agonists: salmeterol and formoterol, are devoid of these disadvantages. Due to the lipophilicity of their molecules, these drugs are very close to β 2 -adrenergic receptors, which first of all 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. In this case, in addition to a long-term effect, formoterol simultaneously has a rapid bronchodilator effect, comparable to the time of the onset of the action of salbutamol. All β 2 -adrenomimetic drugs 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 maximally manifested 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 β 2 -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 treatment of choice for mild to moderate asthma and for patients with nocturnal symptoms of asthma; they can also be used to prevent exercise asthma. In patients with moderate and severe asthma, it is advisable to combine them with ICS.

Theophyllines are the main 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, the smooth muscles of the bronchi are relaxed, the release of mediators from the inflammatory cells is suppressed and the increased vascular permeability is reduced. Theophylline significantly suppresses both the early and late phases of the asthmatic reaction. Prolonged theophyllines are successfully used to control nocturnal asthmatic symptoms. However, the efficacy of theophylline in acute asthma attacks is inferior (both in the speed 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 administration of β 2 -agonists via 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), which usually develop when the concentration of 15 μg / ml in the peripheral blood is exceeded. Therefore, long-term use of theophylline requires monitoring of its concentration in the blood.

Anticholinergic drugs (ipratropium bromide and oxytropium bromide) have a bronchodilator effect by blocking M-cholinergic receptors and reducing the tone of the vagus nerve. One of these drugs, ipratropium bromide (atrovent), has long been registered in Russia and has been successfully used. In terms of the strength and speed of the onset of the effect, anticholinergic drugs are inferior to β 2 -agonists, 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. It 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 a corticosteroid and a prolonged β 2 -agonist have a complementary effect and their clinical effect significantly exceeds that in the case of monotherapy with ICS or a long-acting β 2 -agonist. Prescribing such a combination can serve as an alternative to increasing the dose of ICS in patients with moderate to severe asthma. Prolonged 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, conversely, 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. The simultaneous use of ICS and a prolonged β 2 -agonist not only eases 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 therapy with ICS alone.

The undoubted advantage of these drugs, especially attracting asthmatic patients, is the combination of two active substances in one inhalation device: a metered aerosol inhaler (seretide AIM) or a powder inhaler (seretid multidisc) and turbuhaler containing preparations in the form of powder (symbicort-turbuhaler) ... The preparations have a convenient two-fold dosing regimen; for symbicort, a single dose is also possible. Seretide is available in forms containing various doses of ICS: 100, 250 or 500 mcg of fluticasone propionate with a constant dose of salmeterol - 50 mcg. Symbicort is available in a dosage of 160 mcg of budesonide and 4.5 mcg of formoterol. Symbicort can be prescribed 1 to 4 times a day, which allows you to control the variable course of asthma using the same inhaler, decreasing the dose of the drug when adequate asthma control is achieved and increasing when symptoms worsen. This circumstance allows you to choose an adequate therapy, taking into account the severity of asthma for each individual patient. In addition, symbicort, due to its fast-acting formoterol, quickly relieves asthma symptoms. This leads to increased adherence to therapy: seeing that treatment helps quickly and effectively, the patient is more willing to comply with the doctor's prescription. It should be remembered that combined drugs (ICS + 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 ICS and prolonged 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 the administration of ICS. The criteria for well-controlled asthma are the absence of nocturnal symptoms, good exercise tolerance, no need for emergency care, the daily need for bronchodilators of less than 2 doses, the peak expiratory flow rate of more than 80% and its daily fluctuations of less than 20%, and the absence of side effects from the therapy.

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

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Bronchial asthma is a disease of the respiratory tract that is steadily progressing and, as a rule, develops 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 bronchial asthma is based on and depends on the level of control of the disease, and not on its severity, which may change over time due to the therapy. Disease control consists of two components: controlling symptoms and minimizing the risks of exacerbation. However, in patients with different levels of disease control, the 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 with an uncontrolled course of bronchial asthma.

The scope of the basic therapy is determined individually and has a stepwise approach. There are 5 stages of bronchial asthma treatment. Each step 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 condition 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 unable to provide the necessary therapeutic effect.

If the symptoms worsen and the condition of the patient being 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 (ICS) are the most effective drugs in the basic therapy of bronchial asthma. ICS is able to reduce the severity of symptoms, improve external respiration and minimize the phenomena 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 for bronchial asthma, glucocorticosteroid molecules are found on the epithelium of the respiratory tract. Then they penetrate the membrane and find themselves in the area where reactions occur that stimulate the release of anti-inflammatory molecules.

Some inhalers used for asthma are:

• Budiair;
• Foster;
• Salmecort.

The clinical effect of glucocorticosteroids is achieved with the appointment of various doses and depends on the degree of the disease. Low doses of ICS reduce the frequency of exacerbations, improve external respiration, reduce inflammation and airway hyperresponsiveness. High doses of ICS are used to reduce bronchial hyperreactivity and better control the course of the disease.

Antileukotriene

Antileukotriene drugs for the treatment of bronchial asthma inhibit the cysteinyl leukotriene receptors in eosinophils and neutrophils. This is responsible for their anti-inflammatory effect. They also have a bronchodilatory effect. This group of drugs has found especially widespread use in aspirin bronchial asthma and polypous rhinosinusitis.

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

Bronchodilators (Euphyllin and others)

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

Pharmacological groups that have a bronchodilator effect include:

• beta-2 adrenergic receptor agonists, which are classified as 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 spasm of the bronchi, 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 the respiratory function and oxygenation of the blood.

It is impossible to select 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)

Prednisolone is actively used in the glucocorticoid group. It does not have a bronchodilator effect, but it has a strong anti-inflammatory effect. Glucocorticoids are prescribed for seizures 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, since otherwise the risk of exacerbations will be high.

Cromones

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

Cough in asthma occurs against the background of expiratory dyspnea and is stopped together with bronchial spasm with the drugs discussed above. To treat a cough not associated with an attack should be based on its nature with the use of antibiotics, mucolytic, antitussive and other agents.

List of the most effective medicines

The list of the most effective medicines 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 adults. The use of omalizumab can successfully control the symptoms of bronchial asthma.
2. Zafirlukast is a drug that has anti-inflammatory and bronchodilatory effects. The mechanism of action of Zafirlukast is based on blocking leukotriene receptors and preventing bronchial contractions. The main indications for the appointment: mild to moderate asthma.
3. Budesonide is a glucocorticosteroid with anti-inflammatory antiallergic action. Budesonide for asthma is used in inhalation form.
4. Atrovent (ipratropium bromide) is an inhaled anticholinergic that has a bronchodilating effect. The mechanism of action is based on inhibition of receptors in the muscles of the tracheobronchial tree and suppression of reflex bronchoconstriction.

With bronchial asthma, patients 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 adjunct to the main treatment and, as a rule, is prescribed by the attending physician if indicated. The procedures are selected individually and according to the recommendations of a specialist.

Massage

Massage for bronchial asthma improves blood circulation, activates the respiratory muscles and increases tissue oxygen saturation. Also, massage helps to eliminate congestion in the lungs and improve airway patency in obstructive syndrome.

Physiotherapy

Physiotherapy for bronchial asthma is represented by various methods that vary depending on the period of the disease. For example, during an exacerbation of asthma, aerosol therapy can be performed 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, electrophoresis of calcium ions is used, as well as phonophoresis of hydrocortisone on the 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 climate therapy, thalasso and balneotherapy. The sanatoriums are located in 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 effect.The most effective folk remedy for treating bronchial asthma is herbal medicine. It involves the use of medicinal plants in the form of inhalation and in tablet forms.

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

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

Respiratory gymnastics refers to physiotherapy exercises and includes the performance of exercises, accompanied by holding the breath.

The purpose of this method is to relieve and prevent 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 of a sufficient amount of liquid per day (not less than 1.5 liters).
3. Limiting the consumption of fatty, fried and spicy foods.
4. Preference is given to steamed and boiled food.
5. It is recommended to eat food in small portions many times a day (5-6 times).
6. The diet should be balanced in protein, fat and carbohydrates.
7. The diet should contain both vegetables and fruits, as well as meat and fish.

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

The drugs used to treat the seizure are preferably inhaled or infused.

Bronchodilator therapy for an attack is represented by rapid-acting beta-2 agonists. Then, after an hour, the patient's condition is monitored and, when symptoms are relieved, the beta-2 agonist is continued to be used for every 3 hours throughout 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.

For severe severity, higher doses of oral and inhaled glucocorticosteroids are also added. Shown hospitalization in the inpatient department.

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 through a nebulizer.
2. Epinephrine (adrenaline) is administered subcutaneously or intramuscularly when breathing is threatened.
3. Artificial ventilation of the lungs and resuscitation measures are carried out in the presence of clinical indications for these procedures.

Bronchial asthma is a respiratory disease that cannot be completely cured.Medications for bronchial asthma are used to provide 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.

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

Conclusion

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

Treatment of bronchial asthma involves the use of both medication and non-medication 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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Bronchial asthma is a chronic disease. An asthmatic person has a constant inflammatory process in the wall of the respiratory tract. Muscle cells in the walls of the bronchi spasm, the lumen for the passage of air narrows. The bronchial tree produces a lot of thick, glassy phlegm that clogs the airways and obstructs breathing. All these aspects of the disease determine the importance of a cardinal approach to therapy for bronchial asthma.

There are a number of standard and alternative medical approaches to treating the disease. The approach is usually determined by the form of the disease: allergic or non-allergic asthma, as well as its stage. At more severe stages of the disease, for example, there will most likely be no point in phytotherapy, however, competent basic drug treatment will acquire special meaning.

The main task of the therapy of bronchial asthma is to reduce or completely eliminate the manifestations of the disease as quickly and for a long time as possible, making the patient's life as comfortable and active as possible at the stage of the disease at which treatment was started.

Over the past few years, a stepwise asthma concept has been developed. Depending on the severity of the disease: the frequency and duration of attacks, their recurrence at night, the presence of symptoms of the disease outside the attack, five stages of asthma were identified. The graded structure of the disease is illustrated in the diagram below.

Medication therapy for bronchial asthma is based on a stepwise process. Treatment is as follows:

Monoclonal antibodies to immunoglobulin E are also used, which becomes very abundant in the blood of a patient with allergic asthma.

Phytotherapy for bronchial asthma

Herbal medicine for bronchial asthma is the use of the beneficial properties of various plants to reduce inflammation in the bronchi, expand their lumen and facilitate the separation of phlegm that fills the respiratory tract.

The most commonly used plants are plantain, thyme, anise, marshmallow, violet, wild rosemary, hyssop, coltsfoot, and thyme.

Herbal medicine will suit asthmatics rather in the first three stages of the disease. Later, it makes little sense, because the patient's condition by that time becomes too difficult.

Consider a few phytotherapeutic recipes:

Electrophoretic effect

Electrophoresis can be applied to reduce disease activity. Electrophoresis is one of the methods of physiotherapy, in which constant electrical impulses act on the patient's body. In addition, with the help of electrophoresis, it is possible to introduce into the patient's body some drugs through his mucous membranes and skin. Together with the direct effect of drugs on the patient's body, electrophoresis also has a beneficial neuro-reflex effect on the patient.

The classic procedure is as follows. A drug is applied to the electrodes, after which, with the help of an electric field, its penetration into the patient's body is ensured. In bronchial asthma, electrophoresis is usually used to administer substances such as aminophylline, epinephrine, or ephedrine. In this case, the current strength reaches 8-12 mA, and the duration of the procedure is up to 20 minutes every day during the course. The course includes, as a rule, 10-12 procedures. Also, in asthma, calcium electrophoresis can be performed with a current strength of 0.5-2 mA, the duration of the procedure is 6-15 minutes. Course - 10 procedures.

A device for performing electrophoresis procedures.

The following points should be considered the advantages of electrophoretic effects on the patient's body:

1. The effectiveness of drugs, despite their small doses.
2. Elongation of the action of drugs due to their cumulation in the body.
3. The injected substances are the most active, since they are administered to the patient in the form of ions.
4. The smallest degree of destruction of active substances.
5. Additional beneficial effect of electric currents on the general immune resistance of the patient's body.

In severe forms of bronchial asthma, electrophoresis is strictly contraindicated.

Other physiotherapy methods

Physiotherapy for asthma is widely used. In addition to electrophoresis, there are a fairly large number of techniques indicated for asthmatics. The goals of the methods used are to expand the bronchi, normalize the degree of excitation of parasympathetic fragments of the nervous system, reduce the susceptibility of the patient's body to allergenic substances, as well as facilitate the separation of sputum.

For a patient in a state of bronchial asthma attack, the following physiotherapy methods may be useful:

The procedure is carried out in the initial position of the inductors for five minutes. Then they change their places. The interval between magnetic pulses should be about a minute.

In this case, it is important to exclude all sorts of vibrational influences: beating, patting or chopping movements.

For a patient in between attacks, the following physiotherapy procedures will be helpful:

Patient education

It is good if, before carrying out specific therapy for bronchial asthma, the patient was given a short lecture on the method that will be applied to him. Such a lecture will help the patient understand the essence of the procedures being performed, calm him down and tune in to a positive acceptance of the treatment, which is also important for the result.

The lecture can be printed on a small booklet and then distributed to various patients. In some medical institutions, a lecture on the disease, a lecture on procedures or a lecture on the patient's competent attitude towards their own illness are printed as a colorful poster so that everyone can notice it and get the necessary information.

Conclusion

The approach to the therapy of bronchial asthma is very important, because it determines the main stages of the therapeutic effect on the patient's body. Nowadays there are different methods of influence.

Drug therapy is of a stepwise nature: the range of drugs prescribed is determined by the stage of the disease, the frequency and severity of its symptoms.

In addition, there are non-drug methods of influencing the patient's body. From folk remedies, herbal medicine is suitable, based on the use of the medicinal properties of plants.

Physiotherapy offers a huge number of methods based on the physical properties of substances and other substances, such as a magnetic or electric field during electrophoresis.

A lecture on the mechanisms of work and the benefits of these methods, read to the patient on the eve of the initial stage of therapy, can contribute to the beneficial effect of treatment methods on the patient's body. The patient's emotional status is important. A skeptical patient will not give the doctor the opportunity to fully apply any method; he will be disobedient and uncooperative when he is required to participate in therapeutic activities.

Basic therapy of bronchial asthma can suppress inflammation in the airways, reduce, reduce bronchial hyperreactivity. Such treatment is suppressive, controlling, and preventive.

Attention! The course is developed for a specific patient. Age, severity of 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.

• Teaching the patient to monitor and assess the severity of the disease.
• Development of a treatment plan for the situation if an exacerbation occurs.
• Providing a systematic visit to the doctor to monitor and adjust the developed plan, for example, during use.
• Maximum elimination of allergens and dangerous factors provocateurs (for example, exclusion of excessive physical exertion, which can lead to asphyxiation).

Attention! The fourth point is crucial. The time of treatment and the result directly depend on it. The competence of the doctor is not important here, the decisive factor is how correctly the allergen is determined, as well as how accurately the patient adheres to the recommendations for avoiding contact with such an allergen.

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

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

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

Basic therapy of bronchial asthma: important nuances

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

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

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

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

The principles of treatment of day and night 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.
• Disease analysis weekly.
• : 3 or more signs are noted every 7 days.

Follow-up tactics are determined based on the above principles. Be sure to take into account the peculiarities of the treatment carried out at a particular moment.

Basic BA treatment in children

The basic treatment of bronchial asthma in young patients is carried out in a complex manner. It is important to achieve sustainable. The age of the onset of the initial symptoms, the presence of chronic diseases, and the current state of health are of great importance.

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

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

Small patients are prescribed inhalation glucocorticoids, anti-inflammatory drugs, long-acting bronchodilators.

Basic BA treatment in adults

Basic drugs for the treatment of bronchial asthma prevent the patient's well-being from deteriorating. Assign:

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

Inhaled glucocorticosteroids are indispensable for eliminating seizures. 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 the symptoms of pathology;
• increase patency in the bronchi;
• eliminate inflammation;
• to minimize the penetration of the active components of the drug into the general bloodstream.

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

Thanks to inhalation means, it is possible to eliminate the attack. For the basic treatment of bronchial asthma, glucocorticosteroids in tablet form are required. They are prescribed in a serious condition. With their help it is possible:

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

Attention! You cannot take these medications yourself. Be sure to consult with your doctor.

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

• reduce bronchial hyperreactivity;
• eliminate and prevent allergies;
• prevent the appearance of spasms.

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

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

Basic therapy of bronchial asthma can suppress inflammation in the airways, reduce, reduce bronchial hyperreactivity. Such treatment is suppressive, controlling, and preventive.

Attention! The course is developed for a specific patient. Age, severity of 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.

• Teaching the patient to monitor and assess the severity of the disease.
• Development of a treatment plan for the situation if an exacerbation occurs.
• Providing a systematic visit to the doctor to monitor and adjust the developed plan, for example, during use.
• Maximum elimination of allergens and dangerous factors provocateurs (for example, exclusion of excessive physical exertion, which can lead to asphyxiation).

Attention! The fourth point is crucial. The time of treatment and the result directly depend on it. The competence of the doctor is not important here, the decisive factor is how correctly the allergen is determined, as well as how accurately the patient adheres to the recommendations for avoiding contact with such an allergen.

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

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

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

Basic therapy of bronchial asthma: important nuances

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

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

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

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

The principles of treatment of day and night 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.
• Disease analysis weekly.
• : 3 or more signs are noted every 7 days.

Follow-up tactics are determined based on the above principles. Be sure to take into account the peculiarities of the treatment carried out at a particular moment.

Basic BA treatment in children

The basic treatment of bronchial asthma in young patients is carried out in a complex manner. It is important to achieve sustainable. The age of the onset of the initial symptoms, the presence of chronic diseases, and the current state of health are of great importance.

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

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

Small patients are prescribed inhalation glucocorticoids, anti-inflammatory drugs, long-acting bronchodilators.

Basic BA treatment in adults

Basic drugs for the treatment of bronchial asthma prevent the patient's well-being from deteriorating. Assign:

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

Inhaled glucocorticosteroids are indispensable for eliminating seizures. 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 the symptoms of pathology;
• increase patency in the bronchi;
• eliminate inflammation;
• to minimize the penetration of the active components of the drug into the general bloodstream.

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

Thanks to inhalation means, it is possible to eliminate the attack. For the basic treatment of bronchial asthma, glucocorticosteroids in tablet form are required. They are prescribed in a serious condition. With their help it is possible:

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

Attention! You cannot take these medications yourself. Be sure to consult with your doctor.

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

• reduce bronchial hyperreactivity;
• eliminate and prevent allergies;
• prevent the appearance of spasms.

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

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