Asthma is a well-known pathology of the respiratory system, the development mechanisms of which are still being studied. The treatment of this disease is carried out by various methods. There are several approaches to asthma therapy. A set of measures is aimed at eliminating the causes of asthma attacks, blocking the pathogenesis of the disease and combating symptoms. Currently, there is step therapy for bronchial asthma, which is common throughout the world. The essence of this treatment is the gradual addition of drugs and increasing their dosages with the progression of pathology.
Disease concept
Asthma is an acute pulmonology problem. Despite the fact that scientists have an idea about the etiology of this disease, it is almost impossible to completely eliminate it. The drugs that are used to treat this disease are addictive and affect the hormonal background. In this regard, step-by-step therapy of bronchial asthma was developed . Symptoms of the pathology can be pronounced or, conversely, rarely appear and do not affect the patient's well-being. This is the basis of therapy. Drugs and their doses are selected depending on the severity of the patient's condition. In addition to the clinical picture, data from instrumental studies are also taken into account. The only way to assess the severity of the disease.
In most cases, the disease is allergic in nature. In almost all patients, the trigger for the development of symptoms is hypersensitivity to certain exogenous factors. Among them are food, animals, chemical, dust and plant allergens. Less commonly, bronchial asthma does not depend on the presence of hypersensitivity. In such cases, bacterial and viral microorganisms that cause irritation of the respiratory system are considered etiological factors. Often, bronchial asthma has a mixed developmental mechanism. Step therapy, developed by the association of doctors, helps to influence the main links of pathogenesis.
Symptoms of the disease in adults and children
To understand how step therapy for bronchial asthma works, you need to know the symptoms of pathology and stage. The severity of the pathological process is assessed by the following criteria:
- The frequency of night and day attacks of suffocation.
- Duration of exacerbation and remission.
- PSV (peak expiratory flow rate) during peak flowmetry.
- The presence of symptoms of chronic pathology of the broncho-pulmonary system.
- Forced expiratory volume.
According to these indicators, the severity of the disease is determined. Based on this, there is a selection of medicines. This is the basis for step-by-step therapy of bronchial asthma in adults and children.
By the nature of the course of pathology, an intermittent and persistent form of the pathological process is distinguished. The first is characterized by the fact that asthma symptoms rarely appear and do not affect respiratory performance (FEV1 and PSV). However, there is no tendency to disease progression. According to the rules of stepwise therapy of bronchial asthma according to Gina, with an intermittent course of pathology, only short-acting inhalation agents are prescribed to help quickly eliminate airway spasm.
The mild persistent stage of the disease is characterized by a systematic manifestation of symptoms. During the day, attacks of suffocation can be observed more than 1 time per week. They disrupt normal human activity. Night attacks develop more than 2 times during the month, but not every week. Indicators PSV and FEV1 at the same time remain normal and make up more than 80%. According to the step-by-step therapy of bronchial asthma, with a mild persistent course, short-acting beta-2 agonists and low doses of inhaled glucocorticosteroids (IHC) are prescribed. Hormonal drugs can be replaced with a medication that is part of the group of antileukotriene receptors.
The moderate severity of the disease is characterized by daily attacks of suffocation. At night, symptoms occur more than 1 time per week. The respiratory system index (PSV or FEV1) is from 60 to 80%. In this case, 1 of the following treatment regimens is selected:
- Low doses of inhaled glucocorticosteroids and long-acting bronchodilators (beta-2 agonists).
- IHC and a drug from the group of antileukotriene receptors.
- Medium or high doses of the hormonal drug and short-acting beta-2 agonists.
- IGKS and theophylline.
In severe asthma, frequent asthma attacks occur both day and night. This affects a decrease in working capacity and quality of life. Exacerbations of the disease become more frequent, and remissions become shorter. Indicators PSV and FEV1 are less than 60%. Prescribe bronchodilator drugs of long action and IHC in medium and high dosages. If necessary, theophylline or an anti-leukotriene medication is added to therapy.
If, despite the treatment, the patient's condition worsens, this is regarded as an extremely severe degree of bronchial asthma. Antibodies to immunoglobulin E and glucocorticosteroids in tablet form are prescribed.
Preparations for the relief of bronchospasm
The standard treatment for asthma according to the Gina classification includes several groups of drugs that are basic. Currently, many combinations of these medications are used. This helps reduce the frequency of use of the drug and improve well-being. The main group of medicines needed for asthma are beta-2 receptor agonists. They are short and long acting. The first include drugs “Salbutamol”, “Fenoterol”. Among the long-acting beta-2 receptor agonists, the medicines Formoterol and Salmeterol are distinguished. The main action of these drugs is the relaxation of the muscles of the bronchi, that is, relief of spasm.
The use of hormones
The use of steroid hormones is one of the main principles of the treatment of bronchial asthma. Step therapy includes several types of glucocorticoids. For mild to moderate persistent severity, low doses of hormones are prescribed. In order to avoid the systemic effects of steroids, medications are prescribed in the form of inhalation. With the progression of the disease, the dosage of the drug increases. The hormones against asthma include aerosols Beclomethasone, Budesonide, Fluticasone. Hormone tablets are used only in cases of severe asthma.
Glucocorticosteroids can be replaced with drugs from the antileukotriene group. These include tablets "Zafirlukast" and "Montelukast." Like hormones, they relate to pathogenetic therapy. The main effect of these medications is to block the inflammatory process and eliminate edema of the respiratory muscles.
Step therapy for asthma: treatment standards
Anti-asthma drugs have been used for many years. At the end of the last century, a special group was organized. The main task of the team of doctors and scientists was to develop standardized methods for the treatment and diagnosis of bronchial asthma. The working group included large pharmaceutical companies, experienced doctors and experts. Due to this, step-by-step therapy of bronchial asthma, which is currently used, has been developed. It includes standards for diagnosing and treating a disease. Step therapy is applicable for adults and children from 5 years of age.
Types of combination drugs
To improve the general condition of patients and reduce the frequency of inhalations, many combination asthma medicines have been developed. These drugs include the active substances that are part of the standard step therapy. The most commonly used drugs are Seretid Multidisk, Symbicort. They include a beta-2 agonist and an inhaled glucocorticosteroid.
Alternative medicines
Despite the fact that doctors from all countries are guided by the recommendations of Gina, it is allowed to approach the treatment of each patient individually. Doctors have the right to prescribe additional groups of drugs that are not part of step therapy. These include: M-cholinomimetics, cromon substances. Most often, such medications are used as the drugs "Ipratropium bromide", "Spiriva", "Intal". These drugs are combined with beta-2 agonists and steroids. Step therapy for asthma in children should be combined with the use of antihistamines and antitussive drugs. In addition, the primary measure to eliminate seizures is the elimination of all possible allergens and provoking factors.
Step therapy for asthma: treatment recommendations
Treatment for asthmatic disease should be based on a systematic approach. The recommendations developed by the Gina Association are the basic therapy for this ailment. In addition, each state has its own protocols for the treatment of this pathology. They are based on global recommendations and include additional groups of drugs, as well as other methods of therapy.
Doctors reviews asthma treatment
Specialists such as an allergist, pulmonologist and general practitioner are involved in asthma treatment. According to doctors, the main objectives of therapy are:
- Elimination of all substances that can cause a hypersensitivity reaction.
- The use of inhaled corticosteroids in combination with bronchodilators.
- Symptomatic Therapy
To avoid exacerbations, it is recommended to constantly monitor external respiration indicators, namely, PSV and FEV1. Cold infections are also recommended.