Basic therapy for bronchial asthma is the beginning of the entire treatment for this disease. Pathology is characterized by the formation of chronic inflammation, which involves eosinophils and mast cells in the process.
If the patient is disposed to negative symptoms, the formation of airway obstruction is permissible, which is often reversible due to drug therapy or suddenly. This may be accompanied by hyperreactivity of the respiratory system in relation to internal and external manifestations. Clinical options for basic therapy of bronchial asthma, the treatment of which can be carried out both at home and in the hospital, lie in adherence to the drug regimen.
What is the purpose of such therapy?
The control and monitoring strategy provides for the following tasks, which make it possible to fairly assess the severity of asthma. Recommendations for the basic treatment of asthma in adults will be as follows:
- assessment of the performance of the bronchopulmonary system;
- symptom control;
- elimination of probable secondary manifestations in the treatment of asthma;
- reduction and elimination of mortality from an asthmatic seizure;
- teaching the patient options for the implementation of self-help in emergency cases;
- control of initiating causes, as well as the prevention of contacts, which are triggers of the formation of an asthmatic seizure;
- the choice of the necessary medical therapy during an exacerbation of an asthmatic seizure and in a period of remission;
- in addition, a careful role is given to careful monitoring of the patient’s action and his response to drug therapy.
All of the above problems are considered fundamental in the treatment of asthmatic diseases. Each type of asthma, except for intermittent mild forms, is controlled by pharmaceutical substances, which cannot be achieved with the acute development of the pathology that is associated with this.
Diagnostics
The diagnosis is usually made by a pulmonologist based on complaints and the presence of inherent symptoms. All other methods of examination are focused on establishing the severity and etiology of the disease.
Spirometry. It helps to assess the level of bronchial obstruction, to find out the variability and convertibility of obstruction, and also to assure the diagnosis. In AD, accelerated expiration after inhalation with a bronchodilator in one second increases by 12% (200 ml) and higher. However, to obtain clearer data, spirometry must be done a couple of times.
Peak flowmetry, or the determination of the maximum expiratory flow rate (PSV), makes it possible to monitor the patient's condition, comparing the characteristics with those acquired before. An increase in PSV after inhalation by 20% or more from PSV to inhalation clearly indicates the presence of bronchial asthma.
Additional diagnostics include performing tests with allergens, evaluating the gas composition of the blood, ECG, bronchoscopy, and radiography of the lungs.
Laboratory blood tests have a huge role in proving the allergic nature of asthma, as well as in predicting the effectiveness of cure.
- Ordinary blood test. Eosinophilia and a slight increase in ESR during exacerbation.
- Simple sputum analysis (coughing). Microscopy in sputum can reveal a huge number of eosinophils, Charcot-Leiden crystals (shining colorless crystals that appear after the destruction of eosinophils and have the shape of rhombuses or octahedrons), Curshman spirals (occur due to small convulsive contractions of the bronchi and look like casts of colorless mucus in spiral shape).
Intermediate leukocytes can be detected in patients in the stage of intense inflammatory process.
The accent of Creole bodies during the attack period was also established - these are rounded formations consisting of epithelial cells. A biochemical blood test is not considered the main diagnostic method, since the changes are general in nature and similar examinations are prescribed to predict the condition of the patient during an exacerbation. It is necessary to conduct a thorough diagnosis of the immune status. With this disease, the number and dynamics of T-suppressors rapidly decreases, and the number of immunoglobulins in the blood increases. The use of tests to determine the number of immunoglobulins E is important if there is no possibility to carry out allergological studies.
After all the manipulations, you can start therapy. Treatment for basic therapy of bronchial asthma includes several groups of drugs. The most common ones will be listed below.
Glucocorticosteroids
The main means of basic therapy for bronchial asthma are glucocorticosteroids. The therapeutic effect of pharmaceuticals is primarily due to the likelihood of an increase in their production of adrenergic receptors that can stop the negative effects of allergens. In addition, corticosteroids remove all external manifestations of the disease, namely edema. The difference between these substances from systemic ones is their anti-inflammatory result and the minimum number of secondary manifestations. The medication is dosed based on the severity of the disease and the general condition of the patient.
Systemic glucocorticosteroids
These substances are prescribed orally or infusion with a complicated process of the disease in a small dose (according to a predefined scheme), since they have impressive side effects. It is advisable to administer these pharmaceuticals intravenously. Such necessary drugs are prescribed with the ineffectiveness of other methods of treatment.
Mast Cell Stabilizers
These drugs have a special quality that prevents the degranulation of mast cells, releases histamine elements. Stabilizers have the ability to restrain acute and prolonged bronchospastic responses to an attack of allergens. In addition, these substances reduce bronchial dynamics during inspiration and expiration of air in the cold season, significantly reducing the frequency and duration of an attack. It should not be forgotten that therapy with these drugs should be short-lived, as they can provoke side effects.
Leukotriene Antagonists
Such substances significantly reduce the need for the use of fast-acting adrenomimetics. They belong to the latest generation of anti-asthma and anti-inflammatory substances used in the prevention of bronchospasm.
Basic treatment for children
The main principle of the basic therapy of bronchial asthma in children is the achievement of a strong remission and an increase in the quality of life.
The use of basic therapy is determined by the relevant aspects:
- the frequency of bronchial symptoms (less than two times in a week);
- frequency of night attacks;
- limitation of daily energy;
- the need for emergency treatment;
- the possibility of exacerbations;
- normalization of respiratory activity.
Pharmacotherapy is considered a mandatory component in the treatment of bronchial diseases in a child. Significant progress in the treatment of asthmatic diseases in a child can be achieved with the use of basic substances designed to eliminate inflammation in the lungs and bronchi.
It should be noted that the anti-inflammatory substances used in the framework of basic therapy should be used not only for exacerbation of the disease, but also during remission as a prophylaxis of exacerbation, which confirms the need for long-term treatment.
Mild drug treatment
When providing emergency care during a simple asthmatic attack, drugs are prescribed for inhalation in the basic treatment of bronchial asthma in children. These pharmaceutical products are best suited for a child older than three years, with the ineffectiveness of other bronchodilators.
For the younger age group, the use of Atrovent or Berodual is recommended, but only under the supervision of physicians. These aerosols have a significant degree of protection and can be used during a night attack of asthma. For a young child, the use of metered-dose inhalers with a spacer or a nebulizer is recommended. If the chosen dose of the medicinal product is ineffective, it is recommended to combine bronchodilators with agonists, as well as increase the dose of IHC after agreement with the treating doctor.
Depending on the severity level of asthma for a child from one year old, “Fluticasone propionate” may be prescribed in inhalations at least twice a day. With a mild course of the disease, basic treatment should be carried out every 4-7 hours for 1-2 days.
Medication for a moderate disease
With this degree of asthma in a child, it is advisable to prescribe combination preparations for the basic therapy of bronchial asthma, bronchospasmolytics in the form of a spray (Berodual). If inhalation therapy is not feasible, intravenous administration of a 2.4% solution of Eufillin is recommended, which is diluted with an isotonic sodium chloride solution (in the proportion suggested by the doctor).
Intramuscular, inhalation and anal (suppository) administration of “Eufillin” in a child at this stage of the disease is not used.
After assessing the condition of the children (after 20 minutes), a permission is taken to start treatment with special drugs every 4 hours, with the patient being further transferred to high-speed aerosols and bronchodilators of prolonged exposure.
The basic anti-inflammatory treatment in the child continues with the use of more serious drugs with a gradual increase in the dose by 2 times during the week. In addition, it is recommended to use the anti-inflammatory drug "Ditek".
With a very serious degree of formation of bronchial asthma, emergency hospitalization of children in the intensive care unit with treatment in a hospital setting is needed. At present, the “step-by-step" approach is considered generally accepted for treatment, when the reduction or increase in the size of the therapeutic intervention depends on the severity of the disease symptoms.
Work with patients with pathology
An important role is played by direct contact with an asthmatic. A positive effect is established if, in addition to the peculiar treatment of this disease, the patient has additional data on the etiology of his own disease, the mechanism of its formation and possible complications.
For this, it is recommended to carry out small conversations with the patient, explaining the essence of the manipulations and the favorable result from their use. This makes it possible to emotionally tune him to a positive attitude towards healing, which is important for obtaining a good result.
This aspect in the treatment of bronchopulmonary diseases is very significant for the parents of a child suffering from asthma, since children cannot make the necessary decisions without the help of others. Only an adult can help them, who must understand how to calm the baby and teach him how to use the inhaler in emergency cases.
Prevention
There are three types of disease prevention:
- Primary prevention focuses on groups of healthy people. Prevention consists in preventing the transition of pathologies of the respiratory tract into chronic forms (for example, chronic bronchitis), as well as in preventing allergic reactions.
- Secondary prevention includes measures to prevent the formation of the disease in sensitized individuals or in patients during the pre-asthma period, but not yet suffering from asthma. These are individuals who have allergic diseases, people with a tendency to asthma (for example, there are relatives who have asthma) or people who have proven their sensitivity using immunological methods of study.
- Tertiary prevention is aimed at reducing the severity of the course and preventing exacerbations of the disease in patients with this disease. The main method of prevention is to exclude the patient’s contact with the allergen that causes the attack (elimination regimen).
An important role in healing is given to visiting sanatoriums. Sanatorium-resort therapy has a favorable post-resort effect on patients. In international practice, considerable experience has been gained in effective treatment in climatic resorts. The effectiveness of spa treatment depends on the correct selection of the resort. In choosing a suitable resort area for rehabilitation, the attending doctor will undoubtedly help, who will find a sanatorium for the patient with the possibility of treating underlying and concomitant diseases.