Basic therapy of bronchial asthma is the beginning of all treatment for this disease. Pathology is characterized by the formation of chronic inflammation, which involves eosinophils and mast cells in the process.
If the patient is prone to negative symptoms, airway obstruction is acceptable, which is quite often reversible due to drug therapy or suddenly. This may be accompanied by hyperreactivity of the respiratory system in relation to internal and external manifestations. Clinical options for the basic therapy of bronchial asthma, the treatment of which can be carried out both at home and in a hospital, lie in adherence to the drug regimen.
What is the purpose of this therapy?
The control strategy and implementation of disease monitoring includes the following tasks, which make it possible to fairly assess the level of severity of asthma. Recommendations for the basic therapy of bronchial asthma in adults will be as follows:
- assessment of the performance of the bronchopulmonary system;
- symptom control;
- eliminate likely secondary manifestations in curing asthma;
- reduce and eliminate asthmatic deaths;
- Educate the patient on emergency self-care options;
- controlling the initiating causes, as well as preventing contacts, which are triggers for the formation of an asthmatic attack;
- selection of the necessary medical therapy during the period of exacerbation of an asthmatic attack and during remission;
- in addition, careful monitoring of the patient's action and response to drug therapy is essential.
All of the above problems are considered the main ones in the treatment of asthmatic diseases. Every type of asthma, except intermittent mild form, is controlled with pharmaceutical substances, which cannot be achieved with the acute development of the pathology associated with it.
Diagnosis
Diagnosis is usually established by a pulmonologist based on complaints and the presence of characteristic symptoms. All other methods of examination are focused on establishing the level of severity and etiology of the disease.
Spirometry. Helps to assess the level of bronchial obstruction, to know the variability and convertibility of obstruction, and to assure the diagnosis. In BA, accelerated expiration after inhalation with a bronchodilator increases by 12% in one second (200ml) and above. However, to obtain clearer data, spirometry must be done a couple of times.
Peakflowmetry, or determination of the maximum expiratory flow rate (PSV), makes it possible to monitor the patient's condition, comparing the characteristics with those acquired before. An increase in PSV already after inhalation by 20% or more from PSV before inhalation clearly indicates the presence of bronchial asthma.
Additional testing includes allergen testing, blood gases, ECG, bronchoscopy, and lung x-rays.
Laboratory blood tests play a huge role in proving the allergic nature of asthma, as well as in predicting the effectiveness of the cure.
- Ordinary blood test. Eosinophilia and a slight increase in ESR during an exacerbation.
- Simple sputum analysis (sputum). With microscopy in sputum, it is possible to identify a huge number of eosinophils, Charcot-Leiden crystals (shining colorless crystals that appear after the destruction of eosinophils and have the shape of rhombuses or octahedrons), Kurshman's spirals (arise due to small convulsive contractions of the bronchi and look like casts of colorless mucus in spirals).
Intermediate leukocytes can be detected in patients in the stage of an intense inflammatory process.
It was also established that Creole bodies are accentuated during an attack - these are rounded formations consisting of epithelial cells. A biochemical blood test is not considered the main diagnostic method, since the changes are of a general nature and similarexaminations are prescribed to predict the patient's condition during an exacerbation. It is necessary to conduct a thorough diagnosis of the immune status. With this disease, the number and dynamism of T-suppressors is rapidly decreasing, and the number of immunoglobulins in the blood is increasing. The use of tests to determine the amount of immunoglobulins E is important if there are no opportunities to carry out allergological studies.
After all the manipulations, you can start therapy. Treatment in the basic therapy of bronchial asthma includes several groups of drugs. The most common 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 increasing the production of adrenoreceptors with their help, which can stop the negative effect of allergens. In addition, corticosteroids remove all external manifestations of the disease, namely swelling. The difference between these substances and systemic ones is their anti-inflammatory result and the minimum number of secondary manifestations. The medication is dosed based on the severity of the disease and the general condition of the patient.
Systemic glucocorticosteroids
These substances are administered orally or by infusion in case of a complicated disease process in a small dose (according to a predetermined scheme), as they have impressive side effects. It is desirable to administer these pharmaceutical preparations intravenously. Such necessary drugs are prescribed when other methods of treatment are ineffective.
Mast Cell Stabilizers
These drugs have a special quality that prevents the degranulation progress of mast cells, release histamine elements. Stabilizers have the ability to restrain acute and prolonged bronchospastic responses to allergen attack. In addition, these substances reduce bronchial dynamism during inhalation and exhalation of air in the cold season, significantly reducing the frequency and duration of seizures. It should not be forgotten that therapy with these drugs should be short-lived, as they can provoke side effects.
Leukotriene antagonists
Such substances significantly reduce the need for the use of fast acting adrenomimetics. They belong to the latest generation of anti-asthma and anti-inflammatory agents used in the prevention of bronchospasm.
Basic therapy in the treatment of children
The main principle of the basic therapy of bronchial asthma in children is the achievement of a lasting remission and an increase in the quality of life.
The use of basic therapy is determined by the relevant aspects:
- frequency of bronchial symptoms (less than twice a week);
- frequency of nocturnal seizures;
- limitation of daily energy;
- need to use emergency treatment;
- possibility of exacerbations;
- normalization of respiratory activity.
Pharmacotherapy is considered an essential component in the treatment of bronchial diseases in a child. Significant progress in the treatment of asthmatic diseases in a child can be achieved with the use of basic substances designed to eliminate inflammation in the lungs and bronchi.
It should be noted that anti-inflammatory substances used as part of basic therapy should be used not only during an exacerbation of the disease, but also during remission as an exacerbation prophylaxis, which confirms the need for long-term treatment.
Mild drug treatment
When providing urgent assistance during a simple asthma attack, drugs are prescribed for inhalation in the basic therapy of bronchial asthma in children. These pharmaceutical products are best suited for a child older than three years who has not responded to other bronchodilators.
For the younger age group, the use of "Atrovent" or "Berodual" is recommended, but only under medical supervision. These aerosols have a significant degree of security and can be used during a nocturnal asthma attack. For a young child, the use of metered-dose inhalers with a spacer or nebulizer is recommended. If the selected dose of the drug is ineffective, it is recommended to combine bronchodilators with agonists, as well as increase the dose of ICS after consultation with the attending doctor.
Depending on severity levelasthma for a child from a year old can prescribe "Fluticasone propionate" in inhalation at least twice a day. With a mild course of the disease, basic treatment should be carried out every 4-7 hours for 1-2 days.
Medical treatment of moderate disease
With a given degree of asthma in a child, it is advisable to prescribe combined preparations for the basic therapy of bronchial asthma, bronchospasmolytics in the form of a spray ("Berodual"). If inhalation therapy is not feasible, intravenous administration of a 2.4% solution of "Euphyllin" is recommended, which is diluted with an isotonic sodium chloride solution (in the proportion suggested by the doctor).
Intramuscular, inhalation and anal (candles) administration of "Eufillin" in a child at this stage of the disease is not applicable.
After assessing the condition of the children (after 20 minutes), permission is taken to start treatment with special preparations every 4 hours, with a further transfer of the patient to fast-acting aerosols and long-acting bronchodilators.
Basic anti-inflammatory treatment in a child continues with the use of more serious drugs with a gradual increase in dose 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 presentA “stepwise” approach is considered to be generally accepted for treatment, when the reduction or increase in the size of the therapeutic intervention depends on the severity of the symptoms of the disease.
Working with patients with pathology
An important role is played by direct contact with an asthmatic. A positive effect is established if, in addition to a kind of therapy for this disease, the patient has additional data on the etiology of his own disease, the mechanism of its formation and possible complications.
For this, it is recommended to carry out small conversations with the patient, explaining the essence of the manipulations and the favorable result from their use. This makes it possible to emotionally set him up for a positive attitude towards the cure, which is important for obtaining a good result.
This aspect in the treatment of bronchopulmonary diseases is very significant for the parents of a child suffering from asthma, since children cannot make the necessary decisions without the help of others. Only an adult can help them, who must understand how to calm the baby and teach him how to use the inhaler on his own in case of emergency.
Prevention
There are three types of disease prevention:
- Primary prevention focuses on groups of he althy people. Prevention consists in preventing the transition of respiratory tract pathologies into chronic forms (for example, chronic bronchitis), as well as inprevention of allergic reactions.
- Secondary prevention includes measures to prevent the formation of the disease in sensitized individuals or in patients during pre-asthma, but not yet suffering from asthma. These are individuals who have allergic diseases, people with a tendency to asthma (for example, there are relatives with asthma), or people whose sensitivity has been proven using immunological methods of study.
- Tertiary prevention is focused on reducing the severity of the course and preventing exacerbations of the disease in patients with this disease. The main method of prevention is to exclude the patient from contact with the allergen that generates an attack (elimination mode).
An important role in the cure is given to visiting sanatoriums. Sanatorium-resort therapy has a favorable post-resort effect on patients. In international practice, significant experience has been accumulated in effective treatment at climatic resorts. The effectiveness of spa treatment depends on the correct selection of the resort. The attending doctor will undoubtedly help in choosing a suitable resort area for rehabilitation, who will find a sanatorium for the patient with the possibility of treating major and concomitant diseases.
