Asthma is a well-known pathology of the respiratory system, the mechanisms of which are still being studied. Treatment of this disease is carried out by various methods. There are several approaches to the treatment of asthma. The complex of measures is aimed at eliminating the causes that cause asthma attacks, blocking the pathogenesis of the disease and combating the symptoms. Currently, there is a step therapy for bronchial asthma, which is common throughout the world. The essence of this treatment is the gradual addition of drugs and an increase in their dosages with the progression of the pathology.
Illness concept
Asthma is an acute problem in pulmonology. Despite the fact that scientists have an idea about the etiology of this disease, it is almost impossible to eliminate it completely. Drugs that are used to treat this disease are addictive and affect the hormonal background. For this reason, it has been developedstepwise therapy of bronchial asthma. Symptoms of pathology can be pronounced or, on the contrary, appear rarely 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. This is 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, animal, chemical, dust and plant allergens. Less often - 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 to be etiological factors. Often bronchial asthma has a mixed mechanism of development. Step therapy, developed by the Association of Physicians, helps to influence the main links of pathogenesis.
Symptoms of the disease in adults and children
To understand how the stepwise therapy of bronchial asthma works, you need to know the symptoms of the pathology and stages. The severity of the pathological process is assessed according to the following criteria:
- Frequency of nocturnal and daytime asthma attacks.
- Duration of exacerbation and remission.
- PSV (peak expiratory flow rate) during peak flowmetry.
- Presence of symptomschronic 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. Stepwise therapy of bronchial asthma in adults and children is based on this.
According to the nature of the course of the pathology, there are intermittent and persistent forms of the pathological process. The first one is characterized by the fact that asthma symptoms appear rarely and do not affect breathing parameters (FEV1 and PSV). At the same time, there is no tendency to progression of the disease. According to the rules of the stepwise therapy of bronchial asthma according to Gina, in the intermittent course of the pathology, only short-acting inhalants are prescribed to help quickly eliminate airway spasm.
The mild persistent stage of the disease is characterized by the systematic manifestation of symptoms. During the day, asthma attacks can occur more than once a week. They interfere with normal human activity. Night attacks develop more than 2 times during the month, but not every week. At the same time, PSV and FEV1 indicators remain normal and amount to more than 80%. According to the stepwise therapy of bronchial asthma, with a mild persistent course, short-acting beta-2-agonists and low doses of inhaled glucocorticosteroids (IGCS) are prescribed. Hormonal drugs can be replaced with a drug that is part of the antileukotriene receptor group.
The average severity of the disease is characterized by dailybouts of suffocation. At night, symptoms occur more than once a week. The indicator of the respiratory system (PSV or FEV1) is from 60 to 80%. In this case, 1 of the following treatment regimens is selected:
- Low-dose inhaled glucocorticosteroids and long-acting bronchodilators (beta-2-agonists).
- IGCS and antileukotriene receptor drug.
- Medium to high dose hormone and short-acting beta-2 agonists.
- IGCS and theophylline.
With severe asthma, frequent attacks of suffocation are noted both day and night. This affects the decline in performance and quality of life. Exacerbations of the disease become more frequent, and remissions become shorter. PSV and FEV1 are less than 60%. Prescribe long-acting bronchodilators and ICS in medium and high dosages. If necessary, theophylline or an antileukotriene drug is added to therapy.
If, despite the ongoing 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.
Drugs for the relief of bronchospasm
The standard of treatment for bronchial asthma according to the Gina classification includes several groups of drugs that are the main ones. Currently, many combinations of these drugs are used. This helps to reduce the frequency of drug use and improvewell-being. The main group of drugs needed for bronchial asthma are beta-2 receptor agonists. They are short and long acting. The former include the preparations "Salbutamol", "Fenoterol". Among the long-acting beta-2 receptor agonists, the drugs Formoterol and Salmeterol are distinguished. The main action of these drugs is the relaxation of the muscles of the bronchi, that is, the relief of spasm.
Use of hormonal drugs
The use of steroid hormones is one of the main principles of the treatment of bronchial asthma. Step therapy includes several types of glucocorticoids. With 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. Aerosols "Beclomethasone", "Budesonide", "Fluticasone" are referred to hormonal anti-asthma drugs. Hormones in tablet form 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 belong to pathogenetic therapy. The main action of these medicines is to block the inflammatory process and eliminate swelling of the respiratory muscles.
Stepping therapy for asthma: standards of care
Asthma drugs have been used formany 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 major pharmaceutical companies, experienced doctors and experts. Thanks to this, a stepwise therapy for bronchial asthma was developed, which is currently used. It includes standards for the diagnosis and treatment of the disease. Step therapy is applicable for adults and children from 5 years of age.
Types of combined drugs
To improve the general condition of patients and reduce the frequency of inhalations, many combination medicines for asthma have been developed. These preparations include the active substances that are included in the standard stepwise therapy. The most commonly used drugs are Seretide 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 included in the stepwise therapy. These include: M-cholinomimetics, cromon substances. The most commonly used drugs are Ipratropium bromide, Spiriva, Intal. These drugs are combined with beta-2 agonists and steroids. Stepwise therapy of bronchial asthma in children should be combined with the use of antihistamines and antitussive drugs. In addition, the first step to eliminate seizures is to exclude all possible allergens and provoking factors.
Stepping therapy for asthma: treatment recommendations
Treatment of asthma should be based on a systematic approach. The recommendations developed by the Gina Association are the basic therapy for this disease. 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 medications, as well as other therapies.
Reviews of doctors about the treatment of asthma
Asthma is treated by specialists such as an allergist, a pulmonologist and a general practitioner. According to doctors, the main goals of therapy are:
- Elimination of all substances that can cause a hypersensitivity reaction.
- Use of inhaled corticosteroids in combination with bronchodilators.
- Symptomatic therapy.
To avoid exacerbations, it is recommended to constantly monitor the indicators of external respiration, namely, PEF and FEV1. It is also recommended to avoid cold infections.
