Bronchial asthma is a chronic inflammatory disease of the respiratory tract in which many cells and cellular elements participate. Chronic inflammation is associated with bronchial hyperreactivity, which leads to repeated episodes of wheezing , shortness of breath , chest pain and coughing , especially at night or in the early morning. This is usually associated with diffuse but variable bronchial obstruction, which is often reversible both spontaneously and under the influence of treatment. Patients with bronchial asthma are more likely to develop allergic reactions to drugs.
According to federal protocols, bronchial asthma has four degrees of severity.
The GINA 2006 Guidelines recommend determining levels of control for asthma.
Modern therapy for bronchial asthma is carried out in accordance with the steps.
Stage 1 – drugs “on demand”. Patients with short daily symptoms that occur from time to time (no more than 2 per week in the afternoon). No night symptoms:
– Fast-acting inhaled beta-2-adrenergic agonist to relieve symptoms (no more than 2 per week during the day).
– With increased symptoms and / or periodic increase in their severity – regular regular therapy (level 2 or higher).
Stage 2. One of the drugs of continuous therapy + “on demand” therapy:
– Low doses of ICS as the initial permanent therapy at any age.
– Alternative continuous therapy with leukotriene antagonists in case of impossibility / unwillingness of patients to use IHC.
Stage 3. One or two drugs for continuous therapy + drugs “on demand”.
– For adults – a combination of low doses of inhaled corticosteroids with a long-acting inhaled beta-2-adrenergic agonist in one inhaler ( fluticasone + salmeterol or budesonide + formoterol ) or in separate inhalers.
– Long-acting inhaled beta-2-adrenergic agonist ( salmeterol or formoterol ) should not be used as monotherapy.
– For children – an increase in doses of IGCS to medium.
Additional step 3 – options for adults:
– An increase in doses of IGCS to medium.
– Low doses of IGCS in combination with leukotriene antagonists .
– Low doses of theophylline with delayed release.
Stage 4. Two (always) drugs or more for continuous therapy + drug “on demand”:
– Medium or high doses of IGCS in combination with a long-acting inhaled beta-2-adrenergic agonist.
– Medium or high doses of IGCS in combination with a leukotriene antagonist.
– Low doses of theophylline with delayed release in addition to medium or high doses of ICS in combination with long-acting inhaled beta-2-adrenergic agonist.
Step 5. Additional drugs of continuous therapy + “on demand” therapy:
– The addition of oral glucocorticoids to other drugs of constant therapy can be effective, but pronounced side effects are possible.
– The addition of anti-IgE therapy to other ongoing medications improves the control of atopic bronchial asthma in cases where control has not been achieved.
Treatment of bronchial asthma in patients with tuberculosis is carried out according to the same principles, but taking into account a number of features. The appointment of systemic glucocorticoids and IHC should be accompanied by a controlled intake of anti-TB drugs . The clearance of theophylline drugs when taking anti-TB drugs (especially rifampicins ) is lower, the half-life is longer, which requires a decrease in the dose of the theophylline group drugs, especially in older patients.