When it comes to hormone therapy, most patients have questions about how safe it is, whether it is necessary, whether there is an alternative to hormone treatment. Questions and fears that cause them are fully justified: a person has the right to know what he is treated with, especially if this or that method is covered with many myths.
The purpose of this article is to provide insight into why hormonal treatment of asthma is currently the best way to achieve disease control.
Modern therapy of bronchial asthma
Modern therapy of bronchial asthma includes two directions:
- basic therapy – these are drugs that must be used regularly, regardless of whether there are symptoms or not, in order to prevent the exacerbation and progression of the disease. The basis of basic therapy is anti-inflammatory drugs;
- emergency medicines – that is, those that are used situationally, when symptoms occur, and should always be at hand for every patient with bronchial asthma. These include bronchodilators , or so-called bronchodilators .
Inflammatory nature of asthma
Bronchial asthma (BA) is a disease characterized by airway inflammation that persists even when the patient is in stable remission 1 . This explains the fact that the basis of basic therapy is anti-inflammatory drugs. Moreover, the key to achieving control over asthma is their regular use over a long period of time 1 . Anti-inflammatory therapy is represented by inhaled glucocorticosteroids , or ICS.
History of asthma treatment with hormones
In 1948, scientists discovered that cortisone, a hormone of the adrenal cortex, has a pronounced anti-inflammatory effect in rheumatoid arthritis (an inflammatory disease characterized by symmetrical joint damage and inflammation of internal organs). This discovery led to the fact that glucocorticosteroids began to be used in the treatment of various autoimmune and chronic diseases, including severe forms of bronchial asthma. Despite the high effectiveness of glucocorticosteroids , their use has been limited by a large number of severe side effects due to systemic effects on the body.
At the end of the 60s. aerosols of water-soluble hydrocortisone and prednisolone (synthetic glucocorticoid drugs) have been created. However, their attempts to treat asthma were ineffective.
In the early 70s. A group of fat-soluble glucocorticosteroids for local aerosol application was synthesized , which, unlike water-soluble ones, had a high local anti-inflammatory activity and a low systemic effect 1 . It was a revolution in the treatment of bronchial asthma.
Benefits of inhaled glucocorticosteroids (IGCS)
The main advantage of these drugs is in their form of release. Inhaled corticosteroids act locally , that is, only in the bronchi, without having a systemic effect on the body. At the same time, they have high bioavailability and are quickly excreted from the body 1 .
For inhalation use, glucocorticosteroids are available in the form of metered-dose aerosols, dry powder with an appropriate device for use, solutions and suspensions for nebulizers 1 .
The delivery system used is metered-dose aerosol inhalers (PMIs), spacer -based MDIs, dry powder inhalers, and nebulizers that can replace oral glucocorticosteroids in the treatment of non-severe asthma exacerbations. Nebulizer therapy is especially useful for patients who cannot properly use other dosing devices 2 .
Of course, like any drug, ICS have side effects, the presence of which largely depends on the dose of the drug, the type of dosing device, and the technique of inhalation. As for systemic side effects, they are possible only with prolonged use of high doses.
It is important to note that the most sensitive to high doses of ICS are the elderly and patients with concomitant diseases (diabetes mellitus, thyroid disease, etc.), smokers and alcohol abusers, as well as patients with limited physical activity 2 .
Accordingly, to prevent systemic side effects of high doses of inhaled corticosteroids, it is recommended to strictly follow the recommendations of the doctor and the plan of treatment prescribed by him; choose the right inhaler, take vitamin D3 and calcium; devote time to physical activity; give up bad habits (smoking, drinking alcohol); protect your eyes from ultraviolet radiation with sunglasses and hats 2 .
Efficiency of ICGS
Inhaled corticosteroids are effective in patients with asthma of any age and severity. As a result of regular therapy, they:
- improve the condition of the bronchi;
- reduce the frequency of asthma attacks and, therefore, the need for emergency inhalers;
- prevent exacerbations of asthma and reduce the frequency of hospitalizations;
- reduce mortality from asthma;
- improve the quality of life 3 .