Myths about hormones. Treatment of bronchial asthma

Parents of asthmatic children often agree on any drugs, but not on hormones. Where does their fear come from and does it have any grounds?

Myth. All hormonal drugs are the same.

This is not so, because hormones are different. There are thyroid hormones, adrenal glands, sex hormones and others. And there is a glucocortico ­ steroids . About them in question in this case. In addition, a lot depends on the dose (after all, even from a useful carrot, if it is overeat, toxic damage to the liver can occur). Similarly, the dose of hormones is very important. It is selected individually and only by a doctor. Self-medication is unacceptable.

Finally, the route of administration is also important. For example, drugs in pills and injections, before being in the lungs, get into the bloodstream and spread throughout the body. Long-term treatment with them can lead to hormonal imbalance and the development of side effects (brittle bones, stunted growth, weight gain). Inhaled glucocorticosteroids , which are now used to control asthma, directly reach the source of inflammation in the bronchi and practically do not enter the bloodstream and do not spread throughout the body.

Signs of probable bronchial asthma:

a cough long after ORVI (a child coughs another 2–3 after an illness   weeks);
frequent and   protracted armor ­ hits;
swelling and   inflammation of the mucous membrane of the bronchi, hypersecretion of mucus (an excess of discharge from   bronchi).

Myth.   Non-hormonal medicines are more effective.

All over the world it is recognized that inhaled hormones are the most effective for the treatment of bronchial asthma. Doctors prescribe them, following the international and Russian recommendations, created on the basis of studies involving tens of thousands of patients. Inhaled glucocorticosteroids fall directly into the lungs, which increases the effectiveness of treatment and minimizes the development of side effects compared with systemic steroids. Important and method of delivery of drugs. The best option is to use a nebulizer . It is more effective than metered aerosol and powder inhalers and spacers .

Myth.   Acceptance of hormonal drugs can be canceled (or reduce the dosage) as soon as the condition of the child improves.

You can not cancel therapy or change the dosage of the drug yourself, because the apparent improvement in the child’s condition does not mean that the disease is under control. A prematurely discontinued course makes treatment ineffective.

Myth.   The body becomes accustomed to hormones and subsequently it is no longer peeling off.

It all depends on the severity of the disease. With moderate and mild forms of asthma, hormones are prescribed by certain courses 1–2 times a year, but for severe cases, life-long therapy. But thanks to treatment, the quality of life of patients is almost the same as in healthy ones.

Myth.   With the correct treatment of asthma ­ we symptoms go away very quickly.

In fact, the quality of treatment is not indicated by how quickly the symptoms disappear, but by how long they do not appear. This is what allows you to achieve control of the disease. The longer the remission lasts (a period without outbreaks of the disease), the better the outcome and prognosis of treatment. And uncontrolled asthma can lead to a deterioration in the prognosis of the disease and quality of life.

Myth.   Hormonal drugs are very expensive.

With the established diagnosis of “bronchial asthma” treatment is free. Another thing is that doctors in polyclinics are in no hurry to make such a diagnosis, considering only the presence of seizures for which the child enters the hospital in an ambulance as the basis for it. Precinct police often do not even give directions to specialized medical centers where a child can be examined qualitatively. But the task of the parent is to demand such a direction. It is better to do this in writing and to demand a response, too, in writing, with justification of the refusal.

Myth.   Start treatment better with non-hormonal drugs. Hormones – this is the last option.

The sooner hormone treatment begins, the better (of course, if he was prescribed by a doctor). It would be nice to have time to do this no later than 2 years after the first symptoms appear. The consequences of late initiation of therapy (after 5 years of the onset of symptoms) remain noticeable even after a few years, as research has shown. In addition, the delayed onset of hormonal treatment leads to an increase in dosages of hormones and the appointment of a larger number of systemic drugs.

Exists whether hormone-dependent asthma ?

Probably, many have heard of the so-called “hormone-dependent” asthma. It seems to me that this problem is important both for the sick and for the doctors: after all, as soon as this “diagnosis” appears, the patient is transferred to the ranks of the disabled, and most doctors do not know how to treat it further. So, does hormone-dependent asthma really exist, and, if so, what is it? I think the correct answer to this question will be interesting to all, and first of all to the doctors.

It should be remembered, what are anti-inflammatory hormones? As already mentioned, these tools are analogues of human hormones of the adrenal glands – cortisone and cortisol (hydrocortisone).

Cortisone, cortisol and corticosterone (hereinafter the terms “ glucocorticosteroids ” or “steroids” will be used ) are produced in the cortex of the adrenal glands and perform important regulatory functions: they are involved in the regulation of metabolism – proteins, fats and carbohydrates, ensuring the constancy of the internal environment of the body. To a lesser extent, they (in particular, corticosteroids ) have a regulatory effect on the exchange of water and electrolytes.

The regulatory action of steroids is carried out through their interaction with specific glucocorticoid receptors located on the cell membranes of organs and tissues.

With the defeat of the adrenal glands and insufficient production of hormones of the cortical layer, symptoms of acute adrenal insufficiency develop. Its main manifestations are abdominal pain, high fever, disorders of the gastrointestinal tract function, a sharp impairment of blood circulation with cyanosis (blue) of the skin, severe nervous excitement, collapse and pressure drop, and in the most severe cases – the development of coma. But it should be said that the compensatory properties of the adrenal glands are so great that the symptoms of acute adrenal insufficiency occur only with the destruction or atrophy of 95% of their tissue. In the case of asthma, this is observed against the background of a long and unsystematic reception of synthetic analogues of cortisone, initially suppressing the production of its own hormones, and ultimately leading to atrophy of the adrenal tissue.
But this develops extremely rarely: for my more than 15-year practice, having seen more than one thousand patients, I met only one (!) Similar patient. For more than 30 years she took dexamethasone in a dose of 2 to 5 tablets. By the time of our meeting, she had pronounced complications of hormone therapy: generalized vasculitis with multiple hemorrhages (or, as people say, bruises), osteoporosis – severe changes in bone calcium metabolism, disorders of fat metabolism, Itsenko – Cushing’s syndrome .

With such a “bouquet” of complications on the background of targeted treatment, it was possible to reduce the dose of dexamethasone taken by her from two to half a pill. Despite the more than 35-year experience of the disease, with the help of special ultrasound inhalations, it was possible to restore the performance of its respiratory function to very high values.

All asthma manifestations disappeared, but the remaining half of the dexamethasone pill was not canceled: this provoked the symptoms of acute adrenal insufficiency: blood pressure dropped and collapse developed . A subsequent study of the state of the adrenal glands revealed a marked impairment of their function and inability to maintain a sufficient level of their own glucocorticosteroids in the body . That is, in this case, the dexamethasone taken on performed a replacement role, compensating for the lack of its own hormones.

In this sense, hormone-dependent is not asthma, but a person (!), Who suffers from it. As for the cases of worsening of the course of asthma with the abolition of tablet (and in a broad sense – systemic) therapy with steroids, this is not a manifestation of dependence on hormones, but evidence of the lack of effectiveness of the treatment.

At the same time, many doctors reading this book will surely remember at least one case when even huge doses of hormonal anti-inflammatory drugs, without a doubt providing a sufficient amount of glucocorticosteroids in the blood, do not give the desired result – the patient still suffocates.

Acute adrenal insufficiency may also occur when a sudden discontinuation of hormonal drugs is given against the background of their application in very high doses as a result of temporary adrenal insufficiency. But this is a topic for another conversation.

Well, in general, if we talk about hormone dependence in the sense of worsening the course of the disease, then we will have to admit the existence of not only hormone-dependent asthma, but also consider all diseases for which steroids are used to be hormone-dependent!

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