Broncho-obstructive syndrome is accompanied by impaired bronchial patency, inflammation, the presence of a large amount of thick mucus in the respiratory tract.
Bronchial asthma is an allergic and inflammatory disease of the bronchi. According to modern data, the basis of asthma is a chronic inflammatory process in the bronchi, leading to bronchial obstruction and an increase in bronchial sensitivity (hyperreactivity). The number of mast cells increases, histamine is released, the vascular permeability increases. In response to irritation, a bronchospasm and choking attack occurs.
Medications are used to relieve an asthma attack and for basic therapy (prevention of asthma attacks).
|Means for stopping an asthma attack|
|1.B2-adrenomimetics Salbutamol Berotek Ipradol
2.M – anticholinergics Atrovent Spiriva
3.Combined Berodual Combivent
4.Myolytics Euphyllinum 5. α-β- adrenomimetics Epinephrine Ephedrine
|Basic Asthma Therapy|
|1.Glucocorticoids – Beclomethasone, Flunisolide Budesonide Fluticasone Prednisolone
2.AntihistaminessredstvaKromoglikat – sodium Nedocromil – sodium
3.MyolyticsTeopek, Theodur Teotard, Ventaks Euphilong
4.Leukotriene receptor inhibitors Zafirlukast Montelukast
Medications for the relief of seizures bronchial asthma (bronchodilator)
Bronchodilators are substances that relax smooth muscles and eliminate bronchospasm. They are used inhalation, parenterally, sublingually.
1 – The main place in the elimination of bronchospasm is occupied by adrenomimetics, among them – selective b2-adrenomimetics (salbutamol, fenoterol).
The best are dosage forms for inhalation: metered aerosols (considered emergency means). They act quickly, in a few minutes. Inhalation spend 2-4 times a day for 2 breaths.
2 – M- holinoblokatory with asthma are less effective than agonists. They are prescribed in case of intolerance to adrenomimetics. Often used selective blockers of peripheral M – cholinergic receptors of the bronchi (Ipratropia bromide (atrovent, ipravent), Tiotropium bromide (spirit), “Berodual”, “ Combivant”), to a lesser extent causing side effects than atropine sulfate.
3 – Antispasmodics myotropic actions Methylxanthine derivatives act directly on the smooth muscles of the bronchi (inhibiting phosphodiesterase), causing them to expand. In addition, they expand blood vessels, have a cardiac stimulating effect, lower blood pressure, improve the blood supply to internal organs, increase diuresis, reduce swelling of the brain, excite the respiratory center.
Aminophylline (aminophylline) consists of 80% of theophylline and 20% of ethylene diamine. In acute cases, injected parenterally (into the vein slowly into the muscle). For the prevention of bronchospasmattacks, they are used orally in tablets and rectally in suppositories. Theophylline used in powders and suppositories. Also available in capsules with prolonged action, used once a day – Teotard, Ventaks, Eufilong, Teopak, Theodur and etc.
Undesirable side effects: dyspeptic symptoms (especially when taken on an empty stomach) associated with the irritant effect of the drug. With rapid intravenous administration, dizziness, headache, arrhythmias, convulsions, and a drop in blood pressure are possible.
The use of aminophylline, especially intravenous, is contraindicated in sharply reduced blood pressure, angina pectoris, epilepsy, tachycardia, pregnancy.
4 – Non -selective asthma can be used to relieve an asthma attack. a, b adrenomimetics direct and indirect action (epinephrine or ephedrine), parenterally.
Drugs for basic therapy of bronchial asthma (for the prevention of attacks of bronchospasm)
To prevent attacks of bronchial asthma, drugs are used that have anti-inflammatory and anti-allergic effects:
1) Antihistamines from the group stabilizers membrane cells, which prevent their destruction and the release of histamine from them, thereby preventing the attack of suffocation. These are derivatives cromon 1 and 2 generations.
1st generation – Sodium Cromoglycate (Intal, cromolyn, kropoz). They are administered by inhalation. Intal reduces the degree of bronchial reactivity, reduces the need foradrenomimetics and glucocorticoids, does not reduce the effectiveness of long-term use. Used with mild to moderate severity of bronchial asthma.
2nd generation – Nedokromil- sodium (tayled), 6–8 times more active than intal. It is the drug of choice for basic treatment for all forms of bronchial asthma. Low toxicity, can be used for years, they should not be prescribed to women in the first 3 months of pregnancy.
2) Glucocorticoids they suppress acute and chronic inflammation, reduce swelling of the bronchial mucosa, and reduce choking attacks. They are used for basic therapy with the ineffectiveness ofadrenomimetics , M- anticholinergics and methylxanthines. Apply inhalation – Beclomethasone ( beclocort, backcloth, beclomet), Budesonide (pulmicort), Flunisolide (ingakort), Fluticasone (flixotide, flohal ) 2-3 times a day. They are effectively combined with adrenergic mimics: ” Seretid “, ” Combient “. Use also Prednisolone in tablets according to the scheme, with asthmatic status – in the vein. For the prevention of oral candidiasis inhalers are recommended to use with special nozzles or regularly rinse your mouth.
Contraindications: acute circulatory disorders, renal failure, atherosclerosis, hypertension, diabetes, peptic ulcer and duodenal ulcer.
In the treatment of asthma, important positions have been taken by means of influencing leukotriene system. Leukotrienes are formed from arachidonic acid with the participation of a number of enzymes, the main of which is 5-lipoxygenase. When leukotrienes interact with specific bronchial receptors, inflammation, mucosal edema, and bronchospasm develop .
For the prevention of asthma attacks, leukotriene receptor inhibitors have been proposed – Zafirlukast (acolat), Montelukast (singular) tablets and capsules for oral administration. They show a pronounced anti-inflammatory effect, which is manifested in a decrease in vascular permeability, a decrease in edema of the bronchial mucosa, inhibition of the secretion of thick, viscous sputum. At the same time there is an expansion of the bronchial tubes Of undesirable effects are possible headache, dyspeptic symptoms, pharyngitis, skin rash.
BREATHING MECHANISM. LIFE CAPACITY OF LUNGS
Respiratory movements provide inhale and exhale. When you inhale the intercostal muscles, reducing I, raise the ribs, and the diaphragm moves aside abdomen cavity, becoming flatter. The volume of the chest cavity increases. Since the pressure in the chest cavity is below atmospheres then, as its volume increases, so do the lungs. The pressure in them also becomes lower than atmospheric, and air from the environment rushes into the lungs.
When deep breathing is necessary, the muscles of the body and body are also reduced. The exhalation is passive: the intercostal muscles relax, the ribs are lowered, the diaphragm rises, the volume of the breasts Noah and lung decreases. The pressure in the lungs becomes above atmospheric, and the air escapes from them. With deep expiration, there is an additional contraction of the intercostal and abdominal muscles, and the expiratory volume increases.
Types of external respiration in women and men spilled chatsya In men abdominal type breathing – breathe mainly by sokra diaphragm clearances; at wives chest women – breathe due to contraction of the intercostal muscles.
Vital capacity lay down kih (VOL) – the maximum possible exhalation after the maximum possible inhalation. Medium Vital Capacity Light which is 3500 cm3 and highly dependent on age, by la, fitness. From birth to The indicator increases approximately 45 times and can reach more than 5000 cm3 for a trained person.