Therapy of bronchial asthma: treatment standards for remission and exacerbation

Bronchial asthma is a common disease that affects 4-10% of the population. In childhood, the percentage rises to 10-15.

For bronchial asthma, special treatment standards have been developed. However, in the early stages, it is often misdiagnosed and treated incorrectly.

Therefore, in the case of an illness, the symptom of which is wheezing, it is always worth remembering that it can be asthma.

General information about the disease

Bronchial asthma is a chronic inflammatory pathology that affects the respiratory tract. Periodic asthma attacks are the main clinical manifestation of the disease.

The diagnosis is made by the doctor after a comprehensive examination of the patient. In order not to confuse bronchial asthma with other respiratory diseases, chest images obtained with computed tomography or radiography are studied.

The system of therapy and standards of care for bronchial asthma

Treatment standards exist for many diseases, they represent a step-by-step set of measures necessary for a diagnosis according to all necessary criteria and an effective treatment of the disease.

The standard of asthma treatment includes modern methods of treating pathology, time-tested and improving the patient’s condition.

The standards by which patient care is provided are approved by the Ministry of Health.

In accordance with them, the medical documentation filled in by the doctor is checked, the correctness of the prescribed set of examinations and therapy is analyzed. The use of asthma treatment standards is due to several reasons:

  1. The help that is provided to the patient, in this case, is effective and does not harm health.
  2. All specialists work in accordance with the standards, both in public and private medical institutions.
  3. The standards include the latest scientific data on pathology. This allows for more effective treatment.
  4. A statistical database is being created, common for all.

How the severity of the disease is determined according to the standards

The severity of bronchial asthma is established during diagnosis. The choice of therapy for the disease depends on it. When diagnosing, the intensity of the clinical symptoms of asthma and the results of additional studies are taken into account, namely:

  1. When collecting anamnesis, the frequency of attacks and the time of their occurrence are determined.
  2. An analysis of urine, blood is prescribed, a sputum test is mandatory.
  3. The effectiveness of the prescribed drug therapy is evaluated.
  4. The indicators of external respiration, their deviation from the norm are evaluated.

In terms of severity, the disease is classified as follows:

  • 1st degree is the mildest form of the disease. Shortness of breath, seizures and wheezing appear no more than once a week. Attacks occur after contact with allergens, they are possible during a cold or when cleaning the house, wiping the dust.

Also, an attack can begin from cigarette smoke or a pungent odor. The patient’s speech is not disturbed, the condition between attacks is normal. With an attack, tachycardia is possible, while exhaling, a whistling sound is heard, and inhalation is elongated.

  • Grade 2: Symptoms are more frequent, but suffocation occurs no more than three times a week.

During an attack, it becomes difficult for the patient to breathe. Dry rales are heard in the lungs. When you cough, phlegm sometimes comes out. The patient’s condition is restless. The skin turns pale, and in the area of ​​the nasolabial triangle it acquires a bluish tint. Exhalation is difficult, with a loud whistle.

  • 3rd degree: asthma sufferers may experience choking on a daily basis. Requires constant supportive therapy and medical supervision.

There is a systematic breathing disorder. The patient develops a cold sweat, fear and panic seizes him. Whistling during breathing is clearly audible even from a distance. Blood pressure rises.

  • 4th degree: exacerbations occur several times a day, often choking symptoms bother at night. The patient’s physical activity is limited, since the load often provokes an attack. The patient’s sleep is disturbed. Daily medication is required.
  • 5th degree: severe asthma, poorly corrected. Large dosages of potent drugs are prescribed. The patient’s speech is choppy. Physical activity is severely limited. Death with an attack is possible.

Disease diagnosis according to standards

Diagnostics consists of several stages, each of which is related to the previous one.

  1. Collection of anamnesis and complaints. Most often, the patient complains of shortness of breath, shortness of breath, cough, periodic attacks of suffocation. An important criterion is the change in symptoms with the use of bronchodilators . Risk factors are also being investigated: heredity, allergic reactions, etc.
  2. Objective examination. The doctor records the patient’s shortness of breath, symptoms of excitement during an attack, wheezing on auscultation.
  3. Functional tests. The simplest method is peak flow measurement . Testing allows the doctor to assess the severity of the condition. Every asthmatic person should have a peak flow meter at home for daily monitoring.
  4. Identification of allergens using various techniques. Scarification tests are used , provocative tests are possible.
  5. For differential diagnosis, additional examination methods are prescribed: chest x-ray, ECG, complete blood count, sputum examination.

It is especially necessary to carefully compare the symptoms and test results in children and the elderly, since the symptoms often differ from the standard.

Treatment of bronchial asthma in adults

All drugs that are used in the treatment of bronchial asthma are indicated in the standard of care.

The main indicator of the effectiveness of treatment is the achievement of complete control over asthma.

Step therapy for bronchial asthma

The principle of treatment is as follows: therapy will depend on the degree of dysfunction of the bronchial tree. The number of drugs and their dosage increase with each step.

The drugs are selected taking into account concomitant pathologies, individual intolerance. Each step involves a choice between one or another group of drugs.

If the prescribed drugs do not bring any effect, the transition to a new level is carried out. All stages are prescribed in the standard of treatment of bronchial asthma.

  • 1st stage. Before training, playing sports, and other physical activity, inhaled drugs are taken, such as beta2-agonists, nedocromil sodium. Short-acting theophyllines are sometimes used. However , side effects often appear from their use, so their use is undesirable.
  • 2nd stage. Medicines are the same as in the 1st stage, but the intake is long and daily. Long-acting theophyllines are used. Sometimes inhaled hormonal drugs are used for treatment at a dosage of up to 800 mcg / day.
  • 3rd stage. The patient is prescribed corticosteroids in the form of aerosols at a dosage of 800-2000 mcg / day. In addition to them, long-acting bronchodilators are used as maintenance therapy to reduce the frequency of nocturnal asthma attacks. At the time of the attack, short-acting beta2-agonists are used.
  • Stage 4 Asthma is uncontrollable, you can only improve the patient’s condition, reduce the number of attacks. Inhalation hormones are used in large doses (800-2000 mcg); in severe exacerbations, corticosteroids are taken orally. Rapid-acting beta2-agonists are used for an attack in adults, but no more than 4 times a day.

Help with exacerbations

Exacerbations of asthma occur due to improperly selected therapy or non-compliance with the doctor’s recommendations. Another possible reason is prolonged exposure to allergens.

Often these conditions require urgent medical attention. Dyspnea increases, wheezing rales are heard at a distance.

With an attack, the following groups of drugs are used:

  • inhaled beta2-agonists: salbutamol , fenoterol;
  • inhaled glucocorticoids;
  • GCS in oral form for severe symptoms of asthma;
  • anticholinergics – used in case of suffocation threatening [M27] the patient’s life;
  • humidified oxygen in cases where the asthmatic has signs of hypoxemia.

Treatment of the disease in children

First, it is necessary to eliminate the effect of the allergen on the child’s respiratory tract. Asthma therapy in children (as in other categories of patients) consists of basic therapy and drugs for stopping the attack.

Children have difficulties using the inhaler; it is preferable to use a spacer , which is an intermediate container for the aerosol. A nebulizer is also used for inhalation.

For basic therapy, antihistamines and cell membrane stabilizers are prescribed. In severe cases, hormone therapy is used.

Non-drug therapy of bronchial asthma according to treatment standards includes the use of exercise therapy, massage, physiotherapy and spa treatment.

Treatment methods are selected individually for each patient. One of the modern methods of treating asthma is allergen-specific immunotherapy, the purpose of which is to reduce the body’s sensitivity to a particular allergen.

Prevention of bronchial asthma

All preventive measures are divided into those that are aimed at preventing the development of the disease and those that can slow the progression of the disease.

Smokers, people with a hereditary predisposition to asthma and those who work in hazardous conditions should be required to take primary prevention measures. They must observe all the rules of hygiene, timely treat diseases of the respiratory system, exclude contact with allergens and lead a healthy lifestyle.

Prevention of attacks in asthmatics includes both treatment and measures to prevent exacerbations.

The action of the allergen is excluded, the constant intake of drugs prescribed by the doctor in accordance with the severity of asthma is required . You cannot independently cancel the drug or increase the dosage, as this can lead to an increase in symptoms.

The nurse, in accordance with the doctor’s prescription, should teach the patient to monitor the parameters of external respiration on a daily basis using a peak flow meter at home.

If possible, then every day you need to set aside time for light physical activity.


Asthma is a pathology that, with the right approach to treatment in accordance with modern standards, can be completely controlled. Treatment of bronchial asthma should be prescribed by a specialist.

This takes into account the severity of the disease, the individual characteristics of the patient. In treatment, it is important to monitor the body’s response to the prescribed drugs.

In case of exacerbations, it is very important to take timely measures, if necessary, hospitalize the patient to prevent the development of complications and asthmatic status.

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