Treatment of bronchial asthma medications and other methods: Step 1

What devices to use

Inhalation form is the most effective and safe. The medicine is delivered exactly where it is needed, i.e. in the bronchi. The action develops quickly, the highest concentrations are created in the respiratory tract, systemic (general) action is minimized. Many drugs (anticholinergics) can only be used in inhalation, because when ingested, they are not absorbed. Other drugs in the form of inhalations act topically (locally), which increases not only their effectiveness, but also safety.

The most common dosed aerosol inhalers, activated by pressing on the spray. The disadvantage of it is that many patients find it difficult to coordinate inhaling and pressing. This can be overcome either by using special training, or by using a spacer (reservoir chamber, which creates additional volume).

Two groups of drugs for inhalation

All drugs for medical treatment of the disease are divided into two types: drugs for emergency care or relief of exacerbations and drugs to control the disease (planned basic therapy). If quite simply, the majority of medicines for asthma may say: those that relieve the symptoms without treating the disease itself, and those that are treated, at the time of the attack did not help.

Emergency drugs (symptomatic, for symptom relief).

The most effective drugs to relieve symptoms (wheezing, chest tightness and coughing) are beta-2 agonists with a rapid onset of action. Despite the complex name, they are familiar to everyone: this group includes salbutamol (aka ventolin), etc. They are able to quickly expand the narrowed bronchi, so they are primarily used for acute asthma symptoms. Preference is given to drugs that are more selective , i.e. act almost exclusively on the desired type of receptors in the bronchi, and not on the heart, for example. Therefore, it is not recommended to use non-selective old drugs, such as asthmopent or Novodrin.

Cholinolytics (atrovent ) can be used in those patients who do not tolerate beta-2-agonists poorly. They act more slowly (30-60 minutes before the development of the maximum effect).
There are combination preparations containing drugs of these two groups (berodual = berotek + atrovent).

Short-acting theophylline (aminophylline) can be used for emergency care, but it is less effective than inhaled beta-2 agonists. In addition, the occurrence of undesirable effects is possible, especially in people receiving prolonged drugs of this group. In modern schemes of emergency care for exacerbations in the first place – beta-2 agonists of rapid action in the inhaler or through a nebulizer, and not aminophylline intravenously.

For severe exacerbations, apply systemic hormones in pills or intravenously in a short course. It is important that the short course is really short (3-10 days), therefore, the dose should be sufficient to interrupt the development of an aggravation. It is better to apply a higher dose in a shorter time than a smaller dose for a long time.

But it should always be remembered that, since asthma is an inflammatory disease, simply removing a bronchospasm is not enough. In all cases, except the easiest options with rare and mild symptoms, anti-inflammatory therapy should be carried out. This will allow you to control the disease and avoid the development of severe exacerbations, entering the hospital and the use of systemic hormones.

But it should always be remembered that, since asthma is an inflammatory disease, simply removing a bronchospasm is not enough. In all cases, except the easiest options with rare and mild symptoms, anti-inflammatory therapy should be carried out. This will allow you to control the disease and avoid the development of severe exacerbations, entering the hospital and the use of systemic hormones.

To treat or not to treat? When basic therapy is definitely needed.

If difficulty in breathing occurs rarely and is easily removed with the help of an inhaler, it is possible to do without constant treatment. But if you need the inhaler more than 4 times a week, you need not to lament but to be treated. Anti-inflammatory therapy does not relieve the symptoms and seizures that have already arisen, but prevents their further appearance.

In addition, even for rare, but severe exacerbations, basic therapy is necessary: ​​mild bronchial asthma with severe exacerbations is treated as moderate asthma. It is in the interest of the patient.

The general principle of the basic anti-inflammatory therapy of asthma is a stepwise approach.

In the treatment of asthma, a “graded” approach is currently used, in which the intensity of therapy varies with the severity of asthma.

A step-by-step approach to the treatment of asthma is recommended due to the fact that different people and the same person have different asthma at different times. The goal is to achieve asthma control with the least amount of medication. The number and frequency of medication increases (step up), if the course of asthma worsens, and decreases (step down), if asthma is well controlled for at least 3 months. This should take into account whether the patient is taking medication, and whether there is contact with allergens or other provoking factors. According to a number of studies, it is more effective to first prescribe a more active therapy, and then reduce it according to the “step down” principle, and not vice versa.

Inhaled hormonal drugs and their safety.

It’s no secret – steroid phobia exists. People are afraid of any hormones, while often they do not distinguish which hormones themselves are in question (after all , the thyroid, pancreas, and sex glands are not produced by hormones ), and they do not take into account whether it is possible to do without such drugs. in each case, and from what they can protect. They didn’t come up with something : and what can be “hooked up” on them, as if it were a drug, and that nothing helps after them … E If it is very short, everything is exactly the opposite.

Why are they and how they differ from systemic hormonal drugs (in common parlance – hormones)?

Inhaled hormonal drugs – the most effective means for long-term therapy for bronchial asthma. Long-term treatment with their help reduces the frequency and severity of exacerbations, and therefore, can protect against the need to apply systemic hormones.

Hormones were specially designed in such a way that their action was local (topical): anti-inflammatory, where it is needed (in the bronchi), and with a small dose, and the systemic (general) effect is minimal. Terrible stories, born when there were no hormones, and had to use systemic hormones (hormones in tablets) for routine therapy, do not belong to topical hormones. It has been shown that even long-term therapy does not lead to an increase in the incidence of osteoporosis or bone fractures. Studies involving more than 3,500 children who received hormones from 1 to 13 years have shown that they do not affect growth and development (but untreated asthma slows growth). The risk of diabetes and other equally “pleasant” dangers arise from long-term administration of systemic hormones (in pills), and not inhalation.

It is useless to prescribe inhalation of systemic hormones (hydrocortisone, prednisolone and dexamethasone): these drugs, regardless of the method of use, have only a systemic effect. Up to 80% of patients have difficulty using metered-dose aerosol inhalers, which is why the use of a spacer is so important.

What determines the dose of inhaled hormones.

The dose of hormones depends on the severity of asthma prior to treatment. The higher the severity of asthma, the greater the dose to be applied. The most important factor affecting the dosage is the response to therapy. With a good response, reduce the dose to the minimum effective.

And getting used to them does not happen. Simply, if contact with allergens and provoking factors cannot be eliminated, the need for anti-inflammatory therapy will continue. And if the causative allergen is easily eliminated, after its elimination, the need for hormones will decrease and it will be possible to switch to non-hormonal drugs , or even the need for maintenance therapy will disappear altogether.

Dose: what?

In some preparations, a metered dose is indicated, i.e. one that is in a capsule or blister, or measured by a dosing device. At the same time, on some modern preparations (for example, Symbicort ) they indicate “delivered dose”, i.e. the one that actually gets into the airways with proper use of the inhaler.
In combination preparations, the dose is often indicated through a fraction (Symbicort 160 / 4.5 μg = pulmicort 160 μg + formoterol 4.5 μg in metered doses).

Against the background of inhaled hormones, other anti-asthma medications work no worse, while luchebzhet-2 long-acting agonists are very effective in asthma, they are usually used for moderate to severe cases and are often included in one inhaler (Symbicort, Seretid ). Such single inhalers are convenient for both doctors and patients.

To prescribe inhaled hormones, you should not wait for getting into intensive care or the progression of the disease to severe. The earlier treatment is started, the more effective it is. According to a number of studies, in patients who started IGCC treatment no later than two years from the onset of the disease, control was achieved faster and against the background of lower doses of inhaled hormonal drugs compared to the group that started IGX treatment by after more than five years from the onset of the disease.


  • Hormonal inhalers are not designed to remove the already frisky attack of suffocation! They are appointed according to plan, and it takes time for them to act.
  • You can not leave the treatment halfway. If you have already become better, this does not mean that you should immediately quit and wait for the next deterioration. Reducing the dose and / or amount of drugs can be done only after 3 months of good control of asthma, and on the advice of a doctor, and “stepwise”.

Unwanted effects. In therapeutic doses, the systemic effects of inhaled hormonal drugs are minimal, while local ones are possible, especially with poor inhalation technique. If inhalation is not carried out correctly, coughing occurs due to irritation of the upper respiratory tract, hoarseness of the voice and candidiasis (thrush) of the oral cavity can develop. To avoid this, spacers are used , and after inhalation it is recommended to rinse your mouth (spitting out, rather than swallowing water after rinsing).

Leave a Reply

Your email address will not be published. Required fields are marked *