Non-hormonal drugs to control asthma.
(Salmeterol: Serevent, formoterol: Oxis, Foradil ) – the second most important drugs for bronchial asthma. They are added (they are added, and not appointed instead of !!!) to inhaled hormonal drugs, starting with the moderate severity of bronchial asthma. It has been proven that the combination of these two groups of drugs exceeds twice the dose of inhaled hormones in their effectiveness.
And except for inhaled beta-2-agonists durable of action appointed Cromones, slow release theophylline, antileukotriene drugs.
Cromones are harmless, but their effectiveness and anti-inflammatory activity is low, so they are used mainly for mild asthma. Antileukotriene drugs (Singulair) can be effective in asthma and aspirin syndrome post-exercise bronchospasm (this is a form of asthma, in which difficulty breathing occurs not during exercise, but after 5-30 minutes after that). They are also effective in chronic allergic rhinitis.
As for the Theof of the Illin , their main advantage is the relative cheapness. They are less effective than beta-2 agonists, and their mechanism of action is mainly extrapulmonary (for example, the effect on respiratory muscles). They have little effect on airway inflammation; their place in treatment is rather the gain of another therapy than its alternative.
Systemic hormones as maintenance therapy.
This should be avoided, but sometimes it happens. Sometimes it turns out that they were appointed for a long time, before the advent of modern methods of treating asthma, and nobody has changed the therapy since then. First, if a patient takes systemic steroids, he must receive inhalation, and in large doses, and against their background, under the supervision of a physician, you should try to reduce the dose of systemic steroids as much as possible (ideally, take it off completely). No matter how low the dose of systemic steroids (even a quarter of the pill), such patients should be considered patients with severe asthma. They must be carefully examined to find out why there is a need for such treatment. It often turns out that such patients continue to contact their causative allergen, or do not receive inhaled hormones, or they have some other, more serious disease (not asthma). Or their inhalation technique is completely bad.
Specific immunotherapy (SIT).
This type of treatment is also referred to as therapy controlling the course of the disease. Hyposensitization with allergen extracts is widely used in the treatment of allergic diseases, including bronchial asthma, especially in children. But SIT is most effective in pollinosis with a predominance of allergic rhinitis. However, recent reviews confirm the effectiveness of SIT in bronchial asthma. SIT is carried out under the supervision of a physician (due to the possibility of undesirable reactions), is rather long and is associated with the need for subcutaneous injections. In severe asthma and polyvalent allergies (reactions to many allergens of different groups), its use is limited and can be dangerous.
The timing of treatment.
The concept of “treatment” for chronic diseases does not exist. If everything goes well, every 3-6 months, the possibility of reducing the amount of therapy is considered. If deterioration occurs, take action immediately. The most urgent measures are included in the plan of action for asthma, further prescribed by the doctor, depending on the response of the patient.
Drugs and methods that should not be used during exacerbation:
- Antihistamines
- Sedatives (hypnotics and sedatives)
- Herbs and Phytopreparations
- Mustard plasters, banks
- Calcium, magnesium sulfate
- Mucolytics
- Prolonged bronchodilators ( methylxanthines and beta-2-agonists)
- Antibiotics (shown only in the presence of a bacterial infection)
What should be used in the exacerbation of asthma:
- Basis of treatment: inhaled beta-2 agonist of fast action through a spacer or via a nebulizer up to 3 times during the first hour, and not only subjective indicators of well-being are used to check the degree of response to treatment, but also peak flow data .
- You can add anticholinergics
- Systemic hormones in severe exacerbations (according to the latest data, a large dose of inhaled hormones may be effective – Pulmicort – via a nebulizer )
- Oxygen
- Perhaps the introduction of high-speed methylxanthines (aminophylline) intravenously with insufficient effectiveness of other methods
- Further measures depend on the response to therapy.
- Knowledge of necessary measures in case of exacerbation should not be considered a reason for refusing medical care
- Severe exacerbations of asthma are life-threatening conditions and must be treated in the hospital
Which patients have a higher risk of severe exacerbations?
- In patients who have had such exacerbations in the past
- For those who have just recently stopped using hormones in pills, or have to use them now because of the severity of the condition.
- For those who do not use inhaled hormonal drugs
- In patients spending more than 1 inhaler to relieve symptoms per month ( salbutamol , etc.)
- Have poor adherence to asthma treatment plan
- In people with mental illness who abuse hypnotic drugs and sedatives
Are unconventional treatments, non-drug methods and hardening used in asthma?
Non-traditional and popular methods are very popular, and often they are expected to have a miracle. Alas, the miracle does not usually occur. The fact is that non-traditional methods are not suitable for everyone, and the effectiveness of most of them has not been proven. But their study continues, and it is possible that their attitude towards them will change.
At the moment, the most often we are talking about such methods as various types of respiratory exercises , herbal therapy , acupuncture, homeopathy and others. Many methods have their active supporters, actively promoting their benefits. Gymnastics system Strelnikova was developed primarily for the treatment of diseases of the upper respiratory tract and restore the voice of singers. In essence, this is a special type of respiratory gymnastics, and, of course, is not a panacea.
The Buteyko method is most effective in patients with a tendency to hyperventilation. Bronchial asthma with hyperventilation disorders can be considered as a special neuropsychiatric variant of asthma and is not observed in all patients.
Yoga classes are not contraindicated in asthma, but do not replace drug treatment, but complement it.
Herbal treatment for patients with pollinosis (pollen allergy) can be dangerous. In addition, there is no clear data on the efficacy and safety of various plants included in medicinal fees. The fact that the drug is of natural origin does not guarantee its safety and the absence of toxicity.
There is no evidence of the effectiveness of homeopathy and acupuncture in asthma. In some cases, there is a positive effect.
In any case, one should not refuse effective treatment for the sake of the method with unproven effectiveness.
Respiratory gymnastics is one of the necessary methods in the treatment of bronchial asthma, which increases the functionality of the body and restores the normal functioning of the muscles. The simplest exercise is to train the breath by creating positive pressure at the end of the exhale. In addition to the various devices that are available for this, you can use the simplest device. After a sufficiently deep inhalation, exhalation is made through a cocktail straw dropped into a glass of water. This exercise is repeated 4-5 times a day for 10-15 minutes. A similar technique is used in the famous Frolov apparatus.
Various diaphragmatic breathing exercises are used, in the presence of sputum, drainage positions are used to improve its discharge.
A patient with bronchial asthma without exacerbation can and should engage in active exercise. It is necessary to begin occupations when control of a disease on the background of selected therapy is achieved. It is necessary to increase the load gradually. It is important that sports do not include contact with allergens and precipitating factors. For example, if you are allergic to dandruff of warm-blooded animals, equestrian sports can be dangerous. When swimming, preference should be given to pools where water disinfection is not achieved due to strong chlorination.
An important place in the non-pharmacological treatment of asthma is massage, and as a facial massage, aimed mainly at restoring nasal breathing and chest massage.
Hardening. In traditional hardening programs, a gradual decrease in the temperature of the water is used, and so slowly that during this time there can often be a viral infection, an exacerbation of the disease, and everything will have to start all over again. For a person with asthma, this method is not very suitable. Meanwhile, a method of fast hardening with cold water has been developed, which makes it possible in a short time to turn on the body’s defenses.
Before you start hardening, an examination is necessary: cold hardening technique cannot be recommended for severe diseases of the cardiovascular system (angina pectoris attacks, rhythm disturbances, etc.), for diseases of the urogenital and nervous systems. It is possible to start cold douches without prior preparation, but the condition should be comfortable: you should not be doused if you are already cold and also if you sweat (in this case, you must first wash with warm water). You can use a drench from a bucket or basin (but not a shower!). After a proper douche, the person feels not the cold, but the overflowing heat. Should not be rubbed, but you just need to get the body wet with a towel. At the beginning of hardening (the first 3 months) should not reduce the amount of maintenance therapy.