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Bronchial asthma - chronic inflammatory disease of respiratory tracts. Despite gravity of disease (its "incurability") at carrying out of adequate treatment sick of an asthma long time keep working capacity that underlines necessity of long (actually lifelong) therapy.
It is possible to note two prominent aspects of a problem:
- The bronchial asthma proceeds "wavy", that is the seasons of exacerbations are replaced by remissions during which the patient does not test practically any discomfort. By itself the conclusion about necessity of carrying out of preventive treatment ? for elongation of the seasons of remission arises
- At the heart of pathological process the chronic inflammation lays, hence antiinflammatory treatment should be the core in therapy
In bronchial asthma therapy it is possible to secure two directions:
- Treatment in an exacerbation
- Therapy in remission
Preventive treatment in remission - is long laborious joint work of the doctor and the patient. Problems of the doctor - to select the necessary therapy, to learn the patient to use correctly preparations and intelligently, supervising the condition, without risk for the health to variate a treatment regimen.
Antiinflammatory therapy - basis of preventive maintenance of exacerbations of an asthma.
Now as antiinflammatory preparations use following three basic bunches:
- Inhalation corticosteroids, and in serious cases and system corticosteroids
- Inhalation cromoglicic sodium (kromolin-sodium)
- Inhalation nedokromil-sodium
The choice of bunch of preparations depends on gravity of flow of disease.
Choice preparation at a bronchial asthma remains cromoglicic sodium (Intalum). Being a membrane the stabilizer, Intalum (interfering degranulate of mast cells) is effective at the majority of types of a bronchial asthma (an atopic bronchial asthma, an asthma of physical effort etc.). Monopreventive maintenance of exacerbations by Intalum is possible only at a bronchial asthma of easy flow: periodic reception of a preparation directly ahead of a possible exacerbation, at intermittent flow of an asthma (implication of symptoms is rarer an once in a week), or constant reception of a preparation at persistent character of disease (implication of symptoms from an once in a week to an once in day).
At an asthma of moderately severe and serious flow appointment of inhalation corticosteroids besides Intalum is necessary. The dosage of inhalation steroids as depends on gravity of disease. (At an asthma of moderately severe flow - to 1000mkg/sut; at an asthma of serious flow - from 1000mkg/sut to 1600 (2000) mkg/sut).
Besides antiinflammatory therapy sick of an asthma of moderately severe and serious flow require daily reception b2 - agonists (Salbutamolum) or methylxanthines (theophylline) (that is caused by restriction of physical activity of patients because of frequent occurrence of symptoms of bronchial obstruction).
Preventive maintenance system
Preventive actions at a bronchial asthma should represent system with a reliable feedback. That is the volume of preventive measures should variate constantly depending on a condition of the patient. Thus probably not only intensifying, but also weakening of activity of treatment.
The asthma control should begin with detailed studying of causes of illness at the concrete patient. Quite often "elementary" measures are capable to make appreciable impact on a disease course. So at an atopic variant of an asthma causative factor detection (various allergens, materials - inductors, medicinal preparations etc.) and prevention of contact to it in the subsequent (habitation change; region; a workplace; absence of domestic animals; change of attachment behaviours of the patient to certain products, materials) is capable to relieve the patient of clinical implications of disease.
Important value plays training of patients to competent reception of preparations, correct use of adaptations for introduction of preparations (the dosed aerosols, spacers, diskhalers, turbuhalers, spinhalers, cyclohalers) and for the control of a peak expiratory rate (peak flow metre) “PER”.
The patient should be able: to supervise PER, to know difference between preparations of basic and symptomatic therapy, to avoid asthma triggers, to distinguish signs of deterioration of disease and independently to stop attacks, and as in time to address for medical aid for cupping of serious attacks. Training sick of an asthma ? long process. The patient should receive a maximum of the information on disease and methods of its treatment. Building an asthma-clubs with obligatory participation in their work of physicians is expedient.
The long control of an asthma demands a written treatment planning (algorithm of actions of the patient), it is necessary to include in the plan:
- Individual daily dose of preventive preparations of long action
- Transfer of individual triggers of an asthma which to the patient are necessary for avoiding
- Actions at an aggravation of symptoms, including a dose bronchodilatator
- Signs of an aggravation of symptoms: symptoms, changes PER
- Actions at an exacerbation of an asthma and at cold first signs
- The description of situations when medical aid is necessary
Patients should visit regularly the doctor (some times in a month ? at selection of therapy and a regimen to the patient; once in 2 - 6 months, after achievement of the control of an asthma) during which time it is necessary not only to supervise change in a condition of patients but also to check correctness of use of preparations and adaptations for their introduction.
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