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Wednesday 23 January 2019
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Diagnosis and treatment of asthma

There is a concept of a stepped approach to the treatment of bronchial asthma. Its meaning is to change the dose of drugs depending on the severity of asthma.

Asthma diagnosis

After the manifestation of the first attacks of bronchial asthma, it is necessary to be examined by a pulmonologist, who collects detailed information about the course and duration of the disease, working and living conditions, the patient’s bad habits, and conducts a full clinical examination.

Sometimes asthma attacks are difficult to distinguish from the manifestations of other diseases. For example, pneumonia, bronchitis, heart attacks, pulmonary artery thrombosis, diseases of the vocal cords, tumors can also be the cause of an acute attack of dyspnea, asphyxiation and dry rales.

In the diagnosis of asthma helps the study of lung function (spirometry): for this you will need to exhale air into a special device. Mandatory research is peak fluometry – measurement of the maximum rate of exhalation. Then it will need to be carried out and at home, using a portable pickfluometer. This is necessary to objectively monitor the course of bronchial asthma and determine the required dose of the drug.

Laboratory methods for the diagnosis of bronchial asthma include blood and sputum tests.

With the help of radiography and computed tomography of the lungs, you can exclude the presence of infection, other lesions of the respiratory tract, chronic circulatory failure, or a foreign body in the respiratory tract.

You should also conduct a study with an allergist using skin tests with various allergens. This study is needed in order to determine what exactly can cause an attack.

Treatment of bronchial asthma

Bronchial asthma is a chronic disease requiring daily treatment. Only in this case, you can count on the success of its implementation. Completely cure chronic asthma is not yet possible.

There is a concept of a stepped approach to the treatment of bronchial asthma. Its meaning is to change the dose of drugs depending on the severity of asthma. “Step up” is an increase in dose, “step down” is a decrease in dose. In the majority of clinical recommendations there are 4 such “stages”, which correspond to 4 degrees of disease severity. Treatment must take place under the constant supervision of a physician.

Asthma Medications

Used several groups of drugs for the treatment of asthma. In the choice of how to treat asthma, symptomatic and basic drugs are isolated. Symptomatic drugs whose action is aimed at restoring bronchial patency and removal of bronchospasm are bronchodilators or bronchodilators. These funds include the so-called. drugs “ambulance” for the rapid removal of an attack of suffocation. They are used “on demand.”

The second group is the preparations of basic anti-inflammatory therapy, the action of which is aimed at suppressing allergic inflammation in the bronchi – these are glucocorticoid hormones, cromones, antileukotriene and anticholinergic drugs. Unlike ambulance drugs, basic therapy drugs are prescribed for the long-term prevention of asthma exacerbations; they do not have a quick, momentary action. Without removing the acute attack of suffocation, anti-inflammatory drugs act on the main cause of the symptoms of the disease – inflammation in the bronchi. By reducing and suppressing it, these drugs ultimately lead to a decrease in the frequency and strength of the attacks, and ultimately to their complete cessation.

Since inflammation in the bronchi in asthma is chronic, the use of anti-inflammatory drugs should be long lasting, and the effect of their use develops gradually over a period of 2 to 3 weeks.

Glucocorticoid hormones, in particular their tablet or injection forms, have many side effects:

  • immunosuppression (and as a result, the body’s tendency to various infectious diseases);
  • inflammation and ulcers of the gastrointestinal tract;
  • weight gain;
  • hormonal disturbance and others.

However, the pharmaceutical industry is not in place and the list of drugs than to treat asthma is constantly replenished. Today, a significant achievement of the pharmaceutical industry is inhaled glucocorticoid drugs – local, rather than systemic action. Inhaled glucocorticoids – a large group of drugs of synthetic origin, produced in the form of personal inhalers, dispensers or nebulizers nebulizers.

The creation of such drugs and their active introduction to the clinic was a truly revolutionary step in choosing how to treat asthma. High efficacy, good tolerability and a small number of side effects made these drugs the drugs of choice in the treatment of asthma, including in children.

Among all known anti-inflammatory drugs used to treat asthma today, glucocorticoids have the best balance of safety and efficacy. Their unique property is that when used as a basic therapy, inhaled glucocorticoids can reduce the initial level of reactivity of the bronchial tree, i.e. propensity to respond inadequately to various irritating stimuli.

In addition, regular use of inhaled glucocorticoids allows to translate the course of asthma into a milder degree, and, often, reduce the intake of inhaled adrenostimulators (means of ambulance for asphyxiation) to a minimum.

Do not forget about non-pharmacological treatment of asthma, which can be very effective.

These include:

  • special breathing techniques and the use of various breathing devices;
  • modifications of acupuncture (acupuncture, electroacupuncture, cauterization of wormwood cigars, etc.);
  • physical training techniques;
  • climatotherapy (speleotherapy – treatment in salt mines, the use of so-called gala cameras), etc.

For competent treatment of bronchial asthma, the patient (and, ideally, his relatives) need to visit an asthma school, where he will learn the basic measures for preventing attacks, study the rational breathing technique, the main groups of antiallergenic and anti-asthma drugs, and in addition, if necessary, they will help him to choose individual hypoallergenic diet.

The importance of such schools is hard to overestimate. Indeed, thanks to them, a person does not remain alone with his problem and gets used to the idea that asthma is not a sentence at all, but a way of life. As a rule, asthma schools operate on the basis of polyclinics and hospitals. The address of the asthma school nearest you will be prompted by the district therapist or pulmonologist you are monitoring.

Prevention

There is a primary, secondary and tertiary prevention of bronchial asthma.

  1. The primary prevention of asthma is aimed at the occurrence of asthma in healthy people, which is to prevent the development of allergies and chronic respiratory diseases (for example, chronic bronchitis).
  2. Secondary prevention of asthma includes measures to prevent the development of the disease in sensitized individuals or in patients at the stage of predastma who are not yet suffering from asthma. These are people who have allergic diseases (food allergies, atopic dermatitis, eczema, etc.), people with a predisposition to asthma (for example, have relatives who have asthma), or who have shown sensitization using immunological methods.
  3. Tertiary prevention of asthma is aimed at reducing the severity and prevention of exacerbations of the disease in patients who already suffer from bronchial asthma. The main method of preventing asthma at this stage is to exclude the patient’s contact with the allergen causing the asthma attack (elimination mode).

An important place in the treatment of asthma is visiting resorts. Sanatorium-resort treatment has a favorable post-resort effect on asthma patients. In world practice, considerable experience has been gained in successfully treating bronchial asthma in climatic resorts. The effectiveness of spa treatment of asthma depends on the correct choice of resort. The attending physician will select the optimal resort area for the rehabilitation of the patient with asthma, who will select a sanatorium for the patient with the possibility of treating the main (bronchial asthma) and related (or competing) diseases.