The volume of assistance to patients with bronchial asthma and the choice of drug depends on the severity of illness at this stage of exacerbation.
Stages of flare-related steps are indicated:
Stage 1 - for occasional mild asthma
Asthma treated with this trend by actively identify trigger factors and address them. This has the effect in some cases without any therapeutic measures. For lack of effectiveness can be used short-acting agonists. These drugs are used or INTAL prophylactically before exercise or exposure to an allergen. The course of anti-inflammatory therapy may be assigned to the periods of exacerbation.
Step 2 - for mild persistent asthma
Asthma is characterized by a distinct clinically and functionally expressed persistent symptoms during acute exacerbations, which suggests the presence of this inflammation in the airways, which requires active treatment. Drugs of choice are inhaled anti-inflammatory drugs (INTAL, nedocromil sodium), appointed for the long term. Briefly emerging deterioration in the form of breathing difficulties cropped beta 2 agonists Short-acting, appointed as required, but not more than 3-4 times per day.
Step 3 - During moderate
It is characterized by different variants of the frequency and severity of asthma symptoms, from relatively mild to significant and pronounced lability of the functional parameters, so the therapy of these patients is carried out individually as far as possible.
In treating these patients in various combinations using the whole arsenal of asthma in the light of the inflammatory nature of the disease. The main role in the treatment of inhaled anti-play (INTAL, nedocromil sodium, corticosteroids) appointed day, a long with the selection of individual support in the subsequent doses. As a rule, the dosage of inhaled steroids in asthma moderate flow - up to 1000mkg/sut.; In order to control nocturnal symptoms illustrates the use of long-acting bronchodilator. The choice of drug bronhodilyatiruyuschego decided individually depending on the resulting effect and tolerability. The use of anticholinergics is indicated for vagotonia that occurs in older patients.
For relief of moderate denominated short-term attacks can use beta2-agonists Short-acting. Acute emerging or longer decline, including the development of asthma attacks of varying intensity and duration required for the relief of single or repeated parenteral administration of bronchodilators, and in case of lack of effectiveness - GCS with individual selection of doses and duration of the course.
In addition to anti-inflammatory therapy in patients with asthma, moderate flow require a daily intake (2-agonist (salbutamol) or methylxanthines (theophylline) (due to the limitation of physical activity of patients because of the frequent occurrence of symptoms of bronchial obstruction).
Step 4 - a serious condition
Characterized by a continuous recurrence of symptoms, their degree of severity is so great that it leads to a decrease in physical activity, and often disability. Given the severity of a significant inflammatory changes, a leading place in the treatment of patients in this group belongs to the SCS. It is recommended to combine high-dose inhaled corticosteroids (svyshe1000 mg) with minimal, individually tailored doses of systemic corticosteroids.
Complete normalization of clinical and functional parameters in these patients can not be reached due to the danger of prolonged use of high doses of systemic steroids. The main objective in treating patients with severe asthma is to reduce the need for corticosteroids, which is achieved by combining their use with different groups of bronchodilator drugs with prolonged action. The control of short-term bouts of moderately expressed by means of rare (not more than 3-4 times a day), short-acting agonists techniques.
A more pronounced deterioration in the course of the disease require the appointment of additional doses of corticosteroids, administered parenterally or increase maintenance dose corticosteroids. The criteria for the effectiveness of the treatment is to reduce the incidence of asthma symptoms, the positive dynamics of the data of objective studies of patients, normalization or stable trend to normalization of laboratory and functional parameters.
In addition to anti-inflammatory therapy in patients with severe asthma need to be taken every day (2-agonist (salbutamol) or methylxanthines (theophylline) (due to the limitation of physical activity of patients because of the frequent occurrence of symptoms of bronchial obstruction).
By achieving and maintaining a stable treatment results in the corresponding stage, we can reduce the intensity of therapy to establish a minimal impact medicines needed to maintain control of the disease (step down).
According to MLA standards, the transition to step up (increased medication) is required in cases of inability to control the disease in the previous step, provided the correct performance of patients with doctor's prescriptions.
Inclusion in the arsenal of therapeutic action of other drugs and drug-free funds in accordance with individual indications and contraindications.
