Treatment of bronchial asthma in adults, symptoms, medication, diagnosis

Bronchial asthma is a chronic relapsing disease that primarily affects the respiratory tract. Characterized by altered bronchial reactivity. A mandatory sign of the disease is an attack of suffocation and status asthmaticus. In most cases, the onset of the disease occurs in childhood and adolescence. However, the disease can begin to develop at any age. To diagnose bronchial asthma, pulmonologists at the Yusupov Hospital conduct a comprehensive examination of patients using modern laboratory and instrumental research methods. Patients are advised by an immunologist-allergist.

If a patient develops broncho-obstructive syndrome for the first time in old age, pulmonologists at the Yusupov Hospital must carry out a differential diagnosis with a number of diseases similar in clinical course (chronic obstructive disease, pulmonary embolism, acute left ventricular failure, lung tumor). To make a diagnosis of bronchial asthma, doctors establish the connection between the appearance of symptoms of the disease after contact with an allergen, the combination with rhinitis, seasonal variability of symptoms, the presence of a genetic, hereditary predisposition to allergic reactions in close relatives and the patient.

Pulmonologists individually select medications to treat each patient. Therapy is carried out with drugs registered in the Russian Federation, which are effective and have a minimal range of side effects.

Bronchial asthma is characterized by:

Increased or inadequate reaction of the bronchi (hyperreactivity) to the allergen;
Excessive production of bronchial secretions;
Chronic and protracted course;
Recurrent (paroxysmal) nature;
Shortness of breath;
wheezing;
Attacks of dry cough.

Despite numerous studies devoted to this topic, the problem of diagnosing and treating bronchial asthma remains relevant.
The true prevalence and incidence of asthma is difficult to estimate. This may well be due to the fact that different countries use certain diagnostic criteria that are specific only to this region. Rapid urbanization, environmental pollution, chemicalization of agriculture and the constant use of inorganic food additives have all led to a rapid increase in allergization of the world's population. To date, the highest incidence of bronchial asthma has been recorded in the USA, the Russian Federation and Australia. Treatment of bronchial asthma in Moscow is successfully carried out by specialists from the Yusupov Hospital Therapy Clinic. Experienced doctors with extensive experience use modern techniques for diagnosing and treating various diseases of the respiratory system. Thanks to close cooperation with European clinics and the exchange of experience, patients at the Yusupov Hospital Therapy Clinic have a unique opportunity to receive the most effective and safe medications for the treatment of bronchial asthma, which have minimal side effects on the body.

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The main reasons for the development of the disease

Bronchial asthma is a multifactorial disease, that is, it has different causes of development - both external and internal. Traditionally, asthma is believed to be caused by specific allergens:

Food (honey, citrus fruits, nuts, legumes, seafood, eggs);
Pollen;
Fungal;
Household (feather pillows, house and library dust);
Animal fur;
With pincers.

In order for hypersensitivity of the trachea and bronchi to occur, the amount of allergens during contact with them must be very large.
In the future, if the period of sensitization has passed, only a small part of the allergen is enough to trigger an attack of bronchial asthma. In second place after allergens are pharmacological agents:

Non-steroidal anti-inflammatory drugs;
Beta blockers;
Various dyes;
Aspirin is a classic drug that can provoke acute bronchospasm. A typical attack of aspirin asthma is combined with vasomotor rhinitis and rhinosinusitis.

Environmental factors also play an important role in the occurrence of asthma.
It is most often found in areas with developed heavy industry, high population density, dry climate, frequent temperature changes and stagnant air masses. The fourth reason for the development of AD is considered to be industrial waste. Bronchospasm can be caused by exposure to a variety of compounds used in industry:

Salts of heavy metals (nickel, chromium, platinum);
Wood and plant pollen (cedar, oak, cocoa);
Polymers;
Household chemicals;
Various paints and solvents.

Physical activity can provoke the appearance of symptoms of bronchospasm and bronchial obstruction.
The mechanism of development for this type of bronchial asthma involves temperature changes that occur in the bronchi as a result of increased ventilation and subsequent cooling and dryness of the inhaled air. In addition, a well-known factor is that psycho-emotional lability can both aggravate and improve the patient’s condition. This is directly related to changes in the tone of the vagus nerve. The vagus nerve is responsible for the motor activity of the smooth muscles of the tracheobronchial tree.

Healthy lifestyle

Asthma treatment

Bronchial asthma is an inflammatory process that occurs in a chronic form and is localized in the respiratory system. The disease causes incomplete and reversible blockage of the bronchi, attacks of suffocation and coughing, as well as increased reactivity of the bronchi.

Bronchial asthma

– a chronic disease, the basis of which is a constant non-infectious inflammatory process in the respiratory tract. External and internal factors play a role in the development of the disease. External factors are allergens, infection (viruses, fungi, some types of bacteria), chemical and mechanical irritants, meteorological factors, stress and physical overload. Dust allergy is the most common form. Internal factors include defects in the immune and endocrine systems, impaired sensitivity and reactivity of the bronchi, which can be hereditary, etc.

Asthma symptoms

Characteristic manifestations of bronchial asthma are attacks of suffocation, shortness of breath with difficulty in exhaling, and cough with sputum difficult to separate. Sometimes body temperature rises, which indicates increased activity of bronchopulmonary infection.

When examining the patient’s skin, you can see accompanying allergic manifestations: urticaria, eczema, psoriasis.

Shortness of breath during an attack of bronchial asthma is characterized by a short inhalation and an extended exhalation, accompanied by wheezing, which can be heard from a distance. The muscles of the shoulder girdle, back, and abdomen take part in breathing. The chest is in the position of maximum inspiration. The attack ends with the release of viscous sputum.

Frequent, severe, prolonged attacks of the disease can develop into status asthmaticus, which is one of the most severe and dangerous complications of the disease. This condition is characterized by severe suffocation, in which the number of wheezes decreases until they disappear completely (symptom of a “silent” lung). With the status, resistance to drug therapy is often noted.

Factors predisposing to the development of status asthmaticus are most often uncontrolled use of corticosteroid and sympathomimetic drugs, abrupt interruption of long-term hormonal therapy, acute or exacerbation of chronic diseases of the respiratory system, abuse of sleeping pills and sedatives, etc.

There are several stages of development of status asthmaticus

In the first stage, pain appears in the muscles of the shoulder girdle, chest, abdomen, shortness of breath and cough with sputum difficult to separate.

The second stage is characterized by a serious condition of the patient. The skin takes on a pale gray tint, breathing becomes shallow and rapid, blood pressure decreases, and the pulse is difficult to palpate. Periods of excitement are replaced by indifference.

In the third stage of development of status asthmaticus, consciousness may be absent, the skin is bluish-pale, blood pressure is so low that it is difficult to determine, and there may be convulsions.

Folk remedies for the treatment of bronchial asthma

Prepare a balm from 250 g of aloe, 0.5 liters of Cahors wine and 350 g of uncandied honey. Before cutting the leaves, do not water the plant for 2 weeks. Wipe the cut leaves from dust (do not wash!), cut and place in a glass jar, pour in Cahors and honey. Mix everything thoroughly and leave for 9 days in a cool place, then strain and squeeze. Take 1 tablespoon 3 times a day for the first 2 days, then 1 teaspoon 3 times a day.

Aloe leaves are cut at the age of 3-5 years, kept in the dark for 2 weeks at a temperature of 4-8 ° C, washed, crushed, poured with boiled water in a ratio of 1:3, left for 1-1.5 hours and the juice is squeezed out. 0.5 cups of this juice are mixed with 500 g of chopped walnuts and 300 g of honey. Take 1 tablespoon 3 times a day 30 minutes before meals.

Composition of the medicine: plantain (leaves) – 1 part, elderberry (flowers) – 1 part, sundew (herb) – 1 part, tricolor violet (herb) – 1 part. Four teaspoons of the crushed mixture are poured into a glass of boiling water, kept in a water bath for 5 minutes, then cooled and filtered. The decoction is drunk during the day in 3 doses.

Pour a tablespoon of dry or fresh plantain leaves into a glass of boiling water, leave for 15 minutes, strain. Take 1 tablespoon 4 times a day before meals. It is used as an antitussive for diseases of the respiratory tract with abundant sputum, including bronchial asthma, whooping cough and tuberculosis.

Wash and peel 400 g of ginger root, grate it, pour into a bottle and fill with alcohol. Infuse in warmth or sun for 14 days, shaking the bottle occasionally. The tincture should turn yellow. Strain, squeeze and let sit. Drink 1 teaspoon 2 times a day, with 3 sips of water, after meals.

Thoroughly mash 1 tablespoon of viburnum berries and pour a glass of warm boiled water, add 1 tablespoon of honey and mix everything well. Bring the mixture to a boil and simmer over low heat for 20 minutes. Stir again and strain. The mixture should be drunk throughout the day, taking 1 tablespoon every 1.5–2 hours. For asthmatics prone to hypertension, it is better to take juice from fresh viburnum berries, 1 tablespoon 6-8 times a day. Garlic oil is an effective bactericidal and emollient agent in the treatment of bronchial asthma. To prepare it, grate the garlic, mix it with salt and butter (for 100 g of butter - 5 large cloves of garlic, salt to taste). Garlic oil can be eaten spread on brown and white bread or added to mashed potatoes.

Pour 250 g of ground coffee into 0.5 kg of honey and mix thoroughly. Take small portions before meals. The prepared mixture is designed for 20 days of treatment. If you feel that you have improved, the treatment can be repeated again. You can also mix 0.5 kg of honey, 100 g of butter, 70 g of horseradish and garlic pulp. Take 1 tablespoon one hour before meals for 2 months.

During asthma attacks, massage of the upper body - from the head down to the chest - is very helpful. You can massage using talc or oily cream. To thin the mucus during attacks, drink a little sour wine or take soda on the tip of a knife. Valerian tincture (15–20 drops per glass of water) also helps.

Datura vulgaris is used to treat patients with asthma. This plant has an antispasmodic effect. Take a tincture inside, which is prepared from 1 part of crushed seeds and 5 parts of alcohol, leave for 7 hours. When taking, strictly adhere to the dosage: 2 drops per 3 tablespoons of water. Take 3-5 times a day, you can inhale its vapors for 15 minutes 3 times a day.

Pour boiling water over 40 seed onions and wait until they become soft. Then drain the water and simmer the onion in 0.5 liters of olive oil. Simmer until cooked, then mash to a puree consistency. Take 1 tablespoon morning and evening.

Grate 2 heads of garlic and 5 lemons, add boiled water at room temperature (1 l). Leave for 5 days, then strain and squeeze. Take 1 tablespoon 3 times a day 20 minutes before meals.

For bronchial asthma, whooping cough and chronic bronchitis, wild rosemary decoction is used as an expectorant with an antiallergic effect. Pour a tablespoon of chopped herbs into a glass of boiling water, boil for 10 minutes, cool and take a tablespoon 5-6 times a day.

Mix the fruits of anise, creeping thyme herb, fennel fruits and flax seeds equally. Pour four teaspoons of the mixture into a glass of water at room temperature, leave for 2 hours, boil for 5 minutes, strain. Take 1/3 cup 3 times a day.

Combine the fruits of fennel, the fruits of anise, the roots of licorice, the buds of Scots pine and the herb of creeping thyme in equal parts. Pour 10 g of the collection into 200 ml of water, heat in a boiling water bath for 15 minutes, cool for 45 minutes, strain and bring the amount of infusion to the original volume. Take 1/4–1/3 cup 3 times a day.

Take 4 teaspoons of crushed coltsfoot leaves, brew a glass of boiling water, leave for 30 minutes and strain. Drink 1/4 cup 4 times a day.

Mix common thyme herb, coltsfoot leaf, tricolor violet herb, elecampane root, and common anise fruits in equal proportions. Pour a tablespoon of the mixture into a glass of boiling water and leave for 30 minutes. Take 1/3 cup 3 times a day after meals for bronchitis and bronchial asthma.

Mix 150 g of fresh grated horseradish with the juice of 2-3 lemons and take 1/2 teaspoon after meals in the morning and after lunch, without drinking. This product is intended for adults only.

Mix equal parts of creeping thyme herb, Scots pine buds, common anise fruits, and common fennel fruits. Pour a tablespoon of the mixture into a glass of hot water, heat in a boiling water bath for 15 minutes, cool for 45 minutes. Strain. Take 1/4–1/3 cup 3 times a day.

Remove the shells of 10 raw eggs from the inner film, dry and grind into powder, which must be poured with the juice of 10 lemons and placed in a dark place for 10 days. Strain the resulting mixture through cheesecloth and mix with another composition of the following preparation: beat 10 yolks with 10 tablespoons of sugar and pour a bottle of cognac into the resulting eggnog. Mix the resulting mixture (shell powder, lemon juice, yolks, cognac) thoroughly and take 30 g 3 times a day 30 minutes before meals. Relief should occur soon after taking it. If necessary, the course of treatment can be repeated.

It is recommended to take 0.2-0.3 g of mumiyo in combination with milk or cow fat and honey (in a ratio of 1:20) in the morning on an empty stomach and in the evening before bed. The course of treatment is 25–28 days. It is necessary to conduct 2-3 courses with 10-day breaks.

Mix marshmallow root and creeping thyme herb equally. Pour two tablespoons of the mixture into a glass of boiling water and leave for 30 minutes. Take 1/3 cup 3 times a day after meals for cough, whooping cough, bronchitis, bronchial asthma.

Combine coltsfoot leaves, plantain leaves and pine buds equally. Leave four teaspoons of the mixture in cold water for 2 hours. Then boil in a sealed container for 5 minutes. Strain. Take 1 tablespoon 3 times a day.

Prepare an infusion of the following herbs: calamus root - 50 g, elecampane root - 50 g, coltsfoot - 100 g, wild rosemary - 100 g, tricolor violet - 100 g, cypress seed - 150 g. Grind all the herbs and mix. Brew a tablespoon of the mixture overnight in a thermos with 200 ml of boiling water. In the morning, strain and take 2 tablespoons 3 times a day before meals and 4 times at night.

Diet

The diet of a patient with bronchial asthma should contain a limited amount of carbohydrates, proteins, fats, that is, so-called “acidic” foods, and an unlimited amount of “alkaline” foods – fresh fruits, vegetables, sprouted grains and seeds. The patient should avoid foods that provoke the formation of sputum: rice, sugar, cottage cheese. He should also avoid fried and other poorly digestible foods, strong tea, coffee, seasonings, pickles, sauces and all refined and refined foods. The use of warm alkaline mineral drinks (Borzhom, etc.) is recommended, which help clear the bronchi from phlegm.

Traditional remedies for treating bronchial asthma

For the treatment of patients, bronchodilators (?-adrenomimetics, M-anticholinergics, xanthines), anti-asthmatic anti-inflammatory drugs (leukotriene inhibitors, mast cell stabilizers) are used. Mast cell membrane stabilizers and leukotriene inhibitors are basic therapy. These drugs prevent the development of an attack of bronchial asthma, reduce the reactivity of the bronchi, and reduce the frequency and duration of attacks.

For some forms of the disease, glucocorticoids are prescribed, which are also included in the basic therapy of bronchial asthma. These drugs reduce the inflammatory reaction, swelling of the bronchial mucosa, suppress the activity of the bronchial glands, and also, which is very important for this disease, reduce the reactivity of the bronchi. There are the following types of glucocorticosteroids: inhaled (beclomethasone, fluticasone, etc.) and systemic (prednisolone, dexamethasone, etc.). The advantage of inhaled drugs is that they have a predominantly local anti-inflammatory effect, with virtually no systemic side effects. Systemic glucocorticosteroids are prescribed for severe forms of the disease. They are administered intravenously or, preferably, orally. It is advisable to use them only in extreme cases when no other therapy has produced a positive effect.

Symptomatic therapy is also used. These are bronchodilators. There are a huge variety of them, but they provide only a short-term effect in the form of rapid relief of bronchospasm. The frequency of use of bronchodilators serves as an indicator of the effectiveness of basic therapy, i.e., the more often the patient has to use these drugs, the less effective the use of basic therapy is, and it urgently needs to be adjusted in a hospital setting. Bronchodilators come in a wide variety of inhalers, the advantage of which is that they are very easy to use even outside the home. One or two breaths are enough to relieve bronchospasm and prevent the development of an attack of bronchial asthma.

Stepwise treatment of bronchial asthma is considered internationally accepted. This approach is very convenient in terms of controlling the symptoms of bronchial asthma while using a minimum amount of medications. As symptoms worsen or new signs appear, the frequency of taking medications increases. This is a step up. With adequately selected therapy, the frequency and number of drug doses are reduced. This indicates the effectiveness of the treatment (step down). However, the worsening of the symptoms of the disease is not always associated with the inadequacy of the therapy. Before moving up a step, you need to make sure that the patient is taking the medications correctly.

Physiotherapeutic treatment of patients with bronchial asthma can be carried out both during periods of exacerbation and during remission. UHF therapy, inductometry, microwave therapy, ultrasound therapy, electrophoresis, and erythemotherapy are indicated.

Therapeutic exercise is a mandatory part of the complex treatment of bronchial asthma in patients of any age category. It helps restore respiratory function, promotes drainage of the bronchial tree, improving sputum discharge, prevents the development of emphysema, and also increases the body's resistance and strengthens the nervous system.

Classes are indicated during the interictal period of the disease. Therapeutic gymnastics, walking, games and simulation exercises are used, with special attention paid to breathing exercises. Chest massage, swimming, walking before bed, and hardening are also useful.

Source: www.nmedik.ru

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Development mechanism

The general mechanism of development, which is inherent in different types of bronchial asthma, is a change in the sensitivity and reactivity of the bronchi, which is determined by the reaction of bronchial patency in response to the influence of pharmacological and physical factors.
In persons suffering from the atonic variant of bronchial asthma, the disease is of hereditary origin. Nonbacterial (plant pollen, house dust, animal hair, bird down and feathers) and bacterial (viruses, bacteria, fungi) allergens play a role in the occurrence of allergic forms of asthma. The mechanisms that underlie different types of inflammation are not well understood.

It is assumed that predominantly eosinophilic inflammation is associated with the activation of Th2 lymphocytes and their increased production of interleukins-5 and 13. Neutrophilic inflammation may be a consequence of the use of inhaled and systemic glucocorticosteroids. With an unexpressed inflammatory process, smooth muscles, fibroblasts and neurons of the respiratory tract play a leading role in the development and progression of the disease. The central role of immunoglobulins E in atopic asthma has been proven.

In bronchial asthma, remodeling of the airways occurs:

Thickening of the basement membrane;
Thickening and increase in the number of smooth muscles and goblet cells due to their excessive formation;
Formation of new vessels.

This leads to irreversible changes in the ventilation function of the lungs and the appearance of ventilation defects. The central place in the mechanism of development of “aspirin” asthma is given to leukotrienes. In physical exertion asthma, heat transfer from the surface of the airways is disrupted.

Sources

Franova S., Molitorisova M., Kazimierova I., Joskova M., Forsberg CIN., Novakova E., Sutovska M. Pharmacodynamic evaluation of dihydroxyflavone derivative chrysin in a guinea pig model of allergic asthma. // J Pharm Pharmacol - 2021 - Vol73 - N2 - p.233-240; PMID:33793800
Winslow S., Odqvist L., Diver S., Riise R., Abdillahi S., Wingren C., Lindmark H., Wellner A., Lundin S., Yrlid L., Ax E., Djukanovic R., Sridhar S ., Higham A., Singh D., Southworth T., Brightling CE., Olsson HK., Jevnikar Z. Multi-omics links IL-6 trans-signalling with neutrophil extracellular trap formation and Haemophilus infection in COPD. // Eur Respir J - 2021 - Vol - NNULL - p.; PMID:33766947
Motlagh AJ., Esmaelzadeh Saeieh S., Parhigar O., Salehi L. An asthmatic pregnant woman with COVID-19: A case report study. // Respir Med Case Rep - 2021 - Vol31 - NNULL - p.101296; PMID:33240787
Lee DDH., Cardinale D., Terakosolphan W., Sornsute A., Radhakrishnan P., Coppel J., Smith CM., Satyanarayana S., Forbes B., O'Callaghan C. Fluticasone Particles Bind to Motile Respiratory Cilia: A Mechanism for Enhanced Lung and Systemic Exposure? // J Aerosol Med Pulm Drug Deliv - 2021 - Vol - NNULL - p.; PMID:32960118
Jackson N.D., Everman JL., Chioccioli M., Feriani L., Goldfarbmuren KC., Sajuthi SP., Rios CL., Powell R., Armstrong M., Gomez J., Michel C., Eng C., Oh SS ., Rodriguez-Santana J., Cicuta P., Reisdorph N., Burchard EG., Seibold MA. Single-Cell and Population Transcriptomics Reveal Pan-epithelial Remodeling in Type 2-High Asthma. // Cell Rep - 2021 - Vol32 - N1 - p.107872; PMID:32640237
Triantafillou V., Maina IW., Patel NN., Tong CCL., Papagiannopoulos P., Kohanski MA., Kennedy DW., Palmer JN., Adappa ND., Cohen NA., Bosso JV. In vitro safety of ketotifen as a topical nasal rinse. // Int Forum Allergy Rhinol - 2021 - Vol10 - N2 - p.265-270; PMID:32086998
Basnet S., Bochkov YA., Brockman-Schneider RA., Kuipers I., Aesif SW., Jackson DJ., Lemanske RF., Ober C., Palmenberg AC., Gern JE. CDHR3 Asthma-Risk Genotype Affects Susceptibility of Airway Epithelium to Rhinovirus C Infections. // Am J Respir Cell Mol Biol - 2021 - Vol61 - N4 - p.450-458; PMID:30916989
Satti R., Abid NU., Bottaro M., De Rui M., Garrido M., Raoufy MR., Montagnese S., Mani AR. The Application of the Extended Poincaré Plot in the Analysis of Physiological Variabilities. // Front Physiol - 2021 - Vol10 - NNULL - p.116; PMID:30837892
Seibold MA. Interleukin-13 Stimulation Reveals the Cellular and Functional Plasticity of the Airway Epithelium. // Ann Am Thorac Soc - 2021 - Vol15 - NSuppl 2 - p.S98-S102; PMID:29676620
Lindner K., Webering S., Stroebele M., Bockhorn H., Hansen T., König P., Fehrenbach H. Low Dose Carbon Black Nanoparticle Exposure Does Not Aggravate Allergic Airway Inflammation in Mice Irrespective of the Presence of Surface Polycyclic Aromatic Hydrocarbons . // Nanomaterials (Basel) - 2021 - Vol8 - N4 - p.; PMID:29614747

Modern classification of asthma

Thanks to an in-depth study of such a unique disease as bronchial asthma, many classifications of this pathology have been developed over time. For example, according to the International Classification of Diseases, Tenth Revision (ICD-10), the following forms of asthma are distinguished:

Allergic asthma - in this case, the cause of the development of the disease is mainly allergic processes. As a rule, the allergen can be identified during additional diagnostic studies;
Non-allergic asthma – the disease is not caused by allergic processes;
Mixed asthma - in which both allergic and non-allergic irritants are combined;
Unspecified asthma – the cause of the disease cannot be determined.

After doctors determine the type of asthma, they assess the severity of the patient's condition before starting treatment. For this purpose, classification by severity is used. It is based on four simple indicators:

Frequency of daily exacerbation symptoms per day and per week;
Frequency of nocturnal exacerbation symptoms per week;
The impact of an exacerbation on the patient’s quality of life;
The value of external respiration indicators (PSV and FEV1).

Bronchial asthma occurs in two stages.
The first stage, when symptoms appear from time to time, is called intermittent (episodic) asthma. The second stage, when symptoms are present for a long time or constantly, is called persistent (permanent) asthma. Depending on the severity of symptoms, this stage has three degrees of severity: mild, moderate and severe. Intermittent (episodic) asthma is characterized by short-term episodes of asthma attack, less than once a week. At night, attacks occur no more than twice a month (for at least three months). PEF and FEV1 > 80% of predicted value. Fluctuations in PEF during the day are less than 20%.

Persistent asthma (mild) is characterized by exacerbation of daytime and nighttime attacks (2 times a week). These episodes cause disturbances in sleep and activity. PEF corresponds to 60-80% of the predicted value. Fluctuations in PSV during the day are 20-30%.

Persistent asthma (moderate severity) is characterized by daily attacks of asthma. Nighttime symptoms occur once a week. These exacerbations gradually lead to limited physical activity and sleep disturbances. The patient requires daily use of inhaled medications (short-acting beta2-agonists). PSV - 60-80% of the required indicators. The daily fluctuation of the PSV value is more than 30%.

The persistent form (severe) is characterized by frequent nocturnal attacks, exacerbations, and a sharp limitation of physical activity. PSV

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Treatment from the 1950s

Last spring, someone told him about the Buteyko method, a shallow breathing technique developed in 1952 by Russian physician Konstantin Buteyko. Mr. Wiebe watched the YouTube video and repeated the instructions given in it.

“I felt my airways relax and open,” he recalls, “it was really impressive. Two of the participants in the exercises in the video were practically disabled; due to asthma, they could not go to work. They both admitted that the exercises were difficult, but allowed them to reduce their medication use by 75%. And their standard of living gradually returned to normal.” Mr. Wiebe began searching for information and found the Buteyko Center in the USA in his hometown of Woodstock. This is the newly created official North American representative office of the Buteyko Clinic in Moscow.

“I came to the Center without much hope,” recalls Mr. Wiebe, “within 24 hours I used the inhaler more than 20 times. If I was exposed to some kind of irritant or allergen, it could become life-threatening, and I would again have to go back to hormonal drugs to save myself from death. It was terrible".

However, after three months of training and maintenance classes in shallow breathing techniques, he said: “I use the inhaler no more than once a day and do not take medications, just do breathing exercises.”

Mr. Wiebe does not say he is completely cured, although he believes it could happen if he continues to exercise regularly. He says: “My standard of living has increased beyond my expectations. It is amazing. More people should learn about this method."

Typically, during an asthma attack, people begin to panic and breathe quickly and deeply, exhaling more and more carbon dioxide. The breathing rate is not controlled by the level of oxygen, but by the level of carbon dioxide in the blood, which regulates the acid-base level of the blood.

Dr. Buteyko found that hyperventilation—breathing too quickly and too deeply—may be a major cause of worsening asthma because the level of carbon dioxide in the blood drops so much that the airways constrict to prevent further loss of it. *) - Note below

It may seem that this method is contrary to common sense: according to the Buteyko method, people who are suffocating or are in a state of severe stress should not breathe deeply, but shallowly and slowly through the nose, breaking the vicious circle of sharp quick breaths, compression of the airways and suffocation.

I was intrigued by the shallow breathing method because I discovered its benefits during my daily pool sessions. I noticed that swimmers who took a deep breath during each stroke would stop to catch their breath after swimming a couple of lanes, while I took small breaths after a few strokes and could swim endlessly without getting tired.

The teachers of the Buteyko method at Woodstock, Sasha and Thomas Yakovlev-Fredriksen, were trained in Moscow by Dr. Andrey Novozhilov, a student of Buteyko. Their training consists of two courses of five lessons: one on breathing techniques, the second on correct lifestyle. Breathing exercises allow patients to gradually increase the time between breaths. Previously, Mr. Wiebe was forced to take a breath every two seconds, but now he can take a breath every 10 seconds, if necessary, at rest.

Symptoms

The clinical picture of bronchial asthma is described by three main symptoms:

breathing disorder,
coughing attacks,
presence of distant wheezing.

In most cases, attacks occur at night.
Approximately 70% of asthma patients (without taking into account the form of the disease) wake up between one in the morning and five in the morning during an exacerbation episode. The reason for this is increased bronchospasm. This appears to be associated with increased vagal tone, levels of endogenous catecholamines (adrenaline, norepinephrine) and histamine. Histamine is a biologically active substance synthesized by the cells of the human body, which plays a huge role in the cascade of allergic reactions. So, bronchial asthma is characterized by the following manifestations:

Development of respiratory distress;
Shortness of breath;
Heavy breathing;
Inflating the wings of the nose;
Cyanosis (blue discoloration of the skin due to low oxygen levels in the blood);
Participation in the act of breathing of the auxiliary muscles of the chest;
Excitement, excitement;
Rapid heartbeat;
Remote wheezing;
Sweating.

Before the onset of asthma symptoms, so-called precursors appear.
A clinical picture of conjunctivitis, rhinitis or pharyngitis appears after contact with an allergen. After this, the patient begins to experience a feeling of constriction in the chest. Breathing becomes harsh and expiratory shortness of breath occurs. It is characterized by a rapid and intermittent inhalation, followed by a long, very difficult active exhalation (normally, exhalation is passive). The auxiliary muscles of the upper shoulder girdle and abdominal wall begin to participate in the act of breathing. To facilitate exhalation, the patient takes the most comfortable position for him with the torso tilted forward and emphasis on the hands to fix the shoulder girdle. The attack usually ends with a cough with the discharge of thick, glassy sputum. Often the first manifestation of bronchial asthma is a paroxysmal cough, which is accompanied by expiratory shortness of breath (difficulty exhaling) with the discharge of a small amount of glassy sputum. The developed clinical picture of bronchial asthma is characterized by the appearance of mild, moderate or severe attacks of suffocation. Sometimes an attack begins with the following warning signs:

Copious discharge of watery secretion from the nose;
Sneezing;
Paroxysmal cough.

During an attack of bronchial asthma, the patient takes a short inhalation and an extended exhalation, which is accompanied by wheezing audible from a distance.
The chest is in the position of maximum inspiration. The muscles of the abdominal wall, back, and shoulder girdle take part in breathing. When percussing over the lungs, a box sound is detected; upon auscultation, many dry rales are heard. The attack ends with the release of viscous sputum. One of the most dangerous variants of the course of the disease is the asthmatic state, which can develop into a severe, protracted attack. The asthmatic condition is characterized by a nonproductive cough and increasing resistance to bronchodilator therapy. Pulmonologists distinguish anaphylactic and metabolic forms of the asthmatic condition.

In the anaphylactic form, which is caused by pseudo-allergic or immunological reactions with the release of a large number of mediators of the allergic reaction, an acute severe attack of suffocation occurs.

The metabolic form of bronchial asthma is associated with a functional blockade of beta-adrenergic receptors. It occurs as a result of exposure to adverse meteorological factors, overdose of sympathomimetics during respiratory tract infections, due to rapid withdrawal of corticosteroids, and forms within a few days. Initially, the patient stops producing sputum, and pain appears in the abdominal area, chest, and shoulder girdle muscles. Increased ventilation and loss of moisture with exhaled air lead to an increase in the viscosity of sputum and the closure of the bronchial lumen with a viscous secretion.

The second stage of bronchial status is characterized by the formation of “silent lung” areas in the posterior lower parts of the lungs. There is a clear discrepancy between the severity of distant wheezing and its absence when listening with a stethoscope. The condition of the patients is extremely serious. The chest is emphysematously distended. Pulse is more often than 120 per minute, blood pressure is increased. The ECG shows signs of overload in the right side of the heart. Patients develop respiratory or mixed acidosis (a shift in the body's acid-base balance towards increased acidity).

In the third stage (hypoxic-hypercapnic coma), shortness of breath and cyanosis (bluish color of the skin and visible mucous membranes) increase. The patient's sudden agitation is replaced by loss of consciousness, and convulsions may occur. The pulse is paradoxical (filling decreases during inspiration), blood pressure is reduced.

Patients with bronchial status are hospitalized in the intensive care unit on any day of the week, regardless of the time of day. They are observed by resuscitators using monitors and given therapy aimed at stopping an attack of bronchial asthma. Severe cases of bronchial status are discussed at a meeting of the Expert Council with the participation of candidates and doctors of medical sciences, doctors of the highest category. Leading specialists in the field of pulmonology, immunology and allergology develop patient management tactics. A multidisciplinary approach to the treatment of bronchial asthma allows you to quickly relieve the bronchial status and achieve sustainable remission.

The course of bronchial asthma is largely determined by the age of the patient at which the disease developed. In the vast majority of cases, signs of bronchial asthma in children disappear spontaneously at puberty.

BRONCHIAL ASTHMA: FIVE MAIN MISCONCEPTIONS

16.Dec.2020

Misconception 1: Asthma is a lifelong disease. It is impossible to be cured.

Reality: bronchial asthma is a chronic inflammatory disease of the respiratory tract, manifested by a host of symptoms. Although doctors cannot guarantee a permanent cure for asthma, the disease can be successfully controlled. This means that with proper treatment and following the recommendations of a specialist, a person can live without exacerbations.

Misconception 2. Asthma can develop as a result of untreated colds, acute respiratory viral infections, and bronchitis.

Reality: Frequent colds and viruses are not the root cause of asthma. However, an infection can be a provocateur that triggers an exacerbation of an already existing disease in the body that has not been diagnosed. In reality, three conditions are always required for asthma to occur. The first is a specific, non-infectious inflammation of the respiratory tract. The second is an excessive reaction of the bronchi to the slightest provocateurs, which healthy people simply do not notice. And third, the reversibility of all respiratory symptoms. This means that asthma can go away temporarily with medication or even on its own. But the severity of the external manifestations of the disease can vary significantly. Many asthmatics are bothered only by an occasional cough, only rare episodes of wheezing in the chest or discomfort when breathing.

Misconception 3. An asthmatic is a martyr, forced due to illness to deny himself all the joys of life.

Reality: A properly treated asthmatic differs from a healthy person in only one way: a person with asthma needs to breathe in an inhaler twice a day. If you follow this rule, then you can do everything the same as others: travel, play sports, go to the bathhouse, give birth to children, work intensively. However, a patient with asthma must avoid factors that provoke exacerbation of the disease. The patient must know the characteristics of his illness and navigate the symptoms. So, if a person has a severe allergic form, then it is important to limit contact with the culprit allergen. If an aggravation is caused by a professional factor, you need to change your place of work. If an asthmatic reacts sharply to house dust, it is necessary to remove carpets from the house, store books behind glass and carry out regular wet cleaning of the apartment. If a person is allergic to animal fur, then he should avoid being around pets.

Misconception 4. Asthma is a weather-dependent disease.

Reality: most asthmatics do not tolerate wet, windy weather, dampness, or cold. Therefore, they feel worse in late autumn, winter and early spring. When leaving a warm room, they may experience cold bronchospasm. But this is a property of a particular person, and not a pattern. In the same way, a group of citizens sit down for whom it doesn’t matter what the weather is like outside, but the flowering of a poplar or contact with an animal is a real test for them.

Misconception 5. Asthma medications are addictive; the patient will no longer be able to live without them.

Reality: with some variants of the individual course of asthma, a person is forced to use an inhaler for a long time, sometimes for life. But not because I got hooked on the medicine, it is not a drug, but because this is the essence of the disease. In some people, the course of treatment leads to many months of remission, and this contributes to a temporary cessation of medication. For others, stopping the inhaler causes a deterioration, usually with nightly attacks of coughing and suffocation. In this case, you need to constantly take medications in an optimal manner. Don't be afraid of getting used to the medicine. This doesn't happen. It’s just that sometimes a person experiences an exacerbation, during which it is necessary to increase the dosage or change the treatment regimen.

Diagnostics

The diagnosis of bronchial asthma is made by pulmonologists at the Yusupov Hospital based on the following indicators:

Complaints, medical history and life of the patient;
Clinical and functional examination with assessment of the reversibility of bronchial obstruction;
Specific allergy examination (skin tests with allergens and determination of specific immunoglobulin class E in blood serum);
Exceptions for other diseases.

The following clinical signs increase the likelihood of having bronchial asthma:

The presence of more than one of the following symptoms: wheezing, shortness of breath, chest tightness and cough, especially when the patient's condition worsens at night and early in the morning;
The occurrence of symptoms when exposed to cold air and allergens, physical activity, after taking or β-blockers and acetylsalicylic acid;
A history of atopic diseases, asthma or atopic diseases in relatives;
Widespread dry wheezing when auscultating;
Low peak expiratory flow or forced expiratory volume in 1 second that cannot be explained by other reasons;
An increase in the number of eosinophils in the peripheral blood, unexplained by other reasons.

To establish a diagnosis of bronchial asthma, pulmonologists at the Yusupov Hospital use special diagnostic methods:

Studies of the ventilation function of the lungs with assessment of the reversibility of bronchial obstruction;
Detection of increased bronchial reactivity;
Conducting a specific allergy examination.

When performing spirometry, an important parameter is FEV1 (forced expiratory volume in the first second of the maneuver).
It indicates the degree of bronchial obstruction. In patients with spirometry within normal limits, a methacholine inhalation test is performed. In bronchial asthma, sputum tests reveal eosinophils, Kurshman spirals, and Charcot-Leyden crystals. Eosinophilia is understood as an increase in the number of eosinophils (leukocyte blood cells) of more than 5%. In parallel, the level of IgE in the blood serum increases, which is a specific mediator of allergic inflammation in the human body. When examining sputum under a microscope, one can detect Courshmann spirals (casts of small bronchi) and Charcot-Leyden crystals (shiny, smooth formations formed from the eosinophil enzyme).

All patients with suspected asthma undergo a study of external respiratory function in order to establish the presence, level and degree of obstruction of the tracheobronchial tree. Tests for assessing physical function include:

Spirometry;
Pneumotachometry;
Recording a flow-volume curve.

A decrease in FEV1 of less than 65% of vital capacity and an increase in residual lung volume of more than 25% of vital capacity indicates a serious problem with airway patency.
To establish the reversibility of changes in the respiratory tract, functional tests with bronchodilators are performed. An improvement in spirometry by 25%, as well as complete restoration of bronchial patency after inhalation of these drugs, indicates the reversibility of bronchospasm.

To identify a specific allergen, an allergological study is performed - skin tests with various antigens. Such tests can only be carried out during remission. In the therapy clinic of the Yusupov Hospital, the scope of the planned examination for the patient is determined by a highly qualified specialist.

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Diagnostics and treatment methods in the clinic

Bronchial asthma is diagnosed by a clinic doctor based on the following studies:

spirometry (breath analysis),
chest x-ray,
clinical sputum analysis,
clinical and biochemical blood test,
immunological blood test.

To treat the disease, qualified clinic specialists prescribe the following medications:

anti-inflammatory asthma inhalers,
high quality asthmatic medications,
homeopathic medicines.

Physiotherapy methods are also prescribed in our clinic:

electrophoresis,
ultraviolet irradiation,
intravascular laser irradiation of blood
ultraviolet irradiation of blood,
speleotherapy sessions in a salt cave.

DAY CARE SERVICE

Treatment

Bronchial asthma refers to a certain type of disease that cannot be completely cured, but it can be controlled. Treatment goals set by the doctors at the Yusupov Hospital:

Achieving and maintaining seizure control;
Preventing exacerbations;
Maintaining respiratory function indicators as close to normal levels as possible;
Elimination of restrictions on the physical activity of patients, including physical education and sports;
Minimizing side effects and adverse events from the use of medications;
Preventing the formation of irreversible bronchial obstruction.

Treatment of asthma is based on two stages: symptomatic therapy to provide emergency assistance and preventive or basic treatment to control the course of asthma.

HOW TO CONTROL BRONCHIAL ASTHMA

Bronchial asthma (BA)
is a disease that has been well studied. Science knows the causes, development mechanisms, and approaches to achieving control of bronchial asthma. However, as statistics show, only one patient out of four has the disease under control [1].

At the same time, control of bronchial asthma is the main indicator when it comes to the effectiveness of therapy, and includes such characteristics as:

· severity of symptoms;

frequency of exacerbations;

· frequency of requests for emergency medical care;

· the need for drugs to relieve symptoms of the disease;

· peak flow metry indicators [2].

Symptoms

Every patient diagnosed with bronchial asthma is familiar with its symptoms: wheezing; feeling of chest congestion; suffocation; dry, with sputum difficult to separate, obsessive cough, including at night.

Depending on the frequency of symptoms, several levels of asthma control are distinguished. Thus, with well-controlled asthma, attacks and the need to use drugs to relieve them occur in the patient no more than 2 times a week, the patient does not wake up at night and his physical activity is not limited. With partially controlled asthma, daytime symptoms recur more than twice a week; accordingly, there is a need for an emergency inhaler; patients wake up at night due to attacks. Uncontrolled asthma can be said to occur when the frequency of symptoms and the need for their relief is more than two per week, the patient experiences limited physical activity, and is also forced to wake up at night due to asthma symptoms. (see table) [1.7]

Table 1
Determination of the level of control of asthma symptoms

Therefore, minimal severity of symptoms, as well as rare exacerbations, indicate that the disease is controlled.

The need for emergency drugs

Another marker of uncontrolled asthma is the need for drugs to relieve symptoms (so-called short-acting bronchodilators or rescue inhalers). A short-acting drug relieves symptoms, creating the illusion that everything is fine, although in fact the cause of the disease (inflammation) remains. As a result, the patient finds himself in a vicious circle: symptoms appear more and more often, and the need for bronchodilators increases.

Special questionnaires also help control the disease. In 2021, AstraZeneca, with the support of the Russian Respiratory Society (RRO), launched a large-scale social unbranded program “Assess Addiction”. Patients with bronchial asthma are invited to take a specially designed Test* to assess the risk of dependence from excessive use of short-acting bronchodilators on the campaign website assess-dependency.rf or otseni-zavisimost.ru, and information about bronchial asthma is also provided to help patients better assess their current condition for timely consultation with a doctor.

Patients with bronchial asthma will be able, after passing the Test*, to save its results and show them to the doctor during a consultation, which will significantly simplify the diagnosis of the patient’s condition with asthma. Every day, patients all over Russia visit this program website and take the test*!

Take the test*

The test result* may indicate a high or moderate risk of over-dependence on a rescue inhaler** to relieve asthma attacks - this is a signal to your doctor that your asthma therapy should be reconsidered. Also, the test results may show a low risk of excessive dependence on a rescue** inhaler to relieve asthma attacks, which is a positive factor.

A review of therapy may be necessary if:

You use your inhaler to relieve asthma attacks 3 times a week or more, or you use 12 inhalers (canisters) per year (if this is your situation, do not wait for your next scheduled doctor’s consultation, make an appointment to assess the course of your asthma) [7+ Russian wedge rivers].

What to do next:

Monitor how often you use your rescue** inhaler to relieve asthma attacks. The main goal of prescribing a new drug for the regular treatment of bronchial asthma is to reduce the severity of asthma symptoms, and therefore reduce the need to use a rescue inhaler. If you are taking a new drug for regular asthma treatment but still need to use your inhaler for symptomatic treatment 3 or more times a week, you may need to make a follow-up appointment with your doctor.

Control over future risks

Control of bronchial asthma is not only the absence or minimal severity of symptoms, but also “reducing the potential risk associated with deterioration of the condition, development of exacerbations, progression of the disease, and side effects of medications” [1]. Accordingly, achieving good clinical control of bronchial asthma can reduce the risk of exacerbations [2].

It must be remembered that provoking factors, or so-called triggers, play an important role in the development of exacerbation. Some of them are independent of the patient. For example, concomitant diseases. Others can be controlled by the patient.

The patient must master the correct inhalation technique, since the effectiveness of therapy depends on this.

Another important condition for controlling bronchial asthma is following your doctor’s prescriptions. Bronchial asthma is a variable disease, that is, its symptoms are not always pronounced: a person may feel well, but this does not mean that the disease does not exist. That is why there should be no talk of any self-medication or independent withdrawal of drugs.

In addition, to control bronchial asthma, external influences that can cause its exacerbation (allergens, stressful situations, etc.) are of great importance. Therefore, the patient’s task is to do everything possible to minimize their influence, and therefore reduce the risk of an attack.

Take the test*

** Emergency short-acting inhaler - an inhaler containing short-acting bronchodilators: salbutamol or fenoterol and/or ipratropium bromide or combinations thereof and not containing an inhaled glucocorticosteroid (ICS).

*Not an approved diagnostic method, standard of care, or official guideline. The results of the survey do not constitute a diagnosis, a basis for prescribing treatment or self-medication, as this is the responsibility of the relevant specialists. A test to assess dependence on excessive rescue inhaler use to relieve symptoms of bronchial asthma was developed based on a validated medical questionnaire11 (BMQ) by leading behavioral medicine expert Robert Horne with the support of experts from the International Primary Care Respiratory Group (IPCRG).11 12 The Quality Asthma Care Initiative is an international movement led by the IPCRG and supported by AstraZeneca. ICS – inhaled glucocorticosteroids. #Hypothetical patient.

Sources:

1. Arkhipov V.V. Arkhipov 1, E.V. Grigorieva 2, E.V. Gavrishina 3 Control of bronchial asthma in Russia: results of a multicenter observational study NIKA https://journal.pulmonology.ru/pulm/article/viewFile /423/423

2. Global strategy for the treatment and prevention of bronchial asthma (revision 2011) / Ed. A.S. Belevsky. - M.: Russian Respiratory Society, 2012. - 108 pp., ill., pp. 35-37

3. Medical reference book. Peak flowmetry. Registration of peak flowmetry results [Electronic resource], URL: https://academyexperts.ru/22-pikflowtriya-registraciya-rezultatov-pikflowtrii/, (access date 03/23/2021).

4. Sobchenko S.A., Schetchikova O.S., Leshenkova E.V., Pospelova S.N. Peak flowmetry in the treatment of bronchial asthma // To help the practitioner. 2010. URL: https://cyberleninka.ru/article/n/pikflowtriya-v-lechenii-bronchialnoy-astmy/viewer, (date accessed 03/22/2021)

5. Trushenko N. What is peak flowmetry, who needs it and why // Asthma and allergies. 2014. Vol. 3. URL: https://cyberleninka.ru/article/n/chto-takoe-pikflowtriya-komu-i-zachem-ona-nuzhna/viewer (access date 03/22/2021)

6. Federal clinical guidelines for the diagnosis and treatment of bronchial asthma 2021. Russian Respiratory Society. [Electronic resource], 06.22.2021 https://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/

7. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2021. [Electronic resource], 06/22/2021. Available from: https://www.ginasthma.org/

8. Juniper EF, O'Byrne PM, Guyatt GH et al. Development and validation of a questionnaire to measure asthma control // Eur. Respira. J. 1999. Vol. 14. P. 902–907.

9. Nathan RA, Sorkness CA, Kosinski M. et al. Development of the asthma control test: a survey for assessing asthma control // J. Allergy Clin. Immunol. 2004. Vol. 113(1). P. 59–65.

10. Scales and algorithms in general medical practice. M.: Publishing group "GEOTAR-Media", 2021. pp. 135-138

11. Price D, et al. NPJ Prim Care Resp Med. 2014;24:14009. 4

12. Horne. R. et al. J Psychosom Res. 1999 Dec; 47(6):555-67.

The material is intended for a wide audience.

THE INFORMATION PROVIDED IN THIS SECTION DOES NOT CONSTITUTE AND DOES NOT REPLACE ADVICE OF A DOCTOR. YOU MUST SEEK A DOCTOR'S ADVICE.

AstraZeneca Pharmaceuticals LLC. Address: 123112, Moscow, 1st Krasnogvardeisky proezd, 21, building 1., OKO Tower, 30th floor

Tel.
www.astrazeneca.ru, www.az-most.ru Approval number: SYM_RU-11534. Approval date: 10/12/2021. Expiration date: 10/11/2023

Basic therapy

Today, first-line medications for the preventive treatment of asthma in patients of any age include inhaled glucocorticoid drugs (ICS):

Beclomethasone dipropionate;
Flunisolide;
Fluticasone propionate;
Triamcinolone acetonide;
Mometasone furoate.

Experts prescribe this group of medications to almost all patients with asthma, including those with mild severity of the disease.
ICS are the most powerful anti-inflammatory drugs. Having a wide spectrum of action, they exert their effect on both cellular and humoral mechanisms of the development of allergic (immune) inflammation. These drugs are the choice for patients with persistent asthma of any severity. In addition, ICS is prescribed to all patients with bronchial asthma who take short-acting β2-agonists more than once a day.

In second place in basic therapy are cromones (mast cell membrane stabilizers):

Sodium cromoglycate;
Undercut.

These drugs belong to the group of inhaled non-steroidal anti-inflammatory drugs.
Used in the treatment of patients with mild persistent asthma. In addition, they can be prescribed for prophylactic purposes to prevent bronchospasm during physical activity, inhalation of cold air, and possible contact with an allergen. Antileukotriene drugs (leukotriene receptor antagonists): zafirlukast, montelukast. These drugs are recommended to be taken mainly by patients with aspirin-induced bronchial asthma, as well as to prevent bronchospasm provoked by allergens and physical activity.

Systemic glucocorticoid drugs:

Prednisolone;
Methylprednisolone.

If a patient is diagnosed with severe bronchial asthma, in which high doses of inhaled glucocorticoids in combination with regular use of bronchodilators are ineffective, systemic glucocorticoids are prescribed.

Basic principles of treatment of bronchial asthma

1. Stopping or reducing contact with allergens: air purifiers, air conditioners, humidifiers, fighting dust mites, cockroaches, special covers for bedding, avoiding carpets, keeping pets, a hypoallergenic diet and other measures.

2. Drug therapy: determined by the severity of the disease, prescribed taking into account complications of the underlying disease and the presence of concomitant pathology.

3. Allergen-specific immunotherapy - ASIT - is the main method of treating bronchial asthma. Indications for ASIT in patients with atopic asthma:

clear confirmation of the role of the allergen in the development of the disease (house dust mites, household allergens, pollen, fungi);
confirmation of the IgE-dependent mechanism of sensitization;
inability to stop the patient’s contact with allergens;
age from 5 to 50 years. Contraindications to ASIT:
exacerbation of asthma;
severe asthma;
pregnancy;
oncological, autoimmune, mental diseases, blood diseases;
acute infectious diseases;
chronic infections in the acute stage.

The purpose of this method is to reduce sensitivity to a causally significant allergen, affecting the immune mechanism similar to vaccination. The safety and effectiveness of ASIT has been proven by many years of use of the method by medicine in all developed countries. Duration of treatment is 3-5 years.

Courses of treatment can be:

short pre-season;
full pre-season;
year-round.

The selection of allergens and the course of treatment is determined only by an allergist and is carried out in a medical institution. Allergens (or a mixture of 2-3 allergens) are administered in the form of subcutaneous injections or sublingually in drops (for children) in microdoses, according to standard or individual regimens, with increasing doses and concentrations of allergens.

Expected effects from immunotherapy:

ASIT prevents the transition of BA to more severe forms;
the need for the volume of drug therapy is reduced;
leads to remission of the disease (up to several years);
prevents the expansion of the spectrum of allergens.

The likelihood of receiving a positive effect increases if:

treatment started as early as possible, optimally - at the stage of allergic rhinitis or when the first “signals” of asthma appear - mild, isolated attacks of suffocation;
all foci of chronic infections have been sanitized;
Antihelminthic therapy and correction of the immune status were carried out, if necessary.

Treatment of asthma in adults

Pulmonologists at the Yusupov Hospital, when conducting pharmacotherapy for bronchial asthma, direct all efforts to achieving and maintaining clinical control of the disease over a long period.
If current therapy does not provide control of bronchial asthma, increase the volume of therapy until control is achieved. If partial control of bronchial asthma is achieved, the possibility of increasing the volume of therapy is collectively considered. If control of bronchial asthma is maintained within three months of treatment, the volume of maintenance therapy is reduced in order to establish the minimum number of drugs and the lowest doses of drugs that are sufficient to maintain control. For the treatment of bronchial asthma, 2 types of pharmacological agents are used: emergency medications (to relieve bronchospasm) and medications for basic (“maintenance”) therapy. The first group of drugs includes short- and long-acting β2-agonists (fenoterol, salbutamol, formoterol) and inhaled anticholinergic drugs (tiotropium bromide, ipratropium bromide).

For the basic treatment of bronchial asthma, the following drugs are used:

Inhaled glucocorticosteroids and systemic corticosteroids;
Combined drugs (long-acting β2-agonists + inhaled glucocorticosteroids);
Extended-release theophyllines;
Leukotriene receptor antagonists;
Antibodies to IGE.

At the beginning of 2015, the drug Salmecort was registered in the Russian Federation.
This is a fixed combination of salmeterol with fluticasone in the form of a metered dose aerosol inhaler. It is used for maintenance therapy of bronchial asthma. Emergency care for an attack of bronchial asthma:

Reassure the patient;
Free yourself from restrictive clothing, unbutton your shirt collar;
Provide access to fresh air;
Use the patient’s existing pocket inhaler (can be repeated three times with an interval of 20 minutes);
Give a comfortable sitting position (the patient’s arms should rest on the table or chair rails, elbows spread to the sides).

If there is no effect or the patient’s condition worsens (threat of status asthmaticus), it is necessary to immediately call an ambulance.

Nebulizer therapy

Nebulizer therapy is a modern method of eliminating severe exacerbation of asthma.
The nebulizer operates on the principle of delivering a therapeutic dose of the drug in aerosol form directly into the patient’s bronchi to obtain a rapid clinical effect. The use of this device during exacerbation of asthma allows local administration of high doses of bronchodilators, while the drug is practically not absorbed into the blood and does not have side effects on other organs and systems, as is often the case when taking tablets or using injections. Thus, nebulizer therapy can not only effectively reduce the manifestation of bronchospasm, but also significantly reduce the frequency of systemic side effects of drugs.

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The role of the patient in the treatment of asthma

As with other chronic diseases that require almost daily monitoring (for example, diabetes mellitus, hypertension), success in therapy, without exaggeration, is half dependent on the patient. Suppose you have found a doctor whom you trust, you have been correctly diagnosed, and treatment has been prescribed. But this is just the beginning. What next? Next is a course to reduce symptoms to a minimum, improve quality of life, and achieve long-term remission. For this, in addition to desire, awareness of the disease and treatment, punctuality and patience are important. 5 tips for patients with asthma:

Find out about your illness from a doctor, from popular scientific literature, and not from neighbors and co-workers. If you have similar symptoms, you may have completely different diseases. If you have the same diagnosis, medications prescribed to another asthmatic may be contraindicated.
Visit Asthma School. Carry out all recommended activities in your home. This often helps reduce the frequency and intensity of attacks. If you really can’t get rid of household allergens completely, then you can partially get rid of them.
Do not change the prescribed treatment regimens or dosages of medications on your own, especially do not cancel basic therapy!
Visit your doctor, both for a scheduled follow-up examination and during an exacerbation of the disease.
Monitor your condition and the effectiveness of drug therapy using daily peak flowmetry.

No matter how trivial it may be, I would like to remind you of the important things: nutrition, feasible sports, working conditions, rest, sanatorium-resort treatment. If a disease appears, it’s time to think about it.

Where and from whom to receive treatment, everyone decides for themselves. Choosing a doctor or healer and self-medicating is a matter of personal responsibility for your health. By contacting us, you have the opportunity to undergo a full examination in accordance with the required standards within 1 day, make or clarify a diagnosis as soon as possible, receive adequate treatment and detailed answers to all your questions.

Today we have all the possibilities for this. And yet the main thing: success in the treatment of bronchial asthma lies in a long-term, trusting and effective alliance between the doctor and the patient.

Complications

The most serious complication of bronchial asthma is the development of status asthmaticus. This is a prolonged attack, characterized by severe obstruction, severe respiratory failure, and impaired bronchial drainage function. During such an attack, the patient’s usual inhaled medications do not help. Only inpatient treatment is required. One of the causes of status asthmaticus may be an overdose of inhaled sympathomimetics or rapid withdrawal of glucocorticoid drugs. There are three stages in the mechanism of formation of this complication of asthma:

The first stage is similar to a protracted attack (can last more than 12 hours), which is not controlled by conventional inhaled drugs;
The second stage - at this stage the patient develops tachycardia, lethargy is noted, the skin becomes bluish and becomes covered with sticky sweat. Shortness of breath is significantly pronounced;
Third stage - at this stage the patient develops a sharp disturbance in the activity of the central nervous system up to coma, which causes death.

Another rather rare complication of asthma is spontaneous pneumothorax. With a long and persistent course of asthma, pulmonary emphysema and cor pulmonale develop, which leads to pulmonary heart failure.

Treatment of asthma complications

Since status asthmaticus (AS) is an extremely dangerous complication of asthma, which can potentially threaten the patient’s life, its treatment must be carried out within the walls of a medical institution. The first measure in the treatment of AS is the intravenous administration of large doses of glucocorticoid drugs, in parallel with sympathomimetics and drugs that promote the rapid expansion of spasmodic bronchi. In addition, the patient needs infusion and symptomatic therapy. If it was not possible to stop AS at the first stage, then the patient is transferred to artificial ventilation and undergoes sanative bronchoscopy.

Nutrition for asthma in adults

To prevent recurrence of asthma attacks and alleviate the course of the disease, the patient is recommended to follow a diet. The following are excluded from the diet:

Seafood;
Citrus fruits (except lemons);
Beekeeping products;
Nuts;
Chocolate;
Alcohol and cigarettes;
Dairy products;
Baking and white bread.

Meals should be divided into 4-5 small portions, and try to avoid overeating. With the right approach, avoiding contact with allergens and a favorable psycho-emotional environment, the patient can minimize the frequency of asthmatic attacks and improve their general condition.

Prevention of asthma

Prevention of bronchial asthma is divided into primary and secondary.
The goal of primary prevention is to prevent the development of sensitization in patients at risk. The risk group for the development of allergic diseases includes people with a hereditary predisposition to atopy. Secondary prevention is carried out in a group of people with established sensitization who do not have asthma symptoms. These include children with atopic dermatitis or allergic rhinitis, with a family history of bronchial asthma. For effective prevention, it is necessary to minimize the harmful effects of external factors, which often cause the development of bronchial asthma in adults:

Lead a healthy and active lifestyle;
Avoid contact with allergens (ventilate the room, do wet cleaning, etc.);
Eat properly.

Symptoms (signs) of bronchial asthma

The symptoms of bronchial asthma are similar to many diseases affecting the respiratory system. To exclude other pathologies of the lungs, bronchi, etc., the patient should describe his sensations in as much detail as possible. The more accurately the complaint is stated, the more accurate the diagnosis and treatment will be.

Most often the disease is accompanied by the following symptoms:

Wheezing.

Attacks during inflammation of the bronchi will be heard even by a person unfamiliar with the disease. Manifestations of breathing problems can be heard with the help of special medical equipment (stethoscope or phonendoscope): as the disease develops, side noises are formed, which are usually classified as wheezing. They are divided into two types:

Dry. Appear as a result of spasms in the bronchi, leading to narrowing of the lumen.
Wet. Occurs when edematous fluid and sputum accumulate.

What is sputum? To cleanse the respiratory system, the human body produces mucus. In combination with household dust, bacteria, etc., mucus is converted into sputum. Depending on the type and nature of impurities, sputum is divided into the following types:

purulent;
watery;
glassy (viscous, released in small quantities);
pink (looks like foam);
with bleeding.

Bronchial asthma is characterized by wheezing belonging to the first group. In practice, they are usually called “musical”. The nature of the sputum will depend on what cause preceded the development of bronchial asthma.

Cough.

The symptom is a response to the formation of breathing obstructions in the internal organs. Often, asthma attacks are triggered by phlegm clots. Their occurrence is due to irritation of special zones.

The causes of coughing attacks are:

sputum;
inflammation of the laryngeal mucosa;
contact with an allergen substance;
environment (heat, cold, dry air);
foreign bodies entering the respiratory system;
oncological diseases.

Cough accompanies almost all respiratory diseases. To make a diagnosis, you should carefully characterize this symptom (timbre, duration, time of manifestation, whether there is discharge).

Feeling of congestion in the chest.

Modern experts believe that the feeling of congestion in asthma is only a subjective sensation. It occurs as a result of a suffocating cough and an attack of shortness of breath. A phenomenon reminiscent of this symptom of bronchial asthma was described by G.I. Sokolsky: “it feels like some kind of weight is placed on my chest”

Dyspnea

The symptom manifests itself in the form of heavy breathing during inhalation and exhalation[2].

Disability in AD in adults

The fact that a patient has asthma does not necessarily mean that he is undeniably disabled.
For example, if the severity of the disease is mild or moderate, in most percent of cases he will be refused. The fact is that this disease develops slowly, and from minor restrictions causing the patient can develop into a fairly complex degree, accompanied by other diseases that appear as a result of asthma. Therefore, at the initial stage of its manifestation, disability is not considered. Doctors at the therapeutic department of the Yusupov Hospital provide first-class examination and treatment of patients with respiratory diseases, including bronchial asthma. All studies are performed by specialists using modern medical equipment from leading European countries. Innovative research and therapy methods are used at the hospital. Bronchial asthma is no longer a problem for patients at the Yusupov Hospital. Anyone can make an appointment with a clinic doctor by calling the phone number located on the website. Online consultation is also available 24 hours a day.

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From the patients:

late appeal,
self-medication, especially uncontrolled use of bronchodilators, which is one of the main causes of mortality in asthma,
underestimation of the severity of the condition,
fear of treatment with corticosteroid drugs,
failure to appear for follow-up examinations with a doctor, reluctance to participate in educational programs.

As you can see, the guilt of doctors and patients coincides on many points.

Asthma can occur at any age, most often after a respiratory tract infection. In most cases, the development of asthma attacks is preceded for several years by allergic rhinitis, conjunctivitis, and nonproductive cough. The frequency of attacks depends on the severity of the disease, but I would like to especially emphasize that asthma of any severity requires examination and treatment. Like any chronic disease, asthma requires adequate treatment during exacerbation and prevention during remission.

Medical standards for diagnosis and treatment of patients with bronchial asthma.