Bronchial asthma treatment main groups of drugs

Antihistamines are medications that help reduce the negative effects of allergens on the body. For more than fifty years, antihistamines have been part of the therapeutic course prescribed to patients with bronchial asthma. These medications are prescribed both to relieve acute symptoms and as a preventive measure.

Attacks of bronchial asthma are accompanied by suffocation, which occurs as a result of inflammation and subsequent narrowing of the airways. The patient has difficulty breathing and begins to cough. To alleviate the patient's condition, doctors prescribe antihistamines, the effect of which is to block histamine, which is released from mast cells due to exposure to the allergen.

Histamine complicates the inflammatory processes that form in the bronchi; it provokes symptoms associated with bronchial pathology and suffocation. Antihistamines stop histamine receptors, resulting in a decrease in bronchospasm and edema, while the hyperreaction of the bronchi to histamine is significantly reduced.

Antihistamines do not cure bronchial asthma; they only help cope with exacerbations and alleviate the patient's condition.

• First generation medicines
• Second generation drugs
• Third generation antiallergic drugs

Children's antihistamines for bronchial asthma

Everyone knows that children are more likely to trust medications in liquid form.
Accordingly, pharmaceutical companies have not made an exception for antihistamines and produce them in the form of syrups or suspensions. In pharmacies you can find Clemastine and Loratadine in the form of syrup, as well as Astemizole and Terfenadine in the form of suspensions. Cetirizine drops are also in excellent demand, which can be additionally diluted with drinking water when taken. Loratadine is the most common antihistamine for children. Clinical practice has shown that Loratadine significantly reduces the likelihood of suffocation and seizures in children, which is associated with physical activity. Loratadine is indispensable in the fight against seasonal allergies. It helps not only to avoid suffocation, but also relieves runny nose, sneezing and other symptoms of the disease.

Cetirizine is a non-sedating antihistamine that eliminates bronchial constriction, relaxes muscles and improves breathing. This drug interacts well with various medications, blocks the release of histamine and copes with the symptoms of the disease.

It must be remembered that when the course of the disease is under control, in no case should you self-medicate. Any medications, both for primary and secondary therapy, should be prescribed only by a qualified pulmonologist. Especially when it comes to treating a child.

Signs of symptoms in adults

In most cases, asthmatic cough is accompanied by the spread of inflammation to the upper respiratory tract. The body naturally reacts to irritants that enter the respiratory tract, which provokes a cough symptom.

Asthmatic cough is quite specific. In this case, the patient takes sharp, quick breaths, followed by long and heavy exhalations. In this case, significant expansion of the lungs may be observed, which is accompanied by weak breathing sounds. Sometimes there are wheezing and whistling sounds.

Asthmatic cough may have the following triggers:

• hereditary predisposition, which is associated with a violation of the formation of a substance responsible for the production of antibodies to allergens;
• excess weight;
• gender of the person - boys under 15 years of age suffer from asthma more often than girls;
• allergens – mold, dust, pollen, etc.;
• viruses;
• harmful toxic substances;
• some food products;
• medications;
• smoke (including tobacco).

As already mentioned, with bronchial asthma, cough can be of two types:

1. Dry. No discharge or sputum occurs. The danger of such a cough is that if left untreated it can cause suffocation. A dry cough is almost always accompanied by pain in the chest area, problems sleeping, heavy sweating and weakness;
2. Wet. If asthma occurs against the background of respiratory diseases provoked by infectious agents, there may be an increase in temperature, the development of signs of intoxication, the appearance of a runny nose, and in some cases, suffocation. More often than not, wet asthmatic cough is diagnosed in the cholinergic form of the disease. Treatment of such a cough is carried out taking into account laboratory testing of sputum.

Types of Antihistamines

Antihistamines, depending on the presence/absence of side effects, are divided into three main types:

1. First generation: Tavegil, Suprastin, Diphenhydramine, Pipolfen, Diazolin.
2. Second generation: Semprex, Claritin, Cetrin, Zirtec.
3. Third generation: Telfast, Seprakor.

Each type of medication has its own pros and cons. The course of treatment should be prescribed exclusively by the attending physician.

First generation medicines

What these drugs have in common is that they have a pronounced sedative effect. Their effect lasts about five hours. They help well in the presence of allergic reactions, but have disadvantages. All first-generation antihistamines have many side effects.

Among which:

• increased drowsiness;
• dry mouth;
• quick but short-term effect;
• decreased muscle tone;
• addiction after two weeks of use.

In many countries these drugs are no longer used. In Russia, medications in this category are still used and are quite popular in the fight against allergies. But to relieve exacerbation of bronchial asthma, their use is undesirable. The dryness of the mucous membranes, which occurs as a result of taking these medications, complicates the course of the disease and prevents the discharge of sputum.

Second generation drugs

Second generation antiallergic drugs are not sedatives. They have much fewer side effects. When taking these medications, drowsiness does not occur and brain activity does not decrease. Such medications have a number of advantages:

• long duration of the therapeutic effect, which can reach a day;
• you can take them for a long time without fear of developing dependence;
• do not cause drying of mucous membranes;
• suitable for prophylactic use;
• after completion of the course of treatment, the effect persists for another week.

Despite all the variety of positive factors, such antiallergic drugs have side effects.

In addition, some second-generation antiallergic drugs can provoke ventricular arrhythmia.

For bronchial asthma use:

1. Astemisan. The medicine is effective for all types of allergic reactions. Its action begins three hours after administration. With long-term use, the therapeutic effect is observed throughout the day, and after discontinuation of the drug it persists for another 5–6 days. If you have heart disease, you will need to consult a cardiologist.
2. Gismanal. A highly effective antihistamine that is suitable even for young children.
3. Gistalong. The drug does not have a sedative effect, but can cause arrhythmia, insomnia, and cause nervous disorders manifested in mood swings.

   Indicated for children starting from the age of two.

4. Zyrtec. The drug has a dual effect, in addition to the antihistamine effect, it reduces inflammation caused by histamine. This medicine is well tolerated by children from the age of two. Within twenty minutes after administration, its positive effect is felt.
5. Claritin. It is the best antiallergic remedy in the whole world. The medicine begins to act half an hour after administration. Its medicinal effect lasts for about a day. Suitable for long-term use as a prophylactic agent.
6. Semprex. An effective antiallergic agent, the effect of which is felt 15 minutes after administration. Has a weak sedative effect. The main advantage of this drug is its mild effect on the gastric mucosa. The medicine is not suitable for children; it is prescribed to children from 12 years of age.

Third generation antiallergic drugs

Absolutely all third-generation antiallergic drugs have virtually no sedative effect, and side effects are minimized.

A new generation drug prescribed for the treatment of bronchial asthma is Telfast. This remedy does not cause drowsiness or attention disorders, and does not have a negative effect on the functioning of the heart. The effect of the medicine begins an hour after administration and continues for a day.

List of pharmacological agents

The entire list of medications can be divided into two large categories:

1. Drugs used during an attack: bronchodilators. Such medications quickly stop life-threatening manifestations.
2. For the treatment of pathology. Constant monitoring and treatment tactics of asthma include the use of medications not so much during a relapse, but during a lull. Medicines in this category will not be effective when an attack occurs, since they have a slow effect, gradually reducing the body’s susceptibility to the effects of irritating factors.

The group of drugs involves taking the following drugs: bronchodilators, hormonals, expectorants and a new generation.

Bronchodilators and anti-inflammatory drugs

These drugs are intended to relieve spasms and facilitate breathing. The following tools are used:

• inhalations with fast-acting substances. Medications can be combined with each other;
• medicines in tablets.

With the systematic use of bronchodilators, the susceptibility of the respiratory function to the active drug decreases. This means that when the next attack occurs, the medicine may not be effective and the risk of death increases.

With inflammation of the respiratory system, the disease progresses, so its elimination is the goal of treatment. Anti-inflammatory drugs are the main medication for the treatment of pathology and the prevention of asthma attacks. Non-hormonal mast cell stabilizers, as well as hormonal drugs, are prescribed.

Fat membrane stabilizers

Mast cells are responsible for the allergic response. Stabilizers prevent the production of histamine and reduce their release. Typically provided in inhalation form:

• containing ketotifen, intended for the treatment of mild forms of asthma, characterized by anti-allergenic action;
• with sodium cromoglycate. Side effects are minimal and do not cause addiction;
• preparations containing sodium nedocromil. They have a powerful anti-inflammatory effect and reduce the susceptibility of nerve receptors to the effects of allergens.

Hormonal agents

To provide a strong anti-inflammatory effect, hormonal agents - glucocorticosteroids - are prescribed. They reduce the susceptibility of nerve receptors, reduce sputum production, but are not used to eliminate asthma attacks.

Names of drugs and method of use:

• inhalation agents called aldecine, budesonide, pulmicort, ventolin. The drugs are applied to the damaged area, so the effect on the body is minimal. Suitable for children from three years old. To get rid of side effects, rinse the mouth and throat with a two percent soda solution;
• medications in tablets and injections: prednisolone, dexamethasone. Such drugs for the treatment of asthma completely affect the entire body, therefore they are used in severe forms: at the onset of status asthmaticus, in the absence of effect from medications.

Hormonal drugs
A feature of the use of such medications is a gradual reduction in dosage; you cannot stop taking hormonal drugs. Therapy lasts a long time, at least six months.

Antileukotriene and expectorant

A new category of pharmacological agents, which is used for therapeutic purposes for children from 2 years of age and in adult patients with asthma. Medicines are produced in the form of tablets. Leukotrienes are cells that are involved in the inflammatory process.

Drugs with bronchodilator and anti-inflammatory properties are also prescribed. New agents are used as an alternative to increasing the dosage of glucocorticosteroids. They successfully cope with the oncoming attacks.

In order to eliminate mucus and sputum, two types of cough medications are prescribed: mucolytic and expectorant. The latter contribute to the activation of mucus production, thereby reducing the thickness of the mucus. The former reduce the production of sputum and facilitate its release.

Devices for the treatment of asthma

The most widely used device used to treat bronchial asthma is the Aster device. It can be used both in a clinic and at home.

The Aster device complements drug treatment, and if the condition significantly improves, it can partially replace it. It affects the “pulmonary triangle” using electromagnetic non-thermal radiation.

Using the Aster device helps:

• increase the period between attacks;
• remove phlegm;
• prolong remission with preventive treatment;
• relieve symptoms during exacerbation.

Contraindications to the use of the Aster device may occur during pregnancy, cancer, individual intolerance, skin diseases, and hypertension. In any case, you should not self-medicate and use the Aster device without first consulting a doctor.

When treating during an exacerbation, when anti-inflammatory therapy is carried out, the use of the Aster device for adults is prescribed for a course of 3 months, 2 times a day - morning and evening for 10 minutes. After a week of treatment, it is recommended to reduce the dose of hormonal drugs.

For preventive treatment during remission, the Aster device is used once a day with an interval of 1–2 days for 8 minutes for a course of 3 weeks. This helps relieve symptoms during exacerbations, as well as prolong the period without attacks.

For asthmatics, the Aster device can significantly improve the condition and minimize the amount of anti-inflammatory and bronchodilator drugs taken. It also promotes both the removal of sputum and the complete elimination of the formation of viscous mucus.

Aster is used not only to treat adults, but also for children.

Recommendations

Asthmatics take medications throughout their lives. The dosage of drugs varies depending on the dynamics of the development of bronchial asthma. When prescribing medications, the relationship with each other is taken into account. Attention is paid to breathing exercises, walks in the fresh air, proper nutrition and a hypoallergenic lifestyle.

Medicines for bronchial asthma are used not to cure the disease, but to reduce symptoms and improve quality of life. Treatment of bronchial asthma in adults and children is carried out under the supervision of the attending physician. He decides how to treat the disease; independent use of medications is unacceptable.

Inhalations

When treating bronchial asthma, special devices designed for inhalation are often used:

1. An inhaler is a device that has compact dimensions. Almost all asthmatics carry it with them, as with its help you can quickly stop an attack. Before use, the inhaler must be turned upside down so that the mouthpiece is on the bottom. The patient must insert it into the oral cavity and then press a special valve that delivers the drug in a dosed manner. As soon as the medication enters the patient’s respiratory system, his asthmatic attack is relieved.
2. A spacer is a special chamber that must be placed on a container with a medicinal aerosol before use. The patient should initially inject the medication into the spacer and then take a deep breath. If necessary, the patient can put a mask on the camera through which the medication will be inhaled.

Group of systemic glucocorticoids

When carrying out complex therapy for bronchial asthma, specialists prescribe such medications to patients extremely rarely, since they have many side effects. Each asthma medicine from this group can have a powerful antihistamine and anti-inflammatory effect. The components present in them inhibit the process of sputum production and minimize sensitivity to allergens.

This group of drugs includes:

1. Injections and tablets of Metipred, Dexamethasone, Celeston, Prednisolone.
2. Inhalations of Pulmicort, Beclazone, Budesonide, Aldecine.

Features of the use of antihistamines

Only antihistamines for exogenous, endogenous and mixed bronchial asthma cannot solve the problem. In any case, treatment must be comprehensive. The treatment plan is developed by the doctor based on information obtained during the diagnosis

The individual characteristics of the patient (current state of health, age, living conditions, etc.) must be taken into account.

Children with asthma are most often prescribed Astemizole, Loratadine or Clemastine to block histamine. To improve the condition of seasonal allergies, Loratadine is the most effective. Cetirizine is recommended for patients over two years of age. It relieves asphyxia.

“Suprastin” for infectious, aspirin, allergic, occupational and any other bronchial asthma can be taken only if an allergic agent has led to a deterioration in health and allergy symptoms are observed (for example, conjunctivitis, dermatitis).

Young patients under 5 years of age have increased sputum production. Experts recommend taking this drug in order to reduce its volume. Patients aged 3-12 years are prescribed ½ part of a tablet two to three times a day, adults - 3-6 tablets.

Attention! During a non-allergic attack, Suprastin should not be taken for asthma. Because of this, sputum will not be cleared well.

There are contraindications:

• pregnancy;
• personal intolerance to certain components;
• ulcer of the duodenum and/or stomach.

For treatment to have a positive effect, you should not drink any alcohol or smoke if you have asthma. You should definitely consult a doctor.

Attention! Antihistamines should not be used in the first trimester of pregnancy. If there is such a need, you should consult with specialists

Typically, such medications are prescribed at 4-5 months.

Natural antihistamines are indicated for some asthmatics. Certain medicinal herbs (for example, chamomile or nettle) have an antiallergic effect. Green tea, basil, ginger are recommended. If you have any concerns, you should definitely consult your doctor.

Biological products

Biological drugs are the newest means in the treatment of bronchial asthma. Inhaled glucocorticosteroids do not always have the desired effect (if the phase of the disease is severe). Asthma occurs for a variety of reasons and comes in many forms. For some, interleuins are important - this is the name for information molecules secreted by cells of the immune system.

Interleukin (IL-13) affects epithelial cells in the lungs, causing them to produce excess mucus, increasing the stiffness of the airways. The lungs also produce periostin, a protein involved in the formation of chronic inflammation. If the disease is not controlled, the level rises.

Targeted therapy aimed at blocking interleukins. A series of new drugs are based on monoclonal antibodies produced by cells of the immune system from a single cell clone.

The drug Mepolizumab was developed in the late 90s, but trials were unsuccessful. In 2012, it was approved in Europe for the treatment of asthmatic children over 12 years of age. Clinical trials of the drug in 2014 in Israel showed that a monthly course of Mepolizumab injections reduces attacks by half. Trials in 2020 showed the drug could be used to treat adult patients with asthma.

The British drug Benralizumab blocks the interleukin-5 receptor (L-5), helping to reduce the level of eosinophils in sputum and blood. Trials completed in 2020 showed that Benralizumab reduced the use of glucocorticosteroids by 70%, reducing the frequency of attacks by 50-70%. The product is injected under the skin once every month or two.

When can I take it?

The etiology of asthma can be different: hereditary predisposition, smoking, frequent colds and unfavorable environment, but the symptoms are always the same, regardless of the cause: shortness of breath, cough, wheezing and heaviness in the chest. Allergens can also be added to these reasons, which can provoke an exacerbation of the disease.

For asthma, Suprastin should be taken only when the deterioration of the condition is provoked by the action of an allergic agent and is accompanied by allergy symptoms (rhinitis, dermatitis, urticaria, conjunctivitis).

Recently, information has appeared that antihistamines, which also have an anticholinergic effect, have a positive effect in the treatment of patients with asthma, as they have bronchodilator properties.

In children under 5 years of age, bronchial asthma is accompanied by increased secretion of sputum, so many doctors recommend using Suprastin to reduce its production.

For an adult, the daily dose of the drug is 75-100 mg. As necessary, it can be increased to 150 mg (5-6 tablets). Children aged 3 to 12 years can take ½ tablet (12.5 mg) 2-3 times a day.

During an asthma attack, Suprastin is not recommended for use, as it increases the viscosity of sputum and makes it difficult to clear.

Therapy evaluation

First of all, you need to decide what an exacerbation or asthma attack is. This is a condition in which the patient gradually develops a cough, increases in wheezing, shortness of breath, and symptoms of chest congestion. It is important to remember that exacerbations can develop not only in a patient with an already diagnosed asthma, but also be the very first symptom of a newly emerging disease.

An attack of bronchial asthma can occur in any patient with this diagnosis, regardless of severity, even in patients with mild severity. A typical attack can develop at different rates, sometimes taking a few minutes to develop, and sometimes the symptoms increase over a long period of time, even up to 2 weeks.

Resolution, or attenuation of the exacerbation, also requires a long time, from several days to the same 2 weeks. Exacerbation of bronchial asthma is quite a serious matter. It is known that in any hospital with an emergency department, about 12% of all admissions are attacks of bronchial asthma, and about 5% of those admitted with this diagnosis require direct hospitalization in the intensive care unit.

Clear and understandable criteria for the degree of severity during an attack are the respiratory rate, which during a severe attack exceeds 25 breaths per minute, and an increase in the pulse rate, which during the same severe attack exceeds 110 beats per minute. An important diagnostic criterion is the inability to pronounce any sentence or phrase in one breath.

How to treat exacerbation of bronchial asthma? First of all, this is the prescription of fast-acting bronchodilators, which are beta-2 adrenergic receptor agonists. Then - the use of anticholinergic drugs, as well as a combination of these two groups of drugs, which with a high level of evidence increase the speed of resolution of an asthmatic attack and significantly reduce mortality.

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β-2 adrenergic agonists, used in nebulized or inhaled form, are the most economical and optimal method of managing patients with bronchial asthma in the presence of a mild or moderate attack.

Ventolin affects the adrenergic receptors of smooth muscles of the bronchial tree (β-2), and does not affect similar myocardial receptors, which are called β-1. This leads to a pronounced dilation of the bronchi, which stops an attack of bronchial asthma. The use of salbutamol-Ventolin, in particular, reduces the air resistance of the respiratory tract, increases the vital capacity of the lungs, and activates the ciliated epithelium. This leads to improved secretion and release of mucus, which is very important for the prevention of respiratory infections.

Inhaled forms of salbutamol act very quickly: the onset of the effect develops after 5 minutes, and after another 5 minutes the effect increases to 75% of the maximum, and the duration of action is up to 6 hours. However, this drug must be used more than once, and strictly follow the instructions of the attending pulmonologist.

Ventolin is indicated, first of all, to relieve an attack, and then for prophylactic purposes, in order to prevent an attack of bronchospasm, for example, when a known allergen enters the body, when exposed to frosty air, or during physical activity, when an attack has previously occurred under similar conditions .

Bronchodilators should be used quite often. But in the case of Ventolin, the manufacturer does not recommend using it more often than 4 times a day. The recommended dose for stopping an attack of bronchial asthma is usually one or two inhalations, that is, from 100 to 200 g of salbutamol.

Ventolin is produced by Glaxo Wellcome in an aerosol can for metered inhalation. One spray dose contains 100 mcg of salbutamol; one aerosol can contains 200 doses. The cost of one package ranges from 107 to 136 rubles.

Allergy testing itself is not very informative for diagnosing bronchial asthma, but it is important for recognizing the atopic form of bronchial asthma and identifying allergens that trigger asthmatic symptoms.

The most widely used are skin tests, as well as specific Ig E to a specific set of antigens.

• Hormonal drugs
• Non-hormonal agents
• Kromonov
• Inhaled glucocorticosteroids (ICS)
• Beta-2 adrenergic agonists
• Antileukotriene medications

Correct basic therapy controls the disease, prevents relapses, prolongs remission, and improves the quality of life of asthmatics. Let's take a closer look at asthma medications.

• Salbutamol
• Budesonide
• Beclomethasone
• Sintaris

• Foradil
• Serevent
• Salmecort
• Symbicort

Cromony

• Stabilizing the membranes of mast cells – participants in the process of inflammation
• Blocking inflammatory mediators which include leukotrienes, prostaglandin, bradykinin, histamine
• Preventing bronchial spasm, allergic and inflammatory reactions of the body

• Intala
• Ketoprofen
• Ketotifen
• Cromolina
• Taileda

• Zileuton
• Pranlukast
• Montelukast

These medications are designed for long-term use.

• Dexamethasone
• Prednisolone
• Methylprednisolone

• Disorders of the heart and blood vessels
• Increase anxiety

• Reduced frequency of exacerbations
• Long-term remission ensured
• Reduced need for short-acting medications
• Improved ventilation

Diagnostics and necessary tests

To determine the presence of the disease, you need to consult a pulmonologist and special diagnostic measures:

1. Radiography. This test helps to find out concomitant illnesses, but if the x-ray is not taken at the time of the attack, it may not show the presence of asthma. But in case of suffocation, the image will show a significant decrease or complete absence of the mobility of the diaphragm, increased transparency of the pulmonary fields, the domes of the diaphragm become denser, the mobility of the ribs is limited, and the cardiac contours are not clearly visible. In addition, the pulmonary pattern may be deformed, and the pneumatization of the lungs may be increased;
2. Clinical blood and urine tests;
3. Allergy tests;
4. Inhalation tests;
5. Analysis of sputum microflora;
6. Determination of lung volume - spirography. This study helps to find out how much air enters the lungs within a minute, the volume of the lungs, the maximum capacity of the organs (that is, lung reserves), determine the lumen of the bronchi, and whether there is an inflammatory process in them.