Nowadays, the expression “table of ranks” is more often used in a figurative sense, and not only when we mean the structure of certain institutions. Sometimes they say this about medications, including drugs for the treatment of bronchial asthma.
In the era of evidence-based medicine, the place of a drug in treatment is determined by its effectiveness and safety, which is confirmed by clinical trial data, and not based solely on the fact that these drugs have been used in past years. Drugs for the treatment of bronchial asthma have different effectiveness, how do you know which drug is right for you? So, let's look at the main groups of drugs, and then try to assign them “winning places.”
What can trigger an attack of suffocation in bronchial asthma?
Bronchial asthma and its attacks are caused by various factors.
Today, there are three main groups of causes that provoke both the main chronic disease and isolated attacks:
1. Inflammatory factors:
- respiratory infections and diseases of the respiratory tract (bronchitis, pneumonia, ARVI);
- allergens (pets, dust, plants, food allergies, etc.);
- harmful work that causes lung diseases.
2. Irritants:
- cold air and frost;
- hot climate;
- active exercises in the fresh air, running;
- temperature fluctuations (off-season, flights from hot to cold countries, etc.);
- stress and negative emotions, unfavorable living conditions;
- chemical irritants (allergens, toxins, etc.).
3. Other individual factors:
- hereditary predisposition;
- smoking (active and passive);
- climate and pollution in the city;
- poor nutrition;
- medicines;
- gastric reflux.
Omalizumab (Xolair)
Xolair is an innovative drug for the treatment of bronchial asthma of a new class, which is a special antibody with a blocking effect on immunoglobulin E (the main factor in the development of allergic reactions).
The main indication for its use is moderate to severe atopic (allergic) bronchial asthma in patients with elevated levels of immunoglobulin E in the blood serum, which is not controlled with high doses of inhaled glucocorticosteroids and long-acting beta-2 agonists. An important feature of Xolair is its ability to significantly improve the quality of life in patients with severe bronchial asthma, in which other treatment methods are ineffective due to exposure to household and epidermal allergens. Thus, all of the considered groups of anti-asthmatic drugs are of great importance in the treatment of bronchial asthma. The role of inhaled hormones should be especially noted, since their use has dramatically changed the course of bronchial asthma, and it is these drugs that we call first-line drugs in the treatment of persistent bronchial asthma of any severity, starting with mild.
Thanks to them, severe exacerbations of bronchial asthma, which bring patients to the hospital and intensive care units, have become rare, mortality from asthma has sharply decreased, the quality of life of patients with bronchial asthma has improved, and the effectiveness of anti-inflammatory anti-asthmatic therapy has raised the question of the possibility of achieving complete control of the disease.
But if symptoms occur, beta-2 agonists with a rapid onset of action cannot be avoided, and combination drugs are the most effective in achieving control. Leukotriene antagonists can improve the course of bronchial asthma, including those with a combination of bronchial asthma and allergic rhinitis, with aspirin-induced asthma, exercise-induced asthma, and in some cases with mild bronchial asthma, they can be used as basic drugs without resorting to inhaled hormones . The use of Xolair has created new opportunities to achieve disease control and reduce the amount of drug therapy in patients with severe atopic bronchial asthma. To be continued…..
© Alexey Romodanov
What are asthma inhalers? The history of the creation of the drug in a can
Inhalation is a popular and effective method of treating respiratory diseases. Even in ancient times, people breathed steam and smoke by steaming or burning medicinal herbs. Different nations have a ritual for fumigating living quarters. This custom not only protected the house from “evil spirits,” but also had a bactericidal property and helped patients cope with coughs, allergies, and colds.
Over time, for inhalation, they began to take a clay pot and insert a straw into it. This helped direct the stream of concentrated warm steam to the desired location.
Even in our childhood, many people breathed over potatoes, chamomile, soda or other “potions.”
A modern inhaler is a device for emergency use . It helps to deliver the medicine to the respiratory tract in a matter of minutes and relieve an attack.
The very first inhaler was created in 1845. And today, hundreds of these devices are found on the shelves of pharmacies all over the world - for children, adults, emergency use and for household use.
It is important to remember that the individual device must be selected by the attending physician - a pulmonologist. After all, there is a medicine inside the can.
Types of inhalers for asthma
Inhalation devices vary in the type of medication that fills them. They are divided into aerosol and powder .
And according to the method of transporting the medicine into the respiratory tract, there are:
- spacers;
- powder inhalers for asthma;
- units with dispensers (spray);
- nebulizers;
- automatic inhalers;
- adapters;
- pocket inhalers for bronchial asthma.
Spacers
Spacers are chambers made of metal or plastic that are attached to the inhaler . This unit operates on the valve principle. The medicine enters the lungs only when the patient inhales. When you exhale, the valve closes. This allows you to use the medicine sparingly.
Spacers effectively and quickly deliver the drug to the upper respiratory tract. Inhalations with them are easy and simple. Great for inhalation with children. After all, babies do not always know how to inhale and exhale correctly, and a spacer allows you to get the required dose of the drug, even when the child is not breathing correctly.
Powder inhalers with metering device
These devices help to obtain the required dose of the powder drug . The main advantage of this type of inhaler for asthma is ease of use and effectiveness in use.
The downside is that they are more expensive than conventional aerosol units.
Aerosol inhalers for asthma with dispenser
An aerosol inhaler provides the release of the required amount of medication during an acute attack or chronic bronchitis. The main advantage is the cost of such models and ease of use.
The medicine enters the body only if inhalation is synchronized with the release of the medicine, which complicates the inhalation process itself. Not suitable for small children, as it is sometimes difficult for them to explain the mechanism of operation of the device.
It should be remembered that the aerosol is heavier than the powder, and a small part of the medicine remains . Sometimes accompanied by an unpleasant aftertaste. But doctors often take this factor into account when drawing up a treatment regimen.
Nebulizers
Nebulizers are inhalation units that spray the drug into small fractions. Due to this, small particles of the active substance reach the most remote areas of the lungs. And the treatment is more effective.
According to the mechanism of operation, nebulizers are of two types:
- — ultrasonic (there is a special membrane inside the unit that vibrates and breaks the drug into fractions);
- — compressor.
Compared to pocket inhalers for asthma, nebulizers are quite large. They are difficult to carry and use at the first sign of an attack. But they are very effective for home treatment of asthmatics.
Manufacturers are releasing more and more compact, portable nebulizers every year. These inhalers are powered by batteries or rechargeable batteries. But they have not yet entered the wide market, since they are quite expensive and are in the process of being finalized.
Automatic inhalers
After analyzing data from many studies, scientists came to the conclusion that the effectiveness of inhalation is reduced due to improper inhalation and exhalation by patients. Modern inhalers, which “feel” the inhalation and at that moment release the required amount of medicine, solve this problem remarkably well.
These automatic inhalers work autonomously; more often, the doctor or patient simply turns on the necessary program on the control panel.
Adapter
An adapter is a device that complements the main device and helps to freely supply the medicine in the dose required for the patient. In this case, the patient does not need to somehow independently regulate the dosage.
The main disadvantage of the adapter is the large size of the unit .
Stages of pathology and drugs used
How to treat bronchial asthma at different stages of development. The use of certain categories of medications will depend on the severity of the pathological process:
- In the first stage, bronchodilator medications will be sufficient. There is no permanent therapy.
- The second stage uses mast cell stabilizers.
- Bronchial asthma of the third stage requires an individual therapeutic approach, since the disease progresses differently in each person.
- At the fourth stage of the pathological process, one cannot do without the use of hormonal agents, inhalations and tablets.
Pocket inhalers for bronchial asthma
An asthma attack occurs very quickly and requires immediate intervention. Therefore, most people who have asthma always have special canisters with them. These “helpers” help eliminate an attack of suffocation in a matter of minutes.
Pocket devices, like large ones, come in several types:
- dosed powder;
- aerosol;
- hormonal.
Hormonal inhalers (for example, Salbutamol, Symbicort) are based on glucocorticosteroids with a wide spectrum of action. These drugs help fight inflammatory processes in the body, relieve swelling from the mucous membranes, which works due to adrenaline (hormone).
Most often, steroid medications are prescribed after a course of treatment with oral medications. Basically, hormone-based drugs act only on the respiratory system and do not enter the bloodstream , so side effects are minimized. The medications do not disrupt the body’s metabolism and do not disrupt the hormonal cycle.
The main advantages of a compact inhaler
A pocket inhaler is a canister in which the medicine is pressurized. When pressed, the required dose enters the respiratory tract immediately and begins its action. This type of inhaler is the most effective for an asthmatic attack.
It is often necessary to help the patient in the first minutes of suffocation so that there are no consequences of the attack. The pocket spray can can always be carried with you; it is small in size and light in weight.
A portable inhaler is suitable for people who lead an active life and are often on the move.
These inhalers are easy to use , even children can handle them. Given the fact that attacks happen unexpectedly and at the most unpredictable times, pocket inhalers help people with asthma live a full life.
Which drug to choose is prescribed by a pulmonologist. It is important that the medicine in the inhaler is in such a dose as to avoid an overdose. This is convenient if a child uses the inhaler.
How to use a pocket inhaler correctly?
First of all, you need to remove the cap from the can. Next, the inhaler is turned upside down. The thumb is placed at the bottom, and the index or middle finger is at the bottom of the can. Shake the inhaler well before using it. In some cases it is necessary to turn the dial to the right and left (in ribbon inhalers).
Then you can inhale.
The inhaler is brought to the mouth and the lips are tightly wrapped around the mouthpiece . Then take a deep breath through the mouth and at the same time press the bottom of the can.
Afterwards you need to hold your breath for a few seconds. And you can take the inhaler out of your mouth. After completing the procedure, it is recommended to exhale slowly.
If necessary, a second dose of the drug can be injected after a minute.
How not to make a mistake when choosing a nebulizer?
Surely every person who suffers from bronchial asthma wants to know which nebulizer is best. Here it is important to understand what directly depends on the characteristics of the disease and what kind of medicine the patient is breathing. Therefore, before making a purchase, you need to carefully study the following:
- particle size of the drug in aerosol form;
- compatibility with various medications;
- possibility of autonomous operation;
- equipment.
Attention! The duration of inhalation for bronchial asthma with a nebulizer is influenced by the design features of the device. The simpler the product, the less time the procedure will take. On average, this process takes from five minutes to half an hour. First of all, importance is attached to the size of aerosol particles. This point is extremely relevant if an ultrasonic device is intended to be used. Such equipment does not have the function of adjusting the size of the sprayed molecules. Doctors often use specific topical corticosteroid drugs. Their use in ultrasonic installations is prohibited. If there is an infection in the respiratory tract, then such equipment cannot be used either. You must first get rid of the infection. Antibiotics are taken for this purpose. Experts recommend buying a device that allows you to obtain molecules two to six microns in size. They most quickly enter the upper respiratory tract. Larger or excessively small molecules often do not penetrate deeply enough. As a result, the required effect is not achieved. When a device is purchased for a child, it must be equipped with a respiratory mask. It will limit the spraying of the composition outside the treated area. If the disease occurs in a complex form, then it is wiser to choose a device that can function autonomously. Important! Regardless of the reliability of the device, it will have to be replaced over time. The operating life is on average one hundred procedures. The higher this indicator, the larger the amount the product will cost.
The most popular inhaler drugs for bronchial asthma
The pharmaceutical market today already has a large selection of medications that are included in asthma inhalers. And every year new types of drugs are released, and the inhalers themselves become more convenient and safe to use.
The drug is prescribed by the attending physician - a pulmonologist. Sometimes it is necessary to try several treatment options. All medications are divided into two categories: anti-inflammatory drugs and bronchodilators.
The following drugs are prescribed among bronchodilators:
- Adrenergic agonists - they dilate capillaries and stimulate bronchial receptors. These medications have a quick effect and are often used as an “ambulance” to stop an attack. These are drugs such as Levalbuterol, Terbutaline, Salbutamol, etc.
- "Atrovent" is an M-cholinergic receptor blocker that provides relaxation of the bronchi.
- Methylxanthines block the work of certain enzymes in the body and thereby restore normal breathing in the patient. These are the drugs “Aminophylline”, “Theophylline”.
Anti-inflammatory drugs for bronchial asthma are often used to treat exacerbations and as a preventive course. These are drugs such as:
- "Cromolyn", "Nedocromil" - stabilizers of mast cell membranes. Most often used to treat children;
- Fluticasone, Beclamethasone, Budesonide are glucocorticoids that effectively relieve cell swelling.
- If other drugs are powerless, then in extreme cases, Omalizumab is prescribed, which contains anti-immune globulin E.
Basic treatment methods
Asthma requires an individual approach. Basic principles of treatment:
- identifying and stopping contact with the allergen;
- emergency relief of symptoms (suffocation, spasm, swelling), normalization of breathing;
- carrying out basic drug therapy to prevent attacks;
- selection of a group of drugs based on the principle of maximum effectiveness with a minimum quantity, excluding side effects;
- constant adherence to preventive measures to avoid relapses.
Treatment of bronchial asthma is carried out with a whole range of medications. Medicines belonging to different groups may be incompatible, so they can only be taken as prescribed by a doctor. The medication regimen is selected individually.
Medicines for bronchial asthma can be divided into two groups: emergency and basic therapy.
For emergency relief of symptoms during attacks, immediate-acting symptomatic drugs that dilate the bronchi are used. To suppress the development of the disease and long-term treatment, basic therapy is used.
Contraindications when using inhalers
Inhalers contain medicinal substances and in some cases have a number of contraindications. Most often, it is not the inhaler model itself that may not be suitable for a person, but rather the active substance.
Inhalers are not recommended for use in the following cases:
- pneumothorax and emphysema;
- severe hypertension, hypertensive crisis;
- with internal bleeding in the lungs, hemoptysis, tuberculosis;
- post-stroke and post-infarction period;
- hyperthermia above 38 degrees;
- disorders of blood formation in the bone marrow (oncological diseases);
- individual hypersensitivity to active or additional substances (allergy).
Preventive inhalations should be carried out at least two hours after physical activity, one hour after eating.
After inhalation, an asthmatic should not smoke or inhale nicotine smoke (electronic cigarettes, passive smoking). If the drug is used for the first time, it is better to remain under the supervision of a doctor for the first 20-30 minutes after the procedure.
Inhalers can be used during pregnancy and lactation. Medicines and dosage are strictly selected by the attending physician.
The role of inhalers
After numerous studies, doctors came to the conclusion that most patients make mistakes during inhalations. Therefore, the effectiveness of the prescribed treatment decreases. To solve the problem, scientists invented inhalers . They are designed to activate the patient's breaths.
The inhaler is presented in the form of a special device with the help of which a therapeutic agent enters the respiratory system in order to carry out a preventive or therapeutic effect in bronchial asthma.
The operating principle of such devices is as follows:
- ensuring the accumulation of small particles that enter the patient’s respiratory system;
- transmission of vibrations to the cap using a conductor (gel or moisture entering during use);
- under the influence of vibrations, particles of the medicinal solution are pushed out.
Inhalers are medical and prophylactic devices that allow you to inhale air with various therapeutic components. Using the device, a preliminary transformation of the prepared drug solution is carried out in a cluster of small particles.
Types of inhalers according to the method of drug delivery
There are many types of inhalers used for bronchial asthma. Most often they are divided according to the method of administering the medicine.
The following types of devices are distinguished:
Spacers
These inhalers consist of a valve system made of plastic or metal. They are attached to the medicine inhaler itself. The principle of operation is based on the supply of the active substance only when inhaled.
In this case, when the patient exhales, the valve closes and the supply of medication stops.
This device allows you to save on asthma spray and strictly follow the dosage prescribed by your doctor. Spacers are good for children who are unable to control their breathing cycle.
The main disadvantages of this device include its rather large size, which does not allow the inhaler to be used as a portable one. Most often it is used at home.
Nebulizers
The most effective inhalation type device. It ensures uniform spraying of the medicine onto the surface of the bronchi. Fine particles penetrate even the most remote areas of the respiratory system, ensuring deep distribution of the active substance.
Due to its large size, a nebulizer for asthma is used only at home. That is why this device has not found application in the relief of acute attacks. However, it is effectively used for subsequent treatment, as well as prevention of exacerbations of the disease.
Based on their operating principle, nebulizers are divided into compressor and ultrasonic.
Compressor devices are the most popular. With the help of compressed air supplied to a special nozzle, the liquid is converted into an aerosol.
Fine dispersion is achieved by passing through a deflector. The advantage is the ability to use a wide range of medications.
In ultrasonic nebulizers, an aerosol mixture is created using high-frequency ultrasonic vibrations. Such devices operate very quietly, which makes them indispensable in pediatric therapy.
Currently, work is underway to reduce the size and weight of nebulizers.
Metered inhalers
A common portable inhaler is the aerosol-type nebulizer. These are balloon devices, inside of which there is a medicine pumped under pressure. When pressed, the substance is sprayed. The drug is given in a strict, constantly identical dosage. In addition, these inhalers have a fairly low price, which makes them accessible to any segment of the population.
The disadvantages include the fact that special training in breathing techniques is required for use. In aerosol inhalers, the medicine enters the body along with air when inhaled. In addition, some of the drug substance settles in the oral cavity. It is then swallowed along with saliva and enters the digestive system. When choosing a dose, it is important to take this nuance into account.
Separate mention should be made of metered-dose inhalers. With their help, not an aerosol, but a dry powder mixture enters the human body. Easier use (compared to aerosol-type inhalers) is an undeniable advantage. It should also be noted that it is highly effective due to the fact that the medicine enters the bronchi and does not settle in the oral cavity and pharynx. The disadvantages include a higher price.
