Asthma is a chronic inflammation of the airways that causes unpleasant tightness in the chest and difficulty breathing. In children it occurs mainly in mild form, and in more than 80 percent of cases it is allergic type.
Asthma is caused by a combination of external and genetic factors. It is more likely that you will develop asthma if you have a family member with asthma and if you are sensitive to external allergens and irritants.
The disease is characterized by increased bronchial reactivity to various stimuli. It occurs in episodes, ie acute disease exacerbations rotate during periods in which there are no symptoms of asthma. The attack occurs during worsening of inflammation, usually because there is a provocative factor of asthma in the immediate surroundings.
Asthma is manifested by shortness of breath (dyspnea), wheezing in the chest (wheezing) and cough. These three symptoms are usually associated. Choking occurs in the form of attacks (paroxysms of dyspnea) between which the phases of remission occur. The intensity of the attacks, their frequency and duration are variable. During the attack the patient is breathing rapidly, wheezing, sweating and is scared. He/she takes up a sitting position and relies on the extended hands to fix the muscles of the shoulder belt, which allows the use of auxiliary respiratory muscles. End of attack is often marked by cough with expectoration of thick mucus. Asthma is often worse at night and attacks occur between 2 and 4 AM. The most severe clinical form of asthma is severe acute attack (status asthmaticus) where the patient`s life is in danger.
The goal of asthma treatment is to eliminate the symptoms and to establish normal or as good as possible lung function, as well as to reduce the risk of severe attacks. In addition, treatment should reduce the number and severity of attacks and allow patients a normal life, which includes sport activities. The fulfillment of those objectives should be provided with minimal side effects caused by therapy. The form and severity of obstruction are key parameters when deciding on the treatment of asthma.
In the medical treatment of asthma there are several groups of drugs that are commonly used:
- medicines for preventing obstruction (anti-inflammatory drugs)
Glucocorticoids are the main drugs that are, due to their anti-inflammatory effects, used in the treatment of bronchial asthma. Glucocorticoids are not bronchodilators and are not effective in the treatment of rapid response to the agent causing the attack. However, their implementation is unambiguous in the treatment of chronic asthma in which the inflammatory component dominates.
In the treatment of bronchial asthma from this group of drugs most commonly are used: beclomethasone, budesonide, fluticasone and ciclesonide. They are applied by inhalation, with the help of metered dose inhalers. Their full effect is achieved only a few days after starting the treatment.
- medicines for reducing obstruction (bronchodilators)
Beta 2-adrenergic agonists
These drugs are administered by inhalation, in the form of aerosol, powder or solution, although some of them can be applied orally or parenterally.
In the treatment of bronchial asthma two groups of beta2-adrenergic agonists are used, such as: short-acting drugs - eg. salbutamol. These drugs are used in inhalation, while achieving maximum effects during 30 minutes of application , and their effect lasts for about 4-6 hours; these drugs are generally taken in the symptomatic treatment, if necessary.
The second group consists of the drugs with a longer effect - eg. salmeterol. The drugs are administered by inhalation, and their effect lasts for about 12 hours. They are used regularly, twice a day, in patients in whom glucocorticoid has not achieved complete control of the disease.
Theophylline is used in the form of tablets with the complete release of theophylline and in the prevention of all forms of asthma in children and adults with chronic obstructive bronchitis and pulmonary emphysema.
Montelukast is useful as an additional medicine in the prevention and treatment of persistent asthma, especially in those patients in whom corticosteroids and other bronchodilators cannot completely control asthma. Montelukast is especially useful in patients with allergic asthma, and also in the prevention of attacks that occur due to physical exertion. Montelukast can be used for prevention of attacks of seasonal allergic rhinitis.
It is administered by inhalation, in aerosol form. It is extremely poorly absorbed into the systemic circulation and therefore has few side effects. Maximum effect is achieved 30 minutes after application and lasts between 3 and 5 hours. It may be applied with beta2-adrenergic agonists. It is used for urgent alleviation of symptoms of asthma attacks, as well as salbutamol. This medicine is not effective when patients are exposed to an allergen and has no impact on the late, inflammatory phase of asthma.