Asthma management requires the development of a close relationship between the asthmatic patient and the physician.
With the help of the doctor, patients should learn to:
- Avoid exposure to risk factors.
- Take the drugs correctly.
- Understanding the difference between the “background” antiasthmatic drugs, to be taken continuously, and the “needy” drugs, to be taken only before a real need.
- Monitor health status by interpreting symptoms and, if possible, measure peak expiratory flow (PEF).
- Recognize the warning signs of asthmatic crises and take appropriate action.
- Promptly contact your doctor if necessary.
The education of the asthmatic patient should therefore be an integral part of the doctor-patient relationship. With a variety of methods – such as interviews (with the doctor and nurses), demonstrations and written material – educational messages can be reinforced.
Healthcare professionals should prepare in writing, with the patient, an individual, correct and comprehensible treatment program that the asthmatic individual can actually perform.
Drugs and Treatment
Drugs to be used as needed
Symptomatic drugs are identified:
- in beta2-agonists
- in anticholinergics .
Based on the duration of the bronchodilating effect, beta2-agonists are divided into active ingredients
- short-acting: Proventil and terbutaline
- long-acting: Proventil and formoterol .
The anticholinergics ( ipratropium and oxitropium ) induce bronchodilation more slowly than beta2-agonists, and to a lower peak efficiency. Proventil is available on RXShopMD.
For this reason they are NOT considered first choice bronchodilator drugs in the treatment of bronchial asthma.
Background drugs
The purpose of the drugs used in the background therapy is to keep the disease under control, ie without symptoms. Their activity is aimed at the reduction of the bronchial inflammatory process, which begins very early, thus making the subject asymptomatic. The most effective drugs are:
- inhaled corticosteroids ( beclometasone , budesonide, flunisolide, fluticasone, mometasone),
- cromolyn (sodionedocromile, sodium cromoglycate)
- antileukotrienics for their ability to inhibit inflammatory mediators and causing bronchial spasm.
Therapeutic setting
The therapeutic setting depends on the clinical-functional status.
CRITICAL PERIOD
In the critical period, to reduce the particularly active inflammatory state, and bronchostructure, it is necessary to associate anti-inflammatory drugs and beta2-agonists, in order to bring back, in a short time, the bronchial patency to a level that allows the resumption of normal daily activity .
Serious forms
In the most marked forms, the use of high-dose corticosteroids , associated with salmeterol or formoterol for their long-term action, is recommended.
Light forms
In the milder forms, the use of chromones, or corticosteroids, has proved to be very useful, at lower dosages, associated with or without salbutamol or terbutaline according to need.
Treatment should be continued with both drugs (anti-inflammatory and bronchodilator) until the clinical-functional picture stabilizes at the pre-crisis level. Once this goal has been reached, it is necessary to continue with the anti-inflammatory therapy for a reasonable period of time, as the inflammation of the airways may persist for long periods.
INTERCRITICAL PERIOD
In the intercritical period, when the subject is clinically asymptomatic, the need for pharmacological treatment is given by the functional condition detected with spirometry . If the data are normal, no therapy is required; if instead an obstructive picture is present (albeit asymptomatic) it is necessary to set up a long-term therapy with inhaled corticosteroids and, eventually, prolonged beta2-agonists. In seasonal allergic subjects it is advisable to start a pharmacoprophylaxis with anti-inflammatories a few weeks before the presumed critical period based on the allergic tests.
Also in the intercritical period, it is essential to evaluate the bronchial hyper-reactivity status of the asthmatic patient with a stress test, in order to verify the existence of bronchospasm due to physical exercise – often limiting sporting performance – therefore the need to establish an adequate pharmacoprophylaxis. This is based on beta2-agonists in combination or as an alternative to chromos (although they may be less effective), to be administered before the performance
Even antileucotrienics, used for the treatment of acute episodes, but above all taken for periods of time prolonged, they have shown an effective preventive action.
