Treatment of Asthma
The treatment of asthma must follow an overall plan, agreed between the doctor and the patient. The aim of the treatment is to improve the symptoms, to maintain a normal, or almost normal, lung function, to prevent exacerbations, and have a good quality of life.
Avoid tobacco. Asthmatic patients that are smokers have poor control over the disease and a lower response to drug therapy. It is recommended that all asthmatic patients give up smoking, as well as to avoid passive smoking.
Physical activity. To carry out physical activity on a regular basis improves the cardiovascular condition and tolerance to effort of the patients.
Avoid environmental contamination. Do not exercise out of doors in days of high levels of environmental contamination.
Vaccination. The influenza and pneumococcal vaccination is recommended in patients with moderate-severe asthma.
Avoid contact with allergens:
Dust mites. Reduce rugs, fitted carpets, curtains, and objects that may accumulate dust. Do the home dust cleaning with a damp cloth, wash the bedclothes at least twice a week at high temperatures, use anti-mite covers for the mattress and pillow.
Pollens. Avoid staying out for long in the open air on days with high pollen counts, the type of pollen to which you are sensitised must be known, as well as the seasons in which they are high.
Animals. Remove the animal from the home and carry out an exhaustive clean; if this is not possible, avoid contact with the animal in the bedroom and on the sofa.
Fungi. Avoid dampness in the home, ventilate frequently the dark and humid rooms.
The aim of drug therapy of asthma is to improve the patient symptoms and avoid asthma attacks. It must be adjusted periodically, step by step, depending on the severity and control of the symptoms.
The majority of asthma treatments are administered by inhalation, achieving a local effect at the airways level, with fewer side effects.
A correct inhalation technique is essential to achieve a good response to the treatment.
There are two groups of inhaled drugs:
- Bronchodilators. They are drugs that open or dilate the airways and can be short-acting or long-acting.
- Glucocorticoids. They are anti-inflammatory drugs that reduce the inflammation of the airways.
There are two treatment strategies:
- “Rescue” treatment. Helps to rapidly alleviate the symptoms by administrating a short-acting bronchodilator, which starts to act within a few minutes.
- Maintenance treatment. Helps to control the disease and prevent the appearance of attacks. The cornerstone of this treatment is the use of inhaled glucocorticoids, which can be administered alone, or in combination with long-acting bronchodilators.
Other treatments that help to control the disease are:
- Leukotriene receptor antagonists: They are taken orally and they also have an anti-inflammatory action.
- Anti-histamines. They help to control the allergy symptoms.
- Immunotherapy with vaccines for the allergies. In the case of allergic asthma, where the exposure to the agent to which the patient is allergic cannot be avoided, this treatment is used to desensitise the patient.
The majority of asthma treatments are administered by inhalation, that is to say, the medication is inhaled through the mouth so that it reaches the airways. A correct inhalation technique is essential in order that the medication reaches the zone where it has to act, if not, sufficient medication will not reach the airways and the desired effect will not be achieved.
In general, there are two large groups of inhalers: the pressurised cartridge inhalers and the dry powder inhalers. Within these, there are different types of devices. The patient and the doctor must find the option that best suits the patient and to ensure that the inhalation technique is correctly performed.
New treatments for asthma have been developed in the last few years, which are indicated in the case of severe asthma, which is uncontrolled despite optimal conventional treatment.
- Biological drugs. These are monoclonal antibodies directed against the proteins involved in the inflammation mechanisms of the asthma. They are usually administered subcutaneously. The following are currently available:
- Omalizumab. It acts by blocking immunoglobulin E, a protein involved in allergic inflammation. It is indicated in patients with severe allergic asthma.
- Mepolizumab. It acts by blocking interleukin 5, involved in the inflammatory pathways of asthma. It is indicated in patients with severe asthma with a type of inflammation called eosinophilic.
- Bronchial thermoplasty is an endoscopic procedure. It is carried out using flexible fibre optic bronchoscopy, which consists in applying controlled heat on the walls of the airways, thus reducing the thickness of the bronchial smooth muscle and decrease the bronchial hyper-reactivity. This is only indicated in very select cases of severe asthma, which are not controlled with conventional treatment.
The treatment administered by the inhaled route, in general, is safe, given that the drug acts locally in the airways, and there are few systemic side-effects. The most common adverse effects are:
- Local effects. Such as irritation in the throat, changes in the voice (dysphonia), and appearance of fungi (thrush) in the mouth. This is usually due to there being remains of the drug left in the oral cavity and larynx, and for this reason it is advised to rinse the mouth after each inhalation.
- Systemic adverse effects are usually associated with high doses and prolonged treatment periods. The glucocorticoids can cause osteoporosis, glaucoma, increase in blood glucose levels, adrenal insufficiency, and a higher risk of pneumonia. Bronchodilators can cause tachycardia, trembling, feeling of anxiety and nervousness.
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