Bronchial asthma (BA) is a disease that changes the lifestyle of not only the patient, but also his family. The disease cannot be completely cured, but can be successfully controlled with the help of modern drugs. What are these drugs and how they work, we will tell in our article.
A bit of history
The ability to cure an ailment in which a person loses the ability to breathe has been sought by doctors since they discovered the disease itself. Over time, knowledge about this condition accumulated and an understanding came of how to deal with it effectively.
So, the ancient Greek physician Hippocrates was the first to introduce the term “asthma”. 1 Ancient Roman physician Galen – investigated the mechanisms of development of respiratory disorders in asthma. Medieval Italian doctor Gerolamo Cardano was the first to recommend a healthy lifestyle to asthma patients. 2 Russian scientist Grigory Ivanovich Sokolsky suggested in the 19th century that asthma could have several causes. The influence of the nervous system on the development of the disease was also discovered by our compatriot, physiologist, general practitioner Sergei Petrovich Botkin. 3
It is interesting! Along with science, alternative medicine was also looking for ways to treat bronchial asthma. At various times, they tried to heal asthma by bloodletting, diaphoretic, diuretic and emetics, applying leeches and Spanish flies, inhaling the smoke generated by burning ephedra herb, nettles infused with vodka, opium, enemas, and even cigarettes with belladonna. 1-3 These “therapies” are, of course, unacceptable today.
Adrenaline like a revolution
A revolutionary step in the search for the optimal method of treatment was made about 100 years ago, when adrenaline was first used in the treatment of bronchial asthma. 4 In 1920, in one of the authoritative medical journals, The Lancet 4 , a case was described: a thirty-year-old woman with asthma for 6 years was injected with adrenaline for a week, which led to a complete relief of symptoms, and later to a significant decrease in the number of attacks. four
Already in the 1930s, inhalations with adrenaline -containing drugs became the main weapon in the fight against bronchial asthma attacks. 4 There was one minus: the treatment had many side effects – from tachycardia and headache to damage to the mucous membrane of the upper respiratory tract. 4 Therefore, later attacks of bronchial asthma began to be treated with β 2 -adrenergic agonists – a chemical modification of adrenaline, with the use of which the frequency of side effects was significantly lower. 5
β 2 -agonists relax the smooth muscles of the bronchi, which leads to a decrease in bronchospasm – the cause of suffocation. 5 After inhalation, the effect occurs after 3-5 minutes and lasts 4-6 hours. 5
It would seem that an effective medicine was found. But not everything is so simple: short-acting β 2 -agonists stop the symptoms, but do not eliminate the main cause of the disease – inflammation of the bronchi. Because of this, the patient has the illusion that he controls bronchial asthma, although this is not so. In addition, the frequent use of these drugs is addictive.
Ivanova Natalya Alexandrovna
Candidate of Medical Sciences, Associate Professor of the Department of Children’s Diseases of the Military Medical Academy. CM. Kirov, St. Petersburg
“Our patients, especially adolescents, rarely think about the consequences of misuse of medications. Children begin to breathe with an inhaler containing short-acting adrenomimetics every hour or two, that is, exactly as much as they need to maintain imaginary well-being. An overdose of β 2 -agonists is dangerous for the health and life of a child! The medicine brings quick relief and it seems that you can continue playing football or go on a date, but it’s not!
Thus, β 2 -adrenergic agonists are an emergency remedy for asthma attacks. 5 However, modern therapy is not limited to them.
Glucocorticosteroids : a new stage, a new victory over the disease
A real breakthrough in the fight against bronchial asthma was the discovery in the middle of the twentieth century of glucocorticosteroids (GCS), for which scientists Philip Hench (USA), Edward Kendall (USA) and Tadeusz Reichstein 6 (Switzerland) received the Nobel Prize. So, F. Hench was the first to draw attention to the fact that the condition of patients with rheumatism improves significantly during pregnancy, and suggested that the reason for this is the appearance in the body of steroid substances that are similar in structure to sex hormones, which have a positive effect. 6 At the same time, T. Reichstein (Switzerland) and E. Kendall (USA), independently of each other, managed to isolate glucocorticosteroids (GCS) from the adrenal cortex . 6 The combined results of the discoveries of each of the scientists made it possible to obtain a new effective drug for bronchial asthma – GCS. 6
However, with high efficiency, treatment with corticosteroids gave side effects. Therefore, scientists continued to look for a way to improve it, which was found in the early 80s of the twentieth century: the drug began to be used in the form of an aerosol 6 . If earlier the drug in the form of tablets and injections immediately entered the bloodstream and had a systemic effect on the entire body, now the active substance was delivered exactly where it was needed – right into the bronchi 6. Due to this, the number of side effects has significantly decreased. 6 Well, with the invention of the nebulizer – a device for inhalation, a new stage has begun in the treatment of bronchial asthma 7 .
How it works?
Glucocorticosteroids are hormones that affect the metabolism of carbohydrates, proteins and fats, inhibit inflammation and help a person overcome stress. 10 The action of glucocorticoids is based on the fact that they penetrate into the cell and interact with intracellular steroid receptors. 10 As a result, there is a decrease in mucosal edema and mucus secretion, the normal structure of the bronchial wall is restored, and the risk of exacerbations of bronchial asthma is reduced. 10 In addition, ICS help to suppress the late phase of allergy. eleven
Currently, the treatment of BA with ICS is basic, since glucocorticosteroids not only eliminate symptoms, like β 2 -agonists, but also prevent exacerbations, and also reduce the consequences of allergic inflammation of the bronchial mucosa. 8.9
Inhalation of corticosteroids is also a means of controlling bronchial asthma. 8,9,12 Its use reduces the need for symptomatic therapy with adrenomimetics. 9 There is even such a criterion for the control of bronchial asthma as “the frequency of use of adrenomimetics” 12 : if the patient often uses symptomatic therapy, it means that bronchial asthma is not under control and you should consult a doctor to correct the basic therapy.
Thus, it is the doctor who prescribes bronchial asthma therapy for an asthmatic child . At the same time, it must be remembered that the implementation of the doctor’s recommendations is one of the most important conditions for controlling bronchial asthma, therefore, in order to reduce the frequency of exacerbations, all his prescriptions should be strictly observed.