Bronchial asthma is a serious chronic disease of the bronchopulmonary system of immunoallergic genesis. The disease can develop in people of any age group (even young children) and significantly impair quality of life due to frequent severe, sudden attacks of suffocation. To date, medications for asthma have been developed that allow patients to suppress the clinical manifestations of the disease and lead a normal life.
The effectiveness of drug therapy
implies the appointment of basic drugs that constantly suppress sensitization and inflammation in the bronchi, as well as drugs used “on demand” during an attack of suffocation.
A correctly prescribed treatment regimen allows you to control the course of even moderate and severe bronchial asthma. Subject to the recommendations of the doctor and the systematic constant intake of medications, it is possible to achieve a significant improvement in the patient’s condition, as well as reduce the frequency and severity of asthma attacks. Drug therapy allows most patients with asthma to achieve a stable remission of the disease.
Classification of asthma medications
Medicines with anti-inflammatory and long-term bronchodilatory effects (basic therapy):
- glucocorticosteroids (there are inhalation forms that are used for mild course, and systemic corticoids , which are necessary for severe or complicated course);
- antagonists of leukotriene receptors;
- stabilizers of mast cell membranes ( cromones );
- prolonged bronchodilators ;
- combination drugs.
- beta-2-adrenergic receptor agonists ( bronchodilators );
- M – anticholinergics (anticholinergic drugs);
- combined drugs that include both bronchodilators and anticholinergics;
- theophylline derivatives ( methylxanthines ).
Glucocorticoids (GCS) are hormonal drugs that are artificial analogs of steroids synthesized in the fascicular area of the adrenal cortex.
This group of medicines includes:
- Methylprednisolone ;
- Dexamethasone ;
- Triamcinolone .
These biologically active substances have the following effect on the pathogenetic links of inflammation:
- inhibit the proliferation of monocytic, lymphocytic and eosinophilic cells of the immune system;
- inhibit antigen processing;
- reduce the release and migration of inflammatory cells from the vascular bed;
- block the production of leukotrienes and prostaglandins ( pro-inflammatory mediators).
The term “systemic glucocorticosteroids ” means the use of such a method of drug administration in which the active substance would enter the systemic circulation of the body. This is of fundamental importance, since inhaled forms of GCS are still used for the treatment of bronchial asthma, while there is only a local effect on the mucous membrane of the bronchial lining (the substance does not enter the blood).
Not all people suffering from bronchial asthma need to prescribe systemic hormonal agents. According to the principles of stepwise therapy, when there is a phased prescription of medicines (if the previously prescribed group of drugs is ineffective, the next, higher class of drugs is prescribed), Prednisolone in tablets is used only in the absence of positive dynamics from treatment with all previous groups of pharmacological agents.
Also, the injectable form of systemic corticoids is used for the urgent treatment of status asthmaticus. When stopping a prolonged attack of suffocation, when the effect of inhalations of fast-acting bronchodilators and M- anticholinergics was not enough, intravenous administration of Prednisolone is prescribed.
Derivatives of cromoglycic acid are basic therapy drugs that have an anti-inflammatory effect by inhibiting the release of inflammatory mediators from mast cells. This group of drugs is indicated for mild asthma, is well tolerated by patients and produces a moderate anti-inflammatory effect.
Stabilizers of mast cell membranes include the following pharmacological agents:
- Cromohexal ;
- Ketotifen ;
- Intal ;
- Kromoglin ;
- Nedokromil ;
- Cromoglycate .
Among the non-hormonal drugs that are used to treat asthma, the following pharmacological groups can be distinguished:
- antihistamines (by blocking histamine receptors, reduce the severity of inflammatory reactions);
- beta- adrenomimetics – agents that, due to the activation of adrenaline receptors of the bronchi, cause an expansion of their lumen;
- M – anticholinergics (lead to the expansion of the bronchi due to blocking of cholinergic receptors);
- cromones (reduce the release of mediators that stimulate inflammation);
- antileukotriene drugs – blockers of receptors for leukotriene (the main mediator of inflammatory reactions);
- mucolytic drugs (improve the rheological properties of sputum and facilitate its discharge).
Inhibitors of leukotriene receptors are one of those groups of drugs that have been added to the protocols for the treatment of bronchial asthma more recently. By blocking receptors for inflammatory mediators, the drug reduces the severity of the inflammatory reaction (they have a less pronounced therapeutic effect than inhaled glucocorticoids , but are more effective than cromoglycic acid derivatives). The use of drugs from this pharmacological group as monotherapy does not allow achieving stable remission, therefore, most often they are combined with other anti-inflammatory drugs.
Medicines belonging to this group are divided into the following types, which differ from each other by the substrate of pharmacological action:
- blockers of cysteinyl leukotriene receptors ( Montelukast , Zafirlukast ( Akolat ), Pranlukast );
- direct inhibitors of 5-lipoxygenase ( Zileuton ).
For the treatment of bronchial asthma, many drugs with an inhalation form of administration are used, since this provides a quick and effective delivery of the active pharmacological substance to the pathological focus. Also, the advantage of such medications is that they are not absorbed into the systemic circulation, therefore they rarely lead to complications and side effects.
The following medicines are used in aerosol form:
- inhaled glucocorticosteroids ( Budesonide , Beclomethasone , Fluticasone , Mometasone );
- beta-2-adrenomimetics of short (Fenoterol, Salbutamol ) and prolonged ( Salmeterol , Formoterol ) action;
- anticholinergic drugs ( Atrovent );
- combined aerosols (contain several drugs with different pharmacological actions).
The greatest effect of asthma treatment is achieved with the right combination of drugs from different pharmacological groups. Monotherapy (isolated administration of only one drug) is not effective enough even with the appointment of the newest drugs from the antileukotriene and cromones groups .
Combined drugs combine a pronounced therapeutic effect and ease of use, since they allow the patient to receive the necessary therapy using only one drug (this increases discipline and adherence to treatment in patients).
Common effective combination medicines:
- Seretide (a combination of a long-acting bronchodilator and a local glucocorticosteroid ).
- Berodual is a combination of two bronchodilators (M- anticholinergic and beta- adrenomimetic ).
There are many asthma medications in modern pharmacology that help patients achieve sustained symptom relief and improve their quality of life. To select an effective treatment regimen, the patient needs to be examined by a pulmonologist, and also to perform a number of prescribed laboratory and instrumental studies.