Advair Diskus is a known combined drug to control and prevent symptoms associated with asthma attacks and other types of lung disease, including chronic obstructive pulmonary disease in both variants: emphysema and chronic bronchitis.
Advair Diskus contains two different drugs, fluticasone, and salmeterol. It is only used when single therapy is not available or not sufficient to control respiratory symptoms caused by asthma or COPD. Fluticasone acts in synergy with salmeterol to provide effective relief to respiratory symptoms. Fluticasone is a corticosteroid, and it reduces the inflammatory response, the associated swelling and the irritation of the airways. Salmeterol is a beta agonist drug that stimulates the airways to widen and give more room for breathing.
This drug comes as an inhaler with blister strips of micronized salmeterol and fluticasone in a lactose monohydrate carrier. Thus, lactose intolerant patients and those suffering from a known allergy to milk protein should inform their physician about their condition before starting to use Advair Diskus.
The product has 3 distinct concentrations of fluticasone propionate, but the concentration of salmeterol is the same in all presentations. For each 50 mcg of salmeterol, you can have either 100, 250 or 500 mcg of fluticasone propionate. In all presentations, the dosage recommendation is the same: one inhalation twice a day regardless of the age. The concentration of fluticasone each patient should use depends on the severity of asthma and the age of the patient.
When and how to use Advair Diskus
Advair Diskus is only to be used by 4-year-old patients and older, and it is not indicated to provide relief to acute respiratory symptoms resulting from bronchospasm. Patients may experience an improvement in respiratory symptoms 30 minutes after performing the inhalations, but the greater benefit of using Advair Diskus is achieved after one week of continuous applications. Each patient has different variables and would experience different degrees of symptomatic relief.
Advair Diskus is an excellent combination therapy for asthma and COPD. However, it is not to be treated as a rescue drug, and it does not adequately control asthma attacks. Instead of using Advair Diskus symptomatically, it is best to be taken regularly regardless of the respiratory symptoms until patients regain control of their disease and improve their symptoms with corticosteroids alone.
Thus, Advair Diskus cannot be considered a rescue medication but a preventative combination therapy that reduces the frequency and intensity of asthma attacks and respiratory symptoms in COPD. When your symptoms flare-up suddenly and unexpectedly, use an inhaler instead with salbutamol or any other rescue drug prescribed by your doctor for this situation.
In chronic obstructive pulmonary disease, Advair Diskus reduces airway obstruction caused by emphysema and chronic bronchitis, and it is also indicated to reduce the incidence and severity of COPD exacerbations.
Regardless of the age and pathology, the usual dose of Advair Diskus in both asthma and COPD patients is one inhalation twice a day, 12 hours apart. It is not recommended to increase the dose, it does not add up to the strength and efficacy of the drug, and it does increase the risk of adverse effects.
For patients aged 4 to 11 years old with asthma symptoms, the recommended fluticasone concentration is 100 mcg, which is found in Advair Diskus 100/50. Asthma patients aged 12 years and older may use higher concentrations depending on each particular case. On the other hand, controlling chronic obstructive pulmonary disease usually requires a concentration of 250 mcg of fluticasone, and the recommended presentation for these patients is Advair Diskus 250/50. In every case, inhalations should be no more than one administered twice daily.
In the case of patients who experience shortness of breath and other respiratory symptoms between one dose and the next one, they should use a rescue medication such as short-acting beta agonists to provide immediate relief. It is not recommended to repeat the dose of Advair Diskus to treat acute bronchodilation.
The most common side effects associated with Advair Diskus is upper respiratory tract infection. Patients under corticosteroids may suffer from immunosuppression in the airways, an increased risk of Candida albicans infection, and pneumonia in COPD patients. Headaches are another common side effect, as well as nausea and vomiting. Other possible adverse effects recorded in the scientific literature are pharyngitis, upper respiratory inflammation, bronchitis, cough, and diarrhea.
Advair Diskus may also cause a transient increase in hepatic enzyme levels, usually greater than 1% but not marked enough to suggest discontinuation of the treatment. In pediatric patients aged 4 to 11 years old, the most common adverse reactions after using Advair Diskus 100/50 are limited to throat irritation and increased risk of infection in the upper respiratory tract.
Both fluticasone and salmeterol in Advair Diskus are metabolized by the enzyme CYP3A4. Inhibitors of this enzyme, including itraconazole, ritonavir, clarithromycin and ketoconazole increase the concentration of systemic corticosteroid and the risk of adverse effects.
Patients under tricyclic antidepressants and monoamine oxidase inhibitors should use Advair Diskus with special care or after discontinuing these drugs for a minimum of 2 weeks to prevent adverse effects on the vascular system.
Beta-blockers should also be used with care as they may induce severe bronchospasms and block the effects of salmeterol in Advair Diskus in the pulmonary tissue.
A word of caution for those patients using thiazide diuretics and loop diuretics in a combination with Advair Diskus may result in hypokalemia and ECG changes. Patients under these medications should perform blood chemistry tests to prevent electrolyte imbalances.
Data from placebo-controlled trials in the U.S. has reached to the knowledge that using a long-acting beta-agonist drug such as salmeterol increases the risk of asthma-related hospitalizations and death. Thus, it is not an over-the-counter drug patients are encouraged to use without a prescription. To prescribe Advair Diskus, a physician should evaluate other therapeutic options first, and would only recommend this drug when single therapy is insufficient to control the symptoms associated with asthma and COPD.
Advair Diskus is not to be used as a permanent therapy to reduce respiratory symptoms. After patients have reduced the frequency and severity of asthma attacks, physicians would assess the clinical condition and would recommend discontinuing Advair Diskus and replacing it with an inhaled corticosteroid as a single therapy.
Bronchial asthma: a history of study
The first mention of bronchial asthma is found in ancient Indian doctors. They believed that asthma was the active ingredient present in the chest, which could be cured by smoking a dope.
Datura was among the Ayurvedic remedies. He was smoked either in the form of "roll-ups" or using a pipe. In the 18th century, James Anderson, a physician at a West Indian company, brought this treatment to Europe.
Datura - a herbaceous plant of the family of nightshade, used in medicine. Medicinal raw materials are leaves, tops and seeds. Datura leaves contain mainly hyoscyamine alkaloids, as well as scopolamine and atropine, which have a broncho-relaxing effect. Datura leaves are included in anti-asthmatic fees.
Another medicinal plant for the treatment of asthma was ephedra, known as a medicinal plant to the inhabitants of China for more than five thousand years. This shrub contains ephedrine, the active ingredient in ephedra, which relieves bronchospasm, causes vasoconstriction, reduces the production of mucous secretions.
The Chinese brought ephedra to Greece, from where it became known to other civilizations. One of the oldest medical treatises is contained in the Ebers papyrus. Papyrus was discovered in Thebes in 1862 between the legs of a well-preserved mummy. Georg Moritz Ebers, who collected and studied antiquities, bought papyrus in Luxor eleven years later. The text was written in the hieratic style, a system of abbreviated, italic writing with hieroglyphs used in ancient Egypt by priests and doctors. The hieratic script with an inscription on a tree or papyrus was performed using reed pens, in contrast to the hieroglyphs that were carved into the stone. For treating an asthma attack, it was recommended to use a primitive special apparatus for inhalation of ephedra smoke in case of respiratory failure: heat a stone on the fire, put some medicinal plant on it, cover it with a perforated vessel and insert the reed stem into the hole, attach it to the mouth and inhale the smoke.
The term "asthma" was first used in four aphorisms of Hippocrates. By this term, the author referred to "heavy breathing", accompanied by "breathing" noise. Hippocrates considered this condition more severe than shortness of breath and less severe than orthopnea (shortness of breath in the prone position). This disease was regarded as spasmodic (like epilepsy) and paroxysmal, in which difficulty in breathing occurs like an attack.
Arefei Cappadocian was a contemporary of Galen, but was unknown until the publication of his manuscript in 1554 in Paris. He believed that asthma is more common in women than in men, and much more severe in a dream. In this manuscript there is the first accurate description of asthma: “If from any effort fatigue arises when breathing, then this is called asthma, and therefore a disease called orthopene is called asthma. The premonitory symptoms of this disease are lethargy, difficulty breathing while running. Patients have hoarseness and coughing, belching. If the disease progresses, the eyes protrude, as in the case of asphyxiation, when breathing a noise is heard, which greatly aggravates sleep. The face is pale, except for the reddening of the cheekbones, and the forehead and neck are sweaty. The cough is constant and strong with poor frothy expectoration."
In the Middle Ages, only a few new developments in the field of medical research were launched in Europe. Doctors considered the classical works of Hippocrates and Galen to be final and perfect, so most of them focused solely on improving patient comfort. As a result, the Middle Ages did not give significant progress in understanding the pathogenesis, diagnosis and treatment of bronchial asthma.
In 1859, doctor Kurti described a case of healing a woman suffering from severe and prolonged asthma attacks by injecting atropine. The most significant work of the nineteenth century on asthma was written by Enrico Salter (1823-1871), "Asthma: Pathology and Therapy" and was published in 1860. The author himself suffered from bronchial asthma and therefore was particularly interested in this disease. He first described the presence of eosinophils in asthmatic sputum. He collected 217 cases of asthma and traced a hereditary component to 84 of them. As asthma triggers, he mentioned food and drinks, smoking. E. Salter was the first observer to describe in detail asthma caused by “emanations” (emanatio - outflow, spread) from animals, in particular, obtained from a cat. His description became classic: “This is an unusual phenomenon for me. The cause of this asthma is the proximity of a domestic cat. Symptoms are very similar to the symptoms of hay fever. I think that this asthma begins when I sit near the toilet, and the cat is lying on the carpet, but the effect is. When a cat comes to its feet or is in the face, an asthma attack occurs immediately and is accompanied by flushing, itching of the eyes, rhinorrhea and itching of the face. After removing the cause, the symptoms begin to disappear after five minutes ...”
In 1871, Ernst von Leiden found crystals in the sputum of asthmatic patients. He believed that they were produced by the alveoli and small bronchioles. Jean-Marie Charcot also singled out these crystals, and they were called "Charcot-Leiden crystals." In 1883, Heinrich Kurshmann discovered spirals consisting of mucous fibrils, woven together, which were also present in the sputum of patients with bronchial asthma. The body of the spirals often contains cellular elements or Sharcho-Leiden crystals. In the twentieth century in 1903, Maurice Artus experimented with horse serum and obtained hypersensitivity, called the Artus phenomenon. Meltzer, observing the similarity of bronchospasm in piglets during anaphylaxis with asthma attacks in 1910, suggested that asthma is an anaphylactic reaction, and patients are subjects sensitized to a specific substance. This theory remains relevant today, confirming the allergic nature of bronchial asthma. Surprisingly, the most effective methods for treating bronchospasm are still medicines like ephedrine and atropine. Modern research methods have allowed to obtain much more effective and safe preparations, however, using the principles laid down in deep antiquity.
COPD - what is it, how is chronic obstructive pulmonary disease treated, and how to improve the quality of life?
Most people consider lung cancer to be the most serious disease of the respiratory system. There is also a similarly dangerous pathology not related to oncology - COPD. It affects both women and men, progresses steadily, is difficult to cure, causes irreversible complications and often ends in the premature death of a person.
COPD - what is this disease?
This abbreviation stands for chronic obstructive pulmonary disease. This is an independent pathology, which is characterized by restriction of airflow in the airways. This disease is not completely cured, therapy only helps alleviate the symptoms and slightly increase life expectancy, but such a disease is constantly progressing, and every year it becomes more difficult for a person to breathe.
COPD - classification
There are 3 types of differentiation of the pathology under consideration. The first determines in which clinical form chronic obstructive pulmonary disease (COPD) - emphymatous or bronchitis - takes place. The second classification is carried out according to the phase of the disease (remission and exacerbation). The third stratification criterion is the severity of COPD:
- extremely heavy.
COPD - Causes
The described problem is triggered by irritation of the lung tissue with various pathogenic particles, gases and toxins. It's easier to live with this disease, if you understand the essence of COPD - what it is, how it is treated. The inflammatory process begins in the mucous membranes of the bronchi. The mucus is released in increased amounts and becomes more viscous. Later, the infection joins, and the inflammation spreads to the bronchi, alveoli and bronchioles, and the disease of the lungs develops. COPD.
The main reason (about 90% of cases) of such processes is smoking tobacco products, especially for a long time. Other factors that cause COPD include:
- genetic predisposition;
- inhalation of tobacco smoke (passive smoking);
- professional activity;
- polluted air in the atmosphere or living space;
- frequent respiratory tract infections in childhood, especially if they are improperly treated.
COPD - Symptoms
The clinical picture depends on the stage of pathology. The higher the severity, the more pronounced the signs of COPD. The presented disease has a specific triad of such symptoms:
- a large amount of sputum;
COPD - severity
The stage of disease progression is determined by spirometry, by forced expiratory volume in 1 second (FEV1), lung capacity (VAL) and the presence of the above-described clinical picture. The stages of COPD are characterized by the following features:
- Mild - respiratory function is slightly impaired, but the FEV1 and YEL values are close to normal. Cough and sputum are absent or very poorly expressed, successfully treated.
- Medium - a marked deterioration in respiratory function, as evidenced by the results of spirometry (FEV1 is less than 80% of the norm, its relation to the VL is below 70% of proper values). Sometimes there is a cough with a viscous sputum and shortness of breath.
- Severe - a significant deterioration in respiratory activity, FEV1 less than 50% of the normal rate. There is a triad of specific symptoms that are difficult to cure.
- Extremely severe - severe respiratory failure progresses. All signs of pathology are observed almost constantly.
Cough with COPD
The earliest symptom of airway obstruction, but patients often do not pay attention to it. Ignoring is due to the lack of minimal knowledge about COPD - what it is, how it is treated and manifested. When smoking, cough is considered an expected "side effect", so tobacco users do not attach importance to it. In the early stages, this symptom occurs sporadically. As the pathology progresses, cough quickens up to daily attacks.
If the degree of the disease is mild, sputum in COPD is produced in small quantities. It is viscous, mucous and difficult to expectorate, smokers have an unpleasant smell. In the more severe stages of COPD, this symptom increases and is poorly treated. Expectoration is abundant and with every fit of cough. In some patients it contains pus, this indicates the accession of infection and the exacerbation of the pathology. Outside of relapses, mucus is produced in small volumes.
Dyspnea with COPD
This feature of the disease does not apply to early signs of obstruction processes. Shortness of breath occurs after about 10 years with the appearance of cough. At first, it is observed only in cases of recurrent COPD - exacerbation, especially with associated infection, leads to a sharp deterioration in respiratory activity. In the later stages, shortness of breath appears constantly, it is difficult to treat. Several degrees of this symptom are classified according to the frequency of occurrence:
- 0 - only against the background of physical overload;
- 1 - when walking fast and lifting up;
- 2 - even with a slightly accelerated step;
- 3 - it is difficult to breathe while walking, you have to stop every 100 m;
- 4 - with the slightest physical exertion (changing clothes, washing in the shower).
Diagnosis of COPD
To confirm the presence of the described disease can pulmonologist. It is important to differentiate the diagnosis of COPD and bronchial asthma. These pathologies have a similar clinical picture, especially in the early stages of development. Correct diagnosis helps to properly assess COPD - what it is, how it is treated, because of what is progressing. To confirm the disease using the following laboratory, instrumental studies:
- sputum analysis;
- definition of respiratory function;
- gas analysis tests;
- computer spirography;
- radiography of the lungs;
- peak fluometry;
An important step in the treatment of this pathology is to slow its progression and prevent relapse. Before treating COPD with medications, the pulmonologist patient must give up tobacco products to minimize the influence of occupational factors on the respiratory system. This approach will help reduce irritation of the mucous membranes of the bronchi and lungs, it will have a positive effect on respiratory activity.
COPD - treatment, drugs
Conservative therapy is selected individually, in accordance with the stage of the disease, severity of symptoms and frequency of exacerbations. The doctor must first explain to the patient the main aspects of the fight against COPD - what it is, how it is treated, which will have to be abandoned. It is impossible to completely eliminate the obstruction, but it is possible to significantly reduce the intensity of its signs and improve the quality of life. Used drugs for COPD:
- Mucolytics. These pharmacological agents contribute to the dilution of mucus and facilitate its removal from the bronchi, which prevents the accession of a bacterial infection. COPD is treated with direct and indirect mucolytics. Medicines of the first specified group (Trypsin, Chymotrypsin) interact with the already released sputum, liquefy mucus and accelerate its evacuation. The second type of mucolytics (Bromhexin, Ambroxol) reduce the intensity of production of pulmonary secretions. There are combined drugs that combine both properties.
- Bronchodilators (bronchodilators). Such drugs relax the smooth muscles of the walls of the respiratory tract, which relieves spasm and stops the obstructive processes. These medicines include Formoterol, Atrovent, Salmeterol, Spiriva and others.
- Antibiotics. During exacerbations of COPD, mucus accumulates in the lungs and bronchi, which contributes to the development of a bacterial infection. To prevent these complications, specific antibiotics are prescribed - cephalosporins (2nd generation), penicillins, clavulanic acid preparations.
- Glucocorticosteroids. Acute relapses always begin with a strong inflammatory process. Hormones help to arrest him; Prednisolone and its analogues are used mainly.
- Inhibitors of proinflammatory mediators and receptors. Most glucocorticosteroids have serious side effects that can trigger unwanted complications. To replace them, these drugs are used - Erespal, Fenspirid.
Inhalations for COPD
In cases of recurrent obstruction, emergency delivery of anti-inflammatory drugs and bronchodilators to the respiratory tract is necessary in order to immediately stop the exacerbation. For this reason, COPD therapy is performed predominantly in the form of inhalations. Glucocorticosteroids and the most effective bronchodilator drugs are available in the form of a spray. Such pharmacological agents can only appoint a pulmonologist. Other types of inhalations, including home manipulations, are not recommended without prior consultation with a physician.
Respiratory gymnastics in COPD
Performing special exercises is necessary for:
- improve lung ventilation;
- eliminate the symptoms of respiratory failure;
- prevention of pleural effusion;
- strengthen the respiratory muscles;
- eliminate circulatory failure in the lungs.
Gymnastics with COPD:
- Starting position - sitting on a chair, pressing his spine to his back. Take a short breath with your nose, exhale sharply through tight lips.
- Similar position. Alternately raise your hands while inhaling and lowering as you exhale.
- Inhale freely and slowly. Hold the air for 1-3 seconds. Smoothly exhale.
- Sit on the edge of the chair, lower the arms at the sides of the body, stooping slightly. Slowly inhale and straighten the shoulders, exhale, returningthe original position.
There are other options for exercise in COPD:
- according to Strelnikova;
- according to Tolkachev;
- on Neumyvakin.
COPD - treatment of folk remedies
Official medicine is skeptical of this method of therapy. Taking into account all the available data on COPD - what it is, how it is treated and complicated, it progresses; the effectiveness of popular methods is almost zero. Some pulmonologists allow their patients to use alternative prescriptions, but only after an in-person consultation. It is not always advisable to use unconventional methods, if chronic obstructive pulmonary disease is exacerbated - treatment with folk remedies can increase the irritation of the walls of the respiratory tract and inflammation.
Broth to relieve symptoms
- Iceland moss - 20-25 g;
- water - 1 l.
- Pour boiling water over the raw material.
- Bring to a boil over low heat, turn off the hotplate.
- Insist means 30 minutes.
- Strain the solution.
- Drink a third of the volume of the medicine before each meal, 3 times a day.
Infusion for the prevention of relapse
- chamomile flowers - 100 g;
- flaxseed - 50 g;
- lime color - 100 g;
- eucalyptus - 100 g;
- water - 250 ml.
- Mix the herbs.
- Pour 2 teaspoons of boiling water collection.
- After 40 minutes, strain the medication.
- Drink 100 ml of the drug 2 times a day only during remission.
Complications of COPD
The considered disease is incurable, therapy helps only to stop and alleviate its symptoms. Negative consequences are especially quickly observed if a person does not know anything about COPD - what is it, how is it properly treated. Without medications, pathology progresses rapidly and causes irreversible changes in the respiratory system. Chronic obstructive pulmonary disease - complications:
- polycythemia secondary;
- congestive heart, acute and chronic respiratory failure;
- chronic pulmonary heart;
- spontaneous pneumothorax and others.
COPD - life expectancy
The described pathology progresses steadily, therefore the long-term prognosis is unfavorable. When diagnosing COPD grade 3 and above, the patient rarely lives more than 5 years, especially if there are related problems with the respiratory system, a person over 40 years old or factors provoking a relapse are not eliminated. For the early stages of the disease, the prognosis is more optimistic. With the right treatment, many patients of the pulmonologist safely meet old age, but their quality of life is constantly deteriorating.
Prevention of COPD
The main thing that should be abandoned so as not to develop obstructive pulmonary disease, is smoking. You can not inhale either your own or someone else's tobacco smoke. Preventive measures additionally include notifying the population about COPD - what it is, how effectively it is treated and prevented, what the disease is fraught with. Other methods of prevention:
- timely treatment of pathologies of the respiratory tract, infections;
- exclusion of professional factors provoking COPD;
- organization of good ventilation in residential premises, air purification;
- strengthening immunity and general condition of the body.