Bronchial asthma therapy / PGS (VPL)
The basic goal of therapy is to achieve and maintain control of asthma.
Keeping control of asthma[edit | edit source]
In the clinic, fulfilment of all the following conditions means:
- no or minimal (up to a maximum of twice per week) daily symptoms
- no restrictions on daily activities,
- no nocturnal symptoms,
- no or minimal (up to 2× per week) need for relief drugs,
- normal lung function
- no exacerbations.
Difficulty in treating asthma[edit | edit source]
About 5% of asthmatics do not achieve and maintain asthma under control, which we refer to as difficult-to-treat asthma (OIA).
Complex treatment of asthma[edit | edit source]
In addition to medication, it also includes:
- education and training of patients with a written elaboration of an individual treatment action plan explaining the importance and goals of individual steps.
Regular outpatient visits[edit | edit source]
Pneumologist/allergist at regular check-ups:
- physical examination and examination of the lung function,
- control and consolidation of acquired habits and knowledge.
- The specialist also verifies the diagnosis at the beginning of the disease.
The ongoing care and supervision of the treatment plans may also be carried out by a general practitioner.
Non-pharmacological prevention or regimen measures[edit | edit source]
Limiting exposure to risk factors (inducers of asthma, triggers of exacerbations) is essential.
Pharmacotherapy[edit | edit source]
Two groups of drugs:
- Relief anti-asthmatics (rapid-acting bronchodilators) − are given in case of acute problems:
- β2-agonists with rapid onset of action (RABA = rapid-acting beta agonists):
- phenoterol, salbutamol and terbutaline (short-acting inhaled β2-agonists (SABA),
- formoterol (LABA = long-acting inhaled β2-agonists).
- β2-agonists with rapid onset of action (RABA = rapid-acting beta agonists):
- Controlling, preventive anti-asthmatics − against inflammation of the airways, are taken regularly, on the daily and for a long-term basis (even when the problem is reduced or resolved).
- inhaled corticosteroids (ICS) − have the most pronounced anti-inflammatory effect, being the basis and first-line drug
- antileukotrienes, methylxanthines (theophyllines) and partly LABA (salmeterol and formoterol) − supporting anti-inflammatory effect,
- systemic (p.o.) corticosteroid use − in some patients with severe forms (OIA) is necessary − such asthma is known as cortico-dependent asthma.
Equipotent doses of inhaled steroids used in the Czech Republic
| Dose IKS (μg) | Short adults | Short children | Medium
adults |
Medium children | Tall adults | Tall
children |
|---|---|---|---|---|---|---|
| BDP (beclomethasone dipropionate) | 200–500 | 100–200 | > 500–1000 | > 200–400 | > 1000–2000 | > 400 |
| BUD (budesonide) | 200–400 | 100–200 | > 400–800 | > 200–400 | > 800–1600 | > 400 |
| CIC (ciclesonide) | 80–160 | 80–160 | > 160–320 | > 160–320 | > 320–1280 | > 320 |
| FP (flutikasone propionate) | 100–250 | 100–200 | > 250–500 | > 200–500 | > 500–1000 | > 500 |
BUD and CIC can be administered in a single daily dose.
Dosage and combination of drugs[edit | edit source]
We choose them according to the severity and response to the previous treatment - we step up.
Tiered pharmacotherapy of asthma - Children over 5 years of age, adolescents and adults.
| Stage | specifications | the first choice therapy | alternative therapy |
|---|---|---|---|
| 1 | monotherapy | RABA | SAMA after SABA after LABA after theophyllines with short-term effect |
| 2 | monotherapy | ICS (low dose) | Antileukotrien |
| 3 | Combination – choose one combination | ICS (low dose) + LABA | ICS (medium/high dose) ICS (low dose) + theophylline SR ICS (low dose) + Antileukotrien |
| 4 | Combination – add other 1/more drugs | ICS (medium/high dose) + LABA | + Antileukotrien + theophylline SR |
| 5 | Combination – add one/both drugs | Like stage 4 | + Corticosteroids p.o. (low dose) + Anti-IgE |
Once asthma control is achieved, the dose and intensity should not decrease to a lower level of pharmacotherapy until at least 3 months after control.
Specific allergen immunotherapy or vaccination (SAIT)[edit | edit source]
The indication and implementation is handled by an allergist - indicated by asthmatics that are:
- defined trigger allergen,
- lacking clinical link to multiple allergens,
- asthma has been under control for a long time
This induces tolerance to the causative allergen.
References[edit | edit source]
Related articles[edit | edit source]
In Wikiscript:
External references[edit | edit source]
Literature[edit | edit source]
- SALAJKA, František. Asthma bronchiale : Doporučený diagnostický a léčebný postup pro všeobecné praktické lékaře [online] . 1. vydání. Praha : Společnost všeobecného lékařství ČLS JEP, 2008. Dostupné také z <https://www.svl.cz/default.aspx/cz/spol/svl/default/menu/doporucenepostu/doporucenepostu5>. ISBN 978-80-86998-26-8.
- SALAJKA, F, S KONŠTACKÝ a V KAŠÁK. Asthma bronchiale : Doporučený diagnostický a léčebný postup pro praktické lékaře. 1. vydání. Praha : Centrum doporučených postupů pro praktické lékaře, 2005.
- SALAJKA, F, V KAŠÁK a P POHUNEK. Diagnostika, léčba a prevence průduškového astmatu v České republice : Uvedení globální strategie do praxe. 1. vydání. Praha : Jalna, 2008.
