Bronchial asthma therapy / PGS (VPL)

The basic goal of therapy is to achieve and maintain control of asthma.

Control of asthma (or asthma under control)
In the clinic, fulfilment of all the following conditions means:
 * no or minimal (up to a maximum of 2 times per week occurring) daily symptoms
 * no limitation of daily activities,
 * no nocturnal symptoms,
 * no or minimal (up to 2× per week) need for relievers,
 * normal lung function and
 * no exacerbations.

Asthma difficult to treat
About 5% of asthmatics do not reach and permanently keep asthma under control, which we refer to as difficult-to-treat asthma (OIA).

Complex treatment of asthma
It includes, in addition to medication:
 * upbringing and educating patients by writing an individual treatment action plan explaining the importance and objectives of each step.

Regular outpatient visits
Pneumologist/alergologist to be checked regularly: The ongoing care and supervision of the treatment plans may also be carried out by a general practitioner.
 * physical examination and examination of the lung function of the patient,
 * control and consolidation of acquired habits and knowledge.
 * The specialist also verifies the diagnosis at the beginning of the disease.

Non-pharmacological prevention or regimen measures
Limiting exposure to risk factors (inducers of asthma, triggers of exacerbations) is essential.

Pharmacotherapy
Two groups of drugs:


 * 1) Relief anti-asthmatics (rapid-acting bronchodilators) − are given in case of acute problems:
 * 2) * β2-agonists with rapid onset of action (RABA = rapid-acting beta agonists):
 * 3) ** phenoterol, salbutamol and terbutaline (short-acting inhaled β2-agonists (SABA),
 * 4) ** formoterol (LABA = long-acting beta agonists).
 * 5) Controlling, preventive anti-asthmatics − against inflammation of the airways, are taken regularly, on a daily and long-term basis (even when the problem is reduced or resolved).
 * 6) * inhaled corticosteroids (ICS) − have the most pronounced anti-inflammatory effect, being the basis and first-line drug
 * 7) * antileukotrienes, methylxanthines (theophyllines) and partly LABA (salmeterol and formoterol) − supporting anti-inflammatory effect,
 * 8) * 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 BUD and CIC can be given as a single daily dose.

Posology and combination of drugs
We choose them according to the severity and responses to the previous treatment - we step up.

Grade pharmacotherapy of asthma - Children over 5 years of age, adolescents and adults. 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)
The indication and implementation is handled by an allergist - indicated by asthmatics that are: It induces a tolerance to the causal allergen.
 * defined trigger allergen,
 * lacking clinical link to multiple allergens,
 * asthma is long-term controlled.

Related articles

 * Asthma bronchiale
 * Asthma bronchiale therapy

External references
www.svl.cz/....astma-2008.pdf

Literature

 * 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.