Bronchial asthma therapy / PGS (VPL)

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

Keeping control of asthma
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
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
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
Pneumologist/allergist at regular check-ups: 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,
 * 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 inhaled β2-agonists).
 * 5) 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).
 * 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 administered in a single daily dose.

Dosage and combination of drugs
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. 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: This induces tolerance to the causative allergen.
 * defined trigger allergen,
 * lacking clinical link to multiple allergens,
 * asthma has been under control for a long time

Related articles
In Wikiscript:
 * Asthma bronchiale
 * Asthma bronchiale therapy


 * Asthma
 * Bronchial asthma / case report
 * Asthmatic status
 * Bronchial asthma 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.