Modern drug options. Bronchial asthma Chuchalin a. Chuchalin A. G. Bronchial asthma Chuchalin a g bronchial asthma
Year of issue: 2007
Genre: Pulmonology
Format: PDF
Quality: Scanned pages
Description: Here is a translation into Russian of the new version of the report of the working group of the international GINA program - “Global strategy for the treatment and prevention of bronchial asthma” (revision 2006). This report is the most important document defining further direction diagnosis, treatment and prevention of bronchial asthma, based on the latest advances in medicine, pharmacology and molecular biology. Many national recommendations, including those of the Russian Respiratory Society, are almost entirely based on the principles of " Global strategy"The authors of this document are leading scientists from all continents who are experts in various aspects of bronchial asthma.
The 2006 version contains a number of fundamentally new provisions that distinguish it from previous editions. First of all, this concerns such a concept as “control of bronchial asthma.” International experts propose replacing the concept of “severity of bronchial asthma” with the concept of “control of bronchial asthma”, introducing degrees of control (complete, incomplete, no control), based on the clinical symptoms of the disease. It should be said that this approach is not new for Russian doctors. In clinical practice, concepts such as remission, incomplete remission, and exacerbation are still widely used. Even severe bronchial asthma can be in remission, but it remains severe as long as the patient receives treatment appropriate to this stage of the disease. Perhaps the concept of “control of bronchial asthma” is more successful. At the same time, taking into account the various medical and social features characteristic of our country, we cannot abandon the concept of the severity of the disease, therefore, domestic clinical recommendations will certainly reflect both approaches to assessing the stage of the disease.
SUMMARY OF RECOMMENDATIONS FOR TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN AGED 5 YEARS AND UNDER
DEFINITION AND GENERAL INFORMATION KEY POINTS
DEFINITION
DAMAGE FROM BRONCHIAL ASTHMA
Prevalence, morbidity and mortality
Social and economic damage
FACTORS AFFECTING THE DEVELOPMENT AND MANIFESTATIONS OF BRONCHIAL ASTHMA
Internal factors
Genetic factors
Obesity
Floor
External factors
Allergens
Infections
Professional sensitizers
Smoking tobacco
Air pollution indoors and outdoors
Nutrition
MECHANISMS OF BRONCHIAL ASTHMA DEVELOPMENT
Airway inflammation
for bronchial asthma
Inflammatory cells
Inflammatory mediators
Structural changes in the airways
Pathophysiology
Bronchial hyperreactivity
Special mechanisms
Exacerbations
Nocturnal bronchial asthma
Irreversible bronchial obstruction
Smoking and bronchial asthma
LITERATURE
DIAGNOSTICS AND CLASSIFICATION
CLINICAL DIAGNOSIS
History and complaints
Symptoms
Cough variant of bronchial asthma
Exercise-induced bronchospasm
Physical examination
Research methods for diagnosis and follow-up
Pulmonary function assessment
Assessment of bronchial reactivity
Non-invasive determination of markers of airway inflammation
Assessment of allergic status
DIFFICULTIES IN DIAGNOSTICS AND DIFFERENTIAL DIAGNOSTICS
Children aged 5 years and younger
Children over 5 years of age and adults
Elderly patients
Differential diagnosis of bronchial asthma and chronic obstructive pulmonary disease
CLASSIFICATION OF BRONCHIAL ASTHMA
Etiology
Severity of bronchial asthma
Asthma control level
LITERATURE
MEDICINES FOR THE TREATMENT OF BRONCHIAL ASTHMA
MEDICINES FOR THE TREATMENT OF BRONCHIAL ASTHMA IN ADULTS
Routes of administration
Antileukotriene drugs
Long-acting inhaled β2-agonists
Theophylline
Long-acting oral β2-agonists
Antibodies to immunoglobulin E
Oral antiallergic drugs
Other drugs for maintenance therapy
Allergen-specific immunotherapy
Emergency supplies
Rapid-acting inhaled β2-agonists
Systemic glucocorticosteroids
Anticholinergic drugs
Theophylline
Oral short-acting β2-agonists
Complementary and alternative treatments
MEDICINES FOR THE TREATMENT OF BRONCHIAL ASTHMA IN CHILDREN
Routes of administration
Drugs that control the course of the disease
Inhaled glucocorticosteroids
Antileukotriene drugs
Inhaled long-acting 2-agonists
Theophylline
Cromones: sodium cromoglycate and sodium nedocromil
Oral long-acting 2-agonists
Systemic glucocorticosteroids
Emergency supplies
Inhaled rapid-acting 2-agonists and short-acting oral 2-agonists
Anticholinergic drugs
LITERATURE
TREATMENT AND PREVENTION PROGRAM FOR BRONCHIAL ASTHMA
COMPONENT 1: DEVELOPING COOPERATION BETWEEN PATIENT AND DOCTOR
EDUCATION OF PATIENTS WITH BRONCHIAL ASTHMA
First visit to the doctor
Individual action plans for bronchial asthma
Follow-up and therapy adjustments
Improving adherence to medical prescriptions
Self-awareness of children
EDUCATION OF OTHERS
COMPONENT 2: IDENTIFYING RISK FACTORS AND REDUCING THEIR IMPACT
PREVENTION OF BRONCHIAL ASTHMA
PREVENTION OF THE DEVELOPMENT OF SYMPTOMS AND EXCERNSATIONS OF BRONCHIAL ASTHMA
Indoor allergens
House ticks
Animals covered with fur
Cockroaches
Mushrooms
External allergens
Indoor air pollutants
External air pollutants
Occupational allergens
Foods and Supplements
Medicines
Flu vaccination
Obesity
Emotional stress
Other factors that can lead to exacerbation of bronchial asthma
COMPONENT 3: ASSESSMENT, TREATMENT AND MONITORING OF ASTHMA
ASSESSMENT OF THE LEVEL OF CONTROL OVER BRONCHIAL ASTHMA
TREATMENT TO ACHIEVE CONTROL
Stages of therapy aimed at achieving control
Step 1: emergency drug as needed
Step 2: rescue drug plus one disease control drug
Step 3: rescue drug plus one or two disease control drugs
Step 4: rescue drug plus two or more disease control drugs
Step 5: Rescue drug plus additional disease control options
MONITORING TO MAINTAIN CONTROL
Duration of therapy and its correction
Reducing the volume of therapy for controlled bronchial asthma
Increasing therapy in response to loss of control
Bronchial asthma, difficult to treat
COMPONENT 4: TREATMENT OF ASTHMA EXacERBATIONS
ASSESSMENT OF THE DEGREE OF SEVERITY
OUTPATIENT TREATMENT
Therapy
Bronchodilators
Glucocorticosteroids
TREATMENT IN EMERGENCY DEPARTMENTS
Condition assessment
Treatment
Oxygen
Inhaled rapid-acting 2-agonists
Adrenalin
Additional use of bronchodilators
Systemic glucocorticosteroids
Inhaled glucocorticosteroids
Magnesium sulfate
Helium oxygen therapy
Antileukotriene drugs
Sedatives
Criteria for discharge from the emergency department or transfer to an inpatient unit
COMPONENT 5: SPECIAL CASES
Pregnancy
Surgery
Rhinitis, sinusitis and nasal polyposis
Rhinitis
Sinusitis
Nasal polyps
Occupational bronchial asthma
Respiratory infections
Gastroesophageal reflux
Aspirin-induced bronchial asthma
Anaphylaxis and bronchial asthma
LITERATURE
IMPLEMENTATION OF CLINICAL GUIDELINES FOR DIAGNOSIS, PREVENTION AND TREATMENT OF BRONCHIAL ASTHMA IN HEALTHCARE SYSTEMS OF VARIOUS COUNTRIES
STRATEGIES FOR IMPLEMENTING RECOMMENDATIONS INTO PRACTICE
ECONOMIC EVALUATION OF INTERVENTIONS AND IMPLEMENTATION OF RECOMMENDATIONS FOR THE TREATMENT OF BRONCHIAL ASTHMA INTO PRACTICE
Health care resource use and associated costs
Economic analysis of interventions for bronchial asthma
DISTRIBUTION OF GINA RECOMMENDATIONS AND RESOURCES USED IN IMPLEMENTING THE RECOMMENDATIONS INTO PRACTICE
LITERATURE
81 - M.: Medicine, 1985. 160 p., ill. 50 k. - 100,000 copies.
The book comprehensively covers all aspects of bronchial asthma. The development factors, immunopathology of asthma, clinical picture of the disease, drug and climatic treatment of patients, intensive care during the attack period are described. The clinical pharmacology of drugs used in the treatment of bronchial asthma is described in detail.
The book is intended for therapists.
Preface
The last 20-30 years have been characterized by an increase in the incidence and severity of bronchial asthma. In terms of social significance, bronchial asthma takes one of the first places among respiratory diseases.
Thanks to active scientific research, medical practice is enriched with new data that relate to such aspects as epidemiology and immunopathology of bronchial asthma. Fundamentally new methods for studying the function of external respiration are emerging. The study of the clinical picture of bronchial asthma has been supplemented with new data. Thus, in recent years, issues such as prostaglandin metabolism in patients with bronchial asthma and intolerance to non-steroidal anti-inflammatory drugs, features of physical exertion asthma, and food-related asthma have been highlighted. Therapeutic options have expanded. An assessment of traditional medications from a modern perspective, the role and place of those that have appeared recently are important issues in practical medicine that require regular coverage. "
In this book, the author, summarizing his many years of work experience, the results of scientific observations and research at the Department of Internal Medicine of the II Moscow State Medical Institute named after. N.I. Pirogov and literature data, sought to answer questions that arise in everyday clinical practice.
Corresponding Member of the USSR Academy of Medical Sciences, Head. Department of Internal Medicine
II MOLGMI named after. N. I. Pirogova
A. G. CHUCHALIN
Publishing house "Medicine", 1985
LIST OF ABBREVIATIONS
Definition and classification
BP - blood pressure
BALT - bronchus-associated lymphoid tissue VGO - intrathoracic gas volume
VIP - vasoactive intestinal peptide
Vital capacity - vital capacity of the lungs
IgG, IgM - immunoglobulins COMT - catechol-o-methyltransferase LHF - lipid chemotactic factor
MVL - maximum ventilation
MRS-A - slow reacting substance of anaphylaxis
NSAIDs - non-steroidal anti-inflammatory drugs
NHF - high molecular weight neutrophil chemotactic factor OPG - general plethysmography
FEV - forced expiratory volume
PGE, PGF - prostaglandins
PSDV - air speed indicator
PAF - platelet activating factor
FVD - function of external respiration
FVC - forced vital capacity cAMP - cyclic adenosine monophosphate cGMP - cyclic guanosine monophosphate
ECP - eosinophilic chemotactic peptide
ECHFA - eosinophilic chemotactic factor of anaphylaxis
Most currently existing definitions of bronchial asthma use predominantly clinical signs as criteria. They emphasize the generality and reversibility of bronchial obstruction disorders, increased sensitivity of the trachea and bronchi to physical or chemical irritants, and the presence of nocturnal attacks of suffocation.
In our country, the definition of disease given by G. B. Fedoseev (1982) is most widespread. According to this definition, bronchial asthma is an independent chronic, recurrent disease, the main and obligatory pathogenetic mechanism of which is altered bronchial reactivity, caused by specific immunological (sensitization and allergy) or nonspecific mechanisms, and the main (obligatory) clinical sign is an attack of suffocation due to bronchospasm, hypersecretion and swelling of the bronchial mucosa.
This definition highlights the main signs of bronchial asthma: bronchial hyperreactivity, manifested by spasm of smooth muscles, edema and hypersecretion, and the development of suffocation. G. B. Fedoseev rightly emphasizes that the existing hyperreactivity of the bronchi can be caused by factors that have both immunological and non-immunological mechanisms.
The factors that provoke the development of asthma are so numerous and varied, and the course options are so dissimilar, that there is an assumption about the existence of several diseases, different in pathogenesis, which are united by the term “bronchial asthma”.
The classification of individual forms of bronchial asthma throughout the history of its study has been the subject of extensive discussion. In the middle of the last century, the neurogenic mechanisms of asthma and those patients in whom the neurogenic factor was dominant were intensively studied. Next important stage there was a study of allergic reactions, their role in the occurrence and development of bronchial asthma! At the beginning of the century, the anaphylactic theory of bronchial asthma arose, which in the 20s was transformed into the identification of an atonic (allergic) form of asthma [Co-" A. F. J., Cooke R. A., 1923].
Further study of the mechanisms of the disease, as well as a thorough analysis of the clinical manifestations and features of the course of asthma, made it possible to establish such a variety of forms that could not be explained from the standpoint of one theory or another. As a result, generalizing works appear in which they try to justify the identification of a hereditary form of the disease, toxic, psychopathic, reflex.
The classification proposed by Rackeman (1944) has received practical application and the most widespread classification, according to which exogenous (extrinsic) and endogenous (intrinsic) forms of bronchial asthma are distinguished.
In the exogenous form, it is possible to establish hypersensitivity using an allergological examination, identify an allergen or group of allergens, and thus prove the allergic nature of the disease. If the allergen cannot be identified and the nature of the disease remains unclear, asthma can be considered endogenous. SJ In our country, the classification of P.K. Bulatov and A.D. Ado (1968) was more often used, according to which allergic (atonic) and infectious-allergic forms of the disease are distinguished. This classification reflects an attempt to consider the frequent combination of asthma with chronic bacterial bronchitis as natural.
In the last 20 years, aspirin (prostaglandin) asthma has been studied in more detail, which is based not on allergic reactions, but on a perverted reaction of prostaglandins to non-steroidal anti-inflammatory drugs (NSAIDs). Exercise-induced asthma has been identified, which in some patients may be a feature of the course of the disease, and in others it is the main syndrome. There has been renewed interest in neurogenic factors that may contribute to the onset and progression of the disease. Hormonal disorders in patients with bronchial asthma have not been sufficiently studied. Clinical observations indicate a non-random combination of some endocrinopathies with asthma.V
Achievements of the last 20-30 years have made it possible to specify the genetic forms of the disease. Particular attention is paid to forms in which the balance in the functional activity of adrenergic and cholinergic receptors is disturbed. The great importance of meteorological factors, as well as infectious processes in the respiratory tract, is still emphasized .
As a result of numerous observations and special examinations of patients with asthma, it can be assumed that the mechanisms of development of the disease are different, and in the same person one can observe hypersensitivity to pollen allergens and exacerbation of asthma provoked by a viral infection of the respiratory tract, clinical features of exercise asthma and hormonal disorders, increased sensitivity to non-steroidal anti-inflammatory drugs and meteorological factors, significant psycho-emotional lability.
It is fundamentally important to recognize bronchial asthma as an independent nosological unit, taking into account the existence of clinical forms with a predominance of various pathogenetic mechanisms/
The classification of bronchial asthma by G. B. Fedoseev (1982) is currently generally accepted. The author identifies the stages of disease development, forms of bronchial asthma, pathogenetic mechanisms, severity of bronchial asthma, phases of bronchial asthma and complications.
Classification of bronchial asthma [according to Fedoseev G.B., 1982] I. Stages of development of bronchial asthma
1. State of pre-asthma. This term refers to conditions that pose a risk of bronchial asthma. These include acute and chronic bronchitis, acute and chronic pneumonia with elements of bronchospasm, combined with vasomotor rhinitis, urticaria, vasomotor edema, migraine and neurodermatitis in the presence of eosinophilia in the blood and an increased content of eosinophils in the sputum, caused by immunological or non-immunological mechanisms of pathogenesis.
2. Clinically defined bronchial asthma - after the first attack or status of bronchial asthma
P. Forms of bronchial asthma
1. Immunological form
2. Non-immunological form
III. Pathogenetic mechanisms of bronchial asthma
1. Atonic - indicating the allergenic allergen or allergens
2. Infectious-dependent - indicating the infectious agents and the nature of the infectious dependence, which can manifest itself as stimulation of the atopic reaction, infectious allergies and the formation of primary altered bronchial reactivity
3. Autoimmune
4. Dyshormonal - indicating the endocrine organ whose function is altered and the nature of the dishormonal changes
5. Neuropsychic with indication of variants of neuropsychic changes
6. Adrenergic imbalance
7. Primary altered bronchial reactivity, which is formed without the participation of altered reactions of the immune, endocrine and nervous systems, can be congenital, manifests itself under the influence of chemical, physical and mechanical irritants and infectious agents and is characterized by attacks of suffocation during physical exertion, exposure to cold air, medications, etc.
Note. Various combinations of mechanisms are possible, and by the time of the examination one of the mechanisms is the main one. A patient may have one pathogenetic mechanism of bronchial asthma. During the development of bronchial asthma, a change in the primary and secondary mechanisms may occur.
IV. Severity of bronchial asthma
1. Mild course
2. Moderate course
3. Severe course
V. Phases of bronchial asthma
1. Exacerbation
2. Fading exacerbation
3. Remission
VI. Complications
1. Pulmonary: emphysema, pulmonary failure, atelectasis, pneumothorax, etc.
2. Extrapulmonary: myocardial dystrophy, cor pulmonale, heart failure, etc.
The classification of G. B. Fedoseev is one of the most complete at present. The selection will be of great practical importance. When assessing this condition, one should take into account not only background diseases that can transform into bronchial asthma, but also increased bronchial reactivity, which should be considered a mandatory sign.
It is important to distinguish not only the immunological forms of the disease, but also the clinical ones. The modern clinic has accumulated specific experience in the management of patients with allergic, infectious forms of bronchial asthma. There are aspirin (prostaglandin) forms of the disease, physical exertion asthma, neurogenic and mixed forms of the disease. In clinical practice, a steroid-dependent form of the disease is often identified.
Name: Pocket guide to the treatment and prevention of bronchial asthma.
Chuchalin A.G.
The year of publishing: 2006
Size: 0.47 MB
Format: pdf
Language: Russian
The pocket guide"A Pocket Guide to the Treatment and Prevention of Bronchial Asthma" was written on the basis of the global initiative (strategy) on bronchial asthma for doctors and nursing staff, issues such as diagnosis, classification and main components of treatment of bronchial asthma are considered. special cases in the treatment of bronchial asthma.
Name: Respiratory medicine. Volume 1.
Chuchalin A.G.
The year of publishing: 2017
Size: 30.42 MB
Format: pdf
Language: Russian
Description: The first volume of the manual "Respiratory Medicine" edited by A.G. Chuchalina examines the anatomical, physiological, genetic and morphofunctional features of the respiratory system, the book contains... Download the book for free
Name: Respiratory medicine. Volume 2.
Chuchalin A.G.
The year of publishing: 2017
Size: 22.05 MB
Format: pdf
Language: Russian
Description: The second volume of the manual "Respiratory Medicine" edited by A.G. Chuchalina examines respiratory infections (viral infections, pneumonia, acute abscess and gangrene of the lungs, respiratory tuberculosis... Download the book for free
Name: Respiratory medicine. Volume 3.
Chuchalin A.G.
The year of publishing: 2017
Size: 15.22 MB
Format: pdf
Language: Russian
Description: The third volume of the manual "Respiratory Medicine" edited by A.G. Chuchalina covers such issues of pulmonology as infiltrative and interstitial lung diseases (idiopathic interstitial... Download the book for free
Name: Chronic obstructive pulmonary disease. Guide for practicing physicians.
Chuchalin A.G., Ovcharenko S.I., Leshchenko I.V.
The year of publishing: 2016
Size: 3.14 MB
Format: pdf
Language: Russian
Description: The presented book "Chronic obstructive pulmonary disease. A guide for practicing physicians" examines the basic issues of COPD that are necessary for a practitioner to understand, highlighting such practical... Download the book for free
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The year of publishing: 2016
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Name: Bronchial asthma and chronic obstructive pulmonary disease.
Baur K., Preisser A., Leshchenko I.V.
The year of publishing: 2010
Size: 11.07 MB
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Name: Bronchial asthma in children
Balabolkin I.I., Bulgakova V.A.
The year of publishing: 2015
Size: 3.11 MB
Format: pdf
Language: Russian
Description: Practical guide "Bronchial asthma in children" ed., Balabolkina I.I., et al., examines current state problems of bronchial asthma in children of different age groups. Described... Download the book for free
Name: Functional diagnostics in pulmonology
Chuchalin A.G.
The year of publishing: 2009
Size: 4.16 MB
Format: djvu
Language: Russian
Description: Practical guide "Functional diagnostics in pulmonology" edited by A.G. Chuchalin, examines the principles and possibilities of using modern diagnostic techniques in the treatment of bronchopulmonary...
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A. G. CHUCHALIN, professor
asthma is quite common: drugs have been created that relax the muscles of the bronchi, eliminate allergic inflammation, and thin sputum. Doctors a few decades ago could only dream of such an arsenal of anti-asthma drugs. And yet, these days there are more and more patients who are not always easy to help, even using the newest drugs.
More recently, just twenty years ago, bronchial asthma was considered a rare disease. Currently, the situation has changed significantly: it has become one of the most common diseases among people of all ages.
How can we explain this? The answer was given in-depth study lung functions. It turns out that they not only ensure gas exchange between the environment and the internal environment of the body, but also, along with the spleen, the lymph nodes are an immunological organ. Studying the immunological status of people suffering from respiratory diseases, scientists came to the conclusion that the occurrence of bronchial asthma is based on the imperfection of the body’s immune mechanisms, which makes it difficult for it to fight viral and bacterial infections. Suppress the protective forces and atmospheric pollution, repeated, frequent viral diseases of the respiratory tract. In addition, more and more people are hypersensitive to substances that cause allergic reactions.
In the development of bronchial asthma, the role of diseases that precede it, or, rather, prepare for its development, is great. This is primarily sinusitis, sore throat, bronchitis, pneumonia. Repeated frequently, and even more so becoming chronic, they can lead to increased sensitivity of the respiratory system to allergens and thus contribute to the development of bronchial asthma. This is another evidence in favor of the fact that all these diseases should be treated promptly and persistently, even if the painful manifestations are of little concern.
Along with other methods of treating bronchial asthma, reflexology (acupuncture) is also used.
One of the difficulties in the fight against bronchial asthma is that there is, as they now say, a family of bronchial asthma, which unites several outwardly similar ailments. Indeed, “bronchial asthma can arise as a result of both a hereditary predisposition and an immunodeficiency state that has developed over the years or increased reactivity of the body. Different origins, different stages of the disease dictate different treatment tactics. Some patients require drugs that eliminate inflammatory phenomena, others require medications for reducing the allergic mood of the body, thirdly, medications to relieve bronchospasm, etc.
The doctor selects the necessary medications, changes them in a certain sequence, prescribes them in various combinations, determines the dose depending on the nature of the disease, the characteristics of its course in a given patient at a given time. The patient himself cannot judge this condition and should not try to replace the doctor. Such attempts are obviously doomed to failure.
But trust in the doctor and the patient’s frankness are very important for the success of treatment, as well as faith in recovery. The doctor and the patient must be in constant contact. This is the key to success. Then there will be fewer reasons for self-medication, which is so dangerous for bronchial asthma.
It is known that those suffering from respiratory diseases usually have a hard time with climate change. And this should be taken into account by patients with bronchial asthma when deciding on a vacation, a trip to the sea, to a remote resort.
Too often we observe an exacerbation of bronchial asthma that occurs at the stage of adaptation (getting used to a new climate) and readaptation (when returning home). Only those who have the opportunity to go on vacation for 2-3 months can risk moving to distant lands, and only if bronchial asthma is not severe. We recommend that the vast majority of patients rest in their usual climate.
I would also like to draw attention to the need for hardening, but always gradual and systematic.
Water procedures are useful - rubbing, showering, swimming in the pool, and in summer - in open reservoirs. Swimming helps normalize breathing and strengthen the body's defenses; Swimming with head diving - breaststroke style, for example, is especially beneficial.
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