Gentowa

The therapy of the asthma has gone through relatively long development. It can be stated, that until recent times the patients suffering from the severe illness, dyspnoea (breathlessness) and choking, have been regarded quite common. The modern medication arsenal enables the patients – if it is used, disciplined and diagnosed correctly, to live the life with minimal or no troubles. The therapy must start on time! Delayed or neglected therapy relates to the continuing inflammation, to the gradual change and rebuild of the airways structure. It is more difficult to treat the anatomically changed windpipes and the therapy effect will not result in the absolute normalisation of the clinical conditions.

The asthma clinical symptoms are basically caused by two factors – the windpipes obstruction and the inflammation. The therapy is concentrated against those two processes, as well:

● bronchus dilatative (windpipes are expanding)

● antiphlogistic

The bronchus dilatative (bronchus – windpipes, dilatation – expanding) is a process of expanding (opening, enlarging) of the windpipes, which enables a better breathing. The medications used for this purpose belong to the basic asthma medications, yet they are taken even while suffering other windpipes contraction diseases. The medications are dosed according to the patient’s seriousness of the health conditions. They can be taken perorally (pills, syrup), injected or inhaled. Clinically they suppress the cough, the breathlessness and the whistling sounds. If they are dosed correctly, they enable the patients with contracted windpipes to breathe normally, without feeling sick. The medications are divided into – according to the effects principle several groups:

The basic group is the so called beta2 mimetics, also called betaagonists, which stimulate (irritate) the part of the autonomous vegetative nerve system with the result of released windpipes fibre muscles i.e. the windpipes extension.

The following side effects can occur, as well, although as for the modern medications they are rare:

● heartbeat and faster action

● short ague (especially hands)

● headache

● nervousness

The side effects result from the total medication influence, which effect in addition to the airways even other, especially cardiovascular system. The development of this type of medications is concentrated on the fact that the preparation should affect the airways the most and the other systems only minimal.

The best way to take the betamimetics is the inhalation. Hence many devices used to transfer the effective chemical to the needed place – the airways have been developed. If the preparation is liquid, the “small device”, which makes the aerosol from the liquid with the help of the driving gas, will be used. In this way the small medication particles get into the windpipes and the ronchus after the inhalation.

The second form is the powdered. The effective chemical is adjusted into the bin in the form of the powder and with the help of the ingenious mechanism while inhaling it is transferred into the particular target place. Both mentioned systems have their pluses and minuses.

The modern therapy uses two types of the beta2mimetics – effective for a longer or shorter period of time.

The short-term effective mimetics with the fast start are called the releasers. Their task is the windpipes spasm (cramp releasing). They are used if the patients can not breathe or if the health conditions get worse, since they are effective after several minutes. These medications are taken by the patients suffering from the intermittent asthma, since if the symptoms occur only once in a time (less than once a week), it will be the only therapy needed. If the breathlessness attacks appear oftener, the therapy has to be combined. Naturally, if needed, the patients suffering the severe disease undergo it, as well. Our market offers many preparations: salbutamol (SALAMOL, ECOSAL, VENTOLIN, and VENTODISKS), terbutaline (BRICANYL), fenoterole (BEROTEC also combined with the DITEC).

The long lasting betamimetics release the effective chemical gradually; hence they permanently affect the windpipes, which are extended under their influence. It is sufficient to take them twice a day. Together with the corticoids they are taken by the patients suffering from medium or severe asthma. Their effect start varies. There are salmeterol (SEREVEBT) and formoterol OXIS, FORADIL) used on our marketplace. The peroral betamimetics – either the pills or the syrup (terbitalin, prokaterol, bambuterol, klenbuterol) are used according to their systems side effects only rarely.

The anti-inflammatory therapy is based on the glucose-corticoids (cortisonides) taking, which are the hormonal preparations produced by the adrenal gland cortex (nowadays they are produces synthetically). They influence many levels and factors, which take part in the inflammation process. The best solution offers their local use – in the form of inhalation. The same devices as in the case of the betamimetics are used. In general, either injected or as pills, they are taken only in the most serious states of health. The doses are adapted to the seriousness of the illness. The informed patient can control their therapy to certain extent alone i.e. increase or reduce the doses according to their health conditions. The patient has to follow the criteria stated by his/her doctor.

We use: beclometozone (BECLAZONE, BECLOMET, BECODISKS, BECOTIDE, ECOBEC), budesonide (INFLAMMIDE, MILFONID, PULMICORT) fluzolide (BRONILIDE), flutikazone (FLIXOTIDE, FLIXOTIDE DISKUS), triamcinolone (AZMACORT).

From the point of the comfortableness and the effectiveness (anti-inflammatory and bronchodilative function) the combined preparations belong to the newest preparations. They are usually taken twice in a day. The corticoid element doses are taken according to the seriousness of the clinical health conditions. The Slovak market has two anti inflammatory and bronchodilative preparations at disposal: SERETIDE DISKUS and SYMBICORT. The modern preparations are the so called antileucotriens – the medications, which influence the molecular structure of the allergic inflammation process. These include sappirelukast (ACCOLATE) and montelukast (SINGULAIR), which are applied orally. In additions to these, the rommoglycolates in the inhalation form are used while treating the asthma. As for their advantage, they hardly have any side effects; their disadvantage is the often application (4-6 times a day). Considering the children they are very effective, their influence is restricted concerning the adults. There can be CROMOBENE, CROMOLYN, INTALCROMOGEN and nedopfromol (TILADE) found in our pharmacies.

Additional therapy is provided with the parasympatoliticums – the ipratrophiumbromid (ATROVENT combined with the COMBIVENT). The antihistamines, especially if the asthma is combined with other allergic symptoms, will be used, as well. After the allergen is defined, the allergen vaccination follows (detailed information in next chapter).

The teopfyline preparations (Syntophiline and so on), can not be used in the modern therapy except for the preparations with slow releasing (UNI-DUR, THEO-DUR, TEOTARD)