Aerosol from asthma

Aerosol from asthma is often used because of the availability and ease of use. Bronchial asthma is a chronic inflammatory disease of the respiratory system, which is combined with bronchial obstruction, which has the opposite nature under the influence of medical preparations. Symptoms of this disease develop very quickly and are manifested by relapsing episodes of dyspnea, wheezing, coughing and stiffness in the chest. Therefore, it is necessary to use emergency medicine, and the most accessible form is aerosols.

[1], [2], [3], [4], [5], [6], [7], [8]

Indications for use of aerosol from asthma

Treatment of bronchial asthma, both in children and adults, can be carried out in three ways: injection, oral and inhalation. The most convenient is the method of inhalation delivery of the drug, which is due to the direct delivery of the active substance to the respiratory system and the rapid onset of action.

For treatment, two basic principles are used: the use of basic therapy drugs, which is necessary for the patient constantly, and the emergency medications necessary to stop the attacks of suffocation. Depending on the need, use different medications, so the indications for use differ in the groups of drugs.

The main goal of asthma treatment is to gain control over the symptoms.

As a basic therapy use:

• β2-agonists of long-acting (salmeterol, formoterol, indacaterol);
• anticholinergics of long-acting (tiotropium bromide);
• Inhaled glucocorticosteroids (beclomethasone, fluticasone, budesonide);
• kromony (ketotifen, kromolin sodium);
• antileukotriene drugs (montelukast, zileiton);
• antibodies to immunoglobulin E (omalizumab).

The most effective means to control asthma, to date, are inhaled glucocorticosteroids.

As emergency medicine use:

• β2-agonists of short action (salbutamol, fenoterol);
• cholinolytics of short action (ipratropium bromide).

Given the large arsenal of various drugs, the choice in drug therapy is great. But there are basic principles of treatment that need to be taken into account.

Indications for use of aerosol from asthma:

1. attack of bronchial asthma - in this case, use drugs for emergency care, that is, short-acting;
2. prevention of an attack - taking an aerosol dose in case of possible allergen effect or before physical exertion. Such a preventive device contributes to the early expansion of the bronchi before the likely trigger factor and the symptoms do not develop;
3. as a basic therapy - the daily use of aerosol allows you to monitor the course of the disease. In this case, use long-acting drugs or inhaled glucocorticosteroids.

This is the main treatment for use, but it should also be remembered that any aerosol in asthma has its own application features and its precautions.

Types of aerosols from bronchial asthma and their characteristics

Drugs for treatment can be divided into two groups.

1. Preparations of the first aid. These include:

Salbutamol (Ventolin)

Produced in the form of tablets, in syrup, in ampoules and in a metered-dose inhaler. One dose of the inhaler contains 0.1 mg of the active ingredient.

Pharmacokinetics and pharmacodynamics : the drug stimulates β2-receptors of blood vessels, muscle fibers of the bronchi, uterus and causes their relaxation. During the inhalation use of the drug, its effect is selective - exclusively on β2-receptors in bronchioles and larger bronchi. In addition to narrowing of the bronchi, salbutamol reduces the permeability of capillaries and the release of inflammatory mediators, as well as stimulates the synthesis of the surfactant.

Bioavailability of the drug is small - with inhalation use 10% reaches the lower respiratory tract. The drug begins to act after 4-5 minutes, the maximum concentration and effect of the drug is observed after 30 minutes, and the duration of the effect is 4-5 hours. It is excreted mainly by the kidneys.

Contraindications to the use of salbutamol : absolute - do not isolate, relative precautions include hyperthyroidism, arterial hypertension, paroxysmal tachycardia, pheochromocytoma.

Side effects : skin rash, dyspeptic syndrome, headache, tinnitus, insomnia, arrhythmias.

Doses and methods of using the drug : inhalation aerosol is used for children after twelve years to eliminate bronchial spasm, 0.1 mg (1 dose of the drug), and adults - 0.2 mg (2 doses). For preventive measures use the same dose.

Overdose : possible phenomena of tremor, palpitation, elevation of systolic pressure.

Interaction with other drugs : can not be used with non-selective β-blockers. Potentiate the effect of drugs that stimulate the central nervous system and anticholinesterase.

Storage conditions : shelf life - 2 years. Store at a relative temperature of no higher than 28 degrees, avoiding direct action of high and low temperatures.

Fenoterol (Partusisten, Berotek, Berodual)

Produced in tablets, ampoules, inhalation aerosols of 15 ml, containing 300 doses, 1 dose - 0.2 mg.

Pharmacokinetics and pharmacodynamics : the drug stimulates β2-receptors of the bronchi, uterus, blood vessels and causes their relaxation. During the inhalation use of the drug, its effect is selective - exclusively on β2-receptors of the bronchi. In addition to pronounced bronchodilation, the cilia of the ciliated epithelium of the bronchoalveolar tree increases. The drug begins to act after 3-6 minutes after use, the maximum concentration of the drug after 40-80 minutes, and the duration of the action is 3.5-6 hours. Fenoterol is metabolized by liver enzymes and excreted in the urine through the kidneys.

Contraindications to the use of formoterol : tachyarrhythmias, hypertrophic or dilated cardiomyopathy, excessive genetic sensitivity to the components of medication, hypertension or secondary hypertension, pheochromocytoma, diabetes mellitus, chronic heart failure.

Side effects : urticarial elements on the skin, anaphylactic shock, Quincke's edema, collapse with arterial hypotension. There may be dyspeptic manifestations, vascular and neurogenic pain, pain and twitching of small muscles, arrhythmia, fibrillation.

Doses and methods of using the drug : for adults and children after six years, it is necessary to prescribe about 0.2 mg of the active substance (1 dose-1 inhalation of the aerosol) to eliminate bronchospasm, if it is not effective, then after 7 minutes you can repeat the inhalation. For a day reception is possible no more than four times. Prophylactic doses are the same as those for treatment.

Overdose : possible tremor, tachycardia, an increase in systolic pressure.

Interaction with other drugs : Fenoterol is not recommended for use with antidepressants and MAO-system inhibitors, due to the increased risk of collapse in this case. The combination with other bronchodilators threatens the development of the "ricochet" syndrome.

Storage conditions : shelf life - 2 years. Store at a relative temperature below 27, away from direct fire, avoid infrared rays, do not expose to low and high temperatures.

[9], [10]

Ipratropium bromide (Atrovent)

It is available in the form of injection vials and an aerosol of 10 ml, which is 200 doses. 1 dose of aerosol contains active ingredient 0.2 mg.

Pharmacokinetics and pharmacodynamics : the drug blocks the M-holinoretseptory tracheobronchial tree and in this way promotes the expansion of smooth muscle bronchi. The drug also reduces the secretion of bronchial glands, acts on the vagus nerve and prolongs the relaxing effect.

With the inhalation route of administration, the bioavailability is not more than 10%. The effect occurs after 6-15 minutes after application, the maximum effect is achieved after 1 hour, and the duration of its action is 6 hours, sometimes about 8 hours.

Ipratropium bromide is metabolized by the enzymes of the liver and is excreted by the intestine.

Contraindications to the use of ipratropium : the drug is not taken with excessive genetic sensitivity to its components, as well as to atropine, congenital pathologies of the bronchopulmonary system (cystic fibrosis). It is not prescribed for hyperplasia of the prostate, disorders of the urinary system, glaucoma.

Side effects : dyspeptic phenomena in the form of nausea, vomiting, dry mouth, decreased motor-evacuation function of the intestine. Changes from the pulmonary system - thickening of sputum, cough, laryngospasm, paradoxical bronchospasm, burning of the mucous membrane of the nasal cavity. There may be allergic manifestations in the form of urticar elements on the skin, edema of the tongue, anaphylactic shock, increased blood pressure, palpitation, arrhythmia.

Doses and methods of using the drug : children of six to twelve years are used to eliminate bronchial spasm 0.2-0.4 mg (1-2 doses, which corresponds to 1-2 breaths). Older children and adults - 0.4-0.6 mg (2-3 doses). The drug should not be used more than 5 times during 24 hours. For the prevention of asthmatic attacks before any physical activity or possible action of the allergen this drug is not recommended, since it has many different precautions and undesirable effects.

Overdose : no specific changes were observed when the dose of the drug was exceeded. Possible side effects, spasm of accommodation, arrhythmia, dryness of the epithelium of the oral cavity, violation of normal swallowing.

Interactions with other drugs : when used with short-acting β2-agonists, synergy and enhancement of the effect are possible, as well as a sharp deterioration in the patient's condition with concomitant glaucoma. With simultaneous use with antidepressants, the latter potentiate the effect of Atrovent.

Storage conditions : Ipratropium bromide is 2.5 years old. Keep it at a temperature of not more than 27 degrees, do not let the temperature of low temperatures, exclude the infrared rays.

2. Preparations for the basic treatment of asthma

Inhaled glucocorticosteroids are recommended to be used, starting with a mild persistent asthma form, starting therapy with minimal doses.

Budesonide (Pulmicort)

It is available in capsule, spray, ointment, ampoule and aerosol form. Dosage aerosol consists of 200-dose, 1 dose - 0.2 mg budesonide. There is a form of release of mite - 1 dose of 0.05 mg.

Pharmacokinetics and pharmacodynamics : the drug is a representative of inhaled corticosteroids, which reveal a pronounced bronchodilator effect due to the intense anti-inflammatory effect. The drug acts on inflammatory cells, inhibits their action, reduces the number of inflammatory cytokines, increases the synthesis of anti-inflammatory proteins, reduces the number of T cells. It initiates the work of epithelial cells and increases mucociliary clearance, the number of adrenergic receptors also increases.

Bioavailability of the drug with an inhaled route of administration is about 25%. The maximum concentration is reached after 15-45 minutes. The pronounced effect of the drug occurs only with the course application in 5-6 days.

Contraindications Budesonide : there are no specific absolute contraindications to treatment with budesonide. Do not recommend using the aerosol during lactation, in case of tuberculosis, fungal lesions of the oral cavity, hereditary intolerance of the components of the active substance.

Side effects : regional local manifestations in the form of dryness of the oral mucosa, hoarseness of the voice, burning of the throat, cough, pharyngitis, candidiasis of the oral cavity, nausea

Doses and methods of application : during the exacerbation as a basic therapy from 0.4 mg (2 doses) to 1.2 (6 doses), dividing by 3 times per day. At initial therapy during the remission, minimal concentrations are prescribed - from 0.2 mg to 0.4 mg 2 times per day. Children, given the age, use the form "mite" from 0.05 to 0.2 mg per day.

Overdose : symptoms of chronic drug overdose are signs of hypercorticism in the form of hormonal obesity, thinning of the skin, hirsutism, acne, moonlike face.

Interaction with other drugs : with simultaneous use with certain antibiotics, it is possible to enhance the action of budesonide, when combined with cardiac glycosides, their action is intensified because of hypokalemia, with the intake of diuretic hypokalemia increases.

Storage conditions : Store at a relative temperature of no higher than 27 degrees away from flammable objects, avoid infrared rays, do not expose to low temperatures. Shelf life - 2 years.

[11], [12], [13], [14], [15], [16], [17], [18]

Use of aerosols from asthma during pregnancy

If a woman is sick with asthma, then her pregnancy should be planned. It is necessary to be thoroughly examined and consult with the doctor before planning the child. Bronchial asthma can be complicated by preclamping, so it is important that before the onset of pregnancy, you can achieve the best possible control of asthma in a future mother.

If the pregnancy has already occurred, then immediately it is necessary to see a doctor. It is necessary to control the condition, because any changes in the mother's body affect the child. During an asthma attack, the child is in a state of hypoxia, so the main task is to prevent seizures. But asthma during pregnancy can behave differently: the number of seizures may decrease, or the current may deteriorate. This is difficult to forecast.

The issue of treating bronchial asthma during pregnancy is widely discussed. After all, there is harm to any medical preparations on the fetus. But on the other hand, the use of these drugs has no evidence base with a reliable teratogenic effect. Greater harm and the possibility of complicating pregnancy will bring an aggravation of asthma. Therefore, doctors recommend that asthma be treated to prevent these complications.

The use of aerosols from asthma during pregnancy is the most optimal method of treatment. This is due to the fact that such treatment is local and does not affect the fetus as much as the use of systemic medicines. As for drug groups, the use of inhaled glucocorticosteroids and β2-agonists is considered most appropriate. Their damage to the fetus has not been proven. It is necessary to take those doses that can reduce the number of exacerbations and continue to use the minimum effective dose of aerosols. In the last month of pregnancy, it is necessary to abandon β2-agonists and switch to inhaled corticosteroids, since the uterine myometrium and the premature onset of labor or other complications are possible.

In addition to drug treatment, it is necessary to prevent exacerbations by minimizing physical exertion and avoiding triggers.

Aerosol from asthma is one of the irreplaceable means, because it is a common disease among children, and such treatment is affordable and the effect on the body is minimal. It is necessary to accurately determine the necessary treatment, and only then select the drug and dose. It is very important that the doctor learns to use the inhaler correctly, because such a way of drug administration ensures its concentration in the lower respiratory tract is about 10-15%, and if the patient misuses the delivery vehicle, then the effectiveness may decrease to zero. Therefore, aerosols in asthma are an excellent treatment when used properly.