Internal Medicine

Therapy for bronchial asthma

introduction

Inadequately treated bronchial asthma is associated with a major reduction in the quality of life of those affected and can lead to irreversible damage to the airways.
In children with severe forms of asthma, developmental disorders can occur, which can be expressed in physical and mental impairment.

This is how an asthma attack is treated

The therapy of bronchial asthma consists of different components. Since asthma is usually triggered by an allergic reaction to a foreign substance, the most important therapeutic approach is the so-called Trigger to avoid .. However, in many cases (for example with hay fever) this measure is difficult to carry out.

To combat acute symptoms such as shortness of breath, drugs are used to widen the bronchi, i.e. the smallest airways. In addition, drugs are needed that curb the body's excessive inflammatory response. This includes cortisone.

General measures for asthma therapy

The general measures sometimes require drastic changes in living conditions from the patient, but they also have a major influence on the course of the disease. General measures include:

Avoid substances that trigger allergies!
This is the top priority in allergic asthma. Contact with the triggering allergen should be reduced as much as possible, e.g. By avoiding pets, observing the pollen calendar or reducing carpets and curtains in order to reduce the house dust mite density. In the case of children, soft toys should be frozen about every 4 weeks, this also reduces the house dust mite density. Depending on the triggering allergen, the implementation of complete allergen avoidance is more difficult or even impossible. Above all: do not smoke!
Physical activity:
Although intense physical exertion can trigger an asthma attack, asthmatics should still ensure regular physical activity (endurance sports) during therapy. Above all, endurance sports such as jogging, cycling or swimming improve lung function. However, overloading should be avoided (do not test any limits!).
Learning certain breathing techniques and breathing relaxation exercises can relieve breathlessness during an asthma attack and reduce the frequency of the attacks. One example of this is the "lip brake". You inhale through the nose and exhale through the slightly closed lips. This slows down the air flow somewhat and makes it more even.
Self-measurement of the breath peak impact with “peak flow” devices
By self-measuring the peak breath and noting the values for each day, the patient can be able to recognize the current state of health and the development of the disease himself.Since the disease is often underestimated by those affected in the symptom-free intervals, it can be easier to carry out the correct drug therapy. Children in particular often benefit from keeping an “asthma diary”.
Patient training can provide assistance with general measures. It teaches techniques for allergen avoidance, symptom recognition, self-measurement of the peak flow and gives advice on what to do if an asthma attack is imminent or has occurred.

Drug therapy for asthma

The drugs used for asthma therapy can be divided into two groups:

The so-called control drugs used for causal therapy (also as controller are directed against the inflammatory reaction and try to bring it under control.
So-called relief drugs are used to relieve the asthma symptoms (also known as reliever).

This difference is especially important when adhering to the drug therapy: While the relief drugs only "when necessary", e.g. are used for the onset of breathlessness or to prevent nocturnal asthma attacks, the control drugs must be taken regularly and over a long period of time in order to develop their effect.

Which drugs are used for therapy depends on the severity of the disease. There is a tiered scheme for long-term drug treatment that distinguishes between four degrees of severity. How the degrees of severity differ was described under classification.

Also read: Emergency spray for asthma

Stage scheme in drug therapy for asthma

Level 1: mild, intermittent asthma:
No long-term therapy is necessary here, only the use of relief medication (short-acting beta 2 sympatomimetics) if necessary.

Stage 2: mild, persistent asthma:
Low-dose glucocorticoids (cortisone) should be used as inhalation sprays. Additionally short-acting beta 2 - sympathomimetics.

Stage 3: moderate, persistent asthma:
Glucocorticoids (cortisone) in low to medium dose. In addition, long-acting beta2 sympathomimetics
Or
Monotherapy with a medium-dose glucocorticoid (cortisone)
Or
The combination of a medium dose glucocorticoid plus a leukotriene antagonist or theophylline
In addition, always a short-acting beta 2 - sympathomimetic for the case of need.

Stage 4: severe, persistent asthma:
Inhalation of glucocorticoids (cortisone) in high dose plus long-acting beta2-sympathomimetic
possibly additionally leukotriene modifier or theophylline
In addition, always a short-acting beta 2 - sympathomimetic for the case of need.

What to do if an acute asthma attack occurs? You can find more information at: Asthma attack

Asthma therapy drugs

Control Drugs:
Glucocorticoids (cortisone) are used to inhibit the inflammatory reaction on which bronchial asthma is based. They cause the swelling and mucus build-up in the bronchi to go down. They are administered as breath sprays so that they can take effect as directly as possible at the target lungs.

Relief Drugs:
Here mainly beta 2 -Sympatomimetika and Parasympatholytika used. Beta 2 sympatomimetics lead to a relaxation of the cramped bronchial muscles and thus quickly relieve the shortness of breath in the event of an asthma attack. However, they do not affect airway inflammation. Parasympatholytics also cause the bronchial muscles to relax, and they also reduce the viscosity of the secreted mucus.

Other drugs:

Theophylline: It has a slight bronchodilator effect and is also anti-inflammatory.

Leukotriene Modifiers: They suppress the inflammatory response.

More recently it has been used to treat severe allergic asthma Antibody therapy is also available. Antibodies against the body's own IgE are injected under the skin and the IgE-mediated allergic inflammatory reaction is inhibited. In this way, the number of asthma attacks can be reduced or the dose of the glucocorticoids (cortisone) to be taken can be reduced.

Read more on the topic: Medicines for asthma

When do i need cortisone?

Cortisone is a so-called natural glucocorticoid.
It is produced by the body and affects almost all cells in the body. Glucocorticoids are among the substances that, among other things, have an anti-inflammatory effect. In this way, the allergic reaction that occurs in asthma can be inhibited at all levels of the body. To do this, cortisone intervenes in the metabolism of the individual cells.

A five-stage treatment plan has been established as part of asthma therapy. In the case of mild to moderate asthma attacks that occur rarely, non-cortisone drugs are used. The more frequent and more severe the seizures, the more cortisone is used in therapy.

Cortisone is used in asthma sufferers for various purposes. On the one hand, the permanent alertness of the body in the airways is to be shut down. In an acute asthma attack, the body's strong reaction should be reduced. In the long run, the cortisone serves to reduce the symptoms and can thus counteract rapid chronification.

Due to the different goals of cortisone, a distinction is made between fast-acting cortisone, which is taken in the event of an asthma attack, and long-acting cortisone, which lowers the body's basic alertness.
The fast-acting cortisone is an emergency medication and should therefore only be used in acute asthma attacks. The long-acting cortisone is a long-term medication that should be given in the early stages of asthma to prevent chronification.

Also read: Cortisone therapy for asthma

Homeopathy for the therapy of asthma

Anyone who has been suffering from asthma for a long time is usually dependent on several drugs that are designed to prevent or reduce asthmatic attacks. With the help of homeopathic remedies, the body's propensity for inflammation should also be reduced.

Globules such as Lobelia Inflata, Natrium sulfuricum and Kalium iodatum are used for this purpose. The holistic approach is important in homeopathy, in which the treatment not only relates to the individual symptoms but also the interactions within the body play an important role.

Learn more about it: Homeopathy for Asthma

Schüssler salts for asthma therapy

Schüssler salts are said to reduce the excessive alertness of the body in asthmatics in combination with the conventionally used drugs and thus lead to a reduction in asthmatic symptoms.
A great advantage of the Schüssler salts is their ease of use, which is also suitable for affected children. Substances such as magnesium / potassium / calcium phosphoricum and potassium sulphuricum can be used in episode-free periods. The Schüssler salts are dissolved in hot water and can be drunk throughout the day.