In addition to preventing environmental allergens and irritants, we must resort to drugs, at least during the crisis (in the best, or mild asthma) while the moderate and severe stages require daily medications.

The drugs used in asthma are classified into two main groups:

Bronchodilators

Have a rapid effect, relaxing the muscle cells of the airways. They are used to relieve symptoms. There are three main types of bronchodilators: beta-agonists, anticholinergics and theophylline.

Inflammatory

Also called prophylactic effect by reducing inflammation of the airways. They have no immediate effect and require regular use and maintained to achieve their best effects. A good indicator is the reduced use of bronchodilators. There are also three groups: corticosteroids, chromones and leukotriene antagonists.Both types of drugs can be used in combination, as there are combinations of the same group of drugs that are effective.

Bronchodilators

Beta-agonists: they act on receptors in inducing bronchial muscle relaxation, resulting in an increased caliber of the bronchi. According to the duration of action can be short or long. The former are known for some time (salbutamol and terbutaline) and its action does not reach beyond the 3-4 hours after administration, so it must be ruled several times a day. The long-acting (salmeterol and formoterol) ranging up to 12 hours, so they are more convenient to use by patients, which has led to its increasing use, but may not be as immediate therapy in a crisis. All of them are marketed in sprays with different devices to inhale, so that they are effective (only effective amount of drug reaching the lower respiratory tract).

Anticholinergic act by blocking the nerve impulses reaching the muscle cells of the bronchi, so that they are relaxed. Its effect is mild, so rarely given as a single drug. Seem most effective when there are other conditions that work to narrow the airways, such as chronic bronchitis. The best known of this group is ipratropium bromide. The action also reaches beyond the 4-6 hours.

Theophylline was administered systemically (orally or injected into a vein), and until recently were the most popular and effective. However, it has begun to reduce their use because of side effects, requiring close monitoring, while it has the beta-agonists, long acting, with equal or greater power and easier handling. Today they are still very useful in the treatment of nocturnal asthma.

Inflammatory

Or Prophylactic (preventive). Do not stop an attack in progress, can be used in combination with bronchodilators.

Steroids: budesonide, prednisone, etc. They are most effective for inflammation, and also work to reduce the tendency to contraction. Can be administered orally or inhaled (it only in severe cases or rebels to other treatments). They are powerful and have side effects, but help to achieve the therapeutic goal of achieving an active lifestyle.

Chromones: cromolyn and nedocromil. Decrease bronchial reactivity by preventing the release of substances that stimulate. Require a few weeks of treatment to show its effectiveness. More effective in mild cases and children. Administered by inhalation.

Leukotriene antagonist: Montelukast and Zafirlukast. Reduce airway inflammation caused by leukotrienes released by some cells in response to lung irritants, so that it produces bronchial relaxation. Are relatively recent and its use is indicated in patients whose asthma is difficult to control with corticosteroids and beta-agonists. Are delivered orally, and seem especially effective in the exercise-induced asthma.

credit to: Dr. Paul Klenerman, Dr. Gavin Petrie, Dr. Carl J. Brandt, Dr. Finn Rasmussen, Dr. Alvar Ocano Pueyo

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It is not always easy to reach the diagnosis in mild or intermittent cases, moreover, a single attack does not mean they have asthma, as some infections and chemicals can cause a similar crisis. For a diagnosis is necessary for your doctor to investigate the characteristics of their symptoms during the attack. During auscultation will reveal wheezing that help the diagnosis.

Pulmonary function tests repeated, and repeated after the administration of certain drugs are useful for diagnosis.

Sometimes you have to perform chest x-ray studies, blood tests and arterial blood (ABG) for the diagnosis.

When there are also eczema or allergy symptoms may be needed specific tests and skin tests for sensitivity to certain substances.How can you help your welfare?

There are a few tips that a person with asthma should be noted, since, although there is no way to definitively cure or prevent attacks, it can decrease your number and avoid long term complications.

- It is advisable to stay active. If you are attacked during exercise, certain medications before starting it can be very useful as they relax the bronchial muscles. Swimming seems to be a highly recommended practice.

- Avoid general irritants (smoke, snuff, cold air, etc.), As well as substances which have been shown to be allergic. It is very important to stop smoking.

- Keep the dose of medication prescribed by your doctor even if you have no symptoms. Learn how to use inhalers correctly, and if you have problems talk to your doctor, as there are different systems available that can help.

- Avoid exposure to infections, influenza vaccination is recommended in autumn.

- In case of a severe attack consult your doctor or emergency services. A severe attack can be fatal if not properly treated or it is established later.

- See your doctor treatment. You should know what to do if symptoms worsen during a cold, as you will need to temporarily increase the dose of your medication.

- Familiar with the use of the flowmeter (peak flow meter) will help you assess the state of their asthma during the crisis. This is a simple device that measures the maximum speed at which air is expelled from the lungs.

What are the prospects of someone with asthma?

Asthma is a chronic disease, that is, for the rest of life, but even if not curable, treatment is usually effective in reducing symptoms and allowing an active life.

Approximately 50% of children with asthma is normalized over time.

credit to: Dr. Paul Klenerman, Dr. Gavin Petrie, Dr. Carl J. Brandt, Dr. Finn Rasmussen, Dr. Alvar Ocano Pueyo

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- Difficulty breathing, shortness of breath. Usually appears more or less abrupt and may worsen at night or at dawn and it is aggravated by breathing cold air, their relief is usually spontaneous and gives a great improvement with the use of bronchodilator medications.

- Noisy breathing, wheezing and gasping breath, which requires a great job of the respiratory muscles, and it gets worse with exercise.

- Cough, mainly at night, with slight expectoration of mucus.Symptoms of an attack worse include:

- Waking up at night with cough and/or wheezing

- Cough and shortness of breath even at rest

- Drugs that are inhaled lose effectiveness

Given these symptoms, or if you think that an attack worse, you should consult your doctor immediately.

Danger signs that indicate a severe attack and require immediate attention (emergency symptoms):

- Skin or lips

- Extreme difficulty breathing, which even produces slurred speech

- Anxiety and restlessness

- Accelerated heart rate and sweating

Other symptoms that sometimes may be present are: nasal flaring, coughing with traces of blood, chest pain or tightness, abnormal breathing with prolonged expiration more than inspiration.

credit to: Dr. Paul Klenerman, Dr. Gavin Petrie, Dr. Carl J. Brandt, Dr. Finn Rasmussen, Dr. Alvar Ocano Pueyo

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Asthma is a chronic disease of the airways in the crisis alternating respiratory distress and cough caused by inflammation of the bronchi, with relatively normal periods. Seizures may be mild, moderate or severe, with a variable length from a few minutes to several days, and can occur at any time.

The airway is like a tree, which is a main trunk, trachea, 2-3 cm in diameter, which starts at the bottom of the pharynx and divides into two branches, the bronchi, a for each lung. These in turn are re-divided several times to reach the most remote parts of the lung tissue as small tract of a few millimeters in diameter. The latter have an inner lining that produces mucus, and its wall is muscle cells as a ring, able to contract and relax to open or close these routes according to the needs of the person at different times (for example, open to allow passage of air during exercise, and most are closed during sleep).During an asthma attack, the inflammation affects the superficial mucosa, producing an excess of mucus, while the muscle cells contract narrowing the caliber of the bronchi, which hinders the passage of air and produces a noisy breathing (wheezing) .

People with asthma are very sensitive to different types of irritants in the atmosphere. Some of these irritants are nonspecific (ie, affect almost all individuals), such as cold air, certain viruses or snuff smoke.

Although asthma affects people of all ages, 50% are children, usually younger than 10 years. Among adults is more frequent in women. In recent times we are seeing an increase in cases worldwide, mainly among children.

How do you get to suffer?

Asthma appears to be caused by external agents, whether irritants that are inhaled from the atmosphere to breathe, as well as internal reaction to external influences. Usually there is no demonstrable cause (intrinsic asthma), and only occasionally due to a specific allergy (extrinsic asthma). The factors causing the disease was classified, therefore, into two groups:

Nonspecific factors

All subjects with asthma are affected by a number of irritants such as exercise, cold, smoke, pollution, etc.

Specific factors

Vary from person to person and can be allergens (pollen, dust, animal dander, mold, food), certain viruses and/or bacteria, chemical fumes and other substances in the work environment (isocyanates in paints and plastics, etc..), Acetylsalicylic acid , etc.

Apparently, people with a predisposition to the disease (people with personal or family history of eczema, allergies or asthma) who fail to have a crisis to which they are subjected to exposure to irritants triggers.

credit to: Dr. Paul Klenerman, Dr. Gavin Petrie, Dr. Carl J. Brandt, Dr. Finn Rasmussen, Dr. Alvar Ocano Pueyo

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These drugs are increasingly used to control asthma symptoms and are also prescribed to treat chronic obstructive pulmonary disease. The risk is especially worrisome in people who suffer from COPD and much lower among asthma, the researchers from McGill University and Lady Davis Institute for Medical Research in Montreal.

“Such drugs effectively fight against asthma if their benefits outperform the risk asthmatics,” Dr. Samy Suissa sees. “However, their effectiveness is questionable if chronic obstructive pulmonary disease who also commands higher doses. These risk-benefit ratios are very different. ”

“Inhaled corticosteroids are administered as an aerosol or micropowder and contain, among other substances such as fluticasone (Flonase, Advair), glucocorticoids (Pulmicort, Rhinocort) and beclomethasone (QVAR, Beclovent)” said the statement of the Institute. “It has long been known that oral corticosteroids such as predinisone increase the risk of diabetes, but this is the first time the effect is observed in inhalation.

Dr Suissa and colleagues analyzed data from the Régie de l’assurance maladie du Québec for nearly 400 000 people treated for chronic obstructive pulmonary disease or asthma.

The inhaled corticosteroids increase the rate of diabetes of 5 people per 1 000 (14 to 19 people or 34%) for each year of use.

“The researchers suggest that physicians reserve the use of inhaled steroids for patients who derive real benefits, such as asthma, and not the order only a few people with chronic obstructive pulmonary disease for which the drug is indicated . In all cases, people taking high doses should be examined for possible hyperglycemia and take only the lowest effective dose possible. “

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In mild cases where the perceived existence of a complaint leading to the symptoms of asthma attacks or to prevent further attacks, the medical team or doctor will give medicine Aminophylin and tablets such as prednisolone. For Patients with asthma, it is suggested to Them to Provide / store inhaled medications (Ventolin inhalers) Which Are Wherever they want help loosen respiratory cans while attacks.

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Although based on clinical experience and research of asthma is a disease that is often found in children, but the clinical picture of asthma in children vary greatly, even the heavy-light-attack and often lack the attacks change from time to time. As a result of this disorder are not diagnosed or wrong diagnosis sometimes leading to treatment was not strong.

Generally characterized with clinical symptoms of shortness of breath and wheezing (breathing that sounds). Group of children who are reasonably suspected asthma children who showed a cough and / or wheezing that occur in episodic, likely at night / early morning, seasonal, after the event, as well as a history of asthma and atopy in patients and their families.

Is it asthma?

Based on the definition and clinical experience Scadding Godfrey, asthma in children is a disease characterized by wide variations in short periods of time than the resistance of air flow in the pulmonary respiratory tract manifests as recurrent attacks of coughing or wheezing separated by symptom-free intervals.

Change what’s happening on the network?

• Reduction in airway diameter

• Changes in respiratory muscle response

• Disturbances in the autonomic innervation of smooth muscle regulation respiratory

• Epithelial cell damage respiratory mucosa

Trigger factors of asthma in children:

• Emotional factors; emotional disturbances can cause constriction of respiratory tract

• Factors immunological / allergy; now has a lot of evidence that allergy is one of the important factors of asthma development. Atopy is a real risk factor that can cause asthma symptoms.

• Non-allergic factors; viral / bacterial and irritant substances / pollutants.

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