Asthma aerosol

Aerosols for asthma are often used due to their availability and ease of use. Bronchial asthma is a chronic inflammatory disease of the respiratory system, which is combined with broncho-obstruction, which has a reverse character under the influence of medications. Symptoms of this disease develop very quickly and are manifested by recurrent episodes of shortness of breath, wheezing, coughing and chest tightness. Therefore, it is necessary to use emergency medications, and the most accessible form is aerosols.

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Indications for use of asthma aerosol

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

Two main principles are used for treatment: the use of basic therapy drugs, which the patient needs constantly, and emergency drugs, which are necessary to stop asthma attacks. Depending on the need, different medications are used, so the indications for use differ by drug groups.

The main goal of asthma treatment is to achieve control of symptoms.

The following are used as basic therapy:

• Long-acting β2-agonists (salmeterol, formoterol, indacaterol);
• long-acting anticholinergics (tiotropium bromide);
• inhaled glucocorticosteroids (beclomethasone, fluticasone, budesonide);
• cromones (ketotifen, cromolyn sodium);
• antileukotriene drugs (montelukast, zileuton);
• antibodies to immunoglobulin E (omalizumab).

The most effective means of controlling asthma today are inhaled glucocorticosteroids.

The following drugs are used as emergency medications:

• short-acting β2-agonists (salbutamol, fenoterol);
• short-acting anticholinergics (ipratropium bromide).

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

Indications for use of asthma aerosol:

1. an attack of bronchial asthma - in this case, emergency medications are used, that is, short-acting;
2. prevention of an attack – taking a dose of aerosol in case of possible exposure to an allergen or before physical exertion. Such preventive administration promotes early expansion of the bronchi before a probable trigger factor and symptoms do not develop;
3. as a basic therapy - daily use of aerosol allows to control the course of the disease. In this case, long-acting drugs or inhaled glucocorticosteroids are used.

These are the main directions for use, but it should also be remembered that any aerosol for asthma has its own application features and its own precautions.

Types of aerosols for bronchial asthma and their characteristics

Medicines for treatment can be divided into two groups.

1. Emergency medications. These include:

Salbutamol (Ventolin)

Available in tablet form, syrup, ampoules and in a metered dose inhaler. One dose of the inhaler contains 0.1 mg of the active substance.

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

The bioavailability of the drug is low - with inhalation use, 10% reaches the lower respiratory tract. The drug begins to act in 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: there are no absolute ones; relative precautions include hyperthyroidism, arterial hypertension, paroxysmal tachycardia, and pheochromocytoma.

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

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

Overdose: tremors, palpitations, and increased systolic pressure may occur.

Interaction with other drugs: should not be used with non-selective β-blockers. Potentiates the action of drugs that stimulate the central nervous system and anticholinesterases.

Storage conditions: shelf life – 2 years. Store at a relative temperature not exceeding 28 degrees, avoiding direct exposure to high and low temperatures.

Fenoterol (Partusisten, Berotec, Berodual)

It is available in tablets, ampoules, and 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 inhalation use of the drug, its effect is selective - exclusively on β2-receptors of the bronchi. In addition to pronounced bronchodilation, it increases the work of the cilia of the ciliated epithelium of the bronchoalveolar tree. The drug begins to act 3-6 minutes after application, the maximum concentration of the drug is 40-80 minutes, and the duration of 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: tachyarrhythmia, hypertrophic or dilated cardiomyopathy, excessive genetic sensitivity to the components of the drug, 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. Dyspeptic manifestations, vascular and neurogenic pain, pain and twitching of small muscles, arrhythmia, fibrillation may be observed.

Doses and methods of using the drug: adult patients and children over six years of age should be prescribed about 0.2 mg of the active substance (1 dose - 1 inhalation of aerosol) to eliminate bronchial spasm, if ineffective, then after 7 minutes you can repeat the inhalation. A maximum of four doses per day are possible. Preventive doses are the same as therapeutic doses.

Overdose: tremors, tachycardia, and increased systolic pressure are possible.

Interaction with other drugs: Fenoterol is not recommended for use with antidepressants and MAO inhibitors, due to the increased risk of collapse in this case. Combination with other bronchodilators threatens the development of rebound 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.

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Ipratropium bromide (Atrovent)

Available in the form of injection vials and aerosol of 10 ml, which is 200 doses. 1 dose of aerosol contains 0.2 mg of active substance.

Pharmacokinetics and pharmacodynamics: the drug blocks M-cholinergic receptors of the tracheobronchial tree and thus 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 inhalation administration, bioavailability is no more than 10%. The effect occurs 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 liver enzymes and excreted in the intestines.

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

Side effects: dyspeptic symptoms in the form of nausea, vomiting, dry mouth, decreased motor-evacuation function of the intestine. Changes in the pulmonary system - thickening of sputum, cough, laryngospasm, paradoxical bronchospasm, burning of the mucous membrane of the nasal cavity. Allergic manifestations may be observed in the form of urticarial elements on the skin, swelling of the tongue, anaphylactic shock, high blood pressure, palpitations, arrhythmia.

Doses and methods of using the drug: for children aged six to twelve years, 0.2-0.4 mg (1-2 doses, which corresponds to 1-2 breaths) is used to eliminate bronchial spasms. For older children and adults - 0.4-0.6 mg (2-3 doses). The drug should not be used more than 5 times within 24 hours. This drug is not recommended for the prevention of asthma attacks before any physical activity or possible action of an allergen, as it has many different precautions and undesirable effects.

Overdose: no specific changes have been identified when the dose of the drug is exceeded. Increased side effects, accommodation spasm, arrhythmia, dryness of the oral epithelium, and impaired normal swallowing are possible.

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

Storage conditions: Ipratropium bromide is valid for 2.5 years. It should be stored at a temperature no higher than 27 degrees, not exposed to low temperatures, and avoid exposure to infrared rays.

2. Medicines for basic treatment of asthma

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

Budesonide (Pulmicort)

It is available in the form of capsules, spray, ointment, ampoules and aerosol. The dosed aerosol consists of 200 doses, 1 dose - 0.2 mg of 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 bronchodilating effect due to intensive anti-inflammatory action. The drug acts on inflammatory cells, inhibits their action, reduces the amount 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 adrenoreceptors also increases.

The bioavailability of the drug when administered by inhalation is about 25%. The maximum concentration is reached after 15-45 minutes. The pronounced effect of the drug occurs only with a course of application after 5-6 days.

Contraindications for the use of Budesonide: there are no specific absolute contraindications to treatment with Budesonide. It is not recommended to use the aerosol during lactation, in case of tuberculosis, fungal infections of the oral cavity, hereditary intolerance to the components of the active substance.

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

Doses and methods of administration: during an exacerbation as a basic therapy from 0.4 mg (2 doses) to 1.2 (6 doses), divided into 3 times a day. For initial therapy during remission, minimal concentrations are prescribed - from 0.2 mg to 0.4 mg 2 times a day. For children, given their age, the "mite" form is used from 0.05 to 0.2 mg per day.

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

Interaction with other drugs: when used simultaneously with some antibiotics, the effect of budesonide may be enhanced; when taken together with cardiac glycosides, their effect is enhanced due to hypokalemia; when taken with diuretics, hypokalemia is enhanced.

Storage conditions: store at a relative temperature not exceeding 27 degrees away from flammable objects, avoid exposure to infrared rays, do not expose to low temperatures. Shelf life is 2 years.

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Use of Asthma Aerosols During Pregnancy

If a woman has asthma, her pregnancy should be planned. It is necessary to undergo a thorough examination and consult a doctor before planning a child. Bronchial asthma can be complicated by preeclampsia, so it is important to achieve the best possible control of asthma in the expectant mother before pregnancy.

If pregnancy has already occurred, then you should immediately consult a doctor. It is necessary to monitor 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 attacks. But asthma during pregnancy can behave differently: the number of attacks can decrease, or, on the contrary, the course can worsen. This is very difficult to predict.

The issue of treating bronchial asthma during pregnancy is widely discussed. After all, there is harm from any medications to the fetus. But on the other hand, the use of these drugs does not have an evidence base with a reliable teratogenic effect. Exacerbation of asthma will cause more harm and the possibility of pregnancy complications. Therefore, doctors recommend treating asthma to prevent these complications.

The use of asthma aerosols during pregnancy is the most optimal treatment method. This is due to the fact that such treatment is local and does not affect the fetus as much as the use of systemic drugs. As for drug groups, the most acceptable are inhaled glucocorticosteroids and β2-agonists. Their harm to the fetus has not been proven. It is necessary to take those doses that reduce the number of exacerbations and then use the minimum effective doses of aerosols. In the last month of pregnancy, it is necessary to abandon β2-agonists and switch to inhaled corticosteroids, since they may affect the myometrium of the uterus and premature labor or other complications.

In addition to drug treatment, it is necessary to prevent exacerbations by minimizing physical activity and avoiding trigger factors.

Aerosol for asthma is one of the indispensable means, since this is a common disease among children, and such treatment is affordable and the impact 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 teaches how to use the inhaler correctly, because this route of administration of the drug ensures its concentration in the lower respiratory tract of about 10-15%, and if the patient does not use the delivery device correctly, the effectiveness can decrease to zero. Therefore, aerosols for asthma are an excellent method of treatment if used correctly.