Prevention of bronchial asthma

Prevention of bronchial asthma is a system of comprehensive measures aimed at preventing the disease, exacerbation of the disease, and reducing adverse effects.

A distinction is made between primary, secondary and tertiary prevention of bronchial asthma.

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Primary prevention of bronchial asthma

Primary prevention is aimed at people at risk and involves preventing allergic sensitization (IgE formation) in them. It is known that sensitization can occur already in utero, in the second trimester of pregnancy. Violation of the barrier functions of the placenta leads to the entry of allergens into the amniotic fluid, even small concentrations of which are sufficient for the development of a reaginic immune response in the fetus. This is why prevention of allergies in the fetus in this period is the prevention of the pathological course of pregnancy.

In fact, the only measure aimed at developing tolerance in the postnatal period is maintaining natural feeding of the child up to 4-6 months of life. However, it should be noted that the effect of breastfeeding is transient and short-term. Among the measures of primary prevention, it is justified to exclude the influence of tobacco smoke, the impact of which in both the prenatal and postnatal periods has an adverse effect on the development and course of diseases accompanied by bronchial obstruction.

Secondary prevention of bronchial asthma

Secondary prevention measures are aimed at children who, despite the existence of sensitization, have no symptoms of bronchial asthma. These children are characterized by:

• a burdened family history of bronchial asthma and other allergic diseases;
• other allergic diseases (atopic dermatitis, allergic rhinitis, etc.);
• an increase in the level of total IgE in the blood in combination with the detection of significant amounts of specific IgE to cow's milk, chicken eggs, and aeroallergens.

For the secondary prevention of bronchial asthma in this risk group, preventive treatment with cetirizine is offered. Thus, the ETAC study (Early Treatment of the Atopic Child, The UCB Institute of Allergy, 2001) showed that prescribing this drug at a dose of 0.25 mg/kg per day for 18 months to children from the high-risk group with household or pollen sensitization leads to a decrease in the frequency of broncho-obstruction from 40 to 20%. However, it was later shown that a decrease in the risk of developing bronchial asthma was detected in very small groups of patients with atopic dermatitis (34 and 56 patients with pollen and household sensitization, respectively). Due to the low evidence, the ETAC study was withdrawn from the new edition of GINA (Global Initiative for Asthma, 2006).

Tertiary prevention of bronchial asthma

The goal of tertiary prevention is to improve asthma control and reduce the need for drug treatment by eliminating risk factors for an unfavorable course of the disease.

Great care is required when vaccinating children with bronchial asthma. The following points are taken into account:

• Immunization is carried out on children with bronchial asthma only after control has been achieved for 7-8 weeks and always against the background of basic treatment;
• vaccination is excluded during periods of exacerbation of bronchial asthma, regardless of its severity;
• individually decide on the issue of vaccination against pneumococcus and Haemophilus influenzae (Pneumo23, Prevnar, Hiberix, ActHib, etc.) in case of recurrent respiratory infection of the upper and/or lower respiratory tract that contributes to the uncontrolled course of bronchial asthma (once disease control is achieved);
• children receiving allergen-specific immunotherapy are vaccinated only 2-4 weeks after the administration of the next dose of allergen;
• Patients with moderate to severe asthma are recommended to be vaccinated against influenza annually or during general vaccination of the population (prevents complications of influenza, which are more common in asthma; modern influenza vaccines rarely cause side effects and are usually safe in children over 6 months and adults). When using intranasal vaccines in children under 3 years of age, an increase in the frequency of asthma exacerbations is possible.

Of great importance is a healthy lifestyle, prevention of respiratory infections, sanitation of ENT organs, rational organization of life with the exclusion of active and passive smoking, contact with dust, animals, birds, elimination of mold, dampness, cockroaches in living quarters. A certain caution is necessary in the use of drugs, especially penicillin antibiotics, acetylsalicylic acid and other NSAIDs in children with atopy. Treatment of concomitant diseases can have a significant impact on asthma control: allergic bronchopulmonary aspergillosis, gastroesophageal reflux, obesity (limited number of studies), rhinitis/sinusitis. An important section of tertiary prevention is regular basic anti-inflammatory treatment.

Elimination mode

Elimination of household, epidermal and other causative allergens is a necessary component in achieving control of bronchial asthma and reducing the frequency of exacerbations. According to modern concepts, elimination measures are individual for each patient and contain recommendations for reducing the impact of house dust mites, animal allergens, cockroaches, fungi and other non-specific factors. A number of studies have shown that failure to comply with the elimination regimen, even against the background of adequate basic treatment, contributed to an increase in bronchial hyperreactivity and an increase in the symptoms of bronchial asthma and did not allow achieving complete control over the disease. It is important to use a comprehensive approach, since most elimination interventions used separately are generally unprofitable and ineffective.

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Screening for bronchial asthma

All children over 5 years of age with recurrent wheezing undergo:

• spirometry;
• bronchodilator tests;
• peak flowmetry with self-monitoring diary;
• allergy examination.