Prevention of bronchial asthma

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

There are primary, secondary and tertiary prevention of bronchial asthma.

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Primary prophylaxis of bronchial asthma

Primary prophylaxis is directed at people at risk and provides for the prevention of allergic sensitization (IgE formation). 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 into the amniotic fluid of allergens, even small concentrations of which are sufficient for the development of a fetal immune response in the fetus. That is why prevention of allergy in the fetus in this period is to prevent the pathological course of pregnancy.

In fact, the only event aimed at promoting tolerance in the postnatal period is the preservation of the natural feeding of a 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, whose effects both in prenatal and postnatal periods have 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, if there is 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.);
• increase in the level of total IgE in the blood in combination with the detection of significant amounts of specific IgE to bovine milk, chicken eggs, and allergens.

For the purposes of secondary prevention of bronchial asthma, this group of risk is offered preventive treatment with cetirizine. Thus, the study of ETAS (Early Treatment of the Atopic Child, The UCB Institute of Allergy, 2001) showed that the administration of this drug at a dose of 0.25 mg / kg per day for 18 months to high-risk children with domestic or pollen sensitization leads to a decrease in the frequency of bronchial obstruction from 40 to 20%. However, it was later shown that a reduction 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 little evidence, the ETAS study was withdrawn from the new version of GINA (Global Initiative for Asthma, 2006).

Tertiary prevention of bronchial asthma

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

There is a need for great caution in vaccinating children with bronchial asthma. The following points are taken into account:

• immunization is carried out for children with bronchial asthma only when they reach the control duration of 7-8 weeks and always against the background of basic treatment;
• vaccination is excluded in the period of exacerbation of bronchial asthma, regardless of its severity;
• individually solve the problem of vaccination against pneumococcus and hemophilic rod (Pnevmo23, Prevnar, Hibericks, AktHib, etc.) with recurrence of respiratory infection of the upper and / or lower respiratory tract, which contributes to the uncontrolled flow of bronchial asthma (when disease control is achieved);
• children receiving allergen-specific immunotherapy, are vaccinated only after 2-4 weeks after the introduction of a regular dose of the allergen;
• patients with mild to severe asthma are recommended to vaccinate against the flu every year or with general vaccination of the population (prevents complications of influenza that are more frequent in asthma, modern influenza vaccines rarely cause side effects and are usually safe in children older than 6 months and adults). When using intranasal vaccines in children less than 3 years of age, an increased incidence of asthma exacerbations is possible.

Of great importance is a healthy lifestyle, the prevention of respiratory infections, the rehabilitation of ENT organs, the rational organization of everyday life with the exclusion of active and passive smoking, contact with dust, animals, birds, the elimination of mold, dampness, cockroaches in a dwelling. There is a need for some caution in the use of drugs, especially the antibiotics of the penicillin group, acetylsalicylic acid and other NSAIDs in children with atopy. A significant influence on asthma control can be provided by the treatment of concomitant diseases: allergic bronchopulmonary aspergillosis, gastroesophageal reflux, obesity (a limited number of studies), rhinitis / sinusitis. An important section of tertiary prevention is regular basic anti-inflammatory treatment.

Elimination mode

Elimination of domestic, 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 activities are individual for each patient and contain recommendations for reducing the effects of house dust mites, animal allergens, cockroaches, fungi and other non-specific factors. A number of studies have shown that non-compliance with the elimination regime, even with adequate basic treatment, increased bronchial hyperreactivity and increased symptoms of bronchial asthma and did not allow full control over the disease. It is important to use a comprehensive approach, since most of the elimination interventions used individually are generally unprofitable and ineffective.

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Screening of bronchial asthma

All children older than 5 years with recurrent wheezing are carried out:

• spirometry;
• samples with bronchodilator;
• pikfloumetriju with conducting a diary of self-checking;
• allergological examination.