Outpatient Treatment of Asthma
Asthma is a disease of the airways characterized by three problems obstruction, inflammation and hyperresponsiveness. Asthma requires ongoing medical care.
According to the report of the Guidelines for the Management of Asthma Diagnosis y0 (for physicians) issued by the National Asthma Education, asthma has four phases:
The use of objective measures of lung function (spirometry, peak expiratory flow) to assess the severity of asthma and to monitor the course of treatment.
Drug treatment designed to reverse and prevent the inflammatory component of the airways in asthma treat bronchospasm addition of airways;
Environmental control measures to avoid or eliminate factors that induce or trigger asthma exacerbations, also considering as an alternative to immunotherapy in selected cases;
Truthful information to the patient on Asthma (Medical Education), which involves the doctor (as a promoter), the patient and his family.
According to these guidelines, there are five targets for effective asthma treatment:
• To achieve and maintain levels (almost) optimal pulmonary function indices
• Achieve and maintain normal activity levels, including exercise
• Controlling chronic and troublesome symptoms (eg., Cough or shortness of breath at night, early in the morning or after exertion)
• Preventing acute relapses (episodes) Recurring asthma;
Avoid adverse effects from asthma medications.
There are generally two groups of drugs to treat asthma: anti-inflammatory drugs and bronchodilators.
Anti-Inflammatory Drugs
Anti-inflammatory agents stop and help prevent the development of inflammation in the airways, these include corticosteroids, cromoglycate, the nedocromil, and, lately, the anti-leukotrienes.
Corticosteroids
Corticosteroids are anti-inflammatory drugs more effective for treating asthma. Corticosteroids may be administered orally or inhaled.Generally the oral form is used for short periods of time when the patient's asthma is out of control. The likely effects of prolonged use very frequent or long-term effects include weight gain, elevated blood pressure, cataracts, bone weakness, muscle weakness and swelling (edema).
Inhaled corticosteroids are safe and effective for the treatment of asthma. Since this drug acts on the inflammatory phase of asthma, is used as first-line drug for moderate and severe asthma. Possible side effects include candidiasis (a type of fungus or "thrush") in the mouth and throat, and occasional cough caused by the aerosol device.
Cromolyn Sodium and Nedocromil
Sodium cromoglycate and nedocromil are drugs less anti-inflammatory effect than steroids. They serve as preventive inhaled directly into the lungs to prevent immediate and delayed symptoms. They work by stopping the effects of environmental allergens or irritants (including exercise and exposure to cold air and sulfur dioxide).Not for oral use. Sodium cromoglycate is in the form of inhalable powder to be used with a rotary inhaler device, there is also a liquid for use with nebulizers and a form of metered dose aerosol. The nedocromil comes as a metered dose aerosol only. These two medications do not have serious side effects.
Anti-Leukotrienes
Is a relatively new group of drugs that act in one phase of the inflammatory process, inhibiting the production or blocking the effects of leukotrienes, which are highly potent chemical mediators of inflammation in asthma. It has already approved its use for mild to moderate asthmas as continuous use preventive medications.Bronchodilators
The main role of bronchodilators is to open the airway relaxes the bronchial muscle. The two main types of bronchodilators are beta-adrenergic agonists (beta2-agonists) and methylxanthines (theophylline). Another group of minor anticholinergics are occasionally used for asthma.Beta Adrenergic Agonists
Beta2 adrenergic agonists act by relaxing the muscle of the airway to assist in the control of persistent narrowing of the airways. They are adrenaline-like drugs that can be administered in oral (syrup or tablets), by nebulization, metered dose aerosol or by injection.The injections are used primarily in emergency situations. Inhaled beta2 agonists are the drug of choice for treatment of acute asthma outbreaks and to prevent exercise-induced asthma.
Methylxanthines
Theophylline is the main methylxanthine used for the treatment of asthma. It serves as a bronchodilator in mild to moderate power. The sustained release formulation is useful for controlling nocturnal asthma. It is used sometimes associated with beta2 agonists for greater bronchodilation. It can also help reduce muscle fatigue and has some anti-inflammatory benefits. The main drawback is that theophyllines are common side effects, including abdominal pain, nausea, vomiting, nervousness and insomnia.Immunotherapy
Immunotherapy (allergy shots) is a treatment method scientifically tested and approved for use in moderate or severe Allergic Asmas when the combined use of drugs and environmental control measures do not achieve the goals set out at the beginning. Comprises injection of small amounts of allergen to the patient. This helps create tolerance or resistance (permanent or temporary) to the allergens that cause asthma exacerbations. Allergen concentrations increase with the passage of time up to a limit, to reduce or eliminate the patient's allergy symptoms.Environmental Measures
Between 75% and 85% of patients with asthma have varying types and degrees of allergies. This reinforces the concept that the control of allergies will be beneficial for allergic asthma patient. To prevent allergic reactions, are essential environmental control measures to reduce exposure to allergens and irritants (chemical or physical) indoors and outdoors.For outdoor allergens
Reduce exposure to outdoor allergens staying indoors when the pollen count and humidity levels are high, especially on windy days it spread dust and pollen. Minimize early morning activity when pollen is issued more frequently. Keep windows closed, especially at night and preferably use air conditioning, which cleans, cools and dries the air.For indoor allergens
House dust Components: House dust itself is not an allergen, but what is in it can cause allergic reactions. House dust can be formed of animal allergens (if you are allergic, get rid of all warm-blooded animals in the house), house dust mites (found in mattresses, pillows, carpets, furniture, carpets, blankets, clothing and toys soft) and cockroach allergens.Mold (fungi) Interior: The interior mold can be found in bathrooms, carpets, basements, kitchens and other wet areas. Allow adequate ventilation and frequent cleaning of these areas. Dehumidifiers shall be fixed in less than 50 percent but 25 percent.
Air Control Devices: There are several devices that help control indoor allergens indoors. These include air conditioners, air cleaning units inside, humidifiers and vacuum cleaners.
The apparatus for cleaning indoor air can be helpful, but even more important is to control the source of allergens. The particulate air filter high efficiency HEPA is the most effective and can be used in central heating and cooling systems (cooling) or independent power.
Vacuums can spread allergens during use, therefore allergic patients should wear a mask when vacuuming. There HEPA filters that can adapt to some brands of vacuum cleaner.
Humidifiers are important sources of mold growth if not cleaned properly. Placing the high moisture level, promotes growth of fungi. Put the unit level between 25 and 50 percent humidity.
Other irritants: There are other irritants that can cause exacerbations in patients with asthma. These include snuff smoke, smoke from wood stoves, strong smells, aerosols and air pollutants, including ozone and sulfur dioxide.
It is essential that all patients with Asthma dagnóstico perform these environmental measures as the most important part of their treatment regimen, which will result in better control, and consequently, in a reduced need for other treatments (drugs or vaccines) .
