Asthma drug treatment knowledge
Thematic prevention and treatment of asthma
Modern medicine has recognized that the pathological basis of asthma is chronic allergic inflammation of airway, which is very sensitive to external stimuli. Therefore, in the treatment of bronchial asthma, we should not only relax the bronchus, but also pay attention to anti-inflammation and airway reactivity. With the emergence of new treatment ideas, the focus of asthma treatment has also changed. In the past, the application of bronchodilators was emphasized, and the treatment of relieving bronchial contraction and relieving symptoms could not meet the needs of patients. Hormones with anti-inflammatory effects have become the main drugs to treat asthma.
1, bronchodilator bronchodilator is an asthma drug. It mainly relieves bronchospasm and controls acute asthma attack, but it has no anti-inflammatory effect. Bronchodilators are easy to be accepted by patients because of their quick effect and obvious effect, but we can't rely too much on these drugs to relieve symptoms. Are patients with moderate and severe asthma using it? 2 receptor agonists should be inhaled at the same time as corticosteroids, and a better curative effect can be achieved by taking both measures. Commonly used bronchodilators are divided into the following three types.
( 1)? 2 adrenergic receptor agonists (? 2 receptor agonists):? Receptors exist in cardiovascular system, lungs, muscles and other tissues and organs, which can be divided into? 1 and? Two kinds. Acting on? 1 receptor agonist can increase myocardial contractility, accelerate heartbeat and inhibit intestinal peristalsis. Acting on? Agonists of receptor 2 relax bronchi, increase the ciliary clearance rate of airway epithelial cells, and reduce eosinophils in blood. Epinephrine and isoproterenol (wheezing) and so on? 1 and? Both receptors have excitatory effects, so while relaxing bronchi, they often cause side effects such as accelerated heartbeat, increased myocardial oxygen consumption and arrhythmia. ? 2 agonists, such as salbutamol, can be taken orally and inhaled; There are both long-acting preparations and short-acting preparations. Aerosol inhalation, such as salbutamol, is generally used to relieve asthma after 5 minutes to 10 minutes, but it can only last for 3 hours to 6 hours. And long-acting aerosol? Shi Liwen? Or take it orally? Quantening？ 、? Mei Chuanqing? , can last 12 hours. But? It is best for agonists to act on demand when symptoms appear. If you rely too much? 2 agonists, indicating that anti-inflammatory treatment is not enough, or the inhalation method is incorrect, or there are other infection problems. ? In addition to aerosol inhalation, agonists can also be administered by air pressure pump or oxygen cylinder atomization, which is the first choice for asthma first aid at present.
(2) Theophylline: aminophylline and? 2 agonists have similar effects, which can relax airway smooth muscle, excite the heart and central nervous system, make respiratory secretions easy to be discharged and restore respiratory muscle fatigue. Commonly used are ordinary aminophylline tablets and long-acting theophylline. Its antiasthmatic effect is also good, and the drug concentration in blood works when it contains 5 ~ 20 micrograms per milliliter. Because the individual metabolism of this drug is very different, it would be better if the drug concentration can be determined and the medication can be adjusted accordingly, so as to keep the drug concentration in the blood within the optimal effective concentration range. Ordinary aminophylline tablets are taken every 6 ~ 8 hours 1 time, and children can use (4 ~ 5)mg/kg body weight each time. Long-acting theophylline was taken every 12 hours, and each dose was (8 ~ 10)mg/kg body weight. Adults generally take 0. 1 g to 0. 15 g each time, twice a day. Is there any preparation that can last for 24 hours after taking/kloc-0 once a day? You Chuanping? . However, theophylline can sometimes cause nausea, abdominal discomfort and affect appetite, so it should be taken after meals. (3) anticholinergic drugs: Hydroxyipratropium bromide has a strong relaxing effect on airway smooth muscle, but the effect is slow, reaching a peak 30 minutes to 60 minutes after administration, mainly acting on large and middle airways, and can be compared with? The two agonists are used together, usually inhaled by aerosol or atomized solution. 654-2 is a cholinergic nerve blocker developed in China, which also has the function of relaxing smooth muscle and improving microcirculation. Some patients with chronic asthma can also take small doses orally for a long time.
(4) Leukotriene receptor antagonist: Cysteinyl Leukotriene is a powerful bronchoconstrictor, which can cause airway microvascular leakage, edema and mucus secretion and cause airway eosinophil exudation. Theoretically, it is speculated that its receptor antagonist may be an effective preventive and therapeutic agent for asthma. At present, this idea has become a reality. Jielikang Pharmaceutical Development Consulting Co., Ltd. introduced a selective leukotriene D receptor antagonist (Accolate) in China market, and conducted clinical trials in Peking Union Medical College Hospital and Chaoyang Hospital, which proved to be effective in the prevention and treatment of mild and moderate bronchial asthma. This may be a new breakthrough in asthma treatment.
2, preventive drugs Preventive drugs themselves are not just wheezing, but after taking drugs for a period of time, they can reduce the number of attacks.
Reducing the degree of attack has a certain preventive effect.
(1) corticosteroid inhaler: The commonly used corticosteroids are beclomethasone propionate (? Biketone？ 、? Can the letter be distributed? ) and other aerosols. They can eliminate nonspecific inflammation of bronchial mucosa, prevent mucosal edema and prevent mucosal secretion from producing irritating chemical mediators. Because local inhalation of drugs goes straight to the lungs, it avoids the side effects of oral administration, and it is the safest and most effective commonly used drug at present. Long-term oral corticosteroids can lead to full moon face, osteoporosis, obesity, hypertension, ulcers and so on. Long-term use by children will also affect growth and development. There are many kinds of steroid preparations. Through inhalation, the total dose of 1 day is only 5 mg of oral prednisone110, not to mention inhaling aerosol, and some of it will be discharged. After taking the medicine, you can brush your teeth and rinse your mouth, and the residual drugs in your mouth will be discharged, and the amount is small, and its side effects are minimal. However, inhaled steroids have no function of relaxing smooth muscle, so they have no immediate effect of relaxing bronchi. Therefore, some patients often underestimate its role. Since 1972, some developed countries have started to use inhaled steroids, which have achieved quite good results and accumulated a lot of experience, and used inhaled steroids as the first-line drugs to treat asthma. Some doctors also believe that if it is used in the early stage of asthma, it will achieve good results. A few people will have throat discomfort or hoarseness after inhaling steroids. Flushing the throat with water can eliminate this reaction. When asthma attacks seriously, general asthma drugs can't be controlled, and oral steroids (prednisone) can also be used to relieve symptoms. Oral medication does not exceed 1 week without any side effects. Steroid injection is commonly used in severe asthma and asthma. Commonly used are hydrocortisone and dexamethasone. Because these drugs are hormones, long-term use has certain side effects, so they should be used under the guidance of a doctor.
(2) Sodium cromoglycate: powder capsules are commonly used and can be inhaled with special auxiliary tools or aerosol. It is generally believed that it can be used to prevent asthma attacks. Later, it was found that it was effective not only for allergic asthma, but also for exercise asthma. But it is not clear how it plays a preventive role. Sodium cromoglycate is mainly used to prevent asthma in children with mild to moderate diseases. For example, after 1 ~3 months, although the symptoms are relieved, asthma can not be satisfactorily controlled, so inhaled corticosteroids can be considered.
(3) Ketotifen: It can relieve allergic reactions (such as eczema and allergic rhinitis) of patients, and also has a certain preventive effect on asthma attacks. Ketotifen is also called ketotifen. Tiperidone? This is an antihistamine. It is a tablet. Generally, the dosage is 0.5 mg ~ 1 mg each time, twice a day. The side effect of this medicine is that it is easy to feel sleepy after taking it. But after 1 week, patients can gradually tolerate it. Children are more tolerant to ketotifen. In adults and school-age children, it is best to take 1 tablet before going to bed every day.
3, immunomodulator Because asthma is an allergic reaction of the immune system and is related to other factors such as virus infection, the application of immunomodulator can increase children's immune function, resist various infections, and greatly reduce the onset of asthma. Commonly used are thymosin, nuclear cheese, transfer factor, Kamanshu syrup, Ruzhen, and traditional Chinese medicine Astragalus. Generally, it is widely used in patients with asthma induced by infection, and the application time is about 3 months to half a year. However, if allergic asthma is the main disease, it is not appropriate to use this kind of immunomodulator alone, and comprehensive treatment should be taken.
4. Desensitization therapy Desensitization therapy can reduce the reaction to allergic substances and prevent asthma attacks. Generally, measures are taken to avoid allergens and inhale drugs. Standardized steps for asthma? Treatment can usually control asthma well. Specific immunotherapy can only be considered if allergens cannot be avoided, or if appropriate drug treatment cannot effectively control asthma symptoms. Allergic asthma is an allergic reaction, which is characterized by bronchial spasm and mucosal edema stimulated by allergens. Desensitization therapy is to stimulate patients with a small amount of allergens, so that patients gradually develop tolerance to the allergens, and asthma attacks do not occur after exposure to allergens, thus achieving the purpose of treatment. Patients who adopt this therapy must be allergic asthma with clear allergens; In order to be effective, the desensitizing drug used must be the allergen of the patient. In addition, this method has a long course of treatment, and it is injected, and it may recur after stopping the drug, so its application in children is limited and it has been gradually replaced by other new treatment methods.
It is worth noting that the above methods have different therapeutic responses for each patient. Appropriate drugs should be selected according to the condition of each patient, reasonable compatibility should be carried out, and adjustments should be made at any time according to the changes of the condition to achieve the best curative effect. So? Insist on seeing a doctor, taking medicine according to the doctor's advice and checking regularly? This is very important.
5, antibiotics Because asthma is a chronic disease, it is characterized by airway hyperresponsiveness, not inflammation caused by bacteria, so it is generally not necessary to take antibiotics. However, if the attack lasts for a long time, there will be symptoms such as fever, bronchitis and pneumonia.
When bacteria are infected, antibiotics can be used to control the infection.
6, Chinese medicine treatment
(1) Acute asthma attack: Treatment should be based on syndrome differentiation of deficiency and excess of cold and heat. In acute attack, the effect of decoction is faster. ① Cold phlegm obstructs the lungs, wheezing in the throat, difficulty in coughing up phlegm, white complexion, no sweat, stuffy nose and dry mouth, thin and white tongue coating and slippery pulse. Treatment: Warming lung and dispelling cold, resolving phlegm, relieving cough and asthma. It can be treated with Herba Ephedrae, Ramulus Cinnamomi, Rhizoma Pinelliae, Asari, Rhizoma Zingiberis, Fructus Schisandrae Chinensis, Semen Armeniacae Amarum, Rhizoma Cynanchi Stauntonii and Radix Glycyrrhizae. Xiaoqinglongqi is the main decoction, and Shegan Mahuang decoction can also be used. ② Phlegm can resist lung heat, cough, wheezing, chest tightness, thick and yellow phlegm, difficulty in expectoration, irritability and thirst, and may be accompanied by fever, red throat, dry stool, red tongue, yellow and greasy fur and slippery pulse. Treatment: clearing heat and resolving phlegm, calming lung and relieving asthma. It can be treated with Herba Ephedrae, Semen Armeniacae Amarum, Radix Astragali, Semen Lepidii, Perillae, Cortex Mori, Flos Farfarae, Rhizoma Belamcandae and Radix Peucedani. Gypsum can be added for thermogravimetry; Trichosanthes kirilowii and Trichosanthes Radix can be added to resolve phlegm. The main soup is Dingchuan soup or Maxingshi dry soup.
(2) Remission period: In remission period, we should strengthen the spleen and kidney, strengthen the body resistance and consolidate the foundation. ① Deficiency of both lung and spleen, persistent asthma, pallor, fatigue, hyperhidrosis, common cold, loss of appetite, thin stool, pale tongue, thin and white fur, and slow and weak pulse. Yupingfeng powder (Atractylodis Rhizoma, Radix Saposhnikoviae and Radix Astragali) and Ginseng Jianpi Pill can be used. ② Asthma due to kidney deficiency, chronic illness, weakness, chills, chills in lower limbs, pale complexion, short heartbeat, frequent urination at night, thin stool, pale tongue with white coating and thready pulse. Available? Ginseng clam powder? Addition and subtraction: grinding Radix Codonopsis, Gecko, and Fructus Schisandrae, mixing, and swallowing in several times; You can also use Bushen Fangchuan tablets and Maiwei Dihuang pills. ③ You can also take Guilong Kechuanning for a long time at ordinary times, which has certain antitussive and antiasthmatic effects on mild asthma attack and its remission period.
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