Pharmacologist for patients: ASTMA

The diagnosis of asthma is based on the finding of typical symptoms, namely: shortness of breath, coughing, tightness in the chest, wheezing, among others.

Symptoms occur in pairs and are paroxysmal and variable in nature.

They occur after: exertion, change in weather, contact with an irritant, strong odor, respiratory tract infection.

Factors that increase the likelihood of asthma include: chronic expectoration of sputum, chest pain, tests of varying degrees of bronchial obstruction - significant improvement in the diastolic test.

The differential diagnosis of asthma and its exacerbations should exclude: chronic obstructive pulmonary disease (in patients >40 years of age), inducible laryngeal obstruction, cough associated with chronic rhinosinusitis, bronchodilation, cystic fibrosis (especially in younger patients), heart disease (heart defects, heart failure), hyperventilation, dysfunctional breathing, interstitial lung disease, foreign body in the airways, pulmonary embolism, cough caused by drugs e.g..: angiotensin-converting enzyme inhibitors=prile=ACE / women cough more severely/, whooping cough.

We have 5 degrees of asthma exacerbation:

Grade 1 and 2 mild asthma.

Grade 3 moderate asthma.

Grade 4 and 5 severe asthma.

Medicinal product labeling:

- Inhaled glucocorticosteroid / beclomethasone, budesonide, fluticasone and cyclazonide= Solu- Medrol, Metypred, Pulmicort/.

- SABA / short-acting beta-agonists/ short-acting beta-agonists/fenoterol , salbutamol

- LABA/ long-acting beta-agonists/ long-acting beta-agonists/ salmeterol or formoterol

- LAMA/ long acting anti-muscarinics/ long acting anticholinergic drug / tiotropium - Spiriva, Srivasso, Braltus; glycopyrronium-Seebri; umeclidinium- Incruse

- LTHR leukotriene receptor antagonist / montelukast-Milukante, Astmodil

Treatment of various degrees of asthma exacerbation:

Grade 1: low-dose Pulmicort corticosteroid + formoterol,

Or Glcocorticosteroid Pulmicort inhaled low dose + SEBA salbutamol ad hoc or continuously.

Grade 2: Low-dose inhaled glucocorticosteroid Pulmicort + SEBA salbutamol ad hoc or continuously,

or Pulmicort glucocorticosteroid in a low dose, with a maximum of 6 doses per day.

Or LTR montelukast + Pulmicort inhaled glucocorticosteroid at low dose + SEBA salbutamol ad hoc + sublingual allergen immunotherapy may be considered.

Grade 3: low-dose Pulmicort corticosteroid + formoterol,

or low-dose corticosteroid Pulmicort + LABA salmeterol

or medium-dose glucocorticosteroid + LTRA montelukast

Grade 4: medium-dose Pulmicort corticosteroid + formoterol,

or Pulmicort glucocorticosteroid in medium or high dose + LABA salmeterol , formeterol

or Pulmicort glucocorticosteroid in medium or high dose + LABA salmeterol, formeterol+ LAMA tiotropium or LTRA montelukast

or high-dose Pulmicort corticosteroid + LABA salmeterol, formoterol+ LAMA tiotropium or LTRAmontelukast + sublingual allergen immunotherapy.

Grade 5: Pulmicort high-dose corticosteroid + LAMA tiotropium

Or high-dose corticosteroid Pulmicort + LAMA tiotropium+ azithromycin or LTRA montelukast.

Treatment of the most severely ill patients may include, in addition to inhaled drugs, the use of:

Monoclonal antibodies against:

- Immunoglobulin E omalizumab,

- interleukin 5 or its receptor: mepolizumab, benralizumab,

- α for interleukin 4 dupilumab.

The biological drugs listed are available in Poland under drug programs.

Taking azithromycin long-term, that is, for more than 6 months, difficult because the risk of developing macrolide resistance, QT interval prolongation and hearing disorders must be taken into account.

Dr. of Pharmaceutical Sciences Leszek Borkowski