Asthma medication: pay attention to these issues

1. Principles of asthma pharmacotherapy

The pharmacological treatment of asthma differs in different stages and grades, but the ultimate goal is to achieve both current symptom control and to reduce the risk of future relapses.

The treatment goals for acute exacerbations and chronic persistent phases are different: the goal of treatment in acute exacerbations is mainly to relieve symptoms, lift airflow limitation and improve hypoxemia as soon as possible.

The goal of treatment in the chronic persistent phase is to achieve good control of asthma symptoms, maintain normal activity levels, and minimize the risk of acute exacerbations, irreversible impairment of lung function, and drug-related adverse effects.

The principles of treatment in the acute exacerbation of asthma are to remove the triggers and to give the appropriate treatment plan according to the severity, such as the use of bronchodilators, reasonable oxygen therapy, and the timely and adequate use of systemic glucocorticoids.

The long-term treatment of chronic persistent asthma is mainly based on drug inhalation therapy, emphasizing regular medication, and should follow the principle of graded treatment and step therapy.

Relief medications should be used as needed in each treatment level regimen to provide rapid symptom relief and regular use of control medications to maintain symptom control. Depending on the level of disease control and the level of risk factors, etc., escalation or step-down treatment should be adopted.

2. Selection of medications for asthma attack prevention

Available medications include budesonide (DPI, MDI), fluticasone (MDI), beclomethasone (MDI), budesonide/formoterol (DPI), beclomethasone/formoterol (MDI), salmeterol/fluticasone (DPI), montelukast sodium (granules, chewable tablets, tablets), tiotropium bromide (DPI), and theophylline extended-release tablets.

3. Selection of medications to relieve asthma symptoms during acute exacerbations

Available drugs include salbutamol (MDI, nebulized solution), terbutaline (MDI, nebulized solution), salbutamol/ipratropium bromide (MDI, nebulized solution), budesonide (nebulized inhalation suspension), beclomethasone (nebulized inhalation suspension), fluticasone (nebulized inhalation suspension), ipratropium bromide (MDI, nebulized solution), prednisone, methylprednisolone, aminophylline, and doxorubicin.

4. Escalation and downgrading treatment

Escalation therapy: If asthma is not controlled with the current regimen and factors affecting asthma control (e.g., incorrect inhalation method, poor compliance, continued exposure to triggers, presence of comorbidities, incorrect diagnosis, etc.) are excluded and corrected, the regimen should be escalated until asthma control is achieved.

Step-down therapy: When asthma symptoms are well controlled and lung function has been stable for at least 3 months, the treatment regimen may be considered for step-down. Choose the right time to perform step-down therapy, avoiding respiratory infections, pregnancy, travel, etc.; each step-down therapy should be considered as a trial, involving the patient in the treatment, recording asthma status (symptom control, lung function, risk factors), writing an asthma action plan, closely observing symptom control, changes in PEF (maximal respiratory flow), and following up regularly; usually reduce inhaled glucose It is usually safe and feasible to reduce the dose of inhaled glucocorticoids (ICS) by 25%-50% every 3 months.

5. Proper selection and use of inhalation devices

The proper selection and use of inhalation devices is a crucial part of asthma medication. Inhalation devices are complex to operate, errors in device use are common, and poor patient compliance is a major problem that will directly affect the effectiveness of treatment. Therefore, asthma drug therapy also requires physicians and pharmacists to pay attention to patient medication education and full management. The following is an example of the specific usage of budesonide aerosol, powder aerosol and inhalation suspension.

(1) Budesonide aerosol: Before using the inhalation device for the first time, or before using it again after 14 days or more of non-use, a test snapper should be taken into the air to ensure that the inhalation device is working well.

①Open: Remove the nozzle protection cap and shake well.

②Inhalation: Exhale as much as possible first (do not breathe into the aerosol nozzle). Hold the aerosol vertically, put your index or middle finger on the top of the storage tank, hold the fixed seat with your thumb, and wrap your lips around the nozzle (do not bite the nozzle). Inhale slowly and deeply through the mouth and press the top of the aerosol simultaneously to extract a squirt of medication after starting to inhale (it is very important to synchronize the inhalation and the press in this process). Then take the aerosol out of the mouth and continue to hold the breath for about 10 s. Repeat the procedure if multiple inhalations are required in the prescription.

(3) Closure: Put on the protective cap; finally rinse the mouth.

(2) Budesonide powder aerosol.

①Open the protective cap of the suction nozzle.

②Shake the device up and down vertically 4~5 times to fill the dose cup with the drug.

③Press the top and hear the "click" sound to precisely transfer a dose of medication into the inhalation channel.

④Exhale as far as possible first (do not breathe into the aerosol inhaler) and inhale hard and deep with both lips wrapped around the inhaler. Then take the device out of the mouth and continue to hold the breath for about 10 s. If multiple inhalations are required in the prescription, repeat steps ②~④.

⑤ Cover with the protective cap; finally rinse the mouth.

(3) Budesonide suspension for inhalation.

①Prepare the nebulizer to add the nebulized inhalation suspension under the doctor's instruction, take 1~2 single-dose vials, open them by twisting the top forcefully, and squeeze the medicine into the nebulizer dish, or you can dilute it with saline to the final volume of 2~4 ml.

②Install the nebulizer and use it according to the instructions: wrap the lips together and bite the mouth, breathe calmly, inhale through the mouth and exhale through the nose (avoid spraying the fog into the eyes during nebulization).

③After nebulization, rinse your mouth and wipe off the residual liquid on your face; wash and dry the nebulizer.