Antibacterial agents for the treatment of bronchial asthma

Antibacterial agents for the treatment of bronchial asthma

Antibacterial therapy is carried out in cases of exacerbation of bronchial asthma caused by an acute infectious and inflammatory process in the respiratory system or activation of a chronic one. Sulfanilamides of prolonged action (sulfapyridazine, sulfamonomethoxin, sulfadimethoxine, sulfalene, septrin, kelfisin – course of 7-10 days) and combined preparations (bactrim, biseptol, merafin, potesepil) are used as antibacterial agents in the treatment of bronchial asthma. Of the sulfa drugs most often cause allergic reactions in patients with bronchial asthma, kelfizin and septrin. In necessary cases, semi-synthetic penicillins and tetracyclines are prescribed (until the results of bacteriological examination of sputum are obtained, in the future, taking into account the sensitivity of microflora to antibiotics). A good effect of the use of erythromycin is noted (for 5-7 days, 1 million -1 million 200 thousand units per day). In bronchial asthma, the etiology of which is associated with a hemophilic bacillus and pathogenic staphylococcus, chloramphenicol (up to 2 million units per day) and tetracycline antibiotics (metacyclin up to 900 thousand units per day) can be used. Nitrofuran drugs are effective for the treatment of staphylococcal inflammatory processes: furazolidone (50 mg is recommended six to eight times a day), furazolin, furagin, soluble furagin (solafur). High activity, especially in cases of combination with candidal infection, is possessed by 5-NOC (nitroxoline), which can be combined with the sodium salt of levorin.
ACT However, antibiotics and other antibacterial agents should be prescribed with convincing evidence of an infectious (bacterial) etiology of the inflammatory process in the lungs, which is especially true for atopic bronchial asthma, since antibiotics are not indicated for most viral infections.

After a course of antibacterial therapy for a sluggish, protracted process, as well as intolerance to antibiotics and sulfonamides, treatment with phytoncides is recommended: garlic juice, onion, lingonberry condensate in the form of inhalation, tincture of ordinary myrtle (20-25 drops three times a day two weeks for 15 -20 minutes before meals). Antibacterial therapy is combined with desensitizing, and if necessary with immunocorrective therapy.

Remediation of the bronchial tree in the treatment of bronchial asthma

Therapeutic bronchoscopy in the complex treatment of bronchial asthma is positively evaluated by many experts. However, there are opponents of this method. Remediation is urgent and planned. The former are a component of intensive care and are carried out at the II-III stage of asthmatic status. They are based on the segmental lavage of the bronchi using the phenomenon of injection (developed by G.I. Lukomsky and collaborators). The second is carried out with infectious- allergic bronchial asthma with clinical, laboratory and endoscopic signs of exacerbation of purulent or catarrhal-purulent endobronchitis with the failure of other measures. The method is considered effective. There is an opinion about the preferred use of bronchial lavage in bronchial asthma with non-purulent forms of endobronchitis (lavage is performed after reduction of bronchial obstruction, alternates with debridement bronchofibroscopy).
Remediation of bronchi with bronchial asthma can increase bronchospasm, therefore it cannot be recommended as widely as with chronic bronchitis.

Bronchodilators in the treatment of asthma are divided into the following main groups: adrenergic drugs, anticholinergics, methylxanthines. One of the main principles of long-term bronchodilator therapy is the restrained use of p-stimulating adrenergic drugs, which can cause serious complications. A comparative study of the effectiveness of B-stimulants and methylxanthines (aminophylline) showed that the combined use of their low doses and the isolation of each drug in high doses provide similar bronchodilatory effects, but in the first case, side effects are much less pronounced. The use of bronchodilators can be differentiated depending on the partial pressure of oxygen in the blood, which they affect in case of bronchial asthma differently change it, increase it, reduce it. Decrease most often causes aminophylline, less often – stimulants and atrovent, increase – berotek. The reaction of the bronchi to bronchodilators and a shift in the partial pressure of oxygen depend on the severity of exacerbation of bronchial asthma. In bronchial asthma with the participation of the parasympathetic nervous system, increased sensitivity of the bronchi to various inhalation irritants, as well as the presence of concomitant obstructive bronchitis, preparations of the atropine group are recommended. There is evidence of greater effectiveness of the combined use of berotek with atrovent. There are a number of complex ready-made bronchodilators, which are various combinations of the three main groups of bronchodilators with vasodilators (aminophylln complex “Polfa”, one or two tablets three times a day), analgesic (Antastman “Spofa”), expectorant and soothing drugs (asthmatol “ Spofa ”, theophedrine, etc.). Certain principles of the rational use of bronchodilators in bronchial asthma have been developed.

Hydrating and mucolytic drugs in the treatment of asthma

Hydrating and mucolytic drugs in the treatment of bronchial asthma occupy a significant place. Adequate hydration is important – frequent and sufficient intake of fluid (at least 1.5 liters per day), which helps to thin and expectorate sputum. Many clinicians prescribe (subject to tolerance) a 1 – 3% solution of potassium iodide five to six times a day (drink warm water). However, it is contraindicated in persons with intense irritation of the salivary glands, severe acne and generalized maculopapular rash. Side effects when using potassium iodide – increased salivation, urticaria, acne, rhinitis, conjunctivitis, hypothyroidism, may be serum sickness. It is not recommended for acute inflammation in the respiratory system, bronchoremia, tuberculosis in the evolutionary phase. In the absence of effect from the use of potassium iodide and contraindications for its use, bromhexine (512 days), bisolvonum inside or in the form of inhalation is advisable. In cases of concomitant purulent bronchitis with sputum difficult to separate, Nacetylcysteine ​​(used carefully, in combination with bronchodilators, can cause bronchospasm), in the absence of effect for two weeks, further use is useless. Particular care in the treatment of asthma requires the use of aerosols of proteolytic enzymes (chymotrypsin, chymopsin, deoxyribonuclease), which can cause a severe attack and even asthmatic status. As a hydrating and mucolytic drugs, herbal decoctions and infusions are used: elecampane high, angelica officinalis, coltsfoot, tricolor violets, oregano, thyme, marshmallow, which are effective only with frequent use (every 1-2 hours); ready-made medicinal plant forms: mucaltin – dry marshmallow mucus, allantoin (drug from elecampane). Sputum separation is facilitated by exercise therapy, positional drainage, vibration massage.

Abundant discharge of green-brown sputum with “casts” of the bronchi indicates the release of the distal parts of the bronchial tree. During this period, it is advisable to strengthen bronchodilator therapy, since a strong cough is possible, contributing to an increase in bronchospastic reactions.
Nonspecific antiallergic agents in the treatment of bronchial asthma include calcium preparations, heparin, antikinin agents, glyciram, angiulin preparations and native plasma, etimizol, intal, ketotifen, antihistamines, glucocorticosteroid drugs.

Glucocorticosteroid drugs in the treatment of bronchial asthma

Glucocorticosteroid drugs in the treatment of bronchial asthma are most effective. They are absolutely indicated for the treatment of asthmatic status, in which high doses are prescribed at frequent intervals. After the elimination of acute symptoms, the dose is gradually reduced to the previous level or the drug is canceled (if possible in cases of primary use). Sudden cancellation of hormones can cause severe exacerbation of bronchial asthma. Long-term supportive glucocorticosteroid therapy is indicated for severe to moderate bronchial asthma with no effect of complex treatment with non-steroid drugs with a tendency to frequent seizures and asthmatic conditions.

The minimum dose is established in the process of gradually reducing the initial therapeutic dose (usually 25-30 mg in the equivalent of prednisolone). In the future, the dose is temporarily increased with exacerbation of bronchial asthma, the need for surgical interventions, climate change, stressful situations, which make increased demands on adaptive mechanisms. If possible, an alternating hormone regimen is preferred. Long-term hormonal therapy of steroid-dependent patients can be carried out using steroid aerosols, which have advantages due to a mild systemic effect. Dexamethasone and beclamethasone dipropionate (becotide, beclamet), triamcinoloneacetonide are used. The minimum maintenance dose is 400 mcg (two breaths four times a day with prior use of bronchodilators in the form of an aerosol and orally). In moderate cases, the initial dose is 400-1600 mcg.

Injection depot preparations (Kenalog, Valon A-40, fluorocort-40) are preferred if tablets cannot be used, in particular with concomitant gastric ulcer. Long-term glucocorticosteroid therapy is combined with the introduction of anabolic hormones, vitamin C, potassium preparations, and veroshpiron. When the inflammatory process in the lungs is activated, antibiotic therapy is prescribed. In order to reduce the dose of glucocorticosteroid drugs, ethnmizole, glycyram, intal are used.

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