Asthma is a disease caused due to inflammation / chronic inflammation of the respiratory tract with features such as periodic acute attacks, shortness of breath, wheezing easily, accompanied by cough and sputum hypersecretion, as well as 'wheeze' in patients who have severe asthma. Number of patients with asthma from year to year has increased quite high, so that appropriate treatment is necessary and proper in order not to cause death.
Asthma can occur due to the increased sensitivity of smooth muscle around airways somebody normal airways compared to non-specific stimuli is inhaled from the air, which in healthy people do not give a reaction in the respiratory tract such as changes in temperature, cold, air pollution (cigarette smoke), etc. . Moreover, it can also occur due to allergic reactions, or because of respiratory tract infections that can cause inflammation / airway inflammation that further narrowing in asthma patients again.
PENTATALAKSANAAN THERAPY
Therapeutic target in asthma patients using inhaled corticosteroids are airway inflammation and asthma symptoms. Asthma therapy here aims to inhibit or reduce inflammation and respiratory tract and to prevent or control asthma symptoms, making asthma symptoms diminished / disappeared and the patient remains able to breathe properly.
Asthma therapy strategies can be divided into two non-pharmacological therapy (without medication) and pharmacological therapy (with drugs).
Non-Pharmacological Therapy
For non-pharmacological therapies, can be done with regular exercise, such as swimming. Some think that by swimming, symptoms of shortness of breath will be increasingly rare. This may be due to swim, patients are required to take a deep breath-length, which serves for breathing exercises, so that the respiratory muscles become stronger. In addition, over time the patient will get used to the cold air, thereby reducing the incidence of asthma symptoms. But this exercise should be done gradually and with the condition of the patient.
Moreover, it can be given an explanation to the patient in order to avoid or keep away from known factors that can cause asthma, as well as the handling of what to do if an asthma attack occurs.
Pharmacological Therapy
As for the pharmacological therapy, can be divided into two types of treatment are:
* Quick-relief medicines, the treatment used to relax the muscles in the respiratory tract, allowing patients to breathe, to ease breathing, and is used as an asthma attack (asthma attack). An example is a bronchodilator.
* Long-term medicines, the medication used to treat inflammation of the respiratory tract, reduces edema and excessive mucus, provide control for a long time, and is used to help prevent the onset of an asthma attack (asthma attack). An example is corticosteroids inalasi form.
Asthma medications used include bronchodilators (simpatomimetika: salbutamol, metilsantin: theophylline, anticholinergics: apratropium bromide), corticosteroids (prednisolone, budesonide, etc.) and other medicines as an expectorant (guaifenesin), mukolitik (bromheksin), antihistamines ( ketotifen), and antileukotrien (zafirlukast). To maximize the treatment of asthma are commonly used combination of drugs. Asthma medications are available in various dosage forms, ie oral, parenteral, and inhalation. But that will be discussed further here is a form of inhaled corticosteroids.
Inhaled corticosteroids
Corticosteroids are found in several dosage forms including oral, parenteral, and inhalation. The discovery of fat-soluble corticosteroid (lipid-soluble) such as beclomethasone, budesonide, flunisolide, fluticasone, and triamcinolone, corticosteroids makes it possible to deliver this to the airways with minimal systemic absorption. Inhaled corticosteroids have the advantage that it is administered in small doses directly into the respiratory tract (local effects), so it does not cause serious systemic side effects. Usually, if the use of inhaled corticosteroids is not sufficient then administered orally, or administered in conjunction with other drugs (a combination of, for example with bronchodilators). Inhaled corticosteroids can not cure asthma. In most patients, asthma will recur several weeks after stopping use of inhaled corticosteroids, although the patients had used inhaled corticosteroids at high doses for 2 years or more. Single inhaled corticosteroids are not effective for first aid on a severe acute attack.
Here are examples of inhaled corticosteroids are available in Indonesia, among others:Generic name trade name in Indonesia Preparations Dosage Forms and DosageBeclomethasone dipropionate Becloment (beclomethasone dipropionate 200μg / dose) Inhalation Aerosol Inhalation aerosol: 200μg, 2 times seharianak: 50-100 mg 2 times a dayBudesonide Pulmicort (budesonide
100 mcg, 200 mcg, 400 mcg / dose)AerosolSerbuk inhalation aerosol inhalation Inhalation: 200 mg, 2 times sehariSerbuk inhalation: 200-1600 mg / day in terbagianak dose: 200-800 mg / day in divided dosesFluticasone Flixotide (fluticasone propionate50 mcg, 125 mcg / dose) Inhalation Aerosol Adults and children> 16 years: 100-250 mg, 2 times sehariAnak 4-16 years: 50-100 mg, 2 times a day
Dose for each individual patient may differ, so it should be further consulted with the doctor, and do not stop the use of corticosteroids in person, must gradually with dose reduction.
MECHANISM OF ACTION
Corticosteroids work by blocking the enzyme phospholipase-A2, thus inhibiting the formation of inflammatory mediators such as prostaglandins and leukotrienes. In addition it serves to reduce mucus secretion and inhibit the inflammatory process. Corticosteroids could not relax the airway smooth muscle directly, but by reducing the reactivity of smooth muscle surrounding the airways, improving airway circulation, and reduce the frequency of severity of asthma if used regularly.
INDICATIONS
Inhaled corticosteroids is regularly used to control and prevent asthma symptoms.
CONTRAINDICATIONS
Contraindicated for patients with hypersensitivity to corticosteroids.
SIDE EFFECTS
Side effects of corticosteroids ranged from a low, bad, until death. This depends on the route, dose, and frequency of administration. Side effects of oral corticosteroids is greater than the inhaled. On oral administration may cause cataracts, osteoporosis, inhibit growth, affect the central nervous system and mental disorders, as well as increase the risk of infection. Inhaled corticosteroids are generally more secure, because the side effects often arise locally as candidiasis (yeast infection because candida) around the mouth, dysphonia (difficulty speaking), sore throat, throat irritation, and coughing. These side effects can be avoided by rinsing after use of inhalation preparations. Systemic side effects may occur with high doses of inhaled corticosteroids that inhibited growth in children, osteoporosis, and karatak.
SPECIAL RISKS
In children, the use of high doses of inhaled corticosteroids showed a slightly slower growth in children, but asthma itself can also delay puberty, and there is no evidence that inhalation kortikosteriod can influence adult height.
Avoid the use of corticosteroids in pregnant women, because it is teratogenic.
HOW TO USE inhalers
* Prior to breathe, get rid of all of the breath, as much as possible
* Take the inhaler, then shake
* Hold the inhaler, the inhaler so that the mouth is located at the bottom
* Put the inhaler with a distance less than two fingers in front of the mouth (do not put our mouths are too close to the mouth inhaler)
* Open your mouth and take a deep breath slowly and deeply, along with pressing the inhaler (the time when a deep breath and press the inhaler is an important time for the medication to work effectively)
* Immediately after the drug came in, hold breath for 10 seconds (if it does not take hours, you should count silently from one to ten)
* After that, if it still needed to breathe again repeated as outlined above, according to the rules of use prescribed by a doctor
* When finished, rinse or gargle with water to prevent possible side effects....
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