Bronkhoobstruktivny states to which generally bronchial asthma and the chronic obstructive pulmonary disease (COPD) belong are very widespread pathology among people. Consequences of uncured or incorrectly treated obstructive pulmonary pathology is development of a pneumosclerosis and emphysema, with the subsequent disability and the patient's invalidism. This pathology takes also important place in structure of the reasons of mortality. If at children mainly acute forms of bronchitis and bronchial asthma prevail, then adults to the first place on weight of complications and the adverse forecast have already a chronic obstructive pulmonary disease, one of the most frequent reasons of which is a smoking.
It is necessary to understand that the main difference between bronchial asthma and HOBL consists in reversibility of obstruction — at bronchial asthma it is completely reversible and bronchial tubes of the person out of an asthmatic attack do not differ from bronchial tubes of healthy.
Broncholitic drugs take an important place in schemes of treatment of this pathology. The inhalation form is most preferable to intake of such drugs as it allows to deliver quickly medicinal substance to a target organ and to avoid the expressed system effect.
Classification of bronchodilatory means:
Bronchodilators:
Neurotropic drugs (stimulators of adrenergic receptors and anticholinergic drugs)
Methylxanthines
Glucocorticoids (system and inhalation)
The means preventing release of biologically active mediators of allergic reactions (NPVS, antihistaminic drugs, inhibitors of leukotrienes)
Expectorant and mucolytic drugs
It is necessary to notice that from all listed drugs only neurotropic drugs (adrenergic agonists and holinoblokator) and also glucocorticoids have the inhalation form. We will also talk about them further.
Adrenergic agonists affect adrenoceptors and are subdivided into non-selective (affect all adrenoceptors) and selective (work only on beta-2 receptors of bronchial tubes. In a pathogeny of bronchial obstruction disturbance of an adrenoreaktivnost of bronchial tubes is very important factor as in development of bronkhoobstruktivny pathology reduction of number of receptors, decrease in their sensitivity to catecholamines, disturbance of associativity of receptors to an adenilattsiklazny system is observed.
Non-selective adrenergic agonists, affecting all types of adrenoceptors, in addition to a bronkhodilatation cause the mass of side effects, such as increase in heart rate, increase in arterial blood pressure, premature ventricular contraction, perspiration, a tremor and excitement. Therefore these drugs are used only in case of need the emergency stopping of an attack. Example of an inhalation non-selective adrenergic agonist: izoprenalin.
Selective adrenergic agonists differ in primary action on beta-2 adrenoceptors of bronchial tubes in this connection their side effects are expressed much less, but also the efficiency is slightly lower in comparison with non-selective drugs. Drugs of this group are divided into two views: short-range and dlitelnodeystvuyushchy. Salbutamol, Ventodisk, Terbutalin, Astmopentum, Fenoterolum, Dienergy industry belong to the first group of drugs (Fenoterolum plus kromolin). Dlitelnodeystvuyushchy adrenergic selective agonists are provided by the following drugs: Salmeterol, Formoterol, Volmaks, Saltos.
At aggravation of HOBL the mode of purpose of high doses of short-range adrenergic agonists is used, at the same time it is important to appoint inhalation drug by means of the nebulizer, otherwise he often does not achieve the objectives.
Anticholinergic drugs show the effect due to blockade of cholinergic receptors and the subsequent inhibition of action of a parasimatichesky impulsation on a bronchial tone. Muskarinovy receptors which block these drugs, are responsible for spastic effects of bronchial tubes and their number does not change with age, unlike adrenergic. The most often used drugs: ipratropiya bromide (Atrovent), Troventol and oksitropiya bromide. Also there are combined drugs consisting of anticholinergic drug and the selective beta-agonist (Berotek). Advantages of a combination therapy include strengthening of effect of each of drugs, simultaneous action on the central and peripheral departments of a tracheobronchial tree and also decrease in frequency of side effects at the expense of a smaller dose of each of drug.
Inhalation drugs of glucocorticoids found very broad application as they have no expressed systemic action. They are used as basic therapy of bronchial asthma due to the expressed antiallergenic action. The most widespread drugs: Beclomethasone, Ventit, Flunizolid, Budesonid and others.