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Medicines
Medicinal therapy
The following active substances have proved themselves at the treatment of asthmatic troubles:
A) Antiinflammatoric medicines
1. Glycocorticosteroide
work antiinflammatoryc, antiphlogistic, antiallergic, increasing the mukoziliäre clearance immunosuppressively, impeding the production of inflammation mediators; they restore the sensitiveness of the beta-adrenergic receptors of the bronchial tubes in addition in the state asthmaticus for beta sympathomimetic which is often reduced temporarily so that mention beta 2-sympathomimetic badly! The maximal effect also enters the intravenous gift only after a latency time of several hours!
Systemic application:
The intake should be carried out because of the natural cirkadiane rhythmic at longer-term oral glycocorticoid-therapy early in the morning. When exceeding the cushing threshold dose of 7.5 mg prednisolon has to be raked with side effects. Indication for a systemic application:
- increase of the asthma troubles despite optimal dosage of bronchodilators and steroids
- increasing application of bronchodilators by the patient
- waste of the Peak-Flow values < 60% of the individual best worth
Indication to the intravenous steroid hormone therapy:
State asthmaticus: only short time stosstherapy with initial 100-250 mg Prednisolon intravenous, at obstruction 50 mg of every 4 hours falling off. At a clinical recovery further reduction and rearrangement to an oral therapy. Under consideration of the symptomatic the patient's minimum dose diminution by 5 mg. When falling below 20 mg Prednisolon corticoids are added by 10 mg, it is tried when falling to do without oral clycocorticoide completely. The maximal effect also enters the intravenous gift only after a latency time of several hours!
Inhalativ application as a measuring out aerosol:
Inhalativ steroids are wholesome very well, hardly have systemic side effects and work of all medicines most strongly antiphlogistically. They are therefore the decisive column of the antiasthmatic therapy. You show their effect, however, only after 1 week and therefore aren't appropriate to the acute therapy. clycocorticoide are always used intravenously in the acute asthma attack.
| Substance |
Medicine name |
Dosage in mg/day middle dosage higher dosage into magnesium |
| Beclomethason |
Sanasthmax® |
250 (1 piston stroke) 1000/1000 - 2000 |
| Flunisolid |
Inhacort® |
250 (1 piston stroke) -1000/1000 - 2000 |
| Budesonid |
Pulmicort® |
200 (1 piston stroke) -800/800-1000 |
| Fluticason |
Flutide® |
125 (1 piston stroke) -500/500-1000 |
| Dexamethason |
Fortecortin® |
Oral gift, dosage to symptomatic |
| Prednisolon |
Decortin H |
Oral gift, dosage to symptomatic |
| Fluocortolon |
Ultralan® |
Oral gift, dosage to symptomatic |
Side effects: Candida attack (yeast mushroom) of the oral cavity, rare hoarseness. Systemic side effects are < 1 mg improbable at daily doses. Contraindication: Lung TB, bacterial respiratory systems infections.
Tips for the application:
- At the same total dose the 2 are x minimum gift x the 4 just as effective as minimum inhalation.
- The use of inhalation helps (spacern) improves the intrabronchial disposition (distribution and effect) of the medicines.
- Mushroom settlement of the mouth and pharynx can be usually avoided by inhalation of the medicines in front of eating and following mouth irrigation.
- The therapy with glycocorticoid isn't a short-time but a consistent longer-term base therapy to stop the inflammation reaction durably.
- Using beta 2-sympatomimetic first and inhaling after used broncholyse corticosteroid at an available spasticity graded from the point of view of time.
| Substance |
Medicine name |
Dosage in mg/day middle dosage higher dosage into magnesium |
| Cromoglycic acid |
DNCG®, Cromohexal®, Intal® |
4 x minimum 2 piston strokes |
| Nedocromil |
Tilade®, Nedocromil® |
2-4 x minimum 2 piston strokes |
| Ketotifen |
Zaditen® |
Initial 1 x minimum 1 capsule in the evening, after 2 x minimum 1 capsule |
2. antihistamines/mast cell stabilizers
Is only prophylactically effective (unsuitable for the attack therapy). By antihistamines the messenger substance excessively poured out becomes histamine, neutralized responsibly for the allergic troubles so to speak. The distribution the antihistamines, also called mast cell stabilizers, stabilize the mast cells, these tip out and impede the histamine during an allergic reaction the mast cells the tissue so of histamine from into. This primarily leads to the going down of the nasal mucosas, furthermore an anti inflammatory effect enters. The preparations are well and rapidly effectively primarily at troubles to eyes and nose (tears and nose flow, sneezing stimulus) however also to the prevention of light asthmatic troubles. It is advantage of the antihistamines which are used today and modern that they cause no more tiredness unlike the shapes (antihistamines of the 1st generation) used earlier. Antihistamine preparations are offered as eye drops, nose sprays and into tablet shape as well as aerosols for inhaling (see table.)
B) bronchodilators
Several different types of receptors of which only the beta-adrenergic receptors which are stimulated by beta 2-sympathomimetic lead to a bronchodilatation (dilatation of the bronchial tubes) are found in the bronchial musculature.
1. beta 2-sympathomimetic
You are the most strongly effective bronchodilators and increase the mukociliar Clearance, i.e. the remove of mucus from the bronchial tubes by endogenous mechanisms . they, however, don't have any effect on the inflammation reaction or the bronchial hyperactivity.
Short effective beta 2-sympathomimetic
Working duration 4-6 hour effect admission already after 30 seconds, 1 minute. You are employed to the immediately therapy of the asthma attack. They only should when required, not regularly be taken in the step therapy of the asthma
| Substance |
Medicine name |
Dosage |
| Fenoterol |
Berotec |
1-2 piston strokes at dyspnea (0.1 mg) |
| Salbutamol |
Sultanol, Salbuhexal |
1-2 piston strokes at dyspnea |
| Reproterol |
Bronchospasmin |
1-2 piston strokes at dyspnea |
| Terbutalin |
Bricanyl |
Is available as an emergency medication on the ambulance, subcutan is injected |
Long effective beta 2-sympathomimetic
Working duration 8-12 hour effect admission only after 10-20 minutes they therefore aren't suitable for the immediately therapy of the asthma attack but to the prophylaxis of primarily nightly asthma attacks (alternative to a retarded theophylline) as of step III of the 4 step therapy score, . Formoterol points unite rapid effect admission as salmeterol.
| Substance |
Medicine name |
Dosage |
| Formoterol
|
Foradil, Oxis |
1-2 piston strokes at dyspnea |
| Salmeterol |
Serevent, Aeromax |
1-2 piston strokes at dyspnea |
| Clenbuterol |
Spiropent |
Hardly therapeutic meaning, working admission only after approx. 30 minutes |
Side effects: Tachycardia (heart lawn) and palpitation, ventricular dysrhythmias, blood pressure increase, triggering of an angina pectoris at a coronary heart condition, trembling, hyperkinesia, sleeplessness contraindications: KHK, hypertrophic obstructive cardiomyopathy, tachyarrhythmia, thyroid hyperfunction etc..
Tips for the application:
The choice is the application as a measuring out aerosol since the effect on the short effective ones occurs within a minute - methods.
The use of inhalation helps (Spacern) improves the intrabronchial spreading and effect of the medicines -- (without approx. 10-15 % of the medicine only reach the bronchial tubes, 80-85 % remain into mouth and pharynx space or be swallows).
One only needs approx. 10% of the dose of the oral preparations -- in form of the measuring out aerosols.
It the danger of the unchecked application by the patient insists in which after inhalation of > 4 piston strokes the side effects (primarily cardiac symptomatic) outweigh the effect increase considerably. Passes endangering increasely, if a patient therefore uses up more than 10 piston strokes/24 hour minimally, then and the complete treatment plan must be checked and interpreted more high around a step.
2. theophylline /-derivative (Methylxanthine)
Ttheophyllines are the bronchodilators most frequently used worldwide. Bronchospasmolytic mast cell stabilizing increase the mukoziliäre Clearance and stimulate centrally the respiration and the respiratory musculature work you. In addition, after newer findings they have one anti inflammatory working component. The effect of the theophylline adds itself up at a heavy obstruction to that one of the beta 2-sympathomimetic. If the medical treatment by beta 2-sympathomimetic that is doesn't suffice, theophylline preparations are used in addition. You are particularly suitable for the therapy and prophylaxis of nightly asthma attacks, in addition for the intravenous therapy of the acute asthma attack.
The danger theophyllines have a low therapeutic index, tachykarden the therapeutic area is between 8-20 mg/l of (plasma mirror) above 25 mg/l insists of cardiac dysrhythmias and seizures! Quite a long working times because of a slower metabolization in the liver
- patients > 60 years
- feverish infections
- liver lesion
- right-sided heart failure
- taking of certain medicines (e.g. cimetidine) or caffeine
Dose reduction!
The therapy should therefore always be checked by plasma mirror tests.
Oral application of theophylline preparations
The daily dose is 400-800 mg distributed division e.g. on 2 doses orally be given to Retard tablets under a creeping dosage, (in the morning, in the evening) 1/3 2/3, as a rule.
Intravenous application of theophylline:
200 mg slowly (over 5 minutes) intravenous e.g. Solosin ®; Infusion medical treatment in the clinic: case has no-one theophylline pre-medication taken place to 800 mg in 500 ml of infusionssolution/24 hour under plasma mirror controls.
| Theophylline long effectively oral |
Bronchoretard, Bronchoparat, Afonilum, Euphyllin |
400-800 mg/day on 2 doses distributed |
| Theophyllin intravenous |
Solosin |
200 mg over 5 minutes |
Side effects: Hyperkinesia, sleeplessnesses, headaches, tremor, hyperventilation, heartburn, nausea, vomiting, diarrhea, tachycardia (heart lawn), extrasystoles (extra beats, extrasystole), tachykarde dysrhythmias.
Contraindications: fresh myocardial infarction, tachyarrhythmia, hypertrophic obstructive cardiomyopathy and others
3. parasympatholytics (anticholinergics)
Anticholinergics are considerably more weakly effective than beta 2-sympathomimetic, can be combined with them, however, well, through what the dose of the beta 2-sympathomimetic can be reduced. Anticholinergics are used rarely as a monotherapy, however well effective ready combination preparations are offered with beta 2-sympathomimetic. You have no effect on mucus production or mucoziliar Clearance. Since the working duration of the anticholinergics is 3-6 hours, it is suitable for the prophylaxis of nightly asthma attacks. The effect admission is some minutes. You are protectively effective also well at triggered by ß blockers bronchoconstriction and reflex bronchoconstriction arranged at vagal by dust, cigarette smoke, mechanical stimuli etc..
| Substance |
Medicine name |
Dosage |
| Ipratropiumbromid |
Atrovent |
3 x 1-2 piston strokes/day |
| Oxitropiumbromid |
Ventilat |
3 x 1-2 piston strokes/day |
| Tiotropiumbromid |
Spiriva |
1 capsule = 18 mg 1 x day |
| Ipratropiumbromid + Fenoterol |
Berodual |
3 x 1-2 piston strokes/dayg |
Side effects: rare: Dry mouth.
C) Antileukotriene = Leucotrienantogonisten
New antiasthmatic working principle: Important inflammation mediators are bronchoconstrictoric effect hindering of the leucotriene (this) strongly. Leucotrienantogonisten impede the immediate reaction, the delayed reaction and, the bronchial Hyperreactivity, have an additive effect to beta 2-sympathomimetic and can save glucocorticoide. You are peaceable well, have side effects very rarely and are used at a light asthma of medium difficulty as an addition medication. In addition, you are means of the choice at the analgesic asthma.
1st 5-Lipooxygenase Inhiitoren
2nd Cyst-LT1 antagonists = "Lukaste"
Only prophylactic application (as of step III), not suitable for the therapy of the acute asthma attack. Effect by blocking of inflammation mediators and reactions.
| Substance |
Medicine name |
Dosage |
| Montelukast |
Singulair |
10 mg/day oral |
Side effects: Head jokes, abdomen troubles, rare exanthema etc. contraindications: Pregnancy, silent time, allergic reaction etc..
These informations may be considered a substitute for a piece of medical advice in no case. The content of health-illness.com doesn't can and may be put into any case to make diagnoses or carry out self medical treatment independently.
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