In asthma, inflammation continues throughout the lower respiratory system. Therefore, the future in the treatment of this disease are pressurized inhalers delivering drugs to the tiniest bronchi and bronchioles, the doctors said at the press meeting on Tuesday.
About 300 million people worldwide suffer from asthma – a chronic inflammatory disease of the lower respiratory tract, and in Poland – 4 million. In the disease, there is a strong narrowing of the bronchial lumen, which is accompanied by symptoms such as shortness of breath, coughing attacks, wheezing.
Asthma can lead to death and disability, but only if it is undiagnosed, neglected and poorly treated – emphasized prof. Andrzej Fal, head of the Department of Internal Diseases and Allergology of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw. Thanks to new drugs, people who suffer from it can lead normal, active lives today.
Bronchoconstriction in patients with asthma is caused by two mechanisms – chronic inflammation in the lower respiratory system and bronchial smooth muscle contraction. Therefore, the treatment of the disease is based on two inhaled drugs – a glucocorticosteroid, which relieves the inflammatory process in the bronchi, and a long-acting beta2-agonist that relaxes them.
As emphasized by prof. Fal, it is best to administer them in one inhaler – instead of two separate ones – because it significantly increases the effectiveness of treatment. Firstly, studies show that both drugs work synergistically, i.e. they enhance each other’s effects, and secondly, when using one inhaler, patients better comply with medical recommendations. In Poland, the availability of these preparations for patients is good due to the reimbursement.
From the data cited by prof. Andrzej Emeryk, head of the Department of Lung Diseases and Pediatric Rheumatology at the Medical University of Lublin, shows that only 36 percent. patients who use two different inhalers use them correctly and as prescribed by their doctor. In the case of one inhaler, this percentage is even 92%. In his opinion, the ease of use is also an important condition for the correct use of inhalers.
Asthma is a disease that reigns in the entire lower respiratory system, i.e. larger and medium bronchi, but also in bronchioles and alveoli, with very intense inflammatory processes in the smallest airways – noted Prof. Halyard. It was first noticed in 1946, but it was only described 24 years ago, and the knowledge about it among doctors began about 10 years ago, he recalled.
Physicians’ awareness in this regard is necessary because it determines the selection of inhalers that can deliver drugs to the smallest bronchi, the diameter of which does not exceed 2 mm. Even distribution of the anti-inflammatory and relaxant drug throughout the bronchial tree increases the effectiveness of asthma management. In my experience, however, only 30% of people have knowledge about it. doctors – noted prof. Halyard.
As he explained, the diameter of the smallest bronchioles ranges from 100 to 300 micrometers, i.e. 0,1-03 mm. In order for the drug to get there, it must be administered in an appropriate aerosol – said Prof. Halyard.
According to prof. Emerics, such opportunities are provided by pressurized inhalers based on a CFC-free carrier (i.e. hydrofluoroalkanes, HFA). They enable the administration of a drug solution in the form of homogeneous and superfine particles, which are about half the size of those used in other inhalers. Besides, the cloud of such an aerosol moves more slowly and does not require the patient to coordinate inhalation from the inhaler with inhalation.
Research shows that the pressurized inhaler provides the highest drug deposition in the lungs – 66 percent. the dose of the drug getting into the respiratory system spreads in the central, and 34%. – in the peripheral airways, i.e. in the smallest bronchi.
In the future, probably all inhaled asthma treatment methods will be based on the formula of superfine particles – concluded Prof. Emeric. (PAP)