Despite many efforts to improve the care of patients with bronchial asthma in the last decade, most patients in the world have not seen any advances in this field. Many patients do not receive even elementary therapy.
The WHO working group that developed the global Initiative for bronchial asthma (GINA) identified as a priority, the development, evaluation, and adaptation of the GINA program to local conditions. This initiative should be applied in different healthcare institutions all over the world. It is a confirmed fact that the majority of patients with asthma worldwide live in areas with inadequate medical capacities and limited financial resources.
Additionally, strict scientific protocols for the management of asthma patients and international guidelines often do not fulfill the expectations. There is a “gap” between the stated goals and the results achieved. Every effort must be made to consistently examine approaches, which would guarantee the introduction of effective BA treatment options.
The efforts of specialists around the world including online pharmacy specialists from Secure Tabs are aimed at improving the most significant aspect of patient management – basic therapy. The effectiveness and safety of the most often used anti-inflammatory drugs (iGCS) and the pharmacotherapeutic regimen of their administration should be carefully evaluated.
It is a fact that the largest costs of different health care systems are associated with chronic diseases. Its uncontrolled course increases the share of costs. A new healthcare organization should reorganize the process of hospitalization, resuscitation, emergency care and other expensive types of care. Chronic, long-term diseases require frequent hospitalization that requires great expenses. The reorganization will help reduce costs and provide high-quality BA therapy.
When assessing costs, pharmacoeconomic approaches are applied, which differ at different decision-making levels for the planning and distribution of limited healthcare resources. According to leading experts working in the development of pharmacoeconomic approaches, their use of resources can change the cost structure of BA in general. For this, it is necessary to determine the direction, form, structure, extent of changes in the medical care system. Despite the high cost of effective prevention, the cost of inadequate treatment is significantly higher. Appropriate treatment of bronchial asthma is a problem for patients, healthcare providers, and healthcare organizations. Health organizers and public organizations should take some measures to truly minimize social and economic damage from BA.
GINA recommends new approaches to BA treatment
The Global Initiative for Asthma (GINA) gives new recommendations for the treatment of bronchial asthma. They are fundamentally different from those that have been used in clinical practice for years. The main recommendation they made is to stop the use of fast-acting drugs. GINA is talking about short-acting beta2-agonists – SABA. These drugs have been first-line drugs in the treatment of bronchial asthma for the past 50 years.
In order to control the symptoms of bronchial asthma and reduce the risks of developing severe exacerbations, GINA recommends that all adults and adolescents with this pathology adhere to a treatment that includes the use of inhaled corticosteroids.
For the treatment of mild bronchial asthma, GINA recommends the use of low-dose formoterol, a long-acting beta-agonist. If formoterol is not available, then the combined use of a short-acting beta-agonist with low-dose inhaled corticosteroids is recommended.
Peak flowmetry in the diagnosis and effectiveness evaluation of BA treatment in children
Diagnosis of bronchial asthma and its severity is based not only on anamnestic data, the results of functional studies, in particular, peak volume expiratory flow (PEF).
It is possible to measure PEFR with a spirometer. In wide clinical practice, the method of peak flowmetry is widespread to determine this indicator and monitor asthma. This is due to the relative simplicity of the technique and the low cost of the equipment.
Peak flowmetry allows you to solve the following problems:
- diagnosis of bronchial asthma and determination of bronchial obstruction nature;
- monitoring of bronchial asthma;
- assessment of the therapy effectiveness chosen on an individual basis.
Monitoring asthma using peak flowmetry allows you to optimize the treatment options. It can be used to determine the reversibility of bronchial obstruction, evaluate bronchial hyperreactivity, the severity of the disease, identify mechanisms that provoke bronchospasm, predict exacerbation of bronchial asthma, plan treatment, evaluate its effectiveness.
The peak flowmeter is a small portable device for measuring peak expiratory flow rate (PEFR). In order for the information obtained by peak flowmetry to be complete and reliable, peak flowmetry should be performed for at least 2 weeks, at least 2 times a day with an interval of 12 hours – in the morning (7 am- 8 am) and in the evening (7 pm – 8 pm).
To obtain reliable results, it is important to observe the following rules:
- measurements must always be taken in the same position of the patient (preferably standing straight);
- before measuring, the peak flow meter should be pointed at zero;
- the peak flow meter should be held horizontally without touching the scale;
- taking the peak flow meter in the mouth and tightly clutching the mouthpiece with the lips, the patient should make the most powerful and fast exhale;
- it is necessary to ensure that the tongue and teeth do not cover the mouthpiece of the peak flow meter;
- after recording the result, the peak flow cursor must be returned to its original position;
- the measurement should be repeated 2 more times, select the best result and enter it in a special schedule.