Treatment of asthma are called GINA, Global Initiative for Asthma    
 
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Bronchial asthma is named so based on the ancient Greek word used for heavy breathing, shortness of breath. It is a chronic inflammatory disease of airways with the participation of various cell elements. The key element of asthma is a bronchial obstruction (narrowing of the bronchi) caused by the specific immunological (sensitization and allergy) or nonspecific mechanisms. It is manifested in recurring episodes of wheezing, shortness of breath, feeling of fullness in the chest and coughing. According to the data provided by the World Health Organization, 235 million of people from around the world suffer from asthma.

For the treatment symptomatic preparations for rapid relief of symptoms and preparations for baseline therapy affecting the pathogenetic mechanism of the disease are used. If untreated, the disease can transform into a more severe condition - asthmatic status, an exacerbation of asthma that cannot be suppressed by the standard inhalators and steroids.

The major internationally accepted guidelines for the treatment of asthma are called GINA, Global Initiative for Asthma.

   
 
     
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History

First mentions about asthma can be found in ancient Greek literature, including Homer poems and Hippocrates works. The term “asthma” back then was used as general name for the diseases accompanied with troubled breathing, including troubled breathing accompanied with rapid heart rate (heart asthma) and diseases of the airways with the excretion of viscous mucus.

Further, the Greek medicine identified three forms of breathlessness: mild chronic form called dyspnea, a severe form associated with exacerbations called asthma, and severe with the attacks and worsening of breathlessness in the supine position called orthopnea.

Though asthma was known and acknowledged as a disease even in ancient times, till the mid 18th century, it was granted very little attention as the doctors of that time didn’t identify the breathlessness attacks as a single disease. The major contribution to the understanding of asthma was made by German scientists Curschmann and Leyden who systematized and described the clinical manifestations of asthma identifying a number of cases of sudden breathlessness in a separate disease. Nevertheless, the development of the healthcare at that time didn’t allow coping with the disease effectively and establishing its cause.
In the beginning of 20th century, the theory of allergic nature of bronchial asthma was first suggested by the Russian scientists Manoylov and Golubev. In 1905 adrenalin was first used for the treatment of bronchial asthma. In 1969, Russian scientists Ado and Bulatov proposed the classification of bronchial asthma on the causes of its development. Oral corticosteroids first were used in the 1950s, and selective short-acting beta 2-agonists were started to be widely used in the 1960s.

Currently, it is considered that asthma is developed as a response of the human organism to environmental factors to which such reaction is genetically inherited.

Epidemiology

The incidence of asthma in the world is from 4 to 10% of the population. In the U.S., nearly 1 in 12 people or about 25 million suffer from asthma. In general, since 1980, the number of people with asthma is growing steadily.
According to the analysis of 34 studies on the incidence of asthma in Europe, in Austria, from 1992 to 2002 the incidence of the disease in children increased 4 times. In Italy, from 1974 to 1998 it raised from 7 to 13% of total population. The number of people developing asthma in the UK, Finland, and Switzerland steadily grew till the mid-1990s and now has a bit slowed down. In Germany, the 5% of the population suffering from asthma remains unchanged through many years.

The increased incidence of bronchial asthma is associated with the environmental pollution, sedentary lifestyle, as well as advances in basis therapy. For instance, the implementation of preventive therapy and teaching of asthma sufferers in Ireland caused more than the 5-time reduction of severe asthma development in school students from 1992 to 2002.
The highest incidence of Asthma per capita is observed in New Zeeland, Great Britain, and Cuba. The scientists believe that it is caused by the fact that islands have a higher concentration of allergens both due to local flora and allergens carried by the ocean air currents.

What causes asthma?

Asthma is caused primarily by the genetic and environmental factors (climate, industrial pollution, pollen, dust, etc.) though scientists believe that modern hygiene, food, profession, and even weight can also play an important role for the disease development prognosis.

Genetic predisposition

Inherited predisposition is considered the major factor for asthma development. According to the statistics, one-third of all people with the disease inherited it from their parents. It is a frequent occurrence when mothers suffering from asthma give birth to children with the same diagnosis. In case if one parent suffers from the disease, there is a 20-30% chance that the kid will also have it. In case both parents are asthma sufferers, the chance is 75%. Various studies also include data on the frequent occurrence of bronchial asthma in both identical twins. 

Environmental factors that can provoke asthma

Environmental factors include air pollution through industrial emissions into the air, exposure to tobacco smoke, traffic pollution, increased air humidity, dangerous fumes, pollen, dust, animal dander, dust mites, and so on.
The European Community Respiratory Health Survey 2 that studied 6588 healthy people who were exposed to the effect of unfavorable environmental factors during a set period showed that 3% of participants at the end of the study had symptoms typical for respiratory tract disease. After the statistical analysis of demographic, epidemiological and clinical data, it was concluded that from 3 to 6% asthma sufferers are developing the disease under the exposure to environmental factors.

Hygiene hypothesis

The European Community Respiratory Health Committee conducted a 10-year study in 19 European Union countries proven that detergents for floors and cleaning aerosols contain substances that cause asthma development in adults in 18% of cases.

Other studies suggest that improved hygiene since the first years of life is responsible for inadequate response of immunity to allergens which in its turn causes asthma.
Other factors include the use of antibiotics in infants and cesarean section.

Profession

Professional factors that can contribute to the disease development and exacerbations in adults include the exposure to biological and mineral dust, harmful gasses and vapors. According to the research conducted by the European Community Respiratory Health Committee, people who are exposed to such factors develop a chronic cough with sputum and bronchial asthma. Even when the exposure is terminated, the symptoms and diagnosis remain.

Diet

Diet is considered another factor that can contribute to the worsening of asthma symptoms or their reduction. The studies of diets of people from France, Chile, Mexico, the UK, and Italy show that people who eat mostly vegetable products rich in vitamins, fiber, and antioxidants enjoy the reduction of the disease severity while people who mostly consume animal products on the contrary experience frequent exacerbations and severe form of asthma.

Obesity

Excessive weight, according to data collected from different studies, increases the chances of asthma development in children by 52%.

Triggers for asthma attacks

Asthma exacerbations are commonly caused by certain triggers such as low temperature, pungent smells, physical stress, chemical agents, dust, mites, pollen, smoke, fumes, and others. Besides, as triggers can serve certain medications such as nonsteroidal anti-inflammatory drugs, aspirin, and sometimes paracetamol.

Diagnosis of asthma

The diagnosis is usually made on the basis of a patient’s complaints and the specific tests.

The symptoms that are taken into account when the diagnosis is made include: coughing, shortness of breath, attacks of breathlessness, difficulty in carrying out physical activity, medical history, and clinical signs (broken speech, orthopnea position).

The doctor can perform the physical examination and check the patient for the shortness of breath and wheezing. Then, the most precise method of diagnosis follows which allows identifying the severity of the condition and the treatment. It is called Spirometry. The method measures lung function, the volume and/or flow of air that is inhaled and exhaled.

Besides these tests, a doctor can make the patient to do tests of sputum or bronchial secretions for eosinophils. Additional tests include probes for allergens to identify the main factors that cause the disease and trigger the attacks.
When not exacerbated, bronchial asthma can be present without any symptoms or have only one symptom – coughing with insignificant amounts of sputum. When no specific tests are made for the diagnosis, the disease can be misdiagnosed as bronchitis. Therefore, during the first stages of the disease development when the symptoms are mildly pronounced, it is reasonable to perform functional probes with bronchodilators that can detect the presence of clinically unexpressed bronchospasm and determine the degree of reversible airways obstruction. Other tests such as x-ray or CT can be also needed to exclude the probability of other lung diseases.

Many people who suffer from the disease are also diagnosed with Gastroesophageal reflux disease.

Can asthma be prevented?

Unfortunately, if you are predisposed to asthma development genetically, you cannot completely guard yourself from the disease. However, the frequency of asthma attacks and their severity can be greatly reduced.
First of all, for people who suffer from asthma induced by allergens, it is important to eliminate any contact with the allergen or reduce the exposure to the minimum. For example, for people with asthma attacks induced by pollen, it is advised to spend as little time outside as possible during the blossoming season, keep the windows and doors closed, wear a mask, and use air filters.

According to several studies, in houses where the measures for elimination of allergens such as mole and dust mites were undertaken resulted in lower incidence of asthma in children.

The elimination of contact with allergens and environmental pollution factors in a long-term is a necessary condition for the maintenance and enhancement of health in people suffering from asthma. The main anthropoid urban air pollution substances aggravating the disease are considered suspended dust, nitrogen oxides, sulfur oxides, ozone, atomic oxygen, phenol, formaldehyde, benzopyrene, and carbon monoxide. The elimination of these substances from the air is achieved with the help of air purifiers with HEPA and coal filters changed every month. The elimination of toxic gasses with the low molecular weight in these purifiers is achieved through the airflow interaction with water. With such preventive measure, the number of allergic crises and asthma attacks is reduced by 60-90%.

As a trigger for asthma exacerbation can act viral infections such as flu. Therefore it is advised to get flu vaccines, especially during the flu season.
People whose asthma is worsened in aspirin or nonsteroidal medications use should refrain from taking these drugs. It is also not advised to use beta-blockers, especially non-selective beta-blockers.

Management of asthma with medications

The first and the most effective method of asthma management is to avoid triggers and allergens. Unfortunately, asthma cannot be treated completely with the modern medications but there are medications that are used to suppress asthma attacks and prevent complications. For example, in asthma attacks, inhalers such as Salbutamol, Ciclesonide, Albuterol, and others are used. The inhalers are used to cope with breathlessness when an asthma attack already occurred and they cannot prevent it. They help to cope with the symptoms through the dilating of bronchi and facilitating breathing which is impaired by the spasms. The symptoms can be also reduced taking corticosteroid pills such as Prednisolone, and others.

In the most severe cases, corticosteroids are administered intravenously and hospitalization can be required.

In general, all people who are diagnosed with asthma should always have at hand inhalers and corticosteroids in form of pills. Based on the frequency and severity of asthma attacks, your doctor should create for you an optimal disease management plan which can be revised upon regular medical checks.

People with rare and irregular asthma attacks are usually recommended to use corticosteroid inhalers with the low dosage of the active substance. Patients who have attacks more than twice a week also can use the same low-dosage inhalers, leukotriene antagonist, or a mast cell stabilizer. People with frequent and even daily attacks need inhalers with the higher dosage of the active substance. In case the symptoms do not go away, they can be even hospitalized and administered corticosteroids intravenously and magnesium sulfate.

Where to buy drugs to manage asthma attacks?

Naturally, all people who have asthma have to take prescription medications and their doctors are willing to give them prescriptions for refills regularly. Nevertheless, millions of Americans prefer to buy asthma medications from online pharmacies situated abroad. First of all, this allows them to avoid frequent visits to their doctors for prescriptions. Secondly, they can find the same drugs that are sold in the U.S. several times cheaper in other countries and even with shipping cost these drugs are less expensive than the brand-name medications sold in conventional drugstores.

 
 
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