The role of the GINA structure in the management and control of bronchial asthma. Bronchial asthma: clinical recommendations, federal and international, for children (2016) GINA remains updated

Bronchial asthma - pathology dikhalnyh nobles, Scho has a chronic character. At the core of the disease is burning As a result of the development of hyperreactivity of the organs of the reaction.

Before developing bronchial asthma report, feeling the pressure in the breasts at night and from the wound.

Find special documents of science partnerships, in which, in the backyard and in the style of vision, recommendations from the emergence and illusion of illness can be sought. Such organizational materials are stored for additional assistance to practical doctors, who are engaged in drugs young people, Including bronchial asthma.

Organizaciya, yaka virashuy the problem of bronchial asthma at the international level - tse gina... Zahvoryuvannya has a nevilikovny character and is developed in all the light of people of any kind.

The organization has broken down the rules of medicine, which can be seen by the doctors of the United States. In 2016, the international structure presented a new approach, which promoted the path of relief from getting sick based on the best Danish methodologies... The GINA plan for breaking up with the possibilities for practical implementation in any health protection system

The last update GINA

In 2016, the following are included in the GINA buli document:

• frequent dry cough;
• Seeing health in breast cancer;
• whistling dikhannya;
• keenness;
• almost anxiety, panics;
• zadishka.

Also in 2016, the organization of the bullet was opened. Ailments extend into a few phenotypes, which grow behind the step I will show the patient... See the following types:

1. Allergic. The whole phenotype is most popular. In some of the most common types, the easiest way is to find it, so it is also very simple. For lykuvannya stasis ІKS - corticosteroid ingalants.
2. Non-allergic. The ІKS preparations do not give rise to the type of asthma.
3. Asthma with a start. Wonder in the main woman of mature vik.
4. Bronchial asthma in patients who suffer from obesity.
5. Phenotype, for any characteristic syndrome of impaired respiratory tract. Winikak as a result of frequent and frequent treatment of bronchial asthma.

lykuvannya

The main method for treating asthma is є. There are five steps of the severity of the disease, for the skin of those it is shown especially the treatment. At the same level of severity, becoming ill, it begins as a stage of stagnant therapy.

Uwaga! Through the skin of the month, it is necessary to assess the effectiveness of therapy. If the symptoms of asthma do not go away and the symptoms of asthma become more acute, then it is recommended to use the therapy, passing until the onset of the descent.

As soon as the threat changes, and the patient's self-esteem grows for 3 months, then the therapy will change. In such a drop, the number of ІKS decreases from 25% to 50% through the skin 3 months. However, for such a croc it is necessary to change the patient's respiratory dysfunctions and we will sing, which is not safe for health. On the other hand, it’s not recommended to use the IKS switch.

According to the accessibility of the step, the organization of the GINA has broken down the treatment for the cutaneous step:

1. On the first occasion, there is beta-2 antagonism. The preparation may take a short period of time and is shown to patients with an easy stage of becoming ill. Symptoms of asthma in such people are more than two times per month and smoothed out in case of apparent illusion, however, until the drive without such abuse continues.
2. On the other hand, they are overweight, like they may high risik zagostren. It is recommended to take a lower dose of IGCS (Ingestion Glucocorticoids) and CDBA (short-term beta2-agony), if additional drugs are needed, to relieve asthmatic symptoms.
3. Therapy of the third step is the transfer of low doses of IGCS, combined with LABA (pre-prepared beta2-agony) and CDBA. However, with sharpening such a strategy is not effective.
4. On the fourth gathering it is recommended to combine medium and high doses of IGKS, LABA and KDBA, Orієntuyuchis on the consumer's consumer.
5. At the fifth step, the anti-IgE drug Omalizumab is required. This treatment is shown to patients who were not helped by therapy maximum doses Ingalants

In such a rank, the main method of the treatment of є, in some cases in the days of LABA. This therapy will help you to finish your day.

Important! At the moment, there are no drugs for the repeated reduction of bronchial asthma. However, є medications that relieve symptoms і reduce the allergen.

There is also a diagram of the course of treatment for a few steps. The qia scheme includes offensive recommendations:

• it is necessary to read the patient to the basic self-help tips, to show symptoms of illness for an hour;
• required lіkuvannya sutnіh ailmentsі release of high-pitched bells;
• to come to respect and non-drug therapy, for example, physical options.

Bronchial asthma - the most common. At the same time, carry out the diagnosis smoothly - asthma has symptoms similar to a cold.

Catch asthma from cold help vimir temperatury- with asthma and admission not to be spared. Symptoms:

• seeing a lick from the nose in case of wound awakening, which is supervised by the channes;
• a strong dry cough through the spine of years after awakening;
• bellows of vologo and big severe cough in the afternoon;
• manifestation of symptoms of asthma through the addition of a dib, until the end of the hour, the cough swells with an attack of a similar nature.

Until the symptoms themselves are reported:

• attack-like cough while sleeping;
• zadishka;
• the parting of them;
• vice in the area of ​​the breasts;
• difficulty breathing;
• dry cough when inhaled through the mouth;

It is focused on increasing the development of allergies. For prevention bazhano viddavati perevagu thoracic treatment and insoluvate the child with the flow of Tyutyunov dima.

Russian medical sportsmanship is a powerful strategy for the treatment of bronchial asthma. Document, in a certain way the main approach to diagnostics and treatment of pathology, Є "Federal Clinical Recommendations for Diagnostics and Treatment of Bronchial Asthma". The main recommendations are based on the points of the GINA strategy.

So, in a vіtchiznyа documentі it is also possible to get rid of the steps of the part before it becomes ill. Viznachennya obsyagu therapy lie down at the steepness key manifestations asthma. Respect for a reversal correct techniqueіngalyatsіy, clarification of diagnoses and conditions of suppression of diseases. All the thoughts you need to get through to the onset of the attack. So the very next step is to control and factor in the midst of the midst, to spur a significant infusion on the effectiveness of therapy.

About diagnostics

Diagnosis of pathology in older adults is carried out on the basis of the emergence of common symptoms. Symptoms and stages of obstruction of the psychic nobles vimag of accurate estimates... In such a rank, I will receive again and again cool picture getting sick.

To, for the development of asthma diagnoses, the following should be applied:

• breath, stuck in the chest and cough, wheezing;
• symptoms in case of physical navantazhennі, pіd flood allergens, low temperature;
• show a sign of an ailment by receiving aspirin;
• atopic illness, presence in anamnesis;
• recession factor.

There are also signs that can change the symptoms of ailments:

• stained and darkened eyes;
• regular normal results roundness of breast cells;
• productive cough, which is very chronic in nature;
• snake to the voice;
• manifestation of symptoms as a result of a cold;
• hearts become ill.

Bronchial asthma is a chronic illness of a trivial nature, in which I mean the role of the decongestant factor and the injection of allergens. Head therapy є control over ailments. Correct drug administration can only indicate fahivets for retinal diagnostics. However, krim drug therapy it is important to give respect i correct food Let's see the physical options and minds of the midst of the community.

bronchial asthma

N.M. Nenasheva

The role of national clinical recommendations as one of the key tools for regulating health care and quality of medical aid was revealed, and the history of development of clinical recommendations for bronchial asthma in the Russian Federation was established. The Federal Clinical Recommendations for the diagnosis and treatment of bronchial asthma in 2016 are detailed on the basis of the distributions. A new version of these recommendations is available on the website of the Russian Respiratory Association.

Key words: bronchial asthma, federal clinical recommendations (revised in 2016).

As a matter of fact, the tools for regulating the maintenance and the quality of medical assistance include: guidelines; Health Technology Assessment; standards, including medical and economic; transcripts lykarsky zasobiv; insurance programs and laws. At the end of a series of clinical recommendations, they take a leading position, more often they need to be constantly updated, non-tendential, informatively available, confirmed by professional production of the certificate. Minister of Health Protection of the Russian Federation V.I. Skvortsova in the Interview "Rossiyskaya Gazeta" in 2014 means that the Ministry of Health has recognized an ineffective robot according to the folding of standards for providing medical assistance - it is not a matter of paying for help for them. Now the Ministry of Health is focused on paying for medical aid for clinical-statistical groups and on the basis of national clinical recommendations.

Natalia Mikhailivna Nenasheva - Dr. honey. Sciences, Professor of the Department of Clinical Allergology, Federal State Budgetary Educational Institution of Higher Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Health of the Russian Federation, Moscow. Contact information: [Email protected]

№ З23-Ф3 "About the basics of protecting the health of the Russian Federation"For the first hand of the patron of the minister of health protection

Table 1. Estimation of the level of evidence

Rivne proofs Description

1 ++ metaanalysis of high quality, systematic look at PCI or PCI with even low risk of systematic grants

1+ Clearly conducted meta-analyzes, systematic surveys of PCI or PCI with a low risk of systematic grants

1 meta-analyzes, systematic reviews of PCI or PCI with a high rhizik of systematic grants

2 ++ Visokoyakisnі systematic look at the doslіdzhen vipadok-control or cohort doslіdzhen. High-quality pre-treatment vipad-control of abnormal cohort pre-sensitivities with an even low risk of efficacy or systematic pardons and middle age of causal interconnection

2+ Good pre-testing and diagnostics control for cohort pre-diagnostics from average risk factors for systematic changes and average results of causal interconnection

2 Pre-admission control-monitoring of abnormal cohort dosage with high risk of effects of change of systematic pardons and average imaging of causal interconnection

3 non-analytical messages

4 Dumka experts

The designation here and in the table. 2: PCI - randomized control of the disease.

1999- -2004 rocky

Development and implementation of the Clinical 2nd edition of the recommendation on the BA of the clientele became part of the recommendation of the formulary system

4,5 4,0 3,5 3,0 2,5 2,0 1,5 1,0 0,5

1995 1998 2003 2006 2009 2012 _Godi_

Small. 2. Dynamics of mortality from BA.

RF I.M. Kagramanyan No. 16-05 / 10 / 2-190 dated 01/18/2013 r The Ministry of Health Protection of the Russian Federation of nosological forms and methods of therapy.

At the 2013 office of the academician of the Russian Academy of Sciences, Professor A.G. Chuchalin by the experts of the Russian Respiratory Association (RRO). The whole fact is not vipadkovim, more PPO already has little information on the stem and robots with clinical recommendations on bronchial asthma (BA) (Fig. 1). As a result of the introduction of a number of key recommendations in our country, according to the data of the RRO, there is an increase in mortality from asthma, the incidence of asthmatic status medical aid(Figure 2-4).

Current clinical recommendations for BA (2013) storage of evidence-based medicine positions. Methods for analyzing evidence included looking at published meta-analysis and systematic looking at tables of evidence. The proof base for the recommendations was the publications, which went to the Kokranivsky Library, the bases of the EMBASE and MEDLINE, and 5 rockets became the basis for the message.

Table. 1 and 2 are presented the assessments of the level of evidence and recommendations, which were fixed by the experts with the accumulated clinical recommendations.

0 1995 1998 2003

1995 1998 2003 2006 Rocky

strength Description

And Shonaimenche one metaanalysis, a systematic review of PCI, estimates of 1 ++, immediately stagnant to the whole population and demonstrates a consistent result, or a group of proofs, including high results

In the group of proofs, which includes the results of the pre-test results, estimated at 2 ++, without a median level to the whole population, and demonstrate the extraordinary efficiency of the results in order to extrapolate the results, assessed at the rate of 1+

A group of proofs, which includes the results of pre-tests, estimated at 2+, without average stagnation to the whole population, and demonstrate the extraordinary efficiency of the results, or extrapolated proofs, assessed at 2 ++

D Prove Rivnya 3 or 4 or Extrapolated to Prove with Doslidzhen, estimated yak 2+

Changes and additions, broken down by experts in 2016 key recommendations according to BA, the problems of getting sick, including the value of BA, have come into play:

"Bronchial asthma є heterogeneous illnesses, which are characterized by chronic flames dyhlnyh nobles, in the presence of respiratory symptoms, such as wheezing, sluggishness, numbness in the breasts and coughing, as it warms up for an hour and intensity and manifests itself at once with the variable obstruction of the dysfunctional.

Following the GINA (Global Initiative for Asthma - Global Strategy for the Treatment and Prevention of Bronchial Asthma), the experts of the PPO developed the heterogeneity of asthma, as it manifests itself in different phenotypes, many of them can be quite different CLINIC PRACTICE:

Allergic bronchial asthma;

Non-allergic BA;

BA with a new opening;

BA with fixed bronchial obstruction;

BA in patients with obesity.

directed short characteristic The number of AD phenotypes and the assessment of the importance of their vision for the optimization of the diagnosis, treatment and prevention of AD.

At the distribution "Diagnostics of BA in children", for children of 2-5 years, a table has been added to indicate that it is possible to detect BA in children of 5 years and younger. In addition, in the childbirth "Dodatkovi methods of diagnostics" an algorithm for setting the diagnosis of asthma in children has been added and the paragraph "Keys are shown for

the direction of the child at the age of 5 years and younger on the basis of diagnostics for the future ".

Rozdil "Degree of BA severity"

The severity of asthma in patients who recognize the disease, retrospectively assess the symptoms necessary for the control of symptoms and aggravation of the therapy. Vona may be assessed, if the patient disables treatment with drugs for trivial control by holding decalcaps. With the achieved control of the therapy, there can be changes. The severity of BA is not a static characteristic and can be changed over the course of months and years.

How serious is the severity of BA, if the patient takes regular therapy and is directed to control the disease?

Mild BA - the BA, as it is good to control the therapy steps 1 and 2, so that only a small amount of short-lived P2-agonists (CDBA) for the need practice and especially shown) (Fig. 5).

Moderate asthma is a type of asthma, as it is well controlled by therapy stage 3, so that low doses of IGCS / LABA (long-acting P2 agony) (div. Fig. 5).

Important BA is the BA, which is the therapy of stages 4 and 5, to high doses of IGCS / LABA (stage 4), and / or targeted therapy (anti- ^ E-therapy (^ E - immunoglobulin class E)),

Submit a comprehensive therapy prior to follow-up

Change the overall therapy to the minimum, so that the control is applied

step 1

Bazhana therapy:

for demand Combination of CBDBA and ipratropium bromide

Інші options: Low dose ІHKS

step 2

Bazhana therapy:

Low dose IGCS

Інші options:

Antagonism of leukotrine receptors, low doses of theophilin #

KDBA for demand *

step 3

Bazhana therapy:

Low dose IGCS / LABA

Інші options:

Medium to high doses of IGCS Low doses of IGCS + anti-leukotrienic drug Low dose IGCS + theophilin of advanced vivilnenny

step 4

Bazhana therapy:

for high doses of IGKS / LABA

Інші options:

Give thyrotropic ** High doses of IGCS + anti-leukotrienic drug High doses of IGCS + theophilin spov_lnenny vivilnennya

step 5

look out

Dodatkov

Tiotropium Omalizumab

Інші options:

Give low doses of oral corticosteroids

For consuming KDBA or low doses of IGKS / formoterol ***

Small. 5. Stage therapy of BA. * Regularly prescribed CDBA, as well as long-acting P2-agonists (LABA) are not recommended for every hour of regular IGKS therapy. ** Tіotropіy in іngаlory, sho to revenge roschin (Respіmat), registrations in the Russian Federation for the treatment of patients older than 18 years, as well as іGKS і DDBA, for those who do not reach the control of hypoxia when they suffer *** I will also treat patients with fixed combinations of budeso-nid / formoterol or beclomethasone / formoterol in low doses, which can be consumed quietly as a drug for relieving symptoms, so that in the regimen for the second # For children 6-11 years of age, theofilin is not recommended and shorter 3 - medium dose of IGKS. (By.)

і / or with low doses of systemic glucocorticosteroids (SGKS), in order to save control (step 5) (div. Fig. 5), or BA, as it becomes uncontrolled, unimportant to therapy.

Experts have indicated that ailments with a certain degree of BA can be light, medium-heavy, or important. In a number of ailments with intermittent BA, the importance of clutter up the life zagostrennya on aphids of trivial asymptomatic periods with normal legenevoy function.

How is the development of uncontrolled and the importance of BA? Likary needs to diagnose the most frequent problems, if the diagnosis of an important BA will be seen below:

Unclean technique of ingalyatsiya (up to 80% of ailments);

Low cunning to likuvannya (up to 50% of ailments);

Pomilkovy diagnosis of BA;

The presence of the patient's illnesses, which is injected into the overload of the BA;

Trivial contact with a trigger (allergen in case of suspected sensitization, professional trigger).

Rozdil "Likuvannya stable BA"

For children "Understanding about the control of bronchial asthma", the current cycle of BA therapy was formed:

Achievement and improvement of good control of asthma symptoms lasting a trivial hour;

Minimizatsion of risiks of maybuttal aggravations of BA, fixed obstructions of psychic paths and irrelevant side effects of therapy.

Equivalent control and factor of risk of burning, the formation of fixed obstruction and unnecessary side effects in BA according to OShL 2016.

An additional update has been made to support the diagnosis formulation. In the diagnosis of the fault, the following statements are made:

Ethiology (where this has been established);

Stage of gravity and level of control;

Suppressive discomfiture, which can be inserted into the overrun of the BA;

as well as when it is obvious - sharpening due to the significance of the degree of gravity.

Apply the formulation to the diagnosis.

Rozdil "Stage therapy of bronchial

asthma in children, adolescents and grown-ups "

The main principle of the treatment of BA is the stage of the development of the therapy during the day-to-day control and / or the manifestation of the factors in the risk of the burning out and the decrease in the treatment of the therapy with the achievement of the stabilization and the saving of the control

The vibration of the therapy, of the kind of the first step (div. Fig. 5), is due to the turn of the clinical manifestations of BA.

It’s also ineffective, because it’s because of a shortcoming, because the car is guilty of re-verifying the technique of ingestion, before taking into account the significance, clarifying the diagnosis and evaluating ailments; only when you see the minds of your minds, you go to the therapy (go to the scabbard up the hill) (div. fig. 5).

Two important additions to malnutrition in children about frequent BA therapy in older adults. The mode of a single inhaler, fights for two fixed combinations - budesonid / formoterol and beclomethasone / formoterol, which can be used by patients who are repairing from the age of 3 (the therapy is stagnant Fig. 5). up to ІГКС or ІГКС / ДДМА on steps 4 and 5 (div. fig. 5). In patients in the group, the treatment of the single inhaler regimen is significantly reduced and the same level of asthma control at altogether low doses of IGCS in proportion to the fixed doses of IGCS / DHA is prescribed. demand (strength of recommendation A). Lack of asthma control, the presence of frequent (2 or more on ric) and / or important aggravations of asthma in older adults and adults, who are eligible for therapy in steps 4-5 (IGCS + LABA, including those based on ІHCS in high doses) should be indicated for the recognition of thio-Trope Respimat (strength of recommendation A). Krim

In addition, the presence of a patient with BA who has received IGCS therapy is less likely to receive LABA ( nezazani efekti, Prototype showing either individual intolerance of P2-agonists) to serve as indications prior to the recognition of the thyotropy Respimat as an alternative to LABA (strength of recommendation B).

In adolescents after stage therapy of asthma in children of morbidity and onset of wrinkles. For example, at step 1, it is clear that in children up to 5 years, regular therapy can be started with low doses of IGCS, in children of 2 years - monotherapy with anti-inflammatory drugs, cromones.

Nebulizer therapy (3 6 months - budeso-nid suspension, 3 6 months - also beclomethasone di-propionate), 1 month - fluticasone propionate with spacers. For children "Step 3" it is corrected: "Small vibration (children older than 5 years): low / medium doses of IGCS, or in combination with LABA, or with antagonists of leukotroinovyh receptors". For children "Stage 4" it is added, for those with severe allergic BA, uncontrolled intake of high doses of IGCS in combination with DABA, repaired from the 6-point wick to see the signs of malnutrition.

In order to achieve and control the disease when taking a solution, the dose of any drug is reduced in the first place and because of the rapidity, it is necessary to reduce the severity of BA, side effects lіkuvannya, the triviality of receiving the flow dose, reaching a positive effect and overwhelming the patient. Reducing the dose of IGKS will be guilty of being at the link with the possibility of the development of the sharpening. With sufficient control, the dose of IGS can be reduced by approximately 25-50% of the skin 3 m / s.

We have a whole lot of new additions to the type of BA therapy.

Allergen-specific immunotherapy (Asita) can be a therapy for vibration in children older than 5 years, adults and adults, as well as allergy is a leading role, for example, in BA with allergic market conditions. In the Danish hour, the ASIT form is pedagogical and sublingual. Sublingual and pediatric ASIT may be victorious in patients with mild and moderate BA, associated with allergic rinokonyunctivitis, for the reason, that BA should be monitored by pharmacotherapy) (the strength of the recommendation.

Table 3. The level of severity for acute asthma

The stage of gravity of sharpening Criteria

Pomіrno important One of the offensive: improvement of symptoms; PSV -50-75% of the shortened abo rorachunky result; Adjustment of the frequency of administration of preparations for medical aid> 50% or additional consumption in the form of a nebulizer; no awakening, sensitization of symptoms of asthma and the use of medications in medical aid

Vazhke One of the offensive: PSV -33-50% of reduce the value; frequency of dichannya> 25 for 1 hour; pulse> 110 beats / hv; unkindness of vimoviti phrase on one vidiha

Life-threatening BA One of the offensive: PSV<33% от лучших значений; 8р02 <92%; Р0, <60 мм рт. ст.; а 2 г " нормокапния (РаСО2 35-45 мм рт. ст.); "немое" легкое; цианоз; слабые дыхательные усилия; брадикардия; гипотензия; утомление; оглушение; кома

BA, close to fatal Hypercapnia (PaCO2> 45 mm Hg) І / for the need for mechanical ventilation of the lungs

Designation: PaCO2 - partial grip of carbon dioxide in the arterial blood; Pa02 is a partial squeeze in arterial blood. Here i in fig. 6: Вр02 - the level of arterial blood hemoglobin formation by the pulse oximeter method.

As a result of the ASIT, a concomitant clinical effect of asthma symptoms and steroid sparing effect (strength of recommendation B) is clear. As of today, ASIT is not recommended for monotherapy of BA, in the case of BA and a single clinical manifestation of respiratory allergy (strength of recommendation D).

Vaccination. Respiratory viral infections, flu sprinkling, can lead to important signs of asthma aggravation.

Patients with moderate and important asthma should undergo antihypoxia vaccination for puppies (strength of recommendation D). However, the patients are guilty but the vaccination does not reduce the frequency and severity of BA (recommendation strength A).

Patients with BA, especially children and people who are abducted, may have a high risk of pneumococcal diseases.

However, we recommend pneumococcal vaccination for bronchial asthma (strength of recommendation D).

Rozdil "Likuvannya zagostren BA"

Tsey razdіl іstotno expanded. Given the number of aggravated asthma: aggravated BA (synonyms: attack bronchial asthma, or asthma gostra) є episodic growths, coughing, wheezing, or stuck in the breast cancer, which helps to improve the mode of anxiety. For a sharpened BA, a decrease in peak performance is characteristic (PSV) and a forced video in 1 second (OFVH).

Sharpening can develop in patients with already seen as a diagnosis of asthma or the first manifestation of asthma. An aggravated BA can be diagnosed in any patient regardless of the severity of the disease, ale the stench is a frequent manifestation of a clinical manifestation in patients with difficult-to-control BA.

The speed of the development of a sharpened BA can be varied for children - from decilkokh hilin, or it is up to 10-14 days, so it’s just like an hour will be allowed to sharpen - from 5 to 14 days.

It is caused by the cause of the aggravation, the middle most important є specific and nonspecific triggers (allergen, respiratory viruses, aeroplutants). Prior to the factors of asthma aggravation, the following are included:

Symptoms of uncontrolled BA;

The duration of the IGKS therapy, nasty cunning to the liking;

Nadmirne victoriannya KDBA;

Low OFVH, especially<60% от должного;

Significant psychological and social and economic problems;

Zovnishnі vplivi: kurinnya, infusing an allergen with sensitization;

Disorders: rhinosinusitis, gastroesophageal reflux ailment, pidtverzhena kharchova allergy;

obesity;

Eosinophilia sputum or blood;

vagіtnіst;

Epizodi intubation or intensive therapy through acute asthma;

> 1 important warning in the last 12 ms.

Table. 3, the criterion of the severity of the sharpening is imposed. At the stage of severity, it is difficult to lay down a lot of therapy. During the hour of testing, regularly assess the criteria for the severity of the aggravation, the growth of PSV, the frequency of the heart rate, the frequency of the reaction and the indicators of pulse oximetry.

Patient turning from the sharpening

Get over it, so that the BA is sharpened Take the patient to the groups.

Light or medium heavy

non-threatening

Check out the therapy:

KDBA 4-10 inhalation through DAI + spacer (or through a nebulizer)

Prednizolone 40-50 mg per os

Kisneva (tsilova 8p02 93-95%)

POGIRSHENNYA

Therapy is trivial for the signs of CDBA, which is necessary

Assessment of responses to therapy after 1 year

POGIRSHENNYA

Aimed at stationary treatment for non-practical assistance. Until the transfer of the next therapy KDBA + ipratropia bromide, kissen and SGKS

POLIPSHENNYA

Due to the asthmatic status, there is a reason for the state of mental deficiency in cases of acute asthma. In modern classifications, "asthmatic status" is equivalent to the understanding of "life-threatening BA" and "BA is close to fatal".

Mainly go in from the test to turn on the BA burner (in the order of

nya and in the fallowness of the severity of stinging): oxygen therapy, repeated inhalations of bronchial holiness of the shvidkoy diya, early stasis of the SGS.

The goals of the disease are greater than the reduction of bronchial obstruction and hypoxemia and the possibility of further relapses.

In this distribution, all preparations are shown in detail, which can be used for stopping acute BA. It is not possible to use the optimal and most economical method of rapid reduction of bronchial obstruction in case of mild and moderate aggravations (from 2 to 4 years). Systemic glucocorticosteroids are followed by vicoristovuvati during the treatment of all firestorms, except for those who are the least (proof of evidence A).

Even more important are the additions є algorithms for the administration of the patient from acute asthma at the outpatient (Fig. 6) and hospital stages.

Some options for BA, including professional BA, as well as BA therapy in special groups of patients (

steams) are saved in the quality of the recommendations.

Updated in 2016, the version of the Federal Clinical Recommendations for the diagnosis and treatment of bronchial asthma is available on the PPO website.

List of Literature

1. Veronika Skvortsova: Likuvati a patient for the standards is not possible. Available at: http://www.doctorpiter.ru/articles/10094 Posilannya active as of 01.12.2016.

2. Chuchalin A.G., Aisanov Z.R., Belevsky A.S., Bushma-niv A.Yu., Vasil'va O.S., Volkov I.K., Geppe N.A., Knyazha N.P. ., Kondyurina E.G., Kolosova N.G., Mazitova M.M., Malakhov A.B., Meshcheryakova M.M., Nenasheva N.M., Revuchi-kina V.A., Shubin I.V. ... Federal Clinical Recommendations for the diagnosis and treatment of bronchial asthma. M., 2016 rock; 55s. Available at: http://spulmo.ru/download/ Asthmarec3.pdf Possession active on 12/01/2016.

Documents GINA and GOLD are fundamental recommendations for medical and practical patients who are engaged in diagnostics and diseases of bronchial asthma and chronic obstructive lesions.
The main changes, which were included in the certificate GINA and GOLD on the cob, have been presented in this statistic 2016 r

Tіotropіya bromіd in pіdlіtkіv

In the given hour, the addition of thyrotropy to the treatment of bronchial asthma on Crots 4 will expand to patients in patients ≥12 years of age due to acute anamnesis.

Anti-IL-5 therapy

At Crots 5 to additional options for treating important asthma, as it is not possible to control additional therapy, given by Croc 4, the addition of mepolizumab (a drug based on monoclonal antibodies to interleukin-5) for patients

fluticasone furoate

Fluticasone furoate is added to the table of doses of inhalational corticosteroids for older adults: low dose - 100 mcg, visoka - 200 mcg. Fluticasone furoate / vilanterol in the smallest dose of supplements before the combination of the combination of ingestion corticosteroids and β 2 -agonists of the trivial action at the Croce 3.

Step down therapy

A decrease in the dose of inhaled corticosteroids (by 25-50% over a 3-month interval) in order to achieve good control of bronchial asthma in the Danish hour by the time of proof A.

Asthma in the minds of other resources
(Including and in the ruined lands)

Additional recommendations are needed for economically effective approaches to diagnostics and treatment of bronchial asthma in the minds of neighboring resources. Buv adding material about social and economic factors, which can be added to the development and manifestation of discomfort.

Asthma-COPD pereschresny syndrome

Prior to the choice of pharmacotherapy for patients with asthma-COPD perekhresny syndrome bulo, it was given about the need to improve the development of side effects, including pneumonia.

First and foremost prevention of asthma

Information about the mother's day before the hour of her vaginosity has been given, in the wake of the proof that it is not uncommon to accept such products as milk and arachis. It is also about maternal obesity and increased maternal weight until the hour of vaginosity.

The grease of that plisnyava

There is presented evidence that the power and color are factors in the development of asthma. Riven A is assigned to the evidence that the decline in color and color in the booths will reduce the symptoms of asthma and the rapid consumption of drugs in older patients.

іnshі changes

Information about allergen-specific immunotherapy, vaccination and bronchial thermoplasty has been added to the main text of the standard. Earlier, won Bula is presented only in the online supplement.

Intercourse of corticosteroids
It may seem that the risk of ingestion of corticosteroids in patients with COPD with a low risk of burning can be safe for thinking that patients are unnecessary on the use of antiretroviral therapy for bronchodilators.

rehabilitation

It was established that it was the minimum of classically significant changes in the hour of rehabilitation є -0.4 bali for the CCQ indicator (COPD Control Questionnaire).

Combined preparations of inhalational corticosteroids і β 2 -agonіstіv trivaloi diї for a one-time payment for doba

At the end of the last week, fluticasone furoate / vilanterol (100/25 mcg) was injected 1 time to add fluticasone propionate / salmeterol 2 times and to dob (250/50 mcg); 2-agonies of trivial diy for reception once per day, without showing significant indications of efficiency in terms of drugs for consumption twice a day.

Systemic corticosteroids for the treatment of zagostrenia

Information about those systemic corticosteroids, which are designated for the treatment of COPD flare-ups, reduce the incidence of symptoms and the risk of therapeutic failure, reduce the function of legends, speed up the triviality of overcoming
The effect of stopping the warning signs of a fire hazard during the analysis of common data, and it is shown that systemic corticosteroids during the treatment of fire attacks can speed up the frequency of repeated hospitalizations over the course of the onset of 30 days.

depression

Depression is a factor in the risk of incomplete rehabilitation programs.

Dodatkova information: www.ginasthma.org і www.goldcopd.com

pidgotvala Natalia Mischenko

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Bronchial asthma (BA) is a global problem, the urgency of which in the world of growth. BA is called one of the ailments of civilization, some of which are widespread in a daily suspension to gradually grow. As of today, according to statistics, there are nearly 300 million ailments for bronchial asthma, of which 75 million live in Europe. In Russia, the breadth of BA is also within the reach and reach of the official data of 7 million, and in Kazakhstan, close to 1 million ailments are recorded, but in reality, the number is even larger.Zh.b. Ispaeva, MD, DSc, Professor, President of AACI, Head Department of Allergology and Clinical Immunology KazNMU IM. S. D. Asfendiyarova, parent child allergologist of the Ministry of Health and Social Development of the Republic of Kazakhstan. As well as analyzing the disease of the population of Kazakhstan by the classes of ailments, then, by the way, the disease of the organs of the disease (pneumonia, chronic bronchitis and bronchial asthma) will obstruct 2.5 million individuals and the third of them is bronchial asthma. First for everything, BA is always a chronic affliction, as it is possible to control, but it is impossible to complain. In GINA 2014, a new asthma was presented to rock, as it casts on a heterogeneous nature. There will be a history of respiratory symptoms. Characteristic symptoms of asthma are wheezing, dullness, difficulty in dysfunction, feeling of congestion in the breasts, cough. The smell of growth after the hour appears, the frequency and intensity of the manifestation at once with the variable obstruction of the respiratory pathways. In this rank, the main characteristics of BA according to GINA 2014 є onset:- Firing of the dysfunctional paths. - Symptoms of asthma occur sporadically, while the flaring of the dysfunctional paths has a chronic character. serednogo kalіbru .- ignition Process Got unіversalny character at rіznih klіnіchnih forms of asthma are not deposits i od vіku.- Osoblivostі BA scho vazhko pіddayutsya lіkuvannyu: zbіlshennya number neytrofіlіv, urazhennya bronhіv drіbnogo kalіbru i bіlsh virazhenі strukturnі іzmenenіya.- non-negotiable Bronchial obstruktsіya Mauger vіdobrazhati strukturnі Changes of dykhalny nobles in chronic asthma. Forward, the BA phenotype is induced in GINA, as it can be easily achieved by identifying:- allergic bronchial asthma;
- non-allergic BA;
- BA with a new opening:
- BA with fixed obstruction of the lower dichny nobles;
- BA in ailments with obesity. The identified phenotypes of asthma include: allergic asthma, which is most typical for children, non-allergic asthma (if asthma does not occur due to allergy). In sputum ailments of non-allergic asthma, there may be eosinophils, neutrophils - the stench often does not appear on the ICS, as well as asthma with an onset of ear, asthma with obesity, asthma.
In such a rank, the main changes in the GINA were introduced behind the offensive strains:- the name of the BA's assistant; - Confirmation of BA diagnosis, including patients who receive therapy with BA drive; - a spilna assessment of the control of symptoms and factors in the risk of unpleasant BA symptoms; - a comprehensive approach to therapy, which will preserve individual therapy for all characteristics of the patient, including factors in the patient's risk, bazhan and the patient himself, etc .; - I have a lot of respect for the efficiency of the treatment. The correctness of the technique of storing the medicinal product, the adherence to the treatment, which does not allow the treatment of the therapy; - the onset of a patient's knowledge in case of death will be based on self-behavior from a written plan for the first time before the first medical aid, if necessary, quick help. vary in the process of therapy. - BA in children. Sharpening BA. COPD and BA. Syndrome of overlap. In GINA 2014, the first descriptions of the syndrome of recurrent asthma with chronic obstructive obstructive disease (COPD), so ranks ACOS. One of the newest signs of GINA, asthma is not a heterogeneous disease, which is characterized by chronic incapacitation of dickheads. COPD is an affliction, which is possible for anyone to get it and get it out of the way. It is characterized by persistent intermittent flow, as it evolves to progress and is tied to the development of chronic igniters on the basis of pathogenic pathogens or gases. In low patients, hypertension and concomitant illnesses can be inflicted on the severity of COPD. Asthma-COPD Cross Syndrome (ACOS) is characterized by severe intercourse with AD flow with severe symptoms, so you should be affected by COPD. The urgency of the problem is related to the fact that the prognosis of patients with signs of asthma in the presence of COPD is higher, less if only one diagnosis is evident: they are characterized by more parts and the importance of increased visibility, more and lethality. The prevalence of the syndrome of recurrent BA and COPD in the middle of patients with chronic incapacitation of dysfunctional nobles varies from 15 to 55% and is very much in evidence and statis. One hour diagnosis of asthma and COPD with a doctor - 15-20% of patients with chronic diseases of the respiratory tract. COPD In accordance with the new recommendations for diagnostics of asthma, it should be primed on the basis of the history and physical conditions. Earlier, we were victorious about the method of determining the amount of nitrogen oxide in the second place, which is seen. Vin is not an accurate biomarker in AD and does not give an accurate clinical picture. Biomarkers for specific Ige-antibodies and screening tests can only be done by additional methods in allergy diagnostics. The diagnosis of BA has changed a lot. The leading methods in the diagnosis of BA have become anamnesis, physical pre-condition. It is necessary to use a function of the leg (spirometry, including turnover, more important than a good quality, but it can also be useful if there are resources), the value of an atopia, an alternative, specific FeNO, eosinophilia of sputum) and the value of bronchial hyperreactivity (nonspecific bronchial provocation: metacholine, physical right). lykuvannya. First of all, the food about the improvement of the therapeutic treatment, the patient needs to revise the technique of the inhaler and the adaptability to therapy, non-pharmacological methods, to modify the factor of the disease, suppression. The management of asthma in children younger than 5 years and older than 6 years is the same as in the GINA -2014 strategy. Oscillations of asthma are chronically more fervent of illicit nobles, I am guilty of assessing them, analyzing clinical signs (symptoms, normal awakening, treatment of drugs, intercourse of activity). And for these signs, we talk about control over BA. It is the manifestation of asthma control because of the need for a doctor and the need for a change in therapy. It is very important for the selection of adequate therapy that it is superbly important to correctly assess the level of control over BA. As the key points in the recommendations of the GINA-2015 are of particular importance: value, factor of risk and control, so that we are guilty of taking BA and we cannot control the time. , to that it is even more important to reduce the development of the sharpened BA. How to assess the degree of BA severity? Tilki retrospectively, beruchs until the respect of lіkuvannya, as it is necessary to control the disease. Evaluation of the effectiveness of the treatment for the duration of the skin 3-6 months. As soon as the therapy was indicated, it was effective and the effect is stable, it is possible to change the intensity of the drug infusion. In case of ineffectiveness of stagnant therapy, so that I won’t diminish the clinical course and functional indicators, we should switch to a general treatment gap. English corticosteroids are used in the Danish hour as the most effective anti-pyretic drugs for the treatment of persistent bronchial asthma. There is one peculiarity, if I would like to be brutalized: even earlier in milder forms of asthma, it was not possible to consume in the ingestion steroids and to reach the short-term congestion of short-term sympathomimetics, then the congestion of mild BA stages of congestion It is indicated that when there are low doses of ingestion of glucocorticosteroids, there are symptoms that occur more than 2 times per month; In case of primary asthma due to aggravated aggravations, a short course of inhalational glucocorticosteroids is indicated, which are guilty of being consumed regularly, so that it is necessary to get ahead of the aggravated, so that the aggravated disease does not progress. Consider the cob therapy with control drugs to be changed in 2-3 months, the correction of therapy and the review of nutrition and the change in therapy - in 3 months. These recommendations were lost without changes, as in GINA-2006, 2010, 2012 BA treatment, based on the control of symptoms and minimization of mayy symptoms, do it step by step, in a few stages. On 1 and 2 crocs, a low dose of inhaled glucocorticosteroids is used, and even on the 3rd and 4th crocs, a combination of IGCS / LABA (more beta2-agony) is used, a low, high As soon as up to the 5th period, BA control is attainable, in which case the following drugs are recognized. Thus, the basis of therapy is the ІHKS і іх combination with LABA, which will prevent the symptoms of allergic inflammation. The given strategy knew its image in the last edition of the GINA programs (2006-2015), for the same reason, repairing in 3 steps, the sign of one of the combined therapy options is obov'yazkovim. PoetaNe vimagan therapy:- Navchannya patsієnta samostіyno spravlyatisya of symptoms astmi.- Lіkuvannya modifіkuyutsya faktorіv i suputnіh zahvoryuvan (napriklad, kurіnnya, ozhirіnnya) .- Rekomendatsії nemedikamentoznoї terapії (napriklad, fіzichnih right znizhennya crowbars, uniknennya sensibіlіzatorіv) .- Zbіlshennya obsyagu terapії, Yakscho Je symptoms nekontrolovanі , sharpening risik_v. Before tsogo Etap neobhіdno perevіriti dіagnoz, tehnіku vikonannya іngalyatsії i prihilnіst patsієnta to terapіі.- Zmenshennya obsyagu terapії, Yakscho symptoms kontrolyuyutsya protyagom months at 3, funktsіya legenіv stabіlna 3 mіsyatsі, nіyakih respіratornih іnfektsіy Absent, prisutnіy nizky rizik obostrenіy.- Zmenshennya obsyagu ІKS 25 -50% skin 3 months, which is very cheap and safe for the patient. As a result of the development of the ICS, the development of asthma (level of evidence A). ) scho viznachayut obsyag farmakoterapіі.Osnovnim principle lіkuvannya BA Je stupіnchasty pіdhіd Zi zbіlshennyam obsyagu terapії under control vіdsutnostі i znizhennі terapії at dosyagnennі i i zberezhennі stabіlnogo control vіdsutnostі faktorіv rіska.Rezhіm єdinogo іngalyatora for dopomoga ІGKS / CDF maintained upstream Vibor Je y i grown pіdlіtkіv from BA at 3 and 4 steps from the intake of fixed low / medium doses of IGCS / LABA with additional CDBA according to the need.