9 modern asthma medications

Review of the best according to the editors. About the selection criteria. The the material is subjective, is not advertising and is not serves as a guide to the purchase. Before purchase is needed consultation with a specialist.

The correct diagnosis and treatment of bronchial asthma is serious the problem of modern pulmonology. Asthma – Multifaceted disease. On the one hand, it’s a chronic inflammation bronchial tree, with an abundance of symptoms such as shortness of breath on expiration, i.e. expiratory dyspnea, various wheezing and cough, chest tightness.

Such symptoms appear from time to time, there are various intensity, and are associated with exacerbation of bronchial asthma, which in a typical form proceeds as an attack of suffocation, alternating with interictal periods.

Many patients with bronchial asthma have a pronounced connection with allergies. This is the most common type of asthma that determined already in childhood. In such patients from the earliest age is determined by drug or food allergies, atopic dermatitis, diathesis. In the sputum of these patients severe eosinophilia occurs, and in people with an allergic type there is a good response to hormonal treatment, especially in the form of inhalations. There are other types of bronchial asthma, which we will not dwell on here. It requires long time, comprehensive diagnostics, including spirometry, immunological and allergological studies.

Asthma Risk Factors

However, in all cases it seems extremely important. identify environmental factors that may be involved in the occurrence of bronchial asthma. In addition to allergens, such as dust mites, animal hair, fungi, plant pollen, – it is very important to identify infectious factors, such as frequent viral diseases. Occupational hazards are important as well harmful volatile substances. It is tobacco smoke, sulfur dioxide, products combustion of gasoline and diesel fuel.

Wrong risk factor seems to be nutrition. Asthma patients usually consume a lot of foods, which have the highest degree of culinary processing, and the output is low in antioxidants. Such patients consume little in eating vegetables, fruits, fiber and fatty fish. But fast food, smoked meats, canned food predominates.

In the diagnosis of bronchial asthma in adults, it is very important to pay attention to the following symptoms, which significantly increase the likelihood of such a diagnosis. These are the following symptoms:

  1. the appearance of congestion in the chest;
  2. suffocation;
  3. coughing, especially at night and early morning hours;
  4. provocation of such symptoms by cold air, physical load or various allergens;

increased symptoms of suffocation and cough after taking acetylsalicylic acid, or aspirin, beta-blockers, which are used for stopping tachycardia and treating coronary disease heart

  1. the presence of asthma or atopic diseases in relatives;
  2. a large number of dry, wheezing;
  3. low spirography, such as peak speed expiration
  4. a large number of eosinophils in the peripheral blood.

The treatment of bronchial asthma is a stepwise process, and that’s all five consecutive steps are known in modern medicine treatment. What is the treatment?

About planned and emergency treatment of asthma

Treatment of bronchial asthma (especially remitting and mild) begins with the first step. If it is not effective, then amplified therapy, and the patient is transferred to the second stage. Similar, if the treatment at the second stage is ineffective, then gradually drugs are replaced, other drugs are added, doses are increased, and, in the end, the patient is selected a specific treatment regimen.

Once at this stage control is established over during asthma and eliminated seizures, you can gradually reduce the volume of treatment until it is achieved optimally minimal set of drugs at which or in general seizures do not occur, or they occur no more than once in a week. This treatment of bronchial asthma is called selection. basic therapy. It is carried out, selected, and optimized for a particular patient is not in a state of seizures.

However, there is a second side to the treatment of bronchial asthma. This is actually a relief of an attack of bronchial asthma, which held a little by other rules. This is a connection of two sides therapy – relief of an attack and treatment in the interictal period and forms the basis of modern therapy for bronchial asthma.

Consider the main drugs that intended for emergency care and relief developed attack of bronchial asthma. Needless to say that these drugs are selected in conjunction with a pulmonologist should always be at hand with the patient so that apply them at any time of the day when disturbing symptoms.

All drugs described in this material are not are related to the rating, and their sequence is dictated only a form of presentation of the material. The name of the drug the drug consists of an international non-proprietary Names (INN). Then comes the name of the original a drug that was first marketed under own name. Usually this is the most expensive means, price “flagship” of the line. The following are commercial copies, or generics. The price is usually given for the original product, in the range from the cheapest to the most expensive, and relevant for pharmacies of all forms property for August 2019 in the Russian Federation.

Asthma Review

Nomination a place Name of product price
Emergency therapy: eliminating asthma attacks 1 Bronchodilators – Beta-2 Inhalation Agonists: Salbutamol (Ventolin) 135 rub
2 AHP: Ipratropium bromide (Atrovent-N) 376 RUB
3 Ipratropium bromide + fenoterol (Berodual, Astmasol, Inspirax) 261 rub
4 Adenosergic drugs: Theophylline (Theotard, Teopeck) 135 rub
5 GCS: budesonide (Pulmicort, Benacort) 844 rub
Basic treatment for asthma outside attacks 1 Leukotriene blockers: montelukast (Singular, Almont, Glemont, Montelard, Singleon, Ectalustus). 1 601 rub.
2 Inhalation hormones + β-2 agonist: Budesonide + formoterol, Symbicort Turbuhaler 2 369 rub.
3 Xolar (omalizumab) – monoclonal antibodies 18 500 rub.
4 Spiriva (tiotropium bromide) 2 717 rub.

Emergency therapy: eliminating asthma attacks

First of all, you need to decide what an exacerbation is, or asthma attack. This is a condition in which the patient gradually cough builds up, wheezing increases, shortness of breath appears, and symptom of chest congestion. It is important to remember that exacerbations can develop not only in a patient with an already diagnosed asthma, but also be the very first symptom of a newly appeared diseases.

An attack of bronchial asthma can be in any patient with this diagnosis, regardless of severity, even in patients with mild severity. A typical seizure may develop with different speed, sometimes it takes several minutes to develop, and sometimes symptoms increase over time, even up to 2 weeks.

Resolution, or attenuation of exacerbation, also requires a long time, from several days to the same 2 weeks. Aggravation bronchial asthma is a pretty serious matter. It’s known that in any a hospital with an emergency department, about 12% of all incomes are attacks of bronchial asthma, and about 5% of the number Those with this diagnosis need immediate hospitalization in the intensive care unit.

Clear and understandable severity criteria during an attack are the respiratory rate, which in a severe attack exceeds 25 breaths per minute, increased heart rate, which the same severe attack exceeds 110 beats per minute. Important the diagnostic criterion is the inability to pronounce any sentence, or phrase on one exhale. In case of a fall blood pressure, the development of bradycardia, the appearance of cyanosis skin, or cyanosis, a drop in capillary oxygenation less 92% – this is a life-threatening attack, and such a patient hospitalized in the intensive care unit okay.

How to treat exacerbation of bronchial asthma? First of all, this the appointment of high-speed bronchodilators that are beta-2 adrenergic agonists. Then – application anticholinergics, as well as a combination of these two groups high-evidence drugs that increase the speed of resolution of an asthmatic attack and significantly reduce mortality. Finally, the main treatment for exacerbation may require early use of glucocorticosteroids, as in in the form of systemic administration, and in inhalations, as well as oxygen therapy. Consider the essential drugs used for stopping an attack of bronchial asthma.

Bronchodilators – Beta-2 Inhalation Agonists: Salbutamol (Ventolin)

Popularity Rating: 4.9

Ventolin

Β-2 adrenergic agonists used in nebulization, or inhalation form is the most economical and optimal method management of patients with bronchial asthma in the presence of a lung or moderate attack.

Ventolin affects smooth muscle adrenergic receptors bronchial tree (β-2), and does not affect similar myocardial receptors, which are called β-1. This leads to pronounced expansion of the bronchi, which stops the attack of bronchial asthma The use of salbutamol-ventolin in particular reduces airway resistance, increases vital lung capacity, and activates the ciliated epithelium. This leads to improving secretion and secretion of mucus, which is very important for prevention of respiratory infections.

Inhaled forms of salbutamol are very fast: start the effect develops after 5 minutes, and after another 5 minutes the effect rises to 75% of maximum, and duration of action up to 6 hours. However, the use of this drug is not necessary once, and strictly follow the instructions of the attending pulmonologist. Ventolin is shown, first of all, for stopping an attack, and then prophylactically in order to prevent an attack of bronchospasm, for example, when a well-known allergen, when exposed to frosty air, or during physical load, when in similar conditions an attack has previously occurred. It is also possible the use of salbutamol in complex therapy is not only in the presence of exacerbations, but also for long-term treatment bronchial asthma in the interictal period.

Bronchodilators should be used quite often. But in case Ventolin manufacturer does not recommend using it more often than 4 once a day. Recommended dose for relieving an attack bronchial asthma usually equals one or two inhalations then there are from 100 to 200 g of salbutamol.

The company produces Ventolin Glaxo Wellcome, in aerosol metered-dose inhalation bottle. Single dose by spray accounts for 100 mcg of salbutamol, one aerosol can designed for 200 doses. The cost of one package is from 107 to 136 rub

Advantages and disadvantages

Advantages of all inhaled β2-receptor short-agonists action is a quick effect, the ability to apply it in preventive purposes, as well as the ability to prescribe them with obstructive bronchitis without a diagnosis of bronchial asthma. This the drug is included in the list of vital and important funds (ZhVNLS), and therefore is inexpensive. However, salbutamol and its analogues need to be inhaled several times and there are contraindications to the use of salbutamol in children under two years of age. Despite the selectivity of the drug with caution is used for various pathologies of the heart, thyrotoxicosis, pregnancy, breastfeeding, as well as with decompensated diabetes. There are also various drug interactions.

AHP: Ipratropium bromide (Atrovent-N)

Popularity Rating: 4.8

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Anticholinergics (AHPs) are derivatives atropine, their function is to block specific cholinergic receptors smooth muscles of the bronchi. As a result, the bronchial mucosa dried, mucosal secretion decreases due to inhibition effects on the bronchial glands. Anticholinergics effectively expand the bronchi, and prevent their narrowing, especially due to the influence of cold air, cigarette smoke, remove spasm associated with parasympathetic influences of the X pair cranial nerves. One of the most important representatives of this class of drugs used to relieve an attack bronchial asthma, is ipratropium bromide (Atrovent-N). Effect bronchial enlargement develops after 10 minutes, the maximum development after 2 hours, and the duration of action is up to 6 hours.

Atrovent-N is used to relieve bronchial attacks asthma of mild to moderate severity. Especially recommended apply Atrovent-N if the patient has concomitant damage to the cardiovascular system. Also shown It is a treatment for chronic obstructive pulmonary disease. Atrovent-N in the form of an aerosol is necessary for adults in 2 doses up to 4 times a day, and in case of an attack of bronchial asthma, you can increase the dose up to 12 times a day, however, previously everything this should be agreed with the doctor.

The aerosol dosed for inhalation of Atrovent-N contains in 10 ml can with 200 doses, each dose contains 20 micrograms of ipratropium bromide. Issues Atrovent-N German Beringer Ingelheim company, and the cost of one cylinder varies from 300 to 380 rubles.

Advantages and disadvantages

A big advantage of Atrovent can be considered the absence of an overdose. In order to really poison the body with ipratropium, about 500 doses should be inhaled immediately. System effects associated with anticholinergic symptoms, therefore expressed very weak, and that is why the tool is recommended, including patients with cardiovascular disease. They do not develop tachycardia, urinary retention, palpitations, dry skin and mucous membranes characteristic of atropine exposure. However in some patients may experience coughing, hives, and allergic reactions. If a patient has an asthma attack quickly, you must first take advantage salbutamol, and secondly – Atrovent, since the effect bronchial enlargement rather develops in stimulants beta-adrenergic receptors, and then at Atrovent and its analogues.

Ipratropium bromide + fenoterol (Berodual, Astmasol, Inspirax)

Popularity Rating: 4.7

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In order not to use salbutamol alternately and ipratropium bromide, and not wearing them in different pockets, was created a drug, so to speak, in one bottle, combining β2 – adrenergic agonist and atropine derivative. Only instead Salbutamol was taken its analogue – fenoterol. Such a combination able to provide a more persistent and pronounced effect bronchodilation and elimination of an asthmatic attack than separate use of these drugs. The combination of these funds on pre-hospital stage leads to a decrease in the number of hospitalizations patients, because the improvement in well-being occurs even before Arrival ambulance.

Berodual can also be used in chronic obstructive lung diseases, in the presence of emphysema, and even in the second and third trimester of pregnancy. Inhalation of Berodual in adults in case of an acute attack of bronchospasm can be from 1 ml, or 20 drops to 50 drops, or 2.5 ml. The smallest recommended dose, i.e. 20 drops, diluted with isotonic sodium chloride solution to 4 ml and completely inhaled with a nebulizer.

Releases Berodual German company Beringer Ingelheim, and one bottle of solution for inhalation, in 20 ml, designed for 20 minimum doses, sold in pharmacies at a price of 230 to 270 rubles.

Advantages and disadvantages

Plus Berodual – a proven improvement and decrease hospitalizations, a more favorable pharmacoeconomic profile (two in one), low price. The downside is the need use of a nebulizer, preliminary dilution isotonic solution, as well as some symptoms associated with an overdose fenoterol. This is a heartbeat, tremor, a change in arterial pressure, hot flashes, or a feeling of heat.

Adenosergic drugs: Theophylline (Theotard, Teopeck)

Popularity Rating: 4.6

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The bronchodilator effect of theophylline occurs in connection with blocking phosphodiesterase, binding to adenosine receptors, and muscle relaxation of the internal organs. At the same time, it increases tone of the respiratory muscles, that is, the diaphragm and intercostal muscles, increases the supply of blood with oxygen, that is, increases it oxygenation, and dilates the vessels of the lungs. Theophylline is used for bronchial asthma, emphysema, obstructive bronchitis, and with asthmatic status.

Theophylline and its analogues are currently widely distributed. in developing countries, and in countries with a high level of medicine for a while theophylline was in second-order drugs, he was crowded out by modern beta-2 agonists and anticholinergic means. But now theophylline is gradually again returns to operation, and it is used to treat exacerbations bronchial asthma and in the interictal period.

Theotard is produced in the form of retarded capsules, i.e. with slow release, which ensure uniform and long action. One pack of 40 tablets of 350 mg each, will cost from 220 to 420 rubles. Produces Theotard Slovenian Krka company. It can be used after meals, adults one at a time tablet 1 time per day in the evening, in case of treatment initiation, and maintenance dose twice as much, twice a day. In the process treatment must be adjusted dose, by definition theophylline in serum.

Advantages and disadvantages

Theophylline has a complex effect on blood circulation in lungs and smooth muscles, but at the same time he can cause cramps, anxiety, nasal congestion, nausea, and vomiting. It interacts with many medicinal substances, symptoms of overdose are possible. The obvious downside is the need to regularly determine theophylline concentration in blood serum, therefore, this drug should only be prescribed doctor.

GCS: budesonide (Pulmicort, Benacort)

Popularity Rating: 4.5

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Formerly patients with β2 receptor agonists and other bronchodilators failed to stop the attack of bronchial asthma, glucocorticosteroid hormones were prescribed, with systemic way, most often by the intravenous route. Usually dexamethasone introduced at home by ambulance, and in the department of pulmonology or emergency treatment, the same dexamethasone was injected into patients. If the hospital was richer, then methylprednisolone. Prednisone after stopping the attack, it was then given out in tablets.

In this case, both the intravenous and the oral route are the same effective in exacerbating bronchial asthma, but naturally pills just do not have time to act with a sudden development an attack. Giving prednisone was prescribed for a week, in tablets after cessation of infusion. However, there are inhalation corticosteroids – drugs that are used with metered nebulizers, nebulizers, and are not inferior to infusions and injections of glucocorticosteroid hormones. In some cases, they even surpass them in speed of onset of effect and in profile security.

One such drug is budesonide, or Pulmicort. In addition to stopping asthma attacks, he used for acute obstructive laryngitis, is available in suspension, and is indicated for long-term treatment of bronchial asthma, and for stopping attacks. It must be applied individually, up to 4 mg per day for adults, for maintenance therapy. In case of exacerbations, the dose increases, but be sure to preliminary agreement with a pulmonologist. Pulmicort Launches Turbuhaler Astrazeneca company from the UK, and powder for inhalation in the amount of 100 doses per 200 mg per dose, it costs from 400 to 750 rubles.

Basic treatment for asthma outside attacks

We have already talked about stepwise treatment regimens for bronchial asthma in a planned manner when it comes to seizures. Insofar as at the first stage, the same drugs are used as for relief of attacks, i.e. β2 receptor agonists, and their combination with ipratropium bromide, low doses of inhalation corticosteroids, and they are also present at other steps more serious treatment, we will not dwell on them. Consider only those more powerful and modern medicinal funds that appear at more advanced stages of treatment. At the second stage, antagonists of leukotriene receptors appear. What are these drugs?

Leukotriene blockers: montelukast (Singular, Almont, Glemont, Montelard, Singleon, Ectalustus).

Popularity Rating: 4.9

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The active substance montelukast sodium refers to bronchodilators, but only to specific receptor blockers that called leukotrienes. Their blockade allows you to interrupt chronic inflammation that constantly supports the bronchi in anxiety, hyperreactive state in this disease. IN as a result, the spasm of the smooth muscles of the bronchi decreases, migration active white blood cells such as macrophages and eosinophils in the lungs decreased secretion of mucus and inflammatory immunoglobulins the secretory row also decreases.

The drug is highly active when taken orally, and after a single dose, the effect persists for a long time. Is applied Montelukast (Singular) for the long-term treatment of bronchial asthma, including its aspirin form, as well as for prevention attacks of bronchospasm. In some cases, this drug is indicated and its analogues for the treatment of seasonal allergic rhinitis, hay fever, that is, hay fever. Use the drug in dosage indicated by your doctor. However, according to modern data, still inhaled corticosteroids are drugs that exhibit higher efficiency in the second stage of treatment than leukotriene receptor antagonists prescribed in their place.

It is understood that long-playing, planned therapy for bronchial asthma may not include very fast acting agents, therefore you can do with tableted preparations, and even chewing pills. So, the drug Singular is known pharmaceutical company Merck Sharp and Dome in a dosage of 4 mg per tablet, and 5 mg per tablet. It will cost per pack of 28 5 mg tablets each from 1,400 to 1,700 rubles.

Inhalation hormones + β-2 agonist: Budesonide + formoterol, Symbicort Turbuhaler

Popularity Rating: 4.8

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Moving further along the steps of treating bronchial asthma, we we meet a combination of inhaled glucocorticosteroid drug together with bronchodilator phenoterol, similar in its own way action to salbutamol. One of the most highly effective, but with this expensive means can be considered Symbicort Turbuhaler.

Symbicort should be prescribed to patients no younger than 6 years old, with special care must be taken against tuberculosis lungs, various respiratory infections, with diabetes and other diseases. This drug is indicated, of course, not for emergency relief of attacks, but exclusively for planned treatment, and it is effective in reducing the frequency and severity exacerbations. However, some experts believe that this the drug can be successfully used for relief of attacks, but whether it is worth doing it or not, you need consult with your doctor. Proven that joint influence budesonide and phenoterol are higher than the separate intake of these funds, and reduction in the frequency of exacerbations of the disease, increased lung function and the elimination of symptoms of bronchial asthma is also more pronounced in compared to separate use.

Symbicort should be used at higher levels of treatment, and it is not intended to begin asthma treatment with it, in first time, and especially mild asthma. Usually before Symbicort is assigned to the patient, he has already passed and beta-adrenergic agonists, and ipratropium bromide, and isolated hormonal drugs, and all this did not reach its goal. Maybe, the patient even took leukotriene antagonists. Dose Selection – The Case the attending pulmonologist, it should be the smallest, but nevertheless less, the doctor and patient should control the symptoms of bronchial asthma against the background of this small dose, preventing exacerbations.

At the beginning of therapy in adults, the use is indicated not more often than two inhalations per day, and under special conditions mandatory coordination with the attending physician no more than eight inhalations per day. Having determined the actual treatment dose, it is necessary to slowly and gradually try to remove the amount of daily inhalation, reducing them by one. The ideal option is one dose once. per day, with the subsequent possible abandonment of this serious facilities.

This highly active combination drug is launched by the company. Astrazeneca from the UK, and one bottle of powder for inhalation, calculated for 120 doses based on 160 micrograms of the hormone and 4.5 mcg bronchodilator phenoterol will cost from 2000 to 2700 rubles. At there are analogues of the drug that are much cheaper in such the same dosage and in the same bottle from just 860 rubles.

Advantages and disadvantages

Like any hormonal drug, Symbicort has its own disadvantages, in particular immunosuppressive effect. Often from its use there is a headache, palpitations and tremors, and due to a decrease in immunity with prolonged use may be thrush, or candidiasis of the oral mucosa and pharynx. These side effects develop quite often, from 1% to 10% of all patients. This drug is also quite high. cost, but the best quality. During pregnancy, it’s better not to use this tool, and apply only if the benefits of using the drug will be higher than the possible risk for unborn baby.

Xolar (omalizumab) – monoclonal antibodies

Popularity Rating: 4.7

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Finally, the crown of modern drug therapy, as in case of many other diseases (psoriasis, multiple sclerosis), is an expensive recombinant humanized treatment monoclonal specific antibodies. There is such a tool and for asthma. This drug has a pronounced immunosuppressive effect, and is indicated exclusively for patients with an allergic type of bronchial asthma, also called atopic. Roughly speaking, Xolar binds to immunoglobulins E and eliminate the flow of allergic reactions mediated by reagins. Free immunoglobulin E becomes small, a cascade of allergic reactions do not start, and therefore an attack of bronchial asthma or not arises, or proceeds much easier.

This drug is indicated for the routine treatment of allergic severe asthma, especially if if it is impossible to control the condition by using hormonal drugs, that is, in patients with unpredictable seizures. The second indication is the treatment of severe idiopathic urticaria, which is not treated in any way with antiallergic means.

Xolar is prescribed by subcutaneous injection, in no case cannot be administered intramuscularly or intravenously. Ways of use and doses are subject to special calculation, which is not carried out here. However it should be said that the drug is administered once subcutaneously each month, or every 2 weeks, depending on the initial concentration immunoglobulins E in blood plasma and depending on body weight the patient. So, if the patient has a mass of 80 kg, and the concentration immunoglobulins E higher than 400 units per ml, then it is assigned 300 mg subcutaneously after 2 weeks.

On average, the effect of treatment manifested itself after 4 months, and this recommended for prolonged therapy. If you cancel it, then immunoglobulin E rises again, and the severity of bronchial asthma increases again. The effect of the application is rarer seizures, less urgent need care, relieving seizures and improving well-being interictal period.

It is important to remember that Xolar is not intended for the relief of acute seizures, or treatment of asthmatic status. It’s not consciously here advantages and disadvantages, overdose, and side effects are given effects, since the instruction for use of the drug is multi-page book, you need to either study it in great detail, or not apply the drug at all.

It remains to inform about the price of this drug, manufactured by Novartis Pharma. Like all monoclonal antibodies, they require a very complex technological cycle, and therefore, the medicine is very, very expensive for the Russians. Bottle lyophilisate for the preparation of a concentrate in an amount of 150 mg will be cost in pharmacies an average of 20,000 rubles. Accordingly, a dose of 300 mg will cost the patient 40,000 rubles, and the monthly cost treatment will be 80 thousand rubles. Given that Xolar it is a means for long-term therapy, then the cost of treatment for year will be 960 thousand rubles, which is equal to the cost of domestic new SUV UAZ Patriot.

Spiriva (tiotropium bromide)

Popularity Rating: 4.6

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Finally, in conclusion of a review of drugs used in severe bronchial asthma, at the fifth stage of treatment, consider the drug Spiriva, or tiotropium bromide. Produces this medicinal means the German company Beringer Ingelheim, it is produced in in the form of capsules with powder for inhalation, in each capsule 18 mcg tiotropy. This package of 30 capsules, which is sold with inhaler, will cost retail from 2200 to 2700 rubles.

What is this drug? It is recommended to appoint additionally at the fifth stage of therapy, to all patients with bronchial asthma, in which, despite all the correct treatment, it is difficult and patients are already at high doses inhaled corticosteroids. Perhaps these patients are also already receive monoclonal antibodies, therefore tiotropium, despite its fairly high price seems economically insignificant at compared to the previous drug.

What is this remedy? It is a muscarinic anticholinergic. receptors, which has a lasting effect. Result blockade of specific muscarinic receptors will be pronounced smooth muscle relaxation, or bronchodilating effect, which is dose-dependent, but is valid for at least a day.

Taking this drug increases spirogram indicators already half an hour after a single dose, and this effect lasts day. Spiriva reduces shortness of breath, exercise tolerance, the number of exacerbations and as a result significantly improves the quality patient’s life. It is authentically known that during treatment with this drug risk of death decreased by 16%, which is very lot. This drug is shown exclusively as maintenance therapy, and in no case should be applied as a means to relieve exacerbation. Spiriva is available for inhalation, one capsule per day at the same time time.

Advantages and disadvantages

Improving the quality of life, improving the course of the disease, symptom reduction, a 16% reduction in overall mortality – this excellent data, and the drug is extremely useful. But while still remember that using an inhaler you need to have specific skills, and with an overdose dry mouth and eyes may develop, development conjunctivitis. Spiriva should never be used in at the very beginning of treatment, with mild forms of bronchial asthma, and not should be used for emergency treatment of seizures. Should remember that the drug should not be used in the first trimester pregnancy, in children under 18 years of age, and special care must be observed when prescribing Spiriva in patients with glaucoma, prostatic hyperplasia (adenoma) or cervical obstruction bladder to avoid difficulty urinating.

Popularity rating based on analysis of demand data service wordstat.yandex.ru.


Attention! This rating is subjective, not advertising and does not serve as a guide to the purchase. Before the purchase consultation with a specialist is necessary.

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