tag:blogger.com,1999:blog-36043945483046490332024-02-20T15:36:21.886-08:00BRONCHIAL ASTHMAAnonymoushttp://www.blogger.com/profile/06267357132580929345noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-3604394548304649033.post-47729224600027662812013-11-02T08:41:00.002-07:002013-11-02T08:41:20.157-07:00BRONCHIAL ASTHMA<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><i>BRONCHIAL
ASTHMA<o:p></o:p></i></b></div>
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<b><i> </i>Asthma is defined as a chronic
inflammatory disease of airways that is characterized by increased
responsiveness of the tracheobronchial tree to a multiplicity of stimuli, in
which many cells and cellular elements play a role. This inflammation causes
recurrent episodes of wheezing, breathlessness, chest tightness and coughing,
particularly at night or in the early morning. These episodes are usually
associated with widespread but variable airflow obstruction that is often
reversible either spontaneously or with treatment.<o:p></o:p></b></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Some of the
principal cells identified in airway inflammation include mast cells,
eosinophils, epithelial cells, macrophages, and activated T lymphocytes. The
mechanism of inflammation in asthma may be acute, subacute, or chronic, and the
presence of airway edema and mucus secretion also contributes to airflow
obstruction and bronchial reactivity. Varying degrees of mononuclear cell and
eosinophil infiltration, mucus hypersecretion, desquamation of the epithelium,
smooth muscle hyperplasia, and airway remodeling are present.<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">ETIOLOGY<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Genetic
factors are of major importance in determining a predisposition to the
development of asthma.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The stimuli
that incite acute episodes of asthma can be grouped into seven major categories:<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="FR" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-size: 12.0pt;">allergenic,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="FR" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-size: 12.0pt;"> pharmacologic,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="FR" style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-size: 12.0pt;"> environmental,<o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-size: 12.0pt;"> </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">occupational,
<o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">infectious, <o:p></o:p></span></div>
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</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">exercise-related, and <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-family: Symbol; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">emotional<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">PATHOGENESIS<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Allergic asthma is dependent on an IgE response controlled by T and B
lymphocytes and activated by the interaction of antigen with mast cell–bound
IgE molecules. After taking up an immunogen, these cells migrate to the local
lymph nodes where they present the material to T cell receptors. This leads to
the differentiation of the cell to a T<sub>H</sub>2 subset and also causes B
lymphocytes to switch their antibody production from IgG and IgM to IgE. Once
synthesized and released by B cells, IgE circulates in the blood until it
attaches to high-affinity receptors on mast cells and low-affinity receptors on
basophils. Immune mechanisms appear to be causally related to the development
of asthma in 25 to 35% of all cases. The pathophysiologic hallmark of asthma is
a reduction in airway diameter brought about by contraction of smooth muscle,
vascular congestion, edema of the bronchial wall, and thick, tenacious
secretions. All these can cause to airway remodeling, which is associated with
structural changes due to long-standing inflammation and may profoundly affect
the extent of reversibility of airway obstruction. BA begins to look like COPD.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> IgE-dependent activation of mast
cells leads to release from them big amount of </span><span style="font-size: 14pt; line-height: 150%;">products of arachidonic acid metabolism. </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">These bioactive substances are
not all the time in cells like histamine
or serotonin, and appear during cells activation and then secreted in extracellular fluid. Free</span><span style="font-size: 14pt; line-height: 150%;"> arachidonic</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> acid is used in
two metabolic ways: with the help of cyclooxygenase it changes into prostoglandings , and with the
help of lipooxygenase into the
leukotrienes. Formation of different
forms of prostoglandings depends on kind of cells where all these processes
happen. One of forms of prostoglandings PgD2<sub> </sub>producing a bronchoobstructive action much more strong
then histamine does.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The typical aspirin-sensitive</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> asthma is most studied. Aspirin</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> inhibits prostaglandin G/H synthase 1 (cyclooxygenase type 1).<o:p></o:p></span></div>
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<b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-size: 12.0pt;">CLINICAL FEATURES<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">A
basic clinical sign of bronchial asthma is an attack of shotness of breath
because of convertible bronchial obstruction of bronchial tubes due to</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> contraction of smooth muscle</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">, edema of mucous membrane of
bronchial tubes and hypersecretion of mucus.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> The net
result is an increase in airway resistance, a decrease in forced expiratory
volumes and flow rates, hyperinflation of the lungs and thorax, increased work
of breathing, alterations in respiratory muscle function, changes in elastic
recoil, abnormal distribution of both ventilation and pulmonary blood flow.
During chest examination we can find:<o:p></o:p></span></div>
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<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">End-expiratory wheezing or a prolonged
expiratory phase is found most commonly, although inspiratory wheezing
can be heard. <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level2 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Diminished breath sounds and chest
hyperinflation may be observed during acute exacerbations. <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l3 level2 lfo2; tab-stops: list 1.0in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The presence of
inspiratory wheezing or stridor may prompt an evaluation for an upper
airway obstruction such as vocal cord dysfunction.<o:p></o:p></span></li>
</ul>
</ul>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Displays of symptoms increase at
night or in an early morning. Symptoms can increase at the physical loadings,
viral infections, influence of allergens, smoking, change of external
temperature condition, strong emotions, action of chemical aerosols, reception
of some medications.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> Sinusitis, rhinitis, nasal
polyposis are preceded aspirin-sensitive</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> asthma</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">. </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Combination
of clinical picture of shortness of breath with unbearableness of aspirin and </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">nasal polyposis</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> is named by aspirin or asthmatic triad. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">DIAGNOSTICS<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Diagnosis is
based on the presence of special symptoms which characterized by day's and
seasonal variability. T</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">hick, stringy mucus, which
often takes the form of casts of the distal airways (Curschmann's spirals),
when examined microscopically, often shows eosinophils and Charcot-Leyden
crystals. T<span style="letter-spacing: .35pt;">he total white blood cell count
may </span><span style="letter-spacing: .3pt;">be slightly increased during an
acute attack, and eosinophilia is </span><span style="letter-spacing: .5pt;">common.
</span><span style="letter-spacing: .2pt;">Pulmonary function tests reveal
abnormalities typical of obstractive dysfunction, and partial reversibility
(improvement FVC</span><span style="letter-spacing: 2.05pt;"> </span><span style="letter-spacing: .2pt;">or FEV<sub>1</sub> of at least 12% or improvement
in FEF 25-75 </span><span style="letter-spacing: .65pt;">of at least 25%) is
often demonstrated after an inhaled </span><span style="letter-spacing: .55pt;">bronchodilator
is administered.</span><o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">An allergist
inspection includes: <o:p></o:p></span></div>
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</span></span><!--[endif]--><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">collection of
allergist anamnesis</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> (presence at patient of eczema, seasonal or
whole-year allergic rhinits, food or medicinal allergy, and also BA and atopic
diseases of his family members). U should
ask about respiratory diseases, age of sick in the moment of beginning disease,
seasonality, improvement of the state of house or at work, concomitant
diseases).</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Total serum immunoglobulin E
levels</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> greater than 100 IU are frequently
observed in patients experiencing allergic reactions, but this finding is not
specific for asthma and may be observed in patients with other conditions (eg,
allergic bronchopulmonary aspergillosis, Churg-Strauss syndrome). <o:p></o:p></span></div>
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<!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold;">-<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Allergy skin testing</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> is a useful adjunct in individuals with atopy. The allergens that most
commonly cause asthma are aeroallergens such as house dust mites, animal
danders, pollens, and mold spores. Two methods are available to test for
allergic sensitivity to specific allergens in the environment: allergy skin
tests and blood radioallergosorbent tests (RAST). Allergy immunotherapy may be
beneficial in controlling allergic rhinitis and asthma symptoms for some
patients. <b><o:p></o:p></b></span></div>
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<!--[if !supportLists]--><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold;">-<span style="font-size: 7pt; line-height: normal;">
</span></span><!--[endif]--><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Methacholine- or
histamine-challenge testing <o:p></o:p></span></b></div>
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<ul type="circle">
<li class="MsoNormal" style="line-height: 150%; mso-list: l1 level2 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 1.0in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">
Bronchoprovocation testing with either methacholine or histamine
is useful when spirometry findings are normal or near normal, especially
in patients with intermittent or exercise-induced symptoms.
Bronchoprovocation testing helps determine if hyperreactive airways are
present, and a negative test result usually excludes the diagnosis of
asthma. <o:p></o:p></span></li>
</ul>
</ul>
<h1>
Differential diagnosis</h1>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The differentiation of asthma from other diseases associated with
dyspnea and wheezing is usually not difficult, particularly if the patient is
seen during an acute episode. A personal or family history of allergic diseases
such as eczema, rhinitis, or urticaria is valuable contributory evidence. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Recurrent episodes of bronchospasm can occur with </span><span class="emphi">carcinoid tumors</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> , </span><span class="emphi">recurrent
pulmonary emboli</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> , and </span><span class="emphi">chronic bronchitis</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">. In chronic bronchitis there are no true symptom-free periods, and one
can usually obtain a history of chronic cough and sputum production as a
background on which acute attacks of wheezing are superimposed.<o:p></o:p></span></div>
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<span class="emphi">Eosinophilic pneumonias</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> are often associated with asthmatic symptoms, as are various chemical
pneumonias and exposures to insecticides and cholinergic drugs. Bronchospasm is
occasionally a manifestation of </span><span class="emphi">systemic vasculitis</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> with pulmonary involvement.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Differential
diagnostics of COPD and BA</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
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<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Sign<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">COPD<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">BA<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Allergy<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Not characteristic<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">characteristic<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Cough<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Periodic or permanent<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">paroxysmal<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Shortness of breath <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Permanent</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Attacks of expiration shortness of
breath</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Daily allowance changes of FEV1 </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Less than, than 10% from normal</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">More than 12% from normal</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Bronchial obstruction<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Making progress decline of function
of lungs</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">There is not a making progress
decline of function of lungs, convertibility is characteristic</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Eosinophilia of blood and sputum </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.5pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Not characteristic<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 159.55pt;" valign="top" width="266">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Characteristic<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-align: center; text-indent: .5in;">
<b><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">CLINICAL
CLASSIFICATION <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<h6 style="line-height: 150%;">
<span lang="FR" style="font-family: "Times New Roman","serif"; mso-ansi-language: FR;">Intermittent asthma:<o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">1. Intermittent symptoms occurring
less than once a week <o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">2. Brief exacerbations <o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">3. Nocturnal symptoms occurring
less than twice a month/<o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">4. Asymptomatic with normal lung
function between exacerbations.<o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;"> 5. FEV<sub>1</sub> or PEF rate greater than
80%, with less than 20% variability<o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; mso-ansi-language: EN-US;">Mild persistent
</span><span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;"><o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">1.Symptoms occurring more than once
a week but less than once a day 2.Exacerbations affect activity and sleep <o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">3. Nocturnal symptoms occurring
more than twice a month <o:p></o:p></span></h6>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-weight: normal; mso-ansi-language: EN-US;">4. FEV<sub>1</sub> or PEF rate
greater than 80% predicted, with variability of 20-30%<o:p></o:p></span></h6>
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Moderate
persistent <o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">1. Daily
symptoms <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2. Exacerbations
affect activity and sleep <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">3. Nocturnal
symptoms occurring more than once a week <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">4. FEV<sub>1</sub>
or PEF rate 60-80% of predicted, with variability greater than 30%<o:p></o:p></span></div>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; mso-ansi-language: EN-US;">Severe persistent <o:p></o:p></span></h6>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">1.Continuous
symptoms <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2.Frequent
exacerbations <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">3.Frequent
nocturnal asthma symptoms <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">4.Physical
activities limited by asthma symptoms <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">5.FEV<sub>1</sub>
or PEF rate less than 60%, with variability greater than 30%<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<h6 style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; mso-ansi-language: EN-US;">TREATMENT<o:p></o:p></span></h6>
<div class="MsoNormal" style="line-height: 150%; margin-left: 21.75pt;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The goals for successful management of asthma include the following:<o:p></o:p></span></div>
<ul type="disc">
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Achieve and maintain control of symptoms. <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list .5in;"><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR; mso-bidi-font-size: 12.0pt;">Prevent asthma exacerbations. <o:p></o:p></span></li>
<li class="MsoNormal" style="line-height: 150%; mso-list: l2 level1 lfo4; tab-stops: list .5in;"><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Maintain pulmonary
function as close to normal levels as possible<o:p></o:p></span></li>
</ul>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">There are the
followings levels of control: complete, partial, uncontrolled</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Complete
control<o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Description<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Control
flow<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Daily symptoms <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">not<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Limitation of activity<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> not<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Nightly symptoms</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> not<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Using of </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%;">в</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">2-agonists</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> for a
removal</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">attacks of shortness of breath</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> not<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">FVD<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">normal
indexes<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">acute condition<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> not<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Drug therapy of BA:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> – the different ways of introduction of drugs
are used:</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">- inhalation</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
peroral</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">-
parenterally.</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Preparations
for treatment BA used protractedly for maintenance of BA control.</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Most
preferable way – inhalation. For rapid relief of symptoms</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> short-acting beta-agonists are used</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> . Sometimes more expressed positive
answer is observed from </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">short-acting cholinergic
antagonist</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 480; width: 817px;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 4.2in;" valign="top" width="504">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; tab-stops: 78.0pt; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Drugs<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 92.8pt;" valign="top" width="155">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dose (mcg)<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 95.15pt;" valign="top" width="159">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Duration of action<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 4.2in;" valign="top" width="504">
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> short-acting
beta-agonists</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">: </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">salbutamol</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> (Ventolinum), </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Fenoterol </span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(Berotek).</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 92.8pt;" valign="top" width="155">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">100<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">100<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 95.15pt;" valign="top" width="159">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">4-6<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">4-6<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 4.2in;" valign="top" width="504">
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">short-acting cholinergic antagonist</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">:</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<b><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Ipratropiya bromide </span></b><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">(Ipravent)<b><o:p></o:p></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 92.8pt;" valign="top" width="155">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">20, 40<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 95.15pt;" valign="top" width="159">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">6-8<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 4.2in;" valign="top" width="504">
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Combined
drugs</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">short-acting beta-agonists</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> +</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">short-acting cholinergic antagonist</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">:</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Fenoterol</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> +</span><b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> Ipratropiya bromide </span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(berodual) </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">salbutamol</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> +</span><b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> Ipratropiya bromide</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> ()</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 92.8pt;" valign="top" width="155">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 95.15pt;" valign="top" width="159">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-align: center;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-size: 12.0pt;">Inhaled
Glucocorticoids<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB; mso-bidi-font-size: 12.0pt;">These
drugs are indicated in patients with persistent symptoms. These drugs share the
ability to control inflammation, facilitate the long-term prevention of
symptoms, reduce the need for oral glucocorticoids, minimize acute occurrences,
and prevent hospitalisations.<o:p></o:p></span></div>
<table align="left" border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; margin-left: .1in; margin-right: .1in; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-table-anchor-horizontal: margin; mso-table-anchor-vertical: paragraph; mso-table-left: left; mso-table-lspace: 9.0pt; mso-table-rspace: 9.0pt; mso-table-top: 6.45pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Drugs <o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dose on inhalation<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Beklometazon (Beklofort, Beklazon)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">200-500 mcg<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Budesonid (Budekort)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">200-400 mcg<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Flutikazon (Fliksotid)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">100-250 mcg<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.25pt;" valign="top" width="399">
<div class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Mometazon (Asmaneks)<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 239.3pt;" valign="top" width="399">
<div align="center" class="MsoNormal" style="line-height: 150%; mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-top: 6.45pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">200-400 mcg<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">The most high
type of safety and low system biotavailability
is marked at Flutikazon and Mometazon.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Cromolyn
sodium and nedocromil sodium-their major therapeutic effect is to inhibit the
degranulation of mast cells, thereby preventing the release of the chemical
mediators of anaphylaxis.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Long-acting inhaled</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">β</span><sub><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2</span></sub><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-agonists s</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">hould not be used for symptom relief or for exacerbations. Use only with
inhaled glucocorticoids.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-align: center; text-indent: .5in;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-align: center; text-indent: .5in;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-align: center; text-indent: .5in;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Long-acting
inhaled</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">β</span><sub><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2</span></sub><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-agonists</span></b><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><o:p></o:p></span></b></div>
<table border="1" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; border: none; mso-border-alt: solid windowtext .5pt; mso-border-insideh: .5pt solid windowtext; mso-border-insidev: .5pt solid windowtext; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 275.4pt;" valign="top" width="459">
<h2>
Drugs </h2>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.0pt;" valign="top" width="165">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Dose (mcg)<o:p></o:p></span></div>
</td>
<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.15pt;" valign="top" width="174">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Duration of
action<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 275.4pt;" valign="top" width="459">
<div class="MsoNormal" style="line-height: 150%;">
<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Long-acting
inhaled</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> </span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">β</span><sub><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">2</span></sub><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">-agonists</span></b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; tab-stops: 105.0pt; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Salmeterol</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> (Serevent)</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> <b> </b></span><span lang="RU" style="font-size: 14.0pt; line-height: 150%; mso-bidi-font-size: 12.0pt;">Formoterol</span><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">(Zafiron)</span><b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></b></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.0pt;" valign="top" width="165">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">25,
50<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">4,
12<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.15pt;" valign="top" width="174">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">12<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">12<o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border-top: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 275.4pt;" valign="top" width="459">
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Long-acting
cholinergic antagonist</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<b><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"> </span></b><b><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">Tiotropiya bromide </span></b><span lang="FR" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: FR;">(Spiriva)<b><o:p></o:p></b></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 99.0pt;" valign="top" width="165">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">18 <o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 104.15pt;" valign="top" width="174">
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">24<o:p></o:p></span></div>
</td>
</tr>
</tbody></table>
<h4 style="line-height: 150%;">
<i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Combination
beta-agonist/corticosteroid</span></i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></h4>
<div style="line-height: 150%;">
<span style="font-family: "Times New Roman","serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Inhaled combination medication used frequently in the treatment of
asthma consists of a long-acting beta-agonist and inhaled corticosteroid .<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">SERETID (</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">salmeterol +fluticasone</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">) has dosages 50/25, 125/25, 250/25. </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-outline-level: 1; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Simbikort
(Budesonid + <b> </b></span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Formoterol</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">) – 200/
4 <i> <o:p></o:p></i></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">There are different deliverable
devices – <span style="color: #ff6600;">evohaler, </span></span><span lang="RU" style="color: #ff6600; font-size: 14.0pt; line-height: 150%;">дискус</span><span style="color: #ff6600; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">,
</span><span lang="RU" style="color: #ff6600; font-size: 14.0pt; line-height: 150%;">твист</span><span lang="EN-GB" style="color: #ff6600; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">-</span><span lang="RU" style="color: #ff6600; font-size: 14.0pt; line-height: 150%;">халер</span><span style="color: #ff6600; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">, </span><span lang="RU" style="color: #ff6600; font-size: 14.0pt; line-height: 150%;">турбухалер</span><span style="color: #ff6600; font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">, easy breathing</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">. It is
better to appoint the high doses of inhalation </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">steroids
</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">through
spacer (demonstration). Modern deliverable device is NEBULAYZER (</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">nebula</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> means fog).
With their help it is possible to inhale </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">long and
short acting beta-agonists, </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">inhaled glucocorticoids.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; mso-pagination: none; text-indent: .5in;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Glucocorticoids are the most potent and most effective
anti-inflammatory medications available. Systemic steroids are most beneficial
in acute illness, when severe airway obstruction is not resolving, and in
chronic disease, when there has been failure of a previously optimal regimen
with frequent recurrences of symptoms of increasing severity.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> A preference
gives to prednisolone (5 </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">mg=1</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">tab</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">.) or to
Methylprednisolone (4 mg = 1 </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;">tab.</span><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">) </span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">METHYLXANTHINES<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Theophylline
and its various salts are medium-potency bronchodilators with questionable
anti-inflammatory propertie.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">For
maintenance therapy, long-acting theophylline compounds are available and are
usually given once or twice daily. Single-dose administration in the evening
reduces nocturnal symptoms and helps keep the patient complaint-free during the
day. They are now considered second-line therapy, and as such they are rarely
used in acute situations and infrequently in chronic ones.<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">For basic -
the long-term control of asthma</span></b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> inhaled
glucocorticoids, inhaled glucocorticoids with long-acting beta-agonists,
long-acting cholinergic antagonist, systemic steroids, long-acting
theophylline, combined short-acting beta-agonists are used.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;"> step approach in treatment of
bronchial asthma<o:p></o:p></span></div>
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<tbody>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Intermittent
asthma<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Mild
persistent <o:p></o:p></span></div>
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<td style="border-left: none; border: solid windowtext 1.0pt; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 141.45pt;" valign="top" width="236">
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Moderate
persistent<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Severe
persistent<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">A
controller medication is not needed.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
reliever medication is a short-acting beta-agonist as needed for symptoms<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 113.0pt;" valign="top" width="188">
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
controller medication is an inhaled corticosteroid (200-500 mcg), cromolyn
(adult: 2-4 puffs tid/qid; child: 1-2 puffs tid/qid), nedocromil, or a
leukotriene antagonist. If needed, increase the dose of corticosteroid and
add a long-acting beta-agonist or sustained-release theophylline, especially
for nocturnal symptoms. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
reliever medication is a short-acting beta-agonist as needed for symptoms<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 141.45pt;" valign="top" width="236">
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
controller medication is an inhaled corticosteroid (800-2000 mcg) and a
long-acting bronchodilator (either beta-agonist or sustained-release
theophylline) A combination medication of salmeteorol/fluticasone (Advair) is
a preferred choice to improve compliance. Other agents may include
leukotriene modifying agents or omalizumab. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
reliever medication is a short-acting beta-agonist as needed for symptoms<o:p></o:p></span></div>
</td>
<td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; mso-border-alt: solid windowtext .5pt; mso-border-left-alt: solid windowtext .5pt; mso-border-top-alt: solid windowtext .5pt; padding: 0in 5.4pt 0in 5.4pt; width: 114.15pt;" valign="top" width="190">
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
controller medication is an inhaled corticosteroid (800-2000 mcg), a
long-acting bronchodilator (beta-agonist and/or theophylline), and long-term
oral corticosteroid therapy. <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">The
reliever medication is a short-acting beta-agonist as needed for symptoms.<o:p></o:p></span></div>
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</tbody></table>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Mucolytic agents are used in
symptomatic therapy (group of bromhexine, ambroxole (lasolvan). <o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt;">Information on the clinical course of asthma suggests
a good prognosis, particularly for those whose disease is mild and develops in
childhood.</span><b><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;"> Prophylaxis<o:p></o:p></span></b></div>
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<i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Primary </span></i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">– individual and social conditions,
directed on avoidance of disease- healthy way of life, improvement of house
conditions, effective treatment of rhinosinusitis, chronic infection.<o:p></o:p></span></div>
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<i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">Second </span></i><span style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-US;">– full and in time treatment of exacerbations,
selection of adequate base therapy, treatment of concomitant diseases.</span><span lang="EN-GB" style="font-size: 14.0pt; line-height: 150%; mso-ansi-language: EN-GB;"><o:p></o:p></span></div>
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