It is well known that the reduction of the diameter of the bronchus amount of hyaline cartilage dec

Bronchodilation and the related increase in peak flow is a phenomenon that can help us as well in differentiating various osgood schlatters obstructive and to predict the success of bronchodilator therapy. Bronchodilator test (corresponding to the BDT) are often part of the lung function tests. The choice of drug, dose and route of administration still is a decision that should be made by the clinician based on what he wanted to establish a test question 1. If our aim is to detect whether lung function of patients can be improved with the inclusion of a bronchodilator, it can stick to your current therapy until test. However, if we want to establish whether there is reversible airway obstruction, the patient should be evaluated after the washout period of all medications that could affect bronhomotorniya tone. In a study of Guyatt et al. argue that with a bronchodilator test can not be evaluated potential osgood schlatters therapeutic response to bronchodilator therapy 2. Therefore Pellegrino et al believe that the response to a bronchodilator agent to be tested, or after a single dose or after clinical follow-up osgood schlatters for 2-8 weeks 3.
Special attention should be paid to the standardization of dose and method of drug administration, since it depends on the reproducibility of the results, both for the individual patient and between laboratories. Various medications osgood schlatters used for bronchodilation, have different pharmacodynamics. Of importance is also the size of the particles to be delivered. Lung deposition will be one if using metered aerosol (pMDI), second, if the dose is delivered via pMDI + spacer, and a third if nebulised bronchodilator.
Dosage osgood schlatters aerosols shlorofluorocarbon free (CFC-free) osgood schlatters produce much smaller particles and have an improved (up to 50% of the dose) deposition as compared to those that use CFC 4. In children, a smaller beldorobna deposition as compared to adults, probably in connection with the narrower upper respiratory tract 5. Therefore, it is necessary that each functional diagnostic laboratory to know the dynamic characteristics of the devices used to deliver a dose of bronchodilator test. Where acting bronchodilators?
It is well known that the reduction of the diameter of the bronchus amount of hyaline cartilage decreases, increasing the smooth muscle fibers - Fig. 1. Small bronchi (6 th generation) and bronchioles are highly sensitive to a neurogenic and humoral stimuli. Traditional view of bronchial smooth muscle (BGM) by simple contractile apparatus has undergone some evolution, and now generally felt that the smooth osgood schlatters muscle of the bronchi plays an important role in maintaining bronchial inflammation and remodeling 6. Inflammatory cytokines, such as IL-1β and TNF-α, TH 1 cytokines (interferon-γ), and TH 2 cytokines (IL-13 and IL-5), may enhance the contractile and / or reduce the effects of the dilator BGM. In this sense the anatomical substrate of bronchodilation is smooth muscle, mainly of small bronchi, which largely osgood schlatters determine the aggregate section of the bronchial tree. Relaxation of BGM can be achieved by administration of the three classes of drugs: β 2-agonists, anticholinergic agents and methylxanthines. In recent years, are designed for prolonged action of the first two classes, while the use of methylxanthines was limited due to the need of titration according to the side effects.
In phase III clinical trials are combined drugs that combine the capabilities of long-acting β 2-agonists and anticholinergics (LABA + LAMA). An alternative approach is to create osgood schlatters a dimeric reporter osgood schlatters molecule, combining activities to both types of receptors (M 3-antagonist-β 2 agonist - MABA) 7. Bronchodilators which can be used for corresponding to the BDT
In the current recommendations osgood schlatters of ATS / ERS to standardize research spirometrichnite 1 no compelling message osgood schlatters about the agent to be used in carrying out corresponding to the BDT. Right Pulmonologist to choose drugs that will provide the most appropriate answer to the clinical question. Most frequently in recital includes β 2-agonists and anticholinergics - Table. 1. In clinical practice, known in Bulgaria prevail short-acting β 2-agonists (SABA) and that because mainly looking distinguishing obstruction in asthma and COPD. According to Donohue, who is a supporter of the Dutch hypothesis, such a distinction is impossible, because the two diseases form a natural continuum 9. In one study of Chhabra and Bhatnagar on 133 patients with asthma and COPD 116 describes three different reaction patterns: the only difference in the forced vital capacity (FVC), only in the forced expiratory volume in 1 second (FEV1) and differential in both parameter 10. Patients with asthma more often give an increase in FEV1 of