Assignment: Asthma and Stepwise Management Walden

Assignment: Asthma and Stepwise Management Walden

Assignment: Asthma and Stepwise Management Walden

Introduction

• Asthma is chronic airway inflammation
• Causes hyper-responsiveness of airway
• Causes significant disease burden
• Treated using pharmacological agents
• Managed by avoiding allergens

Asthma is a respiratory condition that arises due to the exposure of an individual to environmental irritants. The condition is characterized by hyper-responsiveness of the airway, chronic airway inflammation and production of mucus. Patients with asthma present to the hospital with symptoms that include difficulties in breathing, chest pains, wheezing, fatigue, and cyanosis among other symptoms. Asthma is associated with significant burden to patients due to high cost of treatment and purchase of

medications alongside the need for frequent hospitalization. The effective management of asthma is achieved using pharmacological agents. The pharmacological agents reverse the inflammation of the airways and restores normal airway integrity. The management of asthma also requires the adoption of non-pharmacological interventions such as avoidance of the environmental irritants and allergens that cause asthma (Schellack Natalie et al., 2017).

Quick Relief Treatment Options: Assignment: Asthma and Stepwise Management Walden

• Beta-2-agonists
• Theophylline
• Anti-cholinergics

The first drug that is used to provide quick relieve to asthma is the beta-2 agonists. Beta-2 agonists belong to the class of drugs called bronchodilators. The drugs work by activating beta adrenergic receptors, hence, the relation of the smooth muscles of the lungs and opening of the airways. Examples of drugs in this category include terbutaline, salbutamol, and fenoterol. The other category of drugs that provide quick relief in asthma is the theophylline medications. Short-acting theophylline medications are used to relieve bronchospasm and symptoms of asthma. Theophylline produces its effect by inhibiting phosphodiesterase, which cause bronchodilation and suppression of the response of the airways to the stimuli causing asthma. Anti-cholinergic medications are also used to provide quick response to asthma symptoms. Anti-cholinergics work by inhibiting the binding of acetylcholine to muscarinic receptors, hence,preventing bronchoconstriction, mucus production, airway remodeling and inflammation in asthma. An example of this drug is Ipatropium bromide (Schellack Natalie et al., 2017).

Long-Term Treatment Options

• Long-acting beta-2-agonists (LABA)
• Inhaled Corticosteroids
• Leukotriene modifiers
• Cromones
• Anti-Ige Medications

One example of medication that is used for long-term treatment of asthma is long-acting beta-2 agonists (LABA). LABA works by binding to beta receptors to produce prolonged bronchodilation. The other type of medications are the inhaled corticosteroids. Inhaled corticosteroids work by suppressing the inflammation through reversing the activation of histones and recruitment of histone deacetylase 2. Leukotriene modifiers is the other group of drugs that work by blocking leukotrienes, causing reverse or inhibition of inflammation and mucus production in asthma. Cromones work by inhibiting the chloride channel opening due to mechanical stress on the mast cells, hence, inhibiting inflammation and production of mucus. Anti-IgE medications work by interfering with antigen binding of the Fc sub-unit to IgE molecule, hence, causing mast-cell stabilization and inhibition of airway inflammation and mucus production (Lommatzsch et al., 2020). Assignment: Asthma and Stepwise Management Walden

Stepwise Approach for Adults

The stepwise approach to management of asthma occurs in six step. Step down is recommended when asthma is well-controlled for a period of at least six months. Step up is adopted in cases where there is poor control of asthma, poor treatment adherence and worsening of asthma symptoms due to comorbid conditions. The first step of the approach entails the use of short-acting beta-2 agonists. Step two entails the use of low dose of inhaled corticosteroids. Alternatives that may be considered in this step in absence of low-dose inhaled corticosteroids include cromolyn, long-acting inhaled beta-2 agonist, theophylline, or Zileuton. The third step in the management entails the use of low dose of inhaled corticosteroids with long-acting beta-2 agonist. The alternatives that may be considered include low dose inhaled corticosteroid with either leukotriene receptor antagonist, Zileuton, or theophylline. The fourth step entails the use of medium dose of inhaled corticosteroid plus long-acting beta-2 agonist. The alternatives include medium dose of inhaled corticosteroid plus either leukotriene receptor antagonist, Zileuton, or theophylline. The fifth step in the management entails the use of high dose inhaled corticosteroid plus long-acting beta-2 agonist and the consideration of Omalizumab in case of patients with allergies. The sixth step entails the use of high dose of inhaled corticosteroid, plus long-acting beta-2 agonist plus oral corticosteroid and Omalizumab if the patient has allergies. In each of the above steps, patient education, management of cormobidities, and environmental control should be considered (Muneswarao, 2019).

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Benefits of Stepwise Approach: Assignment: Asthma and Stepwise Management Walden

• Gain control
• Reduce impairment
• Reduce risk
• Reduce hospitalizations
• Prevent progressive loss of lung function

The stepwise approach in asthma management is important in a number of ways. Firstly, the use of stepwise approach promotes gaining of control and maintenance in asthma management. It ensures that the patient adapts successfully to the pharmacological and non-pharmacological management of asthma, hence, control in the disease process. Asthma is associated with irreversible loss of airway function if not treated or poorly managed. The aim of the stepwise approach is therefore to reduce the risk of airway impairment that might lead to loss of lung function. Stepwise approach also reduces the risk of asthma attacks. The adoption of interventions such as the use of medications, patient education and environmental control reduces the risk of exposure to irritants that cause asthma. Lastly, the stepwise approach prevents unnecessary hospital visits and hospitalizations. The control of the symptoms and factors that precipitate asthma reduces the need for frequent hospital visits by the patient (Beasley et al., 2020).

Conclusion

• Asthma is a chronic condition of the respiratory system
• Can be managed using short and long-acting medications
• Stepwise approach is recommended for effective asthma management
• Health education important in asthma management

References

• Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., & Pavord, I. D. (2020). Optimal Asthma Control: Time for a New Target. American Journal of Respiratory and Critical Care Medicine, 201(12), 1480–1487. https://doi.org/10.1164/rccm.201910-1934CI
• Lommatzsch, M., Buhl, R., & Korn, S. (2020). The Treatment of Mild and Moderate Asthma in Adults. Deutsches Ärzteblatt International, 117(25), 434–444. https://doi.org/10.3238/arztebl.2020.0434

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