Response to QuestionsAsthma and Stepwise Management

Response to QuestionsAsthma and Stepwise Management
Response to QuestionsAsthma and Stepwise Management
Asthma remains one of the leading causes of death in the United States. According to
Craig (2014), about 18.7 million adults (8 percent) have Asthma. Besides, the number of
Asthmatic patients who visit physicians’ offices for diagnosis stands as approximately 14.2
million. Furthermore, about 1.3 million visits are recorded by hospital outpatient units. In
addition, 1.8 million visits are also recorded by emergency units or departments due to
complications attributable to Asthma (Craig, 2014). It is also worth noting that Asthma has also
been established as the first-listed discharge diagnosis based on 438,000 hospitalizations in the
United States, with an average length of stay of 3.6 days. Craig (2014) also discusses that
Asthma accounts for about 3404 deaths annually. This paper presents responses to questions on
Asthma treatment based on the stepwise management approach.
Drugs used in Asthma Treatment
Bronchodilators and Anti-Inflammatories
Asthma medication is usually categorized into two groups: anti-inflammatories and
Bronchodilators typically target tight muscles that restrict the airwaves in the lungs.
These drugs help in relaxing the muscles of the lungs. As a result, the airwaves are widened,
making it easy for asthmatic patients to breathe. It is also worth noting that Bronchodilators are
mainly used as quick-relievers of Asthmatic symptoms (Mayo Clinic, 2018).
Anti-inflammatories are administered to cure inflammations in the lungs. These drugs are
administered to reduce lung irritation and swelling to enhance breathing. It is important to note
that Anti-inflammatories drugs are used on a daily basis for maintenance, and to aid in
preventing Asthma symptoms.
Quick-Relief Medications and Long-Term Asthma Control Medications
Quick-Relief Medications
Treatment for Asthma involves an inhaler and nebulizer dosages of anti-inflammatories
and Bronchodilators. Inhalers are devices that are used to inject or pump prepared dosage of
medicine into the patient’s lungs while nebulizers are battery-powered or plug-in devices that are
used to vaporize liquid drugs or medicine for easy inhalation (Mayo Clinic, 2018; Booker, 2014).
Bronchodilators are usually used as quick-relief, and are also commonly referred to as
quick-relief or rescue therapy medications. Widely used bronchodilators are short-acting beta
agonists, such as levalbuterol (Xopenex HFA) and albuterol (Ventolin HFA, ProAir HFA), and
anticholinergics, such as ipratropium bromide (Atrovent HFA) (Mayo Clinic, 2018). On the one
hand, short-acting beta agonist drugs are inhaled to provide instant relief during attacks. The
relief often lasts for several hours. Nevertheless, short-acting beta agonists are preferred for
exercise-induced Asthma attacks (Mayo Clinic, 2018).
Side Effects of Short-Acting Beta Agonists
Some of the common side effects of short-acting beta agonists include: excitability,
shakiness, fast heart rate, headache, and throat irritation. However, short-acting beta agonists are
also associated with heart arrhythmias in serious cases of Asthma (Ezzell, 2017). Moreover, side
effects for anticholinergics are: nasal irritation, nosebleed, nasal dryness, trouble breathing, and
dry mouth. It is also noteworthy that anticholinergic drugs can cause bronchospasms, which is
characterized by muscle spasms in the lungs that usually results in the narrowing of the airwaves
(Mayo Clinic, 2018). Anticholinergics can also worsen pre-existing conditions such as heart
Long-Term Asthma Control Medications
Long-term medications for Asthma are used for prevention of Asthma symptoms.
Doctors or physicians may prescribe bronchodilator, anti-inflammatory drug, or a combination of
the two medications (Mayo Clinic, 2018; Booker, 2014). Long-term medications are grouped as
Inhalable corticosteroids, Oral corticosteroids, Long-acting beta antagonists, Combination
inhalers, Leukotriene modifiers, Methylxanthines, and Immunomodulators.
Long-Term Asthma Control Medications
Some of the effects associated with long-term asthma medications include: poor
development in children and low minerals in the bones and high osteoporosis risks among female
patients. Besides, long-term medications can cause insulin imbalance in expectant women (Mayo
Clinic, 2018). In addition, extended administration of systemic corticosteroids can also
exacerbate the development of osteoporosis in older patients.
Stepwise Approach to Asthma
The stepwise approach is applied in the treatment or management of Asthma. The
approach helps physicians and patients to gain and maintain control of the condition (Khalid,
2015). The stepwise approach is applied by either increasing or reducing the amount of drug,
frequency, and dosage, of the drugs when necessary. Due to the nature of Asthma as a recurring
health condition, severe cases usually demand therapies that would overpower inflammations
over the long-term to avoid recurring Asthma exacerbations. The short-acting beta-agonist
(SABA) is used for patients with recurring symptoms while the second step involves the use of
small doses of prescribed corticosteroids. Other drugs that are used as substitutes for
corticosteroids include sodium scomolyn and nedocromil. Leukotriene receptor antagonists are
used when symptoms persist. The third step in the stepwise Asthma treatment involves inhalation
of low doses of a (long-acting beta-agonist (LABA) and a corticosteroid. The fourth step usually
marks cases of persistent Asthma, and a set therapy is usually recommended. Inhaled
corticosteroids are administered in medium doses with receptors antagonists of theophylline or
leukotriene. Besides, more stubborn and severe Asthma is treated using a high-dosage of a
corticosteroid in combination with a leukotriene receptor antagonist. According to Mayo Clinic
(2018), omalizumab is used in combination with the leukotriene receptor antagonist for allergic
patients, and marks the fifth step. The sixth step involves the use of a high-dosage inhaled
corticosteroid, leukotriene receptor agonist, and corticosteroid. Omalizumab is also used with a
leukotriene receptor antagonist for allergic patients.
ReflectionGaining and Maintaining Control of Asthma
It is evident that the situation and specific needs of patients are the two main aspects that
determine the stage or step of treatment under the stepwise Asthma management approach. In the
initial steps, physicians usually aim at administering a high level of therapy (advanced therapy)
to assure quick control of the condition. Advanced therapy is achieved by administering inhaled
steroids in higher doses or adding doses of oral steroids to inhaled steroids (Khalid, 2015).
During the later steps, the therapy is stepped down to the level that maintains control of the
symptoms. Persistence of symptoms during severe cases often calls for the re-examination of the
diagnosis. Besides, regular visits or follow-ups are recommended within six months to facilitate
monitoring of the patients condition. Essentially, patients are required to check their symptoms
and take control of their therapy.
Booker, R. (2014). Asthma in children: diagnostic and management dilemmas. Practice Nurse,
Vol. 44(11), 13-18.
Craig, T. (2014). Physician Implementation of Asthma Management Guidelines and
Recommendations: 2 Case Studies. A Supplement to The Journal of the American
Osteopathic Association. Vol. 114(11) Supplement 3: Es4-Es15.
Ezzell, K. G. (2017). Strategies to Guide Medication Adherence Discussions with Parents of
Children with Asthma. Pediatric Nursing, Vol. 43(5), 219-222.
Khalid, A. N. (2015). Stepwise management of asthma. International Forum of Allergy &
Rhinology, 5S41-S44. doi:10.1002/alr.21606
Mayo Clinic. (2018). Asthma: Diagnosis and Treatment. Retrieved from

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