Response To QuestionsAsthma And Stepwise Management

Running head: ASTHMA AND STEPWISE MANAGEMENT 1

Response to Questions—Asthma and Stepwise Management

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ASTHMA AND STEPWISE MANAGEMENT 2

Response to Questions—Asthma 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.

Bronchodilators

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

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

ASTHMA AND STEPWISE MANAGEMENT 3

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

ASTHMA AND STEPWISE MANAGEMENT 4

(Mayo Clinic, 2018). Anticholinergics can also worsen pre-existing conditions such as heart

arrhythmias.

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

ASTHMA AND STEPWISE MANAGEMENT 5

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.

Reflection—Gaining 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 patient’s condition. Essentially, patients are required to check their symptoms

and take control of their therapy.

ASTHMA AND STEPWISE MANAGEMENT 6

References

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

https://www.mayoclinic.org/diseases-conditions/asthma/diagnosis-treatment/drc-

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