Asthma and Stepwise Management uk
Long-term Control and Quick Relief Treatment Options for Asthma and Their Impact on Patients
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There exist two general classes of medications for treating asthma. The first one includes long-acting drugs used to achieve and maintain control of persistent asthma. Such an outcome is achieved primarily by regular use of anti-inflammatory medications since the underlying pathology of asthma is inflammation (Hinkle & Cheever, 2013). Usually, these medications are administered in a form of inhalers. When used over the long term, the drugs have systemic side effects. The second class of drugs involves quick-relief medications for immediate treatment of acute asthma symptoms, exacerbations, and exercise-induced asthma. Hinkle and Cheever (2013) name such quick-relief medications as pirbuterol (Maxiar), levalbuterol (HFA, Xopenex), and albuterol (Ventolin, Proventil, AccuNeb). The listed medicines belong to a group of short-acting beta-adrenergic agonists that relax smooth muscle. Additionally, there is an anticholinergics group of medication, such as ipratropium (Atrovent), that may be used for patients allergic to beta-adrenergic agonists. Anticholinergics inhibit muscalinic cholinergic receptors and reduce the inner vagal tone of airways (Hinkle, & Cheever, 2013).
Long-acting asthma medications used to achieve and maintain control of persistent asthma include corticosteroids, chromolyn sodium, nedocromil, long-acting beta-adrenergic agonists, leuktriene modifiers/inhibitors (also known as antileukotrienes), and immunomodulators (Arcangelo & Peterson, 2011; Hinkle & Cheever, 2013). These drugs might have the following impact on patients. First, corticosteroids are considered the most effective and potent anti-inflammatory medications. They alleviate symptoms, decrease peak flow variability, and improve airway function. Cromolyn sodium and nedocromil act as anti-inflammatory agents, stabilize mast cells, and prevent exercise-induced asthma. Long-acting beta-adrenergic agonists are used with anti-inflammatory medications; they control asthma symptoms, especially at night time, and prevent exercise-induced asthma. Leukotriene modifiers/inhibitors (antileukotrienes) dilate blood vessels and alter permeability. This type of medication may either be used as an alternative to inhaled corticosteroids or added to inhaled corticosteroids to attain greater control in instances of severe asthma (Arcangelo & Peterson, 2011; Hinkle, & Cheever, 2013). Finally, immunomodulators may be prescribed to patients with severe persistent asthma and allergies.
Stepwise Approach to Asthma Treatment and Management: Assisting Health Care Providers and Patients in Gaining and Maintaining Control of the Disease
The method to treating asthma with the least amount of medications to minimize the risk of adverse side effects is called a stepwise approach (National Heart, Lung, and Blood Institute, 2007). In other words, stepwise approach immplies adjusting treatment by using gradual increase or decrease of medication dosage in order to use the least possible amount of medications to maintain asthma control (American Academy of Allergy Asthma and Immunology, n.d.). Within this framework, treatment and control of asthma is viewed in the contexts of risk, impairment and achieving optimal medication regimen. For example, a newly diagnosed patient may be prescribed a larger dose of medications to achieve good sleep and sufficient engagement in work and prevent emergency hospitalization. However, once described goals are achieved and a patient maintains good control of his or her condition, it may be recommended to gradually decrease the dosage to achieve the same control of asthma with lower dosage (Global Initiative for Asthma, 2015). The stepwise approach has two benefits. First, it drives down medication costs. Second, risk of adverse side effects decreases.
Considering the above information, it becomes clear how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. On the one hand, it provides a framework for assessing patient’s status and determining an optimal course of action and medication regimen. On the other hand, the stepwise approach is patient-centered: this method helps to determine optimal treatment tailored to a patient health needs. Lastly, this approach allows involving patients in determining medication regimen and enhances patient-healthcare provider collaboration.
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