Asthma remains one of the most common diseases affecting the airways characterized by three biological hallmarks including bronchial hyperresponsiveness, airflow obstruction, and underlying inflammation. As a chronic inflammatory condition with a high prevalence, understanding the rationale behind its diagnosis, management, and prevention remain critical factors. Research has shown that about 25.7 million individuals in the United States have asthma (Arcangelo & Peterson, 2006 p. 1). Despite its high prevalence, its etiology remains largely unknown. Pharmacological treatment is one of the ways used in the management of asthma. It controls the symptoms and seeks to improve the overall quality of life. The drugs are also known to reduce the intensity of the asthma exacerbations and limit the airflow obstructions. The drugs used in the treatment of asthma can be classified as either short-term for quick relief or the long-term that are taken over an extended period of time. Pharmacological treatment can also follow an approach referred to as the stepwise model. The method of treatment involves the increase or decrease in the frequency of administration of drugs as appropriate. Although the pharmacological approach to treatment has proven benefits in managing and controlling asthma, it also has its downsides due to the associated side-effects.
Long-Term Treatment Methods
The long-term medications for asthma are persistently taken to maintain control over persistent asthma. The drugs used on a long-term basis can be classified as inhaled corticosteroids, inhaled long-acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators (National & Prevention, 2007 p. 216). The mechanism behind the inhaled corticosteroids is simple. They limit the mucus secretion by inhibiting the release of a substance known as secretagogue from the cells macrophages. It, therefore, suppresses any possibility of airway inflammation which is responsible for the changes characterized as asthma (Edmonds et al., 2012 p. 56). They are regarded as the most reliable treatment of severe, moderate, or persistent asthma. The bronchodilators, on the other hand, relieve acute asthma by opening the air pathways (Pelaia, Vatrella, & Maselli, 2012 p. 45). Essentially, the drug works by relaxing the muscles responsible for tightening the airways. As a result, the airways become open hence letting air into the lungs. Leukotriene modifiers work as an enzyme inhibitor, or a receptor agonist opposes the function of an inflammatory mediator known as the leukotriene which is responsible for the asthma-like conditions such as inflammation, bronchoconstriction, and the secretion of mucus.
Delegate your assignment to our experts and they will do the rest.
Cromolyn sodium has also been found to be one of the most effective long-term treatments of asthma. It primarily works by inhibiting the production of inflammation mediators which can come as a result of nonspecific mechanisms that lead to the activation of the mast cells. It is effective in controlling both mild and moderately chronic asthmatic conditions in about 70% of the patients (Pelaia, Vatrella, & Maselli, 2012 p. 958). Theophylline targets the muscles in the airway by inhibiting the production of a chemical known as phosphodiesterases. Immunomodulators primarily target the immune cells such as mast cells, neutrophils, and lymphocytes among others hence reducing inflammation, which is a cardinal symptom associated with asthma.
Side Effects
Since these drugs are used on a long term basis, they can come with a host of side effects. Inhaled corticosteroids have fewer side effects when taken in low doses. However, they can result in hoarseness and thrush on the mouth. On a long-term basis, they can predispose an individual to diabetes, hypertension, and osteoporosis. Inhaled long-acting bronchodilators can lead to trembling, headaches, dry mouth, nausea, vomiting, and diarrhea. Leukotriene modifiers could result in heartburn, stuffy nose, stomach pain, rash, cough, irritability, and headache. Cromolyn can cause an unusual taste in the mouth, cough, wheezing, and nausea. The other drugs have more or less similar side effects that are less serious especially when used in the right dosage.
Short-Term Methods
The quick-relief methods are used whenever there is a need to solve the problem of bronchoconstriction and the accompanying acute symptoms such as chest tightness, cough, and wheezing (National & Prevention, 2007 p. 223).The most utilized drugs include the anticholinergics and the inhaled short-acting beta agonists. The anticholinergic drugs primarily work by preventing the muscles in the airway from potentially tightening. It acts by blocking acetylcholine from binding to its receptors. As such, they inhibit actions known as the parasympathetic nerve impulse. The short-acting beta agonists on their part work by activating the β adrenergic receptors which in turn leads to the relaxation of the muscles in the airways and the lungs.
Side Effects
Just like the drugs used in the long-term, the short-term ones have certain side effects which can be mild especially when the drugs are taken in the correct dosage. The Short-acting beta-agonists are associated with faster heartbeats, shakiness, and nervousness which can effectively reduce as the drugs degenerate in the body. Anticholinergics on their part can lead to dry mouth, blurred vision, dry eyes, constipation, urinary retention, dizziness, and confusion among others.
The stepwise approach to asthma treatment and control is a method in which the administered medications are frequently increased or reduced as appropriate in a bid to achieve control. Treatment of asthma is a long-term procedure, and this can call for frequently altering the amount of medication in a bid to achieve ultimate suppression of the inflammation and associated symptoms. The stepwise approach has four primary aspects. The first one is referred to as the classification of the severity. Here, the focus is to assess the clinical features exhibited before adequate control and treatment (Arcangelo & Peterson, 2006 p. 13).The four main classifications used include mild intermittent, mild persistent, moderate persistent, and last, severe persistent. Secondly, the stepwise treatment has a section for medication that matches the conditions shown as previously classified. Depending on the level of severity, the stepwise approach indicates the type of medication or lack of thereof needed as a means of managing the situation. The third component included is education where depending on the seriousness of the condition, the patient will be advised on behavioral and therapeutically practices to leverage as a remedy. Lastly, decisions, whether to step up or step down the treatment, are provided based on reviewing the manifestations of the patient after a particular period (Stepwise Approach for Managing Asthma in Adults and Children Older than 5 Years of Age: Treatment).
Role of Stepwise In Gaining and Maintaining Control
It remains fundamental to note that the role of the stepwise approach is not to replace but rather assist clinical decision making needed to attain the individual patient needs. Since it classifies severity, patients and health providers understand the scope of the well-being of their patients and the particular intervention required at a particular time. Fornadley, (2014) asserted that the knowledge acquired from classification could enable the patient to acquire drugs without necessarily having to consult the health professionals (p. 102). The stepwise strategy comes with a plethora of health promotional tactics that seek to change behavior. It is in this regard that the patient will receive education on self-management and environmental risk factors.
Conclusion
Asthma is one of the most common health conditions affecting the respiratory system. It has a high prevalence, especially in the US. Treatment can be long-term or short-term. The short-term treatment seeks to relieve the symptoms associated with the disease thus helping an individual to regain normalcy for a short period. However, long-term treatment is taken for an extended period. Both drugs have mild side effects that can have a toll on an individual's well-being. Physicians might need to increase and decrease medication with time-based on the severity of the symptoms. Such a strategy is known as the stepwise approach which increases the power of the patient and the physician in managing their health.
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2006). Pharmacotherapeutics for advanced practice: a practical approach (Vol. 536). Lippincott Williams & Wilkins.
National, A. E., & Prevention, P. (2007). Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. The Journal of allergy and clinical immunology, 120(5 Suppl), S94.
Pelaia, G., Vatrella, A., & Maselli, R. (2012). The potential of biologics for the treatment of asthma. Nature reviews Drug discovery, 11(12), 958.
Edmonds, M. L., Milan, S. J., Camargo Jr, C. A., Pollack, C. V., & Rowe, B. H. (2012). Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database of Systematic Reviews, (12).
Fornadley, J. A. (2014). Stepwise treatment of asthma. Otolaryngology Clinics of North America, 47(1), 65-75.
Stepwise Approach for Managing Asthma in Adults and Children Older than 5 Years of Age: Treatment https://nmhealth.org/publication/view/general/4231/
