Asthma is a respiratory system condition that is characterized by inflammation and hyper-responsiveness of the tracheobronchial tree to a variety of stimuli that result in variable airway obstruction which is reversible either by the use of drugs or spontaneously. During asthma attacks, there is a reduction in the airflow which is as a result of bronchospasms, edema, and inflammation of the mucosa of the bronchioles, and plugging of the small airways with secretions (Ban et al., 2015). Nocturnal and early morning coughs, wheezing, frequent episodes of breathlessness, and chest tightness are manifestations of the airway inflammation. Asthma has no definite cure, but there are medical processes that are put in place to manage the condition. To tackle the symptoms of asthma mentioned above, certain chronological steps must be taken. Two approaches are employed: short term and long-term control of asthma. The asthma stepwise management therapy using the appropriate drugs is beneficial both to the patients and the healthcare providers in preventing exacerbation of the condition.
Long-term Management
In management of asthma treatment aims to ensure symptoms do not recur and that the asthma is controlled. For patient presenting with persistent symptoms, medications prescribed for the management of asthma should be taken daily. Some of the drugs administered in this management approach include long-acting beta-agonists, inhaled corticosteroids, methylxanthines such as theophylline, leukotriene modifiers and inhalers containing combinations of corticosteroids and long-acting beta agonists (Arcanglo & Peterson, 2017). The inhaled corticosteroids are one of the effective and significant medications in the long-term management of asthma. Corticosteroids inhibit the stimulation of the inflammatory cells. Thus, the hyperresponsiveness of the airways is inhibited hence improving the symptoms. Some of the side effects of the inhaled corticosteroids include osteoporosis, oral thrush, retardation of growth, hypokalemia, hyperglycemia, impaired healing of wounds, skeletal muscle myopathy, and coughing corticosteroids (Reddel et al., 2015). It is vital for the providers of health care to monitor patients on these medications and to offer patient education regarding the side effects of the medication.
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Clinicians must formulate action care plans. The asthma care plan aids in recognition of worsening of symptoms. Action plans indicate the drugs and dosages to be administered once an individual experiences an asthma attack. Anxiety, headaches, and tremors are examples of the side effects experienced as a result of using bronchodilators.
Quick Relief
Quick relief is applied in the management of certain flare-ups, including breathlessness, wheezing, coughing, and tightness of the chest when one is experiencing an asthma attack. The drugs prescribed for quick relief are the bronchodilators. They aid in the relaxation of the muscles of the bronchioles. All asthmatic patients should have a rescue inhaler with them always. Most of the bronchodilators have a fast onset of action. Some of them include albuterol, bitolterol, pirbuterol, metaproterenol, and terbutaline (Arcanglo & Peterson, 2017).
Stepwise Approach to Asthma Treatment and Management
The management of asthma consists a stepwise method in the administration of medicines to curb the disease. The treatment for mild asthma attacks is the administration of inhaled beta-2 agonists intermittently. Moderate asthma attacks require the administration of inhaled sodium cromoglycate besides the use of intermittent inhaled beta-2 agonists. If the asthma symptoms persist, then the sodium cromoglycate is replaced with a low dose of inhaled steroids in addition to the intermittent inhaled beta-2 agonists (Arcanglo & Peterson, 2017). If the symptoms continue, a moderate dose of inhaled steroids is used in addition to the beta-2 agonists. In the event of persistent symptoms at this point, the healthcare provider may consider adding theophylline, ipratropium bromide, or long-acting beta-2 agonist. Further symptoms will require a higher dose of inhaled steroids.
Stepwise Management for Health Care Providers and Patients
The stepwise management approach is beneficial both to the patients and to the healthcare providers. This is vital to the healthcare providers since they can monitor the symptoms of the patients and how they respond to the various steps during the management (Ichikawa & Sugiura, 2018). Based on the medications that are being used in the stepwise management, the physicians can formulate questionnaires regarding the various side effects that the patients are undergoing to aid in pharmacotherapy research and better patient management. In a stepwise management approach the healthcare providers may use the treatment modality or to prevent asthma attacks. During each step in the stepwise management, the advances practice nurses and physicians can offer patient education regarding the medications and their probable side effects. Also, during the management, the patient is sensitized regarding the triggers of an asthmatic attack and how to prevent themselves from such attacks via keeping odd such triggers.
Conclusion
Asthma is a manageable disease, but in the event of asthma attacks, lack of adequate management can result in complications and, in some instances, death. Patient education should be availed to those living with the disease. Healthcare providers need to stick to the stepwise approach during the provision of health care to asthmatic patients.
Primary strategies to fight asthma are needed, but be based on a good understanding of the various determinants of the onset of asthma. Most patients with asthma, control of the disease can and should be achieved and maintained.
It is also suggested a change in approach to asthma management, with asthma control, than asthma severity, being the aim of treatment decisions.
References
Arcanglo, V.P., & Peterson, A.M., (Eds). (2017). Pharmacotherapuetics for advanced practice: A practical approach . Ambler, PA: Lippincott Williams & Wilkins
Ban, G. Y., Ye, Y. M., hwan Lee, Y., Lee, S. H., Kim, J. E., Nam, Y. H., ... & Park, H. S. (2015). The Predictors for Asthma Control By Stepwise Treatment in Elderly Asthma Patients. Journal of Allergy and Clinical Immunology , 135 (2), AB175.
Ichikawa, T., & Sugiura, H. (2018). for Adult Asthma. Advances in Asthma: Pathophysiology, Diagnosis and Treatment , 117.
Reddel, H. K., Bateman, E. D., Becker, A., Boulet, L. P., Cruz, A. A., Drazen, J. M., ... & Lemanske, R. F. (2015). A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal , 46 (3), 622-639.
