Asthma Stepwise Management Longterm Control Options in Asthma

Asthma &Stepwise Management

Long-term Control Options in Asthma • Long-term control asthma medications used to: • • Preventing & decreasing swelling in the airways Thus preventing asthma triggers • Long-term control drugs suitable for: • • People having asthmatic symptoms 3 or more times weekly or At night three or more times monthly • Long-term asthma drugs: anti-inflammatory drugs, Leukotriene modifiers & bronchodilators • Anti-inflammatory drugs prevent asthmatic symptoms by: • • Preventing & reducing swelling in the airways after trigger Controlling of mucus to ease breathing

Long-term Control Options in Asthma Cont. ’ • Anti-inflammatory medications include: • • Inhaled corticosteroids like flunisolide, fluticasone & beclomethasone • • • Sustained-release beta 2 -agonist tablets Inhaled cromolyn & nedocromil such as nedocromil sodium & cromolyn sodium • Bronchodilators relax airway muscles opening airways • Bronchodilators include: Inhaled long-acting beta 2 -agonists Sustained-release theophylline • Leukotriene modifiers prevent symptoms triggered by aspirin allergic reactions • Examples of Leukotriene modifiers are zileuton & zafirlukast

Quick Relief Treatment Options in Asthma • Quick-relief medications rapidly relieve asthma symptoms by: • • Fast relaxing muscles in & around the airways Opening up airways • Examples of quick-relief medications for asthma are: • Inhaled anticholinergics & inhaled short-acting beta 2 -agonists • Inhaled anticholinergics work by blocking acetylcholine • Example of inhaled anticholinergics is ipratropium bromide • Short-acting beta 2 -agonists relax airway muscles, reopening airways • Examples of short-acting beta 2 -agonists are pirbuterol, terbutaline & albuterol

Effects of Asthma Medications • Long-term effects of corticosteroids include • • Hypertension Growth suppression especially in children, Diabetes Dermal thinning • Inhaled long-acting beta 2 -agonists cause: • Faster pulse rate, shakiness & hypokalemia

Stepwise Approach to Asthma Treatment & Management • Step 1: • • • Used to treat intermittent asthma symptoms & fit for all age-groups • Treats mild persistent asthma Medications include short-acting beta-agonist like albuterol prn If used for over 2 days per week treatment be stepped up • Step 2: • Drugs include low-dose inhaled corticosteroids, leukotriene blocker or cromolyn as alternative • • Treats modest & severe asthma • Step 3 & 4: Addition of a dose of inhaled steroids or LABA or both depending on asthma severity • 5 th & 6 th steps: • • • Increasing dose of inhaled corticosteroids Addition of omalizumab In 6 th step, addition of oral/chronic corticosteroids is considered

Significance of the Stepwise Management to Health Care Providers & Patients • Patients & healthcare providers are able to use written action plans • Written action plans guide effective control asthma attacks or asthma exacerbations • Healthcare providers are able to provide individualized care d • Patients are able to effectively control the disease process • Effective in preventing & managing of asthma exacerbations

References • • Alangari A. (2014). Corticosteroids in the treatment of acute asthma. Ann Thorac Med. 9(4), 187– 192. • Dunn N, Neff L & Maurer D. (2017). A stepwise approach to pediatric asthma. J Fam Pract. 66(5): 280, 282286 • • • Bateman R, Becker A, Wong G, Soto M et al. (2015). A summary of the new GINA strategy: a roadmap to asthma control. European Respiratory Journal. 1(2). Dima A, Bruin M & Ganse E. (2016). Mapping the Asthma Care Process: Implications for Research and Practice. J Allergy Clin Immunol Pract. 4(5). Laforent L, Manon B, Didier A, Ganse E & Marine G. (2016). Long-Term Inhaled Corticosteroid Adherence in Asthma Patients with Short-Term Adherence. J Allergy Clin Immunol Pract. 4(5), 890– 899. Lampkin S, Cheryl M, Maish W & John B. (2016). Asthma Review for Pharmacists Providing Asthma Education. J Pediatr Pharmacol Ther. 21(5), 444– 471. Tashkin D. (2016). A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 1(11), 2585– 2596.