Stepwise Asthma Management

679 words | 3 page(s)

Asthma is a chronic inflammatory disease that affects the airways, causing symptoms such as airflow obstruction, bronchospasm, coughing, and shortness of breath (National Asthma Education and Prevention Program, 2008). As of 2011, an estimated 300 million people have asthma worldwide (National Asthma Education and Prevention Program, 2008) and its incidence is on the increase, particularly in children (Toelle et al., 2013). For this reason, it is necessary to understand the management techniques that can be used to prevent death from asthma and keep unpleasant symptoms under control.

The major intervention for long-term control of asthma are the corticosteroids, which are presented in an inhaler for daily or bi-daily usage (Toelle et al., 2013). Additionally, long-acting beta-adrenoceptor agonists (LABA) can help prevent asthma attacks when used in the long-term in combination with corticosteroids, although the benefits of these have not been proven in children (National Asthma Education and Prevention Program, 2008). In the short-term (in case of asthma attack or severe inability to breathe) there are other interventions. One of the most common is the short-acting beta-adrenoceptor agonists (SABA), including salbutamol (National Asthma Education and Prevention Program, 2008). These can be used before exercise in those whose symptoms are triggered or worsened by exercise (Toelle et al., 2013). Anticholinergic medications are also used in short-term interventions, most in conjuction with salbutamol or similar jobs. Inhaled epinephrine can also be used in the case of an asthma attack (Toelle et al., 2013).

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The impact that these drugs may have on patients is varied. With long-term management, patient co-operation is always problematic and carrying around and remembering inhalers can be problematic (Toelle et al., 2013). Psychologically, there are cases where (particularly adolescents) are reluctant to use long-term management and short-term interventions in public as they are associated with negative stereotypes culturally (National Asthma Education and Prevention Program, 2008). Taking a daily medication has also been shown to be associated with higher levels of depression and other negative psychological symptoms (National Asthma Education and Prevention Program, 2008). There are also physical side-effects with asthma medications, as with any medical intervention. The most popular long-term therapy – corticosteroid inhalers – are associated with oral thrush and dry throat (Kit et al., 2012). There are also cases in which patients can experience allergic reactions to all the interventions listed above (Kit et al., 2012).

The stepwise approach to asthma management is a popular approach that focuses on maintaining control of asthma and its symptoms whilst using the least amount of medication. Step one, therefore, relies on the SABA medications that are commonly prescribed to all newly-diagnosed patients with asthma as these are the most reliable and require the lowest dosage (Kit et al., 2012). Clinical staff can then move onto step 2, whereby low-dose ICS can be used in place of SABA where this does not control asthma symptoms correctly. Step 3 works with using a LABA + a low-dose ICS or a medium-dose ICS (Kit et al., 2012). There are 6 steps and clinical staff can use these to step up dosage and types of medication where necessary (National Asthma Education and Prevention Program, 2008).

Stepwise management helps healthcare providers in many ways. It offers an easy guidance for deciding which intervention is best for patients and allows healthcare providers to move up progressively (National Asthma Education and Prevention Program, 2008). This gives a benefit to the patient, who is not placed on higher strength medications or combinations which could cause or worsen side-effects from asthma management programs. It also allows healthcare providers to control asthma management in a logical manner, and may also give clues on how bad the patient’s asthma is and what situations trigger their need for higher strength medications (National Asthma Education and Prevention Program, 2008). The stepwise program is split into two main domains, which are reducing impairment on daily life – ensuring that the psychological symptoms associated with taking daily medication are avoided as patients have to take the lowest dose (National Asthma Education and Prevention Program, 2008). It also reduces the lifestyle impact which can be worrying for patients. It also works on reducing risk, which is evidently beneficial for reducing the number of hospitalizations required from asthma (National Asthma Education and Prevention Program, 2008).

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