Asthma is a chronic pulmonary disorder. The inflammation of the airways and their hyper-responsiveness is responsible for several symptoms, which include coughing, wheezing, feeling of tightness in the chest area, and shortage of breath. Other characteristics of asthma include increased eosinophils, increased tissue contractibility, and thickened lamina reticularis. Although asthma has an early onset, all age groups can suffer from asthma, and all patients are at risk for acute asthma exacerbation, which leads to high morbidity and mortality rates.
Because asthma is a chronic disorder, drug therapy needs to be controlled and aimed at managing the disorder. A stepwise approach is used to achieve that goal because it is important to reduce impairment and risks simultaneously (National Heart Lung and Blood Institute [NHLBI], 2007). With that in mind, the dosage, frequency, and types of medication used should be increased when patients experience stronger symptoms than usual and decreased whenever possible.
When assessing the patient’s condition, the healthcare providers determine the severity levels of symptoms, so the treatment starts at the step which is the most appropriate for the patient’s condition (Arcangelo & Peterson, 2013). The severity is categorized into four levels, which include mild intermittent, mild persistent, moderate persistent, and severe persistent asthma.
In the beginning of the treatment, one of four possible lines of therapy is chosen to control the disease and prevent acute exacerbations. In the first line of treatment, short-acting bronchodilatators are used when necessary, and they remain consistent in all lines of treatment. If they are used more than twice per week, the second line of therapy implements a low dose of inhaled corticosteroids. The third line of treatment increases the dose of corticosteroids or includes leukotriene modifiers. Leukotriene modifiers are pregnancy category B drugs, and may be secreted into human milk, so they should not be prescribed to pregnant women or breastfeeding women if there are suitable alternatives (Cerner Multum, 2011b).
In the most severe cases, long-acting beta2-agonists are used with high doses of corticosteroids. The treatment should be reviewed every two weeks until a minimal required dose of medication is established, and the treatment can be reviewed every one or six months (Arcangelo & Peterson, 2013). With that approach, the patient receives the least amount of drugs required to ensure quality of life while preventing overdose or impaired social activities and functioning at work or in school.
The drug treatment of chronic asthma mainly follows the same principles across all age groups, but several considerations need to be taken in account regarding medicine dosage and possible side-effects. The most effective long-term prevention therapy is done with inhaled corticosteroids because they are generally safe and reduce risk of acute exacerbations with their rapid onset. However, fluticasone inhalation is an example of an unsafe inhaled corticosteroid for children because it can retard their growth (Cerner Multum, 2011a). Other corticosteroids show weaker side-effects in children, but children under 5 years of age should use nebulizers instead of inhalers (Arcangelo & Peterson, 2013).
In older patients, long-term use of corticosteroids may promote the onset of other disorders, such as diabetes, obesity, or immunosuppressant disorders (Gibson et al., 2010). Therefore, patient education and lifestyle habits should be prioritized with the aim of reducing the severity level to mild intermittent asthma. In addition, beta2-agonists can induce cardiovascular disorders and symptoms. For example, albuterol was associated with palpitations, tachycardia, deviations in blood pressure, and peripheral vasodilatation (Cerner Multum, 2012), so anticholinergics should be used in addition to beta2-agonists to prevent those side-effects (Arcangelo & Peterson, 2013).
References
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Cerner Multum. (2011a). Fluticasone inhalation. Retrieved from http://www.drugs.com/mtm/ fluticasone-inhalation.html
Cerner Multum. (2011b). Zafirlukast. Retrieved from http://www.drugs.com/mtm/ zafirlukast.html
Cerner Multum. (2012). Albuterol inhalation. Retrieved from http://www.drugs.com/ albuterol.html
Gibson, P. G., McDonald, V. M., & Marks, G. B. (2010). Asthma in older adults. Lancet, 376(9743), 803-813.
National Heart Lung and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/ guidelines/asthma/asthgdln.htm
