Asthma and Stepwise Management
Numerous respiratory and inflammatory disorders cause a significant public health concern, as are characterized by considerable mortality and morbidity rates. One of the conditions identified in this group is asthma. Statistics data shows that 24.6 million people in the USA are suffering from this disease and the number of the affected persons continues to grow (McCance & Huether, 2014). Therefore, sufficient and profound knowledge regarding asthma and its competent medical management can be beneficial to everyone, particularly, to the affected individuals.
Asthma belongs to a group of the most common chronic obstructive diseases that impair respiratory functions. It is characterized by the inflamed bronchial mucosa, “bronchial hyperresponsiveness, severe construction of the airways, and airflow obstruction” (McCance & Huether, 2014, p.1263). Severe genetic alterations, exposure to allergens, excessive smoking, recurrent respiratory viral infections, and unfavorable environmental conditions can cause this disease. In addition, air pollution, residence in the urban areas, and excess weight can increase the risks for the asthma, as well as cause aggravate its occurrence. The disease manifests with severe constrictions, breathlessness, non-productive coughing, labored respiration, and tachycardia (McCance & Huether, 2014). Asthmatics have to involve the additional muscles for inspiration and expiration that consequently increases blood and pulmonary pressure. Insufficient lung ventilation results in severe hypoxemia, which is harmful for all tissues. The represented clinical manifestations can tremendously deteriorate the life quality of the affected patients and pose serious risks without appropriate and competent treatment.
Effective therapy is vital and critical for the asthmatic patients. The approved stepwise medical management for asthma is aimed at decreasing the disease activity, relieving symptoms, reducing discomfort associated with it, and obtaining long-lasting remission. The primary measure, which should be taken by the affected person, is the avoidance of allergic agents and irritants that disturb normal breathing (Morris, 2017). Tobacco cessation, weight control, and antacid medication can ultimately reduce the risks for developing persistent asthma. Such initial actions can effectively prevent from the progression of disorder and stabilize breathing functions, particularly in the genetically predisposed individuals.
Pharmacotherapy is applied for the treatment of mild and severe cases of asthma. It consists of administration of inhaled rapid-acting and short-acting β2-agonists, and short-acting anticholinergic bronchodilators (Kim & Mazza, 2011). Medical practice shows that the prescription of short-action β2-agonists, such as salbutamol, terbutaline, and formoterol, can effectively reduce symptoms, relieve acute asthma exacerbations, and demonstrate positive bronchodilatory and anti-inflammatory effect on the damaged airways. It is estimated that the aforementioned drugs are more efficient compared to short-acting anticholinergic bronchodilators. Both medications largely assist in treating asthma in adults, whereas short-acting anticholinergic bronchodilators are not prescribed in children. However, the administration of long-acting β2-agonists is associated with the increased mortality rates (McCance & Huether, 2014). Therefore, it is recommended to avoid this treatment option them, especially if asthma is effectively controlled by other medication.
Health care providers frequently prescribe anti-inflammatory medication and inhaled corticosteroids that can efficiently assist in combating symptoms of persistent asthma in children and adults. Corticosteroid therapy is efficient in reducing acute symptoms and exacerbations of asthma and thus, improves lung functions in the asthmatic patients (Kim & Mazza, 2011). The stated medication can ultimately relieve mild and severe airway obstruction and provide better outcome in case of regular and long-term intake. Inhaled corticosteroid medication is frequently recommended as the maintenance and control therapy before the severe asthma attacks occur. However, intravenous administration of the stated drugs can be more advantageous due to their ability to accelerate the resolution of airway obstruction and preclude a late-stage immune response. In addition, the combination of inhaled corticosteroid medications along with long-term β2-agonists intake can significantly decrease asthma manifestations in adolescents and grown-ups and thus, improve their condition. Meanwhile, the discussed therapy is associated with certain adverse effects, such as oral thrush, dysphonia, “adrenal suppression, changed bone density, growth retardation,” and vision impairments (Kim & Mazza, 2011, p.6). Prolonged administration of corticosteroids entail weight gain, skin alterations, diabetes, and even psychiatric abnormalities. If the patient does not respond to inhaled corticosteroids therapy adequately, practitioners may include leukotriene antagonists into the treatment regimen. Such drugs as montelukast and zafirlukast are beneficial for the management of asthma. They are usually used as a reserve option for the cases, when patients do not respond to corticosteroid medication. Furthermore, recent studies show lower efficacy of the anti-leukotriene medication compared to inhaled corticosteroids in curing asthmatic adults and children.
Today, clinicians often apply monoclonal antibody therapy for treating moderate and severe persistent asthmatic symptoms, when other therapies are inefficient. This kind of medication refers to the second-line therapy that can intensify the therapeutic effect of the first-line treatment. The Federal Drug Administration approved such drugs as omalizumab, mepolizumab, reslizumab, and benralizumab, as they can significantly improve asthma control in the affected adolescents and adult patients (Morris, 2017). Various clinical trials and practices demonstrate that the aforementioned drugs largely assist in mitigating bronchospasms, improving lung functioning, and reducing the frequency of asthma exacerbations. The stated medications have minor side effects, such as headache, urticaria, and symptoms resembling upper respiratory tract infections, but they appear rarely.
Health care providers may apply allergen immunotherapy in case of prevalent asthmatic symptoms and insufficient immune response to the prescribed pharmaceutical agents. Immunotherapy is particularly beneficial for asthmatics of different ages with allergy-induced asthma. It can reduce symptoms of the stated disease, improve airway hyperresponsiveness, and decrease the need in other medication. However, its usage still remains controversial and requires further research and surveys.
Pulmonologists practice such novel therapy as bronchial thermoplasty for coping with severe asthma. It can improve the condition of the asthmatic patients in case of long-term therapy with inhaled corticosteroids and long-acting β2 agonists. This approach consists of delivery of the “controlled thermal energy into the airway wall” during the bronchoscopy (Morris, 2017, p.1). Multiple researches asserted that bronchial thermoplasty alleviates asthmatic symptoms, decrease exacerbations, and, consequently, reduces the number of visits to emergency departments. The described method of asthma treatment is safe and effective. Furthermore, health care providers involve nebulizer therapy in the treatment process for relieving severe asthma and minimizing respiratory stress. It is appropriate for managing this disease in various groups of patients, including the pediatric ones. In addition, treatment with helium-oxygen can mitigate the labored breathing in patients with the severe symptoms and reduce the need in intubation. Asthma victims can benefit from the aforementioned therapy as far as the named gas can smoothly travel through the narrowed passages and stabilize the breathing process.
Practitioners can prescribe endotracheal intubation for securing lives of the patients, who remain symptomatic despite the long-term intake of corticosteroids and reliever medications. It assists in normalizing breathing process and improving respiratory health of the asthmatics. Such surgical intervention is applied in the most severe clinical cases. Endotracheal intubation is connected with certain risks and requires regular monitoring after the intervention.
Therefore, asthma refers to a group of chronic obstructive pulmonary diseases. The stated respiratory dysfunction can considerably deteriorate breathing functions and reduce the life span of the affected people. It is characterized by bronchial exaggerated responsiveness, inflammation, and impaired respiratory functions. Treatment of asthma starts with avoidance of various allergens and irritants, the administration of reliever and controller medications. Allergen-specific immunotherapy, monoclonal antibody therapy, bronchial thermoplasty, nebulizer, and heliox therapies are efficient treatment modalities for the management of mild, acute and severe forms of asthma. Endotracheal intubation is beneficial in the most severe cases of the disease.