Long-term Control drugs are those taken regularly to control asthma attacks and prevent the occurrence of chronic symptoms. This type of treatment is administered on a long-term basis and is the most common option among asthma patients (Aysola & Castro, 2008). On the other hand, Quick Relief medications are not for regular use but rather the fast short-term treatment of asthma symptoms. They relax the airwaves muscles to open the lungs. They begin to take effect in minutes and remain effective for about six hours (James, 2006).
The five types of medications used for long-term asthma are Inhaled corticosteroids, long-acting beta-agonists, inhaled combinations of corticosteroids and LABAs, theophylline, and leukotriene modifiers. Inhaled corticosteroids are anti-inflammatory medicine used to ease tightening and reduce swelling of the airwaves (Singh, 2011). Examples of inhaled corticosteroids are Ciclesonide, Beclomethasone, Mometasone, Budesonide, and Fluticasone. Their side effects include delayed growth in children, oral yeast infections as well as throat and mouth irritation. Long-acting beta agonists (LABAs) are bronchodilators that reduce swelling and open airways for several hours. They do control not only both severe and moderate asthma but also prevent symptoms that occur at night. The most common example is salmeterol. Despite their effectiveness, LABAs are associated with severe asthmatic attacks. Therefore, they are combined with inhaled corticosteroid for the best outcome. Examples of such medication are Breo, Dulera, Symbicort, and Advair Diskus (Singh, 2011). Theophylline is used for managing mild asthma. It relieves irritation of the lungs and relaxes airwaves. Possible side effects of the medication are gastroesophageal reflux and insomnia. Lastly, Leukotriene modifiers inhibit the effects of the chemicals responsible for the occurrence of asthma symptoms. They include Zileuton, Zafirlukast, and Zafirlukast. Montelukast is associated with psychological effects such as thoughts of suicide, depression, hallucination, aggression, and agitation.
Quick-relief treatment options include quick-relief inhalers with Albuterol or Levalbuterol, ipratropium or Oral corticosteroids. For infrequent and minor symptoms as well as asthma induced by exercise, a patient may use Albuterol or Levalbuterol. These drugs may cause palpitations and jitteriness (Lipworth, Currie, & Fowler, 2001). The other quick-relief drug is ipratropium, a fast bronchodilator meant for chronic bronchitis or emphysema but also good for asthmatic attacks (Camargo, Rachelefsky, & Schatz, 2009). Oral corticosteroids such as Methylprednisolone and Prednisone also give quick relief for severe attacks. However, when used for a long time, these drugs may have negative effects such as slow growth in children, high blood pressure, decreased immunity, muscle weakness, thinning bones, and cataracts (Lipworth, Currie, & Fowler, 2001).
The Stepwise Approach to Asthma Treatment and Management
Based on the conditions of individual patients, asthma varies in severity from time to time. Therefore, it is necessary to classify the severity of each case by categorizing patients according to the most severe level at which each symptom manifests (Expert Panel Report 3, 2007). Also, the doctor has to monitor the dosage of medicine for each asthma patient. Some times, a doctor may have to "step down" or "step up" the medication to manage the symptoms and control asthma. The gradual decrease or increase of asthma treatment doses to find the most appropriate balance is known as a stepwise approach.
Upon diagnosis of asthma, a patient may have to use an increasingly high dosage of asthma control and relief drugs until the symptoms are put well under control. Once the patients can stay active throughout the day and sleep well at night, they do not need a large amount of medication to continue keeping asthma in check (Urbano, 2008). Therefore, they can collaborate with their doctors to adjust their treatment downwards. However, in stepwise management of asthma, patients are required to take their drugs according to prescription. A patient cannot stop taking the drugs or lower their dosage without a doctor's advice even when the symptoms disappear. Also, the stepwise approach requires caregivers to refer the patients to asthma specialists in case they experience difficulties in gaining and maintaining control of the disease (Fabbri, Boulet, Kardos, & Vogelmeier, 2004). The caregivers also need to recommend annual influenza vaccination for their patients on the stepwise asthma treatment plan. Lastly, it is important to note that the main role of the stepwise asthma treatment is not to replace but to assist the necessary clinical decision making in each patient's case.
How Stepwise Management Assists Health Care Providers and Patients in Controlling Asthma
Stepwise management assists health care providers and patients in gaining and maintaining control of the disease in several ways. Apart from eliminating or minimizing chronic night or day symptoms, stepwise approach minimizes or eliminates negative effects of asthma medications. It also helps to minimize the need to use short-acting inhaled beta2-agonist, keep pulmonary function at normal, and minimize exacerbations (Khalid, 2015). Also, by beginning with a high amount of medication then stepping down to a lower one, the stepwise approach enables health care providers and patients to gain quick control of the sickness (Baba & Yamaguchi, 2005). It also comes with education for patients on how to control and manage environmental factors that worsen asthma on their own.
Aysola, R., & Castro, M. (2008). The Goals for Asthma Management: Short and Long Term. Clinical Asthma, 159-163. doi:10.1016/b978-032304289-5.10018-9
Baba, K. N., & Yamaguchi, E. (2005). Issues Associated with Stepwise Management of Bronchial Asthma. Allergology International, 54(2), 203-208. doi:10.2332/allergolint.54.203
Camargo, C. A., Rachelefsky, G., & Schatz, M. (2009). Managing Asthma Exacerbations in the Emergency Department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations. The Journal of Emergency Medicine, 37(2), S6-S17. doi:10.1016/j.jemermed.2009.06.105
Expert Panel Report 3. (2007). Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007. Journal of Allergy and Clinical Immunology, 120(5), S94-S138. doi:10.1016/j.jaci.2007.09.029
Fabbri, L., Boulet, L., Kardos, P., & Vogelmeier, C. (2004). The asthma management gap - why current treatment strategies can fail to provide optimal asthma control. International Journal of Clinical Practice, 58, 1-8. doi:10.1111/j.1368-504x.2004.00259.x
James, J. (2006). Patterns of Quick-Relief and Long-term Controller Medication Use in Pediatric Asthma. PEDIATRICS, 118(Supplement_1), S34-S35. doi:10.1542/peds.2006-0900eee
Khalid, A. N. (2015). Stepwise management of asthma. International Forum of Allergy & Rhinology, 5(S1), S41-S44. doi:10.1002/alr.21606
Lipworth, B. J., Currie, G., & Fowler, S. (2001). On-demand relief treatment for asthma. The Lancet, 357(9271), 1882. doi:10.1016/s0140-6736(00)04983-7
Singh, M. (2011). Chapter-17 Establishment of Individual Medication Plans for Long-term Management. Asthma in Children, 210-221. doi:10.5005/jp/books/11300_17
Urbano, F. L. (2008). Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. Journal of Managed Care Pharmacy, 14(1), 41-49. doi:10.18553/jmcp.2008.14.1.41
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