Asthma is a chronic inflammatory disorder of the airway characterized by airway hyperresponsiveness, mucus hypersecretion, and reversible airflow limitation (Lian, 2009). Chronic inflammation associated with asthma thickens the airway walls or changes their structure, a process known as airway remodeling (Lian, 2009). For acute cases, the patient has bronchoconstriction and airway edema. Asthma varies with genotypes, susceptibility to environmental factors, clinical phenotypes, pathogenesis, severity, and response to treatments. Some of the asthma triggers include exposure to allergen or irritant, viral respiratory infection, stress, cold air, smoking, gastroesophageal reflux, intake of drugs such as aspirin, beta-blockers or nonsteroidal anti-inflammatory drugs, and nonadherence to pharmacologic therapies or sudden withdrawal from corticosteroids.
One of the management strategies of asthma is the administration of corticosteroids. Corticosteroids are potent drugs that can be effective if administered under proper guidelines. Getting to know why and how to use the medicines safely is essential. Corticosteroids are drugs associated with cortisol, a hormone that is naturally produced in the adrenal cortex. Corticosteroids include Betamethasone, cortisone, Dexamethasone, Prednisolone, Budesonide, and Hydrocortisone. Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions such as prostaglandins (Barnes, 2006). Nevertheless, corticosteroids also impede the function of white blood cells. The interference of the white blood cells yields a side effect of increased susceptibility to infection.
Corticosteroids are versatile in their mode of application, and they can be given orally, injected into the vein or muscle, applied locally to the skin or injected directly into inflamed joints (Barnes, 2006). Corticosteroid drugs are sometimes used as ingredients contained in inhalers which treat asthma or bronchial diseases. Administration of systemic corticosteroids as prescribed is also another way to manage asthma. Corticosteroids play a crucial role in the suppression of airway inflammation. Through inhibiting inflammatory cell migration and activation, and blocking late-phase reaction to allergens, corticosteroids reduce airway hypersensitivity, secretions, and edema (Rowe et al., 2001). Systemic corticosteroids are an integral part of the first line medication for moderate to severe asthma attacks. Prednisone, methylprednisolone, prednisolone, dexamethasone, and hydrocortisone are commonly prescribed and issued for 3 to 10 days. Dose duration and reduction of corticosteroid therapy are determined by the severity and chronicity of asthma. So as to prevent a relapse, the patient should be discharged with a 5 to 10-day course of oral systemic corticosteroids.
Even though corticosteroids are safe for short-term use, they can cause hypertension, hyperglycemia, hypokalemia, fluid retention, acute psychosis, allergic reactions, Cushing's syndrome, gastric ulcer, and immune function suppression. Patients on long-term corticosteroid therapy should be closely monitored for adverse drug reactions.
Lian, J. X. (2009). Managing a severe acute asthma exacerbation. Nursing2018 Critical Care, 4(2), 32-39.
Barnes, P. J. (2006). How corticosteroids control inflammation: quintiles prize lecture 2005. British journal of pharmacology, 148(3), 245-254.
Rowe, B. H., Spooner, C., Ducharme, F., Bretzlaff, J., & Bota, G. (2001). Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane database of systematic reviews, (1).
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