Step-Wise Approach for Asthma Treatment

Step-Wise Approach for Asthma Treatment
· Long term asthma control medication
· Quick-relief treatment options
· Impacts of these drugs on asthma patient
The long-term control medications for asthma control include inhaled corticosteroids for keeping it under control (Mayo Clinic, 2019). Other long-term control medicines used are immunomodulators, leukotriene modifiers, and long-acting beta-agonists (Asthma Initiative of Michigan, n.a.). The quick-relief treatment includes fast-acting inhalers like albuterol, also recognized as rescue inhalers. They are not a long-term remedy for treating asthma since if they are taken every time for controlling asthma, then the disease is not effectively in control.
The impact of corticosteroids is that it helps block the allergens that cause a shortage of breath and support in reducing sensitivity produced from the air (Asthma Initiative of Michigan, n.a.). It can remain adhesive for activation of proteins so that inflammation could be decreased and activation of cellular levels could be amplified. The side effects involve changes in voice, consistent coughing, and oral hoarseness. Other side effects have been observed, though they have not been corroborated with enough studies, such as osteoporosis and suppression in growth, particularly growth suspension in children, etc.
Leukotriene modifiers' impact is seen on moderate but persistent asthma if mixed with inhaled corticosteroids (Asthma Initiative of Michigan, n.a.). Several studies have not yet verified its greater impact as an alternate therapy. Still, it has provides instances where it is effective for improving pulmonary functions and giving quick relief. If not taken on proper timings, which is one hour before and two hours after the meals as they are available in the form of tablets, serious ramifications would be observed for the asthma patient.
Long-acting beta-agonists is an effective medication for long term relief when night time symptoms appear. Smooth relaxation of bronchial muscles is experienced with these medications' help, and the functional levels of cellular enzymes are improved. Based on possible side-effects, they are assumed to be better than other long-term medications. They are also taken in the form of tablets but cannot be used to treat acute symptoms.
· Approach for reducing asthma with impairment and risk reduction
· Impairment includes reduction of chronic and worrying symptoms
· Reduction of risk involves less hospitalization and minimizing emergency department (ED) visits
The purpose of asthma treatment ought to be to use the least medications and maximize its control otherwise (National Asthma Education and Prevention Program, 2007). The medicines' adverse effects are to be reduced with two domain approaches, impairment, and risk. The approach for reducing impairment includes preventing chronic and worrying symptoms like coughing, shortage of breath, restlessness during the night, etc. It involves maintaining the normal functioning of pulmonary breathing. The normal levels could be sustained through breathing exercises and physical activities daily. Meeting with asthma patients regularly would motivate them to take personal care of themselves and not be ignorant of the medicine timings so that long-term improvements could reduce the medications.
Reduction of risk is the approach that entails avoidance of recurring symptoms of the disease so that emergency department visits could be minimized. Reduction in the need for frequent hospitalization is also a major aim of this approach. The lung functions are bettered in the youth of 18 years and older with pharmacotherapy that has minimal or no side effects.
· A step-wise approach to asthma treatment and patient management
· Step 1: SABA
· Step 2: Preferred low doses of ICS
· Step 3: Preferred low dose of a combination of ICS and LABA
The expert panel reviews include a step-wise approach for reducing asthma symptoms by suppressing the inflammation on a long term basis. The airways are released of the possible blockage so that breathing is eased and the recurrent exacerbations are reduced (National Asthma Education and Prevention Program, 2007). The first step is the induction of short-acting beta-agonists (SABA) for the quick relief of asthma symptoms. They help in the relaxation of lung muscles, easing spams, and the thinning down of the airways. The second step encompasses a low dosage of inhaled corticosteroids (ICS) that are regarded as the most effective medication for asthma control until now. Even with very low quantities, they can help ease the muscle inflammation of the lungs during asthma symptoms and suppress its adverse effects. The third step is about the intake of a low dose of both ICS and long-acting beta-agonists (LABA).
It is noteworthy that each step requires constant education to the asthma patient about safety and precautions. Coaching about environmental control and controlling comorbidities should be included in the mentoring from the healthcare professionals and the nurses. Another notable thing is that consultation should be taken from an asthma expert if care is required beyond step 4. It might be even better to see a doctor if asthma symptoms are persistent in step 3.
· A step-wise approach to asthma treatment and patient management
· Step 4: A medium dose of ICS and LABA
· Step 5: High dosage of ICS and LABA
· Step 6: High dosage of ICS, LABA, and oral corticosteroid
If the asthma is unfluctuating after step 3, then daily medications are introduced. In step 4, it is preferred that a medium dose of ICS and LABA is continued so that the intensified asthma symptoms are controlled on time. There is an alternative that a medium dose of ICS and leukotriene receptor antagonists (LTRA) can be given to the patient, based on if he has any allergies or reactions to other medications. In step 5, it is preferred to give a high dosage of ICS and LABA, and if the symptoms are still there, then it is suggested to consider Omalizumab for patients having allergies. In step 6, it is recommended to give the patients a high dosage of ICS, LABA, and oral corticosteroid. Again, it is suggested along that Omalizumab is given to the patients. Here, one should keep in mind that constant mentorship about controlling environmental factors inducing asthma and comorbidities should be continued. During step 2 to 4, immunotherapy could also be suggested for patients with allergies. Consultation with the doctor should be after every two to six weeks depending on the severity of asthma symptoms. The stage of asthma beyond step requires direct consultation from an asthma healthcare expert. From all of these six steps, the steps and their relevant dosage could be reduced if asthma is seen controlled within three months, and steps could be upped if symptoms are not seemly better.
· Step-wise management in giving control to the healthcare providers for regulating asthma
· Low national healthcare costs with asthma control
· Use of technology with proper training, especially for quick controlling of asthma in the older population
Uncontrolled asthma can lead to high mortality rates and increased morbidity, decreasing life quality (Rance, 2011). There are consequences of uncontrolled asthma in the healthcare industry, such as increased costs for treating such patients that include both direct and indirect costs. It has been reported by national surveys that patients who have controlled asthma have low utilization of medical assistance that puts less pressure on the national healthcare budgets.
The step-wise approach helps to gain control by the healthcare providers, including both expert doctors and nurse practitioners. It provides best practices with each step and the relevant patient education that the people with asthma should monitor the disease. The healthcare providers can observe whether the asthma goals on a weekly and monthly basis are achieved. The periodic assessment provides an insight into the medical condition of the patients so that the healthcare providers should reduce or increase the medication dosages, as mentioned in the step-wise approach. The impairment and risk domains are evaluated with the patient's history of the disease or any possible manifestation within the family so that the healthcare professionals could prescribe the control therapies. The doctors suggest therapeutic interventions at the appropriate stage of the step-wise guidelines. The nurse interventions are also recommended for older patients so that if they forget to take their medications on time, the nurses at home are hired for taking proper daily care. Even if nurse care is not used at home, the older patients could remain in contact with nurses with the help of telephones and other related technologies (Raju et al., 2012). It must teach accurate training for the older population, though, since, in modern times, e-health can provide prompt control of asthma. Innovative technology can provide population-specific care to the patients by the healthcare providers as they can remain in constant contact with the patients and give prompt advice when their health condition worsens. Technology can help healthcare professionals regulate the patterns of medication use by the patients since that would increase asthma control and consequently reduce the overall medical costs of asthma care.
References
Asthma Initiative of Michigan. (n.a.). Long-term control medications used to treat asthma. Retrieved from https://getasthmahelp.org/ltc-medications.aspx
Mayo Clinic. (2019, June 20). Asthma treatment: 3 steps to better asthma control. Retrieved from https://www.mayoclinic.org/diseases-conditions/asthma/in-depth/asthma-treatment/art-20044284
National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. (2007). Section 4: Step-wise approach for managing asthma in youth ? 12 years of age and adults. In Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute. Available at https://www.ncbi.nlm.nih.gov/books/NBK7222/
Raju, J.D., Soni, A., Aziz, N. & Tiemstra, J.D. (2012). A patient-centered telephone intervention using the asthma action plan. PubMed, 44(5), 348-350.
Rance, K.S. (2011). Helping patients attain and maintain asthma control: Reviewing the role of nurse practitioner. Journal of Multidisciplinary Healthcare, 4, 299-309. DOI: 10.2147/JMDH.S22966