Current statistics show:
- Approximately 25 million people in America have asthma. 1 in 13 people.
- 7.6% of adults, 8,4% of children have asthma.
- More women, 9.7% ….than men, 5.4% have asthma.
- More boys than girls have asthma.
- More children than adults have asthma.
- African-Americans are three times as likely to be hospitalized and to die from asthma.
- 13.4% of African-American children compared to 7.4% of white children have asthma.
(CDC Medical Review, 2018)
Pharmacological treatment of asthma includes treatment of acute asthma exacerbations with quick-relief medications, and prevention of exacerbations with long-term control medications.
Quick relief medications include:
- Short acting beta agonists (Bronchodilators known as AccuNeb, ProAir or Ventalin) act within minutes -as the rescue inhaler used during an attack that treat symptoms immediately by acting on the sympathetic nervous system, and last for several hours. Can be given with a nebulizer or with a metered dose inhaler (MDI) and spacer. Risks include tachycardia, hypokalemia, and hyperglycemia. Albuterol is the gold standard- helps relax the constricted muscles and allow the airways to widen, which will allow more air to travel to the alveoli. With the dilation of the bronchial airways the medication stimulates the beta-2 receptors on the smooth muscle cells, which cause the muscles to relax.
- Corticosteriods (anti-inflammatory agents) Relieves airway inflammation caused by acute asthma attacks within minutes. May be given Intravenously or orally. Prednisone or methylprednisolone are the gold standards (CDC medical Review, 2018).
Long-term control medications include:
- Inhaled corticosteroids, the most beneficial management medication for asthma (anti-inflammatory agents) Used to calm inflamed airways and abate persistent asthma symptoms. They include Flovent, Q-var, Pulmicort, Asthmanex. ICS is considered a preventative medication that needs to be taken every day and can take up to two weeks to be effective. ICS reduces airway sensitivity and inflammation by stabilizing mast cells and not allowing any further inflammatory mediators to be released (Marsh, 2017). ICS is the only medication that can effectively suppress the characteristics of inflammation in the asthmatic airways. Overtime, the use of ICS will not heal asthma but make the attacks better managed.
- Leukotriene modifiers (anti-inflammatory agent) Used to calm inflamed airways. Given orally. Prevents asthma symptoms for up to 24 hours. Singular is the gold standard. Others include Zyflo, and Accolate.
- Combination inhalers (inhaled corticosteroids and a long action Beta agonist, LABA) LABA should only be used in combination with an inhaled corticosteroid. Should only be used when asthma is not well controlled with other therapies. Most common are Advair, Symbicort, Breo and Dulera
(Ortiz-Alverez, O. and Mikroglanaskis, A., 2012).
The optimal asthma treatment depends on a number of factors, including the child’s age, the severity and frequency of asthma attacks, and the ability to properly use the prescribed medications. Successful management of asthma requires the parent and child to monitor their asthma regularly. This is primarily done by recording the frequency and severity of asthma symptoms and the use of the bronchodilator albuterol (Sawicki & Haver, 2018). It is important to note that the above pharmacological therapies must be evaluated using the same assessment tools used to rate severity of disease. This should be done within a comprehensive written action plan that is shared with the patient and family. In so doing, one can:
- verify how well medications are working,
- adjust medications when needed,
- verify if medications are subduing triggering agents and response to same,
- identify when a health care provider needs to be called (Mayo Clinic, 2018).
Therefore, clinically, treatment should be initiated as soon as possible to ensure a more positive outcome:
- Treat hypoxia with supplemental O2 by face mask until SpO2 is >94%.
- Administer short-acting B2-agonists, Albuterol (the gold standard) by metered-dose inhaler and spacer.
- P.O. or intravenous corticosteroids dependent on severity. Prednisone or methylprednisolone are common.
- Assess response to treatment
- Consider other modalities of treatment if necessary.
Management: Prevention measures to control factors contributing to asthma are aimed at limiting exposure to irritants and factors that increase asthma symptoms and precipitate asthma exacerbation. A careful history is needed to identify all the contributory factors, such as environmental factors (stress that the importance of elimination of dust, cockroaches, mold, and etc.) and as well as gastroesophageal reflux after milk drinking before bedtime. Relaxation techniques and controlled breathing are necessary in patient and family teaching and often help to allay the panic and anxiety that aggravate breathing difficulties. Inhaled B2-adrenergic agonists may be used in the treatment of acute attack, and anti-inflammatory agents sodium cromolyn and nedocromil may be used to prevent an asthmatic attack. (Grossman & Porth, 2014, p. 971- 972).
Resources: The National Asthma Education and Prevention Program (NAEPP) and the Global Initiatives for Asthma (GINA) are organizations that empower care providers with tools to help manage Asthma by accomplishing the following actions: 1) selecting initial therapies, 2) systematically assessing patient outcomes, and 3) adjusting therapies based on individual response to medications which appear below (Meghdadpour et al,2018).
Braun,C.,A.,&Anderson C.,M.(2017) Applied Pathophysiology : a Conceptual Approach to the Mechanisms of Disease.(3rd Edition) Baltimore: Wolters Kluwer.
CDC Medical Review, 2018, Living with Asthma.
Eckman, M., & Share, D. (2013). Pathophysiology Made Incredibly Easy!. Philadelphia: LWW.
Grossman, S. C. & Porth, C. M. (2014). Porth’s pathophysiology: Concepts of altered health stats. (9th ed.). Wolters Kluwer/ Lippincott Williams & Wilkins
Irazuzta, J. E., & Chiriboga, N. (2017). Magnesium sulfate infusion for acute asthma in the emergency department. Jornal De Pediatria, 93 Suppl 119-25. doi:10.1016/j.jped.2017.06.002
Rabito, F. A., Carlson, J. C., He, H., Werthmann, D., & Schal, C. (2017). A single intervention for cockroach control reduces cockroach exposure and asthma morbidity in children. The Journal Of Allergy And Clinical Immunology, 140(2), 565-570.
Shah, A. Y., Dooley, D., Shelef, D. Q., & Patel, S. J. (2018). Improving Asthma Outcomes in Children: From the Emergency Department and Into the Community. Clinical Pediatric Emergency Medicine, 19(1), 92. doi:10.1016/j.cpem.2018.02.013
Stanley, D., & Tunnicliffe, W. (2008). Management of life-threatening asthma in