Answer

Treatment and Management of Asthma        

            Asthma is a chronic respiratory disease that can be managed with quick relief and long-term control options. Quick relief agents such as short-acting inhaled beta2-agonists and anti-cholinergic agents are used for addressing the first sign of symptoms to achieve immediate relief.  Both classes of drugs are bronchodilators, which expand the airways into the lungs allowing for movement of more air and out and into the lungs. These medications also clear mucus from the lungs but cannot control airway inflammation, which causes the symptoms. Thus, quick relief medications cannot be used to achieve effective control of the disease (American College of Allergy, Asthma, and Immunology, 2014). Quick inhaler is associated with side effects such as palpitations and jitteriness. Long term use of prednisone and/or methylprednisolone results in side effects such as osteoporosis, cataracts, hypertension, decreased resistance to infection, and reduced growth in children (MayoClinic, 2018).

            Long-term control agents are used for prevention of asthmatic attacks and symptoms. It includes leukotriene modifiers or anti-leukotrienes, inhale corticosteroids, cromolyn sodium, methylxanthines, long-acting inhaled beta2-agonists, immunomodulators, and oral corticosteroids.  They are used every day regardless of absence or presence of symptoms to improve the control of the disease. However, inhaled corticosteroids may reduce the growth rate in children (American College of Allergy, Asthma, and Immunology, 2014). Leukotriene modifiers, especially Montelukast is associated with side effects such as suicidal ideation, hallucinations, aggression, depression, and agitation. Theophylline side effects include gastroesophageal reflux and insomnia (MayoClinic, 2018).

            The stepwise approach to asthma management and treatment provides six steps for management of asthma. This is step 1 to 6. Step 1 through 6 is referred to as step up treatment, whereas step 6 down to step 1 is referred to as step down care approach. Step 1 is indicated for intermittent asthma. Step 3 through 6 is followed in cases that are associated with potential poor adherence to medications, whereas step 5 down to step 2 is indicated in cases whereby asthma is well controlled. Asthma specialist must be consulted in step 4 through step 6 when handling asthmatic patients of all ages. In addition, immunotherapy should be considered in step 2 through step 4 if the case in question is diagnosed as allergic asthma (Khalid, 2015).

            The stepwise management assists patients and healthcare providers to gain and maintain control of asthma. It provides patients and healthcare providers with guidelines on appropriate selection of medications, dosages, and frequency for drug administration.  The dosages, frequency and number of medications to be used can be increased or decreased as directed. The goal of the stepwise management is to maintain and achieve adequate asthma control.  To regain control, care is stepped up, whereas stepping down of care is required when the goal is to maintain control for a significant length of time as well as to lower the risk of side effects (Khalid, 2015). Stepwise management guidelines are associated with beneficial outcomes such as decreased emergency room visits, optimized use of pharmacotherapy with reduced risk of side effects, and promotion of lung growth in children (Khalid, 2015).