Treatment for Asthma
The most successful means available for treating asthma is the elimination of the causative agent(s) from the environment in an allergic asthmatic. Patient education is very important in the treatment of asthma. The patients need to know as much as they can about asthma including precipitating factors, what drugs to use and when to use them, and the appropriate early intervention when symptoms worsen. Asthma education programs include the use of peak flow meters for measurement of PEF (Peak Expiratory Flow) bid or tid at home to follow the day-to-day fluctuation in disease activity, and as a guide for drug dosages and the need for further medical consultation. The PEF and degree of bronchospasm are inversely proportional. For example, if the PEF has decreased, the amount of obstruction and bronchospasm has increased and appropriate treatment can be administered. Treatment may be considered either as management of the acute attack or the day-to-day therapy. Drug therapy enables most patients to lead relatively normal lives with few adverse effects from drugs.
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Chronic TherapyThe goal of therapy is to make the patient stable and asymptomatic, with the best pulmonary function possible. Beta-2-agonist by inhalation via metered dose inhaler (MDI) or small volume nebulizer (SVN) can be used for acute episodes. In patients who have difficulty coordinating inhalation with activation of a metered-dose inhaler, a spacing device should be incorporated. Proper technique for using a MDI alone or with a spacing device must be taught and should include using a pursed lip exhalation for better distribution in the lungs. The most commonly used beta-adrenergic stimulants are epinephrine, isoproterenol, metaproterenol, terbutaline, albuterol, and salbutamol. Terbutaline, albuterol, and salbutamol are highly selective for the respiratory tract (beta-2-selective) and have virtually no cardiac effects except in high doses. Their major side effect is muscle tremor. Another group of bronchodilators are anticholinergic agents (i.e. Atropine and Ipratropium Bromide). They may provide added bronchodilation in patients who have already received beta-2-agents. Since asthma is primarily an inflammatory disease, inhaled steroids/glucocorticoids (Azmacort) and/or mast cell stabilizing agents should be used in patients with persistent symptoms and unstable lung function. Glucocorticoids are not bronchodilators, they are used to reduce airway inflammation. The effect of inhaled steroids is dose dependent. Mast cell stabilizing agents (cromolyn sodium and nedocromil sodium) therapeutic effects are the inhibition of degranulation of mast cells, thereby preventing the release of the chemical mediators of anaphylaxis. Inhaled steroids and mast cell stabilizers improve lung function, reduce symptoms, and lower airway reactivity. These agents frequently take weeks to lower airway reactivity; therefore, a short and intense course of oral glucocorticoids (Prednisone) may be necessary to speed the remission. PEFs and the patient's symptoms should be monitored to assess lung function and adjust medications. Once stabilized, a minimal treatment regime can be established by reducing medications, beginning with the most toxic, to find the minimal drug requirements to maintain stability.