Running head: 1 Stepwise Management for Asthma Walden University NURS 6521: Advanced Pharmacology September 23, 2017

2 Stepwise Management for Asthma Asthma is a chronic respiratory disease characterized by inflammation and narrowing of the airways. In the United States, more than 22 million people are affected by asthma, more than 6 million are children (National Heart Lung and Blood Institute [NHLBI], 2007). The objective of asthma control is to maintain healthy lung function and reduce symptoms. Asthma symptoms can be mild or severe, and attacks can be scary. During an asthma attack, the airways become inflamed causing them to narrow and constrict. The inflammation produces mucus which fills these narrowed passageways (Drugs.com, 2017). Typical symptoms include dyspnea, chest pain, wheezing, cough, tachypnea, and hypoxemia (Hammer & McPhee, 2014). To gain control of asthma the advanced practice nurse must understand the difference in long-term and short-term drug treatments. The purpose of this paper is to describe the two drug treatments and explain the stepwise management of asthma control. Long-term Control of Asthma Not all asthma medications are the same, and not everyone will take the same one. Some medications are inhaled, and some come in a pill. Long-term medications can help you have fewer attacks, but they will not help if you are actively having an attack (Centers for Disease Control and Prevention [CDC], 2012). The goal of long-term medications is to prevent exacerbations. These drugs can be taken every day to maintain control of symptoms. Long-term Medications Inhaled corticosteroids are recommended for everyone with asthma. Dosage depends on the severity of symptoms (Arcangelo et al., 2017). Corticosteroids reduce inflammation by inhibiting the production of end-effector proteins. (Arcangelo et al., 2017) Relief begins in the

3 first week of therapy and continually gets better. Adverse effects are thrush and dysphonia. Individuals should be instructed to rinse their mouth after each use. Long-acting beta-agonists inhalers relax airway smooth muscle and increase ciliary activity (Arcangelo et al., 2017). The long-acting has an onset of 2 hours and duration of 12 hours (Arcangelo et al., 2017). All beta-agonists have a cardiovascular stimulatory effect and can cause an increase in heart rate.