airway becomes hyper-responsive to allergens allowing both bronchospasm and inflammation to contribute to airway obstruction (Pollart, Compton, & Elward, n.d; Nix, 2017).The treatment for acute asthma exacerbation is a slightly different approach than with chronic asthma (Nix, 2017). Medications used to treat acute asthma exacerbations include both short-acting and long-acting beta-adrenergic agonists which relaxes bronchial smooth muscle resulting in bronchodilation (Nix, 2017). Beta agonists have no anti-inflammatory properties; thus, other drug classes are required to control the inflammatory component of chronic asthma (Nix, 2017). Although beta agonists are drugs of choice for treating acute asthma, anticholinergics are alternative bronchodilators used not only for acute asthma exacerbations but for chronic asthma as well (Nix, 2017). The three anticholinergics used for pulmonary disease are Tudorza Pressair, Atrovent, and Spiriva (Adams, Holland, & Urban, 2014; Nix, 2017). The treatment for chronic asthma includes the above mentioned medications with the addition of Methylxanthines (theophylline and aminophylline) which are bronchodilators chemically related to caffeine (Falk, Hughes, & Rodgers, 2016; Nix 2017). Prophylaxis treatment for both acute andchronic asthma include anti-inflammatory drugs such as inhaled corticosteroids, mast cell stabilizers, leukotriene modifiers, and monoclonal antibodies (omalizumab [Xolair]) (Adams, Holland, & Urban, 2014; Nix, 2017).Stepwise Management ApproachThe stepwise management approach is in accordance to the patients’ features and severityof the disease (Arcangelo & Peterson, 2013). Depending on the patients’ circumstances, the type of medication and dose may be “stepped up or stepped down to gain control and manage symptoms (American Academy of Allergy Asthma & Immunology [AAAAI], 2017). The
ASTHMA AND STEPWISE MANAGEMENT 4stepwise approach is meant to assist, not replace, the clinical decision-making required to meet patient’s individual needs (Arcangelo & Peterson, 2013). Step 1 in the step-wise approach recommends inhaled SABA for patients with intermittent asthma without the need for daily medication (Arcangelo & Peterson, 2013). If beta²-adrenergic agonists are used more than two times a week, or a canister is used in a month, the patient should be started on or moved to step 2(Arcangelo & Peterson, 2013). Step 3 treatments consists of a low-dose inhaled corticosteroid
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