cause an increase in heart rate. Leukotriene modifier drugs are indicated as an alternative medication when used in combination with corticosteroids. Response to Leukotriene drugs is noticed during the first week of therapy. The most common side effect is headache. Mast cell stabilizers prevent histamine release and are used to prevent asthma associated with seasonal or allergic rhinitis (Drugs.com, 2017). Mast cells are found throughout the body and release a substance that causes inflammation which can cause asthma. Stabilizers can prevent this release. Common side effects are nausea and bad taste. Methylxanthines bronchodilators such as theophylline relax bronchial smooth muscle, enhance diaphragmatic contractility, and have an anti-inflammatory effect (Arcangelo et al., 2017). Theophylline is dosed to a target drug concentration level. Serum drug concentration range should be between 10-20 mg/L (Arcangelo et al., 2017). Common side effects are tachycardia, nervousness, insomnia, nausea and vomiting, and gastric reflux. Short-term Control of Asthma Anyone with asthma can experience an exacerbation. Symptoms can be mild or severe. Some may even be life-threatening and require hospital management. In an acute exacerbation, an inhaled short-acting beta agonist such as albuterol can be given. The short-acting inhalers have a quick effect of 10 minutes. The initial doses consist of two to six puffs and may be
4 repeated in 20 minutes and then in three to four hours for the next 24 to 48 hours until symptoms are stable (Arcangelo et al., 2017). A short course of an oral corticosteroid is also beneficial in short-term management. Stepwise Approach Guidelines The NHLBI Expert panel (2007), recommends that the goal of therapy is to maintain control using the least amount of medicine with the minimal risk of adverse effects. This is a six step stepwise approach in which the dose, the number of drugs, and the frequency taken are either increased or decreased to maintain control (NHLBI, 2007). This approach has age-specific recommendations. Stepping up in treatment is done if symptoms are not well controlled despite two to three months of being on a long-acting medication (Arcangelo et al., 2017). Before stepping up to a more intensive regimen, medication adherence, inhaler technique, environmental exposures and other medications should be addressed (Arcangelo et al., 2017). Some factors that may make control difficult are allergens, patient behaviors, reflux disease and obesity. The preferred
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