which based upon the severity of an individual’s asthma (Arcangelo et al., 2017). Step by step programs provides a guideline for which practitioners and physician can follow when prescribing the most appropriate treatment (Arcangelo et al., 2017). A practitioner must first determine the diagnosis and which appropriate age tier of treatment a patient would fall (Arcangelo et al., 2017). Tier one is for patients with intermittent symptoms, while tier two through four are for mild to moderate symptoms, and tier five and six are for patients with severe symptoms (Arcangelo et al., 2017). Throughout the tiered step by step, approach medications are increased in strength as well as additional medicines added to assist with increased long-term control (Arcangelo et al., 2017). Asthma severity is determined by presentation of symptoms, lung function capacity, number of exacerbations, effects on daily activity, number of nighttime awakenings, and number of rescue inhaler use (National Heart, 2008). Control of chronic asthma would be determined at follow up visits based upon the patient’s recollection of events and frequency of medication use (Arcangelo et al., 2017). Based upon this information, practitioners would determine to maintain current treatment or to change tiers. Patients are recommended to follow up every two weeks after the initiation of therapy and every one to three months after that, subsequently follow up visits will decrease in length of time as treatment has been proven effective (National Heart, 2008). In consideration to high dose regimens, it is imperative that a practitioner consider a lower tier of treatment once a patient has been well controlled for three months or longer (National Heart, 2008). Patients who have been well controlled for six to 12
ASTHMA MANAGEMENT 5 months are believed to be able to stop treatment without risk of exacerbations (Arcangelo et al., 2017). Achievement of Gaining Control Adequate control is essential for the improvement of overall health and quality of life. As practitioners have a responsibility to educate patients, it is necessary that patients implement the recommended changes of their physician, such as environmental triggers and medication regimens, which are crucial to gaining and maintaining control of chronic asthma symptoms.
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- Fall '13
- asthma management