Asthma.2015

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AsthmaNursing Care

Ninuk DK

Definition of AsthmaDefinition of Asthma

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airwayhyperresponsiveness that leads to recurrentepisodes of wheezing, breathlessness, chesttightness, and coughing

Widespread, variable, and often reversibleairflow limitation

A chronic inflammatory disorder of the airways

Many cells and cellular elements play a role

Chronic inflammation is associated with airwayhyperresponsiveness that leads to recurrentepisodes of wheezing, breathlessness, chesttightness, and coughing

Widespread, variable, and often reversibleairflow limitation

© Global Initiative for Asthma

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Asthma Prevalence and Mortality

Source: Masoli M et al. Allergy 2004

Tujuan Pembelajaran

• Memahami Anatomi fisiologi saluran nafas• Menjelaskan Patogenesis Asma• Menjelaskan Patofisiologi Asma• Menjelaskan Asuhan Keperawatan dan

Kolaboratif pasien Asma

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Structures and Functions of theRespiratory System

• Ventilation• Diffusion (alveolar-

capillary membrane)• Perfusion• Diffusion (capillary-

cellular level)

Gas Exchange

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VentilationMovement of Chest Wall

DiffusionAlveolar-Capillary Membrane

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Perfusion

Oxyhemoglobin Curve

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Types of Bronchial Asthma

– Extrinsic (atopic, allergic)• Allergens: food, pollen, dust, etc.

– Intrinsic (non-atopic)• Initiated by infections, drugs,

pollutants, chemical irritants

Klasifikasi

• Asma ekstrinsik– Allergen p.u. diketahui– Test kulit positif– IgE meningkat pada 60% penderita– Onset biasanya pada anak-anak dan dewasa muda– Asma intermitten– Derajat asma bervariasi– Riwayat alergi keluarga positif

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Klasifikasi

• Asma intrinsik– Allergen tidak diketahui– Test kulit negatif– IgE normal atau rendah– Onset biasanya pada orang tua– Asma terus menerus– Asma pada umumnya berat– Jarang ada riwayat alergi pada keluarga

Common triggers for asthma

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PATHOLOGICAL BASISHallmark of asthma

Inflammation

Tightening of airway muscles

Mucus secretion

Hyper responsiveness

Airway remodeling

Asthma - chronic inflammatory diseasereversible airway obstructionairway remodeling

Source: Peter J. Barnes, MD

Asthma Inflammation: Cells and Mediators

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Mechanisms: Asthma Inflammation

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Asthma Inflammation: Cells and Mediators

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Kesimpulan

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• Allergens – 40%• Exercise (EIA)• Air pollutants• Occupational factors• Respiratory infections – viral• Chronic sinus and nose problems• Drugs and food additives – ASA, NSAIDs, ß-blockers,

ACEi, dye, sulfiting agents• Gastroesophageal reflux disease (GERD)• Psychological factors- stress

Potential Triggers of Asthma

Risk Factors for Asthma

Host factors: predispose individuals to, orprotect them from, developing asthma

Environmental factors: influence susceptibility todevelopment of asthma in predisposedindividuals, precipitate asthma exacerbations,and/or cause symptoms to persist

Host factors: predispose individuals to, orprotect them from, developing asthma

Environmental factors: influence susceptibility todevelopment of asthma in predisposedindividuals, precipitate asthma exacerbations,and/or cause symptoms to persist


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Factors that Exacerbate AsthmaFactors that Exacerbate Asthma

Allergens Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs


Factors that Influence AsthmaDevelopment and Expression

Host Factors Genetic

- Atopy- Airwayhyperresponsiveness Gender Obesity

Host Factors Genetic

- Atopy- Airwayhyperresponsiveness Gender Obesity

Environmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Diet

Environmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Diet


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HistamineLeucotrienesProstaglandins

Smooth muscle constriction

Epithelialremodeling

Mast cells Eosinophils

Th cells

Th cells

Macrophages

Eosinophil granules release airwayremodeling factors

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Epithelial remodeling

• Epithelium is damaged• New blood vessels• New muscle• New mucosal cells• Collagen deposition

CONTROL

Control

Asthma patient

Epithelial remodelingApoptosis

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Loss of columnar cells

Normal

Asthmapatient

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AsthmaAsthma

• Signs /Symptoms:1. Wheezing.

2. Coughing.

3. Dyspnea.

4. Feeling of chest tightness.

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• Cough• Chest tightness• Wheeze• Dyspnea• Expiration prolonged -1:3 or 1:4, due to

bronchospasm, edema, and mucus• Feeling of suffocation- upright or slightly bent

forward using accessory muscles• Behaviors of hypoxemia- restlessness, anxiety,

↑HR & BP, PP

S & S, cont…

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• History and patterns of symptoms• Measurements of lung function

– PFTs- usually WNL between a acks; ↓ FVC, FEV1

– PEFR- correlates with FEV– Measurement of airway responsiveness

• CXR• ABGs• Allergy testing (skin, IgE)

Diagnosis Asthma

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• No (or minimal)* daytime symptoms• No limitations of activity• No nocturnal symptoms• No (or minimal) need for rescue medication• Avoid adverse effects from asthma medications• Normal lung function• No exacerbation• Prevent asthma mortality

• * Minimal = twice or less per week

Therapeutic Goals of Asthma

• Suppress inflammation• Reverse inflammation• Treat bronchoconstriction• Stop exposure to risk factors that sensitized

the airway

Asthma Medications

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Antiinflammatory Agents Corticosteroids- suppress inflammatory response. Reduce

bronchial hyperresponsiveness & mucus produc on, ↑ B2receptors• Inhaled – preferred route to minimize systemic side effects

– Teaching– Monitor for oral candidiasis

• Systemic – many systemic effects – monitor blood glucose– Mast cell stabilizers- NSAID ; inhibit release of mediators

from mast cells & suppress other inflammatory cells (Intal,Tilade)

Asthma Medications

Antiinflammatory Agents Leukotriene modifiers Block action of leukotrienes Accolate, Singulair, Zyflo) Not for acute asthma attacks

Monclonal Ab to IgE ↓ circula ng IgE Prevents IgE from attaching to mast cells, thus preventing

the release of chemical mediators For asthma not controlled by corticosteroids Xolair SQ

Asthma Medications

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Bronchodilators B-agonists- SA for acute bronchospasm & to

prevent exercised induced asthma (EIA) (Proventil,Alupent); LA for LT control Combination ICS + LA B-agonist (Advair) Methylxanthines- Theophylline: alternative

bronchodilator if other agents ineffective. Narrowmargin of safety & high incidence of interactionwith other medications Anticholinergics- block bronchoconstriction .

Additive effect with B-agonists (Atrovent)

Asthma Medications

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Name/dosage/route/schedule/purpose/SE Majority administered by inhalation (MDI, DPI,

nebulizers) Spacer + MDI- for poor coordination Care of MDI- rinse with warm H2O 2x/week Potential for overuse Poor adherence with asthma therapy is challenge for

LT management Avoid OTC medications

AsthmaPatient Teaching- Medications

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GINA- decrease asthma morbidity/mortality & improvethe management of asthma worldwide Education is cornerstone Mild Intermittent/Persistent: avoid triggers,

premedicate before exercise, SA or LA Beta agonists,ICS, leukotriene blockers Acute episode: Oxygen to keep O2Sat>90%, ABGs, MDI

B-agonist; if severe- anticholinergic nebulized w/Bagonist, systemic corticosteroids

AsthmaCollaborative Care

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• Ineffective Airway Clearance• Impaired Gas Exchange• Anxiety• Deficient Knowledge

Asthma Nursing Diagnoses

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Nursing Management:

1. Administer prescribed medications, such as antibiotics, cardiac

medications, bronchodilators,mucolytics, corticosteroids and

diuretics as ordered.

2. Administer oxygen to maintain Pao2 of 60 mmHg or Sao2 ˃ 90%.3. Monitor fluid balance by intake and output measurement, daily

weight.

4. Perform chest physiotherapy and suctioning to remove mucus. Teach

slow, pursed lip breathing to reduce airway obstruction.

5. If the patient becomes increasingly lethargic, can not cough or

expectorate secretions, can not cooperate with therapy, or if PH falls

below 7.30, despite use of the above therapy, report and prepare to

assist with intubation and initiation of mechanical ventilation.

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1. Develop Patient partnership

2. Identify and Reduce Exposureto Risk Factors

3. Assess, Treat and MonitorAsthma

4. Manage Asthma Exacerbations

5. Special Considerations

1. Develop Patient partnership

2. Identify and Reduce Exposureto Risk Factors

3. Assess, Treat and MonitorAsthma

4. Manage Asthma Exacerbations

5. Special Considerations

Asthma Management and PreventionProgram: Five ComponentsAsthma Management and PreventionProgram: Five Components

Updated 2012


Asthma Management and Prevention Program

Goals of Long-term Management

Achieve and maintain control of symptomsMaintain normal activity levels, including

exerciseMaintain pulmonary function as close to

normal levels as possible Prevent asthma exacerbations Avoid adverse effects from asthma

medications Prevent asthma mortality

Achieve and maintain control of symptomsMaintain normal activity levels, including

exerciseMaintain pulmonary function as close to

normal levels as possible Prevent asthma exacerbations Avoid adverse effects from asthma

medications Prevent asthma mortality© Global Initiative for Asthma

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Component 1: Develop PartnershipAsthma Management and Prevention Program

Component 1: Develop Partnership

Educate continually

Include the family

Provide information about asthma

Provide training on self-management skills

Emphasize a partnership among health careproviders, the patient, and the patient’s family

Educate continually

Include the family

Provide information about asthma

Provide training on self-management skills

Emphasize a partnership among health careproviders, the patient, and the patient’s family


Example Of Contents Of An Action Plan To Maintain Asthma ControlYour Regular Treatment:

1. Each day take ___________________________2. Before exercise, take _____________________

WHEN TO INCREASE TREATMENTAssess your level of Asthma ControlIn the past week have you had:

Daytime asthma symptoms more than 2 times ? No YesActivity or exercise limited by asthma? No YesWaking at night because of asthma? No YesThe need to use your [rescue medication] more than 2 times? No YesIf you are monitoring peak flow, peak flow less than________? No Yes

If you answered YES to three or more of these questions, your asthma is uncontrolled and you may need tostep up your treatment.

HOW TO INCREASE TREATMENTSTEP-UP your treatment as follows and assess improvement every day:____________________________________________ [Write in next treatment step here]Maintain this treatment for _____________ days [specify number]

WHEN TO CALL THE DOCTOR/CLINIC.Call your doctor/clinic: _______________ [provide phone numbers]If you don’t respond in _________ days [specify number]______________________________ [optional lines for additional instruction]

EMERGENCY/SEVERE LOSS OF CONTROLIf you have severe shortness of breath, and can only speak in short sentences,If you are having a severe attack of asthma and are frightened,If you need your reliever medication more than every 4 hours and are not improving.1. Take 2 to 4 puffs ___________ [reliever medication]2. Take ____mg of ____________ [oral glucocorticosteroid]3. Seek medical help: Go to _____________________; Address___________________

Phone: _______________________4. Continue to use your _________[reliever medication] until you are able to get medical help.


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Factors Involved in Non-AdherenceAsthma Management and Prevention Program

Factors Involved in Non-Adherence

Medication Usage Difficulties associated

with inhalers Complicated regimens Fears about, or actual

side effects Cost Distance to pharmacies

Medication Usage Difficulties associated

with inhalers Complicated regimens Fears about, or actual

side effects Cost Distance to pharmacies

Non-Medication Factors Misunderstanding/lack of

information

Fears about side-effects

Inappropriate expectations

Underestimation of severity

Attitudes toward ill health

Cultural factors

Poor communication

Non-Medication Factors Misunderstanding/lack of

information

Fears about side-effects

Inappropriate expectations

Underestimation of severity

Attitudes toward ill health

Cultural factors

Poor communication© Global Initiative for Asthma


Component 2: Identify and ReduceExposure to Risk Factors



Measures to prevent the development of asthma,and asthma exacerbations by avoiding or reducingexposure to risk factors should be implementedwherever possible.

Asthma exacerbations may be caused by a varietyof risk factors – allergens, viral infections,pollutants and drugs.

Reducing exposure to some categories of riskfactors improves the control of asthma andreduces medications needs.


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Reduce exposure to indoor allergens Avoid tobacco smoke Avoid vehicle emission Identify irritants in the workplace Explore role of infections on asthma

development, especially in children andyoung infants







Influenza VaccinationAsthma Management and Prevention Program

Influenza Vaccination

Influenza vaccination should beprovided to patients with asthma whenvaccination of the general population isadvised

However, routine influenza vaccinationof children and adults with asthmadoes not appear to protect them fromasthma exacerbations or improveasthma control© Global Initiative for Asthma

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Component 3: Assess, Treat andMonitor Asthma


Component 3: Assess, Treat andMonitor Asthma

The goal of asthma treatment, toachieve and maintain clinical control,can be achieved in a majority ofpatients with a pharmacologicintervention strategy developed inpartnership between thepatient/family and the health careprofessional

The goal of asthma treatment, toachieve and maintain clinical control,can be achieved in a majority ofpatients with a pharmacologicintervention strategy developed inpartnership between thepatient/family and the health careprofessional


Global Strategy for Asthma Management and Prevention

Clinical Control of Asthma

The focus on asthma control isimportant because:

the attainment of control correlateswith a better quality of life, and reduction in health care use


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Determine the initial level ofcontrol to implement treatment(assess patient impairment)

Maintain control once treatmenthas been implemented(assess patient risk)

Global Strategy for Asthma Management and Prevention

Clinical Control of Asthma


Levels of Asthma Control(Assess patient impairment)

Characteristic Controlled(All of the following)

Partly controlled(Any present in any week) Uncontrolled

Daytime symptomsTwice or less

per weekMore than

twice per week

3 or morefeatures ofpartlycontrolledasthmapresent inany week

Limitations ofactivities None Any

Nocturnal symptoms/ awakening None Any

Need for rescue /“reliever” treatment

Twice or lessper week

More thantwice per week

Lung function(PEF or FEV1)

Normal< 80% predicted or

personal best (ifknown) on any day

Assessment of Future Risk (risk of exacerbations, instability, rapiddecline in lung function, side effects)


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Assess Patient Risk

Features that are associated with increasedrisk of adverse events in the future include:

Poor clinical control

Frequent exacerbations in past year

Ever admission to critical care for asthma

Low FEV1, exposure to cigarette smoke,high dose medications



Component 3: Assess, Treatand Monitor Asthma



Depending on level of asthma control,the patient is assigned to one of fivetreatment steps

Treatment is adjusted in a continuouscycle driven by changes in asthmacontrol status. The cycle involves:

- Assessing Asthma Control

- Treating to Achieve Control

- Monitoring to Maintain Control© Global Initiative for Asthma

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A stepwise approach to pharmacologicaltherapy is recommended

The aim is to accomplish the goals oftherapy with the least possible medication

Although in many countries traditionalmethods of healing are used, their efficacyhas not yet been established and their usecan therefore not be recommended

A stepwise approach to pharmacologicaltherapy is recommended

The aim is to accomplish the goals oftherapy with the least possible medication

Although in many countries traditionalmethods of healing are used, their efficacyhas not yet been established and their usecan therefore not be recommended






The choice of treatment should be guided by:

Level of asthma control Current treatment Pharmacological properties and availability

of the various forms of asthma treatment Economic considerationsCultural preferences and differing health caresystems need to be considered

The choice of treatment should be guided by:

Level of asthma control Current treatment Pharmacological properties and availability

of the various forms of asthma treatment Economic considerationsCultural preferences and differing health caresystems need to be considered






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Controller Medications

Inhaled glucocorticosteroids Leukotriene modifiers Long-acting inhaled β2-agonists in combination

with inhaled glucocorticosteroids Systemic glucocorticosteroids Theophylline Cromones Anti-IgE


Estimate Comparative Daily Dosages forInhaled Glucocorticosteroids by AgeEstimate Comparative Daily Dosages forInhaled Glucocorticosteroids by Age

Drug Low Daily Dose (g) Medium Daily Dose (g) High Daily Dose (g)> 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y

Drug Low Daily Dose (g) Medium Daily Dose (g) High Daily Dose (g)> 5 y Age < 5 y > 5 y Age < 5 y > 5 y Age < 5 y

Beclomethasone 200-500 100-200 >500-1000 >200-400 >1000 >400

Budesonide 200-600 100-200 600-1000 >200-400 >1000 >400

Budesonide-NebInhalation Suspension

250-500 500-1000 >1000

Ciclesonide 80 – 160 80-160 >160-320 >160-320 >320-1280 >320

Flunisolide 500-1000 500-750 >1000-2000 >750-1250 >2000 >1250

Fluticasone 100-250 100-200 >250-500 >200-500 >500 >500

Mometasone furoate 200-400 100-200 > 400-800 >200-400 >800-1200 >400

Triamcinolone acetonide 400-1000 400-800 >1000-2000 >800-1200 >2000 >1200


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Reliever Medications

Rapid-acting inhaled β2-agonists Systemic glucocorticosteroids Anticholinergics Theophylline Short-acting oral β2-agonists


Component 4: Asthma Management and Prevention Program

Allergen-specific ImmunotherapyComponent 4: Asthma Management and Prevention Program

Allergen-specific Immunotherapy

Greatest benefit of specific immunotherapyusing allergen extracts has been obtained inthe treatment of allergic rhinitis

The role of specific immunotherapy in asthma islimited

Specific immunotherapy should be consideredonly after strict environmental avoidance andpharmacologic intervention, including inhaledglucocorticosteroids, have failed to controlasthma

Perform only by trained physician

Greatest benefit of specific immunotherapyusing allergen extracts has been obtained inthe treatment of allergic rhinitis

The role of specific immunotherapy in asthma islimited

Specific immunotherapy should be consideredonly after strict environmental avoidance andpharmacologic intervention, including inhaledglucocorticosteroids, have failed to controlasthma

Perform only by trained physician© Global Initiative for Asthma

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controlled

partly controlled

uncontrolled

exacerbation

LEVEL OF CONTROL

maintain and find lowestcontrolling step

consider stepping up togain control

step up until controlled

treat as exacerbation

TREATMENT OF ACTION

TREATMENT STEPSREDUCE INCREASE

STEP1

STEP2

STEP3

STEP4

STEP5

RED

UC

EIN

CR

EASE


Shaded green - preferred controller options

TO STEP 3 TREATMENT, SELECTONE OR MORE:

TO STEP 4 TREATMENT, ADDEITHER

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TO STEP 3 TREATMENT,SELECT ONE OR MORE:

Step 1 – As-needed reliever medication

Patients with occasional daytime symptoms ofshort duration

A rapid-acting inhaled β2-agonist is therecommended reliever treatment (Evidence A)

When symptoms are more frequent, and/orworsen periodically, patients require regularcontroller treatment (step 2 or higher)

Treating to Achieve Asthma Control


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Step 2 – Reliever medication plus a singlecontroller

A low-dose inhaled glucocorticosteroid isrecommended as the initial controllertreatment for patients of all ages (Evidence A)

Alternative controller medications includeleukotriene modifiers (Evidence A)appropriate for patients unable/unwilling touse inhaled glucocorticosteroids



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Step 3 – Reliever medication plus one or twocontrollers

For adults and adolescents, combine a low-doseinhaled glucocorticosteroid with an inhaled long-acting β2-agonist either in a combination inhalerdevice or as separate components (Evidence A)

Inhaled long-acting β2-agonist must not be usedas monotherapy

For children, increase to a medium-dose inhaledglucocorticosteroid (Evidence A)



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Additional Step 3 Options for Adolescents and Adults

Increase to medium-dose inhaledglucocorticosteroid (Evidence A)

Low-dose inhaled glucocorticosteroidcombined with leukotriene modifiers(Evidence A)

Low-dose sustained-release theophylline(Evidence B)






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Step 4 – Reliever medication plus two or morecontrollers

Selection of treatment at Step 4 dependson prior selections at Steps 2 and 3

Where possible, patients not controlled onStep 3 treatments should be referred to ahealth professional with expertise in themanagement of asthma



Step 4 – Reliever medication plus two or more controllers

Medium- or high-dose inhaled glucocorticosteroidcombined with a long-acting inhaled β2-agonist(Evidence A)

Medium- or high-dose inhaled glucocorticosteroidcombined with leukotriene modifiers (Evidence A)

Low-dose sustained-release theophylline addedto medium- or high-dose inhaledglucocorticosteroid combined with a long-actinginhaled β2-agonist (Evidence B)



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Step 5 – Reliever medication plus additional controller options

Addition of oral glucocorticosteroids to othercontroller medications may be effective(Evidence D) but is associated with severeside effects (Evidence A)

Addition of anti-IgE treatment to othercontroller medications improves control ofallergic asthma when control has not beenachieved on other medications (Evidence A)


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Treating to Maintain Asthma Control

When control as been achieved,ongoing monitoring is essential to:

- maintain control

- establish lowest step/dose treatment

Asthma control should be monitoredby the health care professional andby the patient© Global Initiative for Asthma


Stepping down treatment when asthma is controlled

When controlled on medium- to high-doseinhaled glucocorticosteroids: 50% dosereduction at 3 month intervals (EvidenceB)

When controlled on low-dose inhaledglucocorticosteroids: switch to once-dailydosing (Evidence A)


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Stepping down treatment when asthma is controlled When controlled on combination inhaled

glucocorticosteroids and long-actinginhaled β2-agonist, reduce dose of inhaledglucocorticosteroid by 50% whilecontinuing the long-acting β2-agonist(Evidence B)

If control is maintained, reduce to low-dose inhaled glucocorticosteroids andstop long-acting β2-agonist (Evidence D)© Global Initiative for Asthma


Stepping up treatment in response to loss of control

Rapid-onset, short-acting or long-acting inhaled β2-agonistbronchodilators provide temporaryrelief.

Need for repeated dosing over morethan one/two days signals need forpossible increase in controller therapy


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Stepping up treatment in response to loss of control Use of a combination rapid and long-acting

inhaled β2-agonist (e.g., formoterol) and aninhaled glucocorticosteroid (e.g., budesonide)in a single inhaler both as a controller andreliever is effecting in maintaining a high levelof asthma control and reduces exacerbations(Evidence A)

Doubling the dose of inhaled glucocortico-steroids is not effective, and is notrecommended (Evidence A)© Global Initiative for Asthma

Exacerbations of asthma are episodes ofprogressive increase in shortness of breath,cough, wheezing, or chest tightness

Exacerbations are characterized by decreasesin expiratory airflow that can be quantified andmonitored by measurement of lung function(FEV1 or PEF)

Severe exacerbations are potentially life-threatening and treatment requires closesupervision

Exacerbations of asthma are episodes ofprogressive increase in shortness of breath,cough, wheezing, or chest tightness

Exacerbations are characterized by decreasesin expiratory airflow that can be quantified andmonitored by measurement of lung function(FEV1 or PEF)

Severe exacerbations are potentially life-threatening and treatment requires closesupervision


Component 4: Manage AsthmaExacerbations




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Treatment of exacerbations depends on: The patient Experience of the health care professional Therapies that are the most effective for the particular patient Availability of medications Emergency facilities

Treatment of exacerbations depends on: The patient Experience of the health care professional Therapies that are the most effective for the particular patient Availability of medications Emergency facilities






Primary therapies for exacerbations:Repetitive administration of rapid-acting inhaled

β2-agonistEarly introduction of systemic

glucocorticosteroids

Oxygen supplementation

Closely monitor response to treatment with serialmeasures of lung function

Primary therapies for exacerbations:Repetitive administration of rapid-acting inhaled

β2-agonistEarly introduction of systemic

glucocorticosteroids

Oxygen supplementation

Closely monitor response to treatment with serialmeasures of lung function






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Special considerations are required tomanage asthma in relation to: Pregnancy Surgery Rhinitis, sinusitis, and nasal polyps Occupational asthma Respiratory infections Gastroesophageal reflux Aspirin-induced asthma Anaphylaxis and Asthma

Special considerations are required tomanage asthma in relation to: Pregnancy Surgery Rhinitis, sinusitis, and nasal polyps Occupational asthma Respiratory infections Gastroesophageal reflux Aspirin-induced asthma Anaphylaxis and Asthma


Special ConsiderationsAsthma Management and Prevention Program

Special Considerations


Global Strategyfor the Diagnosisand Management

of Asthma inChildren 5 Years

and Younger2009

www.ginasthma.org© Global Initiative for Asthma

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Asthma can be effectively controlled in mostpatients by intervening to suppress and reverseinflammation as well as treatingbronchoconstriction and related symptoms

Although there is no cure for asthma,appropriate management that includes apartnership between the physician and thepatient/family most often results in theachievement of control

Asthma can be effectively controlled in mostpatients by intervening to suppress and reverseinflammation as well as treatingbronchoconstriction and related symptoms

Although there is no cure for asthma,appropriate management that includes apartnership between the physician and thepatient/family most often results in theachievement of control

Asthma Management andPrevention Program: SummaryAsthma Management andPrevention Program: Summary


A stepwise approach to pharmacologic therapy is recommended.The aim is to accomplish the goals of therapy with the leastpossible medication

The availability of varying forms of treatment, culturalpreferences, and differing health care systems need to beconsidered

A stepwise approach to pharmacologic therapy is recommended.The aim is to accomplish the goals of therapy with the leastpossible medication

The availability of varying forms of treatment, culturalpreferences, and differing health care systems need to beconsidered

Asthma Management andPrevention Program: SummaryAsthma Management andPrevention Program: Summary


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Medications to Treat Asthma

Medications comein several forms.

Two majorcategories ofmedications are: Long-term control Quick relief

Medications to Treat Asthma:Long-Term Control

Taken daily over a long period of time

Used to reduce inflammation, relax airwaymuscles, and improve symptoms and lungfunction Inhaled corticosteroids Long-acting beta2-agonists Leukotriene modifiers

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Medications to Treat Asthma:Quick-Relief

Used in acuteepisodes

Generally short-actingbeta2agonists

Medications to Treat Asthma:How to Use a Spray Inhaler

The health-careprovider shouldevaluate inhalertechnique at eachvisit.

Source: “What You and Your Family Can Do About Asthma” by the Global Initiative forAsthma Created and funded by NIH/NHLBI

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Medications to Treat Asthma:Inhalers and Spacers

Spacers can help patientswho have difficulty withinhaler use and can reducepotential for adverse effectsfrom medication.

Medications to Treat Asthma:Nebulizer Machine produces a mist

of the medication

Used for small children orfor severe asthmaepisodes

No evidence that it ismore effective than aninhaler used with aspacer

Asthma.2015

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