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Asthma


Asthma is a long-term illness of respiratory tract involving inflammation and constriction of the airways. Asthma causes a recurrence wheezing, shortness of breath and coughing. Coughing occurs mainly in the morning and early in the night (Edmunds & Mayhew, 2013). Asthma as the illness affects people of all ages and starts early from childhood. Airways play a critical role in carrying air into and out of the lungs. Inflammation of the airways due to asthma makes them sensitive to many substances including inhaled dust and fur. Severe reaction involving the tightening of the muscles on the airways occur due to the above named trigger factors (Edmunds & Mayhew, 2013). In the United States alone, 7.8 percent of the population is asthmatic with the disease afflicting people of all races, genders and socioeconomic status(Frandsen, Pennington, & Abrams, 2014).. The disease occurs disproportionately among ethnic and racial populations. Despite the disease being chronic, death from asthma is rare though the propensity increases with age. (Frandsen, Pennington, & Abrams, 2014).

Many people are unaware of asthma especially in situations when the symptoms are not severe. The severity of the symptoms makes the disease serious. The patient coughs in the morning and early in the night or during exercise. Apart from coughing, the individual experiences troubled breathing in the presence of trigger factors. Troubled breathing is also known as shortness of breath. Individuals experience tightness in the chest and a characteristic wheezing (whistling) sound. Sometimes a cough persists and would not go away (Edmunds & Mayhew, 2013). The problem of breathing is coupled to excessive production of mucus. In severe cases, asthma is associated with hypoxia necessitating oxygen to be given in a clinical setting. Most of the symptoms can appear in isolation ranging to mild to severe cases (Frandsen, Pennington, & Abrams, 2014). Symptoms of asthma happen every time the airways are blocked and irritated.

Medications used in the treatment of asthma targets various factors influencing the appearance of the symptoms. Autacoids play a significant role in the symptoms development with a profound effect on the smooth muscles (Frandsen, Pennington, & Abrams, 2014). An example of autacoid is histamine, angiotensin and prostaglandin. With the inflammation of the air pathways in the respiratory system, the individual experiences bronchoconstriction inducing the development of symptoms. Leukotrienes are inflammatory mediators that lead to airway edema and over secretion of mucus. Furthermore, they initiate the contraction of smooth muscles. The most important leukotriene for asthma fall in the classes LC4, LD4 and LE4 (Frandsen, Pennington, & Abrams, 2014). Medications that block these mediators play a significant role in preventing asthmatic symptoms.

Cyclooxygenase remains the main enzyme for eicosanoid production. Eicosanoids are arachidonate metabolites which include prostaglandin, thromboxane and prostacyclin (Judd, 2012). Inflammation result from eicosanoids with Cyclooxygenase being the first enzyme involved in the syntheses of prostanoids; prostacyclins, prostaglandin and thromboxanes each having varying degrees of the inflammatory response (Judd, 2012). Most of the medication used in the treatment of asthma induces inhibitory effect on cyclooxygenases to reduce the production of eicosanoids.

The NSAID (Non-steroidal anti-inflammatory drugs) class of drugs play a role in the treatment of asthma by inhibiting cyclooxygenase (Judd, 2012). As noted earlier, trigger factors such as pollen grains, dust and animal fur induces asthmatic attack. Histamine plays a significant role in the response towards the presence of allergens in the body. The mammalian cells including those of the respiratory system produces histamine (Judd, 2012). H1 receptor responds to elevated levels of histamine in the cells and exist in endothelium and muscle cells. Inhalation of the trigger factors induces quick response characterized by hypersecretion of mucus, contraction of smooth muscles in the airways and sneezing. Medications in the class of antihistamines such as diphenhydramine prevents the association of histamine with its receptors in the cells (Judd, 2012). All medication used in the treatment of asthma use the common rationale of inhibitory effects to the triggering events leading to a cascade of reactions.

The rationale of the three major drugs used for treatment of asthma is founded both in their mode of action and any side effects. Leukotriene inhibitors are used in the treatment of asthma in both children and adults because they function like NSAIDS with minimal bronchial reactivity. Cyclooxygenase plays a significant role in the body and leukotriene inhibitors require care before admission. Pregnant patients or adults with renal problems are not candidates for leukotriene therapy.

Corticosteroids are used in the treatment of asthma with inhalation being the mode of administration. Some of the corticosteroids should be used with care since they decrease the mast cells and lymphocyte infiltration to bronchial mucosa for both adult and children. Bronchodilators are a class of medicine that relax the smooth muscle of bronchioles making them to open up reverting breathing to normal. Caution should be taken especially when administering theophylline since it induces confusion, seizures, and death.

Drug therapy is the approach that finds applause in treatment and management of asthma. Leukotriene inhibitors serve the same purpose just like NSAIDS because of their antipyretic effects (Edmunds & Mayhew, 2013). They interfere with vasoconstrictive effects induced by leukotriene. In comparison to corticosteroids, they have less bronchial reactivity and airway inflammation. Used to treat asthma in children since they can be taken as chewable tablets or oral syrups. They are effective as an antihistamine in the treatment of allergic rhinitis (Edmunds & Mayhew, 2013). They have minimal side effects and are tolerated in most patients.

Corticosteroids form another class for the treatment of asthma with the useful role in preventing asthmatic attack and chronic asthma. They have immunomodulatory functions and the mode of administration, inhalation prevents the unwanted systemic side effects (Edmunds & Mayhew, 2013). They find use when the leukotriene inhibitors have minimal effects in the body. The drugs act by enhancing the beta-adrenergic response thus relieving the muscle spasm. They have reverse role in mucosal edema, decreasing vasoconstriction and inhibiting the secretion of leukotriene.

Bronchodilators play a significant role in the treatment of asthma. Constriction of the bronchial tubes is one of the symptoms of asthma (Judd, 2012). Bronchodilators are drugs that make the muscles relax and thus dilate. With the relaxation of smooth muscles, breathing revert to normal. Beta 2-agonists and anticholinergic are common bronchodilators for asthma treatment. In the treatment of asthma, short-acting beta 2 agonist helps in acute attack and bronchoconstriction while the long-acting beta2 agonists are used or the long term treatment of asthma symptoms (Frandsen, Pennington, & Abrams, 2014). These drugs adjunct the anti-inflammatory therapy with the common drugs used including the leukotriene inhibitors and corticosteroids. They find relevance for to patients who do not have a positive response to other drugs.

References
Edmunds, M. W., & Mayhew, M. S. (2013). Pharmacology for the primary care provider. St. Louis, Mo: Elsevier-Mosby.
Judd, S. J. (2012). Asthma sourcebook: Basic consumer health information about allergic, exercise-induced, occupational, and other types of asthma, including facts about causes, risk factors, symptoms, and diagnostic tests and featuring details about treating asthma with medication and other therapies. Detroit, MI: Omnigraphics, Inc.Frandsen, G.,
Pennington, S. S., & Abrams, A. C. (2014). Abrams' clinical drug therapy: Rationales for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Asthma

Asthma is a chronic lung condition that affects people of all ages. It can be

severe and is sometimes fatal. It is primarily caused by inflammation of the

airways which causes them to be hyper-irritated and respond with mucus

production and decreased air flow. This irritability may be associated with cough,

wheezing, shortness of breath and mucus production. This condition is usually

reversible with the proper medical management.

The tendency to have extra-irritable ( twitchy ) airways may have an

inherited component, or may be acquired. This tendency is, then , acted on by any

number of stimuli (singly or in combination) including: air temperature,

respiratory viruses, pollution, odors, allergens, stress, chemicals, dust and cigarette

smoke ( active or passive ). The two most important triggers for people are

respectively viruses and cigarette smoke.

Spasm of the bronchial's smooth muscle, may play a role in immediate

symptoms of asthma, but is much less a factor than previously believed. Airway

inflammation is, by far, the more important factor. Some asthma can triggered only

by vigorous exercise which causes airway irritability in susceptible individuals due

to drying of the airways because of rapid breathing in and out.

Many different cells in the lining of the airways produce chemicals which

are responsible for asthma symptoms. Most asthma symptoms can be well

controlled with the proper use of various medicines, regular medical care, and

self-monitoring of the air flow and symptoms. Even a well-controlled asthmatic

who is usually symptom-free on a given therapeutic scheme may except one or

more acute symptom flares a year. Most frequently, these flares result from viral

respiratory tract infection and can be treated more easily if caught early in the

course of the flare.

Inhaled mediums are the mainstay of asthma treatment. These can be either

beta agonists such as Ventolin, Proventil ( which relax tight airway muscles ) or

they can be anti-inflammatory inhalers such as Intal, Vanceril, Azmacort.

Combined therapy may be recommended for some people, depending upon the

nature and severity of the symptoms.

Oral bronchodilators such as theophylline or oral beta agonists may occasionally

be of assistance in addition to inhaled medicines. Currently, however, they play a

far less important role in asthma treatment than they previously did. Oral

Prednisone is the ultimate asthma medicine due to its potent anti-inflammatory

actions, and can be safely taken in moderately strong doses of short periods of

time. Long-term oral Prednisone treatment may be indicated for severe asthma

which fails to respond to all other measures. Side effects of long-term Predinsone

treatment include gastritis, ulcers, weakening of bones, thin skin, easy bruising and

suppression of the normal adrenal gland, cortisone response to stress. These side

effects can be minimized ( but not eliminated ) by the following special dosage

schedules.

Another unique way of treatment is by watching the environment that you

are in! Dust is one of the most common irritant that can give you that " twitchy "

feeling. Many people diagnosed with asthma don't feel like exercising, and many

others are to afraid to. Dr. Sarah Robins said, " You should look up to athletes like

Jackie Joyner-Kersee she holds many World Records, and asthma didn't stop her!

So all asthmatic are encourage to be the best at what they do!"

People who are asthmatic should take many precautions. Untreated asthma

can be fatal. The main reason for asthma-related deaths are ( 1 ) failure to patient

ot recognize the severity of the attack and waiting to use inhalers despite escalating

symptoms; ( 2 ) physician failure to recognize increase inflammatory symptoms

early in the attack.

Symptoms that may indicate worsening condition in a known asthmatic may

include: increase need for a beta agonist inhaler for relief, symptoms interfering

with normal activities of daily living, symptoms a night. Any increase in shortness

of breath, cough, wheeze, or sputum production should be evaluated.

Asthma that is well controlled may be asymptomatic. The optimal path for

good control lies in continuity of medical care. For this reason it is very important

to keep regular clinic visits ( frequency depending on symptoms ) even when you

feel well. This helps to prevent problems from developing, or to catch problems

earlier while treatment is easier.

If breathing symptoms ( including cough, shortness of breath, wheeze,

sputum production ) interfere with activities of daily living or sleep, or if persist

for a long time, medical evaluation is indicated.

Please take care of yourself and each other, please see a doctor just for a

check-up!

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