Asthma Treatment Algorithm
To successfully treat asthma, you must first classify it and then be familiar with step therapy. For this assignment and in this course, we will focus on patients 12 years and older. Complete the blanks in the following table to create an algorithm for asthma care using your textbook as well as GINA guidelines.
Starting treatment
Complete this section using the GINA guidelines provided.
First Assess
- Confirm diagnosis
- Symptoms control and modification risk fators including lung function
- Comorbidities
- Inhaler technique and adherence
- Patient preferences and goals
- Check if the patient is likely to be adherent with daily controller therapy
Fill in the blank
Using Inhaled corticosteroids as reliever reduces the risk of fast and irregular heartbeats compared with using a short acting beta agonists reliever.
Before considering a regimen with a Leukotriene modifiers reliever, check if the patient is likely to be adherent with montelukast, zafirlukast, and zileuton.
Dosing: Low, Medium, High
Low dose ICS provides most of the clinical benefit for most patients. However, ICS responsiveness varies between patients, so some patients may need medium dose ICS if asthma is uncontrolled despite good adherence and correct inhaler technique with low dose ICS. High dose ICS is needed by very few patients, and its long-term use is associated with an increased risk of local and systemic side-effects.
Treating Modifiable Risk Factors
Exacerbation risk can be minimized by optimizing asthma medications and by identifying and treating modifiable risk factors. List the six modifiable risk factors identified in the GINA guidelines that show consistent high-quality evidence.
- Smoking
- Obesity
- Air pollution
- Exposure to second hand smoke
- Exposure to occupational triggers like hairdressing and agricultural chemicals
- Long term use of some drug types
Non-Pharmacological Strategies and Interventions
In addition to medications, other therapies and strategies may be considered when relevant, to assist in symptom control and risk reduction. List the examples the GINA guidelines provide.
- Cessation of smoking
- Physical activity
- Removal of occupational sensitizers
- Consideration of NSAIDS such as asprin
Continue to the next page to apply this information to a case study.
Case Study
Based on the table you created from your book above, how would you classify Haley’s asthma?
Mild Persistent.
Based on the table you created using the GINA guidelines provided, what is the controller and preferred reliever Haley should be prescribed at today’s visit? (Provide general statement and not specific drug- the same as you listed in the table for this severity of asthma)
Avoid exposure to second hand smoke from the father.
Now, looking in your textbook, what are some examples of inhaled corticosteroids or inhaled glucocorticoids? Your book lists six for you to provide here:
- Beclomethasone
- Budesonide
- Ciclesonid
- Fluticasone propionate
- Fluticasone fluoate
- Mometasone triamcinolone
What is the drug classification of formoterol?
ICS and long acting beta.
What is a specific drug you could prescribe today that would meet the drug classification from question 2? Your book provides two options in table 62.1.
- Beclometasone-formoterol
- Mometasone-formoterol
Go to Prescriber’s Digital Reference and identify the dose you would prescribe of the two drugs from Question 5 to fall into the “low dose” range as indicated by the low, medium, high dose table you completed above from the GINA guidelines.
- Beclometasone-formoterol (100-200 low dose)
- Beclometasone-formoterol (250 low low to medium)
Why is it important for Haley to have a LABA in addition to her SABA?
For maintenance and reliever treatment.
What education does Haley, and her parents need regarding when to take the medicine you will prescribe today versus the SABA she is already taking?
They should be informed that when a low ICS dose fails to control Haley’s asthma, adding LABA to the ICS will go along way in improving symptoms and boosting the functions of the lungs. A low daily dosage of ICS-LABA causes symptoms to improve faster, minimizes severe exacerbations by roughly twenty percent, and improves lung function. Tachycardia, headache, and cramps may be related to the LABA component. Nonetheless, when administered together, LABA and ICS are safe for asthma.
What are two environmental factors may be contributing to Haley’s asthma symptoms that were noted in the case study information?
- Exposure to second hand smoke from the father
- Fur from the neighbor’s cat
What do the GINA guidelines say about “action plans”?
All patients should be provided with a written action plan for asthma that correspond with their health literacy and asthma control level. This way, they will be able to identify and respond to worsening conditions of asthma. An action plan instructs the patient on how to spot increasing asthma symptoms, when to increase relief and control medicines, and when to seek medical attention. During severe asthma flare-ups, a brief course of OCS may be required. The written asthma action plan should outline the patient’s typical asthma prescriptions, when and how to increase medicine and begin OCS, and seek medical assistance if symptoms persist.
Do a web search for “asthma action plan”. Provide a link to an example of an asthma action plan you could either use or adapt in your own clinical practice.