Treatment of Asthma in Australia Report

Introduction

Asthma is a medical condition that has been a very important health issue in the world. It is also one of the highest causes of health problems in Australia. It is estimated that the prevalence of the condition in Australia is 10 – 25 percent among children below eight years and about 10-12 percent among the adult population. This is one of the highest rates in the world today. Though not a major cause of mortality, asthma is among the most prevalent health problems that doctors have to deal with and it is often the reason for hospitalization of children particularly boys. Asthma is described as an inflammatory disorder that chronically affects the airways in the lungs. The disorder usually causes problems of breathing since the lungs are the major organs for respiration. An asthma attack occurs during a broncho-constriction where these airways narrow suddenly and the muscles around the airways tighten. The mucus membrane around these air passages becomes inflamed and swell and the mucus glands secrets more mucus that tend to block air causing a feeling of breathlessness.

Asthma Treatment

Asthma attacks usually last briefly or can be felt for several days. For this reason, the medication for the condition is divided into two groups. One acts very fast and is often used for faster relief while the second category is a long-term control [1]. It is also important to note that asthma is incurable though the treatment available can improve the quality of life by alleviating the adverse symptoms of the asthma attack [1, 9].

Long-term medications are used on an everyday basis to keep control of unrelenting asthma [4]. They are basically used to prevent inflammation of the air passages in the lungs [2]. The rapid-acting treatments are taken to quicken the process of reversing acute asthmatic attacks by causing the relaxation of the smooth muscles of the bronchial system.

Use of Medication

Several methods can be used to manage the asthmatic problem. They range from monitoring the activity of the lungs to the use of medication. The medication can be categorized according to the mode of their activity to achieve relief of the symptoms [2]. These medications are divided into two categories that are corticosteroids which are the anti-inflammatory drugs and bronchodilators which are mainly muscles relaxants [3].

Anti-Inflammatory Corticosteroids: these drugs work by reducing the inflamed number of cells and also by preventing more secretion of fluids into the airways [2]. Through these means, the drugs are able to reduce sudden constriction of the airways. When a spasm does not occur, the risk of an asthma attack is reduced [9]. Corticosteroids are usually administered in two basic formulations; the aerosols which are the dosages through spray delivered by a Metered Dose Inhalers or they can be taken orally through pills, tables, or liquid formulations [1]. Inhaled formulations include drugs like Aerobid brand (flunisolide (active)), Beclovent (beclomethasone), and Azmacort (triamcinolone). The pill and tablet formulations are Deltasone (prednisone) also known by names like Meticorten and Paracord, Medrol (methylprednisolone), and Delta Cortef (prednisolone) also called Sterane. The liquids include Prelone and Pedipred mostly used for asthmatic children [3]. There is a new line of drugs that are called leukotrienes which include drugs like Accolate (Zafirlukast) and zyflo (zileuton). Leukotienes mediate the process of inflammation. When these drugs are taken, this is inhibited hence no inflammations occur [3].

Bronchodilators: as suggested in the name they cause the bronchial systems to dilate by relaxing the smooth muscles around them [3]. The flow of air is hence enhanced. Some of them include drugs like Alupent – inhaler (metaproterenol) and Brethaire (terbutaline), Severent – inhaler (salmeterol), and Aerolite – oral (Theophylline). These drugs help to manage asthma when a person is exposed to the irritants that cause the inflammation like at night during sleep [3, 9].

A second classification of the drugs is usually based on the duration of action. Long terms drugs are used for daily control of inflammation over a very long period [3, 4]. Examples here include inhaled steroids like Aerobid (flunisolide) and Pulmicort (budesonide); leukotriene modifiers like Singulair (montelukast) and Accolate (zafirlukast); Theophylline pill; beta-agonist like salmeterol; and combined inhalers like symbicort (Formoteral + budesonide) [5].

Short acting medications are used for quick relief of symptoms of act attacks and such drugs include beta agonist (albuterol); Atrovent (Ipratropium) and IV and Oral cortico-steroids [9, 10].

Treatments Available in Australia for Asthma

There are several types of medication for asthma in Australia that are documented together with either mode of delivery for convenience and efficiency [6]. There is a chart that indicated the colors of these medications. The up-to-date list is comprised of 43 different drugs that are on the market to treat asthma in Australia [7]. The product can be easily recognized as they are usually placed against the current packaging where they are grouped according to classes as well [6]. The classes include relievers, symptom managers, Non-steroid preventers, combined medications, and corticosteroid preventers [6].

Preventers are drugs like Flixotide (orange), tidal (yellow), Intal Forte (white), and Alvesco (rust). These preventers reduce the sensitivity of airways hence swelling and inflammation are lowered. They have to be taken daily and take a while before reaching optimal capacity [7].

Relievers like Ventolin (blue), alleviate the symptoms in a few minutes by relaxing the smooth muscles of the airways, and the flow of air is enhanced. Symptom controllers like Serevent (green) and Foradile (blue). These drugs help in relaxing the smooth muscles around the air passages for long hours up to 12 [10]. They are taken on a daily regimen. Combined medication includes Seretide which is a concoction (purple) of Serevent and Flixotide and Symbicort which is a mixture of Oxis and Pulmicort. These drugs have to be taken concurrently every time every day as prescribed [9].

Recommendation for Appropriate Drug

Patient X, a managed 30 year has previously been diagnosed with asthma by his general practitioner. The only medication available for him is the Ventolin Inhaler used Pro re nata (PRN). However, for the previous fortnight, he has been using the Ventolin puffer at three puffs four times every day regularly [10]. The patient is healthy and fit; he is not on any other medication.

Analyzing the cases above, the patient needs to take a stepwise approach to solve his health problem. The treatment should begin with a beta-2 agonist which should be taken prn [3,8]. Ventolin is appropriate for this as he does not indicate any symptoms that can cause alarm [5]. If the symptoms get to moderate or mild, then inhaled corticosteroids can be introduced. Serevent or Oxis can be used here. They reduce symptoms and prevent exacerbation of symptoms. To maintain the normal function of the body it’s advisable to consider the long-term beta-2 agonist (salmeterol) on a fixed dosage regimen [4,8]. They effectively exacerbate adverse symptoms. If symptoms worsen, the amount of Inhaled corticosteroid is increased and an MDI spacer is introduced [8]. Consider using anti-leukotrienes or Oral Theophylline, though the not first line of defense, Theophylline greatly reduces symptoms of asthma. They are effective than LABA. Finally, oral steroids are can be recommended by a specialist and the lowest possible dose used [9].

Reference List

1. Australian Institute of Health & Welfare. Patterns of Asthma Medication Use in Australia. [Online] 2007. Web.
2. Balter MS, Bell AD, Kaplan Ag, Kim H, & McIvor RA. Management of Asthma In Adults. Can. Med. Assoc. J., 2009, 181(12): 915 – 922.
3. Barnes PJ, The Role Of Inflammation And Anti-Inflammatory Medication In Asthma, Respiratory Medicine, 2000, 96(1): 9-15
4. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, Fitzgerald M, et al Global Strategy For Asthma Management And Prevention: GINA Executive Summary, Eur. Respir. J., 2008, 31(1): 143 – 178
5. Barnes PJ. New Drugs for Asthma, Nature Reviews Drug Discovery 3, 2004: 831-844
6. Chu EK, Drazen J M, Asthma: One Hundred Years of Treatment and Onward. Am. J. Respir. Crit. Care Med, 2005, 171:1202-1208
7. Currie GP, Lee DK & Srivastava P, Long-Acting Bronchodilator or Leukotriene Modifier as Add-on Therapy to Inhaled Corticosteroids in Persistent Asthma?, 2005, 128(4): 2954 – 2962.
8. Herborg, H. Improving Drug Therapy for Patients with Asthma — Part 1 Journal of the American Pharmacists Association, J Am Pharm, 2001, 41: 4.
9. Lasley MV. New Treatments for Asthma Paediatrics in Review, 2003, 24: 222-232.
10. Russell FD, Coppell AL, Davenport AP. In vitro enzymatic processing of radiolabelled big ET-1 in human kidney as a food ingredient. Biochem Pharmacol, 1998 Mar 1; 55(5): 697-701