Allergies and Adolescents by David R. Stukus

Author:David R. Stukus
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Medications

As mentioned earlier in this chapter, asthma is hallmarked by two common components: inflammation of the lower airways and recurrent bronchoconstriction. Treatment of each of these components differs greatly. Assessment of asthma severity and control can help determine whether someone has persistent or poorly controlled asthma, both of which indicate more underlying inflammation and the need for daily long-term controller medications. Short-acting bronchodilators are not effective at treating inflammation and thus anti-inflammatory medications must be used. Anti-inflammatory controller medications offer the most benefit when used daily (often twice daily) and consistently, with less efficacy when used on an inconsistent basis or only when symptoms occur.

The NHLBI asthma guidelines offer a very useful approach to both initiating and adjusting therapy (Fig. 7.1). Patients should be prescribed medications on a stepwise approach, knowing that therapy may need to be increased during times of poor control but also decreased when patients have been well controlled for 3–6 months. Medications may need to be adjusted seasonally, particularly during the autumn and winter when asthma exacerbations occur more frequently. In addition, a patient’s personal history should be used to guide their individual stepwise approach, i.e., if they historically have more symptoms in the spring, then therapy can be increased during that season and subsequently decreased at other times of the year. Asthma treatment should not be a static process but instead requires a thoughtful approach to adjusting medications for each patient throughout the year and over time.

Fig. 7.1 Stepwise approach to asthma management (Source: National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services), SABA short acting beta-agonist, ICS inhaled corticosteroid, LTRA leukotriene receptor antagonist, LABA long acting beta-agonist

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