MEDizzy - A 24-year-old woman was diagnosed with asthma 4 months ago

Feed Library Learning Discuss Leaderboard Journal

Disorders of the Respiratory System and Critical Care Illness

A 24-year-old woman was diagnosed with asthma 4 months ago and was treated with inhaled albuterol as needed. Since her last visit, she feels generally well and typically requires using her inhaler approximately four to seven times a week when around pollen or cats or when exercising in cold air. The inhaled albuterol generally helps, and she only requires a repeat round of inhalations approximately two times a week. She is on no other medications and is a nonsmoker, and her only pet is a goldfish named Puffer. Based on this information, you advise which of the following?

ExplanationThe main drugs for asthma can be divided into bronchodilators, which give rapid relief of symptoms mainly through relaxation of airway smooth muscle, and controllers, which inhibit the underlying infammatory process . For patients with mild, intermittent asthma, a short-acting β 2-agonist is all that is required. However, use of a reliever medication more than twice a week indicates the need for regular controller therapy. This patient is using her reliever medication frequently; therefore, a controller should be added to her regimen. The treatment of choice for all patients is an inhaled corticosteroid given twice daily. It is usual to start with an intermediate dose (e.g., 200 μg twice a day of beclomethasone dipropionate or equivalent) and to decrease the dose if symptoms are controlled after 3 months. If symptoms are not controlled, a long-acting β-agonist (LABA) should be added, which is most conveniently given by switching to a combination inhaler. The dose of the controller should be adjusted accordingly, as judged by the need for a rescue inhaler. Muscarinic receptor antagonists such as ipratropium bromide prevent cholinergic nerve-induced bronchoconstriction and mucus secretion. They are less effective than β2-agonists in asthma therapy because they inhibit only the cholinergic reflex component of bronchoconstriction, whereas β 2-agonists prevent all bronchoconstrictor mechanisms. Anticholinergics, including tiotropium, may be used as additional bronchodilators in patients with asthma that is not controlled by inhaled corticosteroid and LABA combinations. Low doses of theophylline or anti-leukotriene may also be considered as an add-on therapy, but these are less effective than LABA. If asthma is not controlled despite the maximal recommended dose of inhaled therapy, it is important to check compliance and inhaler technique. In these patients, maintenance treatment with an oral corticosteroid may be needed, and the lowest dose that maintains control should be used.