Asthma therapy in the observation unit

The management of asthma is a commonly encountered clinical problem. There have been major advances in the treatment of asthma, including an increase in the drugs available for treatment, as well as in knowledge of the pathophysiology of the disease. Despite these advances, however, the prevalence, morbidity, and mortality for asthma have shown a disturbing upward trend over the past few decades. Experience with the OU management of asthma has shown many advantages: decreased inpatient hospitalization, better quality of life for patients, higher patient satisfaction, cost-effectiveness, and effective patient care. It is estimated that 60% to 70% of asthmatic patients could be treated in an ED observation unit instead of in an inpatient hospital ward. There is a tremendous opportunity for the OU management of asthma to improve patient care, as well as decrease costs, thereby reducing asthma morbidity and mortality.     

Asthma therapy: present trends and future prospects

The short-term treatment of asthma has for years included supplemental oxygen, IV theophylline, and subcutaneously administered and inhaled beta-adrenergic agonists, anticholinergics, and corticosteroids. This regimen has not really changed. What have changed, however, are the specificity of the drugs and the mode of their administration. Metered-dose inhalers can deliver selective beta-adrenergic agonists, anticholinergics, and corticosteroids directly to the airway mucosa. Topical delivery of medication has dramatically reduced the side effects of all classes of medication. As experience accrues, more studies indicate that inhalation therapy may become the mainstay of asthma treatment, even in the emergency department. Metered-dose inhalers have also aided in the resurgence of the use of cromolyn. There is certainly improved ease of administration and perhaps a reduced incidence of rebound bronchospasm. The appearance of newer beta 2-adrenergic agonists with improved beta 2-adrenergic selectivity and longer half-lives underscores the activity in asthma research. There is hope that selective bronchodilating corticosteroids or calcium-channel blockers can be developed. Bronchodilating prostaglandins and leukotrienes, or inhibitors of prostaglandins and leukotrienes that cause bronchoconstriction, are being investigated. An oral mast-cell membrane stabilizer is available and hopefully can be improved. Finally, the transdermal delivery of medication may open an entirely new avenue for the treatment of those suffering from asthma.     

Asthma therapy. Advantages and limitations of various approaches

The physician who understands the various physiologic mechanisms that result in bronchospasm can choose the appropriate management approach. Recommended initial outpatient treatment of sporadic asthma consists of administration of an inhaled beta 2 agent, followed as necessary by a systemic beta 2 agent, a long-acting theophylline preparation, cromolyn, and inhaled ipratropium. Chronic steroid therapy should be used only after a trial of combination therapy with the foregoing drugs, and the daily dose of steroids should be minimized by use of a beclomethasone inhaler. Treatment of acute attacks depends on their chronicity and severity and on the medications the patient has already taken.     

Asthma patients' knowledge in relation to compliance with drug therapy

Patient knowledge of asthma and treatment and compliance levels were assessed among 100 moderate to severe asthmatics recruited from general practice With the use of postal questionnaires non-compliance was found to be high 39% of patients omitted to take their asthma treatment as prescribed The level of patient knowledge had no significant effect on compliance to drug therapy The highest compilers were respondents who reported never receiving an explanation about the condition The majority of patients believe they would know how to manage an attack, but when they 'scored' on their ability only 34 4% were deemed to be safe However, the level of patient knowledge appears to influence a patient's ability to manage an asthma attack Less than half of the patients who had had asthma explained to them reported to have understood the initial explanation, and explanations made by nurses were particularly poorly understood The study identifies reasons why patients do not comply with drug treatments Many feel the drugs are not necessary and many forget to take them Almost half of the cohort admit a reluctance to use their inhalers in public and a third state a preference for tablets rather than inhalers Health professionals must look at other means of improving patient compliance rather than education in isolation Since the general practitioner contract was introduced in April 1990, nurses working in general practice have become increasingly involved with health education as part of health promotion and chronic disease management clinics This study highlights the need for further education in this area     

Asthma in the 1990s. A new approach to therapy.

Asthma has been shown to be an inflammatory disease. Therefore, it makes sense to base treatment strategies on the selection of an appropriate anti-inflammatory agent, with bronchodilators being used as effective rescue medications. Because of recent concerns raised in the literature about the safety of long-term use of beta 2 agonists, early and appropriate medication in the form of inhaled corticosteroids or cromolyn sodium is recommended for daily control of asthma symptoms, long-term patient management, and prevention of acute exacerbations.     

Asthma and pregnancy

During pregnancy the asthma has an incidence of 1-4%. In addition to this pathology we find, during pregnancy, an increased incidence of complications both maternal and fetal. These complications, often serious, happen nearly exclusively in patients with severe asthma and/or badly controlled. Therefore, to reduce the risk of beginning of these complications it's necessary to assess correctly the gravity of asthma before becoming pregnant, to make a careful and periodic control of the respiratory function of the patient, to effect a suitable preventive and/or symptomatic pharmacological therapy and to establish specific sanitary-action measures able to prevent the disease becomes acute.     

Asthma and dualism

The rejection of Cartesian dualism can be taken to imply that the mind is implicated in health and illness to a greater degree than conventional medicine would suggest. Surprisingly, however, there appears to be a train of thought in antidualist nursing theory which takes the opposite view. This paper looks closely at an interesting example of antidualist thinking - an article in which Benner and her colleagues comment on the ways in which people with asthma make sense of their condition - and concludes that it places unduly stringent and arbitrary limits on the mind's role. It then asks how antidualism can lead to such a dogmatic rejection of the idea that states of the body are clinically influenced by states of mind. The answer to this question is that Benner assimilates very different philosophical theories into the same 'tradition'. On this occasion, she has combined Descartes, Kant and the Platonist ascetics into a single package, misleadingly labelled 'Cartesianism', and this move accounts for her unexpected views on the relation between mind and body in asthma.