Treatment of Asthma in Adults

Abstract

The primary categories of pain are nociceptive and neuropathic. The assessment should focus on understanding the category, cause, and additional emotional and environmental factors that relate to the patients’s pain. Nociceptive pain is usually very responsive to opioids and NSAIDS. Neuropathic pain may respond better to antidepressants, anticonvulsants, antiarrhythmics, and sympatholytics. Treatment of related emotional and environmental factors will improve outcomes. Examining coexisting medical and psychosocial conditions can help to prevent poor outcomes and complications. Careful taking of the history and performance of the physical examination should provide the critical diagnostic information. Pain medications have considerable potential for side effects and drug interactions. It is important to obtain careful medication histories. The evaluation should include a screening assessment of the patient’s psychological state, which can uncover signs that more formal pscyhological assessment is needed. Misdiagnosis of brochial asthma is common in adults. Remember bronchial asthma is a heterogenous group of chronic lung disorders characterized by common nonspecific signs and symptoms. Different types of asthma will require diffeent treatments. Clinical overlap with other co-existing conditions, e.g. COPD chronic sinusitis, gastroesophageal reflux disease in common. Asthma patient education is fundamental to an effective treatment and management program. Control of airway inflammation, avoidance of environmental triggers, and individualized pharmacological interventions are essential. Failure to properly manage the inflammatory component of asthma risks increases patient morbidity amd mortality. Prevent acute asthmas exacerbations by controlling triggers and encouraging compliance with controller medications. Women with persistent asthma are at significantly higher risks for developing acute severe exacerbations compared to men. Keep exacerbations as far apart as possible. The key to reducing ashtma morbidity and mortality is prevention. Patient asthma action plans utilizing peak flow monitoring and a combination of controller(s) and reliever drugs to prevent and ameliorate attracks are proven treatment strategies. Personalized treatment plans improve compliance. Consider referring patients who are hospitalized for asthma exacerbations and those with difficult to control asthma to a consultant and/or a pulmonary rehabilitation program. The treatment of elderly adults and pregnant women with asthma differs significantly from that of younger adults. Potential for drug interactions and is greater in the elderly with co-existing medical conditions. The majority of asthma deaths are preventable. Undertreatment of asthma poses a greater risk for death than overtreatment.