MANAGEMENT OF ASTHMA: ROLE OF CLINICAL PHARMACIST

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About Authors:
Languluri Reddenna1*, Sree Nagavalli K2
1Department of Pharmacy Practice, Rajiv Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India-516003
2Department of Pharmacy Practice, S.J.M College of Pharmacy, Chitradurga, Karnataka, India-577502
*reddennapharmd@gmail.com

Abstract
Asthma is one of the common diseases. Asthma was a term used by the ancient Greeks to describe any condition that causes shortness of breath. Early warning signs are breathing changes, sneezing, moodiness, headache, runny/stuffy nose, coughing, chin or throat itches, feeling tired, dark circles under eyes, trouble sleeping. Asthma creates an extensive burden on individuals and families, as it is more often under-diagnosed and under-treated. World Health Organization estimates that 300 million people suffer from asthma, 2, 55, 000 people died of asthma in 2005 and over 80% of Asthma deaths were reported from low and lower-middle income countries. In India, an estimated 57,000 deaths were attributed to asthma in 2004 and it is one of the leading causes of morbidity and mortality in rural India. India had an estimated 15-20 million asthmatics. It was estimated that the number of people with asthma would grow by more than 100 million by 2025.As members of the health care team, pharmacists are in an excellent position to recognize patients who are not under the care of a physician or whose asthma will poorly controlled for a variety of reasons. Particular resources are provided to improve the care of disadvantaged groups with high morbidity, including certain racial groups and those who are poorly educated, live in large cities, or are poor and to address preventable factors, such as air pollution, that trigger exacerbations of Asthma.

REFERENCE ID: PHARMATUTOR-ART-2109

PharmaTutor (ISSN: 2347 - 7881)

Volume 2, Issue 2

Received On: 25/012/2014; Accepted On: 20/01/2014; Published On: 10/02/2014

How to cite this article: L Reddenna, S Nagavalli, Management of Asthma: Role of Clinical Pharmacist, 2014, 2(2), 124-133

Introduction
Asthma is one of the common diseases. Asthma was a term used by the ancient Greeks to describe any condition that causes shortness of breath.[1]It is a chronic inflammatory disorder of the airways associated with increased airway hyper-responsiveness, recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night/early morning. Airway inflammation produces airflow limitation through acute bronchoconstriction, chronic mucus plugs formation and airway wall swelling or remodeling.[2] There are two general categories for classifying asthma, extrinsic and intrinsic depending upon the types of stimuli that trigger attacks.

  • Extrinsic Asthma: It is caused by a type of immune system response to inhaled allergens      such as pollen, animal dander or dust mite particles.
  • Intrinsic Asthma: It is caused by inhalation of chemicals such as cigarette smoke or   cleaning agents, taking aspirin, a chest infection, stress, laughter, exercise, cold air, food preservatives or a myriad of other factors.[3]

Early warning signs are breathing changes, sneezing, moodiness, headache, runny/stuffy nose, coughing, chin or throat itches, feeling tired, dark circles under eyes, trouble sleeping.[4]The diagnosis of asthma usually based on clinical history, objective measures of pulmonary function, and based on assessment of allergy.[5]Asthma creates an extensive burden on individuals and families, as it is more often under-diagnosed and under-treated. World Health Organization estimates that 300 million people suffer from asthma, 2, 55, 000 people died of asthma in 2005 and over 80% of Asthma deaths were reported from low and lower-middle income countries. In India, an estimated 57,000 deaths were attributed to asthma in 2004 and it is one of the leading causes of morbidity and mortality in rural India. India had an estimated 15-20 million asthmatics. It was estimated that the number of people with asthma would grow by more than 100 million by 2025.[6]The prevalence of asthma had risen over the last 30 years but now appears to be stabilized, with approximately 10–12% of adults and 15% of children affected by the disease.[7]Occupation conditions, such as exposure to fumes, gases or dust are responsible for 11% of asthma cases worldwide.[8]

People had recognized the condition for centuries, and many treatments have demanded to cure it. In fact, medicines can only control asthma, not cure it even today. Asthma medications are used to stop, control and prevent asthma symptoms. Most people need to take more than one type of medication to control asthma. There are different medications and available in tablets, aerosol inhalers, powder aerosols, liquids and injections.[9]Even though many people with asthma depend on medications to prevent and relieve symptoms, some people can do several things on their own to maintain their health and lessenthe possibility of asthma attacks. By following the below suggestions and taking medications as needed, can live a healthy, active lifestyle.[10]

  • Keep home smoke free.
  • Keep away from paint or strong smelling cleaning solutions such as ammonia.
  • Avoid strong perfumes and hair spray.
  • Keep the house well ventilated.
  • Remove stuffed animals that can collect dust or wash them often or cover with plastic.
  • Keep bathrooms dry and clean to prevent mold and use a dehumidifier if necessary.
  • Replace filters in air conditioners because they collect dust.
  • Avoid feather pillows and use synthetic materials such as Dacron.
  • Avoid visits to homes with animals and do not have one in home. Select pets, such as fish, that have no dander.
  • Washing hands frequently helps to prevent catching a cold.
  • Avoid unnecessary exposure to colds. If likely to stir up dust, wear a mask or have someone else do the cleaning.
  • Regular exercise strengthens heart and lungs, which helps relieve asthma symptoms.
  • Maintain a healthy weight.
  • Get plenty of sleep.
  • Avoid stress.
  • Vitamins and minerals will be beneficial for asthma (Vitamin- A found abundantly in carrots, pumpkin, sweet potatoes, winter squashes, cantaloupe, pink grapefruit, apricots, broccoli, and spinach. Apples, apricots, avocadoes, breadfruit, blackberries, blackcurrants, blueberries, kiwifruits, jujubes, melons, peaches and pears are rich in Vitamin-C. Vitamin-E found in wheat germ, corn, nuts, seeds, olives, spinach, asparagus, and other green leafy vegetables and vegetable oils. Brazil nuts, dried, oatmeal, brown rice, whole wheat bread, black, dried, walnuts are all selenium rich foods.[11-18]

The goals of asthma management are as follows:

  • Maintain normal activity levels (including exercise and other physical activity).
  • Maintain (near) normal pulmonary functions.
  • Prevent chronic and troublesome symptoms (e.g., coughing or breathlessness in the night, in the early morning, or after exertion).
  • Prevent recurrent exacerbations of asthma and minimize the need for emergency department visits or hospitalizations.
  • Provide optimal pharmacotherapy with minimal or no adverse effects.
  • Pharmacological management of asthma includes long-term management, and management of exacerbations of asthma.[19]

List of Anti- Asthmatic Medicines[20-23] It was displayed in table 1.

Combination Medications It was displayed in table 2.

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